Medical and Dental Consultants’ Association of Nigeria
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   2015| May-June  | Volume 18 | Issue 3  
    Online since March 14, 2015

 
 
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ORIGINAL ARTICLES
Prevalence of anti-A and anti-B hemolysis among blood group O donors in Lagos
OA Oyedeji, TA Adeyemo, AA Ogbenna, AS Akanmu
May-June 2015, 18(3):328-332
DOI:10.4103/1119-3077.151760  PMID:25772913
Background: Group O donor blood is more readily available and is frequently used as universal red cell donor in our environment. The presence of hemolysins in the donors may however lead to hemolysis in the recipients. Attempts have been made to study the prevalence of hemolysins in various populations with results from our environment showing wide variation (20-80%). Aims: To determine the prevalence and titer of anti-A and anti B hemolysins among blood donors at the Lagos University Teaching Hospital and compare results with that obtained elsewhere. Determine if the practice of transfusion of group O blood to nongroup O recipients is permissible in this environment. Materials and Methods: Test for hemolysis was done using the standard tube method. Samples positive for hemolysis were then scored and titrated with the titers read visually and photometrically at 540 nm. Results: Three hundred and fifty blood group O donors with age range 18-58 years and median age of 28 ΁ 8.4 years were enrolled in the study. The overall prevalence of anti-A and/or anti-B hemolysins obtained was 30.3%. Prevalence of anti-A and anti-B hemolysins only was 15.4% and 5.1% respectively whereas both anti-A and anti-B hemolysins were present in 9.7% donor samples. Though anti-A hemolysins were more prevalent than anti-B hemolysins, anti-B hemolysins had higher mean visual (6:7) and spectrophotometric titers (81:101). A visual titer of 8 and above which is considered significant was seen in 18.6% of donor samples. Conclusion: Anti-A and anti-B hemolysins exist in significant frequencies and titers among blood group O donors in Lagos. It is recommended that the use of group O donor blood for recipients who are non-O be discouraged. Clinical studies to determine the frequency and severity of hemolysis in non-group O recipients of blood group O are required.
  7,055 531 4
Does antenatal care attendance prevent anemia in pregnancy at term?
EM Ikeanyi, AI Ibrahim
May-June 2015, 18(3):323-327
DOI:10.4103/1119-3077.151730  PMID:25772912
Background: Anemia in pregnancy is one of the public health problems in the developed and developing world. If uncontrolled it is a major indirect cause of maternal and perinatal morbidity and mortality. This is worst in settings with poor prenatal practices. Quality prenatal interventions therefore are expected to prevent or ameliorate this disorder in pregnancy. Nigerian scientific literatures are full of data on anemia in pregnancy, but few of them are on the influence of prenatal care on maternal anemia. This study, therefore, sought to appraise the role of antenatal care (ANC) services in the prevention of anemia in pregnancy at term in Nigerian women. Objectives: The aim was to estimate the prevalence of anemia at first antenatal visit and determine if antenatal attendance prevents anemia at term among prenatal Nigerian women. To measure the hematocrit levels at booking and at term respectively and compare the proportion anemic at booking with the proportion anemic at term. Materials and Methods: A retrospective cross-sectional comparative study of 3442 prenatal women in a mission hospital in South-South Nigeria from 2009 to 2013. Venous blood hematocrit was estimated from each woman at booking and at term, and the prevalence of anemia for the two periods were compared. Results: There were 1205 subjects with hematocrit of below 33% at booking, an anemia prevalence of 32.2% at booking in this population. At term or delivery at term 736 (21.4% odds ratio [OR] =2.3, P < 0.0001) of the 1052 subjects that fulfilled the study criteria had their anemia corrected, a 69.9% prevention, while 316 (9.2%, OR = 0.43, P < 0.0001) persisted despite their antenatal attendance. The subjects were similar in most of the confounding factors like parity, social class, mean age, body mass index and gestational age at delivery (P value: all > 0.05). Conclusion : The prevalence of anemia in pregnancy is still high in our setting. Quality ANC appeared a valuable preventive intervention that should be made widely available, accessible and affordable to all pregnant women.
  6,369 656 4
Prevalence of depression among health workers in Enugu, South East Nigeria
IE Obi, PN Aniebue, KOB Okonkwo, TA Okeke, NCW Ugwunna
May-June 2015, 18(3):342-347
DOI:10.4103/1119-3077.151726  PMID:25772916
Aims: Determination of the prevalence and distribution of depression among health workers at tertiary level of health care delivery in Enugu South East Nigeria. Settings and Design: A cross-sectional descriptive survey of depression in health workers at tertiary level. Subjects and Methods: By proportional quota sampling, the sample size of 309 was used. Ethical issues were given full consideration. A structured self-administered questionnaire including the Zung self-rating depression scale was used to collect data. Statistical Analysis Used: Data entry and analysis were done using SPSS statistical package version 15. Statistical significance was considered present when P < 0.05. Results: The total of 46 of the 309 workers (14.9%) were found to be depressed. Of the health workers found to be depressed, there were more females (18.0%) than males (8.7%). A feeling of sadness over family, living and working conditions was more consistent among the depressed. Conclusions: The condition of depression is present among health workers in this part of the world. Being a female health worker, may be associated with depression in South East Nigeria. Studies to investigate the determinants and effects of depression in the Nigerian health work force are necessary.
