Background: Controversy regarding the best management strategy for subdural empyema (SDE) attests to the persisting poor outcomes for this uncommon life threatening intracranial suppurative process. Late presentation confounds the problem in developed countries. While craniotomy is commonly recommended, it is not always possible in late presentation with advanced morbidity. The aim of this study was to identify the pattern of clinical presentation and explore the outcomes following management of SDE using burr hole, aspiration, and drainage (BAAD) in resource poor settings. Materials and Methods: This is a retrospective review of prospectively collected data of 18 patients presenting with SDE over a period of 10 years from two neurosurgical centers. Data was abstracted on patients' demographic characteristics, sources of SDE, clinical presentation and site of infection, methods of diagnosis, organisms isolated, treatments received, and outcome. Collected data was entered into the Statistical Package for the Social Sciences version 17 software and subjected to descriptive analysis for all variables. Results: Majority of the patients presented late with Glasgow Coma Scale score GCS of 9/15. Altered sensorium was noted in 14 (77.8%) of the patients, 11 (61.1%) out of the 14 patients had ≤ grade 3 of Bannister and Williams level of consciousness. The mainstay of treatment for all patients was BAAD of abscess and administration of appropriate antibiotics. Fourteen patients (77.8%) were discharged on grade A of H.W. Mauser's grading system. Three mortalities were recorded only in patients who had grade 4 Bannister and Williams grading. Conclusion: BAAD is the near approximated option to standard craniotomy management in a limited resource facility and it has a very good clinical outcome. However, more studies are required to draw the final conclusion.

Background and Purpose: Discoloration of resin-based composites is a commonly encountered problem, and bleaching agents may be used for the therapy of the existing discoloration. The purpose of this study was to investigate in vitro color recovery effect of different bleaching systems on the heavily discolored composite resin. Materials and Methods: Fifty disk-shaped dental composite specimens were prepared using A2 shade nanohybrid universal composite resin (3M ESPE Filtek Z550, St. Paul, MN, USA). Composite samples were immersed in coffee and turnip juice for 1 week in each. One laser activated bleaching (LB) (Biolase Laserwhite*20) and three conventional bleaching systems (Ultradent Opalescence Boost 40% (OB), Ultradent Opalescence PF 15% home bleaching (HB), Crest 3D White [Whitening Mouthwash]) were tested in this study. Distilled water was used as control group. The color of the samples were measured using a spectrophotometer (VITA Easy shade Compact, VITA Zahnfabrik, Bad Säckingen, Germany). Color changes (ΔE00) were calculated using the CIEDE2000 formula. Statistical analyses were conducted using paired samples test, one-way analysis of variance, and Tukey's multiple comparison tests (α = 0.05). Results: The staining beverages caused perceptible discoloration (ΔE00 > 2.25). The color recovery effect of all bleaching systems was statistically determined to be more effective than the control group (P < 0.05). Although OB group was found as the most effective bleaching system, there was no statistically significant difference among HB, OB, and LB groups (P > 0.05). Conclusion: Within the limitation of this in vitro study, the highest recovery effect was determined in office bleaching system among all bleaching systems. However, home and laser bleaching systems were determined as effective as office bleaching system.

Objective: The aim of the study was to study the closure of dry central type of tympanic membrane perforations by chemical cautery and improvement of hearing, to analyse the effect of Gelfoam on nonhealing small tympanic membrane perforations, and to examine the relevance of conservative means of closure of tympanic membrane perforations as an office procedure. Materials and Methods: In this study, 100 patients attending the outpatient department were enrolled. Cautery of perforation margin was carried out with 50% trichloroacetic acid (TCA). After cautery, in small perforations less than 4 mm, a small piece of Gelfoam larger than the size of perforation was cut, impregnated with corticosteroid ointment, and carefully placed over the cauterized area under endoscopic visualization. In slightly larger perforations, that is, between 4 and 5 mm, after applying TCA to the margins of the perforation, a piece of Gelfoam larger than the size of perforation was soaked with corticosteroid ointment and placed in the middle ear cavity. Results: Patients had relief from various symptoms, such as tinnitus, heaviness, and so on. There was some amount of auditory improvement in almost all the cases. It ranged from 5 to 23 dB. Conclusions: Cautery and patching of tympanic membrane perforation may be considered as the first-line management in the small- to medium-sized perforations before attempting the surgical closure.

