Medical and Dental Consultants’ Association of Nigeria
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   Table of Contents - Current issue
Coverpage
August 2017
Volume 20 | Issue 8
Page Nos. 919-1051

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REVIEW ARTICLE  

What is new in recommendations on ophthalmological screening in patients treated with chloroquine and hydroxychloroquine? Update and literature review p. 919
MP Wiacek, D Bobrowska-Snarska, W Lubiński, M Brzosko, M Modrzejewska
DOI:10.4103/njcp.njcp_380_16  PMID:28891533
Based on the present literature, in March 2016, new recommendations of the American Academy of Ophthalmology for ophthalmic screening tests in patients treated with chloroquine and hydroxychloroquine were published. These recommendations emphasized the fact that toxicity is related to the dose calculated by real weight. The recommended hydroxychloroquine and chloroquine doses have been limited. It is no longer recommended to calculate the cumulative dose of chloroquine to establish the risk of toxicity. Kidney failure and the use of tamoxifen are proven risk factors of ocular complications in these patients. The screening agenda was established and available diagnostic methods were evaluated. Screening in patients treated with chloroquine derivatives may prevent an irreversible complication-toxic retinopathy. The present recommendations warn against making premature decision on medicine withdrawal, especially in the light of the most recent studies on their beneficial systemic influence. This paper systematizes the information on ophthalmological screening in chloroquine derivatives users.
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ORIGINAL ARTICLES Top

Effect of irradiation on the shear bond strength of self-adhesive luting cement in different preparation depths Highly accessed article p. 924
O Sahin, D Ö Dede, A Köroğlu, Y Özgüven, D Ö Doğan
DOI:10.4103/1119-3077.180071  PMID:28891534
Objective: The purpose of this study was to evaluate the effects of pre- and post-irradiation application on the shear bond strength of self-adhesive luting cements to dentin and enamel. Materials and Methods: Thirty-two extracted human maxillary incisor teeth were used in this study. Teeth were divided into two main groups according to preparation depth (0.5 mm and 1 mm) as Group E and Group D and were divided into four subgroups according to treatment protocol (n = 12). Teeth were irradiated and preparation was done after radiation. Adhesive luting cement was placed on the irradiated enamel and dentin surface (Groups E1, D1). Preparation was done before irradiation and resin cement was placed on the irradiated enamel and dentin surface (Groups E2, D2). The resin cement was first placed on their enamel and dentin surfaces and then the specimens were irradiated (Groups E3, D3). Irradiation was done with a total dose of 60 Gy, applied in fractions over 6 weeks for each groups (2-Gy/day fractions, 5 days per week). Nonirradiated groups were determined as controls groups (Groups C1, C2). The shear bond strengths of adhesive luting cement were examined. Results: According to the two-way ANOVA results, depth of preparation and treatment protocol and their interactions were significant on shear bond strength of resin cement (P < 0.05). Conclusions: This study detected significant differences between the irradiated and nonirradiated groups, probably due to the changes in the crystalline structure of dental hard tissues.
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Doppler sonographic evaluation of venogenic extremity swellings: Analysis of 170 patients from Kano, Nigeria p. 930
A Ismail, AM Tabari, K Isyaku
DOI:10.4103/njcp.njcp_169_16  PMID:28891535
Introduction: Deep venous thrombosis (DVT) is a serious problem that can potentially lead to many complications including life-threatening pulmonary arterial thrombosis. Screening and confirmation of the diagnosis are critical in the care of this condition. Objectives: The objective of this study was to evaluate the role of Doppler sonography in diagnosing DVT and to illustrate the pattern in 170 suspected cases from our local environment. Materials and Methods: This study was conducted at our department over 18 months. A total of 170 patients with clinical suspicion of limb DVT were recruited. The characteristics of the patients, risk factor for DVT, and the site of the lesion were documented. Sonographic examination was done using 7.5 MHz linear and 3.5 MHz convex transducers. Results: Out of the 170 patients, there are 89 (52.35%) males and 81 (47.65%) females. Their mean age was 50.6 years (+17.9 years). The common risk factors for DVT include chronic medical illness (28.8%), long distance travel (15.3%), previous DVT (8.8%), stroke/paralysis (5.3%), neoplasms (5.9%), pregnancy (5.9%), and trauma/surgery (5.9%). About 55.8% (95) of them were confirmed to have DVT on ultrasound while 44.2% (75) had normal ultrasound findings. There was a female preponderance among the 95 cases of DVT, 58.9% of them were females while 41.1% of them were males. It was found that contiguous femoro-popliteal and ilio-femoro-popliteal segments were most commonly thrombosed. These lesions were predominantly left sided (59.5%). Conclusion: There was a predominance of females and femoro-popliteal segments in DVT. Doppler ultrasound is very useful in the evaluation of extremity DVT. All clinically suspected cases should be evaluated with this modality due to limited sensitivity of clinical evaluation in the diagnosis of DVT. Further correlative studies in comparison to venography and hematologic indices are also recommended.
