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   Table of Contents - Current issue
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January 2020
Volume 23 | Issue 1
Page Nos. 1-127

Online since Friday, January 10, 2020

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ORIGINAL ARTICLES  

Marginal adaptation and fracture resistance of feldspathic and polymer-infiltrated ceramic network CAD/CAM endocrowns for maxillary premolars Highly accessed article p. 1
G Saglam, S Cengiz, O Karacaer
DOI:10.4103/njcp.njcp_231_19  
Objective: The aim of this study was to evaluate the marginal adaptation and fracture resistance of feldspathic and Polymer-Infiltrated Ceramic Network (PICN) CAD/CAM endocrowns for maxillary premolars. Materials and Methods: Twenty extracted human permanent maxillary premolars were randomly divided into two groups (n = 10); Group CEREC (GC), which was produced by feldspathic ceramic and the Group Enamic (GE), which was produced by PICN. All teeth were endodontically treated and decoronated horizontally at 2 mm above the cemento-enamel junction. Endocrown preparations were done with 4 mm depth into the pulp chamber. Endocrowns were manufactured using CAD/CAM from ceramic blocks. Following adhesive cementation, all specimens were subjected to thermocycling. Marginal adaptation evaluated under SEM at 200 × magnification. Each specimen was fixed in a universal testing machine and a compressive load was applied at 45° to long axis of the teeth until failure. Failure load was recorded and failure modes were evaluated. Statistical analyses were performed with SPSS 19.0 software and data were compared using Mann-Whitney U test. Results: There were no significant differences in the marginal adaptation between two groups (P > 0.05). GE presented significantly higher fracture resistance when compared to GC (P < 0.05). Failure pattern was similar and characterized by the tooth-ceramic fracture on the force-applied side. Conclusions: CAD/CAM fabricated feldspathic ceramic and PICN endocrowns provide sufficient marginal adaptation, but the PICN endocrowns shows higher fracture resistance than the feldspathic ceramic endocrowns.
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Clinical measurement of angular profile of the knee and correlation with intermalleolar distance in children in Enugu metropolis p. 7
HC Ekwedigwe, UN Enweani, KA Madu, CU Nwadinigwe, IC Okwesili, RT Ekwunife
DOI:10.4103/njcp.njcp_175_19  
Background: Angular deformities of the lower limbs are commonly encountered deformities in pediatric orthopedic clinics. The values of the tibiofemoral angle undergoes changes as the child grows and these changes are self-limiting. The aim of the study is to establish the normal variation of knee angles of children between 2 and 12 years of age in Enugu metropolis and to establish any correlation between the knee angles and the intermalleolar distances (IMDs). Subjects and Methods: This study was done on 630 school children in Enugu metropolis between the age groups of 2 and 12 years. Multistage sampling was used in the study. The tibiofemoral angles and intermalleolar/intercondylar distances were measured. Results: The maximum tibiofemoral angle from this study was 7.6° ± 2.4° and the age corresponding to this value was 4 years. Only 23 subjects (3.5%) had varus knee angle. The values of the mean tibiofemoral angle and IMDs plateaued from 8 to 12 years. There was a significant positive correlation between average knee angle and IMD (r = 0.785, P < 0.001). Conclusion: The physiological changes in the knee angle (tibiofemoral) follow a similar pattern as established in the literature and there was positive correlation between IMD and the tibiofemoral angle.
