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   Table of Contents - Current issue
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April 2020
Volume 23 | Issue 4
Page Nos. 437-588

Online since Saturday, April 4, 2020

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REVIEW ARTICLE  

Immunosuppressive agents in the treatment of IgA nephropathy: A meta-analysis of clinical randomized controlled literature Highly accessed article p. 437
Junli Zheng, Xuezhong Gong, Zhaolong Wu
DOI:10.4103/njcp.njcp_112_18  
IgA nephropathy (IgAN) is the most common form of glomerulonephritis in the world. Immunosuppressive therapy has been widely used in IgAN patients at home and abroad. The present meta-analysis aimed to assess the efficacy and safety of different immunosuppressive agents in patients with biopsy proven IgAN, in order to provide guidance for the clinical treatment of IgAN treatment options. We conducted a meta-analysis of the published randomized controlled trials (RCTs). PubMed, EMBASE, Web of Science, Cochrane Library, Medline, WanFang, Weipu, and CNKI were searched for relevant RCTs published between 2000 and December 2017. Data were analyzed with the random effects model using Review Manager5.3 to evaluate the effect of immunosuppressive agents on IgAN. 52 RCTs were involving 2,930 patients were included in the review. Compared with steroids, immunosuppressive agents, including acetazolamide (AZA) [complete response (CR)/partial response (PR); relative risk (RR), 5.92; 95% confidence interval (CI) 3.07–11.44; P< 0.00001], leflunomide (LEF) (CR/PR; RR, 1.63; 95% CI,1.22–2.17; P = 0.0008), mycophenolate mofetil (MMF) (CR/PR; RR, 1.59; 95%CI, 1.02–2.49; P = 0.04), cyclophosphamide (CTX) (CR/PR; RR, 3.39; 95%CI, 1.03–11.14; P = 0.04), and Tacrolimus (TAC) (CR/PR; RR, 1.72; 95%CI, 0.99–2.96; P = 0.05) resulted in increased partial or complete proteinuria remission. There was no significant difference in the total effective rate between MMF and Placebo (CR/PR; RR, 0.92; 95% CI, 0.33–2.56; P = 0.87). Compared with CTX, MMF showed higher effectiveness (CR/PR; RR, 3.32; 95% CI, 1.83–6.01; P< 0.0001) and LEF showed higher effectiveness (CR/PR; RR, 1.85; 95% CI, 1.17C–2.92; P = 0.009) with a lower incidence of adverse events. The results showed that immunosuppressive agents are a promising strategy and should be investigated further. MMF is the safest, the best therapeutic result and the least side effects than the other immunosuppressive agents.
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ORIGINAL ARTICLES Top

Could monocyte level/HDL cholesterol ratio predict cardiovascular diseases in patients with COPD? Highly accessed article p. 450
HI Yakar, A Kanbay
DOI:10.4103/njcp.njcp_54_19  
Objective: The role of monocytes and high-density lipoprotein (HDL) levels in the pathophysiology of cardiovascular disease (CVD) is well known. However, the relationship between monocytes to HDL-cholesterol ratio (MHR) and CVD in chronic obstructive pulmonary disease (COPD) patients has not been investigated previously. We, therefore, aimed to investigate the predictor role of MHR in the development of CVD in subjects with COPD. Methods: 185 COPD patients and 89 control subjects were enrolled. Demographic data and laboratory parameters were recorded and MHR was calculated for all participants. CVDs were defined if hypertension, ischemic heart disease, congestive heart failure, or stroke present. MHR levels were compared between the two groups in terms of CVD. Receiver operating characteristic analysis was used to determine the MHR cutoff value that predicts CVD in COPD patients. Results: We found positive correlation between MHR and COPD (r = 0.24, P = 0.001). However, there was no statically significant association between MHR and severity of COPD defined by the Global Initiative for Chronic Obstructive Lung Disease criteria (P = 0.78). MHR was significantly higher in COPD patients with CVD compared to without CVD (P = 0.007). In subgroups' analysis, COPD patients with CVD, MHR was significantly higher in COPD patients with ischemic heart diseases (P < 0001). Similarly, MHR was higher in subjects with CVD compared to the subjects without CVD, but it was not statistically significant (P = 0.68). In the ROC analysis, the MHR cutoff value that predicts CVD in COPD patients was found to be 12.50 (sensitivity of 64.9% and specificity of 65.4%) (area under the receiver operating characteristic curve [AUC] = 0.73, P = 0.001). Conclusion: MHR is significantly associated with CVD in COPD patients. Further prospective studies are warranted to elucidate the predictive value of MHR in COPD patients.
