Background: In dentistry, single-jaw surgery or double-jaw surgery is performed depending on the patient's need to correct severe skeletal malocclusions. The effect of these surgical methods used in treatment is to be investigated with quasi-least squares regression (QLS), which is a new data analysis method for correlated data obtained by extending generalized estimating equations (GEE). Aim: The aim of this study is to investigate whether jaw surgery methods (single jaw and double jaw) and time are effective on some outcome variables (C point menton distance, cervical plane angle, distance from point C to pogonion perpendicular, angle between cervical plane and facial plane) using QLS method. Methods: In application, 114 measurements were performed on the lateral cephalometric radiographs of 34 patients aged 18 years and older who received orthodontic treatment and underwent surgery in the period of 2000–2018. The effects of time and group variables on four dependent variables were investigated and evaluated using QLS and GEE methods. Results: Single-jaw surgery and double-jaw surgery as a group variable on all outcome variables were not significant. Among the working correlation structures used in QLS, the highest correlation value was obtained by “Markov” working correlation structure. Conclusion: Single-jaw surgery and double-jaw surgery were found to be statistically insignificant for outcome variables examined. QLS is superior to GEE in cases where repeated measurements are performed at unequal time intervals and there are missing observations.

Background: Hepatitis B virus (HBV) infection is a major global health problem, and healthcare workers (HCWs) are at high risk for HBV infection. Current guidelines strongly recommend immunization and screening for high-risk groups. Aims: We evaluated immunization and screening for HBV vaccination, assessed post-vaccination immune status of HCW's and characterized potential risk factors associated with poor immune response. Materials and Methods: From January 2010 to December 2018, we retrospectively analyzed comprehensive health checkup data for a total of 303 HCWs who received an HBV vaccination. After vaccination, HBV surface antibody (anti-HBs) titers were collected and the distribution of immune response types was determined. Risk factors for poor immune responses were identified using logistic regression. Results: A total of 213 HCWs were analyzed after exclusion based on the exclusion criteria. In total, 28 (13.2%) HCWs had anti-HBs titers <100 mIU/mL (hyporesponsive/nonresponsive groups), and 185 (86.8%) had anti-HBs titers ≥100 mIU/mL (hyperresponsive group). Follow-up observations found that 75% (21/28) of the hyporesponsive/nonresponsive groups did not have increased anti-HBs titers or did not maintain an increased response. A multivariate analysis showed that HBV antibody titers at the time of employment were a significant risk factor (OR, 6.12; CI, 1.34-27.93; P = 0.019). Conclusions: More attention should be paid to groups that are hyporesponsive/nonresponsive after vaccination and to those with low anti-HBs titers at the beginning of employment. HCWs can be further protected from HBV if their results are discussed at postvaccination follow-ups.

Background: Cerebral palsy (CP) is a commonly occurring disorder of movement and posture that starts in early childhood. It is accompanied by other disturbances including hearing loss which has been shown to worsen the quality of life of the patients due to problems associated with speech and language acquisition. Several factors are responsible for developing hearing loss in CP. Aims: To determine the factors that can help in early diagnosis and treatment of hearing loss in children with cerebral palsy. Methodology: This was a hospital based cross-sectional study conducted among 165 randomly selected children with CP. An interviewer-administered questionnaire was used to obtain relevant sociodemographic and clinical information. The data collected was analyzed using Statistical Product and Services Solution (SPSS) version 21. Results: The age range of the participants was 1–12 years, with a mean age and standard deviation (SD) of 4.49 ± 2.85. The male to female ratio was 2:1. The commonest type of CP encountered was of spastic variety seen in 47.3%, while the least encountered variety was of the ataxic type, seen in only 4.2%;46.7% of the children were reported to have hearing impairment by their guardian. Other comorbidities reported included epilepsy (33.9%), speech impairment (27.3%), mental retardation (17.0%) and visual impairment (8.5%). A statistically significant association was found between the presence of comorbidities (P = 0.05) and hearing loss among children with CP. Conclusion: Hearing impairment is common among children with CP. Several factors are associated with the development of hearing loss among children with CP. However, only presence of comorbidities was found to be a significant determinant of hearing loss among children with CP.

Background: Mean platelet volume (MPV) is associated with cardiovascular morbidity and mortality in type 2 diabetic patients. However, the effects of blood glucose regulation and treatment regime on MPV has not been adequately studied in type 2 diabetic patients. Aims: We studied the effects of blood glucose regulation and treatment regimen on mean platelet volume in Type 2 diabetic patients. Subjects and Methods: A total of 232 diabetic patients who were admitted to the hospital in short intervals of 3 months in the last 2 years were included in the study. When the second admission HbA_1c was greater than the first admission HbA_1c, they were classified as being in the deteriorated blood glucose regulation group, otherwise they were classified in the improved blood glucose regulation group. Also, the deteriorated and improved blood glucose regulation groups were classified based on therapy modalities as the sulfonylurea + metformin group and the insulin + metformin group. Paired t-test was used for comparison of the groups. Results: Of the 232 patients, 98 (42.2%) were male and 134 (57.8%) were female. There were 126 (55.2%) patients using sulfonylurea + metformin, while 106 (44.8%) patients were using insulin + metformin. MPV levels were significantly increased in patients with deteriorating glucose regulation (p = 0.003). This increase in MPV was only seen in the oral hypoglycemic treatment group (p = 0.003). Conclusions: Our results suggested a close relationship between poor glycemic control and increased platelet activity in type 2 diabetic patients with oral antidiabetic therapy when compared to the insulin and metformin therapy modality.