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Comparison of delivery characteristics and early obstetric outcomes between Turkish women and Syrian refugee pregnancies p. 12
H Kiyak, S Gezer, C Ozdemir, S Gunkaya, T Karacan, A Gedikbasi
DOI:10.4103/njcp.njcp_10_18  
Background: Until September 1, 2016, Turkey hosted around 2.7 million Syrian refugees. However, data investigating the pregnancy health concerning the refugees are still limited. Aim: In the present study, we aimed to compare the delivery characteristics and short-term obstetric outcomes in Turkish women and Syrian refugees. Subjects and Methods: The study included 1556 singleton pregnancies which comprised 940 Turkish women and 616 Syrian women between January 2016 and January 2017. The groups were compared for demographic data, obstetric features, and pregnancy outcomes. Results: There were significant differences between Turkish women and the refugees in terms of preterm (18.94% vs. 11.00%, P = 0.003) and post-term delivery rates (11.49% vs. 2.91%, P < 0.001), caesarian delivery rates (33.4% vs. 23.95%, P = 0.002), newborn weights <1000 g (2.55% vs. 0.97%, P = 0.006) and >4000 g (5.32% vs. 3.24%, P = 0.006), pre-eclampsia (5.32% vs. 1.62%, P = 0.009), HELLP (1.28% vs. 0.00%, P = 0.046), and placental anomalies (1.91% vs. 0.00%, P = 0.014), respectively. Being a Turkish resident (P = 0.015) was an important risk factor for the development of unfavorable pregnancy outcomes. Moreover, maternal education of at least 12 years (P = 0.028) and receiving a regular antenatal visit at a tertiary center (P = 0.031) were preventative for the development of unfavorable pregnancy outcomes. Adverse pregnancy outcomes were less prevalent in Syrian refugees compared to that in the Turkish residents which was likely due to the contribution of maternal education and regular antenatal visits which were higher in Syrian refugees. Conclusions: We suggest that providing adequate education particularly for women in undeveloped countries and facilitating access to the tertiary hospitals have the potential to reduce unfavorable pregnancy outcomes in immigrant women.
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Effect of laser application on microtensile bond strength of an orthodontic adhesive to water-aged composite p. 18
FM Korkmaz, MB Ozel, T Tuzuner, O Baygin
DOI:10.4103/njcp.njcp_318_19  
Aim: This study evaluated the microtensile bond strength (MTBS) of an orthodontic adhesive to water-aged composite surfaces using different surface treatments. Subjects and Methods: Twelve composite blocks (10 mm × 10 mm × 5 mm) were fabricated and randomly divided into two groups. Half of the specimens were stored in distilled water for 1 day, and the other specimens were stored for 30 days. The specimens were randomly assigned to six groups according to surface treatments (n = 15): Group 1, control (no treatment); Group 2, phosphoric acid; Group 3, diamond bur; Group 4, diamond bur + phosphoric acid; Group 5, laser; and Group 6, laser + phosphoric acid. One coat of orthodontic adhesive was bonded to one surface of composite blocks, and a microhybrid composite resin was bonded to the surfaces via a Teflon mold. Bond strength was evaluated using an MTBS test. Surface topography was evaluated using scanning electron microscopy (SEM) analysis. The data were analyzed using one-way analysis of variance, Tamhane post-hoc test, and independent sample t-tests (P < 0.05). Results: Bond strength values tended to decrease in all groups (with the exception of Group 2) after storage in water for 30 days (P < 0.05). Laser and diamond bur application (with or without phosphoric acid) enhanced the bond strength. Conclusions: An Er,Cr:YSGG laser application may be a feasible alternative to diamond bur for enhancing the bond strength of orthodontic adhesive to composite resin.
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The effect of kangaroo care on maternal attachment in preterm infants p. 26
FY Kurt, S Kucukoglu, AA Ozdemir, Z Ozcan
DOI:10.4103/njcp.njcp_143_18  
Aim: The study was conducted to determine the effect of kangaroo care on maternal attachment in preterm infants in Turkish mothers. Subjects and Methods: The study was conducted a quasi-experimental research design between October 2015 and February 2016 in the neonatal intensive care units (NICU) of two state hospitals located in the east and west of Turkey. The study population consisted of preterm infants hospitalized in the NICU at the time of the research and met the study-group selection criteria. The study population was divided into two groups as an experimental and control group. Kangaroo care (n = 30) was provided to the infants in the experimental group by their mothers. No intervention was applied to the infants in the control group (n = 30) other than the routine practice. Data were collected by the researcher using the 'Introductory Information Form' and the 'Maternal Attachment Inventory'. Data analysis was performed with SPSS (Statistical Package for Social Sciences) 18 software package. The data were analyzed using percentile distributions, mean, standard deviation, t-test, and Chi-square test. Official permissions and ethical approval were obtained to conduct the study. Results: It was determined that the experimental and control group included in the study were similar in terms of the characteristics of the baby and the mother (P> 0.05). In the study, the mean maternal attachment scale score (MAS) of the group in which the kangaroo care was provided was higher than the control group with a statistically significant difference between the groups (P < 0.05). Conclusion: As a result of the study, it was concluded that kangaroo care positively affects maternal attachment and it is suggested that further studies should be conducted to evaluate the effect of kangaroo care on mother-infant attachment in Turkey.
