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   Table of Contents - Current issue
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June 2019
Volume 22 | Issue 6
Page Nos. 745-880

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ORIGINAL ARTICLES  

Does introduction of user fees affect the utilization of cervical cancer screening services in Nigeria? p. 745
TK Nyengidiki, N Inimgba, G Bassey, RN Ogu
DOI:10.4103/njcp.njcp_257_18  
Background: Screening for cervical cancer improves outcome. This comes at an economic price which some may not be able to afford. Objective: To evaluate the influence of user fees on the utilization of cervical cancer screening services in Port Harcourt. Materials and Methods: A cross sectional study of clients presenting for cervical cancer screening. Data on the number, socio-demographic characteristics, distance from screening center following 1 month of free cancer screening and 7 months of user fee introduction, was collated and analyzed using SPSS version 20 statistical software. Results are presented in percentages, tables and charts with test of significance set at P < 0.05. Results: Of the 167 women who presented for cervical cancer screening during the study period, the mean age was 42.08 ± 8.9 years and range was 20–70 years. The average parity of patients was 2.83 ± 2.24. Clients' utilization of cervical cancer screening facilities was negatively affected by the introduction of user fees P < 0.001). There is no association between the distance of patients' home from the hospital and the utilization of facility (X2 = 0.24, P = 0.887). There was sustained decrease in number of clients with the introduction of fees. Conclusion: The introduction of user fees had a negative impact on the utilization of cervical cancer screening facilities. Eradicating user fee and improving the socioeconomic status of patients may improve the utilization of screening services.
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Up-regulation of hypoxia inducible Factor-1α in patients with diabetic nephropathy p. 750
J Wang, S Ye
DOI:10.4103/njcp.njcp_495_18  
Objective: To study the role of hypoxia inducible factor-1α (HIF-1α) in patients with diabetic nephropathy (DN). Methods: In total, 133 participants were selected to conduct the investigation, parameters such as fasting blood sugar (FBS), blood urea nitrogen (BUN), and urine albumin-creatinine ratio (UACR) were tested and recorded. The biopsy assessment was conducted when renal function or urinary abnormalities. Western blotting was used to test the expression of serum HIF-1α in all patients and control group. Results: The values of FBS, BUN, and UACR were higher in DN and diabetes groups than in the healthy control. The values of FBG, BUN, and UACR were higher in DN patients than in the diabetes patients with no nephropathy. eGFR in DN patients was lower than the other two groups. The expression of HIF-1α was higher than both diabetes patients with no nephropathy and healthy control, P < 0.05. Patients with lots of albuminuria showed the highest expression of HIF-1α than the other groups. HIF-1α in normoalbuminuria and microalbuminuria groups showed no significant difference. Conclusions: HIF-1α was up-regulated in DN patients, which might give clinical basis to the role of HIF-1α in the development of DN.
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Comparison of efficiency of hyaluronic acid and/or bone grafts in healing of bone defects p. 754
C Koca, N Komerik, O Ozmen
DOI:10.4103/njcp.njcp_161_18  
Background: Reconstruction of bone defects in oral and maxillofacial surgery has widespread uses. In recent years, the capacity of various biomaterials alone or in combination with bone graft materials to increase bone healing has been an intensive research topic. The aim of this study is to evaluate the efficacy of hyaluronic acid and/or bone graft material on bone healing in defects created in the rat mandible. Methods: In our study, rats were divided into 4 groups. Group 1 is designated to be treated with no materials, Group 2 with graft material, Group 3 with only hyaluronic acid, and Group with hyaluronic acid and graft material. A critical-size defect of 5 mm in diameter was created bilaterally in the rat mandibles and the rats were divided into the indicated groups accordingly. At the end of the postoperative 6th week, the experiment was terminated. The right halves of the mandibles were evaluated immunohistochemically and histopathologically in terms of bone healing, and the left in terms of mineralization level via microcomputed tomography. Results: Histopathological evaluation showed that healing in the empty group was significantly lower than the other groups that were treated with materials (P < 0.05); but the difference between the material-treated groups was not significant. Immunohistochemical evaluation revealed that the staining was moderately positive/strongly positive in all groups, but the difference between the groups was not significant. The highest mineralization values observed in the defected areas that belonged to 2 groups using hyaluronic acid, and the difference between them was found to be statistically significant (P < 0.05). The lowest mineralization values observed in the defected areas was most frequent in the group where only the hyaluronic acid was used, and there was a statistically significant difference between the other groups (P < 0.05). Conclusion: In conclusion, the use of hyaluronic acid alone or in combination with bone grafting has been shown to contribute positively to the improvement of bone defects in the jaw area.