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Effects of all-on-four implant designs in mandible on implants and the surrounding bone: A 3-D finite element analysis p. 456
G Deste, R Durkan
DOI:10.4103/njcp.njcp_471_19  
Aims: The purpose of this study was to observe the stresses of all-on-four implant designs in an edentulous mandible in the implant, surrounding bone, and monolithic ceramics. Materials and Methods: In mandibular all-on-four implant models, anterior implants were placed vertically, and posterior implants were differently inclined. On the full-arch fixed prosthetic restoration monolithic zirconia framework, monolithic lithium disilicate was prepared as the superstructure. Model 1M (1M–15.5); posterior implants angled at 15° to the occlusion plane and a cantilever length of 5 mm, Model 2M; (2M–15.9), Model 3M; (3M–30.5), and Model 4M; (4M–30.9) were prepared. A total of 300 N bilateral force was applied at an angle of 30° and oblique to the occlusion plane. Stress values on dental implants, abutments, the surrounding bone, and prosthetic restorations were calculated. Results: The highest stress concentration was observed in the 2nd connector region between the canine and the 1st premolar tooth in the monolithic zirconia frameworks (457.21 MPa). Stress concentration in the cortical bone was 60.93 MPa in posterior implants. Stress was higher in posterior angled implants than straight implants. Stress at posterior angulation increased by 21 MPa in implants angled at 15°. Conclusion: In bilateral loading, the force applied to anterior implants does not have a significant effect on the bone structure. Stress concentration increases in posterior angled implants and surrounding bone. Moreover, stress concentration increases as the length of the cantilever, the weakest part in all-on-four implants, increases. As posterior implant angulation increases, stress concentration level and localization are affected.
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The sagittal grooves of the middle nasal turbinate determine paradoxical curvatures and bifidities p. 464
MC Rusu, N Măru, CJ Sava, A Motoc, M Săndulescu, D Dincă
DOI:10.4103/njcp.njcp_63_19  
Background: Paradoxical curvature of the middle nasal turbinate (MT) is a common anatomic variant, usually found and reported on coronal CT slices. However, less attention has been paid to the sagittal groove (SG) which is determining it. Aim: The study aimed to determine paradoxical curvatures and bifidities in the sagittal groves of middle nasal turbinate. Material and Method: A retrospective CBCT study on the archived files of 52 adult patients was performed. Results: Different patterns of MT bifidity were found: (1) unilateral bifid MTs; (2) bifid and trifid MTs and “wandering” single SGs; (3) bilateral bifid middle turbinates and double SGs, (4) bilateral false bifid appearance due to middle and superior turbinates fusion and (5) bifid concha bullosa media. Digital “dissections” of patients' files allowed us to conclude that paradoxical curvature as well as bifidity of MTs relate to the placement and number of the SGs on the MTs. Such SGs were previously documented in prenatal MTs since the 14th week, as well as in pædiatric patients. Conclusions: It seems reasonable to speculate that paradoxical curvature, as well as bifidity of MT, this later being previously undocumented, are just adult vestiges of the primitive MT morphology. Nevertheless, documentation of the MT morphology should not rely exclusively on coronal CTs, as combined morphologies of that turbinate could occur.
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Turkish surgical nurses' attitudes related to patient safety: A questionnaire study p. 470
S Bahar, E Önler
DOI:10.4103/njcp.njcp_677_18  
Background: Surgical nurses work in demanding environments and play a vital role in maintaining and promoting patient safety due to the nature of their work. Hence it is important to know their attitudes toward patient safety. Aim: This research aimed to evaluate the patient safety attitudes of Turkish surgical nurses. Methods and Materials: This was a descriptive cross-sectional and questionnaire research. Data were collected from August 2015–January 2016 using the staff information form and the safety attitudes questionnaire (SAQ). The study population included 231 nurses who work in operating rooms, surgical intensive care, and surgical wards of four hospitals in western Turkey. Data were analyzed with frequency, percentage, mean, standard deviation, the Mann Whitney U test, and Kruskal Wallis tests using the SPSS 18. Results: The teamwork and safety climate scores of operating room nurses were higher than the scores of surgical intensive care and ward nurses. The stress recognition scores of surgical ward nurses were the highest, followed by the scores of the operating room and surgical intensive care nurses. The perception of management scores of operating room nurses was higher than those of surgical ward nurses, and nurses ages 18–30 were higher than those of nurses ages 31–40. None of the six domains of safety culture, including job satisfaction, teamwork, safety climate, the perception of management, stress recognition, and working conditions achieved a positive mean score over 75. Conclusion: This research paper provides an evaluation of the safety attitudes of surgical nurses. Findings can provide information for healthcare leaders to improve the safety culture.
