Medical and Dental Consultants’ Association of Nigeria
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   Table of Contents - Current issue
Coverpage
May 2017
Volume 20 | Issue 5
Page Nos. 507-646

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ORIGINAL ARTICLES  

Practice of trabeculectomy by ophthalmologists in Nigeria p. 507
NN Kizor-Akaraiwe, CE Ogbonnaya
DOI:10.4103/1119-3077.196992  PMID:28513505
Aim: To assess the practice of trabeculectomy among ophthalmologists in Nigeria. Materials and Methods: This was a cross-sectional study in which structured, self- administered questionnaires were distributed to 80 consenting ophthalmologists present during the 2010 annual scientific session of the Ophthalmological Society of Nigeria. All consenting ophthalmologists treat glaucoma patients. Information obtained were demographic characteristics, glaucoma outpatient load, number of trabeculectomies performed in the preceding 1 year and during residency training, and factors influencing trabeculectomy practice. Data were analyzed with Statistical Package for Social Science version 16.0. Relationships between variables were tested using the Χ2 test for statistical significance. Results: Sixty-five of the 80 consenting ophthalmologists responded to the questionnaires (81.3% response rate); 32 (53.3%) were females and 28 (46.7%) were males (5 non-responders). Ages ranged from 30 to 60 years with a mean of 44 years ± SD 7.7. Only 36 (57.1%) performed trabeculectomy in the 1 year preceding the study. There was an overall trabeculectomy rate of 0.9/ophthalmologist/month. Of the 15 respondents who performed more than 15 trabeculectomies during residency, 14 (93.3%) also performed the surgery in the year preceding this study (P = 0.001). The main limitation to the practice of the procedure was patients' unwillingness to accept surgery, as identified by 50 (89.3%) respondents. Conclusions: A low trabeculectomy rate of 0.9/ophthalmologist/month was found in this study. It was significantly associated with insufficient exposure to the surgery during residency training and patients' poor acceptance of the surgery.
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Surgical difficulties, success, and complication rates of orthodontic miniplate anchorage systems: Experience with 382 miniplates Highly accessed article p. 512
Y Findik, T Baykul, E Esenlik, MH Turkkahraman
DOI:10.4103/1119-3077.187320  PMID:28513506
Purpose: The aim of this study was to evaluate the complications and success rates of the miniplates using both maxilla and mandible for orthodontic anchorage in growing patients. Materials and Methods: One hundred and fifty-five consecutive patients (range 8.7–13.8 years) with Class II and III malocclusion without congenital or acquired deformities were included in this study. A total of 382 titanium miniplates were placed by the same surgeon. All miniplates were inserted under local anesthesia. Loading of the miniplates with a force of 200 g with the help of elastics or functional devices were initiated 3 weeks after surgery. Results: The overall success rate of miniplate anchorage in terms of stability was 96.8%. Twenty-one patients reported irritation of the mucosa of the cheeks or lower lip after the surgery in the mandible group. Twelve miniplates needed to be removed and were successfully replaced. Conclusion: Skeletal anchorage miniplates is effective for correcting malocclusions. Success depends on proper presurgical patient counseling, minimally invasive surgery, good postsurgical instructions, and orthodontic follow-up.
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Early pregnancy plasminogen activator inhibitor-1 levels in Nigerian women and its relationship with preeclampsia p. 517
IC Udenze, AP Arikawe, CC Makwe
DOI:10.4103/1119-3077.183256  PMID:28513507
Aim: This study compared early plasma levels of plasminogen activator inhibitor-1 (PAI-1) in normal pregnancy and preeclampsia and determined its relationship with disease severity. Subjects and Methods: This was a prospective cohort study of 195 normotensive, aproteinuric pregnant women without prior history of gestational hypertension. The women were attending the Antenatal Clinic at The Lagos University Teaching Hospital and were within 24 weeks gestation at recruitment. The outcome measures were PAI-1, systolic blood pressure (SBP), diastolic blood pressure (DBP), and significant proteinuria. The endpoint of the study was the development of preeclampsia. The diagnosis of preeclampsia was made by the attending Obstetrician. The data were analyzed using the IBM SPSS statistical software. Statistical significance was set at P < 0.05. Results: First trimester PAI-1 levels were significantly higher in the women who later developed preeclampsia compared to those who had a normal pregnancy (P < 0.0001). In these group of women who later developed preeclampsia, PAI-1 had an inverse relationship with gestational age (r = 0.878) whereas in normal pregnancy, PAI-1 and gestational age had a direct relationship (r = 0.017). Second trimester systolic and DBP values were also significantly higher in the women who later developed preeclampsia compared to normal pregnancy, P = 0.007 and 0.004, respectively. There was, however, no correlation between PAI-1 values and SBP, DBP and proteinuria in the women who developed preeclampsia. Conclusion: Plasma levels of PAI-1 are increased early in pregnancies complicated by preeclampsia, but the lack of correlation of this marker with disease severity may limit its clinical utility.