  4,283 560 4
Diagnosis of periodontal diseases using different classification algorithms: A preliminary study
FO Ozden, O Özgönenel, B Özden, A Aydogdu
May-June 2015, 18(3):416-421
DOI:10.4103/1119-3077.151785  PMID:25772929
Objective: The purpose of the proposed study was to develop an identification unit for classifying periodontal diseases using support vector machine (SVM), decision tree (DT), and artificial neural networks (ANNs). Materials and Methods: A total of 150 patients was divided into two groups such as training (100) and testing (50). The codes created for risk factors, periodontal data, and radiographically bone loss were formed as a matrix structure and regarded as inputs for the classification unit. A total of six periodontal conditions was the outputs of the classification unit. The accuracy of the suggested methods was compared according to their resolution and working time. Results: DT and SVM were best to classify the periodontal diseases with a high accuracy according to the clinical research based on 150 patients. The performances of SVM and DT were found 98% with total computational time of 19.91 and 7.00 s, respectively. ANN had the worst correlation between input and output variable, and its performance was calculated as 46%. Conclusions: SVM and DT appeared to be sufficiently complex to reflect all the factors associated with the periodontal status, simple enough to be understandable and practical as a decision-making aid for prediction of periodontal disease.
  3,222 594 9
Medication compliance behavior in psychiatric out-patients with psychoactive substance use comorbidity in a Nigerian tertiary hospital
CI Okpataku, HO Kwanashie, JI Ejiofor, VO Olisah
May-June 2015, 18(3):371-376
DOI:10.4103/1119-3077.151753  PMID:25772921
Background: Psychotropic medication adherence is a major challenge in psychiatric patients with comorbidity. Objective: The objective was to determine medication adherence behavior among psychiatric out-patients with psychoactive substance use comorbidity in a Nigerian Tertiary Hospital. Settings and Design: A cross-sectional study of a tertiary hospital in Northern Nigeria. Methods: Adult patients who have been attending the out-patient clinic for at least 1 year were included. From the routine clinic, each consecutive fourth patient completed a socio-demographic and drug use questionnaire, a self-administered medication adherence scale, and a semi-structured proforma which sought reasons for poor adherence, information on supervision and who keeps patient medications at home; until a calculated sample of 208 was attained. Statistical Analysis: Done by means of descriptive statistics using the Statistical Package for Social Sciences version 16. The level of significance was set at P < 0.05. Results: Totally, 208 patients participated in the study. 61 (29.3%) of them were substance users, out of which 59% never reported missing their medications. No statistically significant relationship was found between substance use and medication adherence. A significant proportion of substance users were compliant with medication use when the drugs were in their possession. For substance users and nonusers, the major reason for poor drug adherence was the unavailability of the medications, while nonsubstance users were more likely to complain about being tired of the medications. No report of side effects in supervised patients. Conclusion: The use of psychoactive substances in patients with other mental disorders influences their medication adherence behavior.
  3,372 398 3
Prevalence of Mycoplasma pneumoniae: A cause for community-acquired infection among pediatric populaztion
FQ Chen, YZ Yang, LL Yu, CB Bi
May-June 2015, 18(3):354-358
DOI:10.4103/1119-3077.153247  PMID:25772918
Background: Atypical pneumonia caused by Mycoplasma pneumoniae is a leading cause of mortality among the pediatric age group. Objectives: Our study was designed to know the prevalence of M. pneumoniae in children with community-acquired pneumonia and the involvement in the cytoadherence to the respiratory epithelium by M. pneumoniae using electron microscopy and immuno-gold labeling technique. Materials and Methods: A total of 152 children of 1 month to 12 years of age of both sexes attending Hebei Provincial People's Hospital, Shijiazhuang, Hebei with diagnosed pneumonia were included in the study. Results: Out of 152 children 84 (55.3%) were males, and 68 (44.7%) were females. The mean age of the patients in the control group (50 patients) was 18.5 ± 3 months with 31 (62%) males and 19 (38%) females. IgM antibodies against M. pneumoniae were positive in 84 (55.3%) males and 68 (44.7%) females. Out of 50 patients 9 (18%) were found to positive for IgM M. pneumoniae antibodies of which four (44.4%) males and 5 (55.5%) females were positive. Our study observed that the gold particles were clustered on the filamentous extension of the tip of the cells. Out of 152 serum samples subjected to particle agglutination assay 138 (90.7%) were positive 1:320 titer, 9 were >1:80 and 3 showed titer was >1:40. Conclusion: We suggest that clinicians should consider empirical therapy of broad spectrum antibiotics therapy to cover these atypical pathogens to reduce the severity before obtaining the serological results. From our study, we also suggest electron microscopic and biochemical studies for better diagnosis of these pathogens.