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Evaluation of laboratory investigative methods of diagnosing clonal hematological disorders in a resource-poor setting p. 33
HC Okoye, CC Efobi, K Korubo
DOI:10.4103/njcp.njcp_580_18  
Background: The successful treatment of patients with clonal hematological disorders (CHDs) depends largely on making an accurate diagnosis, which is, in turn, is dependent on performing specific diagnostic tests that are necessary. Objectives: This study assessed the laboratory investigative methods of diagnosing CHDs with regard to the specific required tests (SRTs) that were needed to make a final diagnosis in a center with limited resources. Methods: This is a descriptive hospital-based retrospective study. For the study, data about laboratory investigation details of adults diagnosed with CHDs from 1995 to 2015 were retrieved. The SRTs were determined and data analyzed using SPSS version 20. Results: A total of 129 case notes of adults in the age range of 18–80 years, diagnosed with CHDs, were used. Out of the 671 SRTs needed for diagnosis, only 304 (45.3%) were conducted. When an SRT was requested to be done within the treatment facility, the patients were significantly more likely to do it in comparison with when they were requested to get it done from an external referral laboratory. All the patients with aplastic anemia (AA) and paroxysmal nocturnal hemoglobinuria (PNH) had all (100%) their SRTs done while patients with non-Hodgkin's lymphoma (NHL) had the least (15.3%) of their SRTs done. Full blood count (FBC) was the most frequently used (n = 129; 100%) SRT for diagnosis while immunophenotyping (IMPT) was the least (n = 4; 8.3%) used SRT. Conclusion: Most of our patients had CHD diagnosis without the complete SRT, and this may cast doubt on the accuracy of diagnosis. Therefore, there is a crucial need for availability of more comprehensive laboratory services, especially in government-owned hospitals.
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Comparison of the cyclic fatigue resistance of hyflex EDM, vortex blue, protaper gold, and onecurve nickel–Titanium instruments p. 41
AD Uygun, M Unal, S Falakaloglu, Y Guven
DOI:10.4103/njcp.njcp_343_19  
Objective: This in vitro study aimed to compare the cyclic fatigue resistance of HyFlex EDM (HEDM), Vortex Blue (VB), ProTaper Gold (PG), and OneCurve (OC) nickel–titanium (NiTi) instruments. Materials and Methods: About 12 HEDM (25/.~), 12 VB (25/.06), 12 PG (25/.08), and 12°C (25/.06) instruments were included in this study. All the instruments were tested with a 60° angle of curvature and a 3-mm radius of curvature. All the instruments were utilized until fracture occurred, and then the number of cycles to failure (NCF) was calculated. The data were analyzed statistically using Kruskal–Wallis H and Mann–Whitney U-tests. The statistical significance level was set at P < 0.05. Results: HEDM instruments had the highest cyclic fatigue resistance among all the other instruments (P < 0.05). The OC instruments had a significantly higher fatigue resistance than the PG and VB instruments (P < 0.05); however, there was no significant difference between PG and VB instruments in the NCF (P > 0.05). Conclusion: Within the limitations of this in vitro study, it was found that the cyclic fatigue resistance was higher for the HEDM instruments than for the VB, PG, and OC instruments.
