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   2015| March-April  | Volume 18 | Issue 2  
    Online since February 10, 2015

 
 
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REVIEW ARTICLE
Prevalence of hepatitis B virus infection in Nigeria, 2000-2013: A systematic review and meta-analysis
BM Musa, S Bussell, MM Borodo, AA Samaila, OL Femi
March-April 2015, 18(2):163-172
DOI:10.4103/1119-3077.151035  PMID:25665986
Vaccination against the hepatitis B virus (HBV) in the West African nation of Nigeria is lower than many Sub-Saharan African countries. In Nigeria, HBV is reported to be the most common cause of liver disease. However, the extent of HBV exposure among Nigerians at average risk is unknown. Our aim, therefore, was to accurately estimate the HBV prevalence for the country and the prevalence for specific subgroups. We used electronic databases to select systematic reviews and meta-analyses from 2000 to 2013. Forty-six studies were included (n = 34,376 persons). We used a random effects meta-analysis of cross-sectional and longitudinal studies to generate our estimates. The pooled prevalence of HBV in Nigeria was 13.6% (95% confidence interval [CI]: 11.5, 15.7%). The pooled prevalence (% [95% CI]) among subgroups was: 14.0% (11.7, 16.3) for blood donors; 14.1% (9.6, 18.6) for pregnant women attending antenatal clinics; 11.5% (6.0, 17.0) for children; 14.0% (11.6, 16.5) among adults; and 16.0% (11.1, 20.9) for studies evaluating adults and children. HBV prevalence in Nigeria varied by screening method [% (95% CI)]: 12.3% (10.1, 14.4) by using enzyme-linked immunosorbent assay; 17.5% (12.4, 22.7) by immunochromatography; and 13.6% (11.5, 15.7) by HBV DNA polymerase chain reaction. HBV infection is hyperendemic in Nigeria and may be the highest in Sub-Sahara Africa. Our results suggest that large numbers of pregnant women and children were exposed to HBV from 2000 to 2013. Increased efforts to prevent new HBV infections are urgently needed in Nigeria.
  35 42,449 3,019
ORIGINAL ARTICLES
Financial barriers to utilization of screening and treatment services for breast cancer: An equity analysis in Nigeria
IL Okoronkwo, P Ejike-Okoye, AU Chinweuba, AC Nwaneri
March-April 2015, 18(2):287-291
DOI:10.4103/1119-3077.151070  PMID:25666009
Aim: To determine financial barriers that impede the utilization of screening and treatment services for breast cancer among Nigerian women from different socioeconomic groups. Materials and Methods: A descriptive study was carried out in 2013 among women attending the oncology clinic of a tertiary institution in Enugu, Southeast Nigeria. Data were collected from 270 women using an interviewer-administered questionnaire. The links between the influence of socioeconomic factors on barriers to the utilization of breast cancer screening and treatment services were examined. Results: A total of 270 women were studied. The mean age was 34.69 (Standard deviation = 5.07) years. Half of the study participants were single 141 (51.3%), while 105 (38.2%) were married. Cost of medical treatment and not having insurance coverage was major financial barriers to utilization of screening and treatment services. The least poor and poor socioeconomic status (SES) groups utilized screening services and treatment more frequently than the very poor and poorest SES groups ( P = 0.034). There was no significant difference in the utilization of the different treatment options among the different socioeconomic groups with the exception of surgery (χ2 = 11.397; P = 0.000). Conclusion: Financial barriers limit the ability of women, especially the poorest SES group, to utilize screening and treatment services for early diagnosis and treatment of breast cancer. Interventions that will improve financial risk protection for women with breast cancer or at risk of breast cancer are needed to ensure equitable access to screening and treatment services.
  8 2,292 435
Effect of mineral trioxide aggregate and formocresol pulpotomy on vital primary teeth: A clinical and radiographic study
OO Olatosi, EO Sote, OO Orenuga
March-April 2015, 18(2):292-296
DOI:10.4103/1119-3077.151071  PMID:25666010
Background: Pulpotomy is the common therapy for cariously exposed pulps in symptom-free primary molar teeth. Formocresol (FC) is considered the gold standard dressing agent for pulpotomy, but concerns have been raised over the years about its safety. Other alternative pulpotomy agents have been investigated and suggested. Objective: The objective was to evaluate and compare the clinical and radiographic response of FC and white mineral trioxide aggregate (MTA) as pulpotomy materials on primary molars. Materials and Methods: Fifty primary molars, with deep carious lesion that exposed a vital but asymptomatic pulp, in 37 children aged 4-7 years were treated with conventional pulpotomy procedure. The teeth were divided randomly into two groups. Group I (FC) and group II (MTA). The treated teeth were evaluated clinically and radiographically and were followed-up for 12 months. Results: At the end of the 12 months follow-up, the clinical success rates for FC and MTA were 81% and 100%, respectively. There was a statistically significant difference ( P = 0.04) between the clinical success rates of FC and MTA. While the radiographic success rates for FC and MTA were 81% and 96%, respectively, there was no statistically significant difference between the radiographic success of MTA and FC. Conclusion: White MTA showed a higher clinical and radiographic success rate when compared to FC as a pulpotomy agent in vital primary molars, and it has a potential to become a replacement for FC in primary molars.
