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   Table of Contents - Current issue
Coverpage
February 2019
Volume 22 | Issue 2
Page Nos. 149-288

Online since Thursday, February 7, 2019

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REVIEW ARTICLE  

Association between IL-10 polymorphisms rs1800896 and rs1800871 and risk of acute pancreatitis in Chinese Han population: An update systemic review and meta-analysis Highly accessed article p. 149
L Dong, Y Zhu
DOI:10.4103/njcp.njcp_57_18  
The association between interleukin-10 (IL-10) promoter region (1082 A/G (rs1800896), 819 C/T (rs1800871)) polymorphisms, and acute pancreatitis (AP) is inconclusive in Chinese Han population. In this study, six eligible studies extracted from the databases of PubMed, Web of Science, and Cochrane Library were evaluated. The results revealed a significant association between 1082 A/G (rs1800896) polymorphism and AP risk in all these five models (AG/AA: OR = 1.19, 95% Cl = 1.02–1.40, P = 0.03; GG/AA: OR = 1.80, 95% Cl = 1.38–2.23, P = 0.01; AG+GG/AA: OR = 1.29, 95% Cl = 1.11–1.50, P = 0.01; GG/AG+AA: OR = 1.62, 95% Cl = 1.27–2.08, P = 0.01; G/A: OR = 1.29, 95% Cl = 1.15–1.45, P = 0.01). In contrast, no statistically significant association was found in all these five models for 819 C/T (rs1800871) polymorphism. In summary, IL-10 polymorphism 1082 A/G (rs1800896) could increase the risk of AP in Chinese Han population.
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ORIGINAL ARTICLES Top

Dentists' knowledge and behavior toward managing hypertensive patients Highly accessed article p. 154
DF Bogari
DOI:10.4103/njcp.njcp_493_18  
Objectives: Dental office is an ideal screening place to identify undiagnosed/uncontrolled patients with hypertension. The aim of this study was to assess the knowledge and behavior of dentists toward performing proper management of hypertensive patients in Saudi Arabia. Materials and Methods: A close-ended e-questionnaire was created and sent to dentists of all levels (n = 710) in Saudi Arabia. The questionnaire included questions that assessed attitudes and behavior toward using a sphygmomanometer in dental clinics and assessed dentists' knowledge and behavior toward proper management of patients with hypertension. Results: About 62.4% of dentists had a sphygmomanometer in their clinic. Around 79.5% believe that working on patients with high blood pressure (BP) is associated with a risk of complications. However, only 13.3% of them measure the BP of all patients prior to treatment, and 63.3% would do so only if the patient noted a problem. About 54.3% of the respondents prefer using local anesthetics without epinephrine, and they would prefer to refer those patients to dental consultants for treatment. If a patient's BP was 180/100 mmHg, 78.1% of dentists would urgently refer that patient to his or her physician and would not perform a routine elective dental treatment. Conclusion: There is a lack of knowledge and behavior toward proper management of patients with hypertension in our dental sociality. Broadening the breath of dentists' responsibilities to include screening and working together with physicians will help improve the community dental and general health of visiting patients and should be the goal of all dentists.
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Influence of age, gender, and educational background on tooth color Highly accessed article p. 162
MG Demirel, MT Tuncdemir
DOI:10.4103/njcp.njcp_442_18  
Introduction: The purpose of this study was to determine the effect of age, gender, and educational background on the color coordinates of the maxillary central incisor. Materials and Methods: The color of the maxillary central incisor teeth of 302 individuals was measured using a spectrophotometer. The L*, a*, and b* parameters were recorded. T-tests, analysis of variance (ANOVA), and the Scheffe's post-hoc tests were used to describe the relation of the L*, a*, and b* values between color with age, gender, and educational background. Results: The results of this study showed that a significant difference among all three parameters of color and age was observed. There was a significant difference for the a* and b* parameters for gender, but no difference was found for the L* parameter. Finally, there was a significant difference in the L* and a* parameters, but no difference in the b* parameter in terms of educational background. Conclusions: As individuals age, their tooth color darkens. Women have lighter teeth than men. The tooth color of high school graduates was found to be lighter than that of the other groups.