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PPAR-γ, RXR, VDR, and COX-2 Expressions in gingival tissue samples of healthy individuals, periodontitis and peri-implantitis patients p. 46
MM Taskan, F Gevrek
DOI:10.4103/njcp.njcp_349_19  
Objective: Periodontitis and peri-implantitis are irreversible destructive diseases of periodontal and peri-implant tissues. This study aimed to determine the receptor expressions of peroxisome proliferative-activated receptor (PPAR)-γ, retinoid X receptor (RXR)-α, vitamin D receptor (VDR), and cyclooxygenase (COX)-2 in diseased tissues around teeth and dental implants. Subjects and Methods: The study consisted of three groups: group 1, healthy group (C, n = 15); group 2, periodontitis patients with stage 3 grade B (P, n = 15); and group 3, peri-implantitis patients (PI, n = 15). Periodontal clinical parameters such as the plaque index (PI), gingival index (GI), and probing pocket depths (PPD) were recorded. Gingival and peri-implant mucosal biopsies were obtained from all participants and biopsy samples underwent histological tissue processing. Hematoxylin–eosin (H & E) and immunohistochemistry staining were performed. Total inflammatory cell counts and fibroblast cell density were evaluated on H and E-stained slides, while PPAR-γ, RXR-α, VDR, and COX-2 were evaluated through immunohistochemistry. Results: The age of participants were similar, while PI, GI, and PPD values were higher in periodontitis and peri-implantitis groups compared with healthy group. Inflammatory cell infiltration was higher in periodontitis and peri-implantitis compared with healthy group, while fibroblast cell density exhibited a reverse pattern. PPAR-γ and also COX-2 expressions were lower in the healthy group and higher in periodontitis and peri-implantitis groups. RXR-α and VDR were higher in the healthy group and lower in the periodontitis and peri-implantitis groups. Conclusion: The results revealed that RXR-α and VDR levels were higher, while PPAR-γ and COX-2 levels were lower in the healthy group and periodontitis and peri-implantitis groups resulting in similar expressions in the tested parameters.
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Evaluating the levels of knowledge and attitudes of emergency medical technicians and paramedics toward traumatic dental injuries p. 54
A Aras, MS Dogan
DOI:10.4103/njcp.njcp_257_19  
Objectives: The first aid implemented just after the traumatic dental injury (TDI) is of vital importance. This study aims to evaluate the attitudes of emergency medical technicians (EMTs) and paramedics toward TDI and their levels of knowledge about the issue. Subjects and Methods: A questionnaire, which comprised 14 questions, was applied to 389 EMTs and paramedics all across Turkey. The questionnaires were sent to the participants through e-mails, and the results were obtained by an online system. Results: 336 out of 389 EMTs and paramedics (86.4%) mentioned that they did not have any training about the TDI issue. On the other hand, among the ones who mentioned that they received this training, 50.9% suggested that the training was not sufficient. It was observed that 63.5% of the participants encountered cases of injuries in oral and dental regions, and in 83% of these cases the only treatment applied was bleeding intervention. About 75.6% of them think that an avulsed tooth cannot be reimplanted. Conclusion: In conclusion, it was determined that the EMTs and paramedics did not have sufficient and accurate information about the TDI. Lack of knowledge about TDI prevents rapid and accurate intervention to the cases.
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Pattern of malocclusion and caries experience in unrepaired cleft lip and palate patients in Enugu p. 59
LO Okoye, II Onah, OC Ekwueme, KA Agu
DOI:10.4103/njcp.njcp_249_19  
Background: Clefts are common birth defects, usually accompanied by various malformations that include malocclusions, and may be associated with tooth decay. The aim of this study was to assess the malocclusion and caries status of the patients with unrepaired clefts who presented at the National Orthopaedic Hospital Enugu. Subjects and Methods: A cross-sectional, descriptive study was conducted among patients with unrepaired cleft lip and/or palate that presented at the National Orthopaedic Hospital, Enugu between January 2009 and December 2011. Detailed records of 140 patients with cleft deformities who presented to the hospital within the study period were analyzed for the cleft pattern, whereas those patients above 6 years of age (52 patients) were analyzed for malocclusion using the Angle's classification of malocclusion. Assessment for dental caries according to WHO guidelines was made for all the patients. Result: There were 74 males and 66 females. Cleft lip with or without alveolus involvement had equal prevalence (47.1%) (66 patients) with combined cleft lip and palate; eight patients had isolated cleft palate (4.71%). Angle's class 1 malocclusion was statistically significantly higher than other classes (P = 0.000). Class I malocclusion was seen in 38 patients (73.1%), whereas class 111 was seen in 8 patients (15.4%) and class 11 in 6 patients (11.5%). Eight patients (100%) who developed class 111 malocclusion all had a hard palatal defect. Proclining of maxillary anterior teeth (increased overjet) was the most common orthodontic anomalies, reported in 25 patients (48.1%) (P = 0.002). Caries prevalence of 12.9% was observed in this study. Caries experience was statistically significantly higher in deciduous than permanent teeth (P = 0.002). Conclusion: The high prevalence of malocclusion in these cleft patients emphasizes the need for an interdisciplinary team approach and early inclusion of dental care especially oral hygiene to prevent tooth decays.