Objective: To evaluate the effect of various materials as intra-orifice barriers on the force required fracture roots. Materials and Methods: One hundred-thirty five mandibular premolars were decoronated and prepared up to size #40. The root canals were filled and randomly divided into two control and seven experimental groups (n = 15), as follows: Positive control group (the intra-orifice barrier cavity was not prepared), negative control group (the intra-orifice barrier cavity was prepared, but not filled), filling using glass ionomer cement, nano-hybrid composite resin, short fiber-reinforced composite, bulk-fill flowable composite, MTA Angelus, Micro Mega MTA or Biodentine. A fracture strength test was performed, and the data were analyzed using one-way ANOVA and Tukey's post hoc tests. Results: Nano-hybrid composite, short fiber-reinforced composite, bulk-fill flow able composite, and glass ionomer cement increased the force required fracture the roots compared to the positive and negative control groups (P < 0.05). While MTA groups did not increase the force required fracture the roots compared to the control groups, Biodentine increased significantly. Conclusions: Within the limitations of the present study, the use of nano-hybrid composite, short fiber-reinforced composite, bulk-fill flowable composite, and glass ionomer cement as an intra-orifice barrier may be useful in reinforcing roots. MTA placement (MTA Angelus or Micro Mega MTA) did not significantly increase the fracture resistance of endodontically treated roots compared to the control groups, however Biodentine did.

Background and Aim: Postoperative pain is well known and usually disturbing complication of surgery. Inflammation plays an important role in the development and progression of postoperative pain. We aimed to investigate possible relationship between preoperatively measured neutrophil-lymphocyte ratio (NLR) – as an inflammation marker – and postoperative analgesic demand in patients underwent orthognathic surgery. Materials and Methods: We retrospectively investigated medical and anesthesia records of 177 patients underwent orthognathic surgery. Demographical data, preoperative NLR, type of surgery, modified Mallampati score, difficulty degree of intubation, duration of surgery, and postoperative analgesic (tenoxicam – as the first drug of choice, paracetamol, tramadol, or pethidine) usage were recorded. A cutoff value of NLR ≥2 was determined for inflammation threshold. Two groups (Group 1 NLR ≥2, Group 2 NLR <2) were compared for analgesic doses, numbers of patients needed analgesic treatment, and other parameters. Results: Mean administered tenoxicam dose was significantly higher in Group 1 than in Group 2 (P < 0.0001). Further, ratio of patients treated with tenoxicam in Group 1 was significantly higher than that in Group 2 (χ² = 4.779, P = 0.029). Conclusions: Preoperatively measured NLR may help to predict postoperative analgesic demand in patients undergoing orthognathic surgery, and thus sufficient postoperative pain control can be achieved with various preventive treatments taken at the perioperative period such as preemptive analgesia, local anesthetic administration at the end of surgery, or early administration of analgesics.

Background: Type 2 diabetes mellitus (DM) is fast becoming a global epidemic, and its prevalence is increasing in children and young adults. The aim of the study was to identify young adults who had type 2 DM or impaired fasting glucose as well as those at risk of these conditions using anthropometric data and behavioral pattern. Methodology: Two hundred and twenty newly admitted undergraduates who were randomly selected during the registration process were involved in the study. Anthropometric parameters were measured while information on demographic details, medical history, and family history were obtained using a standard questionnaire. Fasting blood glucose was measured using the glucose oxidase method. Results: Two hundred and seven (94%) participants had serum glucose within reference range, 10 (4.6%) had impaired fasting glucose, and 3 (1.4%) had serum glucose >7.1 mmol/L, which is indicative of DM. A large number (91.4%) of individuals engaged in physical activity equivalent to a walk of at least 30 min/day. Most of them (93.2%) had body mass index <25.0 while 6.8% were overweight. One hundred and three participants (46.8%) indicated that they eat 3 or more servings of whole grain per day. Conclusion: Most of the participants are involved in healthy lifestyle. This has resulted in very low prevalence of impaired fasting glucose and type 2 DM among the group. It will be useful to follow up the group and note if they are able to maintain this trend since the risk of developing DM is known to increase with age.