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Urine osmolality in treatment-naïve HIV-positive subjects in Southeast Nigeria p. 936
EN Anyabolu, II Chukwuonye, I Ezeani
DOI:10.4103/njcp.njcp_253_16  PMID:28891536
Background and objectives: Urine osmolality varies over a wide range of values in a healthy state. Dilute urine or concentrated urine may be observed in many environmental, physiologic, and disease conditions. Urine osmolality is not commonly evaluated in routine clinical practice and in human immunodeficiency virus (HIV) subjects. The factors that influence urine osmolality have not been completely identified. The aim of this study was to evaluate urine osmolality in treatment-naïve HIV subjects and to identify the factors that may influence dilute and concentrated urine in this group of patients. Methodology: This was a cross-sectional study of treatment-naive HIV subjects conducted in Federal Medical Centre (FMC), Owerri, Nigeria. Demographic and anthropometric data were obtained. Urine osmolality and other relevant investigations were conducted. Normal urine osmolality was defined as 24-h urine osmolality (24 HUOsm) 300–750 mOsm/kgH2O, dilute urine as 24 HUOsm <300 mOsm/kgH2O and concentrated urine as 24 HUOsm >750 mOsm/kgH2O. The association between the variables and urine osmolality and the strength of variables to predict dilute urine and concentrated urine were determined. Results: The mean 24HUOsm was 564 ± 501 mOsm/kgH2O and the mean spot urine osmolality (SUOsm) 464 ± 271 mOsm/kgH2O. Normal urine osmolality was observed in 29.6%, dilute urine in 64.5%, and concentrated urine in 5.9% of the HIV subjects. There was a significant association between urine osmolality and body mass index (BMI), creatinine clearance, as well as serum cholesterol level. Only high-density lipoprotein cholesterol (HDL) predicted dilute urine, whereas BMI, spot urine protein, 24-h urine protein, spot urine creatinine, serum HDL, and CD4 cell count predicted concentrated urine. Conclusion: The prevalence of dilute urine was high among the treatment-naïve HIV subjects. Abnormalities of serum lipids, renal function, and weight were common in treatment-naïve HIV subjects who had dilute urine. There is a need for clinicians to routinely assess urine osmolality and further diagnose for dyslipidemia, renal function impairment, and abnormal weight in HIV subjects at the early stage of the infection.
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Clinical performance of a combined approach for the esthetic management of fluorosed teeth: Three-year results Highly accessed article p. 943
EU Celik, B Yazkan, G Yildiz, AT Tunac
DOI:10.4103/1119-3077.180066  PMID:28891537
Objective: The long-term clinical performance of combined therapy including enamel microabrasion and vital bleaching is debatable due to the abrasion of outer enamel surface. The aim of this longitudinal cohort study was to evaluate the 3-year clinical performance of enamel microabrasion in combination with vital tooth bleaching for the esthetic management of fluorosed teeth. Materials and Methods: Fifteen patients with 176 fluorosed incisors and canines were included in this study. All the teeth were treated with enamel microabrasion (Opalustre, Ultradent), and at-home bleaching technique (10% Opalescence PF, Ultradent). Fluorosed teeth were evaluated at baseline, after microabrasion, after combined therapy, and at 3-year follow-up in terms of esthetic criteria (esthetic appearance, brown stains, and opaque white areas), side effects, and patient satisfaction using visual analog scales. The data were statistically analyzed (α = 0.05). Results: Fluorosed teeth revealed significantly better esthetic appearance after microabrasion and combined therapy and at 3-year follow-up compared to those at baseline (P < 0.05). There was a significant relapse in the esthetic appearance and brown stains at 3-year follow-up (P < 0.05). Conclusions: The combined therapy was effective in the esthetic management of fluorosed teeth. However, a significant relapse was observed in the esthetic appearance and brown stains of these patients after 3 years, which also reduced patient satisfaction.
