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   Table of Contents - Current issue
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October 2019
Volume 22 | Issue 10
Page Nos. 1313-1462

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REVIEW ARTICLE  

Low-level laser therapy in dentistry: Extra-oral applications p. 1313
AA Nadhreen, NM Alamoudi, HM Elkhodary
DOI:10.4103/njcp.njcp_53_19  
Low-level laser therapy (LLLT) is considered as a recent technique in the dental field. Nowadays, it is used by many clinicians in dentistry. The stimulation of the healing process and pain relief are among its most popular uses. The purpose of this paper is to discuss and review the latest extra-oral applications of LLLT in the dental field. An electronic search of English scientific papers from 2000 to 2018 was accomplished using PubMed and Google Scholar search engines. The following key words were used extra-oral, applications, LLLT, and dental field. This review demonstrates the marked effectiveness of LLLT in the management of many conditions and how it could improve the quality of life of many patients. However, LLLT is still considered a recent alternative and requires more understanding of its mechanism of action by conducting more high-quality randomized clinical trials with larger sample sizes and longer follow-up periods.
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ORIGINAL ARTICLES Top

Roles of UGT2B7 C802T gene polymorphism on the efficacy of morphine treatment on cancer pain among the Chinese han population p. 1319
M Ning, Y Tao, X Hu, L Guo, J Ni, J Hu, H Shen, Y Chen
DOI:10.4103/1119-3077.269019  
Background: Morphine is a common analgesic often used to manage chronic pain, especially for patients with pain due to malignancies. Since UGT2B7 plays an important role in the metabolism of morphine, UGT2B7 gene mutation may influence the efficacy of morphine in patients with cancer being treated by this medication. Aims: The aim of this study is to investigate the relationship between the polymorphisms of UGT2B7 and the efficacy of morphine treatment on cancer pain among the Chinese Han population. Materials and Methods: A total of 120 patients with cancer pain were enrolled in this study. Morphine was administrated through patient-controlled analgesia infusion pump, and the visual analog score (VAS) was used for pain assessment at 0.5, 4, 6, 12, 24, 48, and 72-h post morphine treatment, respectively. The plasma concentration of morphine and genetic polymorphism of UGT2B7 C802T and G221T was analyzed, respectively. Results: The frequencies of UGT2B7 C802T were CC: 13.33%, CT: 45% and TT: 41.67%, and the frequencies of UGT2B7 G221T were GG: 76.67%, GT: 22.5% and TT: 0.83%. Moreover, the VAS score of patients with either C802T CT or TT was significantly higher than that in patients with C802T CC. However, no difference of VAS scores was observed between patients carrying G221T GG and patients carrying G221T GT. The plasma concentration of morphine for patients with the C802T CC was significantly lower than that in patients carrying C802T CT or TT, while there was no significant difference in the level of morphine between patients with G221T GG and G221T GT. Conclusion: The polymorphism of UGT2B7 C802T, but not UGT2B7 G221T, has been associated with the efficacy of morphine treatment on cancer pain among Chinese Han population.
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Clinical observation in edaravone treatment for acute cerebral infarction p. 1324
Z Sun, Q Xu, G Gao, M Zhao, C Sun
DOI:10.4103/njcp.njcp_367_18  
Background: Acute cerebral infarction threats human health and life safety. The edaravone is a new antioxidant and hydroxyl radical scavenger, which is the novel scavenger for clinical use, mainly for nervous system diseases. Objective: The purpose of this study is to observe the clinical treatment effects of edaravone on the degree of improvement of neurological impairment and functional movement impairment in patients with acute cerebral infarction. Method: A total of 130 patients admitted to our hospital because of acute cerebral infarction from December 2015 to May 2017 were selected for group analysis. These patients were divided into a control group (n = 65) and a treatment group (n = 65) with a random odd–even method. The control group accepted conventional treatment, while the treatment group received edaravone treatment on top of the conventional treatment of the control group. After treatment, the differences in functional movement, living ability score, neurological score, treatment effect, and adverse reaction of these two groups were tested and compared. Results: The total treatment efficiency of conventional treatment in the control group was significantly lower than the combination treatment in the treatment group (P < 0.05). The inter-group differences in the National Institutes of Health Stroke Scale, activities of daily living, and Fugl–Meyer assessment scores after the treatment were significant between these two groups (P < 0.05). The posttreatment effect on the treatment group was superior to that on the control group (P < 0.05). The adverse reaction rate of the treatment group did not significantly vary from that of the control group (P > 0.05). Conclusion: Edaravone can significantly improve the degree of neurological impairment during acute cerebral infarction, functional movement, and living quality with a definite effect and high safety. Thus, this drug has a good prospect in clinical treatment.