Aims: The aim of the present study was to investigate mutation status of the cKit and PDGFRA genes in patients with a gastrointestinal stromal tumor (GIST). Methods: In total, 96 patients with a GIST were included in the study, in which polymerase chain reaction amplification and gene sequencing were used to detect the sequences of exons 9, 11, 12, 13, 14, 17, and 18 in KIT and exons 12, 14, and 18 in PDGFRA. Results: KIT mutations were detected in 65 cases (67.71%), of which 81.54% (53/65) were located on exon 11, 12.31% (8/65) were located on exon 9, 4.61% (3/65) were located on exon 17, which included a concomitant mutation of exon 9 and 11, and 4.08% (2/65) were located on exon 13, which included a concomitant mutation on exon 11. The most common mutation in exon 11 was deletion, which accounted for 77.36% (41/53) of the cases, followed by a point mutation observed in 22.64% (12/53) of the cases. Among the 31 GIST cases without a KIT mutation, a mutation in PDGFRA was detected in 5 cases (5.21%, 5/96; 16.13%, 5/31). With respect to gender, age, tumor max diameter, tumor position, and mitotic index, there were no significant differences between KIT/PDGFRA mutations and non-mutations. Conclusions: GIST mainly occurs in the stomach, and the cytological morphology is mainly spindle cells, and the mutations mainly occur in KIT genes. We need a large sample size to analyze the regularity of GIST gene mutations in Hakka population and understand the independent prognostic correlation of all KIT/PDGFRA genotypes.

Background: Adiponectin is an excellent insulin sensitizer. It also possesses anti-inflammatory and anti-atherogenic properties that play a crucial role in the pathogenesis of cardio-metabolic disorders. Evaluating adiponectin distribution in children and factors that modulate its blood level is critical for advancing knowledge in its future role in managing associated non-communicable diseases. Aim: To investigate the adiponectin profile in apparently healthy pre-pubertal Nigerian school children. Methods: This is a cross-sectional study comprising 125 randomly recruited pupils from eight primary schools in Nnewi located in Anambra State, Nigeria. Anthropometric values were taken and venous blood samples assayed for adiponectin using Enzyme-linked immunosorbent assay (ELISA) kits. Analysis of data was done with SPSS software version 22 and R programming software. The level of significance set at P < 0.05. Results: We enrolled a total number of 125 children, which comprised of 68 (54.4%) males and 57 (45.6%) females with a male to female ratio of 1.2:1. The mean age of all the subjects was 7.7 ± 2.0 years. The mean serum adiponectin level of all the participants was 4.67 ± 2.2 ng/mL with a range of 1.9 ng/mL to 10.0 ng/mL. Adiponectin was slightly higher in females than males (4.93 ± 2.4 ng/mL vs 4.45 ± 2.0 ng/mL, respectively; P = 0.223). In males, an inverse relationship was observed between adiponectin and increasing age, whereas in females, a positive correlation was noted (P = 0.637 vs P = 0.639, respectively). The body mass index (BMI) correlated negatively with adiponectin in all the subjects and across both the genders, but these were not statistically significant. Conclusion: Adiponectin varies with sex, age and BMI in pre-pubertal Nigerian children with normal BMI. Further local studies are needed to elucidate its role in the management of associated disease states.

Background: Temporary stage in crowns and bridgework plays an important role in the success and failure of the final restorations. Lack of marginal seal of the temporary restorations can lead to further complications. Recently, digital dentistry has been improved in terms of marginal integrity. Aims: The aim of this study was to evaluate and compare the marginal leakage between CAD/CAM and conventionally made Polymethyl methacrylate (PMMA) interim crowns cemented with different temporary luting cements. Materials and Methods: Sixty resin dies of a maxillary right first premolar were prepared according to the protocol of the tooth preparation for all-ceramic crown. Interim crowns were then fabricated and assigned to two main groups according to the fabrication technique (CAD/CAM technique and conventional technique). Furthermore, the samples were sub-grouped (n = 10) according to the type of the luting cements: Zinc oxide eugenol (RelyX temp E), Zinc oxide non-eugenol (RelyX temp NE), and Zinc polycarboxylate cement (pentron). The specimens were then subjected to thermocycling at 5°C and 55°CC for 30 sec and transfer time of 15 seconds for 1500 cycles. After that, the specimens were immersed in a 2% methylene blue solution for 24 hours. The cemented specimens were sectioned buccolingually and the amount of marginal leakage was evaluated under digital microscope at magnification 50x. The scores of dye penetration were recorded and analyzed using one-way ANOVA at P < 0.05 for all tests. Results: For the fabrication technique, CAD/CAM-made interim crowns had significantly better performance in terms of lower microleakage in comparison to conventionally built interim crowns (P < 0.001). Overall, Zinc Oxide non-eugenol also showed significantly least microleakage as a luting cement then Zinc Oxide Eugenol and the most microleakage was found with Zinc Polycarboxylate regardless of the fabrication method. Conclusion: Interim crowns fabricated by CAD-CAM system are better suited for temporization. Zinc-oxide non-eugenol cements showed the least amount of microleakage in both types of crown.

