In the domain of orthodontics, plaster models are contemplated as one of the important tools for diagnosis and treatment planning. In Dentistry, technological advancement has developed in the section of diagnostic devices, for example, the utilization of a 3D intraoral scanner, which can convert plaster models into digital models. With in-office utilization of this system, orthodontists can more meticulously and precisely construct custom braces, clear aligners, and orthodontic appliances. The digital data can be stored as a stereolithography file; it eliminates the disadvantages encountered with the storage of plaster models like breakage, space required, and distortion of the plaster models. ITero®element is the intraoral laser scanner (ILS) which utilizes parallel confocal scanning technology which maximizes the accuracy of the scan. By utilizing the iTero scanner, the dental measurement can be performed in OrthoCADTM software which is highly accurate. The objective of the contemporary study is to review the literature of studies on in-vivo and ex-vivo scanning with the iTero system.

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Background: Recent evidence has reported significant improvement in clinical profile, quality of life, and prognosis of heart failure subjects with iron replacement. Aims: This study aimed to determine the safety and outcome of parenteral iron replacement among heart failure subjects in Nigeria. Method: A randomized interventional study was done at the Cardiology Clinic of LAUTECH Teaching Hospital, Ogbomoso, Nigeria. One hundred and forty subjects with heart failure were recruited. Iron deficiency and anemia were determined according to standardized criteria. Parenteral iron dextran was administered to a block randomized group of 30 of those identified with iron deficiency and compared with controls. The primary outcome was the six minutes' walk test (6 MWT) after 8 weeks while the Kansas City Cardiomyopathy Questionnaire (KCCQ) score was used to assess the quality of life as a secondary outcome. Statistical analysis was done with the SPSS 20.0. P value <0.05 was taken as statistically significant. Results: Iron deficiency was present in 84 (60.0%) of all study participants. Iron dextran was fairly tolerated with mild to moderate adverse reactions reported in 7 (23.3%) subjects who had an iron infusion. Improvement in the 6 MWT distance (390.1 ± 92.6 vs. 156.9 ± 72.5 meters, P < 0.05) and the KCCQ score (84.5 ± 3.7 vs. 64.2 ± 12.5%, P < 0.05) among iron-deficient heart failure subjects who received iron dextran was significantly higher than those who did not receive the iron replacement. Functional classification according to the New York Heart Association (NYHA) profile and heart rate were also much improved after the iron replacement than those who did not receive it. Conclusion: Parenteral iron dextran therapy was fairly tolerated among heart failure subjects. Iron replacement is associated with improved quality of life, better temporal clinical profile, and functional classification among Nigerians with heart failure. Iron replacement therapy can be an additional therapeutic option in heart failure management among Africans to improve prognosis.

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Background: Pregnancy is a period of heightened calcium demand necessary for the optimum growth and development of the fetus and placenta. Women with low calcium intake may manifest with hypocalcemia in pregnancy. Objective: The aim of this study was to determine the prevalence and risk factors of hypocalcemia among pregnant and non-pregnant women in Maiduguri, Nigeria. Subjects and Methods: A comparative cross-sectional study was conducted at the University of Maiduguri Teaching Hospital, Maiduguri from 1^st January 2017 to 31^st December 2018. For each patient, sociodemographic and clinical characteristics were noted. Serum calcium, phosphate, total protein, and albumin were determined using spectrophometric methods with their specific reagents. The data obtained was analyzed using the SPSS statistical software for windows version 20. Chi-square test, Student t-test and ANOVA were used as appropriate. Odd ratio with multiple logistic regression was used to determine risk factors for hypocalcemia. P value < 0.05 was considered statistically significant. Results: A total of 1,500 (1,000 pregnant and 500 non-pregnant) women were analyzed. The mean age, total protein, and albumin were similar in the pregnant and non-pregnant women. However, the non-pregnant women were of higher parity than the pregnant women (3.75 ± 2.79 versus 2.45 ± 2.24, P < 0.001). The staple food of both group were mainly high carbohydrate diets. The prevalence of hypocalcemia was 29.20% among the pregnant women and 14.20% among the non-pregnant women (X² = 64.34, P < 0.001). The mean serum calcium was lower among the pregnant compared to the non-pregnant women (2.08 ± 0.22 mmol/L versus 2.2 ± 0.19 mmol/L, F = 5.73, P = 0.02). There were no statistically significant differences in the mean serum calcium across the trimesters of pregnancy (F = 1.58, P = 0.21). Conclusion: Hypocalcemia in pregnancy is common in our environment and it is associated with anemia in pregnancy, anorexia, and primigravidity while attainment of at least basic education is protective. We recommend routine calcium supplementation in pregnancy and preconception period.