  3,090 670 4
Efficacy of endoscopic third ventriculostomy in the management of hydrocephalus in children under 2 years of age: Experience from a tertiary institution in Nigeria
OA Ojo, OB Bankole, OO Kanu, NU Okubadejo
May-June 2015, 18(3):318-322
DOI:10.4103/1119-3077.153245  PMID:25772911
Background: The management of hydrocephalus in developing countries is challenging. Hydrocephalus is a common childhood disorder in developing countries in particular and its management is quite challenging. Ventriculoperitoneal (VP) shunt is associated with high failure rates and complications. Endoscopic third ventriculostomy (ETV) with potentially lower complication rate could improve care and reduce cost of management of hydrocephalus. Objective: The aim of this study was to evaluate the efficacy (success rate) of ETV in children ≤2 years and to find out factors that may be responsible for good outcome of ETV. Methods: This prospective observational study was conducted at Lagos University Teaching Hospital, Lagos. Nigeria. All consecutive children ≤2 years of age with hydrocephalus were recruited into the study. Relevant demographic and clinical data documented. All cases had ETV and were followed up to document 6 months outcome. Results: A total of 34 patients (M: F ratio 1.1:1) were recruited over a 2-year period. Age, sex, presumed aetiology and image findings were not statistically significant in influencing outcome of ETV. Good outcome (defined as uneventful postoperative period, not requiring repeat ETV or VP shunt) was documented in 26 (73.5%). A total of 8 (26.5%) experienced poor outcome. Complication occurred in 2 (5.9%) as follows: Wound infection 1 (2.9%) and ventriculitis 1 (2.9%). Aetiology was divided into non post-infective hydrocephalus-20 (58.8%), post-infective hydrocephalus-5 (14.7%) and post-myelomeningocoele repair-9 (26.5%). Conclusions: This study shows that ETV success rate is high in the management of hydrocephalus in children ≤2 years in our clinical practice. Regardless of the clinical diagnosis, where the facilities are available, children with hydrocephalus will benefit from ETV irrespective of the age and aetiology in sub Saharan Africa.
  3,138 504 4
Item analysis and evaluation in the examinations in the faculty of medicine at Ondokuz Mayis University
L Tomak, Y Bek
May-June 2015, 18(3):387-394
DOI:10.4103/1119-3077.151720  PMID:25772924
Background: Item analysis is an effective method in the evaluation of multiple-choice achievement tests. This study aimed to compare the classical and the latent class models used in item analysis, as well as their efficacy in the evaluation of the examinations of the medical faculty. Materials and Methods: The achievement tests in the medical faculty were evaluated using different methods. The two methods used were the classical and the latent class models. Among the classical methods, Cronbach's alpha, split half methods, item discrimination, and item difficulty was investigated. On the other hand, various models of item response theory (IRT) and their statistics were compared in the group of latent class methods. Results: Reliability statistics had values above 0.87. Item no. 7 was found easy, item no. 45 difficult and item no. 64 fairly difficult according to the evaluations done by classical and item response theories. In terms of item discrimination, item no. 45 had lower, item no. 7 had middle and item no. 64 had high discrimination levels. The distribution graph shows that personal abilities are good enough to tick the correct choice. Conclusion: In this study, similar results were obtained by classical and latent methods. IRT can be considered perfect at a mathematical level, and if its assumptions are satisfied, it can easily perform assessments and measurements for most types of complex problems. Classical theory is easy to understand and to apply, while IRT is, on the contrary, sometimes rather difficult to understand and to implement.