Aims: To investigate the distribution, characteristics, and association with subarachnoid hemorrhage (SAH) of aneurysms identified in Turkish adult patients with computed tomography angiography (CTA) performed with suspicion of intracranial aneurysms and/or SAH. Subjects and Methods: A total of 356 patients (164 male, and 192 female) with a mean age of 55.6 ± 4.0 (range, 18–90) years were analyzed retrospectively. The dimension in millimeters, localization, type, and multiplicity of aneurysms were noted. The differences in these parameters between females and males were investigated. The correlations of sex, aneurysm size, multiplicity, and size with SAH were researched. Results: On 356 CTA, 140 cases were identified to have aneurysm (39.3%) (56 males [40.0%], 84 females [60.0%]). The incidence of aneurysms and SAH in females was high relative to males. In 140 patients, a total of 187 aneurysms were present (mean size, 7.25 ± 2.56 mm). The highest number of aneurysms was found in the middle cerebral artery 64 (34.2%) while the least was in posterior circulation 20 (10.7%). There was no significant difference between genders in terms of aneurysm size, type, and multiplicity. Individuals with aneurysm site on the internal carotid artery had lower SAH incidence. Receiver Operating Characteristic curve analysis results determined that individuals with aneurysm size >13.5 mm had increased incidence of SAH. Conclusions: The general properties of intracranial aneurysms investigated with CTA in Turkish adults had similarities to information defined in the literature. These results will likely be beneficial to direct approaches to aneurysm diagnosis and treatment in routine practice.

Background: Obesity is an important cosmopolitan cause of morbidity in children and adolescence age groups. Information on obesity in this age group in Nigeria is scant. Aim: To determine the prevalence of obesity and the associated morbidities seen at the Paediatric Endocrinology clinic of Ekiti State University Teaching Hospital, South West, Nigeria. Methods: A retrospective review of all obese children attending the Paediatric Endocrinology clinic. Sociodemographic and other information related to paediatric obesity and associated morbidities were extracted from the case notes. Data obtained was analyzed using Statistical Package for Social Sciences (SPSS) version 20. Results: A total of 21 obese children attended the clinic in the 10 years of study. The 21 children were made of 14 (66.7%) girls and 7 (33.3%) boys, giving a 2:1 female to male ratio. The ages of the children ranged from 1 to 16 years with a mean age of 8.79 ± 4.35 years. Obesity was secondary to a nutritional cause in 16 (76.2%) of the cases and Type 1 diabetes mellitus, Type 2 diabetes mellitus, Cushing's syndrome, Iatrogenic Cushing's syndrome and post-meningitis in the remaining 1 (4.8%) case each. Seventeen (81%) of the children were from the higher socioeconomic class, and the remaining three (19.0%) from lower socioeconomic class. Four (19.0%) of the children had hypertension with their blood pressure (BP) above the 95^th percentile for age and sex. Hypertension was more common among the higher socioeconomic group, children older than 10 years and the female gender. This association was not statistically significant. A greater proportion of children with body mass index (BMI) >30 had significantly higher rates of hypertension (P < 0.001). Conclusion: Obesity is a common disease condition amongst children attending paediatric endocrine clinic. Strategies to control obesity and progression of severity of obesity may have a place in reducing the prevalence of hypertension in obese children and adolescents.

Aims: We aimed to evaluate the effectivity and safety of botulinum toxin A (BT-A) to reduce sialorrhea in children with hypersalivation due to neurological diseases. Methods: Patients who had a complaint of severe sialorrhea were included in the study. Drooling severity of the patients was evaluated using the classification of Thomas-Stonell and Greenberg. The frequency of aspiration before and after the procedure was recorded. The 24-hour saliva amount and mean duration of two consecutive aspirations were recorded. BT-A was injected into the bilateral parotid and submandibular glands by a otorhinolaryngologist under the guidance of ultrasound guidance (USG). Results: When patients' mean drooling severity scores, drooling frequency scores, mean duration of two consecutive aspirations, and amount of saliva collected before and after procedure were compared, a statistical significance was observed. One-year hospital records before after and injection were examined and it was observed that after BT-A injection, hospital visits were statistically significantly low (P = 0.017). Conclusion: BT-A injection into salivary glands is well tolerated, is minimally invasive, has low complication rates and should be performed into both parotid and submandibular glands under USG. Although there is still no consensus on the ideal dose and frequency of injections, it is thought that a dose of 1U/kg/gland can be used with safety in pediatric age groups and the dimensions of the salivary glands and quantitative measurements of the amount of saliva should be utilized. Larger studies involving more patients are required in order to constitute a standard injection protocol.