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Aims: This clinical study aimed to evaluate the effect of different clinical practices with endodontic emergency treatment on postoperative pain in mandibular permanent molar teeth with symptomatic apical periodontitis. Methods: In the present study, root canal treatment was applied to 100 patients who met the inclusion criteria. Patients were randomly assigned to 5 groups (control, nonsteroidal anti-inflammatory drug [NSAID], NSAID and antihistaminic drug combination, placebo drug, and intracanal cryotherapy) using a web program. In the first visit, after preparation with the WaveOne Gold file system, calcium hydroxide (Ca(OH)₂) medicament was placed on the root canals. However, after the treatment of the patients was completed, six patients patients were excluded from the study because they did not come to the control appointment 7 days later. After the removal of Ca(OH)₂ medicament in the second session, the root canals were obturated according to cold lateral condensation technique and final restorations of the teeth were performed. Patients' preoperative and postoperative pain values (4–8–12–24–48 and 72 hours) determined by visual analog scale (VAS) were recorded. The data were analyzed statistically using analysis of variance, Kruskal-Wallis test, Friedman test, Wilcoxon test, and Chi-square test. Results: According to the results of our study; there was no significant difference between the groups in terms of age, gender, preoperative pain, and postoperative analgesic requirement (P > 0.05). In all groups, there were significant differences between the values of different times (P < 0.05). While initial pain values were higher than the hours after treatment (P < 0.05), there was no significant difference between postoperative pain values (P > 0.05). When the groups in terms of pain scales measured at different times compared with each other; in all times there was no significant difference between the groups (P > 0.05). Conclusion: It was observed that all clinical practices significantly reduced preoperative pain.

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Background: Coronary artery bypass surgery is the most commonly performed cardiac operation and approximately 40-70% of patients require a blood transfusion despite improvements in cardiac surgical techniques. Some preventive perfusion methods to avoid transfusions are described, such as acute normovolemic hemodilution, retrograde autologous priming, and usage of integrated arterial filter oxygenator. Aims: We combined these three techniques (triple combination technique) to evaluate whether it is possible to avoid blood transfusions in adult patients undergoing coronary artery bypass surgery. Materials and Methods: A total of 300 consecutive patients were included in this randomized controlled trial. 150 patients (Group 1) were operated with triple combination technique, The other 150 patients (Group 2) were operated with standard cardiopulmonary bypass technique. The two groups were compared in terms of peroperative and postoperative blood product use. Results: Ninety-two percent (92%) of the patients (Group 1) undergoing coronary artery bypass surgery did not require any blood transfusion. Only 8% of the patients required erythrocyte suspension or fresh frozen plasma transfusion. In Group 2, 58% of patients required blood transfusions. The difference between two groups was statistically significant (p < 0,05). Conclusion: Triple combination technique is safe and cost-effective in coronary artery bypass surgery. We think that most of the patients could be operated without blood transfusion with this technique.