  3,260 297 -
Eliminating the barriers to uptake of cataract surgery in a resource-poor setting: A focus on direct surgical cost
O Okoye, BI Eze, CM Chuka-Okosa
May-June 2015, 18(3):333-336
DOI:10.4103/1119-3077.151768  PMID:25772914
Background: Cataract remains a leading cause of blindness worldwide. Despite the high therapeutic efficacy of cataract surgical interventions, surgical uptake has been sub-optimal, especially in low- and middle-income countries. Objective: The objective was to investigate the effect of surgical fee reduction on the uptake of cataract surgical services at the University of Nigeria Teaching Hospital (UNTH) Enugu. Methods: In a retrospective comparative study, all patients who underwent cataract surgery at UNTH between January 2008 and December 2011 were identified from the eye theatre's surgical logbook. Their clinical charts were recalled and relevant demographic and clinical data were abstracted, categorized into pre (January 2008 to December 2009, Group A), and post (January 2010 to December 2011, Group B) surgical fee reduction groups. Descriptive and comparative statistical analyses were performed. Results: A total of 376 cataract surgeries (Group A, 164 [43.6%]; Group B, 212 [56.4%]) was performed during the 4-year study period. The surgeries were performed on 217 males, and 159 females aged 55.4 ΁ 23.4 standard deviation years (range, 7 months to 89 years). The average annual uptake of cataract surgery was 94 overall, 82 pre and 106 postsurgical fee reductions. The two groups did not differ significantly by age (P = 0.8750) or gender (P = 0.8337). Conclusion: There is low uptake of cataract surgery at UNTH Enugu. Direct surgical fee reduction alone caused only a modest increase in uptake without alteration in age and gender balance. Further fee reduction and exploration of other uptake barriers are warranted.
  2,890 330 2
CASE REPORTS
Single-shot lamina technique of paravertebral block as an adjunct to general anesthesia for modified radical mastectomy
A Rukewe, A Fatiregun, AF Ademola, A Ugheoke
May-June 2015, 18(3):429-431
DOI:10.4103/1119-3077.151805  PMID:25772932
Thoracic paravertebral block can be employed as an alternative or an adjunct to general anesthesia (GA) for breast cancer surgery. There is no report of this new lamina technique for catheter placement in our environment. In low-resource settings, potent opioids are lacking and the extended postoperative analgesia it provides makes this regional block an invaluable addition to an anesthetist's armamentarium. We describe this single-shot, but titratable technique used as an adjunct to GA for modified radical mastectomy with axillary dissection for breast cancer. The total intraoperative opioid analgesic 50 mg pethidine was received at induction. The patient's vital signs remained stable throughout surgery that lasted 115 min. Pain score charted every 10 min in the postanesthesia care unit using the verbal rating scale was 0. The time to the first request for rescue analgesic was 18 h after surgery for which paracetamol 1 g was adequate.
  2,775 436 -
ORIGINAL ARTICLES
Relationship between 1,25-dihydroxy Vitamin D levels and homeostatic model assessment insulin resistance values in obese subjects
U Bilge, M Ünalacak, I Ünlüoglu, M Ipek, Ö çeler, A Akalin
May-June 2015, 18(3):377-380
DOI:10.4103/1119-3077.151757  PMID:25772922
Aim: In this study, our aim is to evaluate the insulin resistance and quality of life in obese subjects and nonobese subjects and to find out the Vitamin D (VD) status and correlations between obesity and control groups and also according to their quality of life scores. Materials and Method: The study was carried out between May and October 2013 which is the period of VD synthesis in Turkey. The participants of this study were volunteering individuals - obese and nonobese individuals defined according to the body mass index (BMI) - that did not receive any VD support in the last 1-year and did not have any known chronic diseases. 1,25-OH VD status and homeostatic model assessment insulin resistance (HOMA-IR) values were evaluated. Results: The study population consisted of 39 individuals with normal weight (23 women, 16 men) and 66 individuals categorized as obese (51 women, 15 men). The difference in HOMA-IR and VD values between the group of obese individuals and the group of nonobese individuals was significant (P < 0.001 vs. P <0.001). The median value of HOMA-IR was higher in the obese group than in the nonobese group (P < 0.001) while the median value of VD was higher in the nonobese group than in the obese group (P < 0.001). The results regarding the relationship of BMI with HOMA-IR and VD show that there was a positive correlation between HOMA-IR and BMI (rs = 0.507; P < 0.001) and there was a negative correlation between HOMA-IR and VD (rs = −0.316; P = 0.0001). Conclusion: Given serious diseases associated with low serum VD levels such as diabetes and cardiovascular disorders as well as low side effect incidence and low cost of VD treatment, it would be a reasonable approach to identify routine serum 25(OH) D and/or 1,25-OH VD levels of obese patients and administer a treatment to patients with low levels of VD.