Aims: The aim of this study was to identify C. parapsilosis complex strains isolated from various clinical samples by sequence analysis and to investigate whether there are any differences between the species in terms of virulence factors and antifungal susceptibility. Methods: The study included a total of 42 isolates identified as C. parapsilosis complex based on the color they formed in chromogenic medium, colony morphology, and microscopic appearance in Corn Meal-Tween 80 Agar and they were confirmed with API 20 C AUX. For the DNA sequence analysis of clinical isolates, V9G forward and LS reverse primers were used as well as internal transcribed spacers (ITS1 and ITS4). Biofilm formation, esterase, phospholipase, and protease activities were evaluated as virulence factors. Antifungal susceptibility was investigated via colorimetric microdilution method. Results: A total of 75 non-C. albicans isolates were obtained from various clinical samples between 2016 and 2017 in a Turkish Tertiary Care Hospital. Of them, 42 were identified as members of the C. parapsilosis complex. Of the 42 strains, 41 were identified as C. parapsilosis sensu stricto (CpSS), while only one was identified as C. orthopsilosis. Of the CpSS strains, 31 (75.6%) were biofilm-positive, six (14.6%) were esterase-positive, nine (21.9%) were positive for phospholipase activity, and 31 (75.6%) were positive for protease formation, whereas all virulence factors of C. orthopsilosis strain were found to be negative. All CpSS strains were found susceptible to amphotericin B, echinocandins, and flucytosine. Conclusions: It has been concluded that the use of molecular methods to identify CpSS would not be effective in routine laboratory practices as it is the most commonly isolated species from the C. parapsilosis complex and there are no significant differences between species in terms of antifungal susceptibility.

Background: Episiotomy is a deliberate surgical incision of the perineum with the aim of increasing the vulval outlet to facilitate childbirth. However, it could be associated with some complications, such as pain, hemorrhage, and wound infection. It is a surgical procedure that requires adherence to basic surgical principles of providing adequate analgesia. Aim: To determine the efficacy of magnesium sulphate (MgSO₄) as an adjunct to local anesthetics for analgesia during episiotomy repair among women that had vaginal delivery at Usmanu Danfodiyo University Teaching Hospital Sokoto, Sokoto, Nigeria. Subject and Methods: This was a single-blind randomized clinical trial. Pregnant women who had episiotomy during the study period were randomized into two groups. Those in Group A had xylocaine administered alone, whereas those in Group B had xylocaine + MgSO₄ administered for repair of episiotomy. Pain was assessed by numeric rating scale at commencement of the repair, at 2 and 6 h after the repair. Patient's level of satisfaction, request for additional analgesia, and side effects were also assessed. Results: The pain score in the xylocaine + MgSO₄ group was lower throughout the period of assessment. There was no significant difference in the pain scores between the two groups at 0 and 6 h. However, there was significant difference in the mean pain scores between the two groups at 2 h (P < 0.001). There was no significant difference in the level of satisfaction, request for additional analgesia, and side effects between the two groups. Conclusion: Both xylocaine alone and xylocaine with MgSO₄ provide adequate perineal pain relief during episiotomy repair. MgSO₄ improves the analgesic effect of xylocaine at 2 h after episiotomy repair without any significant side effect.

Aim: To evaluate the effect of prosthetic framework material and cantilever length on peri-implant strain in mandibular all-on-four implant-supported prostheses with different types of arch antagonist forces. Materials and Methods: Models simulating a completely edentulous mandibular arch fabricated in heat-cured acrylic resin were used. On the acrylic models, four implants were placed at regions 34, 32, 42, and 44 simulating all-on-four implant placements. Implant-supported screw-retained fixed prosthesis frameworks were fabricated using three different materials (cobalt-chromium, zirconia, and polyetheretherketone) and with three different cantilever lengths (zero mm, 15 mm, and 25 mm). Strain gauges were attached on the model at the buccal and lingual positions of each implant. Forces simulating opposing natural dentition, conventional complete denture, and the parafunctional habit were applied to the models. The peri-implant strain in each strain gauge was recorded. Results: Least peri-implant strains (67 microstrains) were observed when forces simulating conventional complete dentures were applied on the models and the highest peri-implant strains (9091 microstrains) were observed when forces simulating parafunctional habit were applied. One-way ANOVA test followed by Tukey's post hoc analysis was performed to compare the mean deformation scores between different materials at 50 N load. The level of significance [P-value] was set at P < 0.05. Tests showed significant differences between zero mm and the other types in all the different materials, and also between 1.5 x AP and 2.5 x AP for Zirconia and Peek material at P = 0.02 & P = .008, respectively. The results showed that the type of framework material, cantilever length, and occlusal forces from the opposing arch influence the peri-implant strain in the bone in all-on-four implant-supported prostheses. Conclusion: Rehabilitation of a single, completely edentulous arch with implant-supported prostheses should consider the situation of the opposing arch. The choice of framework material, as well as the cantilever length, should be altered based on the forces from the opposing arch.