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Evaluation of the effect of honey on the healing of tooth extraction wounds in 4- to 9-year-old children p. 1328
S Mokhtari, I Sanati, Sh Abdolahy, Z Hosseini
DOI:10.4103/njcp.njcp_102_19  
Objective: The aim of the this study was to evaluate the effect of honey on the healing of tooth extraction wounds in children 4‒9 years of age. Subjects and Methods: In the present randomized clinical trial, 51 patients, 4‒9 years of age were selected randomly. All the subjects required extraction of one deciduous molar tooth. The subjects were randomly assigned to two groups. In group 1, after extraction of the tooth, the dentist used a cotton swab applicator to place a layer of honey on a piece of gauze moistened with normal saline solution (NSS) and placed it on the socket. In group 2, honey was not used; rather, NSS was applied. On days 3 and 7 after tooth extraction, the wound sizes were measured. Results: In both groups, the wound sizes decreased significantly on the third day compared with baseline and on the seventh day compared with the third day (P < 0.05). On the third and seventh days after tooth extraction, wound sizes in the honey group were significantly lower than those in the NSS group (P < 0.05). Conclusion: Honey resulted in a decrease in wound sizes and faster healing after extraction of teeth in children. Therefore, use of honey can be recommended after minor surgeries in the oral cavity.
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Cyclic fatigue resistance of waveone gold, protaper next and 2shape nickel titanium rotary instruments using a reliable method for measuring temperature p. 1335
K Olcay, TF Eyuboglu, E Erkan
DOI:10.4103/njcp.njcp_655_18  
Objective: The purpose of this study was to evaluate the cyclic fatigue resistances of the WaveOne Gold (WOG), ProTaper Next (PTN), 2Shape (TS) instruments. Materials and Methods: Totally 45 new WOG (25/.07), PTN (25/.06), TS (25/.06) files were tested inside the artificial canal of a custom-made stainless steel block with an inner diameter of 1.5 mm, a 60° angle, and a 5-mm radius of curvature. A 16-mm-long file segment (from the tip) was introduced and was immersed in 37°C water. The number of cycles to fracture (NCF), time to failure (TTF), fractured fragment length (FL) was recorded and the fractured surface was examined using microscope. Results: WOG > PTN > TS according to TTF results (P = 0.00). PTN > TS according to NCF results (P = 0.00). The FL values showed no significant difference (P = 0.335). Conclusions: Reciprocating motion can be used more safely than continuous rotation due to the higher cyclic fatigue resistance.
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Incident HIV infection and perinatal transmission rates among HIV negative pregnant women who retested in labor in a tertiary health centre, South East Nigeria p. 1341
SD Ejikunle, II Mbachu, C Okeudo, E Dike, E Ejikem
DOI:10.4103/njcp.njcp_130_17  
Background: To reduce the number of new HIV infections among children, retesting of HIV negative pregnant women in labor to identify new infections and instituting appropriate modified obstetrics practices (MOP) has a huge role to play. Aims and Objectives: This study evaluated the HIV sero-positivity in labor among pregnant women who earlier tested negative in antenatal clinic, associated risk factors and the corresponding rate of mother-to-child transmission of HIV infection. Methods: This was a prospective observational study where pregnant women in labor who had earlier tested HIV negative in the antenatal clinic at Imo State University Teaching Hospital Orlu, Imo state, Nigeria, were retested. The infants of the women who seroconverted were tested for HIV infection at 6 weeks using Deoxyribonucleic acid polymerase chain reaction (DNA PCR) by collecting Dried Blood Sample. This study was conducted from October 2015 to March 2016. Result: Out of the 163 patients studied, 6 demonstrated HIV seroconversion giving a seroconversion rate of 3.7%. Deliveries from the seroconverted patients were 5 live births and 1 intrauterine fetal death. All the 5 live babies tested HIV negative at 6 weeks of age. Predictors of seroconversion in late pregnancy include spouse's HIV status and number of other sexual partners. Conclusion: Retesting of HIV negative pregnant women in labor to identify new infections and instituting appropriate modified obstetrics practices has a huge role to play in the prevention of mother to child transmission of HIV infection.