  2,570 358 3
Knowledge and attitude of dentists toward implant retained restorations in Saudi Arabia
F Vohra, R Habib
May-June 2015, 18(3):312-317
DOI:10.4103/1119-3077.151788  PMID:25772910
Objectives: The aim was to assess the knowledge and attitudes of specialists (SP) and general dental practitioners (GDP) toward cement-retained restoration (CRR), screw-retained restoration (SRR) and implant restorations in Saudi Arabia. Materials and Methods: Self-designed-structured questionnaires were distributed between SP and GDP by hand and through E-mails. Opinion of dentists regarding factors vital in selection of CRR and SRR was enquired. Factors included esthetics, retrievability, retention, passive fit, fracture resistance, tissue health, cost-effectiveness, fabrication ease, and required expertise. Participants also graded significance of treatment-planning factors for implant-retained prosthesis. Analysis of comparative response frequencies and significance grades was done using the Chi-square and independent t-test. Results: Of 552 respondents, 64% were SP and 36% were GDP with overall response rate of 67%. About 75% of SP and 80% of GDP used SRR in <50% and <25% of their implant practice respectively. The opinion of GDP and SP was significantly different with regards to esthetics, fabrication ease, retrievability, retention and cost-effectiveness between CRR and SRR ( P < 0.05). Overall, CRR were considered better in terms of esthetics, passive fit, fabrication ease, required expertise and fracture resistance. However, SRR were regarded as having better retention, retrievability, soft tissue health and cost-effectiveness. The average significance scores were significantly higher for SP as compared to GDP for six out of nine factors. Conclusions: Knowledge of SP and GDP for selection of implant-retained restorations was broadly in line with standard evidence. The clinical use of CRR was greater in comparison to SRR.
  2,590 330 1
"Evaluation of fracture strength of teeth restored with different types of posts luted with different luting cements": An in vitrostudy
KA Vachhani, MM Asnani
May-June 2015, 18(3):411-415
DOI:10.4103/1119-3077.151780  PMID:25772928
Aims: The aim was to evaluate the incidence of root fracture of endodontically treated teeth reinforced with glass-fiber posts and metal posts luted with different luting cements. Materials and Methods: Forty maxillary central incisors were sectioned at 1 mm of the cementoenamel junction and endodontically treated. The teeth were divided into four groups (n = 10) and restored with prefabricated metal posts and glass-fiber posts luted with resin-based luting cement and glass ionomer cement. Core built up was done using composite resin. The fracture strength was evaluated using an Instron universal testing machine (Model 4206, Instron Corp., Canton, MA). The results were recorded. Statistical Analysis Used: The Kruskal-Wallis test analysis test was used to analyze the data. Results: Prefabricated metal post was statistically superior to the glass-fiber posts. Posts luted with resin-based luting cement were superior in fracture strength than glass ionomer cement. Conclusions: Teeth restored with prefabricated metal posts present higher fracture strength than those reinforced with glass-fiber posts. Posts luted with resin-based luting cement showed higher fracture strength than glass ionomer cement.
  2,439 425 -
Effects of different cavity-disinfectants and potassium titanyl phosphate laser on microtensile bond strength to primary dentin
F Oznurhan, C Ozturk, E Sungurtekin Ekci
May-June 2015, 18(3):400-404
DOI:10.4103/1119-3077.151774  PMID:25772926
Aim: The aim of this in vitro study was to compare the effects of different cavity-disinfectants and potassium titanyl phosphate (KTP) laser on microtensile bond strength to primary dentin. Chlorhexidine (CHX), propolis (PRO), ozonated water (OW), gaseous ozone (OG) and KTP laser were used for this purpose. Methodology: Twelve primary molar teeth were used in this study. One-third of the teeth (from coronal portion) were removed to obtain flat surfaces. After applying the cavity-disinfectants, an adhesive (prime and bond NT) was applied to dentin surfaces, and composite crowns were built up. One group received no pretreatment and was set as a control (CONT). Ten sticks were obtained from these samples and were stressed in tension until failure using a universal testing machine and the data were recorded. Results: The mean strength values (in MPa) of the sticks were OW (11.12) > KTP (9.58) > CHX (7.58) > PRO (7.42) > CONT (6.38) > OG (5.84) and OW showed significantly higher results than the other groups, except KTP group (P < 0.05). Conclusions: OW and KTP might be used safely without compromising the bond strength of restorative materials.
  2,449 404 2
Pattern and outcome of postneonatal pediatric emergencies in Nnamdi Azikiwe University Teaching Hospital, Nnewi, South East Nigeria
CI Ndukwu, SK Onah
May-June 2015, 18(3):348-353
DOI:10.4103/1119-3077.153246  PMID:25772917
Background: Nigeria is still battling with preventable childhood deaths, being one of the six countries in which 50% of all global child deaths occur. Regular community and health facility audits are needed to determine morbidity and mortality patterns in children which will guide preventive and therapeutic interventions. Objectives: The objective was to determine morbidity and mortality patterns, and identify factors influencing poor outcome of the disease in children seen in the emergency room of Nnamdi Azikiwe University Teaching Hospital, Nnewi. Materials and Methods: This was a 2-year retrospective study (March 2012 to February 2014) involving all children admitted into the children emergency room (CHER). Information on the patients' biodata, diagnosis, and outcome were retrieved from the CHER doctors' log. Analysis was done using Microsoft Office Excel 2007 and Statistical Package for Social Sciences version 20. Results: The total of 1964 patients were seen (1088 males, 845 females, 31 unspecified) with a male to female ratio of 1.3:1. Under-fives constituted 78.8% of the study population. Mean duration of illness before presentation was 18.71 ± 71.94 days. Malaria, diarrheal disease, and respiratory tract infections were the most common morbidities. Sepsis had the highest case fatality rate (CFR) and was the most common cause of death among the 247 patients that died - mortality rate of 12.6%. Most deaths were in under-fives (CFR = 13.9, χ2 = 25.553, P = 0.000), with 74.1% of the mortalities occurring within 24 h of presentation. Patients who presented within a day and those that presented in the 2 nd and 3 rd weeks of onset of symptoms had CFR of 6.4-15.2%, respectively. Conclusion: Infectious diseases remain a menace in our environment with the eventual outcome worsened by late presentation to an appropriate health facility. There is an urgent need to create public awareness on the need to seek prompt medical attention for sick children.