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Harmful effects of formaldehyde and possible protective effect of Nigella sativa on the trachea of rats Highly accessed article p. 523
E Sapmaz, HI Sapmaz, N Vardi, U Tas, M Sarsilmaz, Y Toplu, A Arici, M Uysal
DOI:10.4103/1119-3077.183253  PMID:28513508
Objective: We aimed in this study to investigate the harmful effects of formaldehyde (FA) inhalation and possible protective effects of Nigella sativa (NS) on rats' trachea. Materials and Methods: In this study, 63 adult male rats were used. Animals were divided into nine groups. Group I was used as control group. All other groups were exposed to FA inhalation. Group III, V, VII, and IX were administered NS by gavage. Tissues were examined histologically, and immunohistochemical examination for Bax and caspase-3 immunoreactivity was carried out. Results: Our study demonstrated that FA caused apoptosis in the tracheal epithelial cells. The most apoptotic activity occurred at a 10 ppm dose in a 13-week exposure. Distortion of tracheal epithelium and cilia loss on epithelial surface was present in all groups. However, NS treated Groups VII and IX had decreased apoptotic activity and lymphoid infiltration and protected the epithelial structure, despite some shedded areas. Difference of tracheal epithelial thickness and histological score was statistically significant between Group VI–VII and VIII–IX. Conclusion: FA induces apoptosis and tracheal epithelial damage in rats, and chronic administration of NS can be used to prevent FA-induced apoptosis and epithelial damage.
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Relationship between alexithymia and chronic periodontitis p. 530
U Sezer, K Üstün, SZ Şenyurt, K Altınbaş, K Erciyas
DOI:10.4103/1119-3077.183244  PMID:28513509
Objective: The aim of this study was to investigate the potential relationship between alexithymia and chronic periodontitis. Materials and Methods: A case–control study of 222 male and female subjects aged 21–63 years was conducted. The participants were divided into a chronic periodontitis group (n = 114) and a control group (n = 108) with no history of periodontitis. The Toronto Alexithymia Scale (TAS-20) was used to evaluate alexithymia status of the subjects. Clinical data were collected on parameters such as the plaque index, bleeding on probing, probing depth, and the clinical attachment level (CAL). Socioeconomic data on the patients were also recorded. Results: Chronic periodontitis group showed higher frequency in alexithymic patients as compared to control group. The proportion of high dental anxiety did not differ between the groups. The total TAS-20 score was statistically significantly higher in male subjects than in female subjects (P < 0.05). The bivariate analyses of the psychometric measures and the periodontal parameters revealed positive correlations with the severity of periodontal disease/CAL and the total TAS-20 score (P < 0.05). Conclusion: The results of the current study suggest that alexithymia is a possible risk factor for chronic periodontitis. Further research is needed to identify the underlying mechanism.
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Factors associated with blood pressure control in predialysis chronic kidney disease patients: Short-term experience from a single center in Southern Nigeria p. 537
EI Okaka, OE Ojeh-Oziegbe, EI Unuigbe
DOI:10.4103/1119-3077.197005  PMID:28513510
Background: Hypertension is a leading cause of kidney disease worldwide, and chronic kidney disease (CKD) is a known cause of secondary hypertension. Blood pressure (BP) control is a main-stay in the management of CKD because it retards the progression of established CKD. Aim: To determine BP control and its associated factors in predialysis CKD patients in a tertiary hospital setting. Methodology: CKD patients who attended the renal outpatient clinic during the period from December 2013 to June 2014 were recruited into the study. Demographic and clinical information were obtained from their case records. The average of the three most recent clinic BPs was calculated for each patient. Good BP control was taken as an average BP of <140/90 mmHg. Results: One hundred and three patients (53 males and 50 females) met inclusion criteria for the study. The mean age of the patients was 40.6 ± 17.4 years. Estimated glomerular filtration rate was <60 ml/min in 49.5% of patients. Good BP control was seen in 57 (55.3%) patients. Poor BP control was associated with middle age, proteinuric CKD, and prescription of 3 or more BP medication. Conclusion: BP control in predialysis CKD patients still needs to be optimized. Special attention should be given to middle-aged patients who have proteinuric CKD and those on multiple BP drugs without optimal BP control.