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Fluoride content of commercial drinking water and carbonated soft drinks available in Southeastern Nigeria: dental and public health implications p. 65
FE Ani, EA Akaji, NP Uguru, EM Ndiokwelu
DOI:10.4103/njcp.njcp_248_19  
Objective and Aim: The importance of fluoride in preventing dental diseases cannot be overemphasized. The aim of this study was to determine the fluoride content of commercial bottled water, sachet water and carbonated soft drinks available in Southeastern-Nigeria at the same time, eliciting their dental and public health implications. Method: Determination of fluoride level in water and carbonated drinks was carried out using Colorimetric-SPADNS (Trisodium 2-(4-sulfophenylazo)-1, 8-dihydroxynaphthalene-3, 6-disulfonate) method. This is a simple and rapid technique with high accuracy. 10 brands of bottled water, 10 brands of carbonated soft drinks and 20 brands of sachet water were studied. The experiment for each brand was carried out in duplicates and mean fluoride concentrations generated. Data analysis was done using SPSS version 17. Results: Fluoride contents in mg/L of bottled water brands ranged from 0.0173 ± 0.0019 mg/L to 0.1607 ± 0.0630 mg/L [mean: 0.0442 ± 0.0184 mg/L] and that of sachet water brands was from 0.0131 ± 0.0019 mg/L to 0.1754 ± 0.1344 mg/L. Mean fluoride content of carbonated soft drinks was 0.0228 ± 0.0064 mg/L with one of the brands having as low as 0.0066 ± 0.0028 mg/L fluoride. Conclusion: None of the drinks investigated contained level of fluoride up to standard admissible values suggesting sub-optimal intake. As the suitability of advice on fluoride use in preventing dental abnormalities depends on the individual's total fluoride intake from drinks and other sources, a further study is warranted to relate this total with the baseline decayed missing and filled teeth of the population.
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Prevalence, risk factors, and outcome of hospitalization of neonatal hyperglycemia at a Nigerian health facility p. 71
EO Adeniji, BP Kuti, Jerome B E Elusiyan
DOI:10.4103/njcp.njcp_229_19  
Background: Neonatal hyperglycemia (NNH) like hypoglycemia is a dangerous metabolic disorder often associated with adverse consequences, if undetected and untreated. This study was set out to determine the prevalence, risk factors, and outcomes of babies with the point of admission hyperglycaemia at the Wesley Guild Hospital (WGH), Ilesa. Methods: The study was descriptive and cross-sectional, involving 300 consecutively recruited neonates admitted into the special care baby unit (SCBU) of the hospital. All subjects had blood glucose done at the point of admission using Accu-Chek Active® glucometer (Roche Diagnostics GmbH, Germany). Hyperglycemia was defined as blood glucose ≥7.0 mmol/L. Factors associated with NNH were determined using univariate and multivariate analyses. Results: Of the 300 subjects (Male: Female 1.5:1), there were 74 (24.7%) preterms, 35 (11.7%) small-for-gestational age and 85 (28.3%) low-birth-weight babies. Eighteen (6.0%) babies had hyperglycemia. Parental low socioeconomic class, maternal lack of antenatal care (ANC), vaginal delivery, grand multiparity, outborn status, respiratory distress, probable sepsis, and neonatal anemia at presentation were associated with NNH (P < 0.05). Respiratory distress (OR = 3.800, 95% CI = 1.122-12.873, P = 0.032), and probable sepsis (OR = 4.090, 95% CI = 1.206-13.872, P = 0.024) were independent predictors of hyperglycemia. Hyperglycemia was significantly associated with mortality. (38.9% vs. 11.0%; P = 0.001). Conclusion: Neonatal hyperglycemia was detected in 6.0% of neonatal admission at the WGH, Ilesa and it was associated with increased mortality. Hyperglycemia should be suspected and promptly managed at the point of admission of ill newborns particularly those with respiratory distress and signs of sepsis.