Introduction: There is a paucity of information on the oral microbiome compositions of Nigerians, mostly due to lack of appropriate molecular techniques. In this pilot study, we sought to determine and characterize the oral bacterial compositions of “healthy” females. Materials and Methods: Oral samples were collected from three randomly selected females aged 56, 28, and 8 years. DNA was extracted and 16S rRNA V4 region was amplified using custom-barcoded primers before sequencing with Illumina MiSeq platform. Quantitative Insights into Microbial Ecology pipeline was used for 16S rRNA recognition. Distribution of taxonomic categories at different levels of resolution was done using the ribosomal RNA similarities to entries in the REFseq protein database. Diversity score was calculated based on the inverse Simpson's index. Results: The inverse Simpson's diversity index for the postmenopausal, premenopausal, and prepubertal was 7.74, 6.95, and 7.42 respectively. A total of 12 phyla, 70 genera, and 85 species were detected. Firmicutes followed by Proteobacteria, Actinobacteria, Bacteroidetes, and Fusobacteria dominated the oral microbiome of the subjects. Streptococcus thermophilus (33.19%) was the most abundance species in subject 1, while subject 2 was highly predominated by Haemophilus parainfluenzae (80.65%), and subject 3 was predominated by Haemophilus influenzae (23.05%). Conclusion: The study has revealed that bacteria with varying diversities colonized the subjects and it highlighted the importance of metagenomics in deciphering the oral bacterial compositions from females of different age groups. More studies are needed using metagenomics approach, to appreciate these bacterial organisms that are associated with health and disease in our environment.

Background and objectives: This study aimed to assess the prevalence of traumatic injuries of the permanent incisors in public primary schoolchildren from 8 to 12 years old in South-Eastern Anatolia, Turkey. Additionally, the relationship between traumatic dental injuries, parents' education level, family income, size of incisal overjet and the presence of anterior open bite were examined. Materials and Methods: Data were collected through oral examinations and structured interviews, and included socio-economic indicators. A total of 2907 children of both genders (1498 boys, 1409 girls) were included in the study. The response rate was 97%. Results: The prevalence of dental injuries was 4.6% (n = 135). The highest frequency of trauma in permanent teeth was observed at the age of 12 (8%). Boys experienced more dental injuries than girls, 5.9% and 3.3% (p = 0.001), respectively. The most commonly reported cause of injuries to the permanent incisors was falls (71.8%), followed by collision with objects or people (17.8%). Maxillary central incisors were the most affected by dental injuries (154, 84.6%). The most common crown fracture was in enamel only (67.58%) followed by crown fracture of enamel and dentin (22.52%). Conclusion: Socio-economic indicators and parents' level of education were not statistically significantly associated with the occurrence of traumatic dental injuries. Factors associated with increased risk of dental injuries in permanent teeth were age, gender, having an incisal overjet greater than 5mm and anterior open bite.

Background: Alpha-fetoprotein (AFP) and Des-gamma-carboxyprothrombin (DCP) have been extensively studied as biomarkers for the diagnosis of and prognostication in hepatocellular carcinoma (HCC). However there are only few reports on the clinical characteristics of hepatocellular carcinoma in relation to the combination of the two tumor markers in hepatitis B virus-related HCC. Aim: The aim of this study was to investigate the clinical characteristics of HBV-related HCC in relation to different sets of AFP and DCP values. Methods: Sixty-two patients with untreated HCC were studied. The positive value of AFP was set at 20 1U/L while DCP positive value was set at 150 mAU/ml. Patients were divided into three groups: Group 1(n=36) with AFP ≥ 20 IU/L and DCP ≥ 150 mAU/ml. Group 2(n=24) with AFP <20 1U/L and DCP ≥ 150 mAU/ml. Group 3 (n=2) with AFP < 20 1U/L and DCP < 150 mAU/ml. There were no patients in group 4 meant for those with AFP ≥ 20 1U/L and DCP < 150 mAU/ml. Clinical and laboratory variables were compared among the groups. Results: Clinical and laboratory variables were comparable among the groups with the exception of gender and values of serum alanine aminotransferase (ALT). Males were significantly more than females among the groups (p<0.03). ALT values were significantly different among the groups (p<0.006). Paired comparisons between the groups showed the mean values of serum ALT were significantly higher in group 2 than in group 1(p<0.003). The mean serum ALT values were also higher in group 2 than in group 3 (p <0.014). There was no significant difference between group 1 and group 3 (P = 0.124). Conclusion: HCC patients who are sero-positive for DCP and sero-negative for AFP have significantly higher levels of serum ALT; serum ALT levels may be of diagnostic importance in AFP-negative, HBV-related HCC patients.