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Treatment alternative for irreparable rotator cuff ruptures: Arthroscopic biodegradable balloon p. 952
HÇ Basat, C Kirçil, M Armangil, M Demirtş
DOI:10.4103/1119-3077.196061  PMID:28891538
Background: The treatment of massive irreparable rotator cuff rupture has still no consensus among shoulder surgeons. It is assumed that symptomatic rotator cuff tendon rupture is accepted as irreparable if retraction amount of tendon is Patte stage 3 on MRI; degree of fatty atrophy is Goutallier stage 3 or 4; narrowing of acromiohumeral distance is lesser than 7 mm and excursion of tendon to repair has decreased and patient has severe pain. Biodegradable balloon is one of the newest methods for the treatment of irreparable massive rotator cuff ruptures. Objective: The aim of this study was to assess shoulder function in the patients who underwent biodegradable balloon procedure for irreparable massive rotator cuff ruptures. Materials and Methods: Arthroscopic biodegradable balloon method was carried out on the 12 patients, who presented with symptomatic irreparable massive rotator cuff rupture, from October 2010 to November 2013. Results: Preoperative and postoperative mean constant score of patients were 25.8 and 75.4 respectively. The mean Oxford shoulder score of the patients were 21.3 and 42.9 respectively, and mean shoulder abduction degree of the patients were73.5 and 165 respectively. All the patients stated that they were satisfied with the treatment and there was significant regression in their complaints. Conclusion: If conservative treatment is insufficient for patients with irreparable rotator cuff tears, biodegradable balloon method has yielded favorable outcomes in terms of pain and functionality in comparison with other surgical methods. Moreover, lesser morbidity, short procedure time and absence of postoperative rehabilitation requirement can be considered as advantages of this method.
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Evaluation of the learning and teaching environment of the Faculty of Medical Sciences, College of Medicine, University of Nigeria, Enugu Campus p. 958
O Okoye, CN Ezisi, FU Ezepue
DOI:10.4103/njcp.njcp_414_16  PMID:28891539
Purpose: The study aimed at evaluating the learning and teaching environment of undergraduate students of the Faculty of Medical Sciences, University of Nigeria. Methods: The study was a descriptive, cross-sectional survey. The Dundee Ready Education Environment Measure (DREEM) questionnaire was self-administered to the final year medical students during the second semester of 2013/2014 academic year. The 50-items of the questionnaire were sub-divided into five sub-groups: perception of learning, perceptions of teachers, academic self-perceptions, perceptions of atmosphere, and social self-perceptions. Results: The questionnaire was completed by 128 out of the 139 students (92.1%). Of the maximum score of 200, the total mean score was 101.82 ± 20.36 SD. The mean ± SD score of students' perception of learning was 25.97 ± 4.18 (maximum score, 48). The mean ± SD score of teachers was 24.40 ± 4.74 (maximum score, 44), whereas that of students' academic self-perception, perception of atmosphere, and social self-perception was 19.96 ± 5.29 (maximum score, 32), 19.02 ± 7.69 (maximum score, 48), and 11.86 ± 4.22 (maximum score, 28), respectively. Conclusion: The overall mean score shows that the students' perception of their learning environment was more positive than negative according to the practical guide of McAleer and Roff on the interpretation of DREEM questionnaire. However, there are problematic areas revealed by this study that will inform policy formulation and remedial intervention.
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The effect of calcium phosphate-containing desensitizing agent on the microtensile bond strength of multimode adhesive agent Highly accessed article p. 964
SH Siso, N Dönmez, DS Kahya, YS Uslu
DOI:10.4103/1119-3077.187322  PMID:28891540
Objective: The aim of this study was to investigate the effect of calcium phosphate containing desensitizing pretreatments on the microtensile bond strength (MTBS) and microleakage of the multimode adhesive agent to dentin. Materials and Methods: In this study, twelve noncarious, freshly extracted human third molar teeth for MTBS and 20 premolar teeth for the microleakage test were used. The teeth were restored using Clearfil Universal Bond + Clearfil APX and Teeth mate Desensitizer (TMD). For MTBS test, Group 1: Self-etch, Group 2: Etch and rinse (G1 and 2, nondesensitizer treatment served as a control), Group 3: TMD/self-etch, Group 4: Acid-etch/TMD/etch and rinse. For microleakage test, Class V adhesive cavities (3 mm × 2 mm × 2 mm) were prepared and restored as mentioned before. The restored teeth were subjected to thermal cycling. The MTBS test was performed in all procedures. The MTBS data were submitted to a one-way ANOVA and post hoc Tukey test (P < 0.05). One tooth in each group was prepared for scanning electron micrograph examination. Marginal microleakage was measured based on the penetration of a 0.5% basic fuchsin dye. Dye penetration was then scored. The data were submitted to the Kruskal–Wallis and Wilcoxon signed ranks tests (P < 0.05). Results: Control groups exhibited a higher mean MTBS value than TMD groups, and there were statistical differences between the groups. TMD groups also demonstrated significantly less microleakage than control groups (P < 0.05). Conclusions: This study proves that the application of TMD with a multimode adhesive bonding system produced significantly lower MTBS and microleakage.
