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   Table of Contents - Current issue
Coverpage
Dec 2019
Volume 22 | Issue 12
Page Nos. 1629-1789

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REVIEW ARTICLE  

Retention systems used in maxillofacial prostheses: A review p. 1629
AA Diken Türksayar, SA Saglam, AC Bulut
DOI:10.4103/njcp.njcp_92_19  
Defects in the face area caused by trauma, accident, tumor or congenital defects are treated with special facial prostheses. Besides esthetics, the most common problem with these prostheses is the retention of prostheses. In the present article review, the methods used for the retention of prostheses from past to present were researched, and the advantages of adhesives and implants, which are the most commonly used current methods, were evaluated. Current techniques, new materials, treatment options, and implementation procedures are described. The success of maxillofacial prostheses in meeting the expectations of patients and dentist doctors is increasing day by day with the development of adhesive material science, the emergence of technical knowledge, and the development of implant technology. Increasing the retention provides both ease of use and acceptance by the patient. Therefore, the chosen method for retention has great importance in the long-term prognosis of the prosthesis.
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ORIGINAL ARTICLES Top

Predictors of prenatal distress and fear of childbirth among nulliparous and parous women p. 1635
C Kabukcu, C Sert, C Gunes, HH Akyol, M Tipirdamaz
DOI:10.4103/njcp.njcp_613_18  
Background: Prenatal distress and fear of childbirth negatively affect the health of the mother and the fetus. Sociodemographic and pregnancy related characteristics may influence prenatal distress and fear of childbirth. Aim: This study aimed to explore the relationship between fear of childbirth and prenatal distress levels with accompanying factors. Subjects and Methods: The study was designed as a cross-sectional survey study and conducted in the outpatient clinic of Obstetrics and Gynecology Department of Pamukkale University Hospital, Denizli, Turkey, between April 2017 and January 2018. Survey data were collected from 103 third-trimester pregnant women who had admitted to the hospital for routine prenatal examination. Sociodemographic Information Form, the Revised Prenatal Distress Questionnaire (NUPDQ), and the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) were used to collect data. Sociodemographics, obstetrics, and other variables were summarized by descriptive statistics. Mann-Whitney U-test, Chi-squared test, and Fisher's exact test were used for comparison of data between groups. Results: The mean score of NUPDQ was 7.58 (SD 4.09) in the nulliparous group and 8.17 (SD 5.16) in the multiparous group (P = 0.68). The mean W-DEQ score was 40.46 (SD 21.80) in nulliparous women and 45.55 (SD 26.72) in multiparous women (P = 0.38). The W-DEQ and NUPDQ scores were moderately correlated with a Spearman correlation co-efficient of 0.58 (P < 0.001). Conclusions: The results of this study revealed that fear of childbirth and prenatal distress were moderately and positively correlated. NUPDQ and W-DEQ can be used during pregnancy to understand if pregnant women have fear or distress. This could help to give a better support to pregnant women.
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Distortion and magnification of four digital cephalometric units p. 1644
GY Song, G Li, WH Lu, B Han, TM Xu
DOI:10.4103/njcp.njcp_184_19  
Objectives: To assess the validity of using the calibration ruler for correcting magnification of linear measurements and to explore and compare the vertical and horizontal magnification of four digital cephalometric units. Methods: An acrylic box was imaged at seven sagittal positions using four digital cephalometric units: Orthopantomograph OC100, Orthopantomograph OC200, Sirona Orthophos CD, and Sirona Orthophos DS. The true linear lengths of the phantom, corrected, and uncorrected linear lengths on the images were measured and compared. The validity of measurements using the calibration ruler was assessed. The magnification values and distortion indices were calculated and compared among the four cephalometric units. Results: For linear measurements on the mid-sagittal plane and averaged linear measurements on bilateral symmetric sagittal planes, the bias 1.96 STD of the calibration ruler ranged from 1% to 2% for the four cephalometric testing units. For linear measurements on the single lateral sagittal plane, the bias 1.96 STD ranged from 3% to 6%. The vertical scanning charge-coupled device cephalometric unit produced the greatest distortion, ranging from 1.029 to 0.964. Conclusion: The metal millimeter calibration ruler is an accurate reference for linear measurement magnification correction. Because of unpredictability and machine specificity, the magnification and distortion of a cephalometric unit should be calibrated for the estimation of cephalometric measurement error.