Background: Sickle cell disease (SCD) is a monogenic, phenotypically highly variable disease with multisystem pathology. The phenotypic heterogeneity of SCD is attributed to environmental and genetic factors such as fetal hemoglobin and co-inheritance of α-thalassemia. Objectives: To look for different types of α-thalassemia gene mutations among SCD patients and evaluate the influence of the co-inheritance of α-thalassemia on clinical and hematological variables. Methods: This cross-sectional analytical study included 765 SCD patients, and 150 patients (with low mean corpuscular volume (MCV), low mean corpuscular hemoglobin (MCH) and normal serum ferritin levels) were tested for α-thalassemia gene mutations. Multiplex PCR and reverse hybridization and sequencing for both α genes using the Vienna Lab Strip Assay PCR study were performed using conventional PCR technology. Results: Out of 150 patients tested for α-thalassemia gene mutations, 141 patients were found to have one or more of the mutational types, representing 18.4% of all studied SCD patients. The most common mutations found were the -^3.7 deletion (76.6%), followed by the -^4.2 deletion (12.1%), mutant α2^polyA-1 (Saudi type) (9.2%), and --^MED double gene deletion (7.8%). Acute painful episodes did not differ significantly in sickle cell anemia (SCA) patients with or without α-thalassemia, although the co-inheritance of α-thalassemia has a protective role against many disease-related complications. However, this role was not observed with other types of SCD. The means of red blood cell count, hemoglobin, and hematocrit were significantly higher, while the MCV, MCH, reticulocyte count, and hemoglobin A2 percentage were significantly lower in patients with α-thalassemia gene mutations than in those without α-thalassemia gene mutations (P < 0.05). Conclusions: The co-inheritance of α-thalassemia and SCA confers protection against many disease-related complications and is associated with improved hematological indices. However, this protection was not noticed in patients with other types of SCD.

Background: Endotracheal suctioning is a vital procedure performed by intensive care nurses to maintain airway patency and optimal gas exchange in critically ill patients under mechanical ventilation. As the procedure can cause several complications, intensive care nurses should have adequate evidence-based knowledge on how to perform the procedure. Aims: This study aimed at examining intensive care nurses' knowledge and experience of the closed suctioning system. This study was a prospective, cross-sectional, descriptive, and multi-centered study conducted with 195 nurses working in the tertiary intensive care units in five Turkish hospitals. Subjects and Methods: The data were collected with a questionnaire developed by the researchers in light of the literature. The data were evaluated with Kruskal–Wallis and Mann–Whitney U tests. Results: The mean age of the nurses was 30.58 ± 6.28 years. The mean knowledge score of the nurses for the closed system was 27.35 ± 12.05 (range = 0–80) and 80.5% of them obtained scores ranging between 0 and 40. Also, 71.8% stated that they did not have any difficulty performing suctioning with the closed system catheter, and 85% said that they saved time with the closed system. However, 50.8% of the nurses said they were not able to suction viscous and sticky secretions efficiently, 44.6% stated they did not need to irrigate the inside of the catheter, and 45.1% of them were undecided whether the coude tip catheter led to hemorrhagic secretion more than straight tip catheter. Conclusions: Almost one-fifth of the nurses had good scores on evidence-based knowledge of suctioning. Most of the nurses' experiences regarding the use and manipulation of the closed system were positive. However, almost half of the nurses pointed out that the closed system was not effective enough to suction viscous and sticky secretions. Regular in-service training sessions may help to improve nurses' current knowledge and experiences.

Objective: The primary aim of this study was to assess the effects of a combination of the passive leg raising (PLR) and Trendelenburg positions on the cross-sectional area (CSA) of the right internal jugular vein (RIJV) using ultrasound measurement in awake patients. Methods: This prospective observational cross-over study measured the CSA of RIJV in patients in supine (Supine-I), Trendelenburg, Trendelenburg with passive leg raising (T + PLR position), and repeated supine position (Supine-II). The CSA and vertical and horizontal diameters of the RIJVs were compared before and after each position. Results: A total of 120 adult patients were enrolled in the study. The mean CSA of the RIJV significantly increased from 91.2 ± 31.7 mm² to 110.4 ± 38.2 mm² in the Trendelenburg position compared to the supine position (P < 0.05). However, there were no statistically significant differences in CSA were observed between the Trendelenburg and Trendelenburg + PLR positions. Conclusion: Although the PLR + Trendelenburg position increased the jugular vein diameter relative to the supine position, its clinical usefulness is limited as this increase was still lower than that achieved with the Trendelenburg position alone.

