Aim: The aim of the present study was to determine whether the use of advanced platelet rich fibrin based on the low speed⁺ centrifugation concept (A-PRF⁺) might improve the pain management and healing of delayed wound healing among cases of alveolar osteitis following mandibular third molar extraction. Materials and Methods: The patients (N = 40) with a complaint of alveolar osteitis following third molar extractions were divided into two groups: Group I (control; saline only); and Group II (use of A-PRF⁺). Pain was evaluated using the visual analogue scale (VAS). Soft tissue healing was assessed by the modified Index of Landry, Turnbull and Howley and bone density was assessed with the i-Dixel 2.1.8.2 software. Inter-group comparisons were analyzed by means of a student t-test and the Mann Whitney U test to identify group samples. Analysis of variance and the Friedman test were applied for repeated measurements. The Wilcoxon test and Bonferroni's test for multiple comparisons were conducted at the time-factor level. Yates Correction was used to compare qualitative data. Results: In regard to pain, A-PRF⁺ application demonstrated rapidly and continually reduced pain intensity at each respective time in comparison to the control. Statistically, the healing rates of epithelium and hard tissue were significantly faster in the A-PRF⁺ application group (p: 0.000, P < 0.05). Conclusions: The results show that A-PRF⁺ might represent an improved and accelerating therapeutic development for hard and soft tissue healing in management of alveolar osteitis that is also effective in reducing pain.

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Aims: The purpose of this study is to compare the stresses occurring in the peri-implant bones, implants, crowns, abutments, and screws after loading through finite element analysis by using the poly-ether-ether-ketone (PEEK) materials, which are alternative to titanium abutment and metal supported restorations and to try to reduce the level of neck resorption. Materials and Methods: In our study, three-dimensional modeling of 2 PEEK and titanium abutments, metal-ceramic, and monolithic PEEK upper central dental restorations were made on four titanium implants (Biohorizons^® Implant Systems Ins., Birmingham, AL, USA) with diameters of 3.8 mm and 10.5 mm and four groups were obtained. Then, a stress analysis of the finite element was performed by applying a 178 N oblique force of 45° to the long axis of the tooth 2 mm below the incisal edge of the model's palatal surface. Results: It has been observed that the PEEK material reduces the stresses caused by the force applied on itself during all tests. In all groups, PEEK abutments and PEEK crowns have reduced stress on the abutment. The most significant difference is observed in the stresses on the crowns and screws. When the stresses on the crown are examined, the use of PEEK crown reduces the stresses on itself and the use of PEEK abutment increases the stresses on the crown. Conclusions: The stress on the implant system can be changed through the usage of different prosthetic materials.

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Background: Paraneoplastic syndromes (PNS) have been defined as a constellation of symptoms and signs seen in patients with malignancy, which cannot be ascribed to the local or distant spread of the tumor. Renal cell carcinoma (RCC) is most commonly associated with PNS among urological malignancies. We describe the incidence of PNS and the association between the syndromes and oncological outcomes in our patients with RCC. Subjects and Methods: A retrospective cohort study done at Lagos State University Teaching Hospital, Ikeja, Lagos. This was a retrospective review of our patients who had RCC over 11-year period (2006 to 2016). The incidence of PNS syndromes were hypercalcemia, Stauffer's syndrome, hypertension, anemia, elevated erythrocyte sedimentation rate (ESR), persistent leukocytosis, and its correlation to outcome of disease were analyzed. In addition, the age, gender, clinical features, and stage of disease were analyzed. Chi square, Fischer exact test, and Kaplan–Meier survival, curve and logistic regression. Results: In total, 101 patients were operated within the period. Age of the patients ranged from 11 to 81 years (mean of 45.17 ± 16.3). There were 46 males and 55 females with M:F ratio of 1:1.2. Majority of the patients, 74 (73%), had clear cell variant of RCC. Twenty-seven patients (26.7%) had triad of flank pain, flank mass, and hematuria. The incidence of PNS were hypercalcaemia 7 (6.9%), Stauffer's syndrome 12 (11.9%), hypertension 16 (15.8%), anemia 61 (60.4%), elevated ESR 56 (55.4%), and persistent leukocytosis 3 (3.0%). At a median follow-up of 6 months, 72 patients (71.3%) were alive, whereas 29 patients (28.7%) were dead. Conclusion: Among the PNS, only Stauffer's syndrome was significantly associated with poor outcome.