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Repair potential of a new glass hybrid restorative system p. 763
U Koc Vural, S Gurgan
DOI:10.4103/njcp.njcp_551_18  
Background: Repair of a failed amalgam or composite resin (CR) restoration has been extremely studied and proposed as a routine clinical treatment option; however, repair potential of glass ionomer-based restorative materials was not studied sufficiently in the literature. Aim: The aim of this study is to evaluate the repair potential of a glass hybrid (GH) restorative repaired either by the same material (GH) or CR after different surface treatments using microtensile bond strength (μTBS) test. Methods and Materials: One hundred and twenty bar-shaped (2 × 2 × 8 mm) GH blocks were prepared. After aging, the specimens were divided into two groups (n = 60) and five subgroups (n = 12). The specimens in Group I were repaired with the following protocols: (a) no treatment + GH, (b) diamond bur (B) + GH, (c) cavity conditioner + GH, (d) cavity conditioner + universal adhesive (A) + GH, (e) A + GH, and specimens in Group II were repaired with (a) no treatment + CR, (b) B + CR, (c) B + A + CR, (d) 40% phosphoric acid + A + CR, (e) A + CR. The specimens that were subjected to μTBS testing, scanning electron microscopy evaluations, and fracture modes were determined. Data were analyzed using Kruskal–Wallis and Mann–Whitney U tests (P = 0.05). Results: Repair using CR resulted in higher bond strengths (P < 0.001). The lowest bond strength was obtained in Group Ie. The highest bond strength was obtained when GH was roughened in Group IIc. Conclusion: Repair of restorative GH with CR appears as a preferred option to improve the bond strength.
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Evaluation of mandibular asymmetry in angle malocclusion samples by posterioanterior cephalometric radiography: A preliminary study p. 771
HT Alkis, OM Bilge
DOI:10.4103/njcp.njcp_597_18  
Objectives: The aim of this study was to evaluate the effect of different occlusion types on mandibular asymmetry in different anatomical points using posteroanterior cephalometric radiography. Materials and Methods: This study was retrospectively conducted on 100 patients whose posteroanterior images and malocclusions were registered in a patient database. Asymmetry indices were determined using four linear measurements on images, and the effect of malocclusions, age, and gender on these asymmetry indices was investigated. P <0.05 was considered statistically significant. Results: Right and left horizontal plane gonion distance values varied according to gender, right vertical plane condylar distance and left horizontal plane gonion distance values varied according to age, and right vertical plane condylar distance and left horizontal plane gonion distance values varied according to malocclusions. Conclusion: The measured values of some parameters varied according to age, gender, and malocclusion. Although vertical plane gonion asymmetry index and horizontal plane condylar asymmetry index values varied according to gender, there was no relationship between asymmetry index values of all parameters with age and malocclusion.
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Assessment of cases with sharp and penetrating object injuries p. 777
H Kafadar, S Kafadar
DOI:10.4103/njcp.njcp_625_18  
Background: Sharp and penetrating object injuries (SPOIs) are seen frequently in forensic medicine practice. In this study, we aimed to retrospectively investigate cases with SPOIs. Materials and Methods: This study investigated the charts of patients treated at Adiyaman University Education and Research Hospital between January 1, 2013, and December 31, 2017. A total of 934 inpatients with sharp object injuries were included in the study. Data were assessed using a suitable computer-aided package program. Cases were examined in terms of age, gender, injury body site, suicide or homicide, radiologic findings, presence of vital danger, and severity of injury. Results: In this study, we examined the charts for 934 inpatients with stab wounds. It was stated that 124 (13.27%) of those injured were female and 810 (86.63%) male; the average age of the injured persons was 29.8 ± 18.2 years. It was found that 214 (22.91%) people were exposed to vital danger and that 720 (77.09%) suffered from soft tissue injuries (penetrating skin and muscle injuries). Also, 69.27% of the cases (n = 647) involved people less than 35 years of age. Conclusion: Considering that stab injuries are more frequent in the lower age groups, we believe that such injuries could be reduced by increasing training programs for young people.
