Background and Aim: Development of phlebitis is a painful and common complication in the application of peripheral intravenous catheter (PIC). This is a prospective observational study performed to identify development rate of phlebitis in application of PIC and the factors that affect the development of phlebitis. Materials and Methods: The study universe comprises of catheters applied on inpatients in the internal diseases clinic of a state hospital, and the sample comprises of catheters eligible to be included in the study. Five hundred and thirty-two PICs applied on a total of 317 patients were reviewed. The patient identification form, information form for peripheral venous catheter and treatment, and visual infusion phlebitis (VIP) assessment scale were used to collect data. Results: 31.8% had phlebitis and a large number of them (79.2%) were Level I phlebitis. There was a significant relationship between having a chronic disease, duration of catheterization and type of fluid used and the development rate of phlebitis. Conclusion: The phlebitis in individuals receiving intravenous (IV) treatment was higher than the rate defined by both the centers for disease control and prevention and IV nurses society. It may be recommended to assess phlebitis by VIP assessment scale and to take preventive measures specifically for development of phlebitis.

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Purpose: The aim of this study was to determine the fracture strength of endocrowns made of lithium disilicate ceramic and two different indirect resin composites. Materials and Methods: Forty human mandibular molars were randomly separated into four groups (n = 10 in each group) – Group IN: control group, Group IPS: endocrowns made of lithium disilicate ceramic (IPS e.max CAD, IvoclarVivadent, Schaan, Liechtenstein); Group SL: Endocrowns made of Solidex microhybrid composite (Shofu, Ratingen, Germany); and Group GR: Endocrowns made of Grandia microhybrid composite (GC Europa, Leuven, Belgium). In all of the groups, dual-cure resin cement (Relyx Ultimate Clicker, 3M ESPE, St. Paul, MN, USA) was used to cement the endocrowns. All of the teeth were subjected to fracture by means of a universal testing machine (Instron), and compressive force was applied. The failure type and location after fracture were classified. The data were analyzed using one-way ANOVA, Tukey's post hoc test, and Chi-square test (P < 0.05). Results: Group IPS showed significantly higher fracture strength than Groups SL and GR (P < 0.05). There was no significant difference between the SL and GR groups (P > 0.05). In Group SL, 80% of the specimens exhibited favorable fractures; also, 60% of the specimens exhibited favorable fracture in group GR, and only 10% of the specimens exhibited favorable fracture in group IPS. Conclusions: The lithium disilicate ceramic endocrowns exhibited higher fracture resistance than indirect composite groups. Both of the composite endocrowns showed more favorable failure than the lithium disilicate ceramic endocrowns.

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Background: Maternal mortality remains a public health challenge despite the global progress made toward its reduction. Cultural beliefs and traditional practices contribute to delays and poor access to maternal health services. This study examined cultural perceptions influencing obstetric complications among women who delivered at Yusuf Dantsoho Memorial Hospital, Tudun-Wada, Kaduna. Methodology: The study was a cross-sectional study conducted at the Obstetrics and Gynecology Department of Yusuf Dantsoho Memorial General Hospital, Tudun-Wada, Kaduna, from February to April 2014. Two hundred and six women who delivered during the study period irrespective of their booking status and consented to participate in the study were recruited consecutively. Data were collected using a structured questionnaire. Results: Majority of the participants were Hausas (74.8%), Muslims (94.7%), married (99.0%), unemployed (45.1%), and within the age group of 20–29 years (58.7%). Most had secondary education (44.2%). The most frequent maternal complications encountered were prolonged obstructed labor (27.7%), obstetric hemorrhage (23.4%), severe preeclampsia/eclampsia (18.2%), and sepsis (5.8%). “Feeling embarrassed if delivered in hospital” was significantly associated with prolonged obstructed labor, while “feeling proud if delivered at home” was five times more significantly associated with obstetric hemorrhage. Conclusion and Recommendations: Cultural perceptions and traditional practices are major causes of primary delay in accessing maternal health services. The study emphasizes the importance of maternal health education among women in this region. Cultural perceptions and their influence on maternal mortality and morbidity should be integrated into health education programs.