Objective: The aim of this study is to highlight the clinical characteristics of patients with intermittent testicular torsion and draw attention to this underreported condition. Methods: Clinical and demographic data of all patients treated for intermittent testicular torsion from January 2007 to June 2015 were prospectively collected in a pro forma and analyzed. A diagnosis of intermittent torsion was made on the basis of recurrent scrotal pain, presence of abnormal testicular lie in otherwise normal testes, absence of urinary symptoms, and negative urine cultures. This diagnosis was confirmed by resolution of symptoms following bilateral orchidopexy. All patients had bilateral orchidopexy at the next operative day and were followed up for 12 months. Results: Forty-five patients with a mean age of 20.9 years (±4.02) were seen within the study period. The left testis was more often involved than the right: 53.3% versus 37.8%. The condition was bilateral in 4 patients (8.9%). A total of 84 testes were evaluated. Horizontal lie was the most common anomaly causing intermittent testicular torsion 49%, followed by the clapper-bell deformity 27.5%. Patients experienced a mean of 2.8 (±1.74) acute pain episodes before testicular fixation. Bilateral orchidopexy resulted in resolution of symptoms and preservation of testicular volume. Conclusion: Horizontal lie of the testis is the most common cause of intermittent testicular torsion. The condition is more common on the left than the right testis and is predominantly unilateral. Intermittent testicular pain in the presence of abnormal testicular lie should warrant a diagnosis of intermittent testicular torsion. Early bilateral orchidopexy is efficacious.

Objectives: The aim of this study was to evaluate the effect of different surface treatments on the shear bond strength (SBS) of resin composites to dentin using total etch dentin bonding adhesives. Materials and Methods: Sixty extracted human molars were flattened to obtain dentin surfaces. The samples were divided into three groups (n = 20): Group I: 37% phosphoric acid + optibond FL + resin composite; Group II: Erbium:yttrium aluminum garnet (Er:YAG) laser (medium short pulse [MSP] mode, 120 mJ/10 Hz) + optibond FL + resin composite; Group III: Er:YAG laser (quantum square pulse [QSP] mode, 120 mJ/10 Hz) + optibond FL + resin composite. After the specimens were prepared, the SBS test was performed at a crosshead speed of 0.5 mm/min. The fractured specimens were examined under a stereomicroscope to evaluate the fracture pattern. Statistical analyses were performed with one-way ANOVA and Tukey's honestly significant difference tests. One sample of treated dentin surface from each group was sputter-coated with gold, and scanning electron microscope (SEM) images were captured. Results: Acid etching showed significantly higher SBS than the other groups (P < 0.05). However, the difference between Er:YAG MSP and QSP mode groups was not statistically significant (P > 0.05). SEM images of the acid-etched dentin surface showed opened dentinal tubule with a regular surface, but Er:YAG MSP mode treated surface was irregular. The surface treated with Er:YAG QSP mode represented wide dentinal tubules with a clean and flat surface. Conclusion: Using different modes (MSP and QSP) of Er:YAG laser for dentin surface treatment before application of total etch adhesives is still not an sufficient alternative compared to acid etching.