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Background: Metabolic syndrome (MetS) has become an issue in the public health discipline. Aims: The primary aim of this study is to assess the potential determinants for both knowledge level of metabolic syndrome and health literacy (HL) level among the adult population. The second purpose of this study is to show whether there is a relationship between the MetS knowledge level and the HL level in western Turkey. Methods: This cross-sectional study was conducted between October 10, 2017 and November 15, 2017 in western Turkey. The participants of the study were adult population who applied to seven “family health centers”. The MetS knowledge level was measured with the Metabolic Syndrome Knowledge Level Scale (MetS-KS). HL level was measured with the HLS-EU-Q16. A General Linear Model was constructed to evaluate the relationship between MetS-KS scores and HLS-EU-Q16 scores. For statistical significance, P < 0.05 was accepted. Results: Younger age, having higher education level, being single, having a high family income, not having a chronic disease, doing regular physical activity, viewing television less than 3 hours a day, previous measurement of waist circumference, previous attempts to lose weight, not being abdominally obese, not being at risk for hypertension and not having optimal body mass index (BMI) were associated with high HL levels (P < 0.05 for each one). According to the general linear model, the level of HL was not related to the level of MetS knowledge level (P > 0.05). Conclusions: Younger age, having a high educational level, high socioeconomic level and positive health behaviors were related with both MetS knowledge level and HL level. However, there was no direct relationship between MetS knowledge level and HL level.

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Background: Thrombocytopenia is defined as the platelet count of less than 150 × 109/L and is a prominent cause of bleeding. Aplastic anemia (AA), immune thrombocytopenic purpura (ITP), and thrombotic thrombocytopenic purpura (TTP) are some of the reasons of low platelet counts. Aims: We aimed to interpret different laboratory and clinical findings in these different reasons of thrombocytopenia. Methods: Among patients with these disorders we assessed the performance of the ITP Bleeding Scale Assessment (ITP-BSA), which is principally designed for ITP patients. Results: A hundred patients were included in analysis. Median platelet count at presentation was similar in all three groups. Thrombosis was seen more common in patients with TTP (20.7%) than the others (ITP; 5.6%, AA; 2.9%). In patients with TTP, sepsis (41.4%) and neurological findings (89.7%) are also more common than in the patients with ITP or AA. Bleeding was determined in all patients with AA. However, 13 patients with ITP (%36.1) and 10 patients with TTP (%34.5) had no bleeding. The most common bleeding site was skin in all three groups. There was not any gastrointestinal, lung, genitourinary, and cranial bleeding in patients with ITP. Patients with AA obtained the highest scores from the ITP-BSA. There was a significant difference between AA and the other two groups. The scores were found similar in patients with ITP and TTP (P = 0.17). Conclusion: Clinical variations in thrombocytopenic patients may vary and assist to diagnose the cause of thrombocytopenia. The bleeding scoring systems might be helpful.

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Background: Odontogenic cysts develop from the epithelium of dental structures and generally grow slowly. In children and adolescents, cysts usually grow faster than adults and require much knowledge for diagnoses and treatments. Aims: This study aimed to determine the diagnosis and treatment of odontogenic cysts in different age groups by evaluating the type of lesions, age, gender, and anatomical distribution of odontogenic cysts seen in children and adolescents by cone-beam computed tomography. Materials and Methods: A total of 42 odontogenic cysts (radicular, dentigerous cyst, and odontogenic keratocyst) were determined in children and adolescents aged 7–18 years. Cone-beam computed tomography images of odontogenic cysts were analyzed in terms of types, age, sex, anatomical location, height, width, depth, scalloped borders, lesion shapes, tooth displacement, root resorption, and association with an unerupted tooth. Results: There was a significant correlation between odontogenic cyst types and age groups, scalloped borders, lesion shape, tooth displacement, root resorption, and association with an unerupted tooth. Conclusion: When odontogenic cysts seen in children and adolescents are examined with cone-beam computed tomography, the radicular cyst was the most common form and was predominated in the 13–18 years age group and in boys. Differences in terms of scalloped borders, lesion shape, tooth displacement, root resorption, and association with unerupted teeth were noticed. The knowledge of the distribution and properties of odontogenic cysts in pediatric patients will help diagnose the lesions during clinical and radiological examinations and make appropriate treatment planning.

