Medical and Dental Consultantsí Association of Nigeria
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   Table of Contents - Current issue
November 2018
Volume 21 | Issue 11
Page Nos. 1391-1547

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A comparative study of gloved versus ungloved merocel® as nasal pack after septoplasty p. 1391
J Kaur, M Singh, I Kaur, A Singh, S Goyal
DOI:10.4103/njcp.njcp_414_17  PMID:30417834
Introduction: Septoplasty or septal reconstruction is a corrective surgical procedure performed to straighten the nasal septum. It may be associated with numerous complications. To minimize these complications, both nasal cavities are frequently packed with different types of nasal packing. Materials and Methods: This prospective, observational, and comparative study was undertaken in the Department of ENT, Rajindra Hospital, Patiala, Punjab, India. A total of sixty patients fulfilling the inclusion criteria participated in the study. They were divided into two groups, Groups A and B. After septoplasty, the nasal cavity was packed with gloved Merocel® in Group A and ungloved Merocel® in control group (Group B). The efficacy and patient tolerance for both nasal packings were compared and assessed. The data collected were compiled and analyzed statistically. Results: In our study, it was demonstrated that gloved Merocel® produces less pain during pack insertion (P = 0.001) and produces less pain while insertion of pack in situ (P = 0.001) and during pack removal (P = 0.001). Saccharin transit time (STT) returned back to normal in gloved Merocel® group (P = 0.001) in most of patients (27) by the 2nd week, whereas STT in ungloved Merocel® group returned back to normal by the 4th week postoperatively. The differences in impairment in STT between the two groups were found to be statistically significant. There was no statistical significance between both groups for other parameters. Conclusion: Gloved Merocel® may be preferred over ungloved Merocel® as nasal packing following septoplasty since both types of packs had similar hemostatic, adhesion prevention properties and similar incidence in postoperative complications and gloved Merocel® produces less pain during its insertion, while it is in situ, during its removal with early recovery of nasal mucociliary clearance mechanism of nose.
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The economic burden of malignant and premalignant hematological diseases in Southern Nigeria p. 1396
KI Korubo, HC Okoye, CC Efobi
DOI:10.4103/njcp.njcp_278_18  PMID:30417835
Background: Hematological malignancies are a significant cause of morbidity and mortality. They constitute an economic burden for the patients, their relatives, and the society because of the cost associated with their management, which is usually long term. We aimed to determine the total direct cost of managing patients with premalignant hematological disorders (PMHDs) and malignant hematological disorders (MHDs). Materials and Methods: A hospital-based retrospective study was carried out between 1997 and 2015. Data were retrieved from the case notes of adult patients diagnosed with either PMHD or MHD. The total cost of medical care was calculated as the sum of in-patient and out-patient direct cost associated with their management. Data were analyzed using Statistical Package for Social Sciences. Results: There was a total of 129 patients; 74 (57.4%) males and 55 (42.6%) females with mean age of 45.7 ± 16.3 years and the majority (n = 76, 58.9%) being employed. Males were more affected than the females except in chronic lymphocytic leukemia, myelodysplastic syndrome, and paroxysmal nocturnal hemoglobinuria. The commonest MHD was chronic myeloid leukemia with 37 (28.7%) patients. Full blood count was the commonest investigation done, whereas free light chains were the least (n = 2; 1.6%). The total cost of care for the 129 patients was N30,041,900.00 ($82,306.58) with an average total cost of care per patient of N232,882.95 ($638.04). Patients with non-Hodgkin lymphoma had the highest mean cost of care per patient (N373,196.30; $1,022.46). The average monthly expenditure per patient was about N70,000 ($190). Conclusion: In our setting, management of CHDs constitutes an economic burden.
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Evaluation of normal tibial tubercle to trochlear groove distance in adult Turkish population p. 1403
A Ortug, T Ormeci, N Yuzbasioglu, S Albay, M Seker
DOI:10.4103/njcp.njcp_11_18  PMID:30417836
Purpose: Many studies have confirmed the significance of tibial tuberosity-trochlear groove (TTTG) distance measurement for the preoperative assessment of tibial tubercle osteotomy and refixation of the patients that need surgery. TTTG distance is being used as threshold value for surgery decision. The purpose is to determine the TTTG values for the adult Turkish population and compare this with the values of other studies and establish a possible index. Materials and Methods: This study was conducted on 200 patients (97 female, 103 male) aged between 18 and 65 years, retrospectively, who had magnetic resonance imaging at Istanbul Medipol Mega University Hospital Radiology Department. Individuals with no knee surgical history and deformation included to research group, any deformities related with knee were excluded. The scans were analyzed in Picture Archiving Communication System program and compared with other populations. Significance was evaluated with independent Student's t-test. Results: The mean TTTG distance was found 10.07 ± 1.60 mm in males, 9.96 ± 1.41 mm in females, and 10.02 ± 1.51 mm for total cases. There was no statistically significant difference between sex (P > 0.05). However, overall TTTG distance of right and left knees found significantly different (P < 0.05). Conclusion: Obtained results are similar with the results of Caucasian population but different than Asian. It is believed that these results will be significant in evaluation of patellofemoral disorders and helpful in treatment.