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Background: Assessment of health-related quality of life (HRQOL) in resource-limited settings is critical to evaluate and improve the burden of morbidity and mortality associated with chronic medical disorders. There is a dearth of data on HRQOL among patients suffering from chronic medical disorders in Nigeria. This study assessed the HRQOL of participants with diabetes mellitus (DM), human immunodeficiency virus (HIV) infection, and cancer in a hospital setting with limited resources and highlighted associated factors. Methods: The WHOQOL-BREF instrument was used to study a cross section of the participants at the University of Nigeria Teaching Hospital, Enugu. Data were analyzed using Statistical Package for Social Sciences (SPSS). Results: The distribution of the 613 study population was diabetes mellitus 120, HIV 389, and various cancers 104. Majority (67.9%) earned less than $1 per day and only 7.5% had any form of health insurance. The HIV group had higher QoL scores. Younger age, higher educational status, being employed, and having a care giver were positively associated with higher QoL. Patients with no comorbidities (76.6%) had an overall higher QoL score. Conclusion: Majority of the patients living with chronic medical diseases in Enugu, Nigeria were poor, vulnerable, and without access to health insurance. People living HIV generally had better quality life than those with other health conditions. There is a huge unmet need for people living with chronic medical conditions in Nigeria, which require strategies to counteract.

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Objective: Children with Down syndrome (DS) are at increased risk for obstructive sleep apnea (OSA) compared with children without DS, with reported prevalence of 31 ± 75% among clinical-based samples. We aimed to find out whether there is any effect of OSA on periodontal and dental health in children with DS. Material and Methods: Overnight polysomnography (PSG) was performed. OSA was defined as Apnea-Hypopnea Index (AHI) ≥ 1/h. Children received a full mouth periodontal and dental examination that included probing depths (PD), plaque index (PI), gingival index (GI), and bleeding on probing (BOP) on six sites per tooth. Decay, decay - Missing, missing - Filling, filling - Tooth, tooth (DMFT—for permanent tooth/dmft—for primary tooth) scores were calculated. Results: Children were divided into two groups depending on whether they were diagnosed with OSA or no OSA. Group 1 (DS with OSA) and Group 2 (DS without OSA) included 11 children (age = 11.5 ± 2.2) and 7 children (mean age = 9.7 ± 2.3), respectively. Subjects in Group 1 displayed statistically significantly higher levels of GI (P = 0.020) and BOP (P = 0.006) than Group 2. Conclusion: OSA is an important problem for DS and may affect oral health negatively. Based on our findings, OSA can be associated with impaired gingival health in DS children and close follow-up may be necessary for this group.

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Background: By the end of 2017, human papillomavirus (HPV) vaccine had been introduced in 80 countries, but Nigeria proposes introducing the vaccine into her routine immunization program from late 2020 or early 2021. The current mode of HPV access in the country is through out-of-pocket purchase with only 1.4% of adolescent girls being vaccinated. Cervical cancer has remained the second highest cancer among women in Nigeria, and the incidence rate is significantly higher than the global rate. This study assessed the factors associated with HPV awareness and willingness to vaccinate daughters among mothers of female secondary school students in Abakaliki. Materials and Methods: A cross-sectional study was carried out among 290 mothers of female students selected through multistage sampling technique using a pretested self-administered questionnaire. Data were analyzed with Epi Info™ version 7. Results: The mean age of the mothers was 42 ± 8 years, and 72.8% attained at least secondary education, while 37.2% were traders. Their awareness of HPV and uptake of cervical cancer screening were low, 42.8% and 9%, respectively. Although 89.1% were willing to vaccinate their daughters, only 6.9% of their daughters had ever received HPV vaccine. Lack of awareness on HPV vaccine and cost of purchase were the most cited reasons for low vaccine uptake. Education, screening status, mother–daughter vaccination status, and willingness to encourage others on HPV vaccine for daughters were significantly associated with HPV awareness. Conclusion: Most of the mothers were willing to vaccinate their daughters with HPV vaccine, but they lack awareness and the financial resources for the access. There is an urgent need for vigorous enlightenment campaigns on HPV vaccine and cervical cancer screening. Adding HPV vaccine in the routine immunization program will improve universal access and address financial concerns.