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Evaluation of the possible relationship between obesity and temporomandibular joint disorders p. 476
S Gunen Yilmaz, H Tercanli Alkis,
DOI:10.4103/njcp.njcp_489_19  
Objectives: The objective of this study is to question the existence of a possible relationship between obesity and temporomandibular joint disorders. Subjects and Methods: A total of 256 healthy subjects were included in the study. While the body mass index was used for the detection of obesity, Fonseca anamnestic index was used for the detection of temporomandibular joint disorders. The relationship between body mass index and temporomandibular joint disorders frequency was investigated. Values of P< 0.05 were considered statistically significant. Results: There were 136 female (53.1%) and 120 male (46.9%) subjects. The mean age was 39.02 ± 10.62. 41.4% of the subjects were in normal weight, 32.4% were overweight and 26.1% were obese. The prevalence of temporomandibular joint disorders was 73.8%. Conclusions: There was no statistically significant difference between body mass index and temporomandibular joint disorders frequency, but further larger studies will give more accurate outcomes.
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Determination of the relationship between total antioxidant capacity and dietary antioxidant intake in obese patients p. 481
PS Besagil, S Çalapkorur, H Şahin
DOI:10.4103/njcp.njcp_212_19  
Background: Adipokines secreted from adipose tissue in obese individuals increase oxidative stress in the body and sufficient antioxidant consumption is recommended to reduce the effects of this stress. Consumption of foods rich in antioxidants is thought to be related to serum total antioxidant capacity (TAC) but the effect of dietary antioxidant amount on serum antioxidant capacity is not yet clear. Objective: The aim of this study was to investigate the relationship between dietary antioxidant intake and serum TAC in obese and normal-weight individuals. Methods: Around 36 obese and 24 normal weighted volunteers participated in this study. Demographic characteristics, anthropometric measurements, and antioxidant food consumption from frequency questionnaires (questionnaire TAC) of individuals were recorded. The amount of antioxidant intake from diet (dietary TAC) was calculated from food consumption records. Serum TAC values were measured calorimetrically according to the Trolox equivalent antioxidant capacity (TEAC). Results: The dietary TAC levels of the experimental group were higher than the control group (5.45 ± 6.15 mmol/day vs. 3.20 ± 7.27 mmol/day, P = 0.006); whereas, the ratio of serum TAC per body weight was significantly lower in obese participants (0.013 ± 0.0134 mmol/L vs. 0.017 ± 0.003 mmol/L, P< 0.001). However, a positive relation (r = 0.339, P = 0.008) was observed between dietary TAC and serum TAC. Moreover, a positive correlation between the serum TAC levels of the individuals and the weight in both groups (r = 0.335, P = 0.046 in obese participants, and r = 0.523, P = 0.009 in control group), and the BMI in the experimental group (r = 0.384, P = 0.021). Likewise, there is an association between the diet TAC level and the diet protein ratio (r = 0.478, P = 0.018) in obese participants.Conclusıon: Dietary TAC intake was significantly higher and the TAC/weight lower in the experimental group. Moreover, the relationship between diet TAC and serum TAC was significant.
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Clinical evaluation of bulk-fill resins and glass ionomer restorative materials: A 1-year follow-up randomized clinical trial in children p. 489
H Akman, G Tosun
DOI:10.4103/njcp.njcp_519_19  
Objective: This prospective study aimed to evaluate the clinical performance of different restorative materials in primary molars with class II carious lesions. Materials and Methods: A total of 160 class II carious lesions (with radiographic involvement of the outer half of dentin) in 30 patients were randomly divided into four groups and restored with a glass ionomer restorative system (Equia™), two different bulk-fill composites (Sonicfill™ and X-tra fil™), and a nanohybrid composite (Filtek Z550™). The restorations were clinically and radiographically evaluated at the baseline, and 3, 6, and 12 months according to the modified United States Public Health Service criteria. Statistical analyses were performed using Pearson's Chi-square and McNemar tests. Results: After 1 year, 134 restorations were evaluated in 26 patients. Equia was statistically less successful than the other restorative materials in marginal adaptation and retention criteria (P < 0.05). However, no material was found to be superior to the others over the study period in marginal discoloration, color matching, secondary caries, anatomical form, and postoperative sensitivity (P > 0.05). Conclusion: The bulk-fill and conventional composites exhibited good clinical performance, and Equia exhibited minor changes over the 1-year trial period.