Background: Several publications have presented pattern of maxillofacial surgical conditions based on data from hospital-based studies. The objective of this study is to present the spectrum of maxillofacial surgical conditions from the perspective of a community study. Methods: This is a prospective study of all patients seen and treated from 2011 to 2016. The information obtained included the biodata, clinical history of the disease conditions, radiological result, histopathologic result, diagnosis, and treatment records. Data analysis was carried out using SPSS version 20.0. Results: There was a total of 863 patients, male 464 (53.8%) and female 399 (46.2%). The male to female sex ratio was 1.16:1. The age range was 3 days to 76 years with a mean age (SD) 16.8 ± 15.8 years. The spectrum of surgical conditions: facial clefts 492(57.0%); tumor and tumor-like lesions 126(15.2%), trauma 6(0.7%), and others 48(5.5 %). The size of tumors ranged from 5 to 50.4 cm² with a mean (SD) 21.6 ± 11.9 cm² and the duration of lesion ranged from 1 to 20 years with mean (SD) 8.7 ± 6.0 years. A total of 622(77.4) cases were operated within the study period with immediate jaw reconstruction in 5(0.8%) patients. Minor complications were recorded but there was no mortality. Conclusion: The spectrum of maxillofacial surgery from community-based data was associated with higher percentage of facial cleft as compared to hospital-based study that is associated with higher traumatic injury cases. High level of poverty, ignorance, and poor access to maxillofacial service have been identified as shortcomings in the management of the diseases. There is a need for pragmatic move to improve facility, training, enlightenment, and more funding of outreach programs.

Introduction: Seizures are common reasons for neurologic consultations and investigations. In the absence of magnetic resonance imaging, computerized tomography scanning of the brain is a reliable and cheaper alternative. Little is known about the pattern of brain lesions in patients with recurrent seizures in Nigeria. Objectives: To determine the pattern of significant intracerebral lesions in patients presenting with recurrent seizures in a tertiary hospital in Enugu. Methods: All the medical and computer tomography records of patients with a clinical diagnosis of recurrent seizures were reviewed. The study duration was 11 years (January 2003 to December 2013). Relevant data were obtained and statistical analysis was done using SPSS version 19 and GraphPad Prism 6. Results: The diagnostic yield of CT was 55.1%. Twenty (9.3%) individuals had two lesions each. The significant findings were tumors (20.4%), encephalomalacia (18.9%) and strokes (7.7% (ischemic stroke, 4.1%, intracerebral hemorrhage, 3.1%, subarachnoid hemorrhage/intraventricular hemorrhage, 0.5%). Hydrocephalus (HCP) was found in 18 (9.2%) cases, and 30% of them occurred together with other lesions. The diagnostic yield increased with age reaching 84.4% from the age of 60 years. Only patients with encephalomalacia were statistically older than those with normal imaging. Conclusion: Computed tomography scan has a high diagnostic yield, especially in elderly patients with recurrent generalized seizures. Brain tumors, encephalomalacia, and HCP are most common causes of recurrent seizures in the adults.

Purpose: Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne disease can result in mortality varying from 3.0% to 50.0%. In this study, we wished to discuss computed tomography (CT) findings together with clinical and laboratory findings in patients who had disease-related neurological signs. Materials and Methods: The study included patients who were diagnosed with CCHF. Seventeen patients that had neurological signs were enrolled as the patient group. As a control group, 40 patients diagnosed with CCHF and did not have neurological signs were enrolled. Patients who had neurological signs were examined with brain CT. Radiological and clinical findings of both groups were compared. Results: There were pathological findings in three patients while brain CT's of 14 patients were evaluated as normal. Blood urea nitrogen, lactate dehydrogenase, creatine kinase, total bilirubin, neutrophil, activated partial thromboplastin time, and C-reactive protein levels were significantly higher in the group with neurological signs whereas platelet count and calcium levels were significantly lower in this group. Six of 57 patients died during the follow-up period. Six patients who died were in the group, in which central nervous system (CNS) imaging study was performed. Conclusion: As the presence of CNS signs is a bad prognostic indicator in CCHF, they should be investigated carefully.