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Comparison of elasticity values of the right lobe of the liver of normal weight and morbidly obese Turkish patients p. 542
S Aksoy, C Colak, MO Nalbant, R Turkay, I Erdil, E Hocaoglu, E Inci, H Alis
DOI:10.4103/1119-3077.206362  PMID:28513511
Introduction: Shear wave elastography is a method for the measurement of tissue stiffness. The advantage of this method is that its outcome is not operator dependent. Our aim was to compare the elastiscity values of the right lobe of the liver of normal weighted and morbidly obese patients. Materials and Methods: The mean elastiscity values of the right lobe of the liver were calculated for 38 normal weighted and 37 morbidly obese patients. All the patients had no history of liver disease. Results: The mean elastiscity value was significantly higher in morbidly obese patients than (25,7 +3,30 kPascal) in normal weighted patients for the right lobe of liver (10,55 +2,20 kPascal). Conclusion: Morbidly obese patients have a potential risk for liver fibrosis even in the absence of hepatosteatosis.
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Effects of laser etching on shear bond strengths of brackets bonded to fluorosed enamel p. 545
R Nalçaci, B Temel, S çokakoğlu, H Türkkahraman, S Üsümez
DOI:10.4103/1119-3077.183245  PMID:28513512
Aim: To evaluate the effects of laser etching on the shear bond strengths (SBS) and failure modes of brackets bonded to fluorosed enamel. Materials and Methods: This in vitro study included 34 fluorosed and 34 nonfluorosed teeth. Teeth were divided into four subgroups according to the etching procedure: Group (A) normal enamel etched with 37% phosphoric acid for 15 s, Group (B) nonfluorosed enamel etched with erbium:yttrium aluminum garnet (Er: YAG) laser for 15 s, Group (C) fluorosed enamel etched with 37% phosphoric acid for 30 s, Group (D) fluorosed enamel etched with Er: YAG laser for 30 s. After bonding of the premolar metal brackets, specimens were subjected to the thermal cycles. After SBS test, modified adhesive remnant index (ARI) by using stereomicroscope and failure modes with a scanning electron microscope (SEM) was determined. After bonding, one specimen from each group was examined under SEM to identify enamel-resin interfaces. ANOVA and Tukey post-hoc tests were used to compare the SBS values. The Kruskal–Wallis and Chi-square tests were used to analyze the distribution of ARI scores and failure modes of groups. Results: The highest mean SBS value (17.56 ± 1.05 MPa) was found in Group A, while the lowest (12.25 ± 0.96 MPa) in Group D. Significant differences were found in the SBS test and failure modes among all groups. The differences between ARI scores of the groups were not significant. Conclusion: According to our findings, laser etching reduced the SBS of brackets bonded to fluorosed teeth, but provided clinically acceptable SBS values.
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Electrocardiographic changes and troponin T levels in children with severe malaria anemia and heart failure p. 552
WE Sadoh, JO Uduebor
DOI:10.4103/1119-3077.187313  PMID:28513513
Background: Severe malaria anemia is a major cause of childhood heart failure in malaria endemic countries. The resulting hypoxic-ischemic injuries may cause myocardial damage detectable by electrocardiogram (ECG) and elevated troponin T (cTnT) levels. Objective: Evaluate the ECG changes and cTnT levels in children with severe malaria anemia compared with those who had uncomplicated malaria without anemia. Methods: Consecutive children with severe malaria anemia were recruited as subjects while controls were age- and gender-matched children with uncomplicated malaria without anemia. ECG findings, cTnT levels, and the proportion of children with elevated cTnT were compared between subjects and controls. Results: There were 43 subjects with a mean age of 25.7 ± 22.9 months. Controls were forty children; mean age was 31.2 ± 20.0 months. All the subjects and 10 (25.0%) controls had ECG abnormalities. Five (11.6%) subjects and no control had ST segment changes, P = 0.06. Twenty-three percent of subjects compared to 5% of the controls had prolonged QTc, P = 0.027. Median cTnT of subjects (131.8 ng/L) was not significantly higher than the 85.9 ng/L of controls, P = 0.99. The median cTnT of subjects that died 208.9 ng/L was higher than in survivors 99.6 ng/L, P = 0.51. Conclusion: Prolonged QTc was more prevalent in children with severe malaria anemia compared to those without anemia, suggesting that children with severe malaria anemia were more prone to arrhythmias. The median cTnT value in the subjects was not significantly lower than that in controls, suggesting that children with severe malaria anemia are not prone to myocardial injury any more than those with uncomplicated malaria without anemia.