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The influence of restorative material and glass fiber posts on fracture strength of endodontically treated premolars after extensive structure loss p. 782
FD Oz, N Attar, D Deniz Sungur
DOI:10.4103/njcp.njcp_11_19  
Objective: The aim of this in vitro study was to investigate the fracture strength and cuspal deflection of endodontically treated premolars restored using different composite resins along with or without fiber post application. Materials and Method: Eighty intact premolars were randomly divided into eight groups (n = 10); CO group: intact teeth (control), OPR group: mesio-occlusal-distal-palatal (MODP) preparation (OPR) + endodontic treatment (ET), TC group: MODP preparation + ET + Tetric N-Ceram, TB group: MODP preparation + ET + Tetric EvoCeram Bulk Fill, SO group: MODP preparation + ET + SonicFill 2, TC-P group: MODP preparation + ET + Hahnenkratt glass fiber post + Tetric N-Ceram, TB-P group: MODP preparation + ET + Hahnenkratt glass fiber + Tetric EvoCeram Bulk Fill, and SO-P Group: MODP preparation + ET + Hahnenkratt glass fiber post + SonicFill 2. After thermocycling, specimens were subjected to a compressive load until fracture. Data were analyzed using analysis of variance and Tukey tests (P < 0.05). Results: The mean fracture strength of groups which received post treatment showed similar fracture strength values [TC-P (931.6 ± 97.9), TB-P (882.0 ± 59.7), SO-P (862.0 ± 143.0) (P > 0.05)] and was significantly higher than OPR (530.6 ± 41.7), TC (841.2 ± 93.1), TB (774.5 ± 101.8), and SO (735.0 ± 178.01) groups (P < 0.05). No significant difference was detected among groups considering cuspal deflection (P > 0.05). The fiber post insertion resulted in more unfavorable fractures. Conclusion: Endodontically treated teeth restored with fiber post and bulk-fill or conventional composite resins demonstrated fracture strength values similar to intact teeth.
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Steroid response in primary childhood nephrotic syndrome in a tropical african environment p. 790
AO Asinobi, AD Ademola, OO Ogunkunle
DOI:10.4103/njcp.njcp_206_16  
Background: Earlier studies on childhood nephrotic syndrome (NS) in tropical Africa showed steroid resistance in the majority. More recent studies show a variable picture, necessitating a re-evaluation. This study was aimed at determining the current pattern of steroid response in childhood NS, in an environment known to be dominated by steroid resistance. Patients and Methods: This prospective study of consecutive children who received steroid therapy for primary NS was carried out at the University College Hospital, Ibadan, Nigeria between 2006 and 2013. The outcomes of interest were steroid sensitivity and death. The recruited patients received a 4-6 weeks' course of prednisolone at 60 mg/m2/day followed by alternate day doses of 40 mg/m2 up to total steroid therapy duration of 6 months in steroid sensitive patients. Statistical analysis was carried out using STATA version 12.0. P value <0.05 was considered significant. Results: Of 109 children that received steroids for at least 8 weeks, whose mean (SD) age was 7.9 (3.7) years, 69 (63.3%) were steroid sensitive. Those aged ≥6 years responded as well as those aged <6 years (P = 0.78). Boys were more likely to be steroid-sensitive than girls, 65.2% versus 34.8% (P = 0.039). There was zero mortality among the patients studied. Conclusion: This study has shown a better steroid sensitivity of 63.3% in children with primary NS compared with the previously reported 36.8-42.9% in patients with highly selective proteinuria. This improved steroid response and zero mortality show a remarkable departure from the past.
