Medical and Dental Consultantsí Association of Nigeria
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   Table of Contents - Current issue
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September 2020
Volume 23 | Issue 9
Page Nos. 1183-1331

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ORIGINAL ARTICLES  

Apical peri-prostatic nerve block versus intra-rectal xylocaine gel for trans- rectal ultrasound guided prostate biopsy among Nigerian patients: A prospective randomized study p. 1183
EV Ezenwa, SO Osaghae, EO Ozah, G Okparanta
DOI:10.4103/njcp.njcp_219_19  PMID:32913154
Aims: This study compared the analgesic effect of apical peri-prostatic block with that of intra-rectal xylocaine gel for trans-rectal ultrasound guided prostate biopsy (TRUS-PBx) in Nigeria. Methods: This is a prospective randomized comparative study carried out over one year in University of Benin Teaching Hospital, Edo State, Nigeria. The participants were randomized into two groups; Group A had 10 mls of intra-rectal xylocaine gel instillation while Group B had apical infiltration of 10 mls of 1% xylocaine all before TRUS-PBx. Result: There was a statistically significant difference in the mean pain score during and one hour after TRUS-PBx between Group A and Group B of the study population respectively (p < 0.0001). Those that had intra-rectal xylocaine gel (Group A) had more pain during and after biopsy. There was no difference in the mean pain score during probe insertion between the two groups (p = 0.952). Conclusion: This study demonstrated the superiority of apical peri-prostatic nerve block over intra rectal xylocaine gel instillation during TRUS-PBx with respect to its anesthetic efficacy. Therefore, centers providing TRUS-PBx in Nigeria should consider apical peri-prostatic nerve block as their mode of anesthesia for the procedure due to its efficacy and high safety profile.
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Antimicrobial effects of sodium hypochlorite and Er,Cr:YSGG laser against Enterococcus faecalis biofilm Highly accessed article p. 1188
K Suer, L Ozkan, M Guvenir
DOI:10.4103/njcp.njcp_632_18  PMID:32913155
Aims: The aim of this study was to investigate the antimicrobial effect of Erbium, chromium-doped yttrium, scandium, gallium, and garnet (Er,Cr:YSGG) laser with and without NaOCl solution. A total of 81 extracted human mandibular premolar teeth were used. Materials and Methods: After root canal preparation and sterilization, the samples were inoculated with E. faecalis for 24 hours. The specimens were divided into 4 experimental groups. Group 1 (n = 25) was irradiated with 2 W laser, group 2 (n = 25) was irradiated with 0.75 W laser in combination with 2.5% NaOCl, group 3 (n = 25) was irrigated with 5% NaOCl and group 4 (n = 6) was not treated. Statistical analysis was performed by using Wilcoxon Signed Ranks, Mann-Whitney U and Kruskal-Wallis H tests. Results: The combination of 0.75 W laser with 2.5% NaOCl regime was found to be just as effective at inhibiting the growth of E. faecalis and sterilization of all root canals as 5% NaOCl irrigation (P > 0.001). The 2 W laser had significant bactericidal effect in infected root canals however it did not eradicate all bacteria. The SEM observations were in accordance with the microbiologic findings. Conclusions: Within the limitations of this laboratory study, NaOCl irrigation improved the antimicrobial effect of Er,Cr:YSGG laser irradiation. When the toxic effects of high percentage of NaOCl was considered, the combination of low-powered laser and low concentration of NaOCl can be used as an effective disinfection method in root canal treatment.
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Blood glucose fluctuations in patients with coronary heart disease and diabetes mellitus correlates with heart rate variability: A retrospective analysis of 210 cases p. 1194
Y Chen, T Jia, X Yan, L Dai
DOI:10.4103/njcp.njcp_529_19  PMID:32913156
Aim: This retrospective analysis aims to evaluate the correlation between blood glucose fluctuation (BGF) and heart rate variability (HRV) in patients with coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM). Subjects and Methods: In total, 210 patients with CHD and T2DM from January 2014 to January 2019 admitted to Wenling Hospital of Traditional Chinese Medicine were enrolled in this study. Based on whether BGF existed, patients were allocated to BG control group and BG fluctuation group. The HRV parameters, frequency of adverse events, and Gensini score between groups were recorded and Pearson analysis was performed. Results: Results displayed that no significant differences in age, gender, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), alcohol consumption history, drinking history, or serum lipid were found between groups (P > 0.05 for all items). However, the BGF parameters were significantly higher while the HRV parameters were significantly lower in BG fluctuation group, compared with BG control group (P < 0.05 for all items). Pearson analysis showed that despite mean blood glucose (MBG) and mean amplitude of glycemic excursions (MAGE) both correlated with a standard deviation of NN intervals (SDNN) level, the correlation coefficient of MAGE-SDNN was much higher (-0.705 vs -0.185). Additionally, the frequencies of adverse events and Gensini scores were also significantly higher in the BG fluctuation group than the BG control group. Conclusions: It suggests that BGF strongly correlated with HRV in patients with CHD and T2DM. It also provides experimental instructions for clinical practice.