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Antimicrobial photodynamic therapy (light source; methylene blue; titanium dioxide): Bactericidal effects analysis on oral plaque bacteria: An in vitro study p. 1654
MA Javali, NA AlQahtani, I Ahmad, I Ahmad
DOI:10.4103/njcp.njcp_189_19  
Background: Incomplete eradication of plaque bacteria from the plaque retentive sites and the emerging problem of antibiotic resistance led the scientific community to explore new antimicrobial strategies for improved results and shun antibiotic resistance. Objective: The purpose of this in-vitro study was to evaluate the antimicrobial effect of a novel light based therapy and to assess the susceptibility of oral plaque bacteria to light based technologies with and without photosensitizers. Materials and Methods: Four oral plaque bacterial strains were isolated from the dental plaque sample collected from the patients and exposed to various light based technologies and photodynamic therapy (PDT) with and without photosensitizers. The cultures were analysed for viable colony forming unit (CFU) counts. One-way analysis of variance was used to statistically analyse differences and the Student-Newman-Keuls method to perform multiple comparison procedures. Results: All groups showed remarkable reduction in the CFUs as compared to control group with use of light based technologies and PDT in this study. The difference of antimicrobial effect between all tested groups either with light based technologies and PDT with control group showed significant reduction in CFUs. Conclusions: From the results of this study, we concluded that light based technologies and PDT could be a valuable alternative therapy to mechanical debridement in the prevention of growth and recolonisation of oral plaque bacteria.
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The effect of maternal fatigue on breastfeeding p. 1662
DK Senol, M Yurdakul, SA Ozkan
DOI:10.4103/njcp.njcp_576_18  
Background: Postpartum fatigue means tiredness, sense of suffocation, and decreased physical and mental capacity. Fatigue reduces postpartum women's ability of concentrate, which may increase the frequency of postpartum depression, and their babies and cause babies' weaning off breastmilk earlier. Aim: Postpartum fatigue reduces the ability of mothers to concentrate and has a negative effect on communication between mothers and their babies. This study was performed to determine the effect of fatigue on breastfeeding and breastfeeding behaviors in postpartum women. Subjects and Methods: The study had a descriptive desing and was carreid out in a postpartum clinic of a maternal, obstetric, and pediatric diseases hospital. It included 374 women giving normal vaginal birth. Data were gathered with a socio-demographic features form and Visual Analogue Scale for Fatigue. Results: The mean score was 6,91 ± 2,25 for the subscale fatigue and 2,38 ± 0,91 for the subscale energy. The women reporting that it was not difficult to give birth and that they had little or some fatigue had significantly higher scores for energy (P = 0.001). The women starting to breastfeed in the hour of giving birth (P = 0.003) and the women breastfeeding at 1-hour intervals (P = 0.100) had a lower score for fatigue. The women not needing help while breastfeeding had a significantly lower score for fatigue (P = 0.001), while those reporting to give additional food had a significantly higher score for fatigue (P = 0.014). Conclusion: Women feel tired in the early postpartum period due to giving birth and their tiredness is increased by breastfeeding and infant care.
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A musical perception test for people with hearing loss: Turkish adaptation and normalization of the Music Perception Test (MPT) p. 1669
AS Sahli, E Belgin, M Uys
DOI:10.4103/njcp.njcp_279_19  
Objectives: The aim of this study was to develop a Turkish musical perception test that provide the opportunity to measure music performance of people with hearing loss. Subjects and Methods: In the study, the Music Perception Test (MPT), which was translated and adapted into Turkish, was applied randomly to 100 individuals aged between 18–40 years. The test was applied with computers and professional head phones to 20 individuals chosen as a pilot study. Data obtained after the pilot study were evaluated and the application to the other 80 participants were completed. In order to obtain validity and credibility data, 20 randomly chosen participants were retested. Results: The average total score of the MPT of the participants was 97.5 ± 12.2 (Min: 69, Max: 120). As the total score of the MPT has been examined, low value for ± 1SD was 85.3/top value was 109.7; low value for ± 2SS was 73.1/top value was 121.9; low value for ± 3SS was 60.9/top value was 134.1. In our study, the value of internal consistency of the Turkish MPT was 0.898. This value indicates that the test was reliable. In a similar manner, considering the correlation of test-retest parameters, both subtests and total score results showed the results were reliable. With the examination of the results there were no relation between the total scores of the MPT and age (r:0.176, p: 0.080) but the interest in music (r: 0.641, P < 0.001) and the frequency of listening to music (r:0.479, P < 0.001) had an important effect on the total scores of musical perception. The difference in the total scores of the MPT between female and male participants were found to be statistically significant (p < 0.001). Conclusions: Results of this study show that the Turkish MPT is a valid and reliable musical perception test for the Turkish people who have normal hearing and hearing loss.