  6 3,649 1,341
Knowledge, attitudes and practice of dentists concerning the occupational risks of hepatitis B virus in Al Jouf Province, Saudi Arabia
AH Al-Hazmi
March-April 2015, 18(2):276-281
DOI:10.4103/1119-3077.151067  PMID:25666007
Introduction: Hepatitis B virus (HBV) is a well-recognized occupational risk for all health care workers (HCWs) worldwide. In Saudi Arabia, very little is known about knowledge, attitudes, and practice of dentists toward occupational risk of HBV. Our study was conducted to assess the same parameters. Methods: During February 2012, a cross-sectional survey of 48 dentists with mean age 38 ± 11.2 years was carried out at the primary health care centers in Al Jouf Province of Saudi Arabia. The dentists were asked to fill a valid questionnaire containing their socio-demographic data, and well-designed questions about their knowledge base, attitudes and practice toward occupational risk of HBV. The data were processed and analyzed using the SPSS (version 17) (IBM SPSS Inc., Chicago, IL, USA) program and the level of significance were set at P < 0.05. Results: Response rate of 85.4% yielded 41 questionnaires for analysis. Majority of the dentists surveyed 34 (82.9%) perceived that they are at high risk of contracting and spreading HBV, and 28 (68.3%) had a concern to get HBV. More than half 23 (56.1%) were willing to achieve continuity of care for HBsAg-positive patients. The vast majority 39 (95.1%) believed that HBV vaccine is safe, and 34 (82.9%) were vaccinated. Less than half 17 (41.5%) recognized that HBV is resistant to alcohol and some detergents. During surgical procedures, only 14 (34.1%) always use double gloves and 19 (46.3%) always use goggles. Almost all dentists surveyed were willing to subscribe in a regular training programs about HBV. Conclusion: More education focusing on occupational risk of HBV is recommended for dentists.
  4 1,518 385
Honey and wound dehiscence: A study of surgical wounds in the mandibular bed
CE Anyanechi, BD Saheeb
March-April 2015, 18(2):251-255
DOI:10.4103/1119-3077.151054  PMID:25666002
Background: There is a paucity of literature on the use of honey in wound healing after oral and maxillofacial surgical procedures. Objective: To evaluate the efficacy of the healing properties of Obudu honey in patients who developed wound dehiscence after segmental mandibular resections. Patients and Methods: This was a prospective study of 72 patients who had benign lesions of the mandible, and were treated by segmental mandibular resection, with the surgical wounds developing dehiscence. The subjects were randomized into two treatment groups of A (control, n = 36) and B (experimental, n = 36). Unlike the control, the wounds in the experimental group were dressed in honey after debridement. Results: The ages of the patients ranged from 21 to 73 years with a mean age of 46.3 ± 2.1 years while the male: female ratio was 3:1. There was no significant demographic difference about age ( P = 0.44) and gender ( P = 0.38) between the two groups. The smaller the initial circumference of the surgical wound, the shorter the duration of healing and this was significant ( P = 0.001) in either of the treatment groups. Numerically, more healing was completed in the first 5 weeks in subjects in the experimental group ( n = 19, 52.8%) than the control ( n = 13, 36.1%). However, the duration of healing between the subjects in the control and experimental groups at the end of 9 weeks showed no significant difference ( P = 0.23). Conclusion: Honey speeds up the healing of dehiscence wounds of resected mandible when used as dressing more than the control.
  4 3,255 701
Effects of erbium-and chromium-doped yttrium scandium gallium garnet and diode lasers on the surfaces of restorative dental materials: A scanning electron microscope study
M Hatipoglu, C Barutcigil
March-April 2015, 18(2):213-220
DOI:10.4103/1119-3077.151044  PMID:25665995
Aim: The aim of this study is to evaluate the potential effects of laser irradiation, which is commonly performed in periodontal surgery, on the surfaces of restorative materials. Materials and Methods: Five different restorative dental materials were used in this study, as follows: (1) Resin composite, (2) polyacid-modified resin composite (compomer), (3) conventional glass ionomer cement (GIC), (4) resin-modified glass ionomer cement (RMGIC), and (5) amalgam. Four cylindrical samples (8 mm diameter, 2 mm height) were prepared for each restorative material. In addition, four freshly extracted, sound human incisors teeth were selected. Two different laser systems commonly used in periodontal surgery were examined in this study: A 810 nm diode laser at a setting of 1 W with continuous-phase laser irradiation for 10 s, and an erbium-and chromium-doped yttrium scandium gallium garnet (Er, Cr: YSGG) laser at settings of 2.5 W, 3.25 W, and 4 W with 25 Hz laser irradiation for 10 s. Scanning electron microscopy (SEM) analysis was performed to evaluate the morphology and surface deformation of the restorative materials and tooth surfaces. Results: According to the SEM images, the Er, Cr: YSGG laser causes irradiation markings that appear as demineralized surfaces on tooth samples. The Er, Cr: YSGG laser also caused deep defects on composite, compomer, and RMGIC surfaces because of its high power, and the ablation was deeper for these samples. High-magnification SEM images of GIC samples showed the melting and combustion effects of the Er, Cr: YSGG laser, which increased as the laser power was increased. In amalgam samples, neither laser left significant harmful effects at the lowest power setting. The diode laser did cause irradiation markings, but they were insignificant compared with those left by the Er, Cr: YSGG laser on the surfaces of the different materials and teeth. Conclusion: Within the limitations of this study, it can be concluded that Er, Cr: YSGG laser irradiation could cause distortions of the surfaces of restorative materials. Diode lasers can be preferred for periodontal surgery.
  3 1,337 331
Human rabies: Still a neglected preventable disease in Nigeria
CB Eke, IB Omotowo, OM Ukoha, BC Ibe
March-April 2015, 18(2):268-272
DOI:10.4103/1119-3077.151064  PMID:25666005
Background/Objectives: Adequate surveillance and monitoring of dog bite incidents are veritable tools in the determination of the epidemiology of human rabies infections. There is a paucity of data with regards to rabies in Nigeria. Hence, this study was aimed at describing the pattern and outcomes of dog bites and rabies infections among patients presenting to University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu. Subjects and Methods: This was a 10-year (January 1, 2004 to December 31, 2013) observational retrospective study. Case definition of rabies was based on ICD 10 criteria, while relevant clinical data were retrieved from individual folders of registered victims using a semi-structured questionnaire. Data were analyzed using SPSS version 17.0 while the level of statistical significance was set at P < 0.05. Results: A total of 149 cases of dog bites were reported during the period under review, of which 6 (4.0%) had confirmed rabies. Ninety-six (64.4%) cases presented more than 24 h after the bites. Majority of the offending dogs were stray dogs 86 (57.7%), which attacked their victims unprovoked, in 54.6% of cases. Furthermore, most of the bites were from dogs with unknown history of rabies vaccination 72 (52.3%), while the case fatality rate was 100%. Conclusions: All the cases of rabies reported were as a result of bites from stray dogs with unknown history of rabies vaccinations, and the outcome was 100% fatality in all cases. Efforts should be made to create and strengthen awareness campaigns on control of rabies infections through responsible dog ownership including their regular vaccinations as well as provision and use of prompt postexposure prophylaxis in human cases of dog bites at all levels of health care.