Background: Obesity can lead to psychological, social, and medical problems that may negatively affect the quality of life Aim: In our study, we aimed to evaluate the body perception, psychological distress, and subjective quality of life of obese subjects in comparison with normal weighted ones. Methods: A total of 494 subjects, aged between 18 and 64 years, were included to the study. Patients with the body mass index (BMI) of ≥18.5–24.9 kg/m² were assigned to the control group; BMI ≥ 30 kg/m² were assigned to the obese patient group. An ethical committee approval with protocol No. of 2011/242 was obtained from the Ethical Committee of Eskişehir Osmangazi University Faculty of Medicine. Interviews were performed two times with obese subjects in the 1st and the 6th month of weight loss program, once with the control group. Data identification form, the form which included the biochemical parameters, Trait Anxiety inventory, State anxiety scale, Quality of Life scale-Short Form [(SF-36)(QOL)], Multidimensional Body-Self Relations Questionnaire (MBSRQ), Zung Depression Rating Scale, and Zung Anxiety Rating Scale were applied to participants. Results: Obesity is more common in women. Obesity reduces the quality of life, negatively affects body perception, and triggers anxiety. Because of their body structure, obese individuals are exposed to social pressure and unethical attitudes. Conclusions: Both health risks and social implications of obesity are important. Further studies are needed to ethically evaluate the psycho-social problems caused by obesity.

Objective: Vitamin D status and risk factors of Vitamin D deficiency in chronic kidney disease (CKD) patients in China have been seldom reported before. In this study, we aim to investigate serum 25-hydroxyvitamin D [25(OH)D] status and find the predictors of Vitamin D deficiency in predialysis patients with Stage 3–5 CKDs in Southern China. Methods: In this retrospective cross-sectional study, hospitalized predialysis patients who were diagnosed of Stage 3–5 CKD and had taken measurement of serum 25(OH)D in a single center from January 2014 to June 2015 were included. Patients were divided into Vitamin D deficiency group and nondeficiency group depending on the cutoff serum 25(OH)D value of 37 nmol/L. Clinical and biochemical parameters were collected and evaluated for predictors of Vitamin D deficiency by logistic regression. Results: One hundred and fifty-two patients were included in this study, of which 87 (57.2%) were in Vitamin D insufficiency state while 60 (39.5%) were in Vitamin D deficiency state. Serum 25(OH)D levels of patients in Stage 4 and Stage 5 CKD were lower than that of patients in Stage 3 CKD (P = 0.002). It was discovered that female gender (odds ratio [OR] = 3.674; 95% confidence interval [CI], 1.607–8.396; P = 0.002), serum albumin level <30.0 g/L (OR = 6.816; 95% CI, 2.634–17.633; P < 0.001), and estimated glomerular filtration rate (eGFR) <30 ml/min/1.73 m² (OR = 4.761; 95% CI, 1.353–16.754; P = 0.015) were independent predictors of Vitamin D deficiency. Conclusions: Vitamin D insufficiency and deficiency are common in predialysis patients with Stage 3–5 CKD in Southern China. Female gender, hypoalbuminemia with serum albumin level <30.0 g/L, and severe damaged renal function with eGFR <30 ml/min/1.73 m² are independent predictors of Vitamin D deficiency in predialysis patients with Stage 3–5 CKD.

Background: Femoral shaft fractures are common injuries in adults. Closed locked intramedullary nailing is the recommended treatment for femoral shaft fractures due to its high union rate. Objective: The objective of this study is to determine the outcome of management of closed femoral shaft fractures in adult patients, using open locked intramedullary nailing. Patients and Methods: This is a prospective study which was carried out on all adult patients aged 16 years and above who presented within 2 weeks of sustaining closed femoral shaft fractures to the accident and emergency unit of a University Teaching Hospital in Nigeria from January 2013 to December 2013. Pathological fractures were excluded from the study. The procedure was carried out using standard techniques, and each patient was followed up for a minimum of 1 year. Results: Forty-three patients were recruited into the study. They had a mean age of 36.9 ± 11.7 years, with a male to female ratio of 2.9:1. The most common cause of closed femoral shaft fractures was road traffic crashes (95.3%), with motorcycle-related injuries found to be the highest type (56.1%). The rate of union in the study was 95.3%. The average time to radiological union was 14.0 ± 1.2 weeks while the mean time to painless full weight bearing was 14.2 ± 1.2 weeks. Among the complications encountered were broken nails (4.7%), infection, loosening of the distal screw, and limb length discrepancy (2.3% each). Using Thoresen's criteria, excellent results were obtained in 93% and poor results in 4.7% of patients. Conclusion: Open locked intramedullary nailing gives excellent clinical outcomes with high union and low complication rates in the management of closed femoral shaft fractures in adult patients.