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Inequity in access to childhood immunization in Enugu urban, Southeast Nigeria p. 971
BS Uzochukwu, CC Okeke, E Envuladu, C Mbachu, C Okwuosa, OE Onwujekwe
DOI:10.4103/njcp.njcp_375_16  PMID:28891541
Background: The Nigerian National Programme on Immunization aims at increasing the immunization coverage of children under 1 year of age. However, there is still a gap between the national immunization targets and the immunization coverage rates, and data are rarely disaggregated according to socioeconomic status. As a result, there is a dearth of information about the coverage of subgroups, especially at the local level. This study determined the socioeconomic differentials in immunization coverage for children under 5 years and under 1 year in Enugu urban, Southeast Nigeria. Methods: This was a community-based, descriptive cross-sectional study in Enugu urban of Southeast Nigeria. A modified 30 × 7 cluster sampling design was adopted as the sampling method to select and interview 462 mothers of 685 children under the age of 5 years on their sociodemographic and economic characteristics and immunization status of their children. Principal components analysis in STATA software was used to characterize socioeconomic inequity. Results: Immunization coverage was as follows: Diphtheria, pertussis, tetanus third dose(DPT3), 3, 65.3%; oral polio vaccine 3, 78.0%; hepatitis B3, 65.2%; and measles, 55.8%. The full immunization rates for children 1–5 years and <1 year were 49.8% and 65.2%, respectively. The very poor, poor, and least poor socioeconomic levels significantly had a higher rate of full immunization than the poorest socioeconomic level for children aged <5 years (odds ratio [OR] 1.934, 95% confidence interval [CI] 1.513–2.820). When the 1st year of life was selected as the reference group, the immunization rates in all other age groups decreased significantly. Using the same logistic regression model for children under 1 year of age, every added month of the child's life increased the full immunization coverage, and this was statistically significant (OR 2.752, 95% CI 2.304–3.418). Conclusions: Full immunization coverage for children aged <1 year was lower than the national target of 95%. There are differences in immunization coverage rates between different wealth quartiles in the area with the least poor benefiting more than the poorest, thus creating equity problems. Health managers need such community-based information about the vaccination status of their target population to plan and implement interventions that aim to improve immunization coverage in these areas.
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Drug-induced Stevens–Johnson syndrome in Indian population: A multicentric retrospective analysis p. 978
HN Hirapara, TK Patel, MJ Barvaliya, C Tripathi
DOI:10.4103/njcp.njcp_122_16  PMID:28891542
Background: Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening hypersensitivity reactions mainly caused by drugs. Data on incubation period, hospital stay, and outcome for HIV-positive patients are sparse. Role of corticosteroids in their management is still controversial. Methods: Indoor cases of SJS, SJS–TEN overlap, and TEN were analyzed for causative drugs, incubation period, a severity-of-illness score for toxic epidermal necrolysis (SCORTEN) score, HIV status, treatment, and outcome. Comparison of parameters between HIV and non-HIV cases was done. Utilization pattern of corticosteroids and their role in outcome were evaluated. Results: Four SJS, 15 SJS-TEN overlap, and 21 TEN cases were evaluated. Antimicrobials (27.1%), antiviral (23%), antiseizure drugs (8.4%), and analgesics (8.4%) were commonly associated drugs. Among 12 (30%) HIV-reactive cases, nevirapine (97.6%) and cotrimoxazole (41.6%) were common causative drugs. Males (75%) were affected more than females (25%) among HIV-positive individuals. Incubation period was significantly higher in HIV-reactive patients. Total 30 (75%) patients were treated with corticosteroids. Dexamethasone (90%) and prednisolone (26.6%) were most commonly used. No significant difference was found among cases treated with or without corticosteroids. Conclusions: Antimicrobial drugs are common to cause SJS/TEN. Among HIV-reactive patients, male have more risk, incubation period is more and severity of reaction is less. Effectiveness of corticosteroids for treatment of SJS/TEN is inconclusive.