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The impact of family physicians' thoughts on self-efficacy of family physician's core competencies on burnout syndrome in İzmir: A nested case–control study p. 167
O Aygun, V Mevsim
DOI:10.4103/njcp.njcp_77_18  
Background: Burnout is a psychosocial syndrome, involving feelings of emotional exhaustion, depersonalization, and diminished personal accomplishment at work. Its occurrence is high in healthcare personnel. Job satisfaction is achieved through the feeling of being professionally competent and is an important condition that prevents burnout syndrome. Aim: This study aimed to determine the impact of family physicians' thoughts on self-efficacy of family physician's core competencies on burnout syndrome in İzmir. Subjects and Methods: The study was a nested case–control study and was carried out within the İzmir province from 2013 to 2014. The subject population included 2185 family physicians working in the family medicine centers in the metropolitan districts of İzmir. A total of 395 family physicians who were employed at family medicine centers agreed to participate in the study. After the assessment according to the Maslach Burnout Inventory, 185 physicians had burnout, whereas 210 physicians did not have burnout. Physicians who had burnout were considered as 50% prevalence in the control group; the sampling size was calculated as at least 138 individuals for unpaired cases and control groups, with 0.05 error margin and 80% power. Results: While burnout syndrome was detected in 80.0% of physicians who thought that they were incompetent, it was detected in 30.1% of physicians who believed that they were sufficiently competent in terms of core competencies. Conclusion: Insufficient belief in core competencies by family physicians increases the occurrence of burnout syndrome in these individuals.
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Markers of lipid and protein peroxidation among Nigerian university students with dysmenorrhea p. 174
BE Orimadegun, OA Awolude, EO Agbedana
DOI:10.4103/njcp.njcp_279_18  
Introduction: Oxidative stress has been associated with primary dysmenorrhea, but studies that have assessed multiple markers of peroxidation are scarce. This study investigated malondialdehyde (MDA), nitrotyrosine (3-NT), and protein carbonyls (PrCarb) as markers of oxidative stress and antioxidant status by serum alpha tocopherol level in young Nigerian women with dysmenorrhea. Materials and Methods: In a case–control design, 45 female undergraduates who had had regular menses for at least six previous cycles were recruited consecutively from a university clinic as cases and 45 apparently healthy age-matched counterparts in their hall of residences as controls. Serum levels of MDA, 3-NT, and PrCarb were determined using standard methods, and the values were compared between cases and controls using Mann–Whitney U-test and graphs. Results: Study participants' ages range from 16 to 29 years (mean = 22.0 ± 3.1 years). Serum level of 3-NT (45.89 ± 37.11 vs 21.27 ± 13.94 ng/mL) and MDA (0.75 ± 0.19 vs 0.45 ± 0.11 nmol/mL) was significantly higher in cases than controls. Plasma alpha tocopherol was significantly lower in cases (7.51 ± 1.95 μmol/L) than controls (8.98 ± 1.95 μmol/L). Conversely, PrCarb levels were not significantly difference between cases and controls. There were significant correlations between alpha tocopherol and 3-NT (r = −0.285; P = 0.007) and MDA (r = −0.321; P = 0.002), whereas this relationship was not shown with PrCarb (r = −0.073; P = 0.496). Conclusion: Remarkable lipid and protein peroxidation observed in young Nigerian women with dysmenorrhea was accompanied by correspondingly low level of serum alpha tocopherol suggesting potential need for vitamin E supplementation.
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Clinical evaluation of postoperative fever in patients that had oral and maxillofacial surgery in university of Nigeria Teaching Hospital, Ituku–Ozalla, Enugu, Nigeria p. 181
UC Okechi, CC Uguru, A Obiechina
DOI:10.4103/njcp.njcp_467_18  
Background: Postoperative fever (POF) is often encountered after major oral and maxillofacial surgical procedures. This could become an unwanted complication, requiring detailed clinical evaluation and investigations to determine the cause. Aim: The aim is to determine the major causes of POF in patients that had oral and maxillofacial surgery under general anesthesia at the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu. Materials and Methods: The selected patients were admitted and prepared for surgery. Eight hourly axillary temperature readings were taken from the day of admission till discharge. Necessary samples were collected for laboratory analysis from patients that developed fever after their surgery. Results: The patients consisted of 70 males (64.8%) and 38 females (35.2%) giving a ratio of 1.8:1. The mean age of the patients was 27.15 years (SD 13.1). Of the 108 patients studied, 23 (21.7%) developed fever after their surgery. In majority of the patients, the POF lasted within the first 4 days of surgery. There was a significant relationship between duration of surgery and POF. Conclusion: This study suggests that most cases of POF are of early onset and of short duration. The longer the surgery time, the more likely POF will occur.