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Efficiency of self-adhering flowable resin composite and different surface treatments in composite repair using a universal adhesive p. 1675
S Sismanoglu
DOI:10.4103/njcp.njcp_233_19  
Aims: The aim of this in vitro investigation was to evaluate the efficiency of self-adhering flowable resin composite (Vertise Flow, Kerr, Orange, CA, USA) and different surface treatments in the repair microtensile bond strength (μTBS) of aged nanofill resin composites using a universal adhesive. Materials and Methods: Aged substrates (×5000 thermocycling) were prepared using a nanofill (Filtek Ultimate; 3M ESPE) resin composite and randomly assigned to different surface treatments: (1) no treatment (control), (2) acid etching with 37% phosphoric acid, (3) Al2O3sandblasting, and (4) sandblasting with CoJet (3M ESPE). After surface treatment, specimens were further divided into two groups: no universal adhesive application and universal adhesive application. Vertise Flow was added to the substrates at 2-mm layer increments to a height of 5 mm and light cured. Restored specimens were sectioned to obtain 1.0-mm2 beams for μTBS testing. Data were analyzed with two-way analysis of variance and Tukey's honest significant difference tests (P < 0.05). Results: The lowest μTBS values were recorded in the control and acid etching groups with no universal adhesive application (P < 0.05). Universal adhesive application significantly increased the repair μTBS values of all surface treatments (P < 0.05), except CoJet treatment. There were no significant differences between Al2O3sandblasting, CoJet application, and acid etching groups with the universal adhesive application (P > 0.05). Conclusion: Vertise Flow can be used effectively in the repair of old nanofill resin composites. The usage of universal adhesive with prior acid etching to obtain acceptable repair performance would be the practical choice under clinical conditions.
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Investigation the relaxant effects of proton pump ınhibitors and their relaxation mechanism on sheep sphincter of Oddi p. 1680
S Soylu, B Sarac, A Kurt, A Altun, E Cakmak, HH Pence, YE Kahramanoglu, I Bagcivan
DOI:10.4103/njcp.njcp_115_18  
Background: Using a relaxant agent before an endoscopic retrograde cholangiopancreatography (ERCP) might reduce complications. Study Aims: We aimed to investigate the relaxant effects of proton pump inhibitors (PPIs) on sheep sphincter of Oddi (SO) and the mechanisms that might take part in this relaxant effect. Patients and Methods: The sheep SO was mounted in an organ bath filled with Krebs–Ringer bicarbonate solution under 1.5 g tension and the relaxant effects of PPIs were evaluated in the tissues precontracted by carbachol (10−6 mol/l). The relaxant responses to the PPIs were tested in the presence of various blockers to enlighten the underlying mechanism by the PPIs. Results: The PPIs exerted relaxant responses in a concentration-dependent manner in the sheep SO (P < 0.05). Esomeprazole produced the strongest relaxation. The administration of atropine, indomethacin, L-NAME, methylene blue, clotrimazole, glibenclamide, and 4-aminopyridine into the organ baths did not change the relaxations induced by PPIs in vitro (P> 0.05). On the other hand, Ca+2-activated potassium channel blocker tetraethylammonium (TEA) reduced the relaxation responses created by PPIs (P < 0.05). Conclusions: The present study suggests that PPIs create relaxation on SO partially via Ca+2-activated potassium channels. PPIs, especially esomeprazole, may be beneficial during the ERCP procedure. Further clinical studies are needed to confirm our results.
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The prevalence of obesıty and related factors among prımary and secondary school students p. 1685
S Deniz, AF Oguzoncul
DOI:10.4103/njcp.njcp_173_19  
Objectives: Obesity was previously seen as a problem in high-income countries. It is also a problem in low and middle-income countries today. The sedentary lifestyle has made this situation more pronounced. Childhood obesity continues in adulthood. Adequate and balanced nutrition and mobile lifestyle have a great role in the prevention and treatment of obesity. The aim of this study was to determine the prevalence of obesity among primary and secondary school students and related factors. Methods: The sample size was calculated as 1278 (213 × 6) for the gender distribution to be appropriate and for the primary and secondary school students to be included in the district center and villages. Considering 15% of the students' non-response rate, the number of students planned to be reached is 1500. Selection was made after the students were ranked by class, gender and place of residence. Of the 1500 students who were sampled, 1298 (86.53%) were evaluated. Results: There was no difference in body mass index between gender and place of residence. The prevalence of being overweight or obesity among secondary school students (25.2%) was significantly higher than primary school students (20.5%).Conclusion: In the childhood age group; sedentary lifestyle, having breakfast and obesity in parents had a significant effect on obesity. It is considered important for children and family members to have proper nutrition and mobile life behaviors.