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Aim: The aim of this retrospective study was to evaluate the change in inferior sclera exposition after maxillary protraction with or without skeletal anchorage in patients with maxillary retrognathia. Materials and Methods: Fifteen patients (Group 1) who applied maxillary protraction with teeth-supported appliance and fifteen patients who applied maxillary protraction with skeletal anchorage (Group 2) were compared in order to investigate the effect of different maxillary protraction methods on the visibility of sclera. The patients in both groups had dental and skeletal Class III malocclusion with maxillary retrusion (ANB <0; SNA <80), increased vertical growth pattern (SnGoGn >32) (long face), increased sclera exposure, and no congenital anomalies and dentofacial deformities. Pre- and posttreatment records were used to assess the amount of visible sclera on facial photographs using Adobe Photoshop CS6 program and the change in the movement of maxilla on cephalometric film. The pretreatment and after maxillary protraction values were compared statistically by the Wilcoxon signed-rank test (level of significance, P < 0.05). Results: The amount of inferior sclera exposure to eye height decreased in the right and left eyes of the 30 patients with maxillary protraction. The amount of inferior sclera exposure to eye height of the right and left eyes decreased from 3.59 to 3.5 and from 3.44 to 3.39, respectively, in Group I (P = 0.001 and P < 0.001, respectively). The amount of inferior sclera exposure to eye height of the right and left eyes decreased from 4.17 to 3.93 and from 3.86 to 3.68, respectively, in Group II (P = 0.001 and P < 0.001, respectively). Conclusion: There were important results in both of the two methods. Although more improvement was obtained in the skeletal anchorage group, statistically no significant differences were found between the groups.

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The prosthetic treatment of patients with total maxillectomies is an enormous reconstruction challenge because of insufficient support and retention from the residual tissues. It is not possible to place the bulb in the presence of unfavorable undercuts throughout the nasal cavity floor and borders. The purpose of this article was to describe a prosthetic reconstruction technique which accomplishes optimum sealing, retention, stabilization, and easy placement of an open-hollow acrylic resin obturator using a spring with a resilient liner for a patient who underwent a total maxillectomy. The springs were placed in the resilient liner to facilitate the placement of the obturator prosthesis because of unfavorable undercuts. It was possible to fit the prosthesis in two stages by means of springs. The objective of this technique is to improve the patient's psychological, functional, and social well-being by producing a stable, retentive, leakproof, comfortable, easy-fitting prosthesis. This technique is appropriate for patients who have undergone total maxillectomies when implant placement is not possible.

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Background: Episiotomy is a common surgical procedure experienced by women worldwide to ease labor and improve its outcome. However, it could influence the use of delivery services because of its associated complications. The study assessed knowledge and perception of episiotomy among antenatal clinic (ANC) attendees. Methods: It was a cross-sectional study conducted among 218 women attending ANC in a secondary health facility in Northwestern Nigeria. Data were collected using a structured, interviewer-administered questionnaire and were analyzed using IBM SPSS Statistics 20. Results: The mean age of women attending ANC was 24.2 ± 6.6 years, and 31 (14.2%) of them had had an episiotomy in the past. A majority of them were aware of episiotomy (87.6%) and had good knowledge (83.5%) and good perception (77.5%) of it. In addition, a majority (89.0%) were willing to deliver at the facility even if episiotomy would be given during labor. Knowledge of episiotomy showed statistically significant association with only a history of previous delivery while perception did not show statistically significant association with any of the independent variables. Conclusions: Awareness and knowledge of episiotomy among women attending ANC were high and perception of it was generally good. The major factor associated with the knowledge of episiotomy was a history of previous delivery. Effort should be channeled toward improving awareness and knowledge on episiotomy among intending mothers, and health workers should always ensure that women are adequately informed and counseled before an episiotomy is given to them.

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Context: The concept of burnout is a condition seen in occupational groups working face-to-face with people and resulting in emotional exhaustion, depersonalization, and low professional productivity. Aims: The purpose of this study was to determine burnout levels and associated factors in physicians practicing in Erzurum, Northeast Anatolia, Turkey. Settings and Design: This research was designed as a cross-sectional descriptive study. The research sample size was calculated at 663 participants with a 99% confidence interval and a 3% margin of error using Epi Info software. A 10% incomplete or nonresponse rate was added, for a target cohort of 730 individuals. Seven hundred and eleven physicians agreeing to take part were enrolled. Subjects and Methods: A questionnaire consisting of questions concerning sociodemographic characteristics and the Maslach Burnout Inventory (MBI) was used as the data collection tool. The questionnaires were distributed by the authors and completed by the physicians in person. Statistical Analysis: Descriptive data were expressed as percentage, mean, median, and standard deviation. Data were analyzed using the Kruskal–Wallis and Mann–Whitney U tests and binary logistic regression analysis. P < 0.05 was regarded as statistically significant. Statistical analyses were performed on SPSS 15.00 software. Results: The mean age of the physicians in the study was 34.4 ± 7.7 years. Mean MBI subdimension scores were 15.6 ± 7.0 for emotional exhaustion, 5.7 ± 3.9 for depersonalization, and 21.0 ± 4.4 for personal accomplishment. Mean emotional exhaustion and depersonalization scores were significantly higher and personal accomplishment scores significantly lower in physicians aged under 25, not taking vacations, working in public hospitals, who were working as research assistants. Conclusions: Burnout levels among the participants were low (emotional exhaustion in 75%, depersonalization in 76.2%, and low personal accomplishment in 69.6%).