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The relationship between fatigue and breastfeeding self-efficacy p. 1408
S Fata, SU Atan
DOI:10.4103/njcp.njcp_366_17  PMID:30417837
Background: Postpartum fatigue appears in the early weeks and after childbirth has a clear impact on maternal functioning and breastfeeding. Aim: This study aimed to examine the relationship between fatigue and breastfeeding self-efficacy. Materials and Methods: This descriptive study was conducted at three family health centers (FHCs) in Izmir, Turkey, between June 2013 and March 2014. We used the Self-Description Form for Mothers, the Breastfeeding Self-Efficacy Scale Short Form (BSES-SF), and the Brief Fatigue Inventory (BFI) to collect data from 184 breastfeeding women during the postpartum period. Results: At week 1 postpartum, 98.9% of the mothers in this study experienced fatigue; of those, 12.6% had minor fatigue, 48.3% had moderate fatigue, 36.8% had excessive fatigue, and 0.7% had the highest level of fatigue. At week 8 postpartum, 46.7% of the mothers experienced fatigue, 50.0% of whom experienced fatigue on a minor level, 16.2% on a moderate level, and 2.5% on an excessive level. The present study found that 55.4% and 1.1% of the mothers had BSES-SF mean scores below 50 at weeks 1 and 8 postpartum, respectively. The mean BSES-SF score was 51.21 ± 6.95 (min–max = 19.00–70.00) at week 1 postpartum, which increased to 64.54 ± 9.65 (min–max = 15.00–70.00) at week 8 postpartum. The statistical results indicated that there were no significant relationships between the BSES-SF and the BFI at week 1 postpartum (r = 0.007, P > 0.05) and week 8 postpartum (r = 0.111, P > 0.05). Conclusion: In this study, the mothers' fatigue during the postpartum period was not associated with breastfeeding self-efficacy. Many of the variables identified may be considered modifiable and amenable to interventions. Targeted interventions should be directed toward improved breastfeeding outcomes among Turkish women.
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Comparison of the prevalence of adhesions at the time of diagnostic laparoscopy for infertility between patient who had open myomectomy and those who had no previous pelvic-abdominal surgery or pelvic inflammatory disease p. 1415
JI Ikechebelu, GU Eleje, NN Joe-Ikechebelu, CD Okafor, AO Akintobi
DOI:10.4103/njcp.njcp_39_17  PMID:30417838
Objective: The aim of this study is to determine the prevalence and patterns of adhesions in infertile women with prior open myomectomy compared with women without prior pelvic-abdominal surgery. Methods: A nested case-control study of infertile women who had diagnostic laparoscopy after open myomectomy between January 2008 and June 2015 in Life Institute for Endoscopy Limited, Nnewi Nigeria, was conducted. At diagnostic laparoscopy, the presence, site, and quality (density) of adhesions was noted and recorded. Women with endometriosis and documented prior pelvic infections were excluded. Results: Of the 348 women who were eligible, 121 women had prior open myomectomy (study group) while 227 had none (control group). Of the 121 women, adhesions were detected in 97 women; thus, the prevalence of adhesion after open myomectomy was 80.2% versus 20.3% (46/227) in controls (odds ratio [OR] =15.90; 95% confidence interval [CI] =8.86–28.76; P < 0.001). Compared with controls, adhesions were statistically higher in these sites: uterus (68.6% vs. 14.5%), fallopian tubes (77.7% vs. 16.7%), ovaries (62.8% vs. 20.3%), cul-de-sac (66.1% vs. 16.3%), bladder (45.5% vs. 7.9%), and bowel (53.7% vs. 6.2%) (P < 0.001, for all). Cohesive form of adhesions was also statistically higher, 54 (44.6%) vs. 32 (14.1%) (P < 0.05). Conclusion: In infertile women, post-open myomectomy adhesions have a high prevalence of 80.2% with high predilection in fallopian tubes and uterus, compared with women without prior abdominopelvic surgery at 20.3%. Cohesive form of adhesion predominates.
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Determination of the relationship between patient satisfaction and some global economic indicators using multidimensional scaling p. 1422
O Gorgulu
DOI:10.4103/njcp.njcp_218_17  PMID:30417839
Context: The importance of labor that contributes to the economy and economic power of the country is increasing recently. There is a strong link between health and economy. People are happier, more productive, and provide more contribution to the economy in communities of healthy individuals. In countries with strong economy, serious economic investments are made in the field of health to grow healthy individuals. Aim: The purpose of this study is to determine whether patient satisfaction in primary healthcare services is related to economic strength of countries. Materials and Methods: The data of European Patients Evaluate General/Family Practice (EUROPEP) scale from 2011 at 17 Organization for Economic Co-operation and Development (OECD) countries are used. The data were compiled from OECD reports and Republic of Turkey Ministry of Health Refik Saydam Hygiene Center Presidency School of Public Health patient satisfaction with primary healthcare services reports. Statistical Analysis Used: 17 OECD member countries in 2011 health expenditure data, some health indicators, and patient satisfaction are determined to show how grouping in two-dimensional space with the multidimensional scaling. Results: It was observed to vary by countries and groupings that they located in terms of all three criteria. In some countries' economic and health indicators, although quite high compared to the OECD average, citizen satisfaction of healthcare services was low. In some countries, although health expenditure and health indicators are far below the OECD average, citizens' satisfaction with health services has proved to be very high. Conclusion: Multidimensional scaling analysis findings reveal that countries have different positions and groups in terms of each three indicators. According to these results, it cannot be said that high expenditures in the field of health will affect patients satisfaction. Having a strong economy or spending too much money on health does not increase human satisfaction in health care. Effective expenditures on the field of health will increase healthcare service satisfaction. Policy-makers should consider international criteria and take the right steps according to citizens' expectation and satisfaction of healthcare service to implement effective spending.