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Blood culture results at a research and training hospital and the importance of training p. 1693
FM Sezgin, UT Babaoglu
DOI:10.4103/njcp.njcp_573_18  
Objectives: This study aims to measure the level of knowledge of the nurses who collect blood cultures at our hospital, and after providing the necessary training, evaluate the distribution of microbial growth and rate of contamination in blood cultures that are referred to our laboratory during a 1-year term. Methods and Materials: A survey was conducted to assess the level of knowledge regarding blood culture acquisition with the participation of 99 nurses at our hospital in October 2017. Blood cultures sent to our laboratory during 2017 May-October were retrospectively evaluated in terms of their results, contamination rates, and number of bottles. Taking survey results into account, monthly trainings were provided to the nurses for 6 months starting from October 2017, and blood culture results and error rates were investigated prospectively. Results: It was determined from the survey results that the level of knowledge regarding the need to wipe the rubber septum of the blood culture bottle with alcohol prior to adding the blood sample (23.2%) and definition of a blood culture set (25.3%) were quite low. It was found that while the contamination rate prior to training was 6.4%, it fell to 3.7% after training, and although the rate of single-bottle cultures was 6.3% before training, it decreased by 2.0%. Conclusions: Standardizing blood culture acquisition with the provided training will produce maximal benefit for every laboratory in terms of cost and workload.
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Clinical significance of heat shock protein 90α expression as a biomarker of prognosis in patients with gastric cancer p. 1698
HW Lee, KM Kim
DOI:10.4103/njcp.njcp_68_19  
Background: Heat shock protein 90 (HSP90) possesses two major isoforms – HSP90α and HSP90β. They have essential roles in the protection against stressful conditions. They are also important for the re-establishment of cellular homeostasis. We investigated the clinical significance of HSP90α and HSP90β expression in patients with gastric cancer (GC). Methods: HSP90α and HSP90β expression levels were examined immunohistochemically in surgical specimens obtained from 186 GC patients. The correlations between their expression levels and clinicopathological parameters including patient survival were analyzed. Results: The frequencies of larger tumor size (maximum diameter ≥4 cm) and more prominent tumor invasion (≥pT3) in the high intensity HSP90α expression group were 73.4% and 68.8% higher, respectively, than those in the low intensity group (both P = 0.001). High HSP90α expression level was also significantly associated with lymphatic invasion, lymph node metastasis, and advanced stage (TNM stage ≥III) disease (P = 0.047, P = 0.046, and P = 0.004, respectively). Patients with high HSP90α expression levels demonstrated significantly worse survival than those with low HSP90α expression levels (P = 0.047). In contrast, survival did not differ significantly according to the intensity of HSP90β expression. Conclusions: Our results showed that HSP90α overexpression might be associated with disease progression and poorer survival in patients with GC. Therefore, HSP90α could be used as possible biomarker for the prognosis of GC.
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The prevalence and causes of wrong tooth extraction p. 1706
AM Jan, R Albenayan, D Alsharkawi, FM Jadu
DOI:10.4103/njcp.njcp_206_19  
Background: Dental extraction is a common procedure that is subject to complications and errors including extraction of the wrong tooth. This study aimed to determine the prevalence and identify the causes of wrong tooth extractions and explore the attitude of dentists after extraction of a wrong tooth. Methods: A questionnaire was adapted to fit the needs of this project and was distributed among all the dentists in four teaching dental clinics. The questionnaire was available in both the English and Arabic languages. Results: Of the 486 questionnaires, 186 questionnaires were returned (response rate of 37%) and used for the analysis. The prevalence of wrong tooth extraction was 21.1%. The three most common reasons for extracting a wrong tooth were miscommunication (31.6%), inadequate referral (28.9%), and exhaustion of an overworked dentist (28.9%). Surprisingly, only 50% informed the patient and documented the incident in the patient's chart. Few dentists apologized to their patients or offered any kind of solution or compensation. Conclusion: Wrong tooth extraction is a prevalent yet preventable problem. Most of the common causes of this problem appear to be more system rather than individual related. There is a pressing need to implement the universal protocol for the prevention of wrong site, wrong procedure, and wrong person surgery.