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Alterations of heart rate variability and turbulence in female patients with hyperthyroidism of various severities p. 1349
C Tudoran, M Tudoran, M Vlad, M Balas, T Ciocarlie, F Parv
DOI:10.4103/njcp.njcp_61_18  
Objective: The objective of the this study is to document the existence of statistically significant differences between parameters of heart rate variability (HRV) and heart rate turbulence (HRT), determined in women with overt hyperthyroidism (hT), compared to controls and to highlight their correlations with the level of thyroid hormones and the incidence of arrhythmias. Methods: We studied the HRV in time and frequency domain, and the HRT in a group of 113 women with overt hT, without other cardiovascular risk factors or comorbidities, admitted to the endocrinology clinic of our hospital, between 2012 and 2016. Depending on the severity and duration of hT and levels of thyroid hormones, the patients were assigned to three groups: mild and moderate forms, severe hT with thyrotoxicosis and persistent cases with a relapse of hT. We performed 24 h Holter monitoring in all patients. Results: HRV parameters in time domain (TD) were significantly depressed in patients comparing to controls. All patients had abnormal, positive values of turbulence onset (TO) with significant statistically differences (P < 0.0001) comparing to controls. Although positive, the values of turbulence slope (TS) decreased according to the severity of hT. Conclusion: Patients with hT had depressed values of HRV parameters in TD, correlated with the severity of the thyroid disease and with the incidence of arrhythmias. All patients presented pathological values of TO. TS values were positive, but lower compared to controls.
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Percentage difference of hand dimensions and their correlation with hand grip and pinch strength among schoolchildren in Saudi Arabia p. 1356
KA Alahmari, VN Kakaraparthi, RS Reddy, Paul Samuel Silvian, I Ahmad, K Rengaramanujam
DOI:10.4103/njcp.njcp_121_19  
Aims: The study aimed to assess the percentage difference of hand dimensions and their correlation with grip and pinch strength among school children in Saudi Arabia. Materials and Methods: Anthropometric measurements, hand dimensions, grip, and pinch strength measurements were obtained from 200 healthy schoolchildren in both genders aged 6-16 years. A Jamar electronic handgrip dynamometer was used to measure handgrip strength in kg. Pinch dynamometer was used to measure the two-point pinch strength, three-point pinch strength and lateral pinch strength in kg. Hand circumference was measured following hand arch at the maximum palm level. Hand span from the tip of the thumb to the tip of the little finger with the hand opened as broad as possible. Hand length from the tip of the middle finger to the midline of the distal wrist crease. Palm length from the distal wrist crease to the base of the middle finger. Results: The percentage of difference of hand dimensions between both the genders was statistically significant. Both handgrip and pinch strength were significantly correlated with anthropometric measurements and hand dimensions. Body mass index had mild correlation with both handgrip strength and pinch strength (P < 0.05). Age, hand circumference, hand span, hand length and palm length had moderate to strong correlation with both grip and pinch strength (P < 0.01). Conclusion: The current study provides a source of perspective reference values in clinical settings for hand dimensions. The present study showed significant correlations with handgrip and pinch grip strengths among schoolchildren in Saudi Arabia.
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Dentists' knowledge of chronic orofacial pain p. 1365
EM Hadlaq, H Khan, AB Mubayrik, NS Almuflehi, H Mawardi
DOI:10.4103/njcp.njcp_110_19  
Objective: Orofacial pain (OFP) is a unique group of dental conditions with focus on chronic nonodontogenic pain affecting mouth, jaws, and face. The aim of this study is to investigate the knowledge of dentists in Saudi Arabia toward OFP assessment. Materials and Methods: An English language questionnaire containing 20 close-ended questions was used to capture data. The questionnaire included diagnostic criteria and clinical symptoms and signs of various OFP conditions. It was distributed to general dental practitioners (GDP) and dental specialists in four major provinces in Saudi Arabia. Results: A total of 318 questionnaires were completed by 163 males and 155 females. Most participants were GDPs (193/318) and the remaining were specialists from different dental specialties. A majority of participants were not able to diagnose neuropathic OFP or neurovascular/vascular OFP conditions (33% and 28.6%, respectively). On the other hand, only 40.3% were confident enough to diagnose different types of temporomandibular disorders. The results also showed that graduates from non-Saudi programs had significantly higher self and knowledge assessment score (59.8% and 43.4%, respectively) compared with graduates from Saudi programs (39.9% and 22.6%, respectively). The dental specialists had higher self-assessment scores compared with GDPs (48% vs. 43.7%). Overall, there was a weak positive correlation between self-assessment and knowledge assessment (20.2%). Conclusion: This study demonstrates a higher OFP knowledge and confidence for dental specialists compared with GDPs. However, this difference does not necessarily translate into more competencies in clinical practice. Therefore, the implementation of OFP courses in dental schools' curricula may benefit future dentists and improve patients' care.