  2,356 313 5
REVIEW ARTICLE
Immunization status of internationally adopted children in Rome, Italy
HK Tchidjou, L Gargiullo, F Vescio, R Giampaolo, L Nicolosi, A Finocchi, P Rossi
May-June 2015, 18(3):307-311
DOI:10.4103/1119-3077.151714  PMID:25772909
Aims: International adoption medicine is a relatively new specialty in pediatrics that has emerged to address the specific health care needs of internationally adopted children in high-income countries. This study ascertains the seroprotection rate for vaccine-preventable diseases, especially against pneumococcal diseases. Patients and Methods: We evaluated 67 internationally adopted children that reached the International Adoption Unit of Bambino Gesù Children's Hospital, Rome-Italy. We collected demographic information, data from preadoption immunization records, results of laboratory testing for immunity to vaccine-preventable diseases (tetanus, pneumococcus, hepatitis B, hemophilus influenzae type b (Hib), measles), as well as results of screening for HIV, hepatitis C, quantiferon, immunological and nutritional status. Results: For children that had received ≥3 vaccine doses of tetanus, overall protection was 94% of 31 vaccinated children; with 1-2 vaccine doses for hepatitis B and Hib respectively, protection was 45% of 29 vaccinated children and 63% of 8 vaccinated children, respectively. For children with one or more doses of measles vaccine, protection was 63% of 32 vaccinated children. Regarding pneumococcus vaccine (documented for eight children), 88% of children with one or more doses of vaccine had developed protective immunity. Conclusions: International adoptees without a valid vaccine record need to undergo a complete schedule in accordance with their age and should receive all the vaccines in the adoptive country's schedule.
  2,210 401 5
CASE REPORTS
Dental exarticulation
S Yadav, N Sisodia, V Jha, M Yadav
May-June 2015, 18(3):426-428
DOI:10.4103/1119-3077.151804  PMID:25772931
Tooth exarticulation or avulsion refers to the complete displacement of the tooth out of its socket. It is a complex injury, requiring immediate intervention for optimal results. Literature indicates that prolonged dry time and improper handling may be associated with increased risk of failure. Immediate replantation of the tooth allows for immediate restoration of esthetics and phonetics. This case report presents the management of an avulsed mature tooth in a young boy, with a two-year follow-up, which had been preserved in milk after around 15-20 minutes of injury and transplanted after two hours at a dental hospital. Timely modified endodontic therapy prevented subsequent inflammatory root resorption.
  2,220 368 -
ORIGINAL ARTICLES
Comparison of various current electronic apex locators to determine the working length using the clearing technique
D Altunbas, A Kustarci, D Arslan, K Er, S Kocak
May-June 2015, 18(3):359-363
DOI:10.4103/1119-3077.151769  PMID:25772919
Background: Correct working length determination is an important step for successful endodontic therapy. Objective: The objective was to compare in vitro the accuracy of three electronic apex locators (EALs) (DentaPort ZX [Morita Co., Tokyo, Japan], SIROEndo Pocket [Sirona Dental Systems, NY, USA], and Rootor [Meta Biomed, Cheongwon-gun, Korea]) in detecting the major foramen using the clearing technique. Materials and Methods: Forty-five human extracted single-rooted teeth with mature apices were used for the study and divided into three groups of 15 teeth each. All teeth were embedded in an alginate model, and the electronic measurements were taken following the manufacturers' orientations. Then, the teeth were cleared and photographed under a stereomicroscope with a digital camera. The distance from the file tip to the major foramen was measured using image analysis software program. Statistical analysis was performed using the Kruskal-Wallis, Mann-Whitney U, and Chi-square tests at a significance level of 0.05. Results: The mean distances from the file tip to the major foramen were 0.164 ± 0.292, −0.162 ± 0.234, 0.341 ± 0.166 mm in the DentaPort ZX, SIROEndo Pocket, and Rootor groups, respectively. Statistical analysis showed that there was a significant difference between SIROEndo Pocket and Rootor (P < 0.05). However, no significant difference was found between DentaPort ZX and other EALs (P > 0.05). Conclusion: DentaPort ZX located the major foramen with 100% accuracy within the range of ± 0.5 mm. However, the accuracy of the SIROEndo Pocket and Rootor in locating the major foramen within ± 0.5 mm was 73.3% and 86.7%, respectively. All EALs showed an acceptable determination of the major foramen within the range of ± 0.5 mm.