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Background: A broad spectrum of renal vascular variations has been reported by anatomists and radiologists. The prevalence of these variations is extremely divergent in different populations. Therefore, radiologists and surgeons in different climes must be knowledgeable about the type and prevalence of the variants in their area of practice to avoid diagnostic pitfalls and for optimization of surgical techniques. Objective: The objective of this study is to describe the types and prevalence of renal vascular variations among patients undergoing contrast-enhanced computerized tomography (CECT) of the abdomen in a Nigerian population, as well as provide a concise review of literature on the embryological basis and clinical significance of the identified variations. Materials and Methods: This study was a retrospective review of 200 CECT of the abdomen to identify variations of arterial (accessory, early branching, and precaval) and venous (multiple, retroaortic, and circumaortic) anatomy of the kidneys. Results: We studied 200 patients, 102 (51%) females and 98 (49%) males. Age range is 18–90 years (mean = 53.08 ± 17.01). Prevalence of any renal vascular variations was 50%, arterial variations were 37%, and venous variations were 13%. Variations were significantly more common in males, P = 0.000075. The most common arterial variant was the accessory renal artery (23%) seen in 10% (right) and 13.0% (left); early branching was seen in 4.0% (right) and 0.5% (left) as well as precaval right renal artery seen in 4.5%. Venous variants were late confluence 3.0% (right) and 2.5% (left); multiple veins was seen in 2.5% (right) and 2.5% (left) as well as retroaortic left renal vein seen in 2.0%. The inferior polar accessory artery was the most prevalent accessory artery. Early arterial bifurcation was significantly more common on the right (P = 0.016) while other vascular variants showed no statistically significant association with laterality. Conclusion: Variation of renal vascular anatomy is a frequent finding among Nigerians. Radiologists and surgeons must be aware of these variants for optimization of surgical techniques.

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Objectives: To investigate the color relationships between the anterior teeth in vivo. Materials and Methods: A total of 640 volunteers (age: 18–22) participated in the study. The color measurements of left maxillary and mandibular central, lateral, and canine were performed using a colorimeter. Color differences were calculated according to the CIE L*a*b* (ΔE*) and CIEDE2000 (ΔE₀₀*) system. The National Bureau of Standards (NBS) ratings were also evaluated. Statistical analyses were performed using two-way ANOVA and Fisher's exact test (P < 0.05). Results: Significant differences were found between the L*, a*, b*, and ΔE* values (P < 0.05), except for mandibular central and lateral. ΔE* values were found between 1.5 ΔE* (mandibular central–mandibular lateral) and 8.1 ΔE* (maxillary central–maxillary canine). While the highest L* (80.5) and the least b* (15.1) values were obtained for mandibular central, the mean L* (73.6) and the mean b* values (21.3) were obtained for the maxillary canine. a* value was found to be highest for the mandibular lateral (1.1) and the least for the maxillary central (−0.2) teeth. NBS values were between 1.3 and 7.4 units, and only mandibular central and mandibular lateral teeth exhibited “almost the same” color values, while the other teeth exhibited “slightly different,” “very different,” or “remarkably different” color values. Conclusion: Anterior maxillary and mandibular teeth exhibited “different” color values. Only mandibular incisors and mandibular laterals showed “almost the same” color. Canines were more dark/red/yellow for both mandible and maxilla. Centrals were more bright/green/yellow for maxilla and bright/green/blue for mandibular. Clinicians should select the color one by one for each tooth and be aware of their color relations for optimal esthetics.