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Evaluating surgical outcomes of conventional versus endoscopic septoplasty using subjective and objective methods p. 1372
S Doomra, M Singh, B Singh, A Kaushal
DOI:10.4103/njcp.njcp_101_19  
Objectives: The aim of the study is to compare the pre- and post-operative symptomatology, endoscopic findings, and nasal patency and to evaluate the postoperative outcomes of conventional compared to endoscopic septoplasty (ES). Materials and Methods: This prospective study was conducted at Rajindra Hospital, Patiala, Punjab, India, on 50 patients aged between 18 and 60 years having symptomatic deviated nasal septum and refractory to medical treatment. The patients were divided into two groups: Group A, which included 25 patients in whom conventional septoplasty (CS) was performed, and Group B, which included 25 patients in whom ES was conducted. The postoperative assessment was carried out at once weekly for 1 month and twice weekly for another 2 months. Results: Nasal obstruction was relieved in 79.1% cases belonging to Group A and 91.3% cases to Group B. Headache was relieved in 62.5% cases belonging to Group A and 93.3% cases to Group B. Postnasal drip was relieved in 73.3% cases in Group A and 94.1% cases in Group B. The results were found to be statistically significant. An improvement in visual analog scale score was observed in both groups, but statistically significant difference was seen at 2nd and 4th week. Postoperative nasal patency improvement was observed in both groups by the Gertner plate, and the results were found to be statistically significant. Postoperative hemorrhage was observed in 24% cases in Group A and 12% cases in Group B. Septal perforation, septal hematoma, and mucosal tear were observed in 4%, 4%, and 8% of cases, respectively, in Group A. No such complication was reported in Group B. Conclusion: ES is more effective in terms of relief of symptoms and improvement of nasal patency. It is best for isolated spur, posterior deviation, and revision surgery, but anterior caudal dislocation is best handled with CS. Both these techniques should be taken as an adjuvant to each other.
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Antibacterial activity of Salvadora persica against oral pathogenic bacterial isolates p. 1378
MA Khalil, MS El-Sabbagh, EB El Naggar, RH El-Erian
DOI:10.4103/njcp.njcp_413_14  
Objective: The objective was to determine the antibacterial activity of Salvadora persica extract against bacteria isolated from dental plaque of patients. Materials and Methods: Out of 40 different clinical specimens collected from patients suffering from plaque-induced gingivitis, 12 Staphylococcus aureus and 8 Streptococcus sp. isolates were recovered. The isolates were screened for their biofilm-forming capacity using tissue culture plate (TCP), tube method (TM), and congo red agar (CRA) method. Antibacterial activity of methanolic S. persica extract as well as of commercial antimicrobials against tested isolates was performed. High-performance liquid chromatography–mass spectrometry (HPLC-MS) and gas chromatography-MS (GC-MS) analysis were performed for S. persica crude extract and its volatile oil, respectively, to determine their constituents. Results: Out of 20 isolates, 80%, 85%, and 90% showed positive results using TM, CRA, and TCP, respectively. The highest antimicrobial activity of methanolic S. persica extract was observed at 200 mg/ml. HPLC-MS analysis shows many polyphenols in S. persica extract such as Chrysin-8-c-β-D-glucopyranoside, ferulic acid, gallic acid, and stigmasterol. Chemical composition of the essential oil of S. persica was determined by GC-MS yield; a mixture of monoterpene and hydrocarbons. The major compounds were butylated hydroxytoluene followed by benzene (isothiocyanatomethyl). Conclusion: Methanolic extract of S. persica had significant antibacterial effect against S. aureus and Streptococcus sp. isolates, and it may be gave a good alternative method for controlling oral pathogen.
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Peri-implant bone defects: A 1-year follow-up comparative study of use of hyaluronic acid and xenografts p. 1388
OA Kaya, M Muglali, D Torul, I Kaya
DOI:10.4103/njcp.njcp_502_18  
Objective: The aim of this study was to compare the efficacy of hyaluronic acid (HA) and xenografts on the repair of peri-implant dehiscence-type bone defects occur during implant placement. Patients and Methods: Forty-two dehiscence Class I type defects located on the buccal surface of the implants were included in this study. Defects were divided into two main groups as small sized (height of <3 mm) and medium sized (height between 3 and 5 mm). Both of the main groups were further divided into two subgroups as HA plus xenograft plus collagen membrane (HAXC) or xenograft plus collagen membrane (XC) applied groups. After grafting, repair of defect site was evaluated with the help of the cross-sectional images on cone-beam computed tomography at 6th and 12th months. Results: In both main groups, vertical bone height (VBH) was higher in defects repaired with HAXC (2.65 ± 1.12 mm) than in the XC (2.45 ± 1.10 mm) groups at the 6th month. However, the difference between two subgroups was not statistically significant (P > 0.05). Reduction in VBH was observed up to 6–12 months after prosthetic loading in all defect sites. This reduction was found statistically significant in medium-sized defects that grafted with XC (P < 0.05, paired t-test). However, in other subgroups, the difference between measurements at 6th and 12th months was not statistically significant (P > 0.05). Conclusions: According to the data obtained from this study, it can be concluded that HA did not have a significant positive effect on the repair of defects around dental implants.