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Comparative analgesic efficacy and tolerability of celecoxib and tramadol on postoperative pain after mandibular third molar extraction: A double blind randomized controlled trial p. 796
AO Akinbade, KC Ndukwe, FJ Owotade
DOI:10.4103/njcp.njcp_544_18  
Background: The choice of an efficacious and well-tolerated analgesic for the control of postoperative pain after third molar surgical extraction remains a challenge. Aim: The aim of this study was to compare analgesic efficacy and tolerability of celecoxib and tramadol following mandibular third molar extraction. Materials and Methods: This was a prospective randomized, double blind controlled trial. Ninety patients were randomly assigned equally to either celecoxib or tramadol. Appropriate doses of the assigned drugs were administered orally immediately after the surgical extraction and patients recorded the pain intensity felt before the extraction, immediately after extraction, at 4 h, 8 h, 16 h, 24 h, and 48 h after the extraction using the visual analogue scale (VAS). Adverse effects of the medications were also recorded. Results: Four of the patients dropped out of the study. Fifty five percent of patients in tramadol group experienced adverse effects but none in celecoxib group. The median VAS score of the celecoxib group was lower than tramadol group throughout the postoperative period and there was statistically significant difference in the median VAS score between the two groups 4 hours after drug administration (P = 0.001). Conclusion: In our study, celecoxib was more efficacious and better tolerated than tramadol for the management of pain after surgical extraction of mandibular third molar.
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Comparison of bispectral index values and depth of sedation during deep sedation using sevoflurane anesthesia in healthy children versus children with cerebral palsy p. 801
P Onal, N Oztas, G Kip
DOI:10.4103/njcp.njcp_553_18  
Background: Patients with cerebral palsy (CP) are at significant risk by means of periodontal disease and tooth decay. Pharmacological techniques that require intensive care such as sedation and general anesthesia are generally used for dental treatment of this patient group. Aim: The purpose of this retrospective study was to compare bispectral index (BIS) values and depth of sedation recorded during deep sedation protocols performed for healthy children and children with CP in the Department of Pediatric Dentistry, Faculty of Dentistry, Gazi University. Materials and Methods: The measurements of BIS and hemodynamic variables recorded during treatment of 26 healthy children and 26 children with CP between 3 and 10 years of age who were treated under sevoflurane and 50% N2O–50% O2 mixture deep sedation method were investigated retrospectively. Results: The mean BIS values in the CP group was statistically lower at all the time points when compared with the control group (P < 0.001). While there was no statistically significant difference between groups in terms of duration of treatment (P = 0.657), the median recovery time in the CP group was significantly longer than that recorded in the control group (P < 0.001). Significant correlation was found between modified Ramsay Sedation Scale (mRSS) scores and BIS levels at 5th, 10th, and 20th min in the control group (P < 0.001). Similar correlation was found in the CP group at 15th and 20th min. Conclusion: We concluded that it is necessary to consider the dosage and effect mechanisms of drugs used in children with CP to prevent overuse of anesthetics and emergence of anesthesia-related complications.
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The traditional practices used by couples with fertility problems, affecting factors, expected benefits, and learning paths: The Turkey Sample p. 806
S Fata, MA Tokat, N Bagardi, B Yilmaz
DOI:10.4103/njcp.njcp_383_18  
Objective: Studies related to traditional practices and benefits have been usually performed among women. The literature regarding the traditional practices used by men in Turkey and around the world and their expected benefits is more limited. The aim of this study was to examine the traditional practices used by couples with fertility problems, affecting factors, expected benefits, and learning paths. Materials and Methods: The descriptive study was performed between May and July 2017 in Izmir, Turkey. In total, 151 women with infertility were included. The data related to the use of this practice by men were obtained from women partners. “Personal information form” and “traditional practices evaluation form” were used to obtain the data. Results: In total, 35.8% of the women and 25.8% of the men used traditional practices. The 24.4% of women and 52.1% of men used other practices such as figs, onion cures, and hacamat, whereas 18.2% of women and 14.9% of men used various herbs. The benefits they expected from traditional practices were facilitating conception, ensuring follicle development in women, increasing sperm count, and quality and facilitating conception in men. Overall, 37.0% of women learned of these practices from their friends, 30.7% of men learned from their partners, 20.4% of women and 20.6% of men learned from the internet. Conclusion: The couples in this study widely used traditional practices to solve fertility problems and learned from their friends and partners.