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Background: Nigeria ranks third among the countries with the highest HIV/AIDS burden in the world, next only to India and South Africa. The North-Central zone which Kwara State belongs to has the highest concentration of HIV prevalence rate of 7.5%, while the North-Western zone recorded the lowest prevalence of 2.1%; Kwara state has a prevalence rate of 2.2%. Aims: The study assessed the coping strategies adopted by patients attending HIV clinics in a North-central city of Nigeria. Methods: The study design was descriptive cross-sectional involving 384 HIV-positive patients who were systematically recruited at 5 public service delivery sites in Ilorin- a North-central city, Nigeria was used for the study. Coping strategies were measured using the Brief COPE scale. Data were analyzed using SPSS software version 20.0. Level of significance was pre-determined at P value <0.05 at a confidence level of 95%. Results: Female respondents constituted 222 (58.0%) while males were 162 (42.0%). Respondents experienced varying proportion of coping strategies of which Self-distraction 288 (75.0%), active coping 249 (64.8%), emotional support 228 (59.4%), among others were the major strategies adopted by respondents. Conclusion: HIV is a chronic disease with heavy burden on both patients and health facility rendering services for the care of these patients. A good proportion of respondents interviewed adopted varying coping strategies. Sustained social and psychological support will improve further the coping strategies of living with HIV.

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Background: The use of paravertebral block (PVB) for postoperative analgesia in the thoracic surgery has increased in recent years. However, the traditional methods used to evaluate the success and adequacy of the block are time-consuming, subjective and depend on the patient's compliance. Therefore, the search still continues to find a method to objectively evaluate the success and adequacy of the paravertebral block. Aims: The aim of this study was to investigate whether the Perfusion Index (PI) measured by pulse oximetry technology was an early and quantitative marker for the success of PVB. We also aimed to compare the PI and pinprick method. Methods: The study included a total of 38 patients undergoing elective thoracotomy surgery within the age group of 18-65 years, with class I-II American Society of Anesthesiologists' (ASA) physical status classification. Thoracic PVB was performed for all patients using 20 mL of 5% bupivacaine under ultrasound guidance. After the block was performed, PI measurements were made from the finger and earlobe of the block side for 30 minutes at one-minute intervals. The spread of the block to the anterior chest wall T3-T8 dermatomes was recorded by pinprick sensory test before the block application and fifth, 10^th, 15^th, 20^th, and 30^th minutes following the block application. Results: The PI value measured from the finger on the block side increased 1.5 times compared to the baseline value 12 minutes after the block application (p < 0.05). The sensitivity and specificity of PI in determining the success of PVB at 12th minute were 67% and 85%, respectively. Positive predictive value [PPV] was 93% and negative predictive value [NPV] was 75%. The accepted cut-off PI value was found to be 0.84 for a successful PVB. A weak positive correlation was observed between PI and pinprick test (rs = 0.35, P < 0.05). Conclusion: The present study has shown that PI is an objective, fast, practical and non-invasive method, when compare with pinprick method, that can be used to evaluate PVB success.

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Background: Breast lump is a very common problem in the surgical units of many hospitals. Considering our unique socio-cultural and economic peculiarities, the ideal initial preoperative diagnostic tool for breast diseases should be cost-effective, simple with minimal physical and psychological trauma. Aims: This study aimed to evaluate the diagnostic accuracy of Fine Needle Aspiration Cytology (FNAC) in the management of palpable breast lesions in our center. Methodsology: This is a prospective study that lasted for one year. Fine needle aspiration cytology was done after clinical examination of all patients who gave consent. Open surgical biopsy was used as a reference standard. Results: One hundred and fifteen patients were enrolled. We found that unsatisfactory smears (C1) were seven (6.1%), benign smears (C2), 57 (49.6%), atypical smears (C3), five (4.3%), suspicious of malignancy smears (C4), six (5.2%) and unequivocally malignant smears (C5), 40 (34.8%). Fine needle aspiration cytology achieved high sensitivity (90.4%), specificity (93.7%), positive predictive value (92.2%), negative predictive value (92.2%) and overall diagnostic accuracy (92.2%) for breast lumps in this study. The false positive and negative rates of 7.8% each are both higher than values recommended by National Health Services Breast Screening Program (NHSBSP) of United Kingdom. Conclusion: In view of the high sensitivity, specificity and overall diagnostic accuracy combined with early retrieval of pathologic results on first clinic visit reported in this study, FNAC should become a useful tool in the management of breast lumps in our center.