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A survey of asthma management practices and implementation of Global Initiative for Asthma guidelines among doctors in a resource-limited setting in Nigeria p. 984
EI Chima, MO Iroezindu, NR Uchenna, GO Mbata, CG Okwuonu
DOI:10.4103/njcp.njcp_88_16  PMID:28891543
Background: Bronchial asthma is a global health problem that causes significant morbidity and mortality in all age groups. Global Initiative for Asthma (GINA) seeks to standardize the care asthma patients receive. We assessed the knowledge, attitude, and practices of doctors in Umuahia, Southeast Nigeria, regarding asthma and determined the extent to which they abide by GINA guidelines in their management of asthma. Methodology: It was a descriptive cross-sectional study. A pretested self-administered questionnaire was used to obtain information from the participants regarding knowledge of asthma prevalence, asthma risk factors, and management practices. Results: Out of 142 questionnaires administered, 117 were retrieved giving a response rate of 82%. About 70% were men, and the most common age group was 30–39 years (57.3%). The median duration of medical practice was 6 (3–12) years. About 77% reported asthma prevalence to be on the increase. While 105 (89.7%) respondents had seen a spirometer, only 28 (23.9%) use spirometry in asthma diagnosis. Similarly, 95 (81.2%) had seen a peak flow meter, but only 41 (35.5%) use it in asthma diagnosis. Only 7 (6.0%) respondents reported that their patients keep a peak flow diary. Of 117 respondents, 94 (80.3%) know about GINA guidelines for asthma control, 45 (38.5%) apply GINA guidelines in patient care, 86 (73.5%) regularly review patient inhaler technique, 33 (28.2%) use adult asthma control test while 17 (14.5%) regularly review asthma action plan with patients. Conclusion: There is a wide gap between GINA guidelines and the knowledge, attitude, and practices of doctors in Umuahia regarding asthma management. Improvement and standardization of asthma care are recommended.
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Comparison of Epidrum, Epi-Jet, and Loss of Resistance syringe techniques for identifying the epidural space in obstetric patients p. 992
S Kartal, B Kösem, H Kılınç, H Köşker, S Karabayırlı, NK Çimen, R İ Demircioğlu
DOI:10.4103/1119-3077.214366  PMID:28891544
Background: Identifying the epidural space is essential during epidural anesthesia (EA). Pressure of the epidural space in pregnancy is higher than that in nonpregnant woman. Loss of resistance (LOR) method is the most commonly preferred method for identifying the epidural space. Epidrum and Epi-Jet are recently innovated supporting devices that facilitate identifying process for epidural space. In this study we aimed to compare Epidrum, Epi-Jet, and LOR methods in identifying the epidural space, feasibility of technique. Methods: Two hundred and forty pregnant women who were scheduled for caesarian section surgery under lumbar EA or combined spinal epidural anesthesia (CSEA) were randomized into three groups (Group I Epidrum, n = 80), Group II (Epi-Jet, n = 80), and Group III (LOR, n = 80). We recorded the time required to identify the epidural space and deflation of Epidrum balloon and Epi-Jet syringe, number of attempts, additional methods used to identify epidural space, usefulness of methods, accuracy of identification of epidural space, and outcomes of epidural catheterization. Results: There were no significant differences between the groups with respect to demographic data, duration of deflation of Epidrum balloon and Epi-Jet syringe and distance between skin and epidural space. The mean time required to enter epidural space in Group I was shorter than that in Group II (P = 0.031). Feasibility of Epi-Jet was easier than that of Epidrum (P = 0.015). Number of uncertainties of epidural space identification was higher in Group I than that in Group II (P = 0.009). Also, the requirement for LOR to confirm epidural space and failure rates was higher in Group I than Group II (P < 0.001). Conclusion: We suggest that Epi-Jet is superior to Epidrum in pregnant patients in terms of clarity of epidural space identification, usefulness, and success rates of EA or CSEA.