Background: Assisted Reproductive Technology (ART) as a treatment for infertility has come to stay in Nigeria. However, currently there is no national regulation of the practice even though the Association for Fertility and Reproductive Health has recently produced a guideline for practice by its members. Though there is an international trend toward more information giving to donors/clients/child in gamete donation, opinions and attitudes depend on cultural and societal values. Aim: To investigate the attitude of Nigerian obstetrician/gynecologists toward gamete donation. Subjects and Methods: This is a cross-sectional descriptive study in which a structured questionnaire was administered to 110 obstetrician-gynecologists following an oral informed consent. Data analysis was done using SPSS v. 20 by descriptive statistics of frequency and percentage, with Pearson Chi-square test for association between demographic variables and responses. Results: The age range of respondents was 31–68 years with a mean of 44.5 +/−8.9 SD. Majority (85.5%) were males and 72 (65.5%) were <50 years of age. Seventy-five (68.2%) and sixty-six (60%) respondents were in support of anonymous and non-anonymous gamete donation, respectively. More than two-thirds of participants rejected giving off-springs donor information either in child or adulthood. Forty respondents (36.4%) rejected that parents be honest with the child about his/her genetic origin, whilst sixty-two (56.4%) and forty-three (38%) gynecologists were of the view that sperm and oocyte donors should not be compensated, respectively. Conclusion: There is a greater support for anonymous than non-anonymous gamete donation among Nigerian obstetrician/gynecologists, and they also have a negative attitude to disclosure of donor-information to off-springs from gamete donation. They were more likely to support compensation for oocyte than sperm donors. Legal protection of donors and recipients through a national regulation will provide greater openness among all stakeholders.

Background: Hashimoto's thyroiditis (HT) is one of the commonest endocrine disorders, globally. Often, HT presents a protean range of associated autoimmune features (AAI) such as vitiligo, rheumatoid arthritis, pernicious anemia, skin allergy/atopy, thrombocytopenia, Addison's disease, type 1 diabetes, celiac disease, eosinophilia, etc., The usual treatment of HT is symptomatic with no curative option. In this context, we report our experience on the impact of surgical thyroidectomy on remission of AAI in HT. Aims: To report our experience on the impact of surgical thyroidectomy on remission of AAI in patients with HT. Material and Methods: This is a retrospective study conducted in the Endocrine Surgery department of a tertiary care hospital. A total of 61 patients with HT and various AAI combinations were included in this study. All the clinicoinvestigative and operative data were systematically analyzed. The most frequent indication for surgery was nodular goiter followed by associated malignancy, persistent goiter, and painful thyroiditis. Others were cosmetic/pressure symptoms and not AAI per se. The mean follow-up after surgery was 55.6 ± 11.8 months. Results: The gender ratio was 5.8:1 in favor of women and the mean age was 41.5 ± 5.4 years. The mean preoperative and postoperative serum anti-thyroperoxidase antibody (Anti-TPO Ab) levels were 339 ± 98.2 and 58.75 ± 25 IU/L at the last follow-up visit. A total of 60% AAI manifestations had resolution or significant alleviation. The major improvements in AAI were skin allergy, eosinophilia, rheumatoid arthritis, vitiligo, thrombocytopenia, celiac disease symptomatic episodes; but, type 1 diabetes and Addison's disease showed static response. Conclusions: Surgical total thyroidectomy and anti-TPO Ab-related autoimmunity appear to play a beneficial role and definitive role in the remission of AAI in HT.

Aim: Diabetic retinopathy is a chronic progressive complication with neuronal cell and retinal microvascular involvement and is closely associated with blood sugar and blood pressure levels. Studies have shown that retinal neural dysfunction takes place before the microvascular changes in patients with Type 2 diabetes mellitus. The aim of this study is to compare the retinal microvascular changes of patients who are at the prediabetes stage and healthy volunteers. Method: Our study included 41 patients with prediabetes who were referred to the internal medicine outpatient clinic and 47 healthy volunteers. All patients underwent ophthalmologic examinations, including best visual acuity, intraocular pressure measurement, slit-lamp examination, and dilated fundus examination. Refractive error measurements were performed with the same automatic refractor-keratometer device. Typically, 3 × 3 mm macular images centered on foveola were obtained by using XR Avanti Optical Coherence Tomography Angiography with AngioVue (RTVue XR AVANTI, Optovue, Fremont, CA, USA) device. In the statistical analysis of the measurements, it was examined by Kolmogorov Smirnov test. Conditions expressed as IFG or IGT are considered as prediabetes; IFG is defined as fasting blood sugar to be between 100 and 125 mg/dL, while IGT is the condition in which the second hour value of the oral glucose tolerance test is 140–199 mg/dL. Results: There was no statistically significant difference between the control and pre-DM groups in terms of mean age. The distribution of males and females between groups was statistically similar (P = 0.087). In the pre-DM group, 24 (58.6%) patients had IFG, 16 (39.0%) had IFG + IGT, and 1 (2.4%) had IGT. There were no statistically significant differences between the groups for the nonflow area (NFA) and the foveal avascular zone (FAZ) area (P > 0.05). The mean values of superficial and deep capillary plexus (DCP) density were not statistically significant differences between the groups. No statistically significant difference was found between the control group and pre-DM group in terms of the mean measurements of clinical ocular findings (P > 0.05). Retinal thicknesses were also not statistically significant differences between the groups (P > 0.05). Conclusion: All of the retinal measurements of both patients with prediabetes and healthy volunteers are similar. We did not find any difference between prediabetes and control groups. The ophthalmologic examinations which contain best-visual acuity, intraocular pressure measurement, slit-lamp examination, and dilated fundus examination are similar.