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Efficacy of polishing kits on the surface roughness and color stability of different composite resins Highly accessed article p. 557
H Kocaagaoglu, T Aslan, A Gürbulak, H Albayrak, Z Taşdemir, H Gumus
DOI:10.4103/1119-3077.181387  PMID:28513514
Objective: Different polishing kits may have different effects on the composite resin surfaces. The aim of this study was to evaluate the surface roughness and color stability of four different composites which was applied different polishing technique. Materials and Methods: Thirty specimens were made for each composite resin group (nanohybrid, GrandioSo-GS; nanohybrid, Clearfil Majesty Esthetic-CME; hybrid, Valux Plus-VP; micro-hybrid, Ruby Comp-RC; [15 mm in diameter and 2 mm height]), with the different monomer composition and particle size from a total of 120 specimens. Each composite group was divided into three subgroups (n = 10). The first subgroup of the each composite subgroups served as control (C) and had no surface treatment. The second subgroup of the each composite resin groups was polished with finishing discs (Bisco Finishing Discs; Bisco Inc., Schaumburg, IL, USA). The third subgroup of the each composite resin was polished with polishing wheel (Enhance and PoGo, Dentsply, Konstanz, Germany). The surface roughness and the color differences measurement of the specimens were made and recorded. The data were compared using Kruskal–Wallis test, and regression analysis was used in order to examine the correlation between surface roughness and color differences of the specimens (α = 0.05). Results: The Kruskal–Wallis test indicated significant difference among the composite resins in terms of ΔE (P < 0.05), and there was no statistically significant difference among composite resins in terms of surface roughness (P > 0.05). Result of the regression analysis indicated statistically significant correlation between Ra and ΔE values (P < 0.05, r2 = 0.74). Conclusion: The findings of the present study have clinical relevance in the choice of polishing kits used.
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Relationship between knowledge and quality of asthma care among physicians in South-West Nigeria p. 566
B Adeniyi, O Ilesanmi, D Obaseki, O Desalu, B Betiku, G Erhabor
DOI:10.4103/1119-3077.206363  PMID:28513515
Introduction: Adequate knowledge of asthma management and adherence to international guidelines are known to increase the quality of care offered by Physicians. We conducted this study to assess the level of asthma knowledge and quality of care among physicians practicing in Ondo State. Methods: We conducted a cross sectional survey of 96 physicians from various specialties participating in a continuous professional development (CPD) lecture using adapted questionnaires. Result: Respondents ranged in age from 23-62years (42.5±19.4). There were more male (70%). The minority (17%) had additional postgraduate medical qualifications. There was a high distribution of correct answers for individual knowledge questions. The greatest areas of knowledge gaps appeared in diagnostic instruments, asthma severity and drugs. We observed gaps regarding the use of GINA guidelines (6%) and prescribing combined inhaled steroid and long acting bronchodilator for patients who are not controlled on inhaled steroid alone (29%). A large number of the respondents do not confirm the diagnosis of asthma by spirometry (32%). Only 8% of the respondents with high knowledge reported a corresponding high quality of Asthma care. Conclusion: We concluded that although physicians in South-West Nigeria appear to have good knowledge, there are areas of gap in the quality of asthma care with regards to standard guideline. There is need for constant training and re-training of physicians in order to keep them up to date with international guidelines. In addition, increase access to diagnostic facilities and adapting international guideline to local realities will help improve standard of Asthma care.
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Admission hyperglycemia an independent predictor of outcome in acute ischemic stroke: A longitudinal study from a tertiary care hospital in South India p. 573
SK Marulaiah, MP Reddy, M Basavegowda, PKH Ramaswamy, LS Adarsh
DOI:10.4103/1119-3077.206368  PMID:28513516
Background: Stroke is one of the important causes of long-term disability-related deaths worldwide. Incidence and prevalence of stroke have been steadily increasing in India. Increasing interest has been focused on the role of admission hyperglycemia in the evolution of acute ischemic stroke. Very few studies were conducted in south India; hence, we intended to do this study. Methods: A total of 198 patients with acute ischemic stroke were included in a hospital-based longitudinal study to identify the independent factors (demographic, clinical, and biochemical parameters) associated with poor outcome (functional impairment—mRS ≥ 3 and mortality at 90 days of follow-up. Results: Nearly, 75% of the patients presented with moderate-to-severe stroke. Out of the 198 patients, 117 (59%) had severe disability at admission. At 90 days of follow-up, it was observed that only 10 (5.5%) had severe disability. Patients with hyperglycemia exhibited greater functional impairment, that is, 96 out of 111 study subjects had modified Rankin score (mRS) ≥3, than those with normoglycemia (P < 0.0001). Mortality was high in hyperglycemics when compared with normoglycemics, that is, out of the 20 deaths, 13 patients had hyperglycemia and seven had normoglycemia at presentation (P < 0.015). Logistic regression analysis predicted that higher capillary blood glucose at first presentation, moderate-to-severe stroke, poor drug compliance, stress hyperglycemia, and newly detected diabetes mellitus were associated with poor functional outcome at 90 days of follow-up. Conclusion: Stress hyperglycemia in stroke was associated with higher risk of poor functional outcome in acute ischemic stroke. Hyperglycemia at stroke onset without prior history of diabetes mellitus have particularly poor prognosis, than those with hyperglycemia in known diabetes.