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Protein C and antithrombin levels in patients with sickle cell anemia in Ahmadu Bello University Teaching Hospital Zaria, Nigeria p. 998
IU Kusfa, AI Mamman, SM Aminu, A Hassan, HM Muktar
DOI:10.4103/njcp.njcp_363_16  PMID:28891545
Background: Alterations in the components of hemostasis, namely platelet function, the procoagulant, anticoagulant, and the fibrinolytic systems, are observed in sickle cell anemia (SCA) and are in favor of a procoagulant phenotype. Therefore, study of protein C and antithrombin (AT) levels in patients with SCA in steady state may be used in the treatment and/or prevention of SCA-related thrombotic complications. We studied the changes of these naturally occurring anticoagulants in patients with SCA attending the sickle cell clinic in Ahmadu Bello University Teaching Hospital, Zaria. Methods: We conducted a case–control study involving 50 SCA (HbSS) patients in the steady state as cases and 25 healthy volunteers with normal hemoglobin (HbAA) as controls. Protein C and AT levels were estimated by semi-automation using Diagnostica Stago hematology coagulation analyzer. Frequencies, proportions, and independent t test were performed using SPSS version 20. Results: The mean ages of both the patients and controls were 23.80 ± 7.46 and 24.28 ± 3.48 years, respectively, and study participants comprised 40 (53.0%) women between the ages of 15–50 years and 15–34 years (P = 0.76). The mean values of protein C and AT levels in patients with SCA in the steady state and the control group were 60.26 ± 20.58% versus 81.30 ± 19.74%, 95% CI 11.13–30.96, and 42.11 ± 5.01% versus 61.88 ± 11.27%, 95% CI 16.03–23.51 with P values (P < 0.001), respectively. Conclusions: This study showed that there was a significant decrease in the levels of protein C and AT between the SCA patients in the steady state and the controls. We recommend baseline investigations of these naturally occurring anticoagulants in patients with SCA, especially in those with frequent vaso-occlusive crises. This will give us an insight into the additional pathophysiologic mechanism in SCA-related thrombotic complications for better patient management and outcome.
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Work-Related musculoskeletal pain among lebanese dentists: An epidemiological study p. 1002
S Bou Jaoude, N Naaman, E Nehme, J Gebeily, M Daou
DOI:10.4103/njcp.njcp_401_16  PMID:28891546
Introduction: The aim of this study was to evaluate the prevalence of musculoskeletal disorders and identify their associated factors among a group of Lebanese dentists. Materials and Methods: A total of 314 Lebanese, dentists completed an anonymous questionnaire that focused on occupational health problems. This study was approved by the ethics committee of Saint-Joseph University of Beirut, Lebanon. The statistical analyses were performed using SPSS for windows. The alpha error was set to 0.05. Results: The mean age of the participants was 39.2 (±11.66) years. The results showed that 61.5% of the surveyed dentists complained of spinal pain: 31.6% of cervical pain, 22.3% of lumbar pain and 13.0% of dorsal pain. Moreover, the pain was continuous in 20.7% and, occasional in 65.8%. Our statistics showed that 7.6% had a problem with the carpal tunnel. A total of 22.3% suffered from tendinitis and 9.2% from arthritis of shoulder, elbow, wrist and hand. The frequency of headaches was 30.6%. Concerning sports activity, 49.7% practiced it occasionally and 3.6% did so frequently. Conclusions: The occurrence of musculoskeletal pain in the upper extremities is a serious concern that affects Lebanese dentists. Most of them often complained of tendinitis and headaches because they do not practice sports; thus, encouraging them to practice sports may reduce or solve such health problems. Issuing brochures that include exercises to perform and hiring trained assistants could help reduce the risk of musculoskeletal disorders. Finally, these occupational health problems should be highlighted at all clinical and research symposia to increase awareness.
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Classification of alveolar bone destruction patterns on maxillary molars by using cone-beam computed tomography Highly accessed article p. 1010
G Ozcan, AE Sekerci
DOI:10.4103/1119-3077.180074  PMID:28891547
Objective: The defective diagnosis of alveolar structures is one of most serious handicaps when assessing available periodontal treatment options for the prevention of tooth loss. The aim of this research was to classify alveolar bone defects in the maxillary molar region which is a challenging area for dental implant applications. To our knowledge, this is the first study of periodontal bone defect prevalence by using cone-beam computed tomography (CBCT). Materials and Methods: In this study, the remaining alveolar bone patterns of 669 maxillary molars of 243 patients with periodontal bone loss were investigated on four aspects and the furcation areas of teeth, and then they were classified into six main groups. Combined periodontal-endodontic lesions (CPELs) were also reported in another category. Results: Following exclusion of 39 (5.8%) teeth with CPEL, the most common group was horizontal bone defects (71.4%) and the least seen group was three-walled vertical bone defects (1.9%) in all alveolar bone sides of teeth. Osseous crater was found at the rate of 6.7% on interdental alveolar bone. Dehiscence and fenestration were detected at rates of 2.7% and 3.3%, respectively. In the assessment of furcation areas, there was no furcation involvement in 61.4% of all teeth and the rate of Grade-II involvements was 26.2%. Conclusions: The most appropriate treatment option may be decided through accurate imaging of periodontal defect morphology. CBCT can provide comprehensive information about the remaining alveolar bone structures. In this way, the need for dental implant can be prevented in many cases and be replaced with a more conservative approach on the maxillary molar region.