  3 3,358 596
CASE REPORTS
Acquired ventricular septal defect: A rare sequel of blunt chest trauma in a 7-year-old boy
OO Ogunkunle, CO Duru, SI Omokhodion, BE Adebayo
March-April 2015, 18(2):297-299
DOI:10.4103/1119-3077.151072  PMID:25666011
Ventricular septal defect (VSD) is the most common congenital cardiac lesion encountered worldwide. Only very rarely is it acquired, and causation through blunt injury in a child is extremely rare. A previously healthy 7-year-old boy suffered blunt chest trauma while at play. He presented 11 days later with features of acute congestive cardiac failure. Two-dimensional echocardiographic examination revealed a mid-muscular VSD. The connection between the defect and the trauma was not initially appreciated. Facilities for required urgent open-heart surgery were not available. Cardiac failure was refractory to antifailure therapy. His clinical condition steadily worsened, and he succumbed after 20 days on admission. We conclude that a diagnosis of traumatic VSD, though rare, should be considered in any previously well child presenting in acute congestive cardiac failure following blunt trauma to the chest. Any such patient should undergo careful echocardiographic evaluation. There is an urgent need for facilities for open-heart surgery to be more readily available and accessible in Nigeria.
  2 1,120 213
ORIGINAL ARTICLES
Evaluation of the scope and practice of oral and maxillofacial surgery in Nigeria
VI Akinmoladun, OO Gbolahan, OA Akadiri, CA Akinyamoju
March-April 2015, 18(2):282-286
DOI:10.4103/1119-3077.151068  PMID:25666008
Background: Oral and maxillofacial surgery is still evolving, with the scope of practice in Nigeria inadequately determined. Aims and Objectives: This study aims to ascertain the level of practice in various parts of the country vis-a-vis the global trend and factors influencing the scope in Nigeria. Design of the Study: Cross-sectional. Setting: The study was carried out at the University of Ibadan. Participants included all the maxillofacial surgeons on the mailing list of the Nigerian Association of Oral and Maxillofacial Surgeons and Practicing in Nigeria as at December, 2012. Materials and Methods: Structured questionnaires were delivered to all on the mailing list of the Nigerian Association of Oral and Maxillofacial Surgeons. Respondents were asked to provide information about their demographics, years of practice, areas of practice and factors influencing the choice of practice among others. Nonresponders were reminded a month after initial contact. Data were entered into a personal computer and variables analyzed using descriptive statistical analysis. Results: Thirty-two (56%) of the 57 questionnaires were returned. Most respondents were aged 41-45 years ( n = 11, 34.4%). Twenty-six (81.3%) were males, whereas 6 (18.8%) were females. Twenty respondents (62.5%) practiced in the teaching hospitals. Eighteen respondents (56.3%) practiced in the south-west geopolitical region. Twelve respondents (37.5%) were the only maxillofacial surgeons in their centers. 81.3% routinely practiced traumatology against 15.6% for implantology. Seventy-eight percent ( n = 25) had satisfactory facilities for traumatology, dentoalveolar surgery, and cleft repair surgery, while facilities were least satisfactory in implantology and orthognathic surgery (15.6% and 12.5%, respectively). The highest single factor influencing choice/area of practice was financial reward (100% of respondents). Fifty percent ( n = 16) claimed not to have had adequate training in their area of interest. Most respondents (93.8%) believe the greatest challenge facing oncological maxillofacial surgery in Nigeria was late presentation of patients. Conclusion: The scope of practice of oral and maxillofacial surgery is largely limited in the country relative to what obtains globally.
  2 2,847 280
Bonding performance of two newly developed self-adhering materials between zirconium and dentin
MA Cebe, S Polat, F Cebe, MT Tuncdemir, E Isman
March-April 2015, 18(2):221-226
DOI:10.4103/1119-3077.151046  PMID:25665996
Purpose: This study evaluated the effect of four resin materials on the shear bond strength (SBS) of a ceramic core material to dentin. Materials and Methods: Sixty molar teeth were embedded in a self-curing acrylic resin. All specimens were randomly divided into four groups of teeth, each according to the resin cement used. Sixty cylinders were then luted with one of the four resin materials to dentin (GC EQUIA, Panavia F, Variolink II and Vertise). Then, specimens were stored in distilled water at 37 o C for one day. Shear bond strength of each specimen was measured using a universal testing machine at a crosshead speed of 0.5 mm/minute. The bond strength values were calculated in N, and the results were statistically analyzed using a Kruskal-Wallis and Bonferroni corrected Mann-Whitney U tests. Results: The shear bond strength varied significantly depending on the resin materials used ( P < 0.05). The specimens luted with GC EQUIA showed the highest shear bond strength (25.19 ± 6.12), whereas, the specimens luted with Vertise flow (8.1 ± 2.75) and Panavia F (11.17 ± 3.89) showed the lowest. Conclusion: GC EQUIA material showed a higher shear bond strength value than other resin materials.