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In vitro marginal and internal adaptation of metal-ceramic crowns with cobalt-chrome and titanium framework fabricated with CAD/CAM and casting technique p. 812
K Gurel, S Toksavul, M Toman, E Tamac
DOI:10.4103/njcp.njcp_570_18  
Aim: The purpose of this study was to compare the marginal and internal fit of Co-Cr and titanium ceramic crowns fabricated with 2 different techniques: CAD/CAM milling and traditional casting (TC). Materials and Methods: Ten traditional casting of Co-Cr (TCC), 10 CAD/CAM milling of Co-Cr (MC), 10 traditional casting of titanium (TCT), 10 CAD/CAM milling of titanium ceramic crowns (MT) were fabricated. Silicone replicas were obtained to measure internal gap volume, marginal gap and internal adaptation that was evaluated at 3 regions: axial wall, axio-occlusal angle, and occlusal surface. Measurements were made with a X-ray micro computerized tomography (micro-CT) and analyzed with Bonferroni and Dunnet T3 post-hoc tests (α = 0.05). Results: One-way ANOVA revealed no statistically significant differences among the groups for measurements at the marginal gap (P > 0.05). At axial wall region the mean values of TCT group were higher than those of groups but only statistically not significant for TCC group (P < 0.05). TCC group statistically gives better results than MC group in axio-occlusal and occlusal regions (P < 0.05). The mean measurement of internal gap volume were 20.59 ± 0.83 mm3 for TCC, 22.73 ± 0.82 mm3 for MC, 22.83 ± 1.11 mm3 for TCT and 20.51 ± 1.16 mm3 for MT. Mean internal gap volume values MT group were smaller than those of groups but only statistically not significant for TCC group (P > 0.05). Conclusion: All groups performed similar marginal adaptation. The cement film thickness at axio-occlusal angle point and occlusal region were higher for MC crowns.
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Evaluation of the impact of early childhood caries, traumatic dental injury, and malocclusion on oral health–Related quality of life for Turkish preschool children and families p. 817
D Sakaryali, M Bani, C Cinar, A Alacam
DOI:10.4103/njcp.njcp_581_18  
Aim: The aim of this study was to assess the impact of the presence of early childhood caries (ECC), traumatic dental injury (TDI), and malocclusion, as well as severe conditions, on the oral health–related quality of life (OHRQoL) of preschool children and families. Materials and Methods: A cross-sectional survey was conducted in children aged 1 to 6 years old, who attended to the Department of Paediatric Dentistry, Gazi University. The questionnaires were adapted to Turkish, and OHRQoL was measured using the Turkish version of Early Childhood Oral Health Impact Scale (T-ECOHIS). Children were classified into four main groups, two subgroups in each group based on their severity conditions—Group 1: ECC group; Group 2: TDI group; Group 3: Malocclusion group; Group 4: Control group. Parents answered the questions about sociodemographic conditions and T-ECOHIS. The Kolmogorov–Smirnov test was used for non-normal distribution and Kruskal–Wallis and Mann–Whitney tests were used to compare T-ECOHIS score regarding ECC, TDI, and malocclusion. Results: Both simple and severe conditions of TDI showed a negative impact on the family and child based on T-ECOHIS scores (P < 0.05). The severe condition of ECC and malocclusion showed significantly negative impact on family (P > 0.05) but not on child (P > 0.0.5). Conclusion: The presence of ECC, TDI, and malocclusion has a negative effect on OHRQoL of Turkish preschool children and specially their families. So, public health programs should be carried out about oral health for raising parents' and children's awareness and increasing OHRQoL.