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Development of relationship with patient self efficacy scale: Gender, department, and grade level differences p. 1201
A Cevirme, N Ugurlu, U Sahranc, K Ozdemir, G Durat, O Erturk, S Sahin
DOI:10.4103/njcp.njcp_243_18  PMID:32913157
Background: Self-efficacy has become a cross-disciplinary concept. In the field of healthcare, this concept is considered crucial for nurses; who play an important role in improving the health and well-being of the community. Aims: The aim of this study was to develop a “Relationship-with-the-patient self-efficacy scale” (RPSES). Methodology: A sample of 331 university students (310 females and 21 males; 168 from the midwifery and 162 from the nursing departments) were enrolled in the study. Out of 24 items, 8 behavior items with the highest factor loadings were selected regarding the nurse-patient-relationship self-efficacy according to the results of the preliminary exploratory factor analysis. Results: The final exploratory factor analysis revealed that the selected 8 items of RPSES had a single factor, explaining 83.28% of the total variance. The Cronbach alpha reliability coefficient was c alculated as 0.97. Conclusion: This scale has beendemonstrated to be a valid and reliable instrument.The analyses unfolded that RPSES scores of the students were not different between men and womenand did not differ by the departments the students attended; however, the RPSES scores were different by the grade levels of the students (juniors and seniors). The fourth graders' RPSES scores were higher than those of third graders.
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Fixed orthodontic appliance impact on oral health-related quality of life during initial stages of treatment p. 1207
Laila Fawzi Baidas, Norah AlJunaydil, Mawadh Demyati, Rawan Abu Sheryei
DOI:10.4103/njcp.njcp_681_19  PMID:32913158
Aims: Our study aimed to assess the oral health-related quality of life (OHRQoL) changes during the initial stage of fixed orthodontic appliance therapy and determined the impact of various orthodontic therapy needs on the OHRQoL of Saudi patients seeking orthodontic treatment. Materials and Methods: Forty-two patients aged 14–24 years (69% females) were recruited from the orthodontic clinics. OHRQoL was quantified by a self-administered short version of oral health impact profile (OHIP-14) questionnaire used before treatment (T0) and following bonding of fixed appliance on days 1 (T1), 7 (T2), 14 (T3), and 30 (T4). The higher the OHIP-14 score, the poorer the OHRQoL. The dental health component (DHC) of the index of orthodontic treatment needs (IOTN) was used to assess malocclusion severity. The missing, overjet, crossbite, displacement, overbite (MOCDO) hierarchical scale was used to categorize the most severe feature in each patient and determine the grade of orthodontic treatment need. Changes of OHRQoL over time were compared using the Friedman test. Result: Overall OHIP-14 score significantly increased following orthodontic appliance bonding at T1 and T2 compared to T0 (P < 0.001). The functional limitation domains in OHIP-14 pain and discomfort, physical disability, psychological disability, and psychological discomfort were affected at T1 compared to T0 (P < 0.05). Grade 4 IOTN-DHC (definite treatment needs) significantly influenced most OHIP-14 domains compared to other grades. Conclusion: With the growing therapeutic and cosmetic demands of orthodontic treatment and the focus on OHRQoL, the study findings can be used to enhance patients' cooperation, expectation, and adherence to orthodontic treatment.