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Comparison of arch width changes following orthodontic treatment with and without extraction using three-dimensional models Highly accessed article p. 581
AA Oz, AZ Oz, S Yaziciooğlu, N Arici, M Ozer, S Arici
DOI:10.4103/1119-3077.181389  PMID:28513517
Objective: To compare the arch width changes in patients treated fixed orthodontic mechanics without extraction (Group 1), with upper and lower first premolar extractions (Group 2), and with upper first premolar extraction only (Group 3). Materials and Methods: The study was conducted with pre- and post-treatment digital models from 240 patients. Anterior, middle, and posterior distances were measured on pre- and post-treatment models. At T1 measurements, the distance among the canine cusp tips, the second premolar buccal cusp tips, and the first molar mesiobuccal cusp tips were measured. In addition, the distance (D) between the intercanine and intermolar lines and the distance (D') between the interpremolar and intermolar lines were defined on the anatomic y-axis, and this distance was maintained in calculating posttreatment measurements (T2). Mandibular and maxillary arch width changes were evaluated within and between groups. Results: Anterior, middle, and posterior arch widths increased significantly in Groups 1 and 3. Maxillary anterior and middle arch widths also increased in Group 2, but the increases were not statistically significant. Changes in maxillary anterior and middle arch widths were higher in Groups 1 and 3 when compared to Group 2. However, there was no statistically significant difference in mandibular arch changes between the groups. Conclusion: Extraction treatment mechanics did not cause narrow dental arches, but nonextraction treatment increased arch width in all 3 measurements. Treatments with only upper arch extraction showed similar results with nonextraction treatment.
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Firearm injuries received in emergency room of a Nigerian Teaching Hospital: Aanalysis of pattern, morbidity, and mortality p. 587
NI Omoke
DOI:10.4103/1119-3077.197018  PMID:28513518
Background: The morbidity and mortality associated with civilian firearm injury in developing countries is appreciable. The increasing incidence of gunshot casualties received in hospital emergency rooms is an emerging concern. The aim of this study was to determine the pattern and outcome of firearm injuries in a civilian setting of a developing country. Materials and Method: This was a retrospective analysis of data on the entire patients with firearm injury received in the emergency room of Federal Teaching Hospital Abakaliki from January 2005 to December 2014. Results: There were 214 casualties, male-to-female ratio was 8:1, and mean age was 31.7 ± 0.80 years. The causes of injuries were armed robbery (59.9%), assault (33.6%), and accidental (6.5%). The incidence of armed robbery–related injury peaked in May and was higher in rainy season (P < 0.018), urban areas (P < 0.001) and at night-time (P < 0.033), whereas the incidence of assault-related injury peaked in April and was higher in dry season in rural areas and at day-time. Duration of hospital admission ranged from 1 to 184 days and mean was 16 days. Prolonged duration of hospital admission correlated with perforating wound (P < 0.001), high-velocity gunshot (P < 0.001), fractures (P < 0.001) and wound infection (P < 0.001). Preventable death rate was high, although mortality rate was 5.6%. A high mortality rate correlated with visceral injury (P < 0.001) and hypovolaemic shock (P < 0.001). Conclusion: The temporal distribution of firearm injury varies in location and aetiology of gunshot. This and the factors for relatively high morbidity and preventable death rate observed call for preventive strategies as well as improvement in pre-hospital and emergency room care.
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Attitude and knowledge of family medicine practitioners towards the association between periodontal disease and obesity p. 595
Z Akram, T Abduljabbar, A Hanif, A Khan, F Vohra
DOI:10.4103/1119-3077.197017  PMID:28513519
Objectives: To assess the attitude and knowledge of family medicine practitioners (FMPs) towards the association between periodontal disease and obesity. Materials and Methods: A cross-sectional study was performed and a 13-item survey questionnaire was given to FMPs practicing in 12 different teaching hospitals in Karachi, Pakistan. The questions were aimed at exploring the knowledge of FMP's regarding the association of obesity and periodontal disease and their attitude towards the association of obesity and periodontal disease. Chi-square and Spearman co-efficient were conducted to compare subgroups and correlate factors with the knowledge score of FMPs. Results: A total of 314 questionnaires were completed (response rate = 92%). Median age of participants was 41 years and 57% were females. Almost 61% of FMPs answered all the knowledge questions correctly and 64% reported moderate understanding of the association between periodontal health and obesity. Nearly 73% FMPs inquired from obese patients regarding the periodontal disease and more than half (58%) refer patients to a dentist for evaluation. More than half of FMPs perform periodontal disease screening. Nearly all FMPs considered informing obese patients regarding periodontal disease as one of their roles. Conclusions: FMP's play an important role in the early diagnosis, prevention and treatment of periodontal conditions in obese patients. More than two thirds of FMPs showed good knowledge of the association of obesity and periodontal disease. The attitudes of FMPs towards assessing and referring obese patients at a risk of having periodontal disease were reassuring.