  2 1,451 349
Mature cystic teratomas: Relationship between histopathological contents and clinical features
B Cakmak, M Nacar, Z Ozsoy, N Aliyev, D Koseoglu
March-April 2015, 18(2):236-239
DOI:10.4103/1119-3077.151051  PMID:25665999
Aims: The aim of this study was to evaluate the relationship between pathological findings and clinical features in patients with ovarian mature cystic teratomas (MCTs). Materials and Methods: We reviewed and compared the demographic and clinical features of 32 patients confirmed pathologically as having MCT at a university hospital from 2009 to 2014, with MCT contents such as skin, hair, sebum, and cartilage. Results: The mean age of the patients was 33.7 ± 13.4 years. The mean tumor diameter was 7.1 ± 3.3 cm (range: 2-15 cm). The mean serum CA-19.9 level was 37.5 ± 79.5 IU/ml and the mean serum CA-125 level was 29.1 ± 33.0 IU/ml. The postmenopausal and pregnancy status rates of participants were 18.8, and 15.6%, respectively. The mean age, postmenopausal and pregnancy status, tumor size, symptoms related to MCT and laterality of the tumor did not differ among the patients according to the MCT contents. Conclusions: Our findings suggest no relationship between the clinical features and histopathological contents of MCTs.
  2 1,429 284
Fracture strengths of chair-side-generated veneers cemented with glass fibers
S Turkaslan, B Bagis, E Akan, MM Mutluay, PK Vallittu
March-April 2015, 18(2):240-246
DOI:10.4103/1119-3077.151052  PMID:25666000
Introduction: CAD/CAM (computer-aided design and computer-aided manufacturing) systems have refreshed the idea of chair-side production of restorations, but the fracture of ceramic veneers remains a problem. Cementation with glass fibers may improve the fracture strengths and affect the failure modes of CAD/CAM-generated ceramic veneers. Therefore, this study compared the fracture strengths of ceramic veneers produced at chair side and cemented with or without glass fibers with those of composite veneers. Methodology: Thirty intact mandibular incisors were randomly divided into three groups ( n = 10) and treated with CAD/CAM-fabricated veneers cemented with dual-cure composite resin luting cement (CRLC; Group 1), CAD/CAM-fabricated veneers cemented with a glass fiber network (GFN) and dual-cure CRLC (Group 2), and a direct particulate filler composite veneer constructed utilizing fiber and a restorative composite resin (Group 3). The specimens were tested with a universal testing machine after thermal cycling treatment. Result: The loads at the start of fracture were the lowest for traditionally fabricated composite veneers and higher for CAD/CAM-generated. Veneers cemented either without or with the GFN. The failure initiation loads (N) for the veneers were 798.92 for Group 1, 836.27 for Group 2, and 585.93 for Group 3. The predominant failure mode is adhesive failure between the laminates and teeth for Group 1, cohesive failure in the luting layer for Group 2, and cohesive laminate failure for Group 3, which showed chipping and small fractures. Conclusion: Ceramic material is a reliable alternative for veneer construction at chair side. Fibers at the cementation interface may improve the clinical longevity and provide higher fracture strength values.
  2 6,899 489
Willingness of Saudi dental professionals to treat Hepatitis B virus-infected patients
H Khalil
March-April 2015, 18(2):247-250
DOI:10.4103/1119-3077.151053  PMID:25666001
Background: Hepatitis B virus (HBV) is considered the most important cross-infection hazard in developing countries. Patients infected with hepatitis virus could encounter difficulties in obtaining dental care. The aim of this study was to investigate the willingness of Saudi dental professionals to treat hepatitis B virus infected patients. Materials and Methods: This cross-sectional survey was carried out by distributing 300 questionnaires to Saudi dentists working in 40 government and private dental centers in Riyadh, Saudi Arabia. The questionnaire included questions related to age, sex, vaccination against HBV, screening for HBV antibody levels, willingness to treat hepatitis B infected patients, and the reasons behind any refusal. A t-test was used to compare the results and a P < 0.05 was considered significant. Results: Of the 300 distributed questionnaires, 274 were collected giving a response rate of 91%. The respondents were 212 males (77.4%) and 62 (22.6%) females. Only 10.2% of the Saudi dentists were willing to treat HB infected patients. The other dentists (89.8%) were unwilling to provide dental care for HB infected patients. Although 94.5% of the surveyed dentists were vaccinated against HBV, the main reason behind the refusal to treat HB infected patients (92.3%) was the risk of cross infection. Conclusion: High percentages of Saudi dentists are unwilling to treat HBV-infected patients due to their apprehension about risk of cross infection. Many of the Saudi dentists do not screen for HBV antibody levels. All vaccinated dentists should carefully monitor their antibody levels to evaluate the need for booster doses. There is a need for educational programs to change the attitude of dentists toward treating HBV-infected patients. The strict adoption of cross infection preventive protocols by dentists will reduce the risk of transmitting infectious diseases in dental clinics as identification of blood-borne infections is not always possible.
  2 1,327 283
Comparison of 25 and 50 microgram of misoprostol for induction of labour in nulliparous women with postdate pregnancy in Port Harcourt
IJ Azubuike, G Bassey, AOU Okpani
March-April 2015, 18(2):263-267
DOI:10.4103/1119-3077.151056  PMID:25666004
Background: Induction of labor for postdate pregnancy using misoprostol is one of the most common interventions in pregnancy. However, the optimal dose of misoprostol is yet to be determined with previous reports utilizing different dosages. Objective: The main objective of this study was to compare the effectiveness and safety of 25 μg versus 50 μg of intravaginal misoprostol for induction of labor in nulliparous women with postdate pregnancy. Methodology: This was a prospective study in which 88 nulliparous women with postdate pregnancy were randomly selected to receive either 25 μg or 50 μg of misoprostol for induction of labor. Student's t-test and Chi-square test were used to compare proportions. Results: There was no significant difference between the two groups with regard to the induction-vaginal delivery interval between the two doses. The proportion of women delivering vaginally with a single dose of misoprostol (11/40 vs. 23/43, P = 0.01) and vomiting were significantly greater in the 50 μg group. However, there was no significant difference between both groups in terms of the need for augmentation of labor, caesarean section, tachysystole and hyperstimulation syndrome. Conclusion: Intravaginal administration of 25 μg of misoprostol appears to be as effective, but safer than 50 μg for induction of labor in nulliparous women with postdate pregnancy.