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Serum magnesium in adult patients with idiopathic and symptomatic epilepsy in Maiduguri, Northeast Nigeria p. 186
I Abdullahi, MM Watila, N Shahi, YW Nyandaiti, SA Bwala
DOI:10.4103/njcp.njcp_252_18  
Background: Alteration in the homeostasis of trace elements such as magnesium may play a role in the development of epileptic seizures. This study aims to investigate the levels of serum magnesium in people with idiopathic generalized epileptic (IGE) seizures and symptomatic seizures in Northeast Nigeria. Materials and Methods: Serum magnesium level was measured using atomic absorption spectrometry among 40 adults with IGE, 20 adults with symptomatic epileptic seizures, and 30 healthy controls. Serum calcium, potassium, phosphate, and albumin were also measured. Results: The mean serum magnesium level was significantly lower among people with epilepsy compared with the controls [0.79 ± 0.18 mmol/L vs 0.90 mmol/L ± 0.17, P = 0.007, 95% confidence interval (CI): (−0.189 to −0.031)]. People with IGE had significantly lower levels of magnesium compared with those with symptomatic seizures [0.74 ± 0.17 mmol/L vs 0.9 ± 0.16 mmol/L, P < 0.001 95% CI: (−0.251 to −0.069)]. The mean magnesium level for all groups was in the reference range, but the lowest levels were observed in those with IGE. There is no significant correlation between the level of serum magnesium and the severity of seizure attacks. There was significantly lower level of calcium in people with IGE compared with those with symptomatic seizures [2.3 ± 0.13 mmol/L vs 2.4 ± 0.16 mmol/L, P = 0.012, 95% CI: (−0.177 to 0.023)] or controls [2.3 ± 0.13 mmol/L vs 2.4 ± 0.12 mmol/L, P < 0.01, 95% CI: (−0.156 to −0.044)]. No significant differences were observed in the levels of potassium, phosphate, and albumin. Conclusion: This study suggests that low serum magnesium and calcium may play a role in IGE, and supplementation may be useful in reducing seizures in Black patients with epilepsy.
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DNA repair capacity of the colorectal cancer patients and the correlation between the pathological parameters p. 194
HK Tolan, A Tozan-Beceren, S Sardas, O Senkesen, C Celikel, R Gencosmanoglu, C Yegen
DOI:10.4103/njcp.njcp_251_18  
Background: Colorectal cancers are third most common cancer in both genders. They are associated with genetic and environmental factors. Staging is important in the prognosis. Carcinoembryonic Antigen (CEA) provides preliminary information and there is a correlation between Proliferation Index (PI) and prognostic variables. Our aim is to investigate the relationship between DNA repair capacity and clinico-pathologic factors. Patients and Methods: The blood samples taken from cancer patients were irradiated. DNA repair capacity by comet technique was calculated. The CEA values were recorded. Pathology reports were collected and PI values were calculated. sResults: Total of 30 patients; male (n: 14) and female (n: 16) with a median age of 66.37 ± 10.32 were included. Mean CEA value was 42.85 (1.46 - 422.30 μgr/ml) μgr/ml. Mean % DNA repair capacity was 44.49 ± 5.24. In the pathology; 21 (70%) were T3 tumors; 18 (60%) had lymphatic and 12 (40%) had vascular 2 invasion. Perineural invasion was present in 8 (26.7%). According to the proliferation index (PI); 16 (53.3%) were in high percentile (PI > 66%) group. Conclusions: There was a significant correlation between; perineural invasion and tumor grade (P = 0.043); lymphatic and perineural invasion (P = 0.006); lymphatic invasion and vascular invasion (P = 0.034) and the DNA repair capacity with the lymphatic invasion (P = 0.026). There was also a statistically significant (P = 0.044) relationship between PI and lymphatic invasion. As a result in colorectal cancer patients DNA repair capacity can be used as a biomarker in the staging and also in the prediction of the tumor behavior.
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Study of association between sickle cell trait and renal dysfunction among young adults in South-west Nigeria p. 201
AA Akinbodewa, A Ogunleye, OA Adejumo, VO Daomi, O Okunola, TT Oluwafemi, EO Alli, VO Olalusi, PO Osho, OA Lamidi, F Fadipe, OK Falekulo
DOI:10.4103/njcp.njcp_253_18  
Background: Although sickle cell disease has become a recognized etiology of chronic kidney disease (CKD), the sickle cell trait (SCT) variant was until recently believed to be a benign carrier state with little or no effect on the health of affected individuals. However, recent studies now appear to suggest an association between SCT and CKD. Objective: The objective of the study is to determine the association between SCT (hemoglobin AS) and renal dysfunction among young Nigerian adults. Methodology: This was a cross-sectional, descriptive study among apparently healthy undergraduates of Adeyemi College of Education, Ondo, southwest Nigeria. Their hemoglobin genotypes were determined using standard alkaline electrophoresis; their blood pressure, anthropometry, serum total cholesterol (TC), creatinine, and estimated glomerular filtration rate (eGFR) were determined. Data analyzed using Statistical Package for Social Sciences (SPSS) 20 were significant at P < 0.05. Results: Six hundred and two subjects with HbAS (SCT, n = 465) and HbAA (non-SCT, n = 137) were studied. Their age range was 18–30 years with male-to-female ratio 1:3.8. There was no difference in the prevalence of renal dysfunction between SCT and non-SCT subjects (5.1% vs. 5.2%, P = 0.591). There was no increased risk of CKD among subjects with SCT (PR, 0.99 at 95% CI [0.417–2.348]). Conclusion: SCT was not associated with increased risk of renal dysfunction among young adults in Nigeria. Further studies are needed to clarify the controversy, especially in Nigeria, with a relatively higher prevalence of SCT.