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Background: Septoplasty is one of the frequently applied nasal surgical procedures. There is still no gold standart objective method to evaluate the patients whom suffers from nasal blockage. To evaluate the septoplasty candidate with a Paranasal Computerised Tomography (PNCT) is one of the most discussed topic in the otorhinolaryngology surgical philosophy. Objectives: In this study, we aim to interpret the value of nasal valve areas measured by PNCT for both septoplasty candidates and the control population. We believe that this information could be useful for the evaluation of patients before undergoing a septoplasty procedure. Material and Methods: 600 coronal and axial tomography sections performed between May 2014 and February 2018 at the University Of Gaziantep Radiology Dept. were assessed. These tomography sections were divided into two groups called the septoplasty and the control. The septoplasty group was made up of three hundred paranasal sinus tomography images scanned before patients' septoplasty operations. The control group was created by screening 300 maxillofacial tomography's which were taken due to the suspicion of trauma at the University Of Gaziantep Emergency Clinic between May 2014 and January 2018. Results: There were 192 (64%) patients with left nasal septal deviation and 108 (36%) patients with right nasal septal deviation. The Independent Sample T-Test revealed that the mean internal nasal valve angle in the left septoplasty group was significantly lower than that of the control group (P < 0.005). A comparison of the right side nasal values revealed a significant statistical change according to the Independent Sample T-Test between the value of the right septoplasty and the control groups (P < 0.005). Conclusion: The sectional areas of nasal tomography images may show different values. However, it is still difficult to say that the clinical application of tomography images could be used as one of the indication criteria for the septoplasty procedure.

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Background: The choice of surgical approach can affect the quality of life in patients with a facial fracture. Objective: The aim of this study was to assess the quality of life in surgically treated patients with facial fractures, and to determine the potential difference in the quality of life related to different surgical approaches. Materials and Methods: Ninety facial fracture cases were analyzed. They were divided into three groups: operated by skin incision, mucosal incision, and treated conservatively. To examine the quality of life of patients, a questionnaire on the quality of oral health Oral Health Impact Profile (OHIP)-14 questionnaire was used. Results: In the first days after the injury, patients with transcutaneous approach showed a poorer quality of life in comparison to patients with transmucosal and conservative treatment. The presence of severe posttraumatic pain is significantly more prevalent in patients with transcutaneous surgical approach than in other treatment types. Conclusion: During the immediate posttraumatic period, the quality of life is poorer in patients who have undergone transcutaneous approach. There are no differences in the quality of life 1 month or 3 months after the injury.Discussion: Assessment of complaints in the first days after the injury shows statistically significant differences across various therapeutical methods in variables such as pain, discomfort when eating certain foods, aesthetic appeal, nervousness, and relaxation. There is not sufficient evidence related to the differences in these outcomes regarding different surgical approaches for facial fractures.

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Background: The Medication Adherence Rating Scale (MARS) is a 10-item self-report measure of medication adherence in psychosis which is a vital predictor of illness course and outcome in patient with schizophrenia. The initial and subsequent studies have shown that MARS has good reliability and validity scores after correction for the small sample size in the index study. Aim: This study aimed to determine the psychometric properties of MARS among outpatients with schizophrenia at the outpatient clinic of the Neuropsychiatric Hospital Aro Abeokuta Ogun State Nigeria. Methods: Intra-class correlation coefficient (ICC) was used to determine the internal consistency, item-total correlations, and reliability of the instrument. Factor analysis was done using principal component analysis with varimax rotation. Results: The intra-class correlation coefficient (ICC) for these 10 items (at time T₁) was 0.6 with a P value of <0.001 while for the test--retest analysis was 0.7 with a P value of 0.04. A principal components factor analysis with varimax rotation produced a four-factor solution and factor 4 was found to be the most internally consistent, with Cronbach's alpha of 0.63. Conclusion: This study supports the internal consistency, test--retest reliability, and constructs validity of the MARS.

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Brunner's gland adenoma is usually asymptomatic and sometimes accompanied by nausea, vomiting and swelling. İt is often confused with duodenal malignancy, which may mislead and the physician about its treatment. We want to present a case of a 40-year-old female with a history of weight loss, vomiting and nausea since six months. İnitial imaging studies that revealed a large mass in the duodenum and endoscopic findings that suggested duodenal invagination. Whipple operation had been recommended to the patient by two different general surgery departments. The patient reported to our clinic for gastroenterological evaluation before the operation. At our exmination, a giant polyp, 5 to 6 cm in size, was observed in the second part of the duodenum; it was 9 to 10 cm long and originated from the pylorus. Duodenotomy was performed, and only the giant polyp was removed. Pathological examination revealed hyperplastic Brunner's glands mixed with fibromuscular tissue and mature fat tissue.