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Clinical assessment of mineral trioxide aggregate in the treatment of deep carious lesions p. 600
UK Vural, A Kiremitçi, S Gökalp
DOI:10.4103/1119-3077.183252  PMID:28513520
Objective: This clinical study aimed to assess the effectiveness of mineral trioxide aggregate (MTA) and calcium hydroxide (Ca[OH]2) in the treatment of deep carious lesions using the direct complete caries excavation technique. Subjects and Methods: Hundred permanent molars/premolars were capped either with Ca (OH)2 (n = 49) or MTA (n = 51) and restored with composite resin in 73 patients. Periapical radiographs were taken prior to the treatment, at 6 months and 12 months. Two calibrated examiners clinically and radiographically assessed the periapical pathology and pulpal symptoms. Inter-group comparisons of the observed values were analyzed using Fisher's exact test. Significance was predetermined at α = 0.05. Results: Recall rates were 100% at 6 and 12 months. Four teeth capped with Ca(OH)2 (two each at the end of 6 and 12 months) and one tooth capped with MTA (at the end of 12 months) received endodontic emergency treatment because of symptoms of irreversible pulpitis that were clinically and/or radiographically established. There was no significant difference between the protection of the tooth vitality and pulp capping agents at 6 and 12 months (P = 0.238, P = 0.606, respectively). Conclusion: Both materials were clinically applicable at the end of 12 months.
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Otorhinolaryngological emergencies in a Tertiary Hospital in Port Harcourt p. 606
UM Ibekwe
DOI:10.4103/1119-3077.196988  PMID:28513521
Background: Emergencies are not uncommon in a typical otorhinolaryngological (ORL) clinic. The knowledge of the profile and prevalence of these emergencies will go a long way in helping to equip as well as aid proper and prompt management of these conditions so as to reduce their morbidity and mortality. Patients and Methods: A descriptive retrospective 8 years review of all patients that presented to the ENT Surgery Department from January 2004 to December 2012. This includes referrals from the accident and emergency as well as the children emergency ward. The patients case files, the ward, and theatre records were the source of data. Data collected included; age, sex, presentations, diagnosis, and management. Results: There were a total number of 5660 patients that presented as emergencies, however only 2160 cases were real emergencies. Males were 1328 and females 832 with a ratio of 1.6:1. The age ranged from 6 months to 70 years. The age range 0-10 years were the most affected 670 (31.02%) followed by age range 21-30 years 534 (24.72%). The least was 61-70 years 26 (1.20%). Foreign body aspiration/ingestion/insertion was the commonest emergency 900 cases (41.7%) followed by trauma 650 (30.09%). There were five cases (0.23%) of mortality recorded. Respiratory distresses from upper airway obstruction, dysphagia, and odynophagia were the common presentations. Direct laryngoscopy, esophagoscopy, and tracheostomy were the commonest form of management. Conclusion: ORL emergencies are common. The pediatric age group is the most affected; foreign body and trauma comprise the commonest emergency in our environment.
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Comparison between olfactory function of pregnant women and non-pregnant women in reproductive age group in Ibadan, Nigeria p. 610
U Nwankwo, AJ Fasunla, A Oladokun, OG Nwaorgu
DOI:10.4103/1119-3077.206367  PMID:28513522
Background: Pregnant women require normal olfactory function in order to develop good appetite for healthy living and normal fetal development. This study was carried out to investigate and compare olfactory function of pregnant women with non-pregnant women. Methods: This was a case control study of women in reproductive age group at the University College Hospital, Ibadan, Nigeria from July 2014 to February 2015. Consecutive 70 pregnant women and 70 non-pregnant women (controls) without rhinologic symptoms were studied. A structured questionnaire was administered to obtain participants' information on socio-demographics, pregnancy history, and ability to perceive smell. They subjectively rated their olfactory function on a visual analogue scale of 0 – 100. Olfactory threshold (OT), discrimination (OD), identification (OI) scores and TDI of both groups were determined with“Sniffin' sticks”kits and compared. The level of significance was P<0.05. Results: The mean age of the pregnant women was 30.5±3.9years and control was 28.5±6.6years. There were more pregnant women (7.1%) with hyposmia than the non-pregnant women (2.9%). The subjective rating of olfactory function was 68.2±24.9 (median 70) and 72.3±21.6 (median 69) in pregnant women and controls respectively. The mean OT, OD, OI, TDI scores were higher in pregnant women than the controls. However, it was only in OI (P=0.000) and TDI (P=0.012) that the differences were significant. Conclusions: Pregnant women have olfactory dysfunction more than the non-pregnant women of reproductive age group. Also, they have tendency to develop loss of cognitive olfactory information more than the non-pregnant women.