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The prevalence of microalbuminuria and associated factors among patients with type 2 diabetes mellitus in Botswana p. 1430
OJ Molefe-Baikai, M Molefi, F Cainelli, GM Rwegerera
DOI:10.4103/njcp.njcp_224_18  PMID:30417840
Background: Microalbuminuria (MA) has been established as an early marker of both diabetic nephropathy and vascular disease in patients with diabetes mellitus (DM). Aims: This study was conducted to determine the prevalence of MA and associated factors among patients with type 2 DM in Botswana. Settings and Design: Outpatient tertiary clinic. Materials and Methods: A cross-sectional descriptive study involving 289 patients with type 2DM was conducted from January 2013 to June 2013 in Block 6 Reference Clinic, a tertiary clinic in Gaborone, Botswana. A random spot urine sample was collected from each patient with MA defined as urine albumin-to-creatinine ratio (ACR) between 3.0 and 30.0 mg/mmol. Statistical Analysis Used: Data analysis was done using STATA version 12 (College Station, TX, USA). Unpaired Student's t-test was used for compairing means and Chi-squared test was used for comparison of proportions between groups. A P value of <0.05 was considered statistically significant. Results: The majority of recruited patients (191, 66.1%) were females, and the median age (interquartile range) of the patients was 52 (42–53) years. The mean glycosylated hemoglobin (HbA1c) for the study population was 8.43% with 70.6% of the population having HbA1c over 7%. MA was found in 129 (44.6%) of study participants. The duration of diabetes of 6–10 years, estimated glomerular filtration rate, HbA1c, and higher serum trigerycides levels were significantly associated with presence of MA. Conclusion: High prevalence of MA raises an urgent need for changes in the management of patients with type 2 DM in Botswana, with emphasis on prevention and reduction of MA to avoid development of overt diabetic nephropathy and ensuing cardiovascular morbidity and mortality.
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Pattern of blood donation and characteristics of blood donors in Enugu, Southeast Nigeria p. 1438
AO Ugwu, AJ Madu, CC Efobi, OG Ibegbulam
DOI:10.4103/njcp.njcp_346_17  PMID:30417841
Background: Despite increasing need for blood donation in medical practice, little is known about pattern of blood donation and characteristics of blood donors in some African populations like Nigeria. This information is necessary in designing strategies and policies for improving blood transfusion services in Africa. Aim: The aim of this study is to determine the pattern of blood donation and characteristics of blood donors in Enugu, Southeast, Nigeria. Materials and Methods: A cross-sectional study of 3377 blood donors at a tertiary hospital in Enugu, Nigeria from May 1, 2016 to April 30, 2017. Information sought included donors' sociodemographic characteristics; type of blood donor: Voluntary nonremunerated donor (VNRD), family replacement donor (FRD), or paid donor (PD); willingness to become VNRD in the future after counseling and education (at point of entry to blood bank) on its benefits to clinical practice; hemoglobin (Hb) level; and transfusion transmissible infections (TTIs). Results: Mean age of blood donors was 28.8 ± 8.5 years, majority were male (3011, 89.2%) and students (1289, 32.8%). FRDs were the highest in number (1998, 59.2%), followed by PDs (746, 22.1%) and finally VNRDs (633, 18.7%). Of the 3377 persons that came for blood donation, 2537 (75.1%) were found eligible to donate while 840 (24.9%) were deferred on account of low Hb (602/3377, 17.8%) or positive infectious screening test (238/3377, 7.0%). The odds of a male donor being a VNRD were about one and half times that of a female donor (582/3011 [19.3%] vs. 51/366 [13.9%]; odds ratio: 1.48; 95% confidence interval: 1.09–2.02; P = 0.01). After counseling of FRDs and PDs, majority (54.3%) were willing to become VNRDs in the future. Donors' age >30 years, being of male sex, having tertiary level of education, and being employed were strongly associated with willingness to become VNRDs in the future (P < 0.001). Conclusion: VNRD made up <20% of the total number of donors in Enugu, Nigeria. There is a need for improvement in public enlightenment on the need for VNRDs and employment opportunities of the populace to improve voluntary blood donation.