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Aim: This study aimed to determine the sleeping habits and sleeping periods of kindergarten children, in order to analyze the problems related to sleep hygiene and determine the underlying factors. Methods: The sample size of this cross-sectional study consisted of 390 children. A questionnaire filled in by the parents was used as the data collection tool. The data were analyzed with appropriate statistical tests. Results: According to the mothers, 77.2% of the children had their own room at home. Thirty nine percent of children slept with the full light on in their room, 50.3% slept with night light on in their room, 12.3% slept with the radio/television on in their room. Infant sleep practices found in this study are swaddling (18.5%), wrapping of the infant's arms (21.0%), and rocking (58.7%). Conclusions: In terms of sleep hygiene, the vast majority of the children slept in a bright environment, and there were electronic appliances in the room. Common infant-transition-to-sleep practices observed were wrapping their arms and swaddling them. In our point of view, awareness training for parents about the subject will support sleep hygiene practices.

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Aims: The present study aims to improve the design of cementless femoral prosthesis stem and achieve better bone ingrowth and long-term stability. Materials and Methods: Four models with different directional hollow holes at the proximal end of femoral prosthesis were designed and finite element analysis was applied to calculate the magnitude of conducting force within the differently angled holes and the stress distribution of the femur and prosthesis. Results: Holes in prostheses make no difference on the stress values of femoral inner walls. The conducting forces in models trepanned on the lateral plane were 6.60N (0° pore) and 8.40N (45° pore) while forces in models trepanned on the anterior-posterior planes were 0.45N (upper 0° pore), 0.48N (lower 0° pore) and 1.57N (upper 45° pore), 1.51N (lower 45° pore), respectively. Conclusion: The position and direction of hollow holes influenced the conducting force in holes but had no influence on stress values of femoral inner walls. Prostheses with one 45° hole trepanned on the lateral plane of proximal prostheses presented best in elevating conducting force.

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Background: The upper aerodigestive tract (UAT) includes the nose and paranasal sinuses, oral cavity, pharynx, larynx, and salivary glands. Cancers of the UAT constitute approximately 4% of all malignancies. In this study, the varied nature of the UAT cancers was studied to find out their incidence, etiology, and clinicopathological correlations. Materials and Methods: This prospective, observational, and clinicopathological study was conducted on 100 patients who were presented at outdoor in the Department of ENT, Government Medical College/Rajindra Hospital, Patiala, Punjab, India, from October 2016 to October 2018. Proven cases of UAT cancers were taken up and reviewed to gather data on multiple clinicopathological variables, such as age, sex, predisposing factors, and site of pathology. Histopathological differentiation was noted after conducting a biopsy. Results: Most patients of UAT cancers were in the age group of 40–70 years. Maximum incidence was among males (82%) compared to females (28%). The most common predisposing factor was alcohol + smoking (28%), followed by alcohol + chewing tobacco (25%). The most common symptom in the oral cavity was ulcer and odynophagia (38%) each. In oropharyngeal cancers, dysphagia (92%) was the most common symptom. In laryngeal cancers, dyspnea (68%) and hoarseness of voice (32%) were the most common. The most common site involved in UAT cancers was the oral cavity (31%), followed by oropharynx (28%), larynx (22%), hypopharynx (7%), and salivary gland (5%). The most common histopathological type was squamous cell carcinoma (SCC) (90%). Most of the ulceroproliferative and exophytic growth was moderately differentiated SCC on histopathology. Conclusion: Studies are essential for education and awareness aimed at reducing exposure to habit-forming substances.

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Background: One of the most common neurodevelopmental problems affecting behavior of children all over the world is attention deficit hyperactivity disorder (ADHD). Studies on ADHD prevalence in Africa used either parents' or teachers' disruptive behavioral disorder rating scale (DBDRS) to diagnose ADHD, but this study diagnose ADHD using both parents and teachers DBDRS simultaneously among primary school pupils in Ile-Ife. Materials and Methods: The study was conducted among 1,385 primary school pupils in Ile-Ife using multistage random sampling. The parents' and teachers' DBDRS were used simultaneously to screen children who had ADHD. Results: Sixty-five (4.7%) of the pupils had ADHD. Among the 65 pupils with ADHD, 28 (43%) had the inattentive subtype, 25 (38.5%) had the combined subtype, whereas 12 (18.5%) had hyperactive/impulsive subtype. The prevalence of ADHD was significantly higher in the younger age group than the older age groups (χ² = 7.153, P = 0.007). There was no significant association found between the prevalence of ADHD and the social class (χ² = 3.852, P = 0.146). Conclusion: ADHD prevalence of 4.7% was found among the children in Ile-Ife. Assessment of children for ADHD was done by parents at home and teachers in the school with DBDRS. The inattentive subtype was the most common and the hyperactive subtype was the least seen in the study. Early diagnosis and treatment of this disorder will bring better outcome in the children.