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The efficacy of sequential therapy in eradication of Helicobacter pylori in Turkey p. 616
F Harmandar, SU İlikhan, Y Üstündağn, O Harmandar
DOI:10.4103/1119-3077.196991  PMID:28513523
Background and Aim: Most of the studies about sequential therapy that have been reported from Turkey were levofloxacin based. We aimed to compare the Helicobacter pylori (H. pylori) eradication rates of standard triple, sequential and quadruple therapies including claritromycin regimes in this study. Materials and Methods: A total of 160 patients with dyspeptic symptoms were enrolled to the study. The patients were randomized to four groups of treatment protocols. And 40 patients received standard triple therapy for 2 weeks, 40 patients received bismuth containing quadruple therapy for 2 weeks, 40 patients received 5 + 5 clarithromycin-based sequential therapy, and 40 patients received 7 + 7 clarithromycin-based sequential therapy. H. pylori eradication was assessed by C 14 urea breath test 4 weeks after therapy. Results: Out of 160 patients with H. pylori infection, 131 (81.9%) were eradicated successfully and 29 (18.1%) failed to eradicate H. pylori infection. H. pylori eradication was achieved in 28 of 40 patients receiving standard triple therapy (70%), in 33 of 40 patients receiving quadruple therapy (82.5%), in 37 of 40 patients receiving 5 + 5 sequential therapy (92.5%), and in 33 of 40 patients receiving 7 + 7 sequential therapy (82. 5%). Statistics revealed that 5 + 5 sequential therapy led to significantly higher H. pylori eradication rates compared with that of standard triple therapy (P = 0.019). There was no statically difference between 5 + 5 sequential therapy and the other therapy groups' eradication rates, but it was higher than all of the protocols. H. pylori eradication rate with sequential therapy in our patients with nonulcer dyspepsia was higher than those of patients with standard therapy (93% versus 82%, respectively, P>0.05). Conclusion: 5 + 5 sequential therapy was associated with significantly higher eradication rate of H. pylori compared with standard triple therapy in our study cohort.
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Ureterolithiasis: Management in an environment with limited facilities p. 622
CA Odoemene, PCN Okere, MC Ugonabo
DOI:10.4103/njcp.njcp_14_16  PMID:28513524
Background: In the past 2–3 decades, there has been a dramatic development in the techniques of stone removal. This study highlights the management of symptomatic ureteral stones in an environment without such facilities. Materials and Methods: Sixty-nine patients, comprising 53 (76.8%) males and 16 (23.2%) females, diagnosed of symptomatic ureteric calculi within the study period in two tertiary health institutions were included in the study. Thorough history taking and physical examinations were performed. Extensive laboratory investigations using blood and urine specimens were carried out. Imaging studies, ultrasonography, intravenous urography, and computerized tomographic scan were used to locate the position and size of the calculi. Results: Forty-six (66.7%) patients presented with excruciating flank ureteric colic radiating to the groin in 16 (23.2%) patients and hematuria in 62 (89.9%) patients. Bilateral ureteric calculi occurred in 3 (4.3%) patients. Eleven (15%) stones passed spontaneously. 33 (47.8%) patients had uneventful open surgery. The stones were mixed in nature. Conclusion: Management of ureteric stones in our environment is affected by delay in presentation, low level of awareness of urinary stone disease, lack of modern endourological equipment, and paucity of urological surgeons. Finally, medical treatment should be explored for stones below 10 mm in size.