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Anterior bladder wall thickness, post-void urine residue, and bladder emptying efficiency as indicators of bladder dysfunction in Nigerian men with benign prostatic hyperplasia p. 1215
BU Eze, TU Mbaeri, JC Orakwe
DOI:10.4103/njcp.njcp_67_20  PMID:32913159
Background: Benign Prostatic Hypertrophy [BPH] is associated with voiding dysfunctions. Urodynamic study is the gold standard for diagnosis of voiding dysfunctions but is invasive. Bladder wall thickness (BWT), post-void urine residue (PVR), and bladder emptying efficiency (BEE) are noninvasive predictors of voiding dysfunction. Objective: To study the relationship among BWT, PVR, and BEE in BPH. Subjects and Methods: A hospital-based cross-sectional prospective study of new BPH patients at Nnamdi Azikiwe University Teaching Hospital, Nnewi. The participants had abdominal ultrasonography measurement of anterior BWT (at bladder volume ≥200 mls), prostate volume (PV), and PVR using Prosound SSD3500 (Aloka Co Ltd, Tokyo, Japan) with an abdominal probe frequency of 3.5 MHz. Then the BEE was calculated. The anterior BWT was divided into two groups: <5 mm and ≥5 mm. The data were analyzed using SPSS version 20. Pearson's correlation was used to assess correlation and the differences between the means of the two groups of BWT were compared by Mann–Whitney test. A P- Value <0.05 was considered significant. Results: Seventy seven men with a mean age of 66.66 ± 10.74 years were included in the study. Sixty one percent had symptoms lasting >12 months. The average anterior BWT, PBV, PVR, BEE, PV, and PSA were 4.55 ± 1.02 mm, 260.98 ± 57.44 mls, 58.36 ± 52.94 mls, 77.98 ± 17.37%, 66.31 ± 46.38 mls, and 8.04 ± 5.97 ng/ml, respectively. There was a significant positive correlation between BWT and duration of symptoms (P = 0.044) and a significant negative correlation between BWT and BEE (P = 0.005). An insignificant positive correlation was found between BWT and PVR (P = 0.255). Fifty four (70.1%) had BWT <5 mm and 29.9% had BWT ≥5 mm. The mean IPSS (P = 0.000), PV (P = 0.032) and PVR (P = 0.020) were significantly higher in the ≥5 mm group. The ≥5 mm group also had a significantly lower BEE (P = 0.002). Conclusion: Voiding dysfunction was more severe in patients with BWT of 5 mm or more. There was a positive, but insignificant, correlation between anterior BWT and PVR and a significant negative correlation between BWT and BEE.
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Evaluation of extremity vascular injuries and treatment approaches p. 1221
C Guven, H Kafadar
DOI:10.4103/njcp.njcp_656_18  PMID:32913160
Background: Vascular injuries are commonly seen in both emergency services and forensic medicine practise. They are often life-threatening, with high morbidity and mortality rates. Aims: This study aimed to retrospectively evaluate extremity vascular injuries and the associated treatment approaches. Methods: After obtaining approval from the ethics committee of the university, those patients admitted to the emergency department of Adiyaman between 1 February 2013 and 31 August 2018 were included in this study. The patients' data were obtained through the electronic records system, and the cases were evaluated according to the age, gender and cause of injury, including blunt force trauma injuries (accidents, traffic accidents, crush injuries and occupational accidents) and penetrating injuries (stabbing, gunshot wounds, suicide attempts and assaults). Additionally, the injuries were evaluated based on the extremity, according to the anatomical location and whether the injury was life-threatening. Results: This study included 76 patients with extremity vascular injuries; 65 were males (85.52%), 11 were females (14.48%) and their average age was 33.24 ± 15.85 years. Forty-five (59.2%) of the patients had upper extremity vascular injuries, and 31 (40.3%) had lower extremity vascular injuries. In addition to arterial injuries, 26 (34.21%) of the patients had venous injuries and 22 (28.94%) had nerve injuries. Nine of these patients had neurological deficits due to their nerve injuries. All of the patients were revascularized within 3–5 hours, and none of the patients required amputations. Conclusion: The primary goals in extremity vessel injury cases are to prevent mortality, especially after major vascular injuries, and save the extremity from amputation. With a fast, effective and multi-disciplinary approach, an accurate diagnosis and effective surgical intervention can prevent morbidity and mortality as well as reduce the rate of undesirable complications.
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Comparison of age-based weight estimation with actual measured weight in children aged one to twelve years in Enugu p. 1229
BO Edelu, KK Iloh, OO Igbokwe, CI D Osuorah, ON Iloh, IK Ndu, JN Eze, IN Obumneme-Anyim, OC Nduagubam, UC Akubilo
DOI:10.4103/njcp.njcp_41_20  PMID:32913161
Aims: This study was carried out to evaluate the degree of accuracy of age-based weight estimation methods in assessing the weight of the Nigerian child. Method: The weights of one thousand, four hundred and fifty-six (1,456) children were measured and compared with the updated Advanced Paediatric Life Support (APLS), Best guess, Nelson and Luscombe & Owen methods. Result: The updated APLS, Nelson and Luscombe & Owen methods underestimated the weights in younger children while overestimating in older ones. Best guess overestimated the weights across all ages. The Nelson formula had the best agreement within 10% and 20% of the measured weights among all methods. A linear regression analysis produced an equation for weight estimation: weight (W) = 2.058 Y + 9.925, where W is weight in kilogram and Y is the age in years. Conclusion: None of the weight estimation formulae assessed was entirely accurate in our study, though the Nelson method showed superior agreement.