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Frequency of psychiatric disorders in nonemergent admissions to emergency department p. 208
ME Canakci, N Acar, C Yenilmez, E Ozakin, FB Kaya, E Arslan, T Caglayan, H Dolgun
DOI:10.4103/njcp.njcp_380_18  
Objectives: Repeated admissions of patients with undiagnosed psychiatric problems in emergency departments (ED) is a major contributor to patient unsatisfaction and overcrowding in EDs. We evaluated the presence of psychiatric disorders in non-emergent admissions in the ED of a tertiary care hospital. Materials and Methods: This cross-sectional study was carried out in Eskisehir Osmangazi University Hospital between December 2015 and March 2016. The study group consists of 4320 non-emergent patients (31% of all admissions to non-emergent ED). Psychiatric assessments of patients were done using the Primary Care Evaluation of Mental Disorders (PRIME-MD) scale prior to their discharge from the ED. The Mann-Whitney U, Kruskal-Wallis and Chi-square tests, as well as multivariate logistic regression, were performed for statistical analysis. Results: The mean age was 30 ± 11.7 years years ranging from 18 to 78 years. Among non-emergent cases, 44% had at least one psychiatric disorder. The most frequent psychiatric disorder was mood disorder (major and minor depression). Females with a comorbid disease and lower education level had increased risk for mood disorders, anxiety disorders, and somatoform disorders. Single males with a comorbid disease had increased risk for alcohol dependence. Conclusions: Undiagnosed patients with psychiatric disorders appear to be frequent users of medical emergency department services. These results might be helpful in developing more effective strategies to serve the mental health needs of the undiagnosed. People's awareness of psychiatric disorders should be increased.
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Efficacy of calcium hypoclorite with and without Er,Cr: Yttrium, scandium, gallium, garnet laser activation on Enterococcus faecalis in experimentally infected root canals p. 215
A Dumani, D Tanrisever, D Sihay, SB Kuzu, S Yilmaz, HK Guvenmez
DOI:10.4103/njcp.njcp_457_18  
Aim: The aim of this study was to compare the antimicrobial efficacy of calcium hypochlorite (Ca(OCl)2) and sodium hypochlorite (NaOCl) associated with or without erbium, chromium: yttrium, scandium, gallium, garnet (Er,Cr: YSGG) laser irradiation in root canals experimentally infected with Enterococcus faecalis. Materials and Methods: The root canals of 105 single-rooted premolars were enlarged up to file 40, autoclaved, inoculated with E. faecalis, and incubated for 21 days. The teeth were randomly divided into seven experimental (n = 15) groups according to the protocol for decontamination: syringe irrigation (SI) with distilled water (DW), SI with 2.5% NaOCl, SI with 2.5% Ca (OCl)2, laser-activated irrigation (LAI) with DW, LAI with 2.5% NaOCl and LAI with 2.5% Ca (OCl)2 and LAI with no solution. Microbiological samples were collected and the colony-forming units were counted before and after irrigation procedures and the percentages of reduction were calculated. Results: Mean numbers of recovered bacteria in the SI with DW group were significantly higher than those in the other experimental groups (P < 0.05). The high bactericidal reduction was observed in any of the other treatment groups: SI using NaOCl or Ca (OCl)2 and LAI with DW, NaOCl, Ca (OCl)2 or no solution, with no statistically significant difference. Conclusion: Er,Cr: YSGG laser with or without an irrirgation solution has antimicrobial effects on dentinal tubules infected with E. faecalis. The antimicrobial property of 2.5% Ca (OCl)2 was effective as 2.5% NaOCl on E. faecalis with conventional or laser activated irrigation in root canals.