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Rehabilitation effect of exercise with soft tissue manipulation in patients with lumbar muscle strain p. 629
H Li, H Zhang, S Liu, Y Wang, D Gai, Q Lu, H Gan, Y Shi, W Qi
DOI:10.4103/njcp.njcp_126_16  PMID:28513525
Objective: To study the rehabilitation effect of exercise with soft tissue manipulation therapy for patients with lumbar muscle strain. Methods: Patients with lumbar muscle strain who met the inclusion criteria for study were randomly divided into control and experimental groups. Conventional therapy (i.e., triple therapy of needle, moxibustion, and cupping jar) was implemented for control group patients with lumbar muscle strain, whereas the combination therapy of exercise with manipulation was implemented for experimental group patients with lumbar muscle strain. Pain levels of the two groups of patients were graded using the VAS score, and finally, the rehabilitation effect of the two groups of patients was evaluated. Comparative analysis was performed using SPSS17.0 software, t-test, variance and χ2 test, and other statistical methods. Results: After treatment, there is a significant difference in average visual analogue scale (VAS) score between experimental group and control group, which meets P < 0.05; difference in joint range of motion between experimental group patients and control group patients was P < 0.05; the total treatment efficiency of experimental group patients was 99%, whereas that of control group was 79%. Conclusion: Rehabilitation effect of exercise with soft tissue manipulation therapy for lumbar muscle strain is more significant.
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CASE REPORTS Top

Cecal carcinoid tumor in a Nigerian man: A case report and review of literature p. 634
OA Obateru, JA Taiwo, S Oladejo, DA Awelimobor, OO Fadaunsi, AB Olokoba
DOI:10.4103/1119-3077.206366  PMID:28513526
Carcinoid tumors are rare neuroendocrine tumors that have been reported in a wide range of organs but most commonly involve the gastrointestinal tract (stomach, ileum, appendix, and colon), and rarely ovary and thymus. We present a case of a 56-year-old Nigerian man with a cecal carcinoid tumor that was surgically removed. A 56-year-old Nigerian man, presented to our hospital with a year history of right-sided lower abdominal fullness, audible bowel sounds, occasional diarrhea, nausea, vomiting, and epigastric pain. There was no history of hematochezia or passage of melena stool. Colonoscopy revealed a cecal mass occupying more than two-thirds of the cecal lumen. Histology confirmed carcinoid tumor (well-differentiated neuroendocrine tumor), which was surgically removed. Carcinoid tumors are slow growing rare neuroendocrine tumors. Mortality is low if it is diagnosed early.
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Management of pediatric mandibular fracture using orthodontic vacuum-formed thermoplastic splint: A case report and review of literature p. 637
OO Sanu, AOS Ayodele, MO Akeredolu
DOI:10.4103/1119-3077.187330  PMID:28513527
Fractures of the mandible are relatively less frequent in children when compared to adults. The anatomic features of children are protected. Children have a higher adaptation to maxillofacial fractures compared to adults. Treatment principles of mandibular fractures in children differ from that of adults due to concerns regarding mandibular growth and the developing dentition. A case of a 6-year-old boy with fractured mandibular symphysis managed by closed reduction using a vacuum formed thermoplastic splint and circummandibular wiring is presented. This article also provides a review of the literature regarding the management of mandibular fracture in young children.
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Complete upper urinary tract obstruction caused by penetrating pellet injury of the ureter p. 642
MT Gulpinar, SK Keskin, A Yildirim, T Caskurlu
DOI:10.4103/1119-3077.206365  PMID:28513528
Ureteral injuries due to gunshots are tend to be misdiagnosed because of concomitant vascular and intraabdominal organ wounds. Our case is a 23-year-old man who was admitted to the hospital with multiple abdominal gunshot wounds. Laboratory findings showed worsening anemia, and the computed tomography (CT) scan showed multiple lead bullets inside the abdomen and retroperitoneum. Patient was then taken to the operation room for laparatomy. There were many intestinal injuries and also a stable retroperitoneal hematoma. There was no ureteral injury mentioned in the operation note or the initial CT report. Two weeks after this operation, the patient developed significant urine leakage from the abdominal wounds. Ureteral J stent placement was our first choice of treatment. This was complicated with a late ureteral obstruction. The final treatment was an ureteroureterostomy. Diagnosing ureteral injuries due to traumatic causes can be hard in most of the cases. Physicians should consider early evaluation of the patient for ureteral leakage if there is suspicion about ureteral injury.
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Total gastric necrosis: A case report and literature review p. 645
G Huang, Y Jin
DOI:10.4103/1119-3077.206364  PMID:28513529
Total gastric necrosis is a rare disease and easy to misdiagnose. Here we report a rare case of total gastric necrosis. The patient, an 89-year-old male, had epigastric pain for 5 days. He was transferred to our hospital because of intraperitoneal hemorrhage and hypovolemic shock. We performed an emergency laparotomy. During the surgery, we found a total of 3500ml unclotted blood in the abdomen, splenic infarction and gastric necrosis. Total gastrectomy with Roux-en-Y esophagojejunostromy and splenectomy was performed. However, the patient died on the second day after the surgery. This case suggests that surgical treatment should be performed as early as possible when ischemia of abdominal organs is suspected.
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