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Short segment bulbar urethral strictures: Review of 48 cases managed in a resource-poor setting p. 1020
AO Obi
DOI:10.4103/njcp.njcp_226_16  PMID:28891548
Objective: To share our experience on the presentation and management of short segment bulbar urethral strictures (BUSs) in a resource-poor center. Methods: Short segment bulbar urethral strictures (BUSs) managed from January 2009 to December 2014 were analyzed. Patients'age, stricture aetiology, mode of presentation, stricture characteristics, time to surgery, associated morbidity, operative procedure, and post-operative outcome were reviewed. All patients had bulbar anastomotic urethroplasty (BAU). Results: Total 42 bulbar anastomotic urethroplasties (BAUs) were done. The mean age of the patients in years was 37.46 (± 13.80). Fall astride injuries accounted for most strictures, 39(89.3%) of cases. The mean stricture lenght was 1.04 cm ± 0.49 and was longer in patients who had prior instrumentation,1.45 cm (± 0.37) versus 0.70 cm (± 0.26), P = 0.000. Associated lower urinary tract comorbidities were noted in 38 (79.2%) patients. Mean time to surgery was 10.20 (± 4.96) months. Patients operated on after 6 months of presentation had more associated comorbidities, 24/26 patients (92.3%), compared to those operated on within 6 months; 8/16 cases (50%), P = 0.003. However, this did not impact negatively on the outcome of surgery (P = 0.275). Patients with complete strictures tended to accept surgery earlier than those with incomplete strictures, 29 patients (60.4%) versus 19 patients (39.6%), P = 0.208,with no difference in outcome between the two groups, P = 0.581.The overall success rate was 92.9%. Conclusions: Fall astride injuries are the commonest cause of short segment BUSs. Prior urethral instrumentation is associated with recurrence and longer stricture lenght. Suprapubic catheter-related associated comorbidity increases with the duration of catheterization but does not impact negatively on the surgical outcome. BAU has low morbidity and high success rate of 92.7%. It should be the first line treatment for short segment BUS in low-resource countries.
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Effects of health-care services and commodities cost on the patients at the primary health facilities in Zaria Metropolis, North Western Nigeria p. 1027
O Adegboyega, K Abioye
DOI:10.4103/njcp.njcp_61_16  PMID:28891549
Introduction: The payment for health-care services is a major problem for many poor patients in developing nations. The aim of the study was to examine the cost of services and commodities and how these affect the patients who utilizes the primary health-care centers in Zaria, North western Nigeria. Methodology: A descriptive cross-sectional survey of six primary health-care facilities in Zaria metropolis, namely Baban dodo, Tudun Wada, Magajiya PHCs from Zaria local government areas (LGA) and Samaru, Kwata, and Dogarawa PHCs from Sabon Gari LGA, was carried out. Result: The mean age of the respondents was 28.87± 8.63 years, most of them were married (53.3%), Hausa (63.3%), and Muslims (85.7%); also, they were unemployed housewives with daily stipends from their husbands less than 1 dollar/day. The major method for payment for health-care services was out of pocket (98.3%). More than one-third of the clients were not aware of the National Health Insurance Scheme (NHIS) (39%). There was a significant inverse relationship between the monthly income of the clients and the experience of financial stress and a positive association between patients' monthly income and awareness of the NHIS (P < 0.05). Conclusion: The respondents were paying user fees for essential health-care services at the primary health-care centers and this was not convenient for them. Recommendation: There is a need for the LGA health department to intensify the supervision of the activities at the PHCs. Standardization of prices of services and commodities and the implementation of the National Health Act may alleviate the burdens of the poor community members who access PHCs in Nigeria.