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Objectives: We aimed to evaluate the findings of whole-body computed tomography (WBCT) in pediatric high-energy trauma patients and to determine the distribution of injuries. Materials and Methods: The WBCT images of 1132 pediatric patients who were admitted to emergency department between 2013 and 2018 for high-energy trauma were evaluated retrospectively. Six hundred and twenty patients with abdominal, chest, head, and skeletal injuries were included. Results: Using the WBCT images, we detected skeletal injuries in 557 pediatric patients; spinal, rib, extremity, and pelvic fractures were detected in 113, 57, 51, and 37 patients, respectively. Craniofacial fractures were viewed in 299 patients. We detected intracranial hemorrhage, pulmonary contusion, pneumothorax, and solid organ injuries in 102, 115, 45, and 55 pediatric patients, respectively. Conclusion: The frequency and distribution of injuries in trauma cases vary between adults and children. While there are many studies about whole-body CT findings of adult trauma, there are only a few studies about pediatric high-energy trauma patients. The traumatic injury types also differ in pediatric age groups. WBCT scan (with pediatric radiation dose) is the fast and accurate diagnostic tool in high-energy trauma cases and therefore is associated with low mortality rates.

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Background: Patients on maintenance hemodialysis (HD) are at risk of blood transmitted infections such as hepatitis B and C. Objectives: To determine the prevalence and risk factors for hepatitis B and hepatitis C virus infections among end-stage renal disease (ESRD) patients on maintenance hemodialysis in Gaborone, Botswana. Materials and Methods: A cross-sectional study with a retrospective longitudinal approach involving all eligible public patients undergoing hemodialysis was carried out for a period of 3 months. Data on socio-demographic, clinical characteristics, and hepatitis serology was collected using a case report form. Statistical Software Package for Social Sciences (SPSS) version 24 was used for data entry, cleaning, and analysis. The risk factors associated with Hepatitis B and C infections were determined using bivariate logistic regression analyses. A P value of less than 0.05 was considered statistically significant. Results: Of the 168 participants, 5 (2.98%) were HBsAg seropositive at the initiation of hemodialysis, whereas 2 (1.19%) were seropositive for anti-HCV antibodies at the initiation of hemodialysis. Two patients out of 163 (1.23%) were found to have seroconverted to HBsAg positivity during hemodialysis. One out of 166 patients (0.61%) seroconverted to HCV antibodies positivity during hemodialysis. The duration of hemodialysis, history of invasive procedures, HIV status, frequency of hospitalization, and blood transfusion were not associated with seroconversion for both Hepatitis B and C. Conclusions: The prevalence hepatitis B and C infections among ESRD patients on hemodialysis is low. There was no significant association between the identified risk factors and HBV/HCV infection. Regular audits on seroconversion status for hepatitis B and C are recommended as a way of assessing and supporting the current strategies for infection control among HD patients.

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Background: Health is the main focus of studies on quality of life. Cancer can lead to changes in quality of life in postmastectomy women. Aims: The aim of this study was to examine the relation among sociodemographic factors and to assess the quality of life of women with breast cancer a year from their surgery. Materials and Methods: This single-center cross-sectional study included 104 participants (50 participants with mastectomy and 54 participants with quadrantectomy) aged from 37 to 72 years. The 36-Item Short Form Survey (SF-36) was used to assess physical, psychological, and social functioning of participants, as well as their sociodemographic factors and the clinical variables of the treatment. Results: Participants with quadrantectomy aged up to 50 years had a significantly higher score when assessed in social functioning and mental/emotional health. Older participants expressed no significant differences in quality of life. Participants with quadrantectomy in all age groups had a higher score in social functioning, mental/emotional health, energy, and vitality than participants with mastectomy. Conclusion: A year from the surgery and cancer treatment, the quality of life of postquadrantectomy women was better compared to postmastectomy women.