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Factors influencing the functional outcomes of tibia plateau fractures after surgical fixation p. 1715
B Polat, T Gurpinar, AE Polat, Y Ozturkmen
DOI:10.4103/njcp.njcp_432_18  
Aims: The aim of this study is to assess the functional and radiological outcomes of 52 surgically treated tibial plateau fractures and to determine the factors affecting functional outcomes. Subjects and Methods: A total of 52 patients who were operated between 2007 and 2014 due to tibial plateau fractures were retrospectively reviewed. The Knee Society Score (KSS) was used for the functional outcome assessment. The Kellgren–Lawrence radiological evaluation score was used for the relationship between postoperative trauma and osteoarthritis in the last follow-up. Results: Patients' mean age was 47.7 years (range, 14–84 years). The immobilization period was 4.2 weeks (range, 0–8 weeks), the full weightbearing time was 3.3 months (range, 1.5–5 months), and the follow-up time was 47 months (range, 17–102 months). Patients' mean KSS was 84.3 (range, 40–100). According to the Kellgren–Lawrence classification, 26 patients had grade 0, 11 patients had grade 1, 8 patients had grade 2, 5 patients had grade 3, and 2 patients had grade 4 postoperative osteoarthritis. Conclusion: Use of graft if there is collapse on joint surface, early knee motion, and early started full weightbearing after surgical fixation of tibial plateau fracture is essential for successful outcome. Findings of osteoarthritis on X-rays are not related to poor functional outcome at the mid- to long-term follow-up of surgical treated tibial plateau fractured patients.
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Evaluation of knowledge level related to obstructive sleep apnea syndrome p. 1722
H Senturk, MA Eryilmaz, H Vatansev, S Pekgor
DOI:10.4103/njcp.njcp_612_18  
Objective: Our aim in this study is to evaluate the knowledge level of outpatients about obstructive sleep apnea syndrome (OSAS). Subjects and Methods: This cross-sectional analytical study included 1651 patients and patient relatives who applied to Konya Training and Research Hospital outpatient clinics. Sociodemographic data form and OSAS knowledge level questionnaire were applied to participants. SPSS 21 package program was used for the statistical analysis of the data. It was accepted that p value was <0.05. Results: The average knowledge score in the knowledge level questionnaire was 15.1 (3-33). 61% of the participants had never heard of OSAS before. Those who are married, those living in the city center and women have a higher level of knowledge. When age, education level and income level increased, the score of information also increased. Most of the participants' information source was the social media with 56.5% (n = 364) and least were health workers with 19.8% (n = 127). The knowledge level of people whose information sources were doctors, were significantly higher than other information sources such as nurses, friends, internet and television as. There was no significant difference between the other groups. Conclusion: In our study, it was concluded that the level of knowledge about OSAS in the society was not sufficient and that the society had to be informed about this disease which has serious complications and awareness should be established.
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Geometrical Analysis of the Proximal Femur and the Clinical Application in Total Hip Replacement: A Study of the Igbo Population of South East Nigeria p. 1728
AU Katchy, NR Njeze, S Ezeofor, K Nnamani
DOI:10.4103/njcp.njcp_634_18  
Background: Adult hip reconstruction following trauma and hip pathologies depends on a sound knowledge of the proximal femoral geometry (PFG), which varies from one ethnic population to another. Aim: The aim of the study, therefore, was to evaluate parameters of the proximal femoral geometry in Igbos of South Eastern Nigeria. Methodology: A 5-year review of normal X-rays of the pelvis showing both hips of patients' age 18–64 between 1 January 2012 to 31 December 2016 at Radiology Department of University of Nigeria Teaching Hospital Enugu was done. Results: There were 554 patients, 273 (49.3%) males and 281 (50.7%) females. The values of the head width established in this study showed there was a mean difference between the right and left proximal femurs, which was statistically significant (P < 0.05). There was statistical significant difference (P < 0.05) between the means of the parameters of the proximal femoral geometry when compared between gender, the only exception being the left medial cortical thicknes, which did not show any difference (P > 0.05). A comparison of means of PFG parameters of the Igbos and that of the Turkish population showed that there was statistically significant difference on both sides. Conclusion: Our study demonstrated that there was no difference in the means of both sides of femoral neck width and the intertrochanteric width of the left side. The correlations between PFG parameters showed that there was strong positive correlation that was significant apart from the right acetabular angle that did not correlate with other parameters.