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Effects of patient-specific three-dimensional lumbar traction on pain and functional disability in patients with lumbar intervertebral disc prolapse p. 498
F Asiri, JS Tedla, MS D Alshahrani, I Ahmed, RS Reddy, K Gular
DOI:10.4103/njcp.njcp_285_19  
Background: Prolapsed lumbar intervertebral disc is one of the most prevalent causes of low back pain and traction is one of the most common physical therapy treatments offered to affected patients. Advancements in traction equipment are needed to ensure their effectiveness in clinical situations. Aims: The objective of the study was to find out the effect of patient-specific three-dimensional lumbar traction on pain and functional disability in individuals with lumbar intervertebral disc prolapse. Subjects and Methods: Original article and Experimental design. Twenty-five participants (age range: 34–67 years) diagnosed with lumbar intervertebral disc prolapse were included in this study. Patient-specific three-dimensional lumbar traction was given as three sessions per week for the duration of one month. All participants completed a 10-cm visual analog pain scale and pain pressure threshold to assess pain and the Oswestry disability index to assess the functional disability. Results: On pre to post interventions, a significant change in mean values were found for visual analog scale pain score, pain pressure threshold, and Oswestry disability index (P < 0.001). The pain intensity was reduced from 8.5 to 3.2, pain pressure threshold increased from 0.7 to 1.6 kg/cm2, and functional disability was reduced from 53.5% to 31.3%. Conclusion: Twelve sessions of patient-specific three-dimensional lumbar traction promoted a reduction in pain and improvement in functional disability among subjects with lumbar intervertebral disc prolapse.
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The effect of gestational age on women's preference for quality goods p. 503
MA Ahmed, B Akram, M Anwar ul Haq, R Ahmad, M Ahmad
DOI:10.4103/njcp.njcp_40_18  
Background: It is a well-established fact that hormonal changes significantly influence the consumer behaviors and their purchase intentions. However, attention to the conspicuous buying due to the mood swings, as a result of hormonal changes, during the pregnancy have been largely ignored in the literature. Aims: The current research aims to examine the prospective association of conspicuous purchase intentions with hormonal changes and mood swings during the pregnancy. Methods: An experimental procedure was used to assess the data collected from pregnant women (n = 116) and the hypotheses were analyzed using recall probability and recall position measures. Results: The hormonal changes during the pregnancy were analyzed in three stages known as pregnancy trimesters suggested by the relevant literature (Trimester-1 = 39, Trimister-2 = 36 and Trimester-3 = 41). The respondents were exposed to visual attention of specifically designed images with a unique combination of the status and functional products. The ROC values for Trimester 2 is higher in all 4 graphs (0.923, 0.960, 0.892, and 0.923) respectively than Trimester 1 and 3. Conclusion: Findings revealed that the women purchase preferences shift as pregnancy move from one trimester to another. Women pay more attention to status products during the 2nd trimester as compared to 1st and 3rd trimesters of pregnancy.
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The effect of cervical preflaring on the apical debris extrusion of single or multiple rotary Ni-Ti files p. 510
B Gunes, KY Yeter
DOI:10.4103/njcp.njcp_599_19  
Background: There were no comparing data about the effect of recently developed file system OneCurve on apical debris extrusion. Aim: The aim of this in vitro study was to compare the influence of the rotary nickel—titanium (Ni-Ti) files on apical debris extrusion after cervical preflaring. Materials and Methods: Sixty-six lower incisor teeth with a single root canal were used in this study. After the determination of working length, the specimens were divided into six experimental groups according to root canal preparation. G1: ProTaper-Next, G2: EndoFlare + ProTaper-Next, G3: 2Shape, G4: EndoFlare + 2Shape, G5: OneCurve, and G6: EndoFlare + OneCurve. Each specimen was inserted into separate preweighed Eppendorf tubes to collect apically extruded debris. A total of 8 mL of distilled water was used for each specimen for irrigation. After the completion of root canal preparation, the Eppendorf tubes were weighed again after evaporation to calculate the amount of extruded debris. The data were statistically analyzed with one-way analysis of variance (P > 0.05). Results: There was no statistically significant difference between the experimental groups. The amount of apically extruded debris was similar after preparing root canals with ProTaper-Next, 2Shape, and OneCurve with and without cervical preflaring. Conclusion: Under the conditions of this in vitro study, ProTaper-Next, 2Shape, and OneCurve files had similar apical debris extrusion values. Cervical preflaring of root canals did not affect the amount of apically extruded debris.
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Cultural adaptation and validation of the nursing students' perceptions of instructor caring into spanish p. 515
M Romero-Martín, J Gómez-Salgado, JC Safont-Montes, Y Navarro-Abal, JA Climent-Rodríguez, N Jiménez-Picón
DOI:10.4103/njcp.njcp_386_19  
Objective: This paper aims to provide a Spanish version of the nursing students’' perceptions of instructor caring with content validity and reliability. Methods: A forward and backward translation procedure was conducted, and a panel of 15 experts assessed face validity. Content validity was established by calculating content validity indexes for each item and for the scale. The internal consistency was assessed in a sample of 120 students. Results: Content validity indexes resulted in higher than 0.78 for all items except Does not reveal any of his or her personal sides and serves as a trusted resource for personal problem solving; content validity index for the scale was 0.9 and Cronbach α was 0.942. Discussion: Results regarding reliability were similar to that of other studies in which the nursing students' perceptions of instructor caring has been used as a measuring tool. Item 12 deletion implies a considerable improvement in internal consistency. Conclusion: The Spanish nursing students' perceptions of instructor caring is a valid and reliable tool to be used in the Spanish context. Its use will enhance the understanding of clinical mentors' impact on nursing students.