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Efficacy of Endoactivator, CanalBrush, and passive ultrasonic irrigation in the removal of calcium hydroxide paste with iodoform and p-chlorophenol from root canals p. 1237
D Turkaydin, FB Basturk, S Goker, B Tarcin, Y Garip Berker, H Sazak Ovecoglu
DOI:10.4103/njcp.njcp_710_19  PMID:32913162
Aims: We evaluated and compared EndoActivator, CanalBrush, and passive ultrasonic irrigation (PUI) in the removal of calcium hydroxide and calcium hydroxide with iodoform and p-chlorophenol paste (Calcipast Forte) from artificial standardized grooves in the apical third of root canals. Materials and Methods: A total of 34 mandibular premolars were prepared and then split longitudinally. A standardized groove was prepared in the apical part of both segments. The grooves were filled with either calcium hydroxide or Calcipast Forte, and the segments were reassembled. CanalBrush, EndoActivator, or PUI were used. The amount of remaining medicament was evaluated using a four-grade scoring system. Results: None of the irrigation methods could completely remove the pastes from the grooves. More Calcipast Forte paste was detected compared with calcium hydroxide (P < 0.01). PUI was the least effective method in removing Calcipast Forte. Conclusions: It was more difficult to remove Calcipast Forte than a water-based calcium hydroxide paste.
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Evaluation of choroidal thickness before and after strabismus surgery in paediatric patients by spectral-domain optical coherence tomography p. 1243
AA Yetkin, A Simsek
DOI:10.4103/njcp.njcp_500_19  PMID:32913163
Aim: This study aimed to determine the effects of strabismus surgery on choroidal thickness in paediatric patients with Spectral Domain-Optical Coherence Tomography (SD-OCT). Material and Methods: Sixty eyes of 60 children with esotropia were included. The mean age was 9.5 ± 3.1 years. The choroidal thickness was measured using SD-OCT, which was performed before the surgery and 1 week, 1 month and 3 months postoperatively. At the same time, the patients' visual acuity was evaluated. Results: There were no statistically significant differences between the preoperative and postoperative values in terms of the visual acuity (P > 0.05). When compared to the preoperative values, decreases were found in the choroidal thicknesses in all of the areas measured during the first week evaluation (P < 0.05). In the postoperative first month, significant decreases were also found in the choroidal thicknesses in all the areas measured (P < 0.05); however, in the postoperative third month, there were no changes in any of the areas (P > 0.05). Conclusions: We observed that there was a significant decrease in the choroidal thickness during the early postoperative period and no significant change in the late postoperative period in paediatric patients of double horizontal muscle surgery. Moreover, these early changes in the choroid in paediatric patients show that it does not cause a functional loss.
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Are outcomes of surgery for retina detachments from giant tears worse than from other holes and tears in this era of small gauge vitrectomy and perflorocarbon use in Sub-Saharan Africa? p. 1248
O Oderinlo, A Hassan, O Okonkwo, T Bogunjoko, O Idris
DOI:10.4103/njcp.njcp_227_20  PMID:32913164
Aims: To report a comparison of clinical features, visual and anatomic outcomes between patients with retinal detachments from giant retinal tears (GRTs) and those from other types of holes and tears undergoing retina reattachment surgery in the same institution within the same time period in sub-Saharan Africa. Materials and Methods: A retrospective noncomparative case series of patients undergoing primary retina detachment (RD) repair for rhegmatogenous retina detachment (RRD) at Eye Foundation Hospital Retina Institute between January 2014 and December 2018 was done. Results: A total of 275 eyes of 275 patients met the inclusion criteria. Ages ranged from 7 to 87 years. And 81 (29.4%) eyes had giant tears were categorized as group A and 194 (70.6%) eyes had other types of tears were categorized as group B. At presentation Visual acuity in 66 eyes (79.6%) in the group A was worse than 3/60, compared to 117 eyes (60.3%) in group B. Primary anatomic success was achieved in 73 eyes (92.4%) in-group A and 157 eyes (86.7%) in group B. Final anatomic success was achieved in 75 eyes (94.9%) in group A and 164 eyes (93.2%) in group B. Good visual outcomes were achieved in 48 eyes (59.3%) in group A and 126 eyes (65.6%) in group B. Conclusion: Good anatomic and visual outcomes can be achieved after surgery for RRD secondary to giant tears in a sub-Saharan Africa setting in this era of small gauge vitrectomy and perflourocarbon use, these outcomes are comparable to those from surgery for RRD secondary to other types of holes and tears.