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Apical extrusion of debris after canal shaping with three single-file systems p. 79
MM Elashiry, SE Saber, SH Elashry
DOI:10.4103/njcp.njcp_319_19  
Objectives: The aim of this study was to evaluate the quantity of apically extruded debris after canal shaping with three single-file systems. Materials and Methods: Sixty mesiobuccal canals of mandibular molars were divided into three experimental groups according to the used file systems—WaveOne Gold, RECIPROC Blue, and HyFlex EDM One file. Debris extruded during canal shaping were collected in preweighed vials. Each canal was irrigated with 5 mL of distilled water via a 30 G side-vented needle. The amount of the debris extruded from each canal was calculated by subtracting the preinstrumentation from postinstrumentation measurement. The preparation times were recorded. Data were analyzed using analysis of variance (ANOVA) and posthoc Tukey tests with α = 0.05. Results: WaveOne Gold extruded the least amount of debris. Results between WaveOne Gold and HyFlex EDM were significantly different. No significant differences in canal shaping time were detected among the three groups (P > 0.05). Conclusion: WaveOne Gold showed the best results regarding apical debris extrusion. Difference between WaveOne Gold and HyFlex EDM suggests that file design and motion kinematics affect the quantity of debris extrusion.
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Retrospective analysis of traumatic dental injuries in the western black sea region of Turkey p. 84
M Gokcek, S Durmuslar, F Kokturk
DOI:10.4103/njcp.njcp_230_19  
Background: The incidence of traumatic dental injuries is affected by social, environmental, and socioeconomic variables. For this reason, epidemiological studies are an important tool for increasing social consciousness and guiding the necessary precautions about trauma. Objectives: The study aims to analyze the epidemiological and clinical data of traumatic dental injuries in patients attending Department of Pediatric Dentistry, Faculty of Dentistry, Bulent Ecevit University, from around Zonguldak, over a period of 3 years (between January 2014 and January 2017). Materials and Methods: Data obtained from trauma charts were analyzed for age, sex, the time elapsed between injury and referral to the clinic, cause of trauma, number, and type of the teeth, type of the trauma, treatment, and seasonal distribution. Results: In all, 188 patients, including 120 boys and 68 girls with a total of 316 traumatized teeth were evaluated. Most (61.7%) of the patients were 7–12 years old (the remaining 38.3% were 1–6 years old). The main cause of injury in both genders was falling. The most common types of trauma were subluxation in primary teeth and enamel dentin fracture in permanent teeth. In the primary dentition, examination and follow-up were the most applied treatments, whereas in permanent dentition, restorative treatments were the most applied treatments. Conclusion: Early intervention is important for the prognosis of the injured tooth. However, except for severe injuries, the rate of referral to the clinic after trauma was low. Therefore, the level of social awareness and knowledge of trauma should be increased.
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Effect of transparent film on the duration of pressure ulcer formation for noninvasive ventilation patients: A randomized controlled trial p. 91
G Ozbudak, OU Yesilbalkan
DOI:10.4103/njcp.njcp_673_18  
Background: Due to the prolonged use of face mask in noninvasive ventilation, pressure ulcer is a common complication. Pressure ulcer can occur within a few hours at the site where the mask contacts in 2-70% of cases. Aims: The aim of this study is to conduct a randomized controlled trial to investigate the effects of transparent film use on the duration of pressure ulcer formation in the nasal region in patients undergoing noninvasive ventilation. Methods: This study was a randomized controlled trial. 46 patients who met the sample selection criteria and agreed to participate in the study were included in the study at a university hospital in İzmir, Turkey. Of them, 25 were assigned to the intervention group and 21 to the control group. Data were collected using the Socio-demographic and Disease-related Characteristics Questionnaire, The Noninvasive Ventilation Parameters Monitoring Form, and The Pressure Ulcer Classification Form at 4-hour intervals. Results: The duration of pressure ulcer formation in intervention group was longer than that in control group, and the difference between them was statistically significant (P < 0.05). Conclusion: In this study, the use of nasal protective film (transparent film) prolonged the duration of pressure ulcer formation on the nasal bridge in patients who underwent noninvasive mechanical ventilation.