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The efficacy of resin infiltrate on the treatment of white spot lesions and developmental opacities p. 1444
ZZ Ciftci, S Hanimeli, H Karayilmaz, OE Gungor
DOI:10.4103/njcp.njcp_235_18  PMID:30417842
Objectives: The aim of this study was to evaluate the changes in opacities by applying resin infiltrate to developmental enamel opacities and applying resin infiltrate or fluoride varnish to white spot lesions (WSLs). Materials and Methods: A total of 132 teeth with WSLs and developmental enamel opacities were included in the study. WSLs were treated with resin infiltrate (Group 1) and fluoride varnish (Group 2), and developmental enamel opacities were treated with only resin infiltrate (Group 3). Lesions were evaluated in accordance with International Caries Detection and Assessment System (ICDAS II) criteria and DIAGNOdent Pen scores before applying the material (T0), just after the application (T1), and after 1 month (T2) and 3 months (T3). Results: A significant decrease in DIAGNOdent Pen scores was observed in all the groups and the most important decrease was seen in Group 2 (P < 0.05). A significant decrease in ICDAS II scores was observed in Groups 2 and 3 (T0–T1) and Group 1 (T1–T2) (P < 0.05). Conclusion: DIAGNOdent pen scores decreased and the lesion was partially masked after resin infiltrate was applied to treat developmental enamel opacities; the resin infiltrate application, however, was more successful than fluoride varnish on WSLs. Treating WSLs with resin infiltrate was a good option due to shorter term esthetic recovery and high patient satisfaction.
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Incidence of pyramidal thyroid lobe in the university college hospital Ibadan p. 1450
OO Ayandipo, OO Afuwape, OY Soneye
DOI:10.4103/njcp.njcp_326_17  PMID:30417843
Introduction: The pyramidal lobe of the thyroid gland is derived from remnant of the thyroglossal duct. Its presence may be missed clinically; however radiologic and intra-operative findings reveal its presence in up to 50% of cases. The incidence of pyramidal lobe is however not clearly known in Sub-Saharan Africa, particularly in Nigeria. Our aim is to determine the incidence and histological variation of pyramidal lobe of the thyroid gland among surgical patients who underwent thyroid surgery in the University College Hospital, Ibadan. Methodology: Consecutive surgical patients that underwent total thyroidectomy in the Endocrine Surgery Division, Department of Surgery, University College Hospital, Ibadan between April 2013 and April 2017 were recruited irrespective of age, sex and clinical diagnosis. The presence, anatomy and subsequent histological diagnosis of the pyramidal lobe were noted. Results: One hundred sixty thyroid surgeries were done. Pyramidal lobe was found in 70 patients (44.0%). The presence of the pyramidal lobe was most often associated with multinodular goitres 42 (61.8%) and least found in thyroids with malignant tumours 3 (4.4%). The pyramidal lobe originated commonly from the midline (50.0%) and least from the right (10.3%). The length of the pyramidal lobes ranged from 8 to 80 mm (average 50 mm) in males and 5 to 54 mm (average 42 mm) in females. Conclusion: The presence of a pyramidal lobe is not uncommon in people of southwestern Nigeria with its morphologic and histologic profile akin to what obtains in other geographical locations of the world.
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Dental fear in primary school children and its relation to dental caries p. 1454
FA Alsadat, AA El-Housseiny, NM Alamoudi, DA Elderwi, AM Ainosa, FM Dardeer
DOI:10.4103/njcp.njcp_160_18  PMID:30417844
Background: Successful management of dental fear in children prevents its progression into adulthood. This study aimed to assess the level of dental fear among school children and to determine its relationship with dental caries. The study design was a cross-sectional analytical study. Materials and Methods: A sample of 1,546 primary school children were randomly selected. The Children's Fear Survey Schedule–Dental Subscale (CFSS-DS) was completed in class to assess child dental fear. Caries experience was measured as decayed, missed, and filled permanent and primary teeth (DMFT/dmft) according to the World Health Organization (WHO) criteria. Results: Approximately 24% of the participated children had high dental fear, and 12.50% of them had severe dental fear. Girls had higher rate of severe dental fear than boys (20% vs. 5%). The severity of caries was significantly increased in children who had higher fear scores (P = 0.035). Conclusion: About one quarter of 6- to 12-year-old children had dental fear; about half of them had severe dental fear. Dental fear has a direct relationship with decayed permanent teeth and an inverse relationship with restored permanent teeth.
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Comparison of sleep quality and quality of life indexes with sociodemographic characteristics in patients with chronic kidney disease p. 1461
A Karatas, E Canakci, E Turkmen
DOI:10.4103/njcp.njcp_146_18  PMID:30417845
Aims: Chronic kidney disease (CKD) is a serious health problem due to high mortality and morbidity, negative impact on the patients' quality of life (QOL), high diagnostic and therapeutic cost, and the burden on society. Sleep, which is one of the main needs of the human body, is important regarding the health and QOL in all ages. The objective of our study was to plan the quality of sleep and life quality in adults with CKD. Materials and Methods: Total 240 cases (91 healthy volunteers, 75 predialysis patients, and 74 hemodialysis (HD) patients) were included in our study. Our study was designed as a prospective survey with a face-to-face interview method. The sleep quality was evaluated with Pittsburgh Sleep Quality Index (PSQI). The WHO Quality of Life-short version (BREF) survey questions were used for QOL, and scoring was performed. Results: The analysis showed that the results of PSQI scores, QOL scores, and evaluation of the age variable were statistically significant (P = 0.001, P < 0.001, P < 0.001, respectively). Likewise, the PSQI scores were low in healthy volunteers but were the highest in predialysis patients. The scores of the HD patients were between the scores of predialysis and healthy volunteers. The score of the QOL increased with educational level. There was a positive correlation between Modification of Diet in Renal Disease (MDRD) level and QOL (P < 0.001; r = 0.260) and a negative correlation between MDRD level and PSQI score (P < 0.001, r = −0.202). Conclusion: Like in HD patients, close follow-up of predialysis patients with CKD is critical considering the resolution of the encountered problems. We believe that the increase in QOL and sleep in patients with CKD may decrease the morbidity.