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Background: Hepatitis B virus (HBV) infection has been recognized globally as a major public health challenge necessitating a global call for increased awareness, patients' identification, and development of activities for prevention and control of the disease. Consequently, massive health education campaigns and screening exercises have been mounted globally to mark the World Hepatitis Day (WHD). Aims: As part of WHD 2016 activities, we undertook a survey and screening of health care workers in order to raise awareness, identify patients and contribute to the Global Health Strategy goal of eliminating HBV infection by the year 2030. Method: This was a cross-sectional analytical study done at the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria. Hospital workers voluntarily presented themselves to be screened using a rapid test kit and completing a semi-structured investigator-administered questionnaire. Results: A total of 3123 participants were studied. The mean age of the participants was 39.4 ± 9.6 years. The seroprevalence of HBV infection was 2.3%. Most (97.0%) of the participants had previously heard about HBV infection and over two thirds (68.1%) could correctly identify risk factors and modes of transmission of HBV. Twenty-eight and a half percent of the participants knew their hepatitis B virus status prior to the study. Conclusion: The seroprevalence of HBV among healthcare workers in Enugu, Nigeria is relatively low compared to figures from other African countries. The healthcare workers have considerable knowledge of the disease. However, the observed knowledge gaps in awareness and screening need to be addressed.

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Peritonitis is a common and serious complication of peritoneal dialysis and often primary factor of change over to hemodialysis treatment. Raoultella planticola is known as as environmental bacterium and rarely causes infections in humans. We present a case of peritoneal dialysis related peritonitis due to Raoultella planticola and review the clinical manifestations and treatment options of this microorganism. As far as we know, this is the third case of Raoultella planticola peritonitis in the literature.

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Background: Central serous chorioretinopathy (CSC) is a posterior segment disease caused by macular serous detachment as a result of inflammation and oxidative stress due to hypoperfusion of choriocapillaris. Aims: The aim of the study was to assess the oxidant/antioxidant balance in CSC.s Materials and Methods: The plasma levels of malonyl dialdehyde (MDA), glutathione peroxidase (GSH-Px), myeloperoxidase (MPO), catalase (CAT), and xanthine oxidase (XO) were assessed in 21 patients with CSC (group S) and in 23 individuals without any eye pathology as the control group (group C). Furthermore, the disease was staged through routine opthalmologic examination as well as optic coherence tomography (OCT). Results: MDA levels were significantly higher in group S (25.36 ± 4.51 nmol/ml), when compared with group C (22.79 ± 3.23 nmol/ml) (P = 0.035). In addition, the levels of CAT were significantly lower in group S (8.28 ± 5.85 U/ml) when compared to group C (14.02 ± 8.61 (P = 0.014). Conclusion: Prevention of the oxidative injury may be considered among the associated treatment options under the light of the changes detected in the oxidative/antioxidative parameters.

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Aim: To investigate the effect of intravitreal dexamethasone implant on central foveal thickness and choroidal thickness in retinal vein occlusion. Materials and Methods: Clinical records and optical coherence tomography (OCT) scans of 41 naïve patients with retinal vein occlusion (RVO), who were initially treated with intravitreal dexamethasone (DEX) implant between 2016 and 2017 at Kocatepe University Faculty of Medicine, Department of Ophthalmology were investigated. Collected data included age and sex of the patients, crystalline lens status, baseline and final intraocular pressure, and OCT parameters including central foveal thickness and choroidal thickness. Results: Twenty-two (53.7%) female and 19 (46.3%) male patients were enrolled in the study. There were 30 phakic and 11 pseudophakic patients. The intraocular pressure increased significantly from 15.19 mmHg to 17.8 mmHg (P = 0.005), and cataract extraction was performed in two patients who developed cataract after the treatment. There was a significant decrease in the central foveal thickness from 556 μm to 288 μm (P < 0.001). In addition, although there was no statistically significant change in choroidal thickness in the patients with branched retinal vein occlusion (P = 0.423), the patients with central retinal vein occlusion had statistically significant decrease in choroidal thickness measurements (P = 0.049). Conclusion: Therapeutic effect of the DEX implant not only influences retinal layer. Its influence may also extend further to the choroid layer, thereby leading to decrease in the choroidal thickness. Our results were mostly similar to the results of studies in literature which investigated the effects of the DEX implant therapy on the choroidal thickness of the patients with RVO.