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Investigation of the barriers about insulin therapy in patients with type 2 diabetes p. 98
P Soylar, BU Kadioglu, K Kilic
DOI:10.4103/njcp.njcp_138_19  
Aims: This study aimed to explore barriers regarding insulin initiation in patients with Type 2 diabetes and investigate the relationship of some demographic characters of patients. Materials and Methods: A cross-sectional study was conducted with 142 patients with Type 2 diabetes whose doctors had recommended insulin therapy and who had been unwilling to comply. The participants were patients at an endocrine outpatient clinic in Kovancilar State Hospital in the rural area in Elazig, from November 2016 to May 2017. Results: Half of the patients were illiterate, 60.6% of the participants were female, and the mean age was 57.33 ± 10.56. The most commonly reported barrier was injection-related anxiety (63.4%). In total, 58.5% of the patients refused insulin therapy because they felt it indicated that their disease had worsened and that they had failed at diabetes management. Female patients were 6.9 times more likely to think injection-related anxiety that affecting their decision about insulin therapy than male patients. Elderly patients were 8.2 times more likely to think of their disease worsened than younger patient. Conclusions: Patients' beliefs related to insulin therapy were very much influenced by their gender, educational status, and age. Giving patient-centered education is a cost-effective way to decrease negative health behaviors.
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Prevalence of psychological workplace violence among employees of a public tertiary health facility in Enugu, Southeast Nigeria p. 103
AT Chinawa, AC Ndu, SU Arinze-Onyia, IJ Ogugua, TJ Okwor, WC Kassy, N Agwu-Umahi, EN Aguwa, TA Okeke
DOI:10.4103/njcp.njcp_160_19  
Background: Psychological violence is the most common form of workplace violence (WPV) that can affect job performance and health of the workers. Aims: This study sought to determine the prevalence of psychological WPV among employees working in a tertiary health institution in a South-eastern state of Nigeria. Methods: A descriptive cross-sectional study done in 2018 among healthcare workers at the University of Nigeria Teaching Hospital Enugu State using a pretested self-administered questionnaire adapted from Workplace Violence in the Health Sector Country Case Study Questionnaire. Proportionate sampling method was used to select 412 respondents. Data were analyzed with SPSS version 23 using Chi-square test of significance and P value set at 0.05. Results: Prevalence of psychological violence among the participants was 49.7%. Verbal abuse was the most form of psychological violence experienced 168 (40.8%) followed by bullying 29 (7.0%) while sexual abuse was reported by 8 (1.9%). Majority 114 (55.6%) of the perpetrators of the psychological violence were patient's relative, whereas 48 (23.4%) were staff members. In response to the violence, 58 (28.6%) of the healthcare workers took no action, while only 2 (1%) completed incident/accident form. Bullying was statistically significantly higher in healthcare workers who have spent less than 10 years (χ2 = 3.978 P = 0.046). There was a significant association between verbal abuse and frequent interaction with patients (χ2 = 4.757, P = 0.029). Conclusion: This study has shown that the prevalence of psychological WPV was high among healthcare workers in University of Nigeria Teaching Hospital, Enugu State. Therefore, there is need for the hospital management to develop policy interventions specific to psychological WPV.
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Effect of surface flattening and phototherapy on shear bond strength immediately after bleaching with different modes of universal adhesive p. 110
D Surmelioglu, ZM Ozdemir, S Atilan, NE Yeniceri
DOI:10.4103/njcp.njcp_337_19  
Objective: The aim of this study was to compare to effect of phototherapy and surface flattening after immediately bleaching on the shear bond strength to bleached enamel. Methods: Ninety-six human upper incisors were divided into 4 groups (n = 24). Group NB: no bleached, group P: phototherapy with YSGG laser, group F: 0.5 mm surface flattening, group PF: 0.5 mm surface flattening and phototherapy with Er;Cr:YSGG laser. Then, each group was assigned to 2 subgroups according to adhesive mode (n = 12) as; subgroup S (self-etching mode), subgroup T (total-etching mode) which are universal adhesives. All surface conditionings and restorations were performed with composite resin materials immediately after bleaching. Shear bond strength test was performed by using universal testing machine. The surfaces were also evaluated with SEM. The data were statistically analyzed with one-way ANOVA post-hoc Tukey tests. Results: The lowest SBS values were achieved in FS (13.72 ± 2.29) while the highest ones in PT (28.01 ± 6.81). However, the differences were not significant (P > 0.05). All surface conditioning methods provided SBS values similar to the control (P > 0.05). All subgroups of self-etching mode were significantly lower than their total-etching counterparts (P < 0.05). Conclusions: The present study showed that surface removal and phototherapy have a potential clinical application for eliminate to undesirable effect of bleaching treatment. Surface conditioning with either flattening and/or phototherapy may provide clinicians to restore bleached teeth at the same visit with bleaching and reduce chair-time.