  2 2,489 545
Reference intervals for serum cystatin C and creatinine of an indigenous adult Nigerian population
IN Okonkwo, II Ogbu, UN Ijoma, II Ulasi, CK Ijoma
March-April 2015, 18(2):173-177
DOI:10.4103/1119-3077.151036  PMID:25665987
Background and Aim: Estimation of the glomerular filtration rate (GFR) is important for the evaluation of patients with kidney disease. Some studies suggest that GFR estimated from serum cystatin C (Cys C) is more accurate than that from serum creatinine (SCr). For Cys C to be used for this purpose, normal values need to be determined for various populations. This study determined the serum Cys C levels and reference intervals (RIs) of a Nigerian population. Materials and Methods: Three hundred and four healthy adult subjects were analysed. Serum Cys C and SCr were determined by particle enhanced turbidimetric immunoassay and modified Jaffe kinetic method respectively. Data were analysed using the Statistical Package for Social Sciences version 17.0 (SPSS for Windows Inc., Chicago, IL, USA). Estimation of RIs was done as per the International Federation of Clinical Chemistry guidelines. Results: The RIs for Cys C were 0.65-1.12 mg/L (median 0.86) for males, 0.62-1.12 mg/L (median 0.85) for females and 0.64-1.12 mg/L (median 0.86) for all the subjects. The RIs for SCr were 73-110 μmol/L (median 89) for males, 65-102 μmol/L (median 82) for females and 66-106 μmol/L (median 86) for all the subjects. There was no significant gender difference in the RIs for serum Cys C, (P > 0.05). The SCr levels and RI were significantly lower in females than in males (P < 0.001). Conclusion: This study has determined the serum Cys C levels and RI of an indigenous healthy adult black population in Nigeria.
  2 2,382 339
Body mass index and its effect on serum cortisol level
IA Odeniyi, OA Fasanmade, AO Ogbera, AE Ohwovoriole
March-April 2015, 18(2):194-197
DOI:10.4103/1119-3077.151040  PMID:25665991
Introduction: Cortisol measurement is indicated in suspected over or underproduction of cortisol by the adrenal cortex. The finding of low cortisol can create concern and initiate further investigations for the exclusion of adrenal insufficiency. Cushing's syndrome is frequently included in the differential diagnosis of obesity. Some literature describes reduced serum cortisol levels in obesity, however, this is not a well-recognized phenomenon. Aim: The aim of this study was to determine the relationship between body mass index (BMI) and serum cortisol levels. Subjects, Materials and Methods: Seventy healthy participants agreed to take part in the study. The anthropometric measurements (weight, height, and waist and hip circumferences) were done. Exclusion criteria include those with a history of adrenal/pituitary disease or medications altering cortisol level. The basal cortisol (BC) sample was taken at 8 a.m. immediately before administration of an intravenous bolus injection of 250 μg adrenocorticotropic hormone (ACTH). BMI categories were defined as normal and high if BMI was 18.5-24.99 kg/m 2 and ≥ 25 kg/m 2 , respectively. Results: Forty (57.1%) participants had normal BMI while 30 (42.9%) participants had BMI ≥ 25 kg/m 2 (P0 = 0.053). The mean BC level was lower in participants with BMI ≥ 25 kg/m 2 but not significant. There was a negative correlation between BMI and BC level ( r = −0.205, P = 0.88) while a positive correlation existed between stimulated cortisol level and BMI (r = 0.009, P = 0.944). Conclusion: Persons with BMI above 25 kg/m 2 had lower BC level though not statistically significant, the trend was noticed. Subjecting people whose BMI is above 25 kg/m 2 to further stimulation with ACTH because of low BC is not advised because their response to ACTH stimulation was similar to those who have normal BMI.
  2 1,870 450
CASE REPORTS
Ruptured subcapsular hematoma of the liver due to pre-eclampsia presenting as interstitial pregnancy and the role of intra-abdominal packing
NC Ngene, N Amin, J Moodley
March-April 2015, 18(2):300-303
DOI:10.4103/1119-3077.151074  PMID:25666012
Ruptured subcapsular hematoma of the liver (RSHL) can mimic ruptured interstitial pregnancy because each of these conditions occasionally presents at the same gestational period and both do manifest hemodynamic instability. The similarities between the two conditions pose a diagnostic challenge, especially in an unbooked patient. We report a case of an unbooked primigravida, at 21 weeks of gestation, who arrived at a regional hospital with evidence of intra-abdominal bleeding and hypovolemic shock. She was diagnosed as potentially having a ruptured interstitial pregnancy. During the ensuing emergency laparotomy, RSHL was discovered, the area around the ruptured liver capsule was packed with large abdominal swabs, and the patient recovered. This case report illustrates the need to consider RSHL in patients presenting with features of ruptured interstitial pregnancy, as this will assist in the planning of intraoperative care. We also describe abdominal packing and highlight the need for this essential surgical intervention to be taught to doctors practising in low-resource settings.
  1 1,749 365
Histoplasmosis presenting with solitary pulmonary nodule: Two cases mimicking pulmonary metastases
C Ye, G Zhang, J Wang, Y Chai
March-April 2015, 18(2):304-306
DOI:10.4103/1119-3077.151075  PMID:25666013
Pulmonary histoplasmosis is a granulomatous disease, whose diagnosis is not always easy, as it may simulate metastatic lesions due to similar radiographic findings. We herein report two cases of histoplasmosis with solitary pulmonary nodule in asymptomatic patients with histories of cancer surgeries, whose diagnoses were confirmed by postoperative pathological examinations. Doctors must pay attention to risk factors for immunosuppression such as the histories of chemotherapy, radiotherapy, or malignancy, which may increase chances of developing histoplasmosis. Limited surgical intervention is the treatment of choice for these localized lesions.