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Self-reported confidence with ocular examination and management of eye diseases by general medical practitioners p. 1254
AA Onyiaorah, NN Kizor, SN N Nwosu
DOI:10.4103/njcp.njcp_674_19  PMID:32913165
Aims: The aim of the study is to determine the confidence of general practitioners (GPs) with ophthalmic exam and management of eye diseases. Materials and Methods: Using self-administered questionnaire, information on sociodemographics, medical practice experience, confidence with eye exam, and management of eye diseases was obtained from GP at the General Outpatient Department. Responses on level of confidence were ranked with Likert scale and analyzed with the Statistical Package for Social Science, version 23. Results: Twenty-two GPs with mean medical practice experience of 17.4 ± 8.5 years participated. Twelve (54.5%) GPs routinely examined patients' eyes. Pen torch assessment of ocular surface was most commonly performed eye exam, 1 (4.6%) did visual acuity, while none performed ophthalmoscopy. Seventeen (77.3%) GPs rated themselves average or higher in interpreting pen torch examination of ocular surface. Expressed diagnostic confidence was highest for pterygium, 19 (86.4%), and low for interpreting visual acuity, 8 (36.4%); 13 (59.1%) were confident with diagnosing cataract. While all GPs (100.0%) were not confident with diagnosing and managing posterior segment diseases, 19 (86.4%) felt that they could confidently manage allergic and bacterial conjunctivitis, respectively. Seventeen (77.3%) GPs thought their undergraduate exposure in ophthalmology was inadequate and 21 (95.5%) felt that update courses in ophthalmology were necessary. Conclusions: Half of the GPs performed eye examination. Self-reported confidence in ophthalmoscopy, diagnosis, and management of posterior segment diseases was low among GPs. Diagnostic confidence was highest for pterygium. Continuing ophthalmic education and provision of basic ophthalmic equipment are recommended to improve confidence of GP in management of ocular disorders.
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The effect of kinesio taping with the web strip technique on pain, edema, and trismus after impacted mandibular third molar surgery p. 1260
ME Yurttutan, KT Sancak
DOI:10.4103/njcp.njcp_23_20  PMID:32913166
Backgound: There are many methods used to alleviate edema, trismus, and pain after impacted third molar (3M) removal, one of which is Kinesio Taping (KT). Aims: This study aimed to evaluate the effectiveness of Kinesio Taping with Web Strip technique on postoperative morbidity after impacted mandibular 3M extraction. Methods: The study employed a split-mouth and controlled randomized clinical trial design. A total of 60 patients were scheduled for surgical extractions of bilateral lower 3Ms. They were randomly divided into two groups, and KT was applied to one group while the others was determined as a control group without KT application. Tape was applied directly after surgery and maintained for postoperative (post-op) 7 days. Pain intensity was recorded subjectively using a Visual Analogue Scale (VAS). Pain and analgesic usage were recorded on the post-op 1st, 2nd, 3rd, and 7th days. Trismus was evaluated before the surgery and on the post-op 2nd and 7th days. Facial edema was analyzed on the post-op 2nd and 7th days by VAS and by measuring the lengths of three lines using a flexible plastic tape measure. Results: VAS pain scores were statistically lower in the KT group on the post-op 1st, 3rd and 7th days. Total analgesic usage was also significantly lower in the KT group. On the post-op 2nd day, measurement of the lengths of three lines showed a statistically less edema in the KT group. Similar results were obtained from the measurement of edema using VAS. Maximum mouth opening was statistically higher in the KT group on the post-op 2nd and 7th day. Conclusion: KT with the web strip technique should be considered more economic and less traumatic than other approaches, as it is free from systemic side effects and is a simple method to carry out to decrease morbidity.
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Does the plasma application time affect the tensile bond strength between PMMA and a silicone-based denture liner? p. 1266
K Soygun, E Tamam, A Dogan, S Keskin
DOI:10.4103/njcp.njcp_692_19  PMID:32913167
Aims: This study evaluated the effect of oxygen plasma and argon plasma treatments with different application times on tensile bonding of a silicone-based denture liner to polymethylmetacrylate (PMMA). Methods: Seven groups (n = 5) were prepared and six of them treated by argon plasma or oxygen plasma with 30s, 60s, and 120s, respectively; one group was left untreated served as control. After processing of denture liner, the specimens were deflasked and stored dry for 24 h, and they were then subjected to tensile bond strength testing. Differences in tensile bond strength values were determined using one-way ANOVA (α = 0.05). Results: Highest tensile bond strengths were observed in the oxygen plasma groups, followed by untreated group and argon plasma groups in turn in order. Tensile bond strenght were increased with time for both type of plasma applications tested. Conclusion: This study suggests that the adhesion between PMMA and denture liner is improved under conditions of oxygen plasma treatment with extended exposure time rather than argon plasma treatment.