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Neuropathic pain responds poorly to common analgesics that effectively control nociceptive pain because its pathophysiology is different and it is usually associated with co-morbidities such as sleep disturbance, depression and anxiety. Patients with this chronic pain are sometimes left with neurolysis as the last resort. A 65-year-old male multiply-injured retiree presented with disabling pain following traumatic brachial plexus injury sustained from road traffic accident 5 years earlier. Other injuries resolved with therapy except the chronic severe burning and electrifying pain (VAS score 9) in the paralyzed left upper limb associated with allodynia and insomnia which was unresponsive to conventional analgesics. PainDETECT score was 29. A test supraclavicular block with 0.25% Bupivacaine was done, followed by chemical neurolysis one month later. He was placed on oral Gabapentin. The pain score a week post injection was 3 and has remained same 18 months post injection. Patient's level of satisfaction on 5 point Likert scale was 5. Chronic neuropathic pain following traumatic brachial plexus injury could be successfully managed by chemical neurolysis and oral gabapentin.

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Background: The aim of this study was to evaluate the level of knowledge about HIV, and intraoral signs that can be seen in HIV positive patients and the interpretation of attitudes toward HIV positive patients of fourth- and fifth-grade students at Marmara University Faculty of Dentistry, İstanbul, Turkey. Material and Methods: In our study, a questionnaire consisting of 23 questions was applied to 100 fourth- and 100 fifth-grade students totalling 200 dental students who are educated in Marmara University Faculty of Dentistry. Besides the knowledge level of the students, their attitudes were evaluated using the survey conducted. Chi-square (or Fisher's exact test at appropriate locations) was used to examine the relationship between categorical variables. Statistical significance level was determined as P < 0.05. Results: Of the 200 participants, 46 (23.0%) were males and 154 (77.0%) were females. One hundred people (50%) are fourth grade, 100 people (50%) are fifth grade. The rate of fifth grade agreements for the question “Treatment of HIV positive patient increases the risk of transmission of HIV infection to dentist” was statistically higher than that of fourth-grade students (Fisher's exact P < 0,05). Fifth-grade knowledge of oral symptoms of HIV/AIDS was statistically higher than fourth grades (Fisher's exact P < 0.05). Conclusion: As the grade level increases, the knowledge about HIV/AIDS raises portraying a relevant approach to patients with AIDS. Comprehensive training and motivation for improving dentistry students' awareness against HIV-positive patients will also improve knowledge and attitudes of the students that enable them to take better care of HIV-positive patients.

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Objective: The aim of this study was to evaluate the initial experience and outcome of clubfoot treated using the Ponseti technique in a regional orthopedic hospital setting of a developing country. Methods: This was a retrospective review of all the clubfoot patients who were treated at the clubfoot clinic of National Orthopaedic Hospital Enugu from 1^st of August 2013 to 31^st January 2015. Result: There were 175 patients with 273 clubfeet. The male to female ratio was 1.2:1, and the age range was 1 week to 27 years with a median age of 11 months. One hundred and fifty-one patients (86.5%) had congenital clubfoot, whereas 24 (13.5%) had acquired clubfoot. The mean Pirani score of the patients at presentation was 4. The mean number of cast sessions needed for correction was 6.3. The majority of the feet (96.6%) were treated and correction achieved with Ponseti method alone, whereas 3.4% had other additional surgical procedures. Seventy-two (41.1%) patients afforded and used foot abduction brace as prescribed. Plaster sores in 12.5% of patients were the most common complication. At a mean follow-up period of 6 months, a relapse rate of 3.4% was observed. Conclusion: Ponseti clubfoot management technique alone is very effective in most cases of clubfoot in our setting. Late presentation of patients and foot abduction brace related challenges observed call for a policy response aimed at educating the public on the importance of early presentation and improving the use of foot abduction brace.