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Color stability, roughness, and water sorption/solubility of glass ionomer–Based restorative materials p. 824
S Savas, O Colgecen, B Yasa, E Kucukyilmaz
DOI:10.4103/njcp.njcp_592_18  
Objectives: The aim of this study was to investigate the effects of various drinks on color stability and roughness of glass ionomer cement–based/–containing restorative materials and water sorption/solubility behavior of them. Materials and Methods: A total of 130 specimens for each material (GC Equia, GCP Glass Fill, Ketac N100, Glasiosite; a total of 520) were prepared using a Tefl on ring (7 × 2 mm). After specimen preparations, baseline color and surface roughness measurements were performed using a spectrophotometer and surface profi lometer, respectively. Specimens were immersed in four different solutions (n = 15; distilled water, cola, orange juice, and chocolate milk) during the 28-day test period. The immersion media were renewed daily. Color and surface roughness measurements were repeated at 1st, 7th, and 28th days. For water sorption, specimens (n = 15) were immersed in 10 mL of distilled water in individual containers and weighed at 1st week, 14th, and 28th days. After a total immersion time of 28 days, the specimens were dried to a constant mass, in a desiccator for 28 days. Each specimen was measured using a digital electronic caliper. Data were statistically analyzed (P < 0.05). Results: After 28 days, the highest ΔE* value was calculated in GCP Glass Fill immersed in chocolate milk (10.54 ± 0.69). All the tested materials showed signifi cantly higher Ra values compared with baseline scores after immersion in various beverages regardless of the immersion solutions used (P < 0.05). Glasiosite showed the smallest water sorption (16.75 μg/mm3) among the tested materials, whereas Ketac N100 (155.41 μg/mm3) and GCP Glass Fill (161.01 μg/mm3) had the highest. Conclusions: The compositions of restorative materials play key roles in their color stability, surface roughness, and water sorption/solubility.
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Mechanical performance of a newly developed glass hybrid restorative in the restoration of large MO Class 2 cavities p. 833
ZB Kutuk, C Ozturk, FY Cakir, S Gurgan
DOI:10.4103/njcp.njcp_628_18  
Objective: To evaluate the mechanical properties of a glass hybrid (GH) restorative system (EQUIA Forte/GC) and compare it with a microhybrid composite (G-aenial Posterior/GC) by compressive strength (CS) and fracture resistance (FR) tests. Materials and Methods: Cylindrical specimens were subjected to a CS test (n = 12). There were about 48 mandibular molars were used for a FR test and divided into four groups: Group 1 (positive control), sound teeth; Group 2 (negative control), extended size Class 2 cavities prepared on the mesial surfaces of teeth; Group 3, extended size Class 2 cavities restored with a composite; and Group 4, extended size Class 2 cavities restored with GH. Specimens were subjected to loading until a fracture occurred. Data were analyzed statistically (α = 0.05). Results: The fracture modes were examined by scanning electron microscope (SEM). The CS values of the composite and GH were 278.20 ± 17.34 MPa and 164.62 ± 25.72 MPa, respectively (P < 0.05). No differences were observed between the FR of restored groups (P > 0.05). Conclusions: The GH exhibited sufficient mechanical properties as a restorative material, and could be preferred for extensive caries lesions on posterior teeth.
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Glomerular hyperfiltration in excess weight adolescents p. 842
NJ Iduoriyekemwen, MO Ibadin, HA Aikhionbare, SE Idogun, MT Abiodun
DOI:10.4103/njcp.njcp_123_18  
Background: Childhood overweight/obesity burden is on the rise worldwide. Obesity affects virtually all organs. In the kidney, glomerular hyperfiltration that manifests as elevated glomerular filtration rate is a frequent manifestation in obesity. This adaptive renal manifestation to excess metabolic demand on the kidney, in children, has been studied mainly in the severely obese and is uncertain if it is present in less severe forms of excessive weight. In addition, glomerular hyperfiltration has been reported to be associated with high levels of the indicators of cardiometabolic risk, and these latter finding are solely from adult studies. Objective: To ascertain if glomerular hyperfiltration occurs in overweight and less severely obese children and to determine any significant relevance of some indicators of cardiometabolic risk associated with hyperfiltration. Subjects and Methods: This cross-sectional study involved 49 adolescents (28 overweight, 21 obese) and 49 normal weight adolescents. The participants were subjected to clinical examination, anthropometric measurement, laboratory investigation using standard techniques. Estimated glomerular filtration rates (eGFR) were calculated using the modified Schwartz equation. Hyperfiltration was defined as eGFR ≥140 ml/min/1.73 m2. Results: Hyperfiltration was observed in 20 (40.8%) of the overweight/obese adolescents. The prevalence of hyperfiltration among the overweight and the obese adolescent was 24.5% and 16.3%, respectively. The mean estimated glomerular filtration rate of the overweight/obese adolescents was 141.0 ± 46.2 ml/min/1.73 m2, whereas that of the normal weight adolescents was 99.2 ± 17.1 ml/min/1.73 m2 (P = 0.0001). A higher prevalence of hypertension was observed among the overweight/obese adolescent with glomerular hyperfiltration. Conclusion: Glomerular hyperfiltration is not limited to morbidly obese children as the burden is also high in overweight and less severely obese adolescents.