Background: Although the demand for esthetic filling of primary teeth with resin composite is increasing, there is no enough data on the adhesive performance of composite restorations in primary teeth. Despite the improvements in resin composites, interfacial gap is still a disadvantage as it may cause marginal staining, secondary caries, and restoration failure. Previous studies have validated the efficiency of optical coherence tomography (OCT) in the evaluation of adhesive interface in permanent teeth, but not in primary teeth. Aims: The aim of this study was to assess microleakage upon composite restorations in primary teeth using cross-polarization OCT (CP-OCT). Methodology: Cylindrical class-V cavities were prepared in extracted human primary second molars and divided into four groups randomly. In groups 1 and 2, cavities were restored using Tetric N-Universal adhesive in the self-etch mode followed by IPS Impress Direct Composite and Ceram.x One Universal composite, respectively. In groups 3 and 4, one-step self-etch Prime and Bond Elect adhesive was used followed by ID composite and CX composite in groups 3 and 4, respectively. The specimens were then immersed in a contrasting solution followed by interfacial microleakage examination under CP-OCT. The recorded images were analyzed to quantify the mean gap percentages. Results: All tested groups showed variable degree of interfacial microleakage under composite restorations. Two-way ANOVA showed the composite factor was significantly influencing the results, unlike the adhesive. Group 1 and 2 had the lowest and highest mean gap percentage, respectively, which were significantly different from the other groups. Groups 3 and 4 were not significantly different. Conclusion: Based on the current finding, a polymeric restorative system from the same manufacturer reduces the risk of interfacial microleakage in primary teeth.

Background: The high maternal death burden in developing countries when compared to the developed could be attributed to differences in use of antenatal and skilled delivery care. Aim: To assess the differences in utilization of antenatal and delivery services in urban and rural communities of Ebonyi state, Nigeria. Methods: A cross-sectional comparative study design was used. Two stage (cluster) sampling technique was used to select 660 women in 4 of 13 local government areas in the state. The respondents were women who were permanent residents of communities and have delivered in last one year. Outcome measure was good utilization of antenatal and delivery services and was assessed by proportion of respondents who obtained antenatal and delivery from a skilled provider and also made at least four antenatal visits. Results: The mean age of respondents was urban, 29.6 ± 6.2 and rural, 28.6 ± 5.1 years. Majority in urban, 51.8% utilized tertiary health facility for antenatal care while in rural, 77.9% used primary health centers (P < 0.001). Comparable proportions in urban, (77.3%) and rural, (79.1%) had good use of antenatal and delivery services (P = 0.572). Predictors of good use of antenatal and delivery services in urban included having one child (AOR = 4.8; 95%C1: 1.4--17.0), having attained tertiary education, (AOR = 2.6; 95%C1: 1.2--5.5), being in low socioeconomic class, (AOR = 0.4; 95%C1: 0.2--0.7), and having good knowledge of danger signs, (AOR = 2.6; 95%C1: 1.3--5.4). In rural, predictors included having one child, (AOR = 2.8; 95%C1:1.1--7.1), being unmarried, (AOR = 0.3; 95%C1: 0.1--0.9), and having good knowledge of danger signs (AOR = 3.7; 95%C1: 1.8--7.5). Conclusion: Utilization of antenatal and delivery services in health facilities in study area was high but there is room for improvement. There is need to plan specific interventions aimed at improving utilization of maternal health services by some groups like urban poor and unmarried mothers, especially teenagers. Emphasis should also be placed on improving community understanding of danger signs of pregnancy.