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Comparison of the efficacy of eutectic mixture of local anesthetics (EMLA) and dorsal penile nerve block (DPNB) in neonatal circumcision p. 1737
VI Modekwe, JO Ugwu, OH Ekwunife, AN Osuigwe, SO Obiechina, IV Okpalike, JC Orakwe
DOI:10.4103/njcp.njcp_266_19  
Background: Neonates feel pain. There is a concern among practitioners that pain of injecting analgesics to neonates prior to circumcision could as well be the same as the pain of the procedure. This has made many reluctant to offer effective analgesia for circumcision. If eutectic mixture of local anesthetics (EMLA) provides analgesia comparable to dorsal penile nerve block (DPNB), it will obviate needle prick and encourage analgesia use in neonatal circumcision. Aim: To determine how the analgesic efficacy of EMLA compares with that of DPNB in neonatal plastibell circumcision. Methods: A prospective study of 110 male neonates for plastibell circumcision randomized into two groups: A and B, of 55 each, received EMLA or DPNB as analgesia prior to circumcision, respectively. The pulse rates and SpO2 were recorded with pulse oximeter pre-procedural and at four stages of the procedure (adhesiolysis, dorsal slit, tying, and excision) for each neonate. Also the modification of neonatal infant pain scale (NIPS) was recorded during the procedure. Results: There were differential changes in SpO2 (lower absolute mean values) and pulse rate (higher absolute mean values) for neonates who received EMLA when compared with DPNB before the procedure. These differences were significant with SpO2 at adhesiolysis (91.0% and 95.0%), dorsal slitting (90.9% and 94.7%), and excision stages (93.4% and 95.3), respectively (P < 0.05). They were also significant with the pulse rates at adhesiolysis (167.9 and 158.6), dorsal slitting (174.3 and 161.7), and tying stages (182.2 and 169.0), respectively (P values = 0.013, 0.015, and 0.044, respectively). This shows DPNB is better than EMLA. However, the difference was not significant at the tying stage with SpO2 and at excision stage with PR (P > 0.05). Conclusion: EMLA produces analgesic effect. However, it does not provide effective analgesia for plastibell circumcision in neonates. DPNB provides a better analgesia than EMLA for neonatal plastibell circumcision.
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Relationship between healthy lifestyle behaviors and health related quality of life in turkish school-going adolescents p. 1742
N Ilhan, K Peker, G Yildirim, G Baykut, M Bayraktar, H Yildirim
DOI:10.4103/njcp.njcp_190_19  
Background: The aim of this study is to determine the relationship between healthy lifestyles behaviours and health-related quality of life (HRQOL) among Turkish school-going adolescents.Subjects and Methods: This cross-sectional study was conducted among 413 students studying in a secondary school of Istanbul, Turkey. Data were collected using a questionnaire containing socio-demographic characteristics, health promoting lifestyle behaviors and the Turkish generic health-related quality of life questionnaire for children (Kid-KINDL). Data were analyzed using descriptive statistics, t-test, Pearson's product-moment correlation, and a hierarchical multiple regression analysis. Results: Univariate statistics showed that gender, school grade, parental education level, monthly income, and all healthy lifestyles behaviours except for fruit and vegetable intake were associated with adolescents' HRQOL. Multivariate statistics indicated that participation in social activities and talking about their problems were the most important predictors of better HRQOL. Healthy lifestyles behaviours, especially talking about their problems to close friends and/or family members and participation in leisure-time social activity were related to better HRQOL of Turkish adolescents, independently of socio-demographic factors. Conclusion: Collaborative efforts among providers of school health and counseling services are urgently needed to improve all aspects of adolescent health.
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Oral mucosal melanoma in four Nigerian teaching hospitals p. 1752
MC Nwoga, OA Effiom, BF Adeyemi, OO Soyele, CU Okwuosa
DOI:10.4103/njcp.njcp_176_19  
Background: Oral mucosal melanoma (OMM) is a malignant lesion of melanocytes of oral epithelium. The prevalence in four Nigerian teaching hospitals is reported. Aims: This study shows the hospital based prevalence and the clinicopathologic features of OMM in four Nigerian teaching hospitals. Subjects and Methods: A retrospective study of patients diagnosed with OMM in four teaching hospitals in Nigeria was carried out. All records of patients with orofacial lesions from 1969 to 2016 were identified and retrieved from the archives of four oral pathology departments. The biodata and relevant clinicopathologic information of those diagnosed with OMM were reviewed. Data analysis was done with SPSS for Windows, version 20. Results: There were 10,877 orofacial lesions managed during the period. Oral malignant lesions constituted 14.4% (1,552/10,877). OMM was diagnosed in ten patients with prevalences of 0.09% and 0.6% of all orofacial lesions and oral malignancies, respectively. There was a male predilection of 4:1 and a mean age of occurrence of 53.8 (±12.6) years. The palate was the most frequent site, 40.0% (4/10). Regional lymph nodes were hard, fixed, or matted in 50.0% (5/10) of patients and distant metastases observed in 20.0% (2/10). Among those followed up, only one was documented alive after 6 months. Amelanotic OMM, 20.0% (2/10) did not show ulceration or regional and distant metastasis. Conclusions: OMM has a low prevalence but with poor prognosis. Amelanotic OMM showed less clinical aggression. Early diagnosis and prompt treatment are recommended.