  2,169 414 3
Self-reported sleep parameters among secondary school teenagers in middle-belt Nigeria
EO Sanya, PM Kolo, OO Desalu, OA Bolarinwa, PO Ajiboye, MF Tunde-Ayinmode
May-June 2015, 18(3):337-341
DOI:10.4103/1119-3077.151737  PMID:25772915
Background: Available evidences seem to suggest increasing trend in sleep deficit among teenagers worldwide, and there is limited information on this among Nigerian teenagers. This study was carried out to determine the basic sleep schedule and sleep duration among schooling teenagers in Ilorin, Nigeria. Methods: This is a descriptive cross-sectional study conducted among 20 selected public secondary schools in Ilorin, Nigeria. A multistage sampling technique was used to randomly select participating schools. Result: A total of 1033 students participated in the study; of these 47.3% were males and 51.7% females. Students mean age (standard deviation) was 15.3 ± 1.6 years with a range of 12-19 years. Majority (76.2%) of participants co-share bed with at least one person and some (23.8%) slept alone in bed. The three leading reasons given for going to bed were: Tiredness - 31.1%, completion of house assignment - 20.5%, and parental directive - 12.4%. 10% of teenagers do make regular phone calls at night and 5.5% surf internet and use computers at night. Regular habits of daytime sleepiness were reported by 8.2% of study participants. Students' mean sleep duration during school days was 9.33 ± 2.29 h compared to 10.09 ± 1.32 h at weekend (P < 0.05). The duration of night time sleep was adequate (>9 h) in 41% of students; borderline (8-9 h) in 44.3% while 13.3% of the students had insufficient nighttime sleep duration (<8 h) P < 0.05. Conclusion: A substantial number of students had borderline nighttime sleep duration and so had potentials to transit into the problematic insufficient range. To prevent this, there is a need to educate schooling teenagers on the dangers associated with prolonged sleep insufficiency.
  2,308 251 2
Shear bond strength of a self-etched resin cement to an indirect composite: Effect of different surface treatments
OT Harorli, C Barutcugil, O Kirmali, A Kapdan
May-June 2015, 18(3):405-410
DOI:10.4103/1119-3077.151783  PMID:25772927
Objectives: The aim of this study was to compare the shear bond strength of resin cement (Rely X-U200) bonded to differently conditioned indirect composite samples. Materials and Methods: Sixty-six composite resin specimens (5 mm in diameter and 3 mm in thickness) were prepared with an indirect composite resin (Grandia) and randomly divided into six groups. Surfaces of the samples were treated with one of the following treatments; %37 phosphoric acid etching, sandblasting, 1,5 W, 2 W and 3 W erbium, chromium: Yttrium-scandium-gallium-garnet laser application. An untreated group was used as a control. In each group surface of the sample was analyzed with scanning electron microscopy. The remaining samples (n = 60) were built up with a self-adhesive resin cement (Rely X-U200) 3 mm in diameter and 2 mm height. After 24 h water storage at 37°C, the prepared specimens were submitted to shear bond strength test. One-way analysis of variance was used to analyze the bond strength values of different groups. Results: Highest shear bond strength values were observed in sandblasting group however there were not statistical difference among the tested surface treatment methods. conclusion: In Shear bond strength of resin, cement was independent of the surface conditioning methods applied on tested indirect resin composite.
  2,168 358 2
CASE REPORTS
Progressive myelopathy, a consequence of intra-thecal chemotherapy: Case report and review of the literature
BF Chukwu, IF Ukekwe, OU Ezenwosu, CO Ani, AN Ikefuna, IJ Emodi
May-June 2015, 18(3):432-435
DOI:10.4103/1119-3077.151806  PMID:25772933
Intra-thecal chemotherapy is a recognized therapy for hematological malignancies such as acute lymphoblastic leukemia (ALL). Despite the advantage of these drugs in treating or preventing central nervous system disease, they are not without complications. The authors describe a 12-year-old girl with ALL, who developed progressive myelopathy following intra-thecal administration of cytosine arabinoside. Initial presentation was urine and fecal retention that progressed to paraplegia, and finally encephalopathy. magnetic resonance imaging of the neuroaxis showed T2-weighted foci of increased signal intensity within the substance of the cervical cord indicative of myelopathy. Physicians should be wary of this rare complication of intra-thecal chemotherapy.