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Common types and countermeasures of ankle ligament injury caused by intense basketball movement p. 1036
H Hu
DOI:10.4103/njcp.njcp_145_16  PMID:28891550
Objective: To analyze ankle ligament injury of basketball players caused during movement, summarize injury types, analyze the causes of injury, and put forward corresponding control measures. Methods: The author selected 3100 basketball players with ankle ligament injury during basketball movement and admitted to different hospitals from June 2011 to June 2015 for stochastic analysis. Through the literature, investigation, and observation, etc., common types of injuries of basketball players are analyzed, and damage preventive measures of basketball players are discussed, so as to find measures to prevent and treat ankle ligament injury of basketball players and promote physical rehabilitation of players, which is in favor of their better career development. Results: Basketball players are prone to ankle ligament injury in training or competition, which has a direct relationship with players' poor safety consciousness and insufficient preparation during movement. Conclusion: Basketball players will often have serious ankle ligament injury in the process of movement. Basketball coaches and players should reduce serious injury to players in training or competition, so as to stimulate passion of more professional basketball sports students for basketball, which also has a positive meaning for their future career.
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CASE REPORTS Top

Mondor's disease of the breast in a Nigerian woman previously treated for invasive ductal carcinoma in the contralateral breast: A case report p. 1040
SA Olarinoye-Akorede, BT Silas
DOI:10.4103/njcp.njcp_354_16  PMID:28891551
Mondor's disease is a self-limiting sclerosing angitis mostly affecting the superficial veins of the breast and chest wall. It is seldom diagnosed, and its etiology and epidemiology are speculative. However, numerous predisposing factors including breast cancer have been postulated. In Nigerian literature, only two cases have been documented to the best of our knowledge. This report is aimed at reminding breast specialists to include it as a diagnostic consideration in patients presenting with a breast lump in the appropriate clinical setting. Its imaging features are also highlighted because it may be incorrectly overlooked as mere ductal dilatation. We present the case of a 60-year-old woman who complained of a painful cordlike lesion in her right breast. Mondor's disease was diagnosed based on the clinical and radiological findings. She had also been previously treated for invasive ductal breast carcinoma in the contralateral breast. Mondor's disease is usually a benign entity, which may resolve spontaneously. On the other hand, it may also be the sole presenting symptom or clue of a breast malignancy; hence, a need for increased awareness.
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Omental herniation through the diaphragmatic defect: Two cases mimicking mediastinal lipomas p. 1044
Z Zhu, Y Chai
DOI:10.4103/njcp.njcp_242_16  PMID:28891552
Omental herniation through a diaphragmatic defect without involvement of the stomach is rare and has often been misdiagnosed as mediastinal lipoma. We herein report two cases of intrathoracic omental herniation through adiaphragmatic defect in patients that were misdiagnosed as a mediastinal lipoma at presentation. They both underwent successful laparoscopic diaphragmatic hernia repairs with full resolution of their symptoms. Doctors should pay attention to the differential diagnosis between diaphragmatic hernia and mediastinal lipoma when a fatty mass is found in the mediastinum at the magnetic resonance imaging (MRI) or computed tomography (CT) scan.
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Hyperthyroidism and sick sinus syndrome, a rare but challenging association: A study of three cases p. 1046
M Tudoran, C Tudoran
DOI:10.4103/njcp.njcp_288_16  PMID:28891553
Hyperthyroidism is usually associated with sinus tachycardia or supraventricular tachyarrhythmias, but rarely with dysfunction of the sinus node or other conduction disturbances. Evidence of bradyarrhythmia in patients with hyperthyroidism is clinically relevant, but the fact that several drugs with negative chronotropic effects (beta-blockers and calcium channel antagonists) are frequently used in the management of these patients must be taken into account. In the presence of sick sinus syndrome (SSS) or other conductance disturbances, therapy with agents that delay the activity of sinus node or atrioventricular conduction can lead to extreme bradycardia with syncope. In this paper, aspects of diagnosis and therapy in three patients with SSS and hyperthyroidism, admitted in the Clinic of Endocrinology or/and Cardiology of the County Hospital, Timisoara, have been presented.
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Interocclusal registration for diagnosis and treatment planning for implant restorations p. 1049
S AlZain
DOI:10.4103/njcp.njcp_65_17  PMID:28891554
This paper describes a new technique to record the interocclusal relationship of an implant case where multiple posterior teeth are missing and need to be replaced by implant restorations. In the case presented, an appliance was designed to be supported only by hard immovable tissues; teeth that provide a precise fit of records. The well-fitting appliance can be used to accurately mount implant cases with inadequate posterior support for diagnosis and treatment planning. This technique of interocclusal registration has the advantages of accurate mounting, preservation of materials and financial expenses, and reduction of chair-side time. This appliance may also be used in all cases of multiple missing posterior teeth requiring prosthodontic treatment.
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