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How are the color parameters of a CAD/CAM feldspathic ceramic of the material affected by its thickness, shade, and color of the substructure? p. 523
E Tamam, MB Güngör, SK Nemli
DOI:10.4103/njcp.njcp_517_19  
Objectives: The purpose of this study was to evaluate the effect of the tooth color, ceramic color, and ceramic thickness on the final color parameters of a feldspathic computer-aided design (CAD)/computer-aided manufacturing (CAM) ceramic material. Materials and Methods: Resin specimens (12 × 14 × 4 mm) were prepared from six shades, namely, 0M1S, 1M1S, 2M3S, 3M2S, 4M3S, and 5M3S, to simulate tooth color. Ceramic slices with thicknesses of 0.3, 0.5, 0.7, and 1 mm were sectioned from Vitablocs Mark II (12 × 14 × 18 mm) in 10 shades—OM1C, 1M1C, 1M2C, 2M1C, 2M2C, 2M3C, 3M1C, 3M2C, 3M3C, and 4M2C. An intraoral spectrophotometer was used and three axes of Commission Internationale de l'Eclairage (CIE) LAB color space (CIE L* a* b*) and chroma (C) and hue (H) values were obtained. Results: The a* and b* values showed a decrease with increasing thickness. Generally, C decreased with the increasing ceramic thickness. The effect of ceramic thickness on H changed depending on the block and substructure color. The change of ceramic thickness resulted in changes in the lightness parameter (L*) of the ceramics. Generally, with an increase in the thickness, the L* value increased. The univariate analysis of variance (ANOVA) indicated a significant interaction between ceramic thickness and substructure color (P <. 005) and ceramic thickness and ceramic color (P <. 005). Conclusion: The final color parameters of a feldspathic CAD/CAM block were significantly affected by the changes in the ceramic thickness and substructure color.
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Prevalence of middle mesial and middle distal canals in mandibular molars in an Egyptian subpopulation using micro-computed tomography p. 534
MK Alashiry, R Zeitoun, MM Elashiry
DOI:10.4103/njcp.njcp_550_19  
Objectives: To study the prevalence of middle mesial and middle distal canals in permanent mandibular molars in Egyptian subpopulation using micro-computed tomography. Materials and Methods: Two hundred and forty extracted mandibular permanent molars of Egyptian patients were scanned using micro-computed tomography, then the images were reconstructed to allow for the detection of the middle mesial (MM) and middle distal (MD) canals of the molars examined. The path of each extra canal was studied to determine the configuration of each canal. Data were analyzed statistically using the Chi-square test with a level of significance set at P< 0.05. Results: The evaluation of three-dimensional (3D) images of this study showed that no significant difference was found between the percentage of MM (27.5%) and MD canals (22.5%) (P = 0.2064); however, there was a significant difference between the percentage of teeth having both extra canals (10%) and teeth having only one of these canals (P < 0.05). The confluent configuration (71%) was significantly higher than the other configurations (P < 0.05). Conclusion: A higher percentage of MM canal was detected followed by the MD canal. The least significant was both canals occurring within the same molar. The percentage of the confluent configuration was the highest. The apt knowledge of the variations of the root canal system anatomy and the respect of the discrepancies associated with diverse demographic areas will ensure the proper management of each tooth with endodontic involvement and its long-term success.
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Comparative efficacy of medical treatment versus surgical sphincterotomy in the treatment of chronic anal fissure Highly accessed article p. 539
T Acar, N Acar, F Güngör, E Kamer, H Genç, K Atahan, ON Dilek, M Hacıyanlı
DOI:10.4103/njcp.njcp_383_19  
Background: Anal fissure which is defined as a longitudinal tear in anoderm below the dentate line is one of the most common benign diseases of anorectal area. Severe pain during the defecation and emotional stress that it causes may reduce people's quality of life. Aims: In this randomized clinical trial, we aimed to compare the efficiency of the topical ointment with medical treatment and surgical lateral internal sphincterotomy. Method: This is a randomized clinical trial of 550 patients who were treated for chronic anal fissure. Patients were randomly divided into 4 groups according to the treatment type they received. Results: In a vast majority of the patients, the primary complaint was pain (92.3%) and bleeding during defecation (62%). Both pain relief and healing of the fissure, which are the components of response to treatment, had not been observed in 56 (37.3%) patients of topical nitroglycerin ointment group until the second month. Among the recalcitrant patients in both topical nitroglycerin (56) and topical diltiazem ointment (47) groups, 27 (48.2%), and 36 (76.5%) patients underwent surgery, respectively. The best response to treatment was also obtained in lateral internal sphincterotomy group. Conclusion: LIS is still the gold standard for the treatment of chronic anal fissure when the physicians would like to avoid recurrence and obtain the best pain relief.