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Parental monitoring and substance use among youths: A survey of high school adolescents in Lagos State, Nigeria p. 1468
OO Odukoya, OO Sobande, A Adeniran, A Adesokan
DOI:10.4103/njcp.njcp_15_16  PMID:30417846
Background: Risk behaviours including marijuana use, alcohol consumption and cigarette smoking have a significant impact on the present and future health of adolescents. There are limited studies in sub-Saharan Africa to show evidence, if it exists, of the relationship between parental monitoring practices and the prevalence of substance use among adolescents. The aim of this study is to assess the relationship between parental monitoring practices and alcohol consumption, cigarette smoking and marijuana use among in-school adolescents in Mushin Local Government Area of Lagos State, South-Western Nigeria. Methods: This was a cross-sectional survey of 437 in-school adolescents randomly selected from two schools in Mushin Local Government Area of Lagos State, Nigeria. Information on socio-demographic characteristics, the three domains of parental monitoring practices (Parental monitoring; negotiated unsupervised time and parental trust) and substance use were elicited using a modified version of parental monitoring practice scale and the Youth Risk Behaviour Surveillance System (YRBSS) questionnaire. Independent T tests and logistic regression models were used to assess relationship between parental monitoring practices and substance use. Results: The overall prevalence of use of any of the substance was 21.7%. Negotiated unsupervised time was significantly associated with use of alcohol (P < 0.05), marijuana (P < 0.05) and cigarette smoking (P < 0.05). After controlling for age and gender, one unit increase in parental monitoring reduced the odds of engaging in any substance use by 10% (AOR = 0.90, 95% CI = 0.81-0.99) while a similar increase in negotiated unsupervised time significantly increases the odds of any substance use by 7% (AOR = 1.07, 95% CI = 1.01-1.14). Conclusion: Of the three domains assessed, negotiated unsupervised time was consistently associated with substance use among these youth. Efforts to educate parents on the need to restrict unsupervised time of their wards may be warranted.
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Knowledge, risk perception and practices related to antibiotic resistance among patent medicine vendors in Sokoto metropolis, Nigeria p. 1476
KJ Awosan, PK Ibitoye, AK Abubakar
DOI:10.4103/njcp.njcp_69_18  PMID:30417847
Background: Resistance to antibiotics is now a serious threat to global health, and inappropriate use of drugs has been identified as a major contributing factor in the developing countries. Objectives: The aim of this study is to assess the knowledge, risk perception, and practices related to antibiotic resistance among patent medicine vendors (PMVs) in Sokoto metropolis, Nigeria. Materials and Methods: A cross-sectional study was conducted among 200 PMVs selected by multi-stage sampling technique. Data were collected with a set of pretested, self administered, semi structured questionnaire. Results: A larger proportion (83, 42.1%) of the 197 respondents who completed the questionnaire were aged 20 29 years. Most of them were males (80.2%) and had tertiary education (80.7%). Most of the respondents had adequate knowledge of the causes of antibiotic resistance (94.9%), and its prevention (98.0%). Most of the respondents also perceived antibiotic resistance as a serious threat to their own health (95.4%), and the health of their clients (89.4%). Practices favorable to the development of antibiotic resistance were very prevalent among the respondents. Majority of respondents (59.9%) consistently sell antibiotics to clients without doctor's prescription, and close to half of them (49.2%) consistently practice self-medication. Conclusion: Despite high levels of knowledge of the causes, prevention, and perception of the risks associated with antibiotics resistance, practices favorable to its development were very prevalent among PMVs in Sokoto, Nigeria. Government should regulate and closely monitor PMVs' practices in order to avert the looming crisis in medical practice that will become inevitable if there are no potent antibiotics.