  1 1,793 327
ORIGINAL ARTICLES
Determining the localization of premolar zenith positions according to the gingival line
I Duran, B Yilmaz, N Tatar, C Ural, AU Güler
March-April 2015, 18(2):273-275
DOI:10.4103/1119-3077.151066  PMID:25666006
Background: The gingival zenith (GZ) positions according to a reference line in the premolar (PM) area remain concern, especially for the clinicians in placing the gingival contours during surgery. Objectives: The objectives of this study are to determine the maxillary PM GZ positions according to GZ line (GZL). Materials and Methods: A sample population of 63 patients with healthy gingival tissue was studied. The GZ was determined at the most apical point of the gingival marginal scallop. A horizontal-zenith line (ZL) was drawn connecting the GZ from the ipsilateral canine (C) and central incisor teeth. Reference lines were drawn, and bilateral measurements were taken in the respective stone casts in the PM area. Results: No statistically significant differences were found between bilateral first premolars (FPM) and second premolars (SPM). When considering ipsilateral FPM and SPM, statistically significant differences were found between them. For all PM teeth, the mean distance value of GZ to GZL was approximately 1.32 mm. Conclusions: The present study results showed that GZs of FPM and SPM teeth for both left and right sight was coronally located according to ZL.
  1 1,621 265
Assessment of root surfaces of apicected teeth: A scanning electron microscopy evaluation
F Ayranci, LB Ayranci, H Arslan, MM Omezli, MC Topcu
March-April 2015, 18(2):198-202
DOI:10.4103/1119-3077.151041  PMID:25665992
Objectives: The aim of this study was to determine the apical surface characteristics and presence of dental cracks in single-rooted premolars, resected 3.0 mm from the root apex, using the Er: YAG laser, tungsten carbide bur, and diamond-coated tip, by scanning electron microscopy (SEM). Experimental design: Thirty single-rooted premolar teeth were collected. The instrumented and obturated teeth were divided into three groups according to the root resection method (2.94 μm, 100 mj, 20-Hz Er: YAG laser, plain tapered fissure tungsten carbide bur at a low speed of 40,000 rpm, or a diamond-coated SG6D tip coupled to the handpiece of a conventional ultrasound device). The specimens were prepared for SEM and analyzed by the Kruskal-Wallis and Mann-Whitney statistical tests. Results: The SEM images showed that tungsten carbide burs produced significantly smoother resected root surfaces than the diamond-coated tip. There was no statistically significant difference between the Er: YAG and tungsten carbide bur groups. The analysis of scores obtained for the cut quality by the Kruskal-Wallis test revealed no significant differences among the groups. In our study, five teeth had no cracks after the apical resection. The mean number of cracks per tooth was 3.5 ± 1.780 (Er: YAG laser group), 2.5 ± 1.716 (tungsten carbide bur group), and 4.5 ± 2.593 (diamond-coated tip group). Conclusions: Under the tested conditions smoother surfaces were observed in the groups treated with the tungsten carbide bur and Er: YAG laser when compared with the diamond-coated tips.
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Cervical Spine Injury: A ten-year multicenter analysis of evolution of care and risk factors for poor outcome in southeast Nigeria
EO Uche, OE Nwankwo, E Okorie, I Nnezianya
March-April 2015, 18(2):203-208
DOI:10.4103/1119-3077.151042  PMID:25665993
Study Design: Retrospective study. Objective: To describe the evolution of care and risk factors for poor outcome in patients with cervical spine injury (CSI) treated at three centers in southeast Nigeria. Setting: Nigeria, southeast. Materials and Methods: A 10-year retrospective multicenter analysis of patients with CSI, managed at three centers in southeast Nigeria, from January 2003 to December 2012. Results: Two hundred and seven patients (55%) had CSI out of 377 spinal injury cases in the three study centers, but 195 cases had complete records and were studied. There were 148 males and 47 females. The age range was 3-74 years with a mean of 32.6 (΁1.9) years 95% CI. Most injuries (149 cases) resulted from motor vehicular accidents (MVA). The C5 spinal level was involved in 75 (38%) cases One hundred and seventeen patients (60%) presented with American Spinal Injury Association A (ASIA A) injury. CSI care evolved from the application of a Minerva jacket or cervical traction only to cervical traction and spinal fusion resulting in a reduction in hospital stay (F = 52.5, DF (2, 3) P < 0.05). When compared to 51 patients with incomplete injuries, who improved in neurologic al status at discharge, only three patients with ASIA grade A experienced some improvement. The mortality rate from our series is 16% (32 patients). Those who died were more likely to have a complete injury (25 patients) or a high cervical injury (X 2 = 61.2, P < 0.05) among other factors. Conclusion: The cervical spine is the most commonly injured spinal segment in southeast Nigeria. Although treatment evolution has resulted in reduction of hospital stay, the associated mortality risk still remains high.