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The relationship between teamwork attitudes and caring behaviors among nurses working in surgical clinics: A correlational descriptive study p. 849
G Kucukakca Celik, S Taylan, SD Guven, H Cakir, M Kilic, CA Akoglu
DOI:10.4103/njcp.njcp_623_18  
Aim: This study was planned and carried out to determine how teamwork attitudes of nurses working in surgical clinics affect their caring behaviors. Materials and Methods: The research was conducted as a relational descriptive study. The research population consisted of 126 nurses working in the surgical clinics of a state hospital. A total of 116 nurses who agreed to participate in the study were admitted to the study. Data were collected using the Descriptive Characteristics Question Form, the Teamwork Attitudes Questionnaire (TAQ), and the Caring Behaviors Inventory-24 (CBI-24). Data were analyzed using counts, percentage distributions, Mann–Whitney U test, and Kruskal–Wallis tests, Games–Howell post hoc test, and Spearman's correlation. Results: The nurses participating in the study were found to have a mean score of 112.11 ± 17.86 for the TAQ and a mean score of 4.95 ± 0.54 for the CBI. There was a statistically positive correlation between the nurses' teamwork attitudes and caring behaviors (P < 0.05). Conclusion: It can be said that the teamwork attitudes of the nurses had a positive effect on their caring behaviors. It may be suggested to plan relevant research studies examining especially observational behavioral assessments.
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Physical and socioeconomic impact of asthma in Nigeria: Experience of patients attending three tertiary hospitals p. 855
OO Desalu, CC Onyedum, MA Makusidi, AO Adeoti, EO Sanya, JO Fadare, MD Isah, A Aladesanmi, OB Ojuawo, CM Opeyemi
DOI:10.4103/njcp.njcp_294_18  
Background: Understanding the impact of asthma is the key to optimal care. Objective: To determine the physical, economic, and social impact of asthma from the perspectives of individual patients in Nigeria. Methods: This was a multicenter study of 172 adult asthma patients attending tertiary hospitals. We assessed the different impact of asthma in the preceding 12 months using a questionnaire. Physical impact (such as daily activity/chores, sport/exercise, and sleep quality), social impact (such as job loss, mental anguish, employer, and peers discrimination) and economic impact (like savings, indebtedness, mortgage/asset, and school or work absence). Results: The physical, social and economic impacts were perceived by 59.3%, 47.7%, and 51.2% of patients, respectively. The physical impacts were poor sleep (44.2%), limitation of daily activity/chores (38.4%), and sporting/exercise (39.5%). The economic impacts were reduced savings (38.4%) and indebtedness (17.4%). Absence from school and work were respectively reported by 75% of students and 38.3% of workers. Socially, 34.9% reported mental torture, 10.5% changed job, 4.7% experienced discrimination and 3.5% lost their jobs due to asthma. Asthma-related emergency department visit was 42% and hospitalization was 32.6%. The physical impact was associated with non-adherence to ICS and persistent asthma symptoms. Economic impact was associated with asthma hospitalization, work absenteeism, comorbidity, and National Health Insurance (NHIS) coverage. Male sex and lack of post-secondary education were associated with social impact. Conclusion: Asthma causes broad and substantial physical and socioeconomic impacts in our sample of patients. Exploring these impacts and engaging the patient is imperative for holistic management and good health outcomes.