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Do ozonated water and boric acid affect the bond strength to dentin in different adhesive systems? p. 1758
E Akturk, OO Bektas, S Ozkanoglu, EG G Akin
DOI:10.4103/njcp.njcp_281_19  
Aim: The aim of this in vitro study was to compare the effects of the application of three different cavity disinfecting agents to dentin on the micro-shear bond strength (μ-SBS) of one self-etch and two universal adhesive systems. Materials and Methods: In total, 120 caries-free human permanent molar teeth were used in this study. Mid-coronal dentin surfaces were revealed by cutting occlusal enamel and a standard smear layer was obtained by using 600-800-1200 grid silicon carbide abrasive papers. Specimens were randomly assigned to four groups according to the disinfectant used: Group 1: Control (no disinfectant); Group 2: 2% chlorhexidine based (Consepsis); Group 3: 10 ppm ozonated water (TeknO3zone); Group 4: 5% boric acid (Handmade). Each group was divided into three subgroups according to the type of adhesive (Clearfil SE Bond, OptiBond XTR, and Tokuyama Universal). Specimens were bonded using either Clearfil SE Bond, OptiBond XTR or Tokuyama Universal, which were employed according to the manufacturer's instructions. Resin composite microcylinders were bonded using Tygon® tubes for μ-SBS testing. After specimens were stored for 24 h, at 37°C in distilled water, μ-SBS test was measured with a universal test machine (LF Plus, Lloyd, Instrument). μ-SBS results were analyzed by one-way analysis of variance (ANOVA) and Tukey's tests. Results: When the mean microshear bond strength values of the control group were compared, the difference between the subgroups was not significant (P < 0.05). When the mean microshear bond strength values of the chx, ozonated water, and boric acid were compared, the difference between Clearfil SE Bond and Tokuyama Universal was significant (P < 0.05) and the difference between the other groups was not significant (P > 0.05). Conclusion: Ozonated water and boric acid may be as an alternative to other materials used as cavity disinfectants.
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Isometric handgrip exercise training attenuates blood pressure in prehypertensive subjects at 30% maximum voluntary contraction p. 1765
GU Ogbutor, EK Nwangwa, DD Uyagu
DOI:10.4103/njcp.njcp_240_18  
Background: Prehypertension highlights a category of subjects who are at high risk of developing hypertension. Aim: This study assessed the blood pressure attenuating effect of isometric handgrip exercise in the management of prehypertension. Materials and Methods: A total of 400 prehypertensive subject with a mean age of 40 ± 10 years and recently diagnosed as prehypertension were recruited for the study. They were randomly distributed into exercise and control groups (n = 200). The control group was placed on lifestyle modification only, while the exercise group performed a 24 consecutive days isometric hand grip exercise training at 30% maximum voluntary contraction (MVC) for 2 min each day in combination with lifestyle modification protocol. Results: The results show a statistically significant reduction in systolic blood pressure (SBP) and diastolic blood pressure (DBP). The exercise group had a mean reduction of 7.48 ± 0.06 and 6.41 ± 1.01 mmHg of the SBP and DBP, respectively. It was further observed that both the SBP and DBP and pulse rate significantly increased acutely within 5 min post exercise at 30% MVC with a mean value of 8.60 ± 0.20 mmHg, 7.33 ± 0.03 mmHg, and 8.24 ± 0.20 beats/min of the SBP and DBP and pulse rate, respectively. However, this increase returned to pre-exercise value within 10 min post exercises to a mean value of −0.68 + 1.64 mmHg, 1.48 ± 1.02 mmHg, and 3.00 ± 0.11 beats/min, respectively. Conclusion: This study has shown that isometric handgrip exercise is effective in the attenuation of blood pressure in prehypertensive subjects especially when combined with the routinely recommended lifestyle modifications. However, caution should be taken when recommending it because of acute increase in blood pressure.