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Aim: Brucellosis is a highly contagious zoonotic infection affecting livestock and human beings. This study aimed to investigate the prevalence of Brucella in raw milk collected from a provincial center and central villages in the Central Anatolian region. Materials and Methods: This cross-sectional study was completed between March and September of 2016. The sample size for research was calculated as 263 milk samples with the Epi Info 2000 program. Samples were tested with the milk ring test, Rose Bengal test, and standard Brucella tube agglutination test. Suspicious samples according to these tests were seeded on medium for observation. Results: In this study, 202 cow's milk samples collected from 14 central villages were researched for the presence of Brucella abortus, a Brucella species bacterium. According to the medium seeding results, 35 of 202 raw cow's milk samples (17.32%) were identified as suspicious. Conclusion: The research investigated the prevalence of Brucella in milk samples collected from bovine farms used for consumption and production of raw milk products. The most significant infection route in our region is considered to be consumption of milk and milk products such as raw milk and fresh cheese. Especially in rural areas, households consuming their own produced milk are common. In regions with family-style milk and milk product production and consumption, interventional studies with the aim of improving knowledge, attitudes, and behavior related to zoonotic diseases should not be neglected.

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Background: Discharge summaries are important components of hospital-care transitions in ensuring continuity of care. Aim: We assessed the adequacy and accuracy of discharge summaries written by junior doctors. Methods: An instrument, adapted largely from the current hospital discharge summary template and recommendations regarding content from the Joint Commission International, was used to study 420 discharge summaries written in 2012 from the ophthalmology service of a Rural Teaching Hospital in Nigeria. The simple descriptive analysis was done with Statistical Package for the Social Science version 17. Results: Completeness of entries was relatively high in many traditional areas (biodata of patient, admission/discharge dates, name of supervising consultant, principal diagnosis, surgical procedures done, follow-up instructions, and condition on discharge) of the summaries. The portion of the paper-based template titled “summary” of the admission was most problematic; with information on medication changes and result of tests missing in 368/420 (87.6%) and 334/420 (79.5%), respectively. Conclusion: Educational intervention for doctors in training with the provision of oversight and feedback by their supervisors is required. Standardized discharge summary templates recognizing the peculiarities of specialized patient groups are recommended. Transition to electronic discharge summary system is imperative.

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Background: Sickle leg ulcer (SLU) is a chronic and debilitating complication of sickle cell disease (SCD) associated with huge physical and psychosocial discomfort. The occurrence of SLU has remained steady despite successful preventive strategies and advances in SCD care. Although multifactorial factors have been implicated in SLU, these are not fully understood, and data on how these relate to young Nigerian SCD patients are scanty. Aims: This study aims to evaluate the sociodemographic, clinical, and laboratory markers of SLU in a young Nigerian SCD cohort. Patients and Methods: This study involved 109 young SCD patients and 67 healthy peers. The sociodemographic and laboratory parameters of the participants were examined in addition to the evaluation of the SCD cohort for SLU. Results: Only the HbSS patients had SLU. This was found in six of them giving a prevalence of 5.9% (6/101). Their median age was 17, range 14–21 years. There was a preceding history of trauma in 4 (66.7%), and this included a case of traditional scarifications for local therapeutic purposes. Two of the three (66.7%) males with SLU also had priapism (P = 0.0132). Patients with SLU were older, had less frequent bone pain crises, and significantly belonged to the low socioeconomic class (P < 0.05). Although patients with SLU had relatively higher lactate dehydrogenase, platelet count, aspartate transaminase, bilirubin, white blood cell, and lower Hb concentration and HbF, these did not attain statistical significance (P > 0.05). Conclusion: This study confirms that SLU is common among young SCD patients with HbSS genotype, low socioeconomic background, and older age. It also suggests that SLU could be more related to hemolysis-associated SCD phenotypes among the patients.

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Objective: Multiple sclerosis (MS) is a chronic inflammatory and demyelinating autoimmune disease of the central nervous system. It is known that the disease, which is manifested by a wide variety of symptoms, may exacerbate after anesthesia and show different responses to muscle relaxants in the normal population. It is planned to measure train-of-four (TOF) values of MS patients to be operated under general anesthesia before sugammadex application. Materials and Methods: With the approval of the local ethics committee of the University of Health Sciences Bagcilar Training and Research Hospital and with written consents of participants, we anesthetized ten patients (from April 2014 to March 2017) with MS and ten American Society of Anesthesiologists I-III patients without MS. Neuromuscular conduction was assessed by the acceleromyometric method using a TOF-Guard apparatus (Organon, Holland). The patients were extubated after recovery of TOF higher than 0.9. The primary efficacy variable was the time from the start of administration of sugammadex to recovery of the TOF ratio to 0.9. Results: The demographic characteristics of both groups, the type and duration of surgery and anesthesia applied, and the temperature of the operation room were similar. Similar characteristics of both groups were of concern for postoperative residual paralysis, and therefore we did not notice any difference between time to TOF >90/s for both groups. Conclusion: Sugammadex and TOF patients will increase patient safety in general anesthesia practice.