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Macromastia can cause serious psychological problems in women as well as psychosocial problems due to esthetic appearances. For this reason, proper technique in breast reduction surgery yields a dramatic physical and psychological improvement for the patient. Inverted T-scar breast reduction using the inferior pedicle technique is the most commonly used breast reduction method. The most common complication in this technique regards wound healing at the T-junction area. There are no literature reports citing the use of local flaps for the repair of tissue defects in the T-junction area following reduction mammoplasty. In this study, we present a case of using a salvaged local, Limberg-like fasciocutaneous flap for tissue defect repair at the T-junction area after the inverted T-scar reduction mammoplasty using an inferior pedicle.

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Midfacial fracture is discontinuity of the bone affect maxilla, palate, zygomatico-maxillary complex, nasal bones, orbits, nasal-orbital-ethmoid complex, and frontal sinus. Delayed treatment can lead to malunion or nonunion bone. A 28 years old man presented with epiphora of the left eye and upgaze diplopia. There were enophthalmos, hypoglobus of the left eye, flat nasal bridge, and depressed left malar eminence. CT scan examination revealed multiple fractures of left nasal bone, left and right anterolateral wall of maxillary sinuses, left medial orbital wall and orbital floor, and left zygomatic bone. Lacrimal irrigation test showed obstruction of left nasolacrimal duct. He underwent osteotomy and fixation with plate and screw, orbital floor reconstruction with silicone block implant, external dacryocystorhinostomy with silicone tube insertion procedure. In delayed treated malunion of midfacial fracture, fixation with plate and screw after refracture using an osteotome and orbital floor reconstruction with silicone block can be a good option for restoring normal anatomy. External dacryocystorhinostomy with silicone tube insertion is an effective treatment for post traumatic nasolacrimal duct obstruction.

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Background: Patients who have undergone a lung resection owing to primary spontaneous pneumothorax (PSP) may develop prolonged air leak (PAL) during the postoperative period. The present study investigates potential risk factors associated with postoperative PAL in patients who were operated on for PSP. Materials and Methods: Patients who underwent operations for PSP between January 2004 and November 2017 were investigated retrospectively. Patients who developed postoperative PAL constituted Group 1, and patients without PAL formed Group 2. A comparison of the two groups was made to identify potential risk factors for the development of prolonged air leak. Results: Of the total 79 patients who underwent operations, 18 (22.78%) developed prolonged air leak. All of the patients in Group 1 were male, and the mean age of this group was 23.72 ± 5.76 (18–36) years. Of the patients in Group 2, 51 (83.61%) were male and 10 (16.39%) were female, and the mean age of this group was 25.81 ± 5.91 (17–39) years. There was no statistically significant difference noted between the two groups regarding the investigated factors including age, gender, the total number of previous episodes, number of ipsilateral episodes, number of contralateral episodes, the preferred treatment method for the last episode, smoking status, computerized tomography findings, or the presence of a preoperative air leak. Conclusions: PAL is the most common complication associated with PSP surgeries. Although several factors may affect PAL development, no definite conclusion could be drawn concerning the investigated risk factors. We believe that similar studies may contribute to the care of this rare patient population.

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Objective: To study the relationship between vitamin D and thyroid antibodies with thyroid benign-malign neoplasms. Materials and Methods: The vitamin D vitamin and thyroid antibodies of 179 patients who underwent thyroidectomy for thyroid nodule were retrospectively reviewed. Results: The mean age of the patients was 44.97 ± 14.139. Vitamin D levels were 14.473 ± 4.9999 ng/ml in women and 19.584 ± 6.1981 ng/ml in men and the mean was 15.016 ± 5.3579 ng/ml. There was a significant relationship between sex and vitamin D level (P < 0, 05). Antithyroglobulin antibody (anti-TGB) had been detected in 95 patients and Antithyroid peroxidase antibody (anti TPO) in 58 patients. There was no significant relationship between vitamin D levels (P: 0, 65), anti-TPO positivity (P: 0, 86), and anti-TGB (P: 0, 12) with benign-malignant neoplasm of thyroid. There was no relationship between vitamin D and metastatic disease (P: 0, 30) as well. In addition, no association was found between malignancy and metastasis (P = 0.068, P = 0.14, P: 0, P = 0, respectively) with thyroid antibody positivity (anti TPO and/or anti TGB) in severe deficiency (<10 ng/ml) and deficiency (<20 ng/ml) of vitamin D. Conclusion: Vitamin D deficiency or thyroid autoantibodies did not have any significant effect on thyroid malignancies or metastatic disease separately or together.