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CASE REPORTS Top

Hypereosinophilia (HE) in acute myeloid leukemia (AML) with normal karyotype: A report of two cases p. 116
X Zhang, B Wang, R Zhang, X Chai, H Chao
DOI:10.4103/njcp.njcp_585_18  
We present two rare cases of hypereosinophilia (HE) in acute myeloid leukemia with normal karyotype (NK-AML) at diagnosis. The first case is a 29-year-old female who presented with HE. On evaluation, she was found to have NK-AML. She failed to achieve complete remission (CR) after the first induction therapy with standard idarubicin and cytarabine (IA). She achieved CR after two cycles of reinduction chemotherapy with cytarabine, aclarubicin, and granulocyte colony-stimulating factor (G-CSF) (CAG) but had early relapsed. Reinduction chemotherapy with fludarabine, Ara-C, and G-CSF (FLAG) led to her second remission, followed by unrelated umbilical cord hematopoietic stem cell transplantation (HSCT). Unfortunately, she died of thrombotic thrombocytopenic purpura. The second case is a 23-year-old male who was diagnosed as NK-AML with HE. IA regimen was successively used in two cycles treatment achieving CR. He underwent haploidentical HSCT but had a relapse after 17 months of sustained remission and died 4 months later. The presence of HE may be a poor prognostic feature in NK-AML.
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Sevoflurane induced diffuse alveolar haemorrhage in a young patient after orthopedic surgery: A case report p. 120
O Cengiz, A Kivrak, M Yegen, M Demir
DOI:10.4103/njcp.njcp_51_19  
We present a very rare case of Sevoflurane Induced Diffuse Alveolar Haemorrhage in a young male patient with a closed tibial fracture after direct trauma to the right cruris. The patient was operated for tibial fracture, but diffuse alveolar haemorrhage developed after sevoflurane inhalation in the postoperative period following general anesthesia. Diffuse alveolar haemorrhage (DAH) is associated with inhalation injury from halogenated gases and reported as a unique entity in the literature that practicing clinicians should be aware of and consider in post-operative cases of acute respiratory distress. As DAH usually presents with symptoms the presence of hemoptysis, anemia, dyspnoea and radiological alveolar infiltrates, rapid detection of the aetiology and initiation of cause-directed treatment are of great importance on survival.
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Rapid healing of a persistent corneal epithelial defect (PCED) with autologous serum treatment p. 123
N Akagun, PA Ozer, S Gazyagci
DOI:10.4103/njcp.njcp_172_19  
Autologous serum drop (ASD) is a safe and efficient treatment option for most of the ocular surface diseases. We report a case of a persistent corneal epithelial defect in a patient treated by ASD. A 28 year old male patient presented to our clinic with eye pain and blurry vision in his left eye. Best corrected visual acuity (BCVA) was 20/20 in the right eye and 20/200 in the left eye. Slit lamp examination revealed a central corneal epithelial defect on the left eye and the right eye was normal. Corneal epithelial defect appeared after left upper eyelid chalazion surgery and persisted for 2 months without any response to treatment with eye patching, bandage contact lenses, and artificial eyedrops. We started the treatment with ASD six times daily and preservative-free netilmicin eyedrops four times daily to prevent infection. The drops were used simultaneously with eyepatching for the first two days. The eye was left unpatched after the second day. The corneal epithelial defect resolved after 48 hours. We did not detect a new epithelial defect in the follow up visits. ASD is a quick, safe, and effective treatment option in persistent epithelial defect cases.
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LETTER TO EDITOR Top

Treatment of large-scale oral plasmacytoma in a patient with multiple myeloma p. 125
E Soylu, YN Kaba, T Pergel
DOI:10.4103/njcp.njcp_261_19  
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