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Preliminary data on clinical performance of bulk-fill restorations in primary molars p. 1484
B Oter, K Deniz, SB Cehreli
DOI:10.4103/njcp.njcp_151_18  PMID:30417848
Context: In pediatric clinic practice, bulk fill composite is gaining importance for shortened clinical time with a limited shrinkage. Aims: The present study evaluated the 1 year clinical performance of bulk fill composite and conventional composite material in occlusal caries of primary molars. Settings and Design: The study was designed as randomized single blind clinical trial and a total of 160 restorations were placed in the cavities of the 80 patients. Materials and Methods: Each patient received two restorations: one with Filtek Z250 (3M ESPE, St Paul, MN 55144, USA); the other restored with Filtek Bulk-Fill Restorative (FBF) (3M ESPE, St Paul, MN, USA). All restorations were clinically evaluated after baseline, 6 months, and 1 year in terms of retention, color matching, marginal discoloration, marginal adaptation, secondary caries, surface texture, anatomic form, and postoperative sensitivity. Statistical Analysis Used: Besides the descriptive statistical methods, the Friedman test and the Wilcoxon Signed Ranks were used. Results: Bulk fill was found to be worse compared to control with regard to postoperative sensitivity at baseline without statistical significance (P > 0.05). All of the evaluated restorations were retained and were still in function after 1 year (P > 0.05). With respect to marginal discoloration and marginal integrity, there were no significant differences between bulk fill and composite restorations at all intervals (P > 0.05). Conclusions: Based on this short term data, restoration of Class I cavities with both bulk fill and conventional composite restorations can be performed successfully. Postoperative sensitivity can be an issue with the restorations completed with Bulk fill restorative.
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Anisakiasis: The risks of seafood consumption p. 1492
K Furuya, H Nakajima, Y Sasaki, Y Urita
DOI:10.4103/njcp.njcp_256_17  PMID:30417849
Context and Aims: Japanese cuisine is now popular worldwide, and consumption of raw fish has thus increased at sushi bars and Japanese restaurants outside Japan. Anisakiasis, also known as herring-worm disease, is caused by ingesting larval nematodes in raw seafood and is a common illness in Japan. However, due to the rising popularity of Japanese food, gastroenterologists outside Japan need to be familiar with this disease. Subjects and Methods and Results: We treated 158 patients presenting with acute gastrointestinal manifestations caused by anisakiasis from April 1991 to April 2000. One or more nematodes were removed endoscopically within 48 h of presentation in 44% of these patients, which resulted in prompt resolution of symptoms. Major endoscopic findings were gastric ulcer accompanied by hemorrhage, erosion, redness, and edema of the gastric mucosa in areas penetrated by larvae and other areas. Conclusions: Endoscopy was valuable for the diagnosis and treatment of anisakiasis. We recommend endoscopy in suspected cases of anisakiasis. Moreover, it is desirable to combine complementary tests such as immunological tests/IgE measurement. As the popularity of Japanese cuisine increases, reports of anisakiasis are likely to be more frequent in countries other than Japan.
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Radiographic features associated with temporomandibular joint disorders among African, White, Chinese, Hispanic, and Indian racial groups p. 1495
S Obamiyi, S Malik, Z Wang, S Singh, EP Rossouw, L Fishman, C Feng, D Michelogiannakis, RH Tallents
DOI:10.4103/njcp.njcp_63_18  PMID:30417850
Context: Various radiographic features have been associated with temporomandibular joint disorders (TMDs); however, these characteristics have not been compared among different racial groups. Aims: To radiographically evaluate and compare craniofacial patterns and condylar findings suggestive of TMD among African, White, Chinese, Hispanic, and Indian racial groups. Settings and Design: This multicenter retrospective study used data from three private orthodontic practices and a University Orthodontic Clinic. Subjects and Methods: Panoramic and lateral cephalometric radiographs were collected from 250 subjects who were equally divided into five racial groups: Africans, Whites, Chinese, Hispanics, and Indians. All radiographs were initial records from patients seeking orthodontic treatment. Linear and angular cephalometric measurements were used to evaluate and compare cephalometric characteristics associated with TMD among groups. Panoramic radiographs were analyzed to compare the presence of condylar abnormalities and antegonial notching among groups. Statistical Analysis Used: One-way analysis of variance, followed by Tukey's test. Results: African and Chinese groups had the smallest mean cranial base measurements, while the Indians had the largest. The mean Y-axis value was significantly larger in the Chinese group compared with the other groups. Increased mandibular plane angles were seen in the Chinese and African patients, compared with subjects from other groups. The mean percentage of condylar anomalies was higher in the Chinese subjects compared with all other groups. Conclusions: Chinese patients presented with more radiographic features suggestive of TMD, whereas the Indians showed the least, compared with subjects from the White, Black, and Hispanic racial groups.