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Marginal discrepancy of 3-unit Co-Cr metal copings fabricated with additive and subtractive manners: A comparative study p. 1274
O Onoral
DOI:10.4103/njcp.njcp_33_20  PMID:32913168
Background: Poor marginal adaptation may give rise to a series of biological complications. Despite its importance, comparative studies on marginal adaptation of metal-ceramic fixed restorations fabricated with newer methods are limited. Aim: Therefore, it was aimed to assess the marginal accuracy of copings fabricated with subtractive and additive manners used in contemporary dentistry. Materials and Methods: For a typodont model, 60 three-unit cobalt-chrome metal copings were fabricated by selective laser sintering (SLS), hard alloy milling (HAM), and soft alloy milling (SAM) in comparison to casting (C). Marginal discrepancy assessment was performed by using replication technique. Mesiodistal and buccopalatal cross-sections of silicone replicas were investigated under a stereomicroscope at × 80 magnification. A total of 960 measurements were subsequently made by means of corresponding image-review software on captured images after calibration of the software to μm scale. Obtained data were subjected to nonparametric Kruskal Wallis and Tamhane post-hoc tests (α =0.05). Results: Marginal adaptation of C group was significantly inferior to test groups in both canine- and premolar-teeth measurements (P < 0.05). Marginal fit was found to be tooth dependent (P < 0.001). HAM, SAM, and SLS groups exhibited analogous marginal discrepancy values on canine-tooth measurements. Differences among these groups were not statistically significant (P > 0.05). SAM and SLS groups demonstrated better marginal adaptation than others on premolar-tooth measurements. Also, no statistically significant difference was detected between SAM and SLS groups (P > 0.05). Conclusions: SAM group demonstrated superior marginal accuracy. All groups had clinically acceptable marginal discrepancy values (<120 μm), except cast group.
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Knowledge and behaviors of veterinary students about rabies: A descriptive study from Turkey p. 1281
E Pirincci, O Kurt, AF Oguzoncul, SE Deveci
DOI:10.4103/njcp.njcp_108_19  PMID:32913169
Aims: This study aimed to obtain data on the knowledge, behavior, and immunization status of veterinary students about rabies. Methods and Materials: The population of this descriptive study consisted of all the 770 students of a veterinary faculty (response rate 85.7%; n = 660). A survey was conducted querying the knowledge and behaviors of the participants about rabies. Results: Of the surveyed students 28.6% (n = 189) stated that they were exposed to animal bites at least once, and 50.3% (n = 95) of these students stated that they were vaccinated following the exposure. Of the participants, 23.6% (n = 156) indicated that they received protective rabies treatment (prophylactic vaccination). About 32.9% (n = 217) of the students taking part in the study had pets at home. Around 70.7% (n = 153) of these students stated that their animals were vaccinated against rabies. A significant relationship was found between having a pet and being bitten by an animal (P < 0.001). 50.5% (n = 333) of the students who participated in the study were competent in knowledge, while 48.3% were competent in behavior. Students competent in knowledge or behavior were considerably more in the clinical classes compared to preclinical classes. A significant relationship in favor of men was found between the sexes concerning both knowledge and behavior levels. Conclusions: The study revealed deficiencies in the students' awareness levels regarding rabies. Ascertaining a sufficient amount of theory and practice courses on rabies in the veterinary faculty curriculum, starting from earlier classes will contribute to the knowledge and behaviors of the students.
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Internalized stigma in acne vulgaris and its relationship with quality of life, general health, body perception, and depression p. 1289
D Kotekoglu, A Parlakdag, FS Koramaz, G Varol, V Aslankoc, S Bozkurt, C Memis, AA Karakas, E Alpsoy
DOI:10.4103/njcp.njcp_86_20  PMID:32913170
Backround: Internalized stigma, adoption of negative attitudes, and societal stereotypes regarding acne vulgaris (AV) have not been previously studied. Objective: To investigate the internalized stigma state in AV and determine its association with quality of life, perceived health, body image, and depression Methods: A total of 77 AV patients (43 female, 34 male; aged 19.7 ± 2.3 years) were enrolled in this cross-sectional study. The scales used in the study were Acne Internalized Stigma Scale (AISS), Acne Quality of Life scale (AQOL), FDA Global score, Perceived Health Status (PHS), Body Image Scale (BIS), and Beck Depression Inventory (BDI). Results: Mean AISS scores (53.68 ± 13.6) were significantly higher in males than in females (57.41 ± 14.37, 50.39 ± 12.25, P = 0.042). There was a significant positive correlation between mean values of AISS and AQOL (r = 0.816, P < 0.001), FDA Global grade (r = 0.391, P = 0.002) and BDI (r = 0.440, P < 0.001). Lower PHS (P = 0.027) was another determinant of high AISS scores. The mean AISS score of patients with a family history was significantly lower than those without a family history (P = 0.007). VAS was also found to be correlated with mean values of AISS and AQOL. Linear regression analysis revealed that the most important determinant of internalized stigma was AQOL (β = 0,632; P < 0.001), followed by gender (β = -0,229; P = 0.001), FDA Global score (β = 0,193; P = 0.007), and BDI (β = 0,177; P = 0.024). Discussion: Significant and independent predictive factors for high internalized stigma state were the negative quality of life, male gender, the severity of the illness, and depression. Therefore, internalized stigma may be one of the major factors responsible for the psychosocial burden of AV.