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Background: Knowledge of ICU clinicians about Intensive Care Unit Acquired Weakness (ICU-AW) is a vital step in implementing prevention strategies. Aim of Study: The purpose of this study was to investigate the level of knowledge of ICU clinicians in teaching hospitals in Southwest Nigeria about ICU-AW. Methods: ICU clinicians were surveyed using a self-administered questionnaire to obtain data on knowledge about ICUAW. Data were summarized as frequency and percentages, mean and standard deviation using SPSS version 20. Results: Total of 134 ICU clinicians (56 anesthetists, 35 physiotherapists, and 43 nurses) responded to the questionnaire, of which 100 were aware of ICUAW. Three of the 100 correctly identified ICU-AW as a neuromuscular disease. Totally, 40% correctly indicated Medical Research Council Scoring Scale as a diagnostic tool for ICU-AW. Severe sepsis and prolonged mechanical ventilation were the two highest identified risk factors for ICU-AW. However, only 35% of respondents were able to identify either use of aminoglycosides, and prolonged use of vasopressors as risk factors for ICUAW. Almost half (49%) reported having methods of managing ICUAW at their institution. Conclusion: Though awareness about Intensive care unit-acquired weakness (ICUAW) among clinicians in teaching hospitals in the Southwestern Nigeria is high, but knowledge about diagnosis and classification is low. This highlights the need for specialized training of ICU clinicians about ICUAW to enhance prevention and early detection.

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Background: The aim of this study was to evaluate the effect of intracanal separated instruments with different lenghts on periapical pH levels using calcium hydroxide (CH) as an intracanal medicament. Materials and Methods: In total, 60 teeth were used. Following root canal preparation, teeth were divided into four groups (n = 15). In Group 1, 2 mm and in Group 2, 4 mm weakened from the tip of Revo-S NiTi SC2 (Micro-Mega, Besancon, France) instruments were separated in the apical portion of root canals. In Group 3, there was no separated instrument. CH paste was placed in the first three groups. In Group 4, there was no separated instrument or CH paste. Teeth were placed in containers with deionized distilled water. After 1 h and 1, 2, 7, 15, and 30 days, the pH of the solution was measured. Results: At 1 h, Group 3 showed a significantly higher pH than Groups 1 (2 mm) and 2 (4 mm; P < 0.05). At the same time point, Group 1 (2 mm) showed a higher pH than Group 2 (4 mm) without significance. At 1, 2, 7, 15, and 30 days, Group 2 (4 mm) showed a significantly lower pH than Groups 1 (2 mm) and 3 (P < 0.05). At the same time points, Group 1 (2 mm) showed a lower pH than Group 3 without significance. Conclusions: Separated instrument may affect the rise in periapical pH level when using CH as the intracanal dressing. Therefore, 4 mm of separated instrument in the apical third showed a significant effect.

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Background: The presence of vitamin D, and parathyroid hormone receptors has been demonstrated in the vascular endothelium. Variations in vitamin D, and parathyroid hormone levels may affect coronary flow and cause the coronary slow-flow phenomenon (CSF). Methods: We enrolled 93 patients who had undergone coronary angiography and had near-normal coronary arteries. Blood samples were taken to determine the calcium, phosphorus, 25-hydroxy vitamin D, and parathyroid hormone levels. Vitamin D deficiency was defined as a serum 25-hydroxy vitamin D level of less than 20 ng/mL. We divided the study population into two groups according to thrombolysis in myocardial infarction frame count (TFC) levels. Results: Patients with TFC ≤27 were in the control group (n = 39), and those with TFC >27 were in the CSF group (n = 54). 25-Hydroxy vitamin D levels were similar in both groups: 17.5 [3.3-36.1] ng/ml in the CSF group and 15.2 [5.3-34] ng/ml in the control group (P = 0.129). When we analyzed TFC for each of the coronary arteries, we found a weak negative correlation between vitamin D level and TFC of the right coronary artery in the CSF group (r = −0.314, P = 0.021). Parathyroid hormone levels were similar in both groups: 48 [16-140] pg/ml in the CSF group and 52 [25-125] pg/ml in the control group (P = 0.297). Conclusion: The study failed to demonstrate a relationship between serum parathyroid hormone level and CSF. However, a weak negative correlation was found between vitamin D level and TFC of the right coronary artery.

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