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Profile of patients with chronic obstructive pulmonary disease in Ilorin who were never-smokers p. 221
OB Ojuawo, AO Aladesanmi, CM Opeyemi, OO Desalu, AE Fawibe, AK Salami
DOI:10.4103/njcp.njcp_344_18  
Background: The most recognized risk factor for chronic obstructive pulmonary disease (COPD) worldwide is cigarette smoking. However, recent surveys have revealed an increasing trend from nonsmoking causes especially from biomass exposure. This study, therefore, aimed to determine the proportion of patients and the clinical pattern of COPD among never-smokers in Ilorin. Subjects and Methods: This is a retrospective study in which case records of patients with clinical diagnosis of COPD from January 2013 to December 2017 were reviewed. Data were collected with respect to their sociodemographic characteristics, clinical details, comorbid illnesses, and severity of the disease. Results: A total of 135 case records of patients with COPD were reviewed, of which 66 had spirometric confirmation of the disease. In all, 38 (57.6%) of them were never-smokers with a male-to-female ratio of 1:1.1. The mean age of the subjects was 64.5 ± 11.7 years. Cough and exertional dyspnea were the most common symptoms (89.5% each), and systemic hypertension was the most common comorbid illness. Firewood exposure constituted the most common nonsmoking risk factor (47.4%), and the majority of the patients had mild COPD. When compared with ever-smokers, the mean post bronchodilator lung function parameters were found to be significantly better in never-smokers. Conclusion: Over half of COPD cases in Ilorin were never-smokers with firewood exposure as the main risk factor. This study has further highlighted the need for increased awareness of the hazards of biomass fuel exposure in our setting.
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Short-term antibacterial activity and compressive strength of biodentine containing chlorhexidine/cetirimide mixtures p. 227
C Deveci, T Tuzuner, C Cinar, ME Odabas, CK Buruk
DOI:10.4103/njcp.njcp_436_18  
Background and Purpose: Aim is to evaluate the antibacterial activity and physical properties of Biodentine containing chlorhexidine (CHX)/cetrimide (CT) mixtures at 24 h. Materials and Methods: Powder formulations of CHX (2.5%) and CT (2.5%) were added to the powder of Biodentine and served as experimental groups (EXP). Antibacterial free groups were designed as control (CNT). The antibacterial acitivity (AB) (n = 5; for each) of disc-shaped specimens against Streptococcus mutans and Lactobacillius casei and compressive strength (CS) (n = 10; for each) tests used both for groups after 24 h after polymerization. Statistical Analysis Used: Normality of data were tested with the Shapiro–Wilk test. Significant differences were analyzed with the Mann–Whintey U test for both the methods (agar disk diffusion and compressive strength) at a significance level of P < 0.05. Results: Significantly higher antibacterial effects were obtained in EXP groups compared to the CNTs for both bacteria after 24 h, distinctly (P < 0.01). No differences were found between groups regarding the CS values (P > 0.05). Conclusion: Since the incorporation of 5% CHX/CT to the Biodentine exhibited acceptable antibacterial activity without hampering compressive strength values at 24 h, this combination could be a promising alternative for eliminating the residual bacteria for indirect pulp-capping therapies.
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Drug pooling: A cost-saving strategy to enhance antibiotics availability for pediatric in-patient in Nigeria p. 232
MD Ughasoro, IC Nwakoby, OE Onwujekwe, AI Odike
DOI:10.4103/njcp.njcp_206_18  
Background: Antibiotic use is common but has a lot of challenges. Implementation of an efficient and cost-effective policy, which can improve the availability and sustainability of pediatric antibiotic use, is required. In this study, we explore the concept of antibiotic drug pooling (DP) as a means to overcome challenges often associated with antibiotic use. Materials and Methods: The study was undertaken in three public tertiary hospitals in Southeast Nigeria using a mixed-methods approach. Three focus group discussions with caregivers of in-patient children and 16 in-depth interviews with physicians, nurses, and pharmacists provided the data for the study. In addition, the medical records of patients on admission were examined. Information collected centered mainly on antibiotic use and challenges, participants' perception of antibiotics pooling, as well as possible ways to improve on antibiotic availability and sustainability. Results: Out of 53 children on admission, antibiotics were prescribed for 45 (84.2%) of them children. Seventeen (37.8%) of the 45 on antibiotics had their initial antibiotics changed. The major challenges encountered by all the caregivers interviewed were the cost of the antibiotics (85%). None of the caregivers was willing to submit their purchased drugs for pooled use by other in-patients. Health-care providers, however, lauded the concept of DP and made the following suggestions on ways the proposed concept could be improved: harmonized prescription, billing, and unit-dose dispensing for the first 72 h antibiotic treatment. Conclusion: The adoption of a harmonized prescription pattern and billing as well as unit-dose dispensing for the first 72 h antibiotic treatment will provide a cost-effective means of ensuring antibiotic availability and sustainability. The drug-pooling concept will not only enhance prompt commencement and discontinuation of antibiotic treatment but will also reduce waste and improve time-out policy.