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Evaluation of low back pain frequency and related factors among people over 18 years of age p. 1295
H Kaptan, MN Ilhan, AU Dikmen, H Ekmekci, C Ozbas
DOI:10.4103/njcp.njcp_351_19  PMID:32913171
Aims: The present study aimed to evaluate the incidence of LBP and related factors in over 18-year-olds. Materials and Methods: This research was a cross-sectional study involving individuals over 18 years of age with any complaints in the period from May 2015-June 2016 at different hospitals. The research data were evaluated by the SPSS 15.0 statistical package program. Descriptive statistics were presented as mean (±) standard deviation, median (min, max), frequency distribution, and percentage. Pearson's Chi-square test, Yates corrected Chi-square test, and Fisher's test were used as statistical methods. Statistical significance was accepted as P < 0.05. Results: A total of 5,989 people admitted during that period and 50% unknown frequency were taken to reach 1715 subject persons with 2% deviation and 95% confidence interval which reached 1720. The sociodemographic status, occupational conditions, the frequency of low back pain, and risk factors have been evaluated. Around 92.9% of individuals of 65 years of age and older have lifelong LPB while 57.1% have present LBP. The difference was statistically significant for “the satisfaction of working people” and “individuals working more than 41 h a week.” (P < 0.001). Conclusion: Low back pain is still a serious problem that can be avoided by ensuring optimal working conditions and a healthier life.
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Evaluation of treatment adherence and illness perception in cardiology patients p. 1305
D Yildirim, D Baykal
DOI:10.4103/njcp.njcp_666_19  PMID:32913172
Objective: The aim of this study was to investigate the effects of the cardiology patients' illness perception on their medication adherence will guide in the development of training and consultancy strategies. Material and Method: The study was conducted with 110 patients who were followed up in the cardiology clinics of a university hospital. The study included patients over the age of 18 years, who agreed to participate in the study and were diagnosed with a cardiovascular disease at least six months before. The data were collected using a patient information form questioning the subjects such as the patients' age, gender, marital status and economic condition, the Illness Perception Questionnaire and the Morisky Medication Adherence Scale. Results: The results showed that 72.7% (n=80) of the group had forgotten to take their medicine, 38.2% (n=42) had a trouble remembering to take their medicine, 29.1% (n=32) stopped taking their medicine when they felt good and 32.7% (n=36) stopped taking their medicine because they sometimes felt bad after taking their medicine. It was determined that there was no statistically significant correlation between Morisky Medication Adherence Scale scores and Illness Perception Questionnaire subscale scores (P >0.05). It was determined that there was a statistically significant difference between the educational backgrounds, in terms of the personal control subscale mean scores (P=0.003; P<0.01). Conclusion: Patients try to explain their disease in the light of their personal experiences, knowledge, values, beliefs, and needs. Illness perception which is among the most important factors providing treatment adherence is an important factor affecting many areas from the person's psychological adaptation to the course of disease. Illness perception and treatment adherence are affected by educational level. Dr. D Yıldırım
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Investigation of the esthetic outcomes of white spot lesion treatments p. 1312
J Lee, LO Okoye, PP Lima, PT Gakunga, BT Amaechi
DOI:10.4103/njcp.njcp_119_20  PMID:32913173
Objective: The present study compared the ability of bleaching, resin infiltration and microabrasion to restore the appearance of existing white spot lesions (WSL) on tooth surfaces as close as possible to that of the original healthy enamel. Materials and Methods: Sixty extracted human teeth with WSL were randomly assigned to three treatment groups (20/group). Prior to treatment, the colour of the surrounding healthy enamel and the WSL were measured as the baseline and pre-treatment (PreRX) colours respectively using spectrophotometer based on CIE L*A*B. The L-value was used for the statistical comparison. WSLs in each group were treated respectively by bleaching, infiltration or microabrasion following the manufacturer's instructions. Colour measurement was repeated after treatment. Both intragroup and intergroup comparisons were performed using ANOVA followed by Tukey's multiple comparison test (α=0.05). Result: In all groups the mean L-values were significantly higher in PreRX WSL (P < 0.01; Tukey) compared to baseline (sound enamel). After treatment the difference in mean L-value between baseline and WSL increased significantly (P < 0.01, Tukey) in Bleaching and Microabrasion groups by 1.4% and 1% respectively, but decreased in Infiltration group by 3.4%. Thus resin infiltration decreased the L-value of the WSL, bringing it closer to the L-value of the sound enamel while bleaching and microabrasion increased the L-value. Conclusions: Among the three treatment modalities investigated in this study, resin infiltration was the most effective in masking the WSLs.