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Effects of the incısıon preference ın acetabular surgery on the postoperatıve functıonal outcomes p. 862
M Erem, C Copuroglu, E Copuroglu, M Ciftdemir, M Ozcan, K Saridogan
DOI:10.4103/njcp.njcp_455_18  
Background: Many factors are known to affect the functional outcomes of the acetabular surgery. The aim of this study is to evaluate the effects of incision preferences and number of incision on scores and clinical functional outcomes. Patients and Methods: Forty-seven adult patients who had undergone acetabular surgery and had been followed up for at least 1 year in our clinic were included in the study. Demographic data, trauma type, acetabular fracture type based on the Judet ve Letournel classification, presence of any additional traumatic fractures, time to surgery, operation duration, surgical technique, and postoperative complications were recorded. Range of motion measurements, SF-36 and Harris Hip function scale score, and full weight-bearing times were evaluated on the postoperative first year follow-up and reviewed retrospectively. Results: Our study suggests that use of double incisions in the surgery of associated fractures shortens the full weight-bearing time. The localization and the number of incisions were found to be unrelated with the Harris Functional Hip scale, SF-36 (PCS, physical component score), and SF-36 (mental component score, MCS) scores. Conclusion: Incision type and number of incisions must be determined based on the fracture type and fracture localization for better functional outcomes. The factors that have the most effects on the functional outcomes are the type and the localization. In associated fractures, performing multiple incisions reduces the time for full weight bearing and enables patients to return to their daily routine early but have no effect on the functional outcomes.
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CASE REPORTS Top

Mediastinitis as complication of odontogenic infection: A case report p. 869
E Soylu, A Erdil, E Sapmaz, BT Somuk, N Akbulut
DOI:10.4103/njcp.njcp_539_18  
Odontogenic infections are one of the most common dental problems, which affect 80%–90% of the population. Untreated odontogenic infections can cause life-threatening complications such as necrotizing fasciitis, descending necrotizing mediastinitis, internal jugular vein thrombosis, cavernous sinus thrombosis, carotid artery pseudoaneurysm or rupture, and systemic inflammatory response syndrome. This report aims to present a mediastinitis case, in a 22-year-old healthy male patient, which originated from an odontogenic infection. The patient was hospitalized because of worsening general health status, despite the antibiotherapy. Computed tomography (CT) scan revealed that periapical abscess was spreading to the mediastinum through retropharyngeal space. The patient was successfully treated by IV antibiotherapy, transcervical drainage, and extraction of tooth.
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Papillon-Léage and psaume syndrome patient with multiple dental and orofacial anomalies p. 872
DD Kilinc, E Ozsarp
DOI:10.4103/njcp.njcp_451_18  
Papillon-Léage-Psaume Syndrome, also known as oral-facial-digital syndrome (OFDS) type I, describes a group of neurodevelopmental disorders that are characterized by anomalies of the oral cavity, facial features, and the digits. Central nervous system (CNS) anomalies and visceral organ abnormalities such as kidney, pancreas, and ovarian cysts can also be seen in these patients. Among 13 potential types, female-inherited OFDS type I is the most common and it has been reported to be lethal in males. After the identification of the genetic relation of OFDS in 2001, it is now known that, except X-linked OFDS Type I and VIII, generally all types of OFDSs are autosomal recessive. The dentist's knowledge about the syndrome can reduce the development of physical and dental anomalies by facilitating early diagnosis. This article presents a patient with Papillon-Léage-Psaume Syndrome (Oral-Facial-Digital Syndrome Type I).
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Postoperative cognitive dysfunction developed in donor nephrectomy- Case report p. 877
H Akelma, ET Kilic, F Salik, EA Bicak, S Kaya
DOI:10.4103/njcp.njcp_483_18  
With the effects of anesthetic drugs on all organs and systems, it is known it affects the central nervous system functions at different grades and durations beyond acute unconsciousness. This causes cognitive functions of upper brain activities to be affected at varying degrees after anesthesia. After exposure to anesthetic agents, psychomotor and cognitive functions are deteriorated for 10--12 h, with sensitive tests it was showed that this deterioration lasted for 1--2 days. It has also been reported that this process can last till 3 months. Rapid recovery and mental readiness of patients, applied general anesthesia, are important objects for anesthesiologists. Postoperative cognitive functions are assessed in order to investigate mental changes caused by anesthesia and surgery or determine the level of recovery by determining the effects of anesthetics. In this case report, postoperative cognitive dysfunction (POCD) after donor nephrectomy was aimed.
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