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Investigating the effect of handedness on the dental caries pattern, gingival index, and plaque index in 6–10 years old children p. 545
S Mokhtari, I Sanati, F Ahmadian Babaki, S Alamdari, N Tavana
DOI:10.4103/njcp.njcp_600_19  
Background: Handedness is one of the individual characteristics that causes different mental and practical capabilities including different abilities to perform oral hygiene instructions. It seems that the right-handed and left-handed individuals have different ability in brushing and removing plaque at different areas of the mouth. Aims: To investigate the effect of handedness on decay pattern, gingival index, and plaque index in 6–10 years old children. Subjects and Methods: In this cross-sectional study, children 6–10 years of age who fulfilled the inclusion criteria were selected. Dental caries and plaque and gingival indices were also measured and recorded for each child. Then the relationship between the handedness and the recorded variables was evaluated. Independent t-test and nonparametric Mann–Whitney test were used for the statistical comparison of quantitative variables between two right-handed and left-handed groups and Chi-square test was used for the statistical comparison of qualitative variables between these two groups. Data were analyzed using SPSS software version 20. Results: The results showed that there was no significant relationship between any of the variables with being left- or right-handed. A significant relationship was observed only between the lowest plaque index and handedness (P < 0.05). Conclusion: A relationship cannot be considered between the handedness of children and their oral health status.
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Evaluation of sagittal condylar guidance angles using computerized pantographic tracings, protrusive interocclusal records, and 3D-CBCT imaging techniques for oral rehabilitation p. 550
TA Naqash, S Chaturvedi, A Yaqoob, S Saquib, MK Addas, M Alfarsi
DOI:10.4103/njcp.njcp_544_19  
Objective: The goal of registering the condylar guidance is to recreate the patient's occlusion as exactly as possible on the articulator, and is therefore essential for successful prosthodontic rehabilitation. Clinical, radiographic, and pantographic methods are used to determine sagittal condylar guidance angles (SCGAs). These methods generate different angles in the same patients. The present study is the first disquisition to evaluate and correlate SCGAs determined by the use of pantographic tracing (PT), protrusive records (PR), and radiographic (CBCT) techniques. Materials and Methods: The condylar guidance was measured using PT, PR, and CBCT imaging techniques in 23 nonpatient participants aged between 18 and 30 years irrespective of sex. PT was recorded using Cadiax® Compact system, a computerized recorder of SCGAs. PR was obtained using polyvinyl siloxane bite registration material, transferred to a semiadjustable articulator (Denar Mark II, Whip Mix Corp., USA) using facebow transfer (Denar Mark II, Whip Mix Corp., USA) and CR records, to determine SCGAs. Images of the mid-facial region were obtained using CBCT scan for 3D reconstruction. The angle formed between Frankfort horizontal plane (FHP) and a line extending from the most supero-anterior point on the glenoid fossa to the most convex point on the apex of articular eminence (AE) was measured to obtain SCGAs. Results: The mean left and right SCGAs were as follows: PT (34.42° and 33.93°, respectively), PR (32.14° and 31.82°), and CBCT (38.96° and 38.12°). The Pearson coefficients for the correlations with PT and PR on the left and right sides were 0.899 and 0.907, respectively, while it was 0.911 and 0.934, and 0.842 and 0.874 from PT and CBCT, and PR and CBCT, respectively. Conclusion: Strong correlations were found between SCGAs obtained using PT, PR, and CBCT techniques.