Aims: The objective of this study was to discuss the outcomes of the oncology patients whose PET/CT scans show incidental focal thyroid 18F-FDG uptake. Methods: This retrospective analysis examined 2575 18F-FDG PET/CT scans from 1803 patients with no known thyroid cancer history. The survival rates were analyzed for patients with and without cytopathological evaluation. Results: Increased metabolic activity of the thyroid was detected in 96 patients. Of those, 72 were diagnosed with a focal uptake of 18F-FDG and 24 subjects had a diffuse uptake. All 72 patients with a focal uptake were referred for ultrasound (US) and fine-needle aspiration cytology (FNAC). Of those patients, 44 were admitted for US and 16 underwent FNAC. The mean SUVmax was 16.0 ± 7.97 for patients with malignant lesions and 3.24 ± 0.88 for patients with benign lesions (p = 0.023). The mortality rate was higher in the patients who were not evaluated with FNAC. Conclusion: Patients with incidental focally increased thyroid 18F-FDG accumulation on PET/CT are known to have a high risk of malignancy. These patients require additional diagnostic procedures to distinguish the underlying pathology. However, the clinical condition of these patients will be the primary concern when performing these procedures.

Background: Fasting and coronary functions are prestige fields for the study. There are a limited number of studies on these topics. The effect of Ramadan fasting on endothelial dysfunction, which can be manifested by loss of nitric oxide bioavailability, has been demonstrated via flow-mediated vasomotion in patients with the slow coronary flow in a small number of studies. To our knowledge, there is no study showing the relationship between TIMI frame count and Ramadan fasting. Aims: We aimed to prove that Ramadan fasting can improve endothelial dysfunction which can be documented via the TIMI frame count method in angiography. Method: This retrospective study included 67 patients diagnosed with the coronary slow flow by coronary angiographic before Ramadan. All of them were evaluated again via TIMI frame count within a period of 1 to 3 months after Ramadan. We tested our hypothesis that fasting may improve endothelial dysfunction and it was proved by the TIMI frame count method in our study. Results: TIMI frame counts measured angiographically from LAD, Cx, and RCA and they were significantly lower than the counts before fasting. All coronary frame count parameters showed significant improvement after Ramadan compared with the baseline values before the Ramadan fasting period (P < 0.001). Conclusion: Our results revealed that fasting and lifestyle changes during Ramadan may be beneficial for the improvement of endothelial dysfunctions in patients with the slow coronary flow and this can be showed easily using TIMI frame count. This is a practical and easy method for showing coronary functions.

Background: The quality of cataract surgery can be measured by visual outcome, which is sometimes limited by intraoperative complications, most commonly posterior capsular rupture. Aims: The aim of the study was to assess visual outcome at the last visit (≥8 weeks) following posterior capsule rupture (PCR) in patients who had manual small incision cataract surgery (MSICS) managed without access to an automated vitrector. Methods: A review of medical records of all manual small incision cataract surgeries performed between January 2013 and December 2016 at the National Eye Centre, Kaduna, Nigeria was conducted. Descriptive statistics and logistic regression analysis were performed using STATA 14.0 to examine risk factors for the development of a poor visual outcome and to assess the impact of PCR on development of poor visual outcome. Results: In total, 405 patients were operated on with MSICS (50.6% males). Mean age was 62.4 (SD 12.6) years. PCR was the most common complication (n = 19 (4.7%)). The proportion of good outcomes (≥6/18) rose from 12.4% non-PCR and 0.0% for those with PCR at day 1 postoperative review, to 71.5 and 26.3%, respectively, by final follow up (P = 0.001). Patients with PCR were 7.0 (P = 0.0001) times more likely to have borderline/poor visual outcome (<6/18) compared to those without PCR. Age >60 years increased the odds of borderline/poor by 1.4 times (P = 0.002). Conclusion: PCR significantly affects the visual outcome of cataract patients in settings with no facilities for automated vitrectomy. Minimizing complications will improve visual outcome of cataract patients and increase uptake of cataract surgical services.

The association between parathyroid and thyroid diseases is not uncommon; however, the concurrent presence of parathyroid adenoma and thyroid cancer is rare. Awareness of this situation will enable clinicians to consider possible parathyroid pathology in patients with papillary thyroid cancer. The presence of parathyroid adenoma leading to primary hyperparathyroidism and the coexistence of thyroid papillary cancer is rare. We report a case of a 55-year-old female with papillary cancer admitted for surgery. Preoperative laboratory findings revealed normal calcium level and normal intact parathyroid hormone (PTH) level. Thyroidectomy and excision of abnormal enlarged double parathyroid glands were performed. Histological examination revealed parathyroid adenoma. Serum calcium was within the normal range after surgery. We recommend a preoperative check of calcium in patients with thyroid cancer.

A 39-year-old Nigerian woman presented to the eye clinic for a new pair of spectacles on account of a two-week history of headaches and bilateral eye ache. She was a known spectacle wearer for the past nine years. The presenting visual acuity was 6/6 and 6/36, respectively, in the right and left eye. Anterior segment examination was essentially normal bilaterally. Posterior segment examination with binocular indirect ophthalmoscopy of the right eye revealed a punched out hyperpigmented, chorioretinal scar in the periphery at 6 o'clock and in the left eye, a large macula hole adjacent to a hyperpigmented chorioretinal scar along the inferotemporal arcade was present. Active inflammation was absent in both eyes. Optical coherence tomography confirmed a left, grade-4 full-thickness macula hole.