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The effect of surgical margin on cancer-specific survival in patients treated with nephron-sparing surgery p. 1396
F Kizilay, U Eskidemir, T Bahceci, A Simsir, H Ozdemir, B Sarsik, B Turna
DOI:10.4103/njcp.njcp_267_18  
Background: Nephron-sparing surgery (NSS) is currently the recommended treatment modality for selected renal tumors. The prognostic significance of positive surgical margin (PSM) and surgical margin width (SMW) after NSS is controversial. Aim: To evaluate the effect of PSM and SMW on cancer-specific survival (CSS) in patients who underwent NSS. Materials and Methods: The pathological samples of 142 patients who underwent NSS were reviewed. Patients were divided into two groups with PSM and negative surgical margin (NSM), and after that those with PSM were divided into two groups according to SMW as those with 0.1–2 mm and those >2 mm. CSS was calculated using Kaplan–Meier method. Cox regression analysis was used to adjust the clinicopathologic variables. A P value < 0.05 was considered statistically significant. Results: Local recurrence rate and distant metastasis rate were higher in patients with PSMs than those with NSMs (P = 0.018 and P = 0.039, respectively). However, there was no significant difference between the two groups in terms of CSS. In the group with SMW 0.1–2 mm, the tumor diameter was longer (P = 0.018), enucleation number was higher (P = 0.026), and local recurrence was higher (P = 0.034) than the group with SMW > 2 mm. There was no significant difference between the two groups in terms of CSS. Conclusion: In patients who underwent NSS, PSMs and SMWs have a negative effect on local recurrence but have no significant effect on CSS.
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Are empathy and emotional intelligence missing in dental practitioner's toolkit in Saudi Arabia? A cross-sectional study p. 1403
ST Gokhale, SM Al-Qahatani, RS Raj, BS Al-Qahatani, SK Vaddamanu, AA Jathmi, WA Alshehri, RR Nagati
DOI:10.4103/njcp.njcp_605_18  
Background: Empathy and emotional intelligence (EI) of a dentist are two factors vital for developing fruitful relations between clinicians and patients. Establishing a good relationship with patients may improve patients' outcomes. Data on empathy and EI in dental practitioners in the Kingdom of Saudi Arabia is scarce. Aims: Hence, we aimed to evaluate and compare empathy and EI among dental practitioners in Abha and Khamis Mushayat cities of Saudi Arabia. Methods: We conducted a cross-sectional survey study. A total of 183 dental practitioners who were reachable at survey time were included. A self-administered questionnaire on empathy and EI was structured based on Jefferson Scale of Physician Empathy (health professions version) and Schutte's Emotional Intelligence Scale, respectively. Statistical analysis was done using Mann–Whitney and Kruskal–Wallis tests. Results: No significant difference was observed between both genders regarding empathy and EI (P = 0.73 and 0.97, respectively). Similarly, no significant difference was observed between participants with different qualifications or different work settings (P > 0.05). However, a statistically significant positive correlation was observed between empathy and EI (r = 0.722). Conclusions: Irrespective of gender, qualification, or different work settings, dental practitioners in both cities showed adequate empathy and EI levels. Dentists with high empathy scores seem to show high EI levels. Clinical Significance: Evaluating and monitoring empathy and EI practice among dental practitioners have paramount importance to improve clinical practice and healing potential of patients. Low levels of empathy and EI practice would suggest modifications to training curriculum or healthcare policies.
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Treatment of primary hepatic carcinoma through ultrasound-guided microwave ablation p. 1408
L Fang, X Meng, W Luo, XD Zhou
DOI:10.4103/njcp.njcp_368_18  
Objective: To study the clinical effect of ultrasound-guided microwave ablation on primary hepatic carcinoma. Method: The subjects comprised 94 patients with primary hepatic carcinoma who were admitted to our hospital between August 2014 and November 2016. They were divided into two groups in accordance with a random-number table. The control (n = 47) and study (n = 47) groups received conventional surgical excision and ultrasound-guided microwave ablation, respectively. The operation duration, clinical effect, complication occurrence rates, and hepatic functions of the two groups were compared. Results: The control group exhibited longer duration of operation and length of stay but significantly lower quantities of intraoperative bleeding and blood transfusion (P < 0.05) than the study group. The study group demonstrated significantly higher (P < 0.05) effective rate of treatment but significantly lower (P < 0.05) occurrence rate of complications than the control group. The study group exhibited significantly higher (P < 0.05) albumin and total bilirubin levels but significantly lower alanine aminotransferase and aspartate transaminase levels than the control group. No difference was observed in prothrombin time between the two groups (P > 0.05). Conclusion: Ultrasound-guided microwave ablation treatment offers the advantages of minor injury and low complication occurrence rates. Moreover, it is associated with faster postoperative recovery and improved hepatic function. Thus, it is worthy as a clinical option and must be promoted and applied.