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Does preoperative chemical depilation make any difference in postoperative wound infection? p. 1318
CC Okoli, SN Anyanwu, CD Emegoakor, GU Chianakwana, E Ihekwoaba, MD Ughasoro, OA Egwuonwu, H Nzeako
DOI:10.4103/njcp.njcp_149_20  PMID:32913174
Background: Preparation for surgery has traditionally included the removal of body hair from the intended surgical wound site. The effect of this practice on postoperative wound infection is yet to be fully elucidated.Aims: This study sought to determine if preoperative chemical depilation reduces the risk of surgical site infection (SSI). Methodology: Two methods of preoperative hair removal: razor shaving and depilatory cream were compared. The eligible patients were randomized into two groups and the presence of postoperative wound infection was evaluated using the Southampton wound grading system. Data were analyzed using SPSS version 21 Chicago-Illinois, statistical significance was inferred at Pvalue ≤ 0.05. Results: In total 100 patients were analyzed with 20 patients excluded due to co-morbidities and noncompletion of the study. The overall prevalence of SSI was 18.0% (7 (14.0%) and 11 (22.0%) in the depilatory cream and razor shaving groups, respectively). The difference in the rate of SSI was not statistically significant (P = 0.436). Hair was completely removed in 47 (94.0%) compared to 38 (76.0%) patients in the razor shaving group (P = 0.012) while skin injuries were noted in 21 (42.0%) vs 1 (2.0%) patients who had razor shaving and chemical depilation(P = <0.0001), respectively. Conclusion: There was no significant difference in SSI rates in patients that had preoperative chemical depilation when compared with razor shaving.
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CASE REPORTS Top

Recurrent syringomatous adenoma of the nipple following a misdiagnosis: A case report p. 1324
V Abeciunas, K Jurgaitis, N Jakutis
DOI:10.4103/njcp.njcp_1_20  PMID:32913175
Infiltrating syringomatous adenoma of the nipple (SAN) is a rare benign neoplasm of the breast that is often misdiagnosed. SAN may present with a subareolar lesion and clinical, mammographic, and ultrasonographic findings associated with malignancy. We present the case of a 60-year-old woman with a painful, firm, solid tumor in her left breast and deformation of the left nipple-areolar complex (NAC). Histopathological test results were conflicting. The tumor, including the NAC were locally excised. Postsurgical immuno-histochemical tests revealed squamous histology, whereas myoepithelial cells were present in the resected specimen, a feature consistent with SAN. The pathologist noted microscopically positive surgical margins. Three months after surgery, tumor recurrence occurred. The patient underwent revision surgery with wide excision of the skin and gland around the lesion, followed by immediate breast reconstruction, using a pedicled myocutaneous latissimus dorsi (pLD) flap. Extreme care should be taken when diagnosing SAN to ensure proper treatment and prevent recurrence.
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Rehabilitation of the completely edentulous young patient with the “Malo Bridge”: A case report p. 1328
A Gulnar, SH Altintas, O Yilmaz, G Ates
DOI:10.4103/njcp.njcp_170_20  PMID:32913176
It is possible to rehabilitate fully edentulous patients with implantsupported fixed or removable prostheses; however, implantsupported fixed prostheses are the gold standard for patients who not prefer to use removable dentures. This case report, prosthetic rehabilitation of a completely edentulous young patient with an implantsupported fixed hybrid prosthesis using the “Malo Bridge” technique is described. A 18 years old male patient was referred to the clinic with complaints of tooth loss, aesthetics, function, and phonetic. A total of 5 implants were placed in both the jaws. Considering that screw holes may cause aesthetic problems due to the Class III occlusion, these problems have been solved with the implant-supported hybrid prosthesis called Malo bridge. With the Malo Bridge design, the patient's aesthetic, functional and phonetic loss was eliminated, patient comfort and quality of life were improved, and patient expectations were met. It is a viable treatment option to rehabilitate completely edentulous jaws with a cross relationship and increase interarch distance using Malo Bridge to support a fixed prosthesis.
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