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Sonographic determination of normal subcutaneous fat thickness in children in Southern Nigeria p. 238
AI Ngaji, EE Ekanem, DE Bassey, GB Inah
DOI:10.4103/njcp.njcp_246_18  
Background: Subcutaneous fat is a highly active metabolic tissue that exerts control on numerous biochemical and physiological processes in health and disease. Children are particularly susceptible to nutritional problems, hence the need to measure subcutaneous fat thickness (SFT) which can be used to determine their body composition. Ultrasonography provides an affordable, noninvasive, available technique of achieving this. Objective: The aim of this study was to determine the normal values of SFT at the triceps, subscapular, and abdomen in children age 1–5 years using ultrasound in southern Nigeria. Materials and Methods: This was a prospective study of 1750 healthy children age 1–5 years in nursery and primary schools in Calabar, Nigeria. Their body mass indexes were calculated from their weights and heights, while their triceps fat thickness (TFT), subscapular fat thickness (SuFT), and abdominal fat thickness (AFT) were measured using a 7.5-MHz linear array transducer of a Hitachi portable ultrasound machine. Results: The mean TFT value for girls was 4.6 ± 2.0 mm and 3.99 ± 1.8 mm for boys. Girls had mean SuFT value of 2.37 ± 1.41 mm and boys 2.14 ± 1.02 mm. The mean AFT value for girls was 5.53 ± 2.94 mm and for boys 4.53 ± 2.37 mm. The values at all sites were generally higher in females than in males. Conclusion: This work has provided a sonographic normogram of SFT at various sites for preschool children in Nigeria.
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Skin changes and dermatological life quality index in chronic kidney disease patients in a tertiary hospital in Southern Nigeria p. 245
Oluseyi A Adejumo, Roli C Madubuko, Afeaje B Olokor, Omodele T Aina
DOI:10.4103/njcp.njcp_270_18  
Background: Cutaneous changes commonly occur in chronic kidney disease (CKD), however, there is limited information on its effect on quality of life of these patients. This study determined the prevalence and pattern of skin changes in CKD patients and their effects on the dermatology life quality index (DLQI) of the patients. Materials and Methods: This was a descriptive cross-sectional study that involved stages 3–5 CKD patients who were examined for skin changes. The effects of the observed skin changes on DLQI were assessed using the standardized DLQI questionnaire. Results: One hundred and five CKD patients participated in the study consisting of 56 males and 49 females with a mean age of 51.93 ± 15.23 years. The prevalence of cutaneous changes was 94.3%. Common skin manifestations were pallor 99 (94.3%), hyperpigmentation 58 (55.2%), fluffy hair 55 (52.4%), Lindsay nails 48 (45.7%), and pruritus 44 (41.9%). The effect of dermatoses on DLQI was mild in 34 (32.4%), moderate in 13 (12.4%), and severe in 4 (3.8%).There was no significant association between dermatoses and CKD stage. There was significant positive correlation between DLQI scores and number of skin dermatoses (r = 0.522, P = <0.001), duration on maintenance hemodialysis (r = 322, P = 0.017). There was significant negative correlation between DQOL scores and packed cell volume (r = −0.232, P = 0.022). On multiple regression analysis, number of dermatoses was the only significant predictor of DLQI (P = <0.001). Conclusion: Skin changes occur commonly in CKD patients and significantly affected their DLQI. This study highlights the significant burden that skin changes add to CKD.
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HGF-1 proliferation on titanium dental implants treated with laser melting technology p. 251
O Arifagaoglu, S Oncul, A Ercan, O Olcay, B Ersu
DOI:10.4103/njcp.njcp_364_18  
Background: Titanium and its alloys are currently the most common dental implant materials. For the best bone-implant contact, machined titanium is subjected to various surface treatments. In the present study, proliferation of human gingivial fibroblast (HGF-1) cells on Grade 5 titanium disks covered with Grade 23 titanium by selective laser melting technology was evaluated. Aim: The main aim was to provide a novel surface procedure providing more biocompatible external structure with a biomechanically intact inner structure and increasing cell proliferation. Materials and Methods: Forty-eight titanium Grade 5 machined disks with 5 mm of diameter was divided into four groups. Group 1, also known as the control group, was not subjected to any surface treatment. Group 2 was treated with sand-blasted, large-grid, acid-etching (SLA) technique and Group 3 was treated with selective laser melting (SLM) method. Group 4 was treated with both SLM and SLA. The surface topography was analyzed using scanning electron microscope and the roughness of the samples was evaluated via optic profilometer. Additionally, optical tensiometer was used to measure the surface wettability. To obtain further insights on biocompability of the samples, HGF-1 cell viability at 48 h was assessed with MTT assay. These results were also confirmed by fluorescent staining. Results: Although Ra value and wettability of Group 4 were the highest amongst the samples handled, based on 48 h MTT results and fluorescent staining, highest cell proliferation was observed in Group 3. Conclusions: It was verifed that the surface topography, roughness, and wettability are all crucial factors on healthy cell populations. Therefore, it was concluded that disks treated with SLM were shown to express the most suitable condition for biocompability.