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Surgical outcomes and clinical courses of solitary fibrous tumors of pleura p. 1412
F Yanik, YA Karamustafaoglu, Y Yoruk
DOI:10.4103/njcp.njcp_213_18  
Aim: This study's aim is to define the clinicopathological and surgical outcomes, clinical courses, and results of long-term follow-up of cases that underwent surgical treatment for solitary fibrous tumors of the pleura (SFTp). Subjects and Methods: Clinical and long-term follow-up records of 16 consecutive patients who had surgery for SFTp between 2006 and 2016 were reviewed in the retrospective chart review. There were nine males (56%) and seven (44%) females with an average age of 60.5 ± 17.1 (range 30—87 years). Etiological factors, diagnostic procedures, clinical and surgical outcomes, 5-year overall survival (OS), and disease-free survival (DFS) in these patients were researched. Results: There was no remarkable common etiological factor. Nine of the cases were asymptomatic. Other symptoms were chest pain, dyspnea, cough and hypertrophic osteoarthropathy, respectively. Thoracotomy for the removal of pleural mass was carried out in 15 (94%) cases. Additional resection procedures included the chest wall resection in two cases and lobectomy in two. Video-assisted thoracoscopic surgery (VATS) resection was performed in one (6%) case. Complete surgical excision was performed in 74% of cases. Nineteen percent of cases were malignant SFTp (mSFTp). One of the mSFTp cases died in the 19th month after the diagnosis. The mean follow-up time was 50.6 ± 34.2 months (2--114 months). Mean survival of mSFTp patients was 40.6 ± 19.08 months (19--55 months) and that for benign SFTp (bSFTp) was 52.9 ± 37.05 months (2--114 months). Five-year OS--DFS were 93.5% and 74%, respectively. Conclusion: SFTp is an uncommon benign neoplasm but it can have malignant features. Even in the case of recurrence, the main treatment is total surgical excision. Oncologic treatments can be tried in unresectable and metastatic cases. VATS can be used in surgical total excision for small diameter and appropriate tumors. Understanding the nature of these tumors, immunohistochemical, and genetic studies may be a guide in future.
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Changes in thyroid volume and insulin-like growth factor 1 in pre- and post-pubertal obese children p. 1417
M Karaoglan, O Balci, M Keskin
DOI:10.4103/njcp.njcp_262_19  
Background: There is a mutual dynamic interaction between thyroid volume (TV), insulin-like growth factor-1 (IGF-1), and body mass index (BMI). These covariates undergo a change with the transition into puberty. The heterogeneity of the variates and study populations complicate the evaluation of the role of pure pubertal effect. Objective: The purpose of this study was to investigate the effect of puberty on IGF-1 and TV in a predetermined homogenous population such as obese children. Subjects and Methods: Three hundred and eighty children (202 girls and 178 boys) aged between 6 and 18 were enrolled in this prospective study. The children were assigned to two groups according to their pubertal status, i.e., prepubertal (n = 169) and postpubertal (n = 211). According to age and sex, the obese group (n = 222) was made up of children at and above the 95th percentile, and the control group (n = 158) of children under the 85th percentile. The following parameters were evaluated in all children: BMI, pubertal status, TV, and serum IGF-1, IGFBP-3, and IGF-1:IGFBP-3 molar ratio. Results: In comparison to the prepubertal obese group, the obese group at Tanner stage 2 had a larger mean TV (P = 0.008) and higher IGF-1 level (P = 0.033). There was a positive correlation between IGF-1 and TV both in the prepubertal and pubertal group (r169= 0.369, P = 0.001; r211= 0.316, P = 0.004, respectively), whereas there was no correlation between IGF-1 and BMI (r169= 0.99, P = 0.092; r211= 0.094, P = 0.088, respectively). Conclusion: This study showed that the TV and serum IGF-1 levels were increased in obese children in the early stage of puberty and that there was a positive correlation between these two variables in all children, which shows the specific effect of the early stage of puberty on the increase in TV and IGF-1 levels and suggests that increased TV is associated with the increase in IGF-1 levels in a homogenous group such as obese children.