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Background and Aim: Technological developments and enhancement of knowledge level enable heart surgery with low mortality rates in most centers. On the other hand, increased systemic inflammatory response against cardiopulmonary bypass (CPB) plays a critical role in the development of postoperative complications. We aimed to compare the effects of centrifugal pump where it is claimed that blood is exposed to minimal trauma and roller pump techniques on inflammatory response and oxidant status during CPB. Materials and Methods: A total of 40 patients, who had coronary artery disease and underwent coronary artery bypass graft (CABG) surgery using either roller or centrifugal pump between June 2012 and June 2013 were enrolled in this study. Patients over 40 years old and without any known immunologic, infectious, or inflammatory incidents and hematological problems for the past 6 months were included in the study. Two study groups (Group R: roller pump group and Group C: centrifugal pump group) were created. During CABG surgery tumor necrosis factor (TNF) alpha, interleukin (IL)-6, IL-8, superoxide dismutase (SOD), catalase (CAT), and nitric oxide levels were measured before and after CPB. Results: TNF alpha, IL-6, and IL-8 levels measured before and after CPB were found to be similar between groups. SOD, CAT and Nitric oxide levels were also similar between groups. After the CPB period, glutathione peroxidase enzyme activities in Group R measured after CPB were significantly lower than those measured in Group C. The platelet-activating factor (PAF) levels before CPB usage period were same in both groups, where PAF levels after CPB were found to be significantly higher in roller pump group than centrifugal pump group. At inter-group comparisons, the levels of PAF were same at each group before and after CPB. Conclusion: The study findings indicate that usage of the centrifugal pump does not have a clear superiority in terms of the effects on inflammatory response and oxidant status during CPB when compared to roller pump. Nevertheless, we believe that our results should be supported by further clinical and experimental studies.

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Objective: To report the risk factors for poor visual outcome in traumatic hyphema. Materials and Methods: A retrospective study was done by collecting data from medical records between January 2011 and December 2015 in Jakarta, Indonesia. Clinical data included initial visual acuity (IVA), final VA at 3 months, slit lamp evaluation with grading of hyphema, intraocular pressure, and fundus findings on direct or indirect ophthalmoscopy. Results: The study included 97 patients, with males showing a preponderance, the ratio being 9:1. Soft gun pellet was the most common cause (27.8%), others being workplace injuries (12.4%), sports injury (14.4%), traffic accident (2.1%), and other injuries (43.3%). Poor visual outcome was due to vitreous hemorrhage, cataract, iridodialysis, and choroidal rupture. On statistical analysis, significant risk factors were causality (P = 0.018), IVA (P = 0.026), onset of injury (0.000), and grade of hyphema (P = 0.000). Conclusion: Grade of hyphema, IVA, causality, and onset of injury were significant risk factors related to poor visual outcome in traumatic hyphema.

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Objectives: The objective of this study is to explore time-dependent dimensional stability of three different elastomeric impression materials – vinyl polyether silicone (VPES), vinyl polysiloxane (VPS), and polyether (PE) – through micro-computerized tomography (μ-CT) imaging, allows three-dimensional (3D) imaging and measurement without sample preparation or chemical fixation. Materials and Methods: Thirty specimens were created using 3 mm high, 30 mm wide Teflon molds (n = 10). Specimens were scanned with μ-CT on the 1^st (T1) h and 1^st (T2), 7^th (T3), and 14^th (T4) days. 3D models were created at the above-mentioned times, volumetric measurements were conducted and dimensional changes were calculated. Diameters and heights of each impression material were measured with 2D analyses. Furthermore, contact angle measurements of these elastomeric impression materials were collected using the sessile drop method during and after polymerization at 0, 2, 5, 20, 60, 120, and 240 s These measurements were made on specimens (n = 10) prepared in standard sizes using a 50 μm deep stainless steel die with dimensions of 62 mm × 20 mm × 3 mm. Results: Evaluation of the dimensional volume changes of the VPES, VPS, and PE measurements showed there to be no statistically significant differences between the T1, T2, T3, and T4 (P > 0.05). Only the decreases in the volume averages of T3 and T4 in the VPES were statistically significant (P < 0.05). As a result of binary comparisons, the evaluation of contact angle measurements of VPES, VPS, and PE materials during and after polymerization were compared. The average contact angle measurements of the VPS group were statistically significantly lower than the averages of the VPES and PE groups (P < 0.01). Conclusions: VPS was found to be the most stable impression material concerning dimensional change and wettability.