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Significance of the difference in the estimates of glomerular filtration rate obtained using different models p. 258
J Onyekwelu, CH Nwankwo
DOI:10.4103/njcp.njcp_360_17  
Objective: Chronic kidney disease (CKD) prevalence is rising in Nigeria. Most cases are diagnosed as end stage disease despite availability of formulae to estimate glomerular filtration rate (GFR). Existing formulae, none of which is modelled on Nigerian variables, give different estimates. This study tests the significance of the difference in the estimates obtained using Modified Diet in Renal Disease (MDRD) Study and Chronic Kidney Disease-Epidemiology (CKD-Epi) formulae. Methodology: This is a cross-sectional study. Data on age, gender, and serum creatinine were used to estimate GFR. Paired sample t test was used to check for difference in means, Pearson correlation test for correlation and Bland and Altman plot for systematic bias. Simple linear regression was used to check for presence and significance of proportional bias. Results: Of the 166 patients studied, 62 were males and 104 were females. Mean age was 49.06 years ± 15.26. Youngest was 18 years and the oldest 81 years. Mean eGFR of 69.4 and 72.77 ml/min/1.73m2 for MDRD and CKD-Epi models respectively differed significantly, P < 0.001. Bland and Altman plot showed lack of agreement of eGFR estimates from the two models with significant bias of -3.37ml/min/1.73m2 despite good correlation, r = 0.984. There was significant proportional bias, P < 0.001. Conclusion: MDRD significantly underestimated GFR compared to CKD-Epi in a Nigerian population. This bias was proportional and increased as mean eGFR increased. MDRD and CKD-Epi models do not agree in their measurements of eGFR and should not be used interchangeably. There is urgent need for further studies to develop GFR estimating model on Nigerian variables.
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Effect of terlipressin infusion therapy on recipient's hepatic and renal functions in living donor liver transplantations: Experience from a tertiary hospital p. 265
P Karaaslan, S Sevmis
DOI:10.4103/njcp.njcp_268_17  
Background: Patients with end-stage liver disease are prone to hemodynamic disturbances which may be aggravated with liver transplantation. Blood pooling in splanchnic area and portal hypertension cause reduction in central blood volume. Terlipressin reduces mesenteric and hepatic blood flow, causing vasoconstriction in the smooth muscles of the arteries in the splanchnic region. Objective: We investigated the efficacy of perioperative terlipressin infusion in patients who received living donor liver transplantation (LDLT) on hepatic and renal functions. Design: Retrospective. Setting: University hospital. Method: The study included 86 adult patients who received LDLT, due to end-stage hepatic disease, between April 2014 and July 2016 in our institute. Data were collected by searching the medical archives of patients. A standard anesthesia protocol was administered to all patients. In a selected group of patients, terlipressin infusion was initiated at 3 μg/kg/h, immediately after anesthesia was induced. The dose was halved following arterial anastomosis and was continued at this dose for the subsequent 3 days. Patients who received terlipressin infusion were compared with patients who did not receive it. Main Outcome Measures: There is no evidence in this trial to show evidence of effectiveness as a result of terlipressin infusion. Results: Patients in the terlipressin group were statistically significantly older. Central venous pressure, cardiac index, global end diastolic volume, and extravascular lung volume did not show significant differences between the groups. Urine output was similar in both groups; however, regarding the use of packed red blood cells and fresh frozen plasma, terlipressin group patients needed more packs. Perioperative liver function tests were similar between the groups except for aspartate aminotransferase and alanine aminotransferase values on the first and third postoperative days. Conclusion: Terlipressin infusion was not found to be significantly effective among the liver and kidney function tests. Limitations: This may be a result of randomization defect of our retrospective study design. Many prospective randomized studies should be planned to reach more accurate results.