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Comparison of three different ketofol proportions in children undergoing dental treatment p. 1501
G Kip, D Atabek, M Bani
DOI:10.4103/njcp.njcp_188_18  PMID:30417851
Aim and Background: Sedation is gaining popularity among dental procedures in children. Ketamine and propofol mixture, known as ketofol, is one of the promising choices in sedation protocols; however, there is no consensus on the exact ratio of ketamine plus propofol especially in dental practice. The aim of present study was to compare perioperative side effect profiles, recovery profiles, and satisfaction rates of both parents' and dentists' following three different ratio of ketofol mixtures in children undergoing dental treatment. Materials and Methods: Three study groups each containing 30 children scheduled for dental treatment were created. Following anesthesia induction with 5% sevoflurane, 50% nitrous oxide mixture in 50% oxygen, 1 mg/kg bolus ketofol dose was administered. Patients in Group 1 received ketofol as a 1:1 mixture, patients in Group 2 received 1:2 ketofol while in Group 3; 1:4 ketofol was administered at a constant dose of 100 μg/kg/min. Additional doses of the ketofol solution at the same concentration with infused solutions in groups (0.5 mg/kg from either 1:1, 1:2, or 1:4 proportions) were administered if required. Perioperative vital signs, side effects, postoperative side effects, recovery durations, parents' and dentists' satisfaction levels were compared between groups. Results: There were no significant differences between groups in terms of perioperative vital signs and side effects. Depth of sedation, dentists' satisfaction levels and postoperative side effects –myoclonus, hypersalivation and tachycardia were significantly higher in Group 1. Parents' satisfaction was highest in Group 3, however, necessity of additional doses and dissatisfaction of dentists' were found highest in this group. Mean duration of recovery recorded in Group 3 was shortest compared with other groups. Conclusion: Decreased ketamine doses in ketofol mixture was related with decreased side effect profile, high parents' satisfaction with fast recovery, however, dentists' satisfaction was lower. In this context, results of present study indicated that ketofol mixture of 1:2 ratio was more reliable choice than others when all investigated parameters evaluated simultaneously.
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Tubal sterilization during cesarean section at a training hospital in Turkey: A clinical and demographic analysis p. 1508
S Arlier
DOI:10.4103/njcp.njcp_391_16  PMID:30417852
Background: The total fertility rate is 2.1 children per women in Turkey. The population is expected to increase to 84 million by 2023. Maternal (19/100,000 live births), infant, and child mortality rates (20/100,000 live births) are still higher than desired levels in Turkey. We investigated factors affecting the choice of tubal sterilization (TS) after cesarean sections (CSs) and determined intraoperative and short-term postoperative maternal effects of this procedure. Materials and Methods: We compared 1,849 CSs for demographic characteristics and clinical parameters including obstetric outcomes between two patient groups who underwent CSs with or without TS. Intraoperative and short-term postoperative maternal effects of TS in these patients were also evaluated. Results: Twenty-one percent of women underwent both CSs and TS. A significantly higher ratio of TS was found in women with low education levels who had obstetric risk/systemic disease in their present pregnancy. Apart from a hemoglobin deficit and slightly higher duration of hospital stay, TS did not influence postoperative wound infection or heavy bleeding pattern that requires reoperation. Conclusion: These findings conclude that in developing countries TS can safely be applicable as a contraceptive method without additional cost at time of CSs and should be considered as an option for those women who desire or would benefit from it.
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Evaluation of content and cost of traditional eye medication in a resource-poor country – Implications for eye care practice and policy p. 1514
AE Aghaji, IV Ezeome, ER Ezeome
DOI:10.4103/njcp.njcp_201_18  PMID:30417853
Background: Cataract, glaucoma, and conjunctivitis are common causes of ocular morbidity in Nigeria. A major obstacle in reducing the burden of ocular morbidity in rural areas is access to eye care services. Up to 80% of the population in developing countries use traditional medications for their primary healthcare needs because they are accessible, available, and affordable. The aim of this study is to evaluate the content and cost of commercialized traditional medications used in the treatment of common eye conditions in Nigeria. Patients and Methods: All the registered traditional healers (THs) at an International Trade Fair in Enugu who treated eye problems were identified. Data on their location and scope of their practice were collected by the researchers. Proxy patients consulted THs in the trade fair with simulated cataract, glaucoma, and bacterial conjunctivitis, and treatment was sought. Medication for the treatment of the simulated disorders was paid for and procured. The mode of administration and the cost of the drugs were recorded by proxy patients. Each medication was labeled with a code and sent to the laboratories of the National Agency for Drug Administration and Control for analysis. Data were entered into a database on Microsoft Access and transferred to STATA V12.1 (StataCorp) for analysis. Results: Cataract was treated by 87.5% of all the traditional eye healers interviewed. A total of 32 samples were collected and analyzed. These comprised mainly oral (53.1%) and topical traditional medications (43.8%). The pH of the topical samples ranged from 3.5 to 10, while the mean microbiological load per topical solution was 3.3 × 104 cfu/mL ± 0.96. The cost of treatment of cataract ranged from 4 to 70 USD. Conclusion: The content of the majority of the samples of traditional eye medications in this study had high extremes of pH and/or had a high microbial content. The practice of THs should be regulated.
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The distribution and pattern of neurological disease in a neurology clinic in Ile-Ife, Nigeria p. 1520
MA Komolafe, OF Owagbemi, TI Alimi
DOI:10.4103/njcp.njcp_230_16  PMID:30417854
Background: Neurological disorders are common and contribute significantly to disease burden, disability-adjusted life years and death. Objective: To assess the distribution of neurological disease in patients presenting to our hospital. Methods: The records of the Adult Neurology Clinic in Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun state, Nigeria were reviewed retrospectively for the years 2003-2005 and 2010-2014, and diagnoses as made by the Consultant were obtained and analyzed. Results: The total number of complaints was 1,524 and 86.4% of these were neurological in nature. Episodic and paroxysmal disorders (ICD-10) accounted for 54.1% of the diagnoses, and epilepsy and stroke were the most common of these. Of the 1,226 patients seen during the period, 91.4% had neurological disorders. The peak occurrence of these disorders was within the first three decades of life. Conclusion: Epilepsy and stroke are the commonest neurological disorders in the outpatient setting and there should be more studies in the community on their prevalence and impact.