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Nephrotic syndrome (NS) in childhood may be associated with thromboembolic complications, mainly in venous origin. However, arterial thrombosis may also be seen as a very rare and life-threatening complication. Herein, we described a case of steroid-resistant NS who did not respond to full-dose steroid treatment for 8 weeks and was complicated by neurological findings. The renal biopsy was consistent with focal segmental glomerulosclerosis. His cerebral magnetic resonance angiography showed the sudden termination of M3 branch of the left middle cerebral artery which corresponded with subacute infarction in the left frontoparietotemporal area. Thrombosis panel yielded the results of hyperhomocysteinemia (46.1 μmol/L, range: 5–15 μmol/L) and heterozygous methylene tetrahydrofolate reductase mutation (C677T, A1298C). After that, the patient was given medical therapy including anticoagulant treatment. Improvement in the neurological outcome was determined on the 1^st month of follow-up examinations.

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Background and Objectives: Hypertension (HT) is one of the risk factors associated with atherosclerosis. Midkine (MK) plays a role as a growth factor in various biologic and pathologic events. In some reports, MK expression has been shown to be linked with vascular smooth muscle proliferation and neo-angiogenesis in atherosclerotic vessels. The aim was to research relationship of MK serum levels with some atherosclerotic risk factors in hypertensive patients. Methodology: This study examined 60 patients with essential HT and 30 healthy controls. Serum biochemistry, including lipid profile, MK, Vitamin B₁₂, C-reactive protein, zinc and copper levels were obtained. Results: MK levels of the HT patients were significantly higher than the control group (24.8 ± 6.8 ng/mL vs. 18.39 ± 5.6 ng/mL, respectively, P < 0.01). Lipid profile parameters such as total cholesterol, triglyceride, low-density lipoprotein (LDL) were also significantly higher in HT patients (P < 0.021, P < 0.01, and P < 0.01, respectively). Zinc levels were 179.13 ± 34.06 μg/dL and 172.55 ± 45.47μg/dL in the HT and control group, respectively. Serum MK levels were positively correlated with diastolic (r = 0.288, P < 0.05) and systolic blood pressures (r = 0.390, P < 0.002), and also with serum total cholesterol (r = 0.406, P < 0.002) and LDL cholesterol (r = 0.318, P < 0.015) levels. Furthermore MK was also negatively correlated with zinc and Vitamin B₁₂levels (r = −0.298, P < 0.023, r = −0.334, P < 0.027, respectively). Conclusion: This study has demonstrated an important association between increased serum MK levels and risk factors of atherosclerosis such as HT, increased total and LDL cholesterol.

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Studies have reported that intraocular pressure (IOP) might change markedly during hemodialysis. We report the case of a 34-year-old Nigerian female with a 3-year history of chronic kidney disease secondary to chronic glomerulonephritis who presented with acute symptomatic elevation of IOPs following hemodialysis. She had no ocular complaints immediately before undergoing hemodialysis. She presented with a history of pain, redness, and mild blurring of vision in the left eye about 15 min after hemodialysis. Examination revealed circumciliary injection, shallow anterior chambers, and closed angles on gonioscopy in both the eyes. She was treated with pilocarpine (4%) four times daily and dorzolamide/timolol (2%/0.5%) twice daily combination eye drops with subsequent relief of symptoms and IOP reduction from an initial 48 and 74 mmHg to 10 and 12 mmHg for the right and left eyes, respectively. This case highlights the need for sensitization and awareness among renal physicians and ophthalmologists of the possibility of extremely high IOP during or immediately following hemodialysis. It also emphasizes the importance of gonioscopy and treatment of at-risk patients with narrow angles before hemodialysis.