Objective: The aim of the present study was to evaluate the optimum dose of ropivacaine by comparing three different dosing regimens of isobaric ropivacaine 1% (naropin 10 mg/ml, Astra Zeneca) administered intrathecally and to demonstrate the effects of anesthesia in pregnant women scheduled for cesarean section. Patients and Methods: Sixty ASA grade I-II patients were scheduled to undergo elective cesarean sections under spinal anesthesia. The patients were randomly assigned into three groups. Group 1 received 15 mg ropivacaine 1%, Group 2 received 20 mg ropivacaine 1%, and Group 3 received 25 mg ropivacaine 1%. Results: Intraoperative hemodynamic variables were not significantly different between the three groups, and sensory block time, motor block time and time to reach maximal sensory block time, and motor block time were similar between the three groups. The time to two-segment regression of sensory block was longer in Group 3 compared to other groups, and the difference was statistically significant (p < 0.05). The motor block time was longer with higher doses of ropivacaine; however, the difference was not statistically significant. Conclusion: Ropivacaine administration produced rapid induction of anesthesia and satisfactory anesthesia level, ropivacaine 15 mg and 20 mg dosing regimens are satisfactory for spinal anesthesia.

Aim/Background: Associations between axial length (AL) to corneal radius of curvature (CR) ratio and refractive status in a healthy Nigerian adult population were studied. Materials and Methods: Healthy students and members of staff of Obafemi Awolowo Teaching Hospitals Complex, Ile-Ife, South West Nigeria, free of obvious ocular diseases except possible refractive errors were recruited. Consecutive consenting volunteers were recruited by simple random sampling and a proportionate sample of each population based on its representative fraction in the hospital community was recruited. The study was conducted between June and August 2011. Noncycloplegic objective refraction was done and spherical equivalent refraction (SER) of the right eyes was used for calculation. The AL, CR, and keratometric readings were measured with the IOL Master. The AL/CR ratio was calculated. The data were analyzed with statistical software package STATA 13. Results: Three hundred and fifty volunteers aged 18–60 years were studied. The mean ± standard deviation of AL/CR and SER were 3.04 ± 0.10 and −0.38 ± 1.42D, respectively. AL in myopia was significantly higher than in emmetropia and hypermetropia. There were no significant differences between CR in the refraction groups. Myopes had significantly higher AL/CR than nonmyopes. On controlling for age and gender, 1 mm increase in AL increased SER by −0.77D (95% confidence interval [CI] −0.91–−0.64D) while a unit increase in AL/CR increased SER by −8.89D (95% CI −10.00–−7.78D). Whereas AL accounts for 39% of variability in SER (P < 0.001), AL/CR accounts for 51% of the variability observed in SER (P < 0.001). Conclusion: This study has further confirmed that the AL remains a strong determinant of refraction, but a derived factor AL/CR accounts for more variation in final refractive status than AL in isolation.

Background: To determine an exploratory estimation of the strength of type 2 diabetes mellitus (T2DM) and hypertension diagnoses as risk indicators for missing teeth in a sample of Mexican adults. Materials and Methods: A comparative cross-sectional study of sixty adult patients in a health center in Mexico included as dependent variable, the number of missing teeth (and having a functional dentition) and as independent variables, diagnoses for diabetes or hypertension, age, sex, maximum level of schooling, and tobacco use. Of the 60 participants, 20 were diagnosed with T2DM, 13 with hypertension, and 27 were otherwise diagnosed as healthy in their most recent medical checkup. A negative binomial regression (NBR) model was generated. Results: Mean age was 50.7 ± 16.2 and 50.0% were women. Mean number of missing teeth was 4.98 ± 4.17. In the multivariate NBR model, we observed that individuals with T2DM had higher risk of more missing teeth (incidence rate ratios [IRRs] = 3.13; 95% confidence interval [CI] = 2.09–4.69), followed by those with hypertension (IRRs = 2.63; 95% CI = 1.77–3.90). In addition, participants with current tobacco use were significantly more likely to have suffered tooth loss (P < 0.05) than those who were never smokers or former smokers, just like older participants (P < 0.05). Conclusions: T2DM and hypertension are independently associated with higher experience of missing teeth in an open adult population in Mexico. Future studies with a more sophisticated epidemiological design and encompassing a more detailed landscape of chronic diseases, type and length of use of long-term medications, and patterns of dental care use are needed to better delineate these associations.