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Pathological changes in appendectomy specimens including the role of parasites: A retrospective study of 2400 cases of acute appendicitis p. 270
M Tayfur, MG Balci
DOI:10.4103/njcp.njcp_271_18  
Background: Parasitic infestation of the appendix is uncommon. Parasitic infections can cause inflammation in the appendix and can imitate acute appendicitis clinically. Enterobius vermicularis and Taenia species are among the most common parasitic agents causing acute appendicitis. Objective: We have studied the ratio of parasites causing acute appendicitis in appendectomy specimens and whether there is any relationship between the type of the parasite, histopathological type of acute appendicitis, age of the patient, and gender of the patient in the appendectomy cases. Materials and Methods: We retrospectively analyzed the data of 2400 patients who underwent appendectomy with the prediagnosis of acute appendicitis between 1st January 2004 and 31st March 2018 at Erzincan University. The age of the patient, gender of the patient, histopathologic type of acute appendicitis, and the type of parasite were retrospectively analyzed. Positive appendectomy specimens for histopathological features of acute appendicitis were classified into four groups: catarrhal appendicitis, suppurative appendicitis, gangrenous appendicitis, and perforated appendicitis. Results: In all, 1451 were males and 949 were females. The mean age was 25.51 years. No acute inflammation was found in 36 appendectomy specimens. The distribution of 2364 cases involving acute appendicitis was as follows: catarrhal appendicitis: 438, suppurative appendicitis: 300, gangrenous appendicitis: 1082, and perforated appendicitis: 544. Parasites were identified in 32 cases. The ratio of appendices to parasites was 1.3%. The number of appendectomy cases with Enterobius vermicularis was 22, and the number with Taenia species was 10. Conclusion: Although they are a rare cause of acute appendicitis, parasitic infestations must always be considered. Accurate identification of acute appendicitis and appropriate therapy will improve the quality of life as much as the prevention of acute appendicitis sourced from parasites.
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CASE REPORTS Top

Laser-assisted management of ectopic eruption of permanent incisors p. 276
V Ciftci, HN Uguz, M Ozcan
DOI:10.4103/njcp.njcp_477_18  
Ectopic eruption originates from the malpositioning of a tooth bud ending in the eruption of the tooth in an improper direction. This anomaly is a consequence of ectopic development of the tooth germ. This condition gives rise to significant aesthetic and occlusal issues in the early mixed dentition stage. The most frequently influenced teeth are the maxillary first molars, accompanied by the maxillary cuspids. Ectopic eruption is seldom seen and might derive from traumatic injury. In some cases, hyperplastic and fibrotic gingival tissue may lead to ectopic eruption of a permanent incisor. Managing ectopically erupting teeth generally rests on several reasons including extraction of supernumerary tooth, removal of cyst and excision of hyperplastic tissue and subsequent to orthodontic movement of tooth if necessary. In this case, the use of Er, Cr: YSGG lasers for the correction of hyperplastic soft tissues involving ectopically erupting permanent incisors are depicted considering two cases.
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Lessons learned from an unusual condition of incidental synchronous multiple hernias of indirect inguinal hernia, femoral hernia, and incarcerated obturator hernia p. 281
LL Jiang, CC Chen, K Yang
DOI:10.4103/njcp.njcp_200_18  
Hernias are one of the most common diseases. The frequency of multiple hernias is much higher than the frequency reported during herniorrhaphy. Multiple hernias may account for some of the so-called recurrences, in which the small hernia may be veiled by the bigger one and omitted. In this study, we present a case of an 83-year-old female who suffered from multiple hernias namely a left-sided indirect inguinal hernia, a right-sided femoral hernia, and a right-sided incarcerated obturator hernia. Additionally, the characteristics and treatment of obturator hernia were discussed. Ultrasound and computed tomography (CT) are capable of accurately diagnosing groin hernia. Preoperative bilateral ultrasound of examinations or abdominopelvic CT should be recommended to perform routinely for patients with suspected hernias to avoid ignoring the concurrent hernias. A careful exploration of the operative field in the operation is mandatory. The CT is also helpful for early diagnosis of obturator hernia. In addition, the intra-abdominal approach through a low midline incision might be a preference for the treatment of obturator hernia.
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Middle distal canal of mandibular first molar: A case report and literature review p. 285
DO Kirici, S Koc
DOI:10.4103/njcp.njcp_315_18  
A successful root canal treatment can only be achieved by gaining adequate access to all root canals, ensuring adequate mechanical preparation, and disinfection as well as placing a three-dimensional impermeable filling in these root canals. Practitioners must be very careful when detecting the root canals in mandibular first molar tooth, because it shows a wide variety of root canal variations and it is the first permanent tooth erupted in the mouth that frequently requires endodontic treatment. Our case report presents the endodontic retreatment of a left permanent mandibular first molar having two roots that consist of three distal canals and two mesial canals (Type XVIII root canal pattern). After all the root canals were identified with endodontic explorer adequate preparation and disinfection were provided, the root canals were filled with calcium hydroxide-based canal sealer and gutta-percha and the crown was restored with resin composite at the second appointment. In addition, a short review of literature for similar cases is presented in this paper.
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