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The morphology of proximal tibia geometry amongst the Igbos of South East Nigeria and its implication in total knee replacement p. 1423
AU Katchy, AU Agu, IT Ikele, E Esom, NJ Nto
DOI:10.4103/njcp.njcp_93_19  
Background: The morphological parameters of the proximal tibia play a major role in total knee replacement and there are ethnic and gender variations to these parameters. Aim: To evaluate parameters of the proximal tibia geometry amongst the Igbos of South Eastern Nigeria and discuss the clinical implications in total knee replacement. Methods: The proximal tibia parameters of 558 adult tibiae bones, 300 right-sided and 258 left-sided, collected from the osteological unit of the department of anatomy University of Nigeria Enugu campus were measured using a Venier calipers. Results: The values of the determined parameters are as follows: anterior posterior dimension (APD): 5.50 cm, medial lateral dimension (MLD):7.53 ± 5.56 cm, proximal length (PL): 7.32 ± 0.67 cm, proximal width (PW) CM: 4.10 ± 0.30 cm, medial tibia posterior slope (MTPS):11.36 ± 4.15° and lateral tibia posterior slope (LTPS):5.65 ± 2.72°. The correlation test between these parameters of the proximal tibia shows a strong significant correlation between LPTS and MPTS (r =0.814, P <.001). The comparison of the means of the MPTS of both sides using independent samples t test shows a mean difference that is not significant (p =0.628). A comparison of the values with other populations shows significant mean difference for MLD with that of Chinese and American populations (p <.05). The mean difference between the APD of this study and the Chinese is significant (p =0.007). A comparison of MPTS and LPTS for Malaysian, Chinese, and white Americans shows a significance difference for all the three populations (p <.05). Conclusion: These determined values should be taken into consideration during tibia surface coverage in total knee replacement amongst the Igbo population.
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Is there any association between jugular venous reflux and nonpulsatile subjective tinnitus? A preliminary study of four-dimensional magnetic resonance angiography Highly accessed article p. 1430
D Yildirim, D Alis, S Turkmen, A Bakir, D Temirbekov, C Samanci, Ali Ahmet Sirin, FE Ustabasioglu
DOI:10.4103/njcp.njcp_128_19  
Objective: To demonstrate whether there is an association between jugular venous reflux and nonpulsatile subjective tinnitus (NST) using real-time four-dimensional magnetic resonance imaging (MRI) angiography. Materials and Methods: Patients with unilateral NST who underwent contrast-enhanced MRI with a special protocol were included in the study. Thick slab dynamic maximum intensity projection images were obtained including interleaved stochastic trajectories (TWIST)-MRI examination. All patients were requested to perform Valsalva maneuver during the sequence. Jugular venous reflux grading was performed as follows: absence of reflux or if reflux does not reach the base of the skull: grade 0; if reflux reaches the jugular bulb, but no intracranial contrast is observed: grade 1; and if reflux extends into the intracranial cortical veins and/or the cavernous sinus above the jugular bulb: Grade 2. Results: A total number of 30 patients, 23 male and 7 female, were included in the study. Jugular venous reflux was not identified (Grade 0) in 20 patients. Grade 1 reflux was determined in 7 cases and Grade 2 reflux was observed in 3 cases. Notably, only patients with Grade 2 reflux described worsening of their tinnitus symptoms during the examination and their daily activities as well. Conclusions: NST might also be associated with hemodynamic problems of the venous system and the MRI protocol starting with TWIST accompanied with Valsalva maneuver is not well-known, yet seems to be a feasible and beneficial method to detect potential jugular venous reflux in NST patients.
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Evaluation of the effects of hemoglobinopathies on the mandible with fractal dimension analysis p. 1435
G Serindere, CA Belgin
DOI:10.4103/njcp.njcp_196_19  
Aims: The aim of this study was to evaluate the mandibular bone changes on panoramic radiographs of thalassemia and sickle cell anemia (SCA) patients using fractal dimension (FD) analysis and to compare the findings obtained from healthy individuals. Materials and Methods: A total of 90 panoramic radiographs (from 30 patients with thalassemia, 30 patients with SCA and 30 healthy individuals) were assessed to measure FD, mandibular cortical width (MCW), panoramic mandibular index (PMI) in the mandible. Three region of interests (ROI) of angulus, corpus, and interdental bone were created. FD was calculated using ImageJ program. Results: In thalassemia group, the mean value of FD was 1.11, 1.03, and 1.02 in interdental bone, corpus, and angulus, respectively. In SCA group, the mean value of FD was 1.10, 1.05, and 1 in interdental bone, corpus, and angulus, respectively. In control group, the mean value of FD was 1.09, 1.04, and 1 in interdental bone, corpus, and angulus, respectively. FD value of interdental bone are significantly higher in thalassemia group than control group. FD values of corpus and angulus values did not show a significant difference between the groups. Conclusions: Fractal analysis may be used and recommended for evaluation of the bone changes induced by hemoglobinopathies.