  1 1,538 310
Frequency and determinants of erectile dysfunction in Turkish diabetic men
M Kiskac, M Zorlu, M Cakirca, B Büyükaydin, C Karatoprak, ErdinÁ Yavuz
March-April 2015, 18(2):209-212
DOI:10.4103/1119-3077.151043  PMID:25665994
Background: Erectile dysfunction (ED) or impotence is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual performance. ED is observed more frequently and manifests earlier in diabetic patients compared to the normal population. Material and Methods: One hundred and seventeen consecutive male type 2 diabetes patients seen in our Diabetes Outpatient Clinic were included in our study and these patients were evaluated in terms of the presence and duration of ED, treatment and response to treatment of ED, duration of diabetes mellitus, HbA1c levels, and the presence of microalbuminuria, estimated from 24-hour urine collections. Results: The patients included in our study were divided into three groups: Patients with no ED, mild-to-moderate ED, and severe ED. Twenty-nine patients (24.8%) fell in the no ED group, 28 (23.9%) in the mild-to-moderate ED group, and 60 (51.3%) in the severe ED group. There were statistically significant differences between these three groups in terms of age ( P = 0.015) and duration of diabetes mellitus ( P = 0.03). The groups were similar in terms of microalbuminuria measured from 24-hour urine collections and HbA1c levels ( P = 0.328 and P = 0.905, respectively). Twenty-three of the 88 patients with ED (26.1%) were on ED treatment and 43.5% of these patients reported benefit from the therapy. Conclusion: Age and duration of diabetes were the main determinants of the presence and severity of ED in male Turkish type 2 diabetic patients. The HbA1c levels were higher in patients with ED, but the differences in levels between the groups did not reach statistical significance.
  1 1,462 341
Clinical features of diabetes retinopathy in elderly patients with type 2 diabetes in Northern Chinese
X Yu, S Song, F Yang, H Dai, Z Yang
March-April 2015, 18(2):183-188
DOI:10.4103/1119-3077.151038  PMID:25665989
Objective: The objective was to estimate the prevalence and clinical characteristics of diabetes retinopathy (DR) in elderly individuals with type 2 diabetes mellitus in Northern Chinese. Materials and Methods: 595 eligible subjects (263 men, 332 women) assisted by the community health service center in Beijing, China were involved with averaged 70.6 ΁ 8.8 years old and male ratio is 0.44. All subjects were interviewed face to face by questionnaire and underwent the extensive physical examinations including ophthalmologic and systemic conditions. Results: Prevalence of DR was 17.1% and DR was significantly associated with nephropathy (odds ratio [OR]: 4.17, 95% confidence interval [CI]: 1.829-17.577, P = 0.001), arteriosclerosis of retina (OR: 0.41, 95% CI: 0.207-1.102, P = 0.01), diabetic foot gangrene, (OR: 5.32, 95% CI: 1.674-30.063, P = 0.001), diabetic neuropathy (OR: 5.23, 95% CI: 2.896-17.334, P = 0.001), hypertension (HTN) (OR: 1.70, 95% CI: 0.990-3.923, P = 0.05). Clinical characteristics of DR by risk factors analysis were polydipsia (OR: 2.73, 95% CI: 1.716-6.567, P = 0.001), polyuria (OR: 2.06, 95% CI: 1.303-5.005, P = 0.001), polyphagia (OR: 1.80, 95% CI: 1.127-4.499, P = 0.01), weakness (OR: 2.00, 95% CI: 1.264-4.825, P = 0.001), high blood lipid (45.76%), high blood sugar (22.89%), and renal dysfunction (12.33%). Conclusions: Diabetes retinopathy in elderly diabetes patients in Northern Chinese is prevalent and associated with these chronic complications such as HTN, nephropathy, arteriosclerosis of retina, diabetic foot gangrene, and diabetic neuropathy.
  1 2,126 517
Effects of hemostatic agents on shear bond strength of orthodontic brackets
R Oksayan, O Sökücü, NE Isman, KM Kayali, MA Cebe
March-April 2015, 18(2):189-193
DOI:10.4103/1119-3077.151039  PMID:25665990
Objectives: The aim of this study was to determine the effects of blood contamination and hemostatic agents on shear bond strength (SBS) of brackets and bond failure. Materials and Methods: The study material consisted of 57 freshly extracted human premolar and randomly divided into four groups: Group I, control group (n0 = 14); Group II, contamination with blood (n = 13); Group III, contamination with epinephrine ( n = 14); and Group IV, contamination with Ankaferd blood stopper (ABS) ( n = 16). After the bracket bonding procedure, all bonded teeth thermal cycled in deionized water at 5 ± 2°C to 55 ± 2°C for 500 cycles. SBS was applied using a universal test machine. Results: According to Kruskal-Wallis test significant differences were found among the groups P < 0.05. Furthermore, significant differences were recorded between groups with Mann-Whitney U statistical test with Bonferroni correction (P = 0.0083). Conclusions: Examples contaminated with blood showed a statistically significant lower in vitro SBS than those contaminated with epinephrine, ABS, and control groups. Clinical Significance: In impacted tooth surgical operations, blood contamination poses a substantial risk of bond failure in bonding attachments applications to the impacted teeth. Epinephrine and ABS may be used on surgical exposed impacted teeth operation for the prevention of blood contamination.
  1 1,557 309
Malignant tumors of the upper aerodigestive tract as seen in a Nigerian tertiary health institution
D Sabageh, TO Solaja, BJ Olasode
March-April 2015, 18(2):231-235
DOI:10.4103/1119-3077.151050  PMID:25665998
Background: Cancers of the upper aerodigestive tract constitute a diverse heterogeneous group of malignant neoplasms with unique epidemiological, pathological, and treatment considerations. Only few studies have been conducted so far on these tumors in Nigeria. This study aims to study in greater detail, the pathological features of these cancers in Nigerian patients. Materials and Methods: The surgical specimens of patients diagnosed with malignant tumors of the upper aerodigestive tracts in the Department of Morbid Anatomy and Forensic Medicine, Obafemi Awolowo University Teaching Hospital Complex (OAUTHC) in Ile-Ife, Nigeria, over a 10-year period, formed the basis of this study. Analysis was done for differences in proportion using the Chi-square test (P is significant at < 0.05) by SPSS version 15. Results: There were a total of 62 cases. The overall mean age was 50.7 years, while the age range was from 3 years to 90 years. The male to female ratio was 3.1:1. A majority of the patients (67.7%) were older than 40 years. About 30.6, 27.4, and 16.1% of cases occurred in the larynx, nasopharynx, and nasal cavity, respectively, while 93.5% of the tumors were carcinomas. Squamous cell carcinoma was the most common histological variety. Nonepithelial tumors were not seen below the age of 20 years. Conclusion: This study shows that malignant upper aerodigestive tract tumors seen in our environment are mainly diseases of adulthood that tend to occur about seven to nine years earlier than in other populations. Squamous cell carcinoma is the predominant histological variety. Although the larynx is the most frequent anatomic site, the nasopharynx and nasal cavity are more commonly affected than the oral cavity unlike in other populations. Nonepithelial tumors are extremely rare below the age of 20 years.