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Perceived social support and depression levels of women in the postpartum period in Hatay, Turkey p. 1525
H Tambag, Z Turan, S Tolun, R Can
DOI:10.4103/njcp.njcp_285_17  PMID:30417855
Objectives: Postpartum depression is one of the major problems affecting the mother and baby's health. Inadequate social support system may affect the occurrence of this problem. This study was performed to determine the depression and social support in women at the postpartum period. Materials and Methods: This study was designed as a cross-sectional study. The research was conducted in Narlıca No. 2 family health center located in the city center of Hatay with 177 women who have given birth at least 2–4 months before and agreed to participate in the study. Edinburgh Postpartum Depression Scale (EPDS), Multidimensional Scale of Perceived Social Support (MSPSS), and Sociodemographic Information Form was utilized for data collection. Results: It was determined that women's scores of EPDS and MSPSS were affected by the variables of intended pregnancy and obtained support for infant care (P < 0.05). A significant negative correlation (P < 0.01) was found between MSPSS and EPDS scales. Conclusion: This study concludes that as social support levels increase there is a decrease at postpartum depression risk. It is recommended that planning of interventions should be in accordance with the factors affecting the social support and depression levels at women in the postpartum period.
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Diagnostic values of diffusion tensor parameters in 3 T breast magnetic resonance imaging: Differentiation of breast tumors from bilateral healthy breast parenchyma p. 1531
ST Ozal, E Inci
DOI:10.4103/njcp.njcp_222_17  PMID:30417856
Purpose: Our aim is to search diagnostic value of diffusion tensor parameters in the breast cancer. Materials and Methods: We included 46 patients with contrast enhanced magnetic resonance imaging of the breast between the dates of July 2015 and December 2016. We measured fractional anisotropy (FA), apparent diffusion coefficient (ADC), relative anisotropy (RA) and volume ratio (VR) values of the malignant mass, ipsilateral and contralateral healthy breast parenchyma in each patient. Results: ADC and VR values of the malignant lesions were significantly lower than normal parenchyma (P < 0.01). FA values were statistically higher in masses than normal breast parenchyma (P < 0.05). RA values were statistically higher in the mass than ipsilateral breast parenchyma (P < 0.01) but not significantly different from in contralateral breast parenchyma (P > 0.05). Only ADC values were statistically lower in contralateral side than ipsilateral breast parenchyma (P < 0.05) other parameters showed no statistical significance between parenchymas. Conclusion: DTI findings, such as FA, ADC, RA and VR, provide significant contribution in differentiating cancer from healthy breast tissue.
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Comparison of serum concentration of Ca, P, Mg, and Fe between hemifacial spasm patients and healthy controls; prospective randomized controlled study p. 1537
EK Ulusoy, DM Ulusoy, S Kilic
DOI:10.4103/njcp.njcp_103_18  PMID:30417857
Purpose: In this study, we aimed to measure the serum vitamin D level in hemifacial spasmic (HFS) patients and show the role of HFS in the pathogenesis and place in etiology. Materials and Methods: This study included 43 prospective newly diagnosed HFS patients and 43 healthy volunteers in the neurology clinic. The serum (Ca, P, Mg, Fe) concentration of 4 essential elements was measured with a biochemical device. The groups were correlated in terms of four essential element concentrations. The severity of the disease was measured using Lee's Quality of Life Scale and correlated with the concentration of four trace elements. The results were compared using the independent t-test and Mann–Whitney U-test. Results: Concentration of serum Ca, P, and Mg in the HFS patients was found to be lower in the control group which was statistically significant (P < 0.05). There was no statistically difference between the groups in terms of Fe concentration (P > 0.05). There was no significant correlation between trace element concentration and severity of illness and daily life quality in the patient group. Conclusion: These results show us the role of HFS in the pathogenesis of these four trace elements and the importance of its location in etiology. We think that changes in the concentration of trace elements in HFS can lead to demyelinization, which may lead to spasm.
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Extrusion of ventriculoperitoneal shunt cathether through a herniotomy wound in an infant: Case report and review of literature p. 1542
KE Ibebuike
DOI:10.4103/njcp.njcp_237_18  PMID:30417858
Cerebrospinal fluid (CSF) diversion through the insertion of ventriculoperitoneal shunt (VPS) is the standard treatment for hydrocephalus. Many complications have been reported following VPS insertion. A case of extrusion of a VPS through a herniotomy wound is reported in a 4-month old male infant, who had a herniotomy performed on him by a General Practitioner (GP) for scrotal swelling. The extruded VPS was first externalized to the chest to aid healing of the groin wound and maintain CSF diversion. Later the VPS was removed to aid sepsis control. Although the parents did not comply with follow up instructions following their request for discharge, the patient remained well during telephonic communication 7 weeks after discharge. The case demonstrated higher risk for abdominal complications in the setting of background spina bifida and presence of intraperitoneal catheter. The need for optimal management of such complications by appropriate specialists cannot be over emphasised.
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