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Effect of surface treatments to remove temporary cement remnants on the bond strength between the core composite and resin cement p. 1441
SH Altintas, K Hamiyet, S Kilic
DOI:10.4103/njcp.njcp_174_19  
Background: There was no enough data about the appropriate surface cleaning of core composite material after temporary cementation. Aim: To evaluate the effects of surface cleaning techniques on initial shear bond strength (SBS) between core composite material and resin nanoceramic crown materials after temporary cementation. Material and Methods: Cubic specimens were prepared from prosthetic materials, including Lava Ultimate. Cylinder-shaped composites were cemented to glass slides with eugenol-free temporary cement, resulting in a total of 44 cylinders (n = 11). The surfaces of composite cylinders were then cleaned with an Er, Cr:YSGG laser, 37% orthophosphoric acid, yellow tape diamond bur, or dental explorer. Cleaned cylinders were bonded to cubic specimens with resin cement. Initial SBS tests were performed with a universal testing machine at 0.5 mm/min crosshead speed. One-way ANOVA and post hoc Tukey tests were used to analyze the obtained data (P =0.05). Results: Initial SBS values were significantly affected by the different surface cleaning methods (P <.05). The highest SBS value was obtained with the laser group (SBS = 17.14), while the lowest was obtained with dental explorer group (SBS = 5.95). There was no significant difference between the diamond bur group and the laser group (P =0.982). Conclusions: Laser irradiation or yellow tape diamond bur cleaning of the core composite surface could be recommended to strengthen bond strength between the resin luting cement and the core composite. Before adhesive or conventional cementation of prosthetic restoration, the core composite surface should be cleaned.
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CBCT analysis of schneiderian membrane thickness and its relationship with gingival biotype and arch form p. 1448
S Chaturvedi, SB Haralur, MK Addas, MA Alfarsi
DOI:10.4103/njcp.njcp_186_19  
Objective: The purpose of this study was to investigate a relationship between gingival tissue biotypes and arch form with Schneiderian membrane thickness, using limited cone beam computed tomography. Materials and Methods: A total of 90 subjects were selected. For each subject three parameters were assessed – gingival biotype - clinically by Probe transparency method as thin or thick and coded as 0 and 1, respectively, gingival thickness and Schneiderian membrane thickness in mm, arch form as square, oval, or tapered (radiographically by cone beam computed tomography images). Central incisors and first molars were assessed for gingival biotype and gingival thickness and Schneiderian membrane thickness was determined at 16. Numerical data were estimated for normal distribution. Analysis of Variance test was followed by Tukey honestly significant difference test and Pearson's correlation coefficient test for analysis. Results: Thin gingival biotype was found associated with the central incisors and thick gingival biotype with molars. Limited cone beam computed tomography scans evaluation revealed highest prevalence of square arch form followed by oval, and tapered. The average thickness of the Schneiderian membrane was 1.18 ± 0.43 mm on left side and 1.09 ± 0.41 mm on right side with a range of 0.50 – 2.00 mm. Mean Schneiderian membrane thickness was more in case of thick gingival biotype and with square arc form both on right and left sides. Conclusions: The Schneiderian membrane thickness was positively and highly associated with gingival biotype. The gingival biotype and arch form had significant effect on Schneiderian membrane thickness and can provide valuable clinical information on Schneiderian membrane thickness preoperatively for implant placement and sinus lift procedures.
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CASE REPORTS Top

Cyst of the canal of nuck: A rare cause of inguinal swelling in women p. 1457
T Erol, MB Uner, D Karakoc, E Hamaloglu
DOI:10.4103/njcp.njcp_588_18  
Among various reasons of swellings in the female inguinal region nuck canal cysts are rare entities. Abnormal persistence of procesus vaginalis opening cause this formation. Presentation at adults can lead misdiagnosis. Inguinal hernia, tumors (benign or malign), cysts, lymphadenopathies and endometriosis are other common reason for female groin swelling. Once diagnosed surgical excision is definitive treatment.
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The use of expandable metallic airway stent in a baby with tracheomalacia: A case report p. 1459
A Ulusan, L Elbeyli
DOI:10.4103/njcp.njcp_595_18  
Tracheobronchomalacia is a rare condition in the pediatric age group which may be life-threatening when it occurs. The common form of tracheomalacia is congenital, presenting with wheezing and cough. We report a case of a 65-day-old baby who was treated with non-invasive mechanical ventilation due to respiratory distress since the day of birth. Tracheomalacia was diagnosed based on the physical examination and the thorax computerized tomography (CT) findings. Patient was initially treated with noninvasive positive pressure ventilation and thereafter, fitted with a tracheobronchial conical fully-covered self-expandable nitinol stent. After stent insertion and the respiratory situation of the patient improved, ventilatory weaning and extubation were possible. A careful selection of suitable patients, appropriate stent type and the site, where it has to be placed is mandatory for successful airway stenting. Also, children must be adequately followed-up to prevent the possible life-threatening complications after stent insertion.
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LETTER TO EDITOR Top

Comment on: “Value of procalcitonin levels as a predictive biomarker for sepsis in pediatric patients with burn injuries” p. 1462
Z Sahraei, B Abtahi-Naeini, A Saffaei
DOI:10.4103/njcp.njcp_414_19  
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