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Introduction: Mushroom intoxication (MT) can lead to acute liver injury which may result in Mushroom intoxication-related liver failure (M-ALF) requiring liver transplantation (LT). In the present study, we want to share the experience of our institute regarding living-donor LT (LDLT) due to mushroom poisoning. Aim: The aim of this study is to identify the predictors of poor prognosis in patients with ALF secondary to mushroom intoxication requiring LDLT. Materials and Methods: All patients with MT between 2008 and 2016 were evaluated. Demographics, symptoms, interval between symptoms and admission to our institute, laboratory data, model for end-stage liver disease (MELD)/pediatric end-stage liver disease (PELD) scores, clinical course, and outcomes of supportive therapy and LT were evaluated. There were two groups in the study: Group A = responsive to supportive therapy (n = 9) versus Group B = unresponsive to supportive therapy (n = 9). Results: During the study, a total of 18 patients were admitted with M-ALF. Twelve (66.7%) of them were female, and the mean age was 39.9 ± 18.2 years. All of the nine patients in Group A fully recovered with supportive therapy. In Group B, one patient died during waiting period for LT and 8 patients received LDLT LDLT. Three of the eight patients who were transplanted died in the postoperative early period within postoperative 5 days. The patients in Group B had significantly higher MELD/PELD scores and encephalopathy rate than in Group A (P < 0.05). International normalized ratio (INR), bilirubin, ammonium levels, and platelet count were significantly different between groups (P < 0.05). The patients in Group B had significantly longer interval before admission to our institute (P < 0.05). Conclusion: The presence of encephalopathy, higher MELD/PELD, INR, bilirubin, ammonium levels, and lower platelet count was related to poor prognosis in MT. LDLT provides a good therapeutic option in patients with M-ALF. The time is a crucial factor in successful treatment of MT. Early admission to a tertiary referral center with expertise in LT results in a better prognosis and increased survival following M-ALF.

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Background: Chronic kidney disease (CKD) is a global public health problem with increasing incidence and mortality in Africa. Autonomic dysfunction (AD) has been implicated as a major contributor to the disease morbidity and mortality, but little is known about the predictors of this dysfunction in African populations. Understanding the predictors of this condition is necessary for early detection and management of CKDs. Objectives: This study was designed to determine the predictors of AD in CKD patients in Nigeria. Materials and Methods: It was a cross-sectional study of CKD patients at University of Nigeria Teaching Hospital, Enugu, Nigeria. The CKD patients with AD were compared with those without AD and a normal control group. Autonomic function was assessed through noninvasive cardiovascular tests: measurement of resting tachycardia, orthostatic hypotension, heart rate response (HRR) to standing, HRR to Valsalva maneuvre, and HRR to respiration. Data on symptoms of CKD and AD were obtained using a validated questionnaire. Results: The mean age of the CKD patients was 41.3 ± 1.5 (range: 21–69) years. Early hospital presentation is associated with significantly less risk of the development of AD (P < 0.001). Dizziness, nocturnal diarrhea, and impotence are the major markers/predictors of AD in CKD patients (P < 0.05). Conclusion: AD is common among predialysis CKD patients in Nigeria, and best predicted by the presence of postural dizziness, nocturnal diarrhea, and impotence in men. Physicians should, therefore, be on the lookout for these features for prompt and adequate management of cases.

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Introduction: Elevated skull fractures, previously thought of as a very rare variety of fractures, are no longer very uncommon. They are expectedly gradually finding a slowly growing list of references in neurosurgical literature. They are mostly posttraumatic compound fractures due to the mechanism of injury. Outcome of operative neurosurgical care is generally rewarding. Materials and Methods: A 4-year retrospective study of case notes, operation registers, and radiology records of patients diagnosed with elevated skull fractures who had neurosurgical care at the University of Nigeria Teaching Hospital, Enugu, Nigeria, between 2012 and 2015, was done. Only patients with evidence of elevated skull fracture on head computed tomography scan were included. The presenting Glasgow Coma Score and Extended Glasgow Outcome Score (GOSE) at the time of discharge from the hospital and 6 months thereafter were analyzed. Results: Out of 209 patients managed with skull fractures over the study period, eight met the inclusion criteria. Seven (87.5%) were males. The latency to presentation was 6 h in one case and >8 h in the other cases. All the patients had operative care involving debridement, duroplasty, and bone-fragment realignment (cranioplasty) either primarily or on an interval basis. The GOSE at 6 months was at least 7 in 87.5% of the patients. Conclusions: Despite the grotesque appearance at presentation, outcome of properly managed elevated skull fractures is good.

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