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Background: Periodontal regeneration is the anticipated result of periodontal tissue therapy. Of the many scaffold materials utilized, collagen has been shown to possess characteristics that strongly promote the periodontal regeneration process. Gourami (Osphronemusgoramy) scales can be utilized as an alternative source of collagen due to their abundant availability, the absence of risk of zoonosis, and lack of religious strictures against their use. Aims: To analyze the characteristics of collagen extracted from gourami scales. Methods and Materials: A combination of scanning electron microscopy (SEM), Fourier Transform Infrared Spectroscopy (FTIR), and in vitro enzymatic biodegradation analysis were employed to determine pore sizes, constituent functional groups, and the degradation rate of collagen extractedfrom gourami scales. Results: Collagen extracted from gourami scales demonstrated an average porosity of 13.779 μm. The FTIR test results indicated Amide A, Amide B, Amide I, Amide II, and Amide III peaks. The degradation rate of extracted collagen from gourami scales was 92.00 ± 0.8165% on the first day, 95.75 ± 1.70783% on the third day and 100% on the seventh day. Conclusion: The pore sizes ofcollagen extracted from gouramy scalesare suitable for use as scaffold. FTIR analysis indicated that this collagen possessed a triple helix structure. Collagen extracted from gourami scales was completely degraded within seven days when treated with 0.6 g/mL collagenase solution.

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Background: Currently, transperineal anastomotic urethroplasty approach is the reference standard in the surgical reconstruction of pelvic fracture urethral distraction defects. The approach is suitable for all but the most complex cases which might require abdominoperineal approach. Aims: We reviewed our recent experience with transperineal anastomotic urethroplasty with respect to success rate and complications. Patients and Methods: This was a retrospective descriptive study carried out at Jos University Teaching Hospital from March 2015 to March 2018. The case notes of male patients who had transperineal anastomotic urethroplasty for pelvic fracture urethral distraction defects within the study period were retrieved. Patients' demographics, cause and nature of pelvic fracture urethral distraction defects, the success rate, and complications were collected and subjected to statistical analysis using SPSS^® version 22. Results: Sixteen men with mean age of 29.6 ± 7.8 years had transperineal anastomotic urethroplasty for pelvic fracture urethral distraction defect (PFUDD) during the study period. The mean defect gap length was 4.5 cm (range, 2–7 cm). Out of the 16 patients, 6 (37.5%) had simple transperineal urethroplasty, while 10 (62.5%) underwent a more extensive transperineal urethroplasty. Four patients (25%) had inferior pubectomy. A total of 7 (43.8%) patients had erectile dysfunction (ED) before and after the urethroplasty. Five (31.3%) patients had ED before the urethroplasty 2 (12.5%) patients developed ED after the surgery. After mean follow-up duration of 2 years (range, 1–4 years), 12 (75%) patients had satisfactory urinary stream. The mean Qmax for the 16 patients was 16 ml/s (range, 0–35 ml/s). The 12 (75%) patients that had no complaints of LUTS, had Qmax ≥ 15 ml/s at mean follow-up duration of 2 years. Conclusion: Transperineal anastomotic urethroplasty for PFUDD is considered suitable technique for treatment of PFUDD with good surgical outcome.