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Scarless neck endoscopic thyroidectomy via the breast approach: A preliminary report of 45 cases with total or near-total thyroidectomy plus central compartment dissection p. 1772
H Yan, Y Wang, P Huang, Y Hong, Q Ye, Q Xie, Q Zhao, P Wang
DOI:10.4103/njcp.njcp_120_19  
Background: There are various endoscopic techniques for thyroid carcinoma dissection but few reports regarding the scarless neck technique and central compartment dissection (CCD) via the breast approach, especially for bilateral CCD are available. In this study, we reported 45 cases with scarless neck endoscopic total or near-total thyroidectomy plus CCD via the breast approach. Materials and Methods: Forty-five female patients with papillary thyroid carcinoma (PTC) were enrolled in the study, from January 2011 to March 2013. In brief, 5 mm ultrasonic coagulation device (Harmonic Scalpel, HS; Ethicon Endosurgery, USA) was used to perform thyroid vessel management and thyroidectomy. Twenty patients underwent total thyroidectomy and 25 underwent near-total thyroidectomy. CCD was performed in all 45 patients, including 13 with bilateral CCD and 32 with ipsilateral CCD. Results: The procedure was successful for all 45 patients. Sixteen patients (35.6%) had lymph node metastases in central compartments. Postoperative transient adverse events included voice changes (9 patients) and hypocalcemia (18 patients), including 7 (21.9%) in the unilateral group and 11 (84.6%) in bilateral group. There was no permanent hypocalcemia or recurrent laryngeal nerve (RLN) palsy. None of the case were converted to open surgical procedure. All patients were satisfied with the cosmetic result of the scarless neck endoscopic thyroidectomy (SET). No evidence of residual or recurrent disease was found during a mean follow-up of 22.84 months (range, 12–34 months).Conclusions: Experienced thyroid surgeons performed the scarless neck endoscopic total or near-total thyroidectomy plus unilateral or bilateral CCD via the breast approach for selected PTC patients. The procedure was safe and feasible with excellent cosmetic results.
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CASE REPORTS Top

Generalized cystic lymphangiomatosis incidentally recognized in an asymptomatic adult: Peroperative, CT, MRI, and histopathological findings of a very rare case p. 1778
KN Arda, S Akay, KT Kizilkanat
DOI:10.4103/njcp.njcp_582_18  
Generalized cystic lymphangiomatosis is an uncommon congenital lymphatic malformation that may affect soft and hard tissues as well as organs. It is rarely seen in adult patients. Osseous lesions appear as well-defined cystic lesions with a sclerotic rim without periosteal reaction or a soft tissue component. A nonenhancing lesion in fluid density appears to be one of the most common characteristics of abdominal diseases, and clinical features are directly related to the extent of the disease. In this report, we present peroperative, computed tomography (CT), magnetic resonance imaging (MRI), and histopathological findings of a very rare case of generalized cystic lymphangiomatosis recognized in adulthood.
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Coexistence of unusual and distinctive initial manifestations of severe systemic lupus erythematosus: A child's case, presenting as adrenal insufficiency associated with autoimmune polyglandular syndrome p. 1781
M Karaoglan
DOI:10.4103/njcp.njcp_667_18  
The involvement of multiple endocrine organs is rarely identified as initial manifestations of systemic lupus erythematosus (SLE) and autoimmune polyglandular syndrome (APS) in infancy. Childhood SLE tends to present with more severe clinical symptoms at an early age and with a set of unexpected findings. In the literature, the case reports of children presenting with SLE and APS components at the same time are extremely rare. Adrenal insufficiency may be overlooked due to mild clinical findings in later periods, except for neonates characterized by marked salt depletion and ambiguous genitalia signs. Moreover, adrenal insufficiency as an initial symptom in childhood is quite unusual as a component of SLE-associated APS. This report describes the overlap of unexpected, unusual, and severe clinical findings in an infant with APS with a comorbidity of SLE, where the involvement of multiple endocrine organs coexists with multiple serious clinical manifestations from the beginning.
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CASE SERIES Top

Spontaneous regression of lumbar disc herniations: A retrospective analysis of 5 patients p. 1785
K Oktay, KM Ozsoy, UA Dere, NE Cetinalp, M Arslan, T Erman, A Guzel
DOI:10.4103/njcp.njcp_437_18  
The aim of this study is to describe patients who represent spontaneous regression of lumbar disc herniations (LDHs) subsequent to conservative treatments. In this retrospective study, medical records of 862 patients who had presented to our neurosurgery department with LDHs between May 2014 and May 2016 were studied. All of these patients had a history of low back pain and radiculopathy. Lumbar magnetic resonance imaging (MRI) scans were performed to diagnose them.LDHs were categorized into four subtypes including disc bulging, protrusion, extrusion, and sequestration. Five patients developed spontaneous regression of LDHs according to spinal MRI scans. All patients relieved radiculopathy symptoms in 2 to 4 weeks and low back pain symptoms in 3 to 8 weeks except one patient. In one patient hypoesthesia symptom, in one patient motor deficit, and in one patient low back painremained after the regression. The clinical and diagnostic imaging characteristics and outcomes of these five patients are described and the pertinent literature regarding spontaneous regression of LDHs is reviewed. Sequestrated disc herniations represent the main candidates for spontaneous regression according to our clinical research and the pertinent literature. Dehydration and inflammation-related resorption are the main mechanisms for this event. Conservative treatment modalities should not be underestimated for the treatment of such patients in the absence of definitive surgical indications.
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