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Prevalence and risk factors of ibs among medical and nonmedical students in the jouf university p. 555
FA Wani, AH Almaeen, AH Bandy, A Thirunavukkarsu, TA Al-Sayer, A Flah, K Fayed, MM Albalawi
DOI:10.4103/njcp.njcp_512_18  
Background: Irritable bowel syndrome is common in the community and its prevalence is higher among the medical students. Aim: The current study was carried out to estimate the prevalence and evaluate the risk factors of irritable bowel syndrome among medical and nonmedical students of the Jouf University. Subjects and Methods: This cross-sectional study was carried out among medical and nonmedical students of the Jouf University. Study targeted 200 medical and nonmedical students using the convenience sampling technique. A self-administered questionnaire was adopted for the study and consisted of three parts with questions on demographic characteristics, lifestyle, eating habits, academics, and irritable bowel syndrome. Descriptive statistics were carried out to present the demographic characteristics. Chi-square test, odds ratio with 95% CI was calculated for analyzing differences between study variables using SPSS version-16. Multivariate analysis of lifestyle and dietary predictors of IBS was carried out by the enter method. Results: With a response rate of 90.5%, 181 students completed the questionnaire. Around 53 (29.28%) were found to be suffering from IBS with 41 (77.35%) being males. Male gender, married status, and living status of participants were significantly associated with the occurrence of IBS. Prevalence of IBS was found to be more in students who were from the medical college (P = 0.000), students who smoke (P = 0.003), who slept less than 8 h (P = 0.042), and students who often take carbonated drinks (P = 0.003). Smoking, frequency of exercise, coffee intake, and intake of carbonated drinks were strong predictors of IBS on multivariate analysis of lifestyle and dietary factors. Conclusion: We conclude that there is an increased prevalence of irritable bowel syndrome among medical students. Male gender, married status, living in hostel, smoking, less than 8 h sleep, and carbonated drinks were predictive factors for IBS in our study. We recommend screening of medical students for irritable bowel syndrome and institution of interventional measures.
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The gingival crevicular fluid levels of growth factors in patients with amlodipine-induced gingival overgrowth: A pilot study p. 561
KN Kose, S Yilmaz, U Noyan, B Kuru, HS Yildirim, OB Agrali, HO Ozener, L Kuru
DOI:10.4103/njcp.njcp_532_19  
Background: Amlodipine, calcium channel blocker (CCB), is used in the management of cardiovascular diseases which causes gingival overgrowth (GO). The growth factors may have a role in the pathogenesis of amlodipine-induced GO. Objectives: This pilot study aimed to investigate the growth factors including transforming growth factor-b1 (TGF-b1), platelet-derived growth factor-BB (PDGF-BB), and basic fibroblast growth factor (bFGF) in gingival crevicular fluid (GCF) of patients with amlodipine-induced GO and compare with of healthy subjects. Methods: GCF samples were collected from 56 sites presenting GO (GO + group) and from 38 sites not presenting GO (GO- group) of 5 patients using amlodipine for more than one year, and from 45 sites (control group) of 5 healthy subjects. The levels of TGF-b1, PDGF-BB, and bFGF were determined by using ELISA kits. Results: The mean concentration of TGF-b1 in GCF samples of GO + group (9.50 ± 7.30 ng/ml) was higher than both GO- group (2.07 ± 0.50 ng/ml) and control group (2.74 ± 1.01 ng/ml) (P = 0.014). No significant difference was found among the groups in the GCF levels of PDGF-BB (P = 0.767). bFGF was detected in only 33% of the sites from patients. Conclusion: These preliminary results suggest that TGF-b1 may play a crucial role in the pathogenesis of amlodipine-induced GO.
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Comparison of biochemical markers of bone metabolism between conventional labial and lingual fixed orthodontic appliances p. 568
AN Gujar, HA Baeshen, A Alhazmi, MS Ghoussoub, AT Raj, S Bhandi, SC Sarode, KH Awan, D Birkhed, S Patil
DOI:10.4103/njcp.njcp_501_19  
Objectives: The applied orthodontic force causes remodeling of the periodontium through the selective release of cytokines causing resorption of bone, enabling controlled movement of the tooth. This study compared the cytokine profile between patients treated with conventional labial and lingual fixed orthodontic appliances. Patients and Methods: The study included 80 patients in need of orthodontic treatment, out of which 40 patients were treated by the labial fixed appliance and 40 by the lingual fixed appliance. Gingival crevicular fluid (GCF) specimens were gathered from both the groups using a microcapillary pipette. The samples were collected at the beginning of the treatment and after 21 days. Enzyme-linked immunosorbent assay was performed to evaluate the cytokine levels. Results: Interleukin (IL)-1α, 1β, 2, 8, and tumor necrosis factor-alpha (TNF-α) levels were significantly high (P < 0.001) in GCF of participants treated with conventional labial fixed appliance. IL-1α, 1β, 2, 6, 8, and TNF-α levels were significantly high (P < 0.001) in GCF of participants treated by the lingual fixed appliance. The concentrations of TNF-α and IL-1β were increased higher than other cytokines in both the treatment groups. Conclusion: Overall, the lingual fixed appliance had higher cytokine levels than a labial fixed appliance. Analyzing the GCF cytokine levels during orthodontic treatment could provide an ideal platform for monitoring the progress of the treatment.