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Phyllodes tumors are uncommon breast neoplasms that constitute of 1-2% of breast malignancies. The tumor can mimic fibroadenoma clinically, radiologically and histologically. Ductal carcinoma in-situ in the epithelial component of phyllodes tumor is very rare. When ductal carcinoma in-situ is detected within the specimen, the management of treatment changes completely. We report a rare case of low grade ductal carcinoma in-situ arising in a malignant phyllodes tumor in a 55-year-old female patient.

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Background: Complex cardiac anomalies are a set of associated heart structural anomalies requiring some adaptive mechanism to maintain life. Objectives: This is to determine pattern and prevalence of common complex cardiac anomalies among children presenting for cardiac surgery in Enugu. Methodology: The children that present for cardiac surgery in our center over a six-month period were admitted and rescreened using a standardized echocardiographic method, information on biodata, oxygen saturation and 2D echo diagnosis were recorded in a proforma. Results: A hundred and one (101) children with different structural heart diseases presented for cardiac surgery, 53 females and 48 males, 99 (98%) had congenital heart defects (49 cyanotic and 50 acyanotic). Complex cardiac anomalies were noted among 49 and 50 were non-complex, 6 (12.2%) acyanotic, and 43 (87.8%) cyanotic complex P < 0.01. This was noted among 21 females and 28 males. Children less than 3 years had 31 cases (63.3%) of the complex heart diseases while children between 5 years to 18 years had 14 (28.6%). The top three complex congenital heart disease were complex Tetralogy of Fallot which was found among 26 (53%) subjects. Tricuspid atresia and Truncus arteriosus were found in 3 children with congenial heart disease each, Shone complex was found in a child, Hypoplastic left heart syndrome was also noted in a child. Conclusion: The incidence of complex congenital heart diseases among prospective Paediatric cardiac surgery patients is high. Efforts should be made to improve access to preventive cardiology in order to curb these diseases.

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Background: Böhler's angle (BA) and the crucial angle of Gissane (CAG) are the most frequently used objective measurements for the follow-up of fixation following calcaneus fracture surgery. However, the measurements of these angles by different people can affect the results and cause conflicting interpretations of different results obtained. This has caused confusion in the literature. Aims: The aim of this study was to investigate the reliability and disagreement of BA and the CAG, and to interrogate the veracity of angular changes in the postoperative period of calcaneal fractures. Methods: In the first round, a total of 82 postoperative lateral radiographs were investigated to assess the inter-tester reliability and disagreement. Second round; all radiographs were re-evaluated by two testers 15 days after the first measurement. These values were used to assess the intra and inter-tester reliability, disagreement and false negative/positive angular change. All measurements were performed separately by a radiologist and an orthopedic surgeon. Results: Inter- and intra-tester reliability was found low to high in BA (ICC: 0.465 to 0.837), and moderate to very high in CAG (ICC: 0.661 to 0.926). The mean inter-tester disagreement of BA was 4.19° and 6.07°. These values were 4.76° and 7.22° for CAG. The mean intra-tester disagreement of BA was 4.09° for the orthopedic surgeon and 3.97° for the radiologist. These values were 4.96° and 4.39° for CAG respectively. The false negative angular difference was found for BA in 51 (62.2%) cases for the orthopedic surgeon and 46 (56.1%) cases for the radiologist. The mean values were -3.87° and -4.21°, respectively. For the CAG, the false positive angular difference was found in 43 (52.4%) cases for both the orthopedic surgeon and the radiologist. The mean values were +5.01° and +4.72°, respectively. Conclusion: These angles alone should not be considered to be of guidance in the postoperative period. If any angular change is determined on the lateral radiographs, this could arise from a disagreement or false angular change.

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Trauma remains the leading cause of death in individuals less than 45 years. Management of major trauma is protocol driven around the world. Most protocols are in line with the popular Advanced Trauma Life Support (ATLS) principles. These principles have been adjudged to be safe and consistent even in the presence of infectious diseases while employing standard precautions. In view of the current community spread, large cases of COVID 19 in the Federal Capital Territory (FCT) and the magnitude of the infectivity, it has become necessary to adjust our local trauma resuscitation protocols in order to ensure the safety of the trauma team and the trauma patients as well.

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