Gastric signet ring cell carcinoma (SRCC) is a rare form of highly malignant adenocarcinoma. It is an epithelial malignancy characterized by the histologic appearance of more than 50% of cells as signet ring cells filled with mucin. The incidence of SRCC is rising,^[1],[2] therefore, the diagnosis of these cancers in the early stage is important as it is the only stage that curative measures can be done. A 49-year-old female was hospitalized due to epigastric pain, postprandial bloating for 3 months. Upper gastrointestinal endoscopy with narrow band imaging (NBI) showed 1.5 cm lesion in the lesser curvature of the stomach with irregular pit pattern and accentuated vascularization of the surrounding mucosa. Histopathology confirmed the presence of more than 50% of the cells as signet ring cells. We report on the importance of optical diagnosis in early gastric cancer with the help of NBI, the subsequent patient management, and prognosis.

Multiple primary tumors occur in clinical practice causing diagnostic dilemma. It is not very common, but the incidence has increased gradually since it was first described very many years ago. However, in spite of its increasing incidence, the presence of such primary malignancies in the breast and colon has been rare and far between, as against its presence in breast and lungs, both breasts, colon and stomach, two colonic sites, and endometrium and ovaries. It could be due to genetic disorders such as Li-Fraumeni syndrome in which case the affected individuals develop multiple cancers in childhood or early adulthood. This is, however, very rare. It could be due to metastasis of one cancer to another site. The challenge is making a correct diagnosis and giving the appropriate management. Erroneously handling one as a metastasis of the other and instituting management as such would be inappropriate. It is necessary to make proper clinical and histopathological diagnosis and to institute proper management. We report the case of a woman who had primary cancers involving rare organ combinations of the breast and ascending colon.

Therapeutic plasma exchange (TPE) is performed frequently and effectively in developed countries, whereas the reverse is the case in developing countries. Guillain-Barre syndrome (GBS), synonymous with acute inflammatory demyelinating polyneuropathy, is an important indication for TPE, but this is rarely administered in the treatment of such patients in Nigeria due to lack of such automated facility, limited expertise, and high cost. This report therefore presents an uncommon case of GBS in which automated TPE was utilized in the management, with the aims of highlighting the current status and challenges of therapeutic apheresis services in Nigeria. A 42-year-old male presented with rapidly progressive (in an ascending fashion) paralysis of all four limbs within 24 h without any preceding history of fever or other symptoms. Clinical examination revealed a young man, afebrile, not pale, and also not dehydrated. Central nervous system examination showed a conscious man, alert, and oriented in time, person, and place. There were no signs of meningeal irritation and the cranial nerves were grossly intact. There was no power in the limbs: global hypotonia and areflexia were noted on examination. However, he had intact sensory perceptions to touch and pain. Following a diagnosis of GBS, he was treated with four sessions of plasmapheresis and TPE. The TPE session was done using a discontinuous flow apheresis machine which exchanged one plasma volume (3 L of plasma) and 5% albumin used for replacement. The patient made gradual but steady recovery as return of power to the upper limbs and trunk started by the 2^nd week of treatment. TPE is an important treatment modality in the management of GBS as well as several other conditions, and it is becoming increasingly available in Nigeria. However, it is still grossly underutilized, thus the need for more therapeutic apheresis facilities and trained personnel, in addition to concerted efforts to subsidize the cost of accessing the treatment.