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CASE REPORTS Top

Bilateral calcaneal insufficiency fractures due to chronic carbamazepine use for trigeminal neuralgia: A case report p. 574
O Kaya, C Hurel, G Gumussuyu, O Kose
DOI:10.4103/njcp.njcp_515_18  
Stress fractures of calcaneus are uncommon cause of heel pain. Stress fractures could be seen in risc groups such as metabolic diseases/medications causing poor bone quality and exposing repetitive microtrauma. Anti-epileptic drug (AED) use is related with poor bone quality and increased fracture risc. Although carbamazepine-induced stress fracture is a well-known entity and there are case reports in other bones such as the femoral neck, bilateral calcaneal insufficiency fractures is an extraordinary location. To the best of our knowledge, this is the first case reporting an insufficiency fracture involving calcaneus in the relevant literature. Due to the rarity of both conditions, we decided to present and discuss this patient. When patients receiving AED treatment present with heel pain without previous plantar fasciitis history or traumatic event, insufficiency fractures should be kept in mind. This case highlights the importance of screening adverse effect of CBZ on bone metabolism in patients with long CBZ use. We report here a 41-year-old lady suffering from bilateral heel pain without trauma history. Her complaining did not respond to analgesics and stretching exercises of plantar fascia. In her past medical history she reported ongoing carbamazepine (CBZ) use over 8 years for trigeminal neuralgia. She had had low bone mineral density; defined as osteopenia. Both calcaneus MRI revealed bilateral stress fractures of calcaneum. She had been advised immobilization for 6 weeks, vitamin D and calcium supplements. CBZ has been stopped by neurology specialist and she had undergone microvascular decompression surgery for intractable pain of trigeminal neuralgia. She is doing well with full recovery from heel pain and trigeminal neuralgia at the end of one year. CBZ use causes poor bone quality through vitamin D metabolism. Heel pain without traumatic event, objective findings of plantar fasciitis and calcaneal spur syndrome in an CBZ using patient insufficiency fracture of calcaneus should be remembered and evaluated rigorously.
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Orthognathic surgery with two-segment le fort i and sagittal split ramus osteotomies of open bite deformity in an amelogenesis imperfecta patient via virtual planning: A case report p. 577
U Ertas, M Ataol, A Kiki, M Uğurlu
DOI:10.4103/njcp.njcp_316_19  
Amelogenesis imperfecta (AI) is an enamel defect and is often associated with the anterior open bite (AOB) and transverse maxillary deficiency. It is known that in such cases when AI and AOB appeared together, posterior maxillary impaction with or without bilateral mandibular ramus osteotomies is a frequently preferred treatment option. Virtual planning is more reliable rather than the conventional model surgery planning, especially for complicated cases. Usage area of virtual 3D anatomical models reconstructed from Cone Beam Computed Tomography (CBCT) data is expanding day by day for both diagnosis and surgical planning. The aim of this study is to present a patient with AI and AOB and transverse maxillary deficiency and management of this case with virtually planned two-segment Le fort I and sagittal split ramus osteotomies followed by prosthetic rehabilitation.
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Adult-onset still's disease, an unusual cause of severe acute liver injury: A case report p. 581
SC Adiyaman, G Bengi, M Civak, M Birlik, Z Kuruuzum, C Altay, M Soyturk
DOI:10.4103/njcp.njcp_1_19  
Adult-onset Still's disease is a systemic inflammatory disease that often presents with spiking fever, typical rash, arthritis, and serositis. However, adult-onset-Still's-disease associated liver injury and acute liver failure are rare. Herein, we report a case of acute liver injury in a 23-year-old female patient with adult-onset Still's disease. She presented to the emergency department with a high fever and sore throat. She was then admitted to the department of infectious diseases with a preliminary diagnosis of an atypical respiratory infection. After being treated with antibiotics and antiviral agents, she was discharged. A few days later, she returned to the emergency department with jaundice and was rehospitalized. This time, she was admitted to the department of gastroenterology, where she was diagnosed with adult-onset Still's disease-associated acute liver injury. Eventually, the patient responded to immunosuppressive treatment with significant clinical improvement.
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Obstructive jaundice caused by ulcerative duodenal stenosis: A case report p. 586
L Chen, X Zhu, L Wei, Z Liu
DOI:10.4103/njcp.njcp_537_18  
A peptic ulcer is a rare cause of distal common bile duct stricture, Obstructive jaundice as a complication of ulcerative duodenal stenosis is quite difficult to differentiate from malignant disease, especially in those in which esophagogastroduodenoscopy examination does not reveal an ulcer. In this case report, a 61-year-old male suffered from right upper quadrant pain, chills and fever caused by duodenal and distal common bile duct stenosis originating from ulcer and was treated surgically.
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