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Combined low dose local anesthetics and opioids versus single use of LA for transurethral urological surgery: A meta-analysis
Y Ding, M Li, L Chen, Q Zhang, A Jiang, Y Chi
March-April 2015, 18(2):256-262
DOI:10.4103/1119-3077.151055  PMID:25666003
Introduction: The combination of reduced dose of local anesthetics (LA) and highly lipid-soluble synthetic opioids for patients undergoing transurethral surgery could reduce block duration and side-effects. However, it remains unclear what are the most appropriate levels of low dose and the extent to which the side-effects could be controlled. A meta-analysis was conducted to address this concern. Materials and Methods: Based on twelve randomized controlled trials, this meta-analysis pooled previous results to generate integrated evidence. Results: Combined low dose of LA and opioids had similar sensory block and significantly shorter motor block duration (weighted mean difference: -39.31 min, 95% confidence interval (CI): -50.58-−28.05, P < 0.00001) compared with single use of LA. There was no evidence of higher risk of analgesic failure in the combination group. In addition, combined low dose LA and opioids was associated with significantly reduced rate of postoperative hypotension (risk ratios (RR): 0.60, 95% CI: 0.37-0.96, P = 0.03) and shivering (RR: 0.27, 95% CI: 0.11-0.64, P = 0.003), but with higher rate of sedation (RR: 3.14, 95% CI: 1.02-9.66, P = 0.05). Conclusion: Combined low dose LA and opioids is a better choice for patients received transurethral surgery compared with single use of intrathecal LA.
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One lung ventilation using double-lumen tubes: Initial experience from Lagos, Nigeria
AA Majekodunmi, BA Falase, BO Udom, MO Sanusi, OA Ikotun
March-April 2015, 18(2):227-230
DOI:10.4103/1119-3077.151048  PMID:25665997
Background: One lung ventilation (OLV) is a technique routinely used in thoracic anesthesia to facilitate thoracic surgery. Double-lumen tubes (DLT) remain the most popular and reliable choice for one lung ventilation especially in adult patients though use in Nigeria is limited. This study aimed to describe the experience in our institution with the use of double-lumen tubes for one lung ventilation. Materials and Methods: This was a retrospective cross-sectional study conducted on all patients who had double-lumen tube intubations for one lung ventilation between March 2008 and Feb 2013. Results: A total of 55 patients (27 males and 28 females, with a mean age of 39.6 ± 15.7 years) had left double-lumen tube intubations during the period. There were 30 left-sided (54.5%) and 25 right-sided (45.5%) surgical procedures performed. Tube position was verified by flexible bronchoscopy in 50 patients (91.9%) and by chest auscultation in 5 patients (9.1%) with satisfactory collapse in all but one of the procedures. The major surgical indications for one lung ventilation were Video-assisted Thoracic Surgery (VATS) in 22 patients (40%) and Heller's cardiomyotomy in 17 (30.9%). There were no mortalities and all patients had a complete recovery with no sequelae attributable to double-lumen tube use or one lung ventilation. Conclusions: One lung ventilation is an integral component of modern anesthetic practice. It can be safely practiced in Nigeria with appropriate equipment and expertise. The use of DLT for OLV to enhance thoracic anesthetic practice should be encouraged in other Nigerian institutions.
  - 1,434 287
Sonographic analysis of adult polycystic kidney disease: Retrospective data from South-East Nigeria
PCN Okere, SN Ezeofor, NI Iloanusi, PO Ibinaiye, IJ Okoye
March-April 2015, 18(2):178-182
DOI:10.4103/1119-3077.151037  PMID:25665988
Background: Autosomal dominant polycystic kidney disease (APKD), an inheritable multisystem disease characterized by intrarenal and at times extrarenal disease, has been studied extensively among Caucasian populations. Despite the fact that being black is a risk factor for progressive disease, there is paucity of local published data. As a result, true local incidence and peculiarities in clinical and sonographic characteristics are unknown. Aim: To present data from 19 patients diagnosed with APKD in a medium-sized facility over a 16-year period. Materials and Methods: A retrospective search was done on the ultrasound registers for patients who had undergone abdominal ultrasound in 16 years (1997-2013). Of the 29 sonographic diagnoses of bilateral PKD made, only 19 had complete records and were included in the study. Data extracted were- age, sex, working diagnosis, renal size, diameter of renal cysts, presence or absence of extrarenal cysts, family history of renal cystic disease, blood pressure at diagnosis, and patient outcome. Results: A total of 19 diagnoses of APKD were made- 12 males and seven females with a sex ratio of 1:0.6. Total mean age was 54.8 years (range 31-79 years)- 40.1 years for females and 57.2 years for males. In 89.5% of cases, no family history of APKD was obtained. Only six (31.6%) patients were hypertensive at presentation and three patients (16%) were already in renal failure. Ultrasound showed a mean renal size of 88.92 cm 2 for the right kidney and 98.97cm 2 for the left. Mean cyst diameter was 3.46 cm (range 2.08-4.85cm). Only one patient had documented extrarenal cystic disease. Two patients were lost to renal failure and congestive cardiac failure. Conclusion: APKD appears to be uncommon in our environment; however, more studies may be elucidatory. Standard sonographic protocol for collecting data from patients with APKD is needed.
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