  2,158 297 2
ORIGINAL ARTICLES
Clinicopathological comparison of triple negative breast cancers with non-triple negative breast cancers in a hospital in North India
MG Nabi, A Ahangar, MA Wahid, S Kuchay
May-June 2015, 18(3):381-386
DOI:10.4103/1119-3077.153248  PMID:25772923
Introduction: Breast cancer is the second most common cancer worldwide (1.3 million cases, 10.9%) and ranks 5 th as cause of death from cancer overall (458,000 cases, 6.1%). Triple-negative breast cancer (TNBC) is a subtype of breast cancer with characteristic biological and pathological features. Among the subgroups of breast cancer, triple negative cancer is particularly feared because it is associated with poor outcome. However, clinical data on TNBC in Asian population are limited. The present study was aimed to find the prevalence of TNBCs and to compare various clinicopathological features of TNBC with non TNBC patients in our population. Materials and Methods: Clinical and pathological data of 180 breast cancer patients who visited our department from January 2009 to December 2013 were analyzed. Statistical analysis was done using the Chi-square test and Mann-Whitney U-test. Results: Of 180 cases, 62 (34.4%) had TNBC. Data analysis revealed significant difference in mean age, mean tumor size, tumor grade between TNBC and non-TNBC patients. Axillary lymph node metastasis and lymphovascular involvement were also more in TNBC patients however this was not statistically significant. Extranodal spread was recorded more in non-TNBC patients as compared to TNBC patients, but the results were statistically insignificant. Conclusion: Triple negative breast cancer represented 34.4% which is higher than the range normally reported in the literature. TNBC are associated with younger age, large tumor size, high-grade tumors, and a higher rate of axillary lymph node metastasis.
  2,021 375 5
Effect of a re-wetting agent on bond strength of an adhesive to primary and permanent teeth dentin after different etching techniques
E Yildiz, ES Karaarslan, M Simsek, F Cebe, AS Ozsevik, B Ozturk
May-June 2015, 18(3):364-370
DOI:10.4103/1119-3077.151786  PMID:25772920
Objective: This study investigated the effect of a re-wetting agent on the microtensile bond strengths (mTBS) of primary and permanent dentin after acid or laser etching. Materials and Methods: Twelve permanent and 12 primary molar teeth were ground to expose an occlusal dentin surface. Each group teeth were randomly divided into groups; I-II: 37% phosphoric acid etching with/without re-wetting agent, III-IV: Erbium: Yttrium aluminium garnet laser etching with/without re-wetting agent. An etch-and-rinse adhesive was used, and vertical sticks were obtained for the microtensile test. Results: mTBS of permanent teeth was higher than that of primary teeth (P < 0.05). Re-wetting agent groups were similar with control groups in both etching groups in the permanent teeth (P > 0.05). Re-wetting agent group was similar with the control group in acid etch group (P > 0.05) and lower than the control group in laser etch group in primary teeth (P < 0.05). Conclusion: Acid etching in permanent teeth; laser etching in primary teeth was found more successful. The use of re-wetting agent did not provide an advance on bond strength of the adhesive in both primary and permanent teeth after acid-etch or laser-etch.
  1,897 297 -
CASE REPORTS
Multimodal approach to blood conservation in the surgical patient
AD Nwosu
May-June 2015, 18(3):422-425
DOI:10.4103/1119-3077.153249  PMID:25772930
Allogeneic blood remains a scarce and expensive resource, even as the risks of disease transmission and other complications associated with blood transfusion are well known. Blood conservation, however, is a quality-of-care concept that transcends these and other known and unknown complications of transfusion, to involve a gamut of strategies meant to prevent exposure of patients to allogeneic blood. In urging a halt to incessant allogeneic blood transfusion, we report three cases to highlight the benefits of multimodal multidisciplinary collaboration in blood conservation. The three patients were chosen on account of either religious objection to any blood transfusion or the likelihood of exposure to several units of allogeneic blood. The blood conservation plan proposed for each patient was discussed with the respective surgeon and patient. Multimodal multidisciplinary approach to blood conservation utilising combination of strategies best suited for each individual patient will remarkably reduce the exposure of patients to allogeneic blood thereby ensuring better use of the scarce resource, and and preventing potential clinical complications and spiritual trespass of Jehovah's Witnesses.
  1,675 387 -
ORIGINAL ARTICLES
Dynamic assessment of Capparis spinosa buds on survival of periodontal ligament cells using a real-time cell analysis method
F Ozan, Ü Özan, EA Oktay, O Toptas, H Özdemir, Er Kürşat
May-June 2015, 18(3):395-399
DOI:10.4103/1119-3077.151766  PMID:25772925
Background: Tooth avulsion is the most severe type of traumatic dental injuries and it results in the complete displacement of the tooth out of its socket in alveolar bone. Reimplantation of the tooth is considered to be a best treatment modality due to its biological and psychological advantages. Its prognosis depends on the extra alveolar time, the storage medium, and the patient's general health. Objective: The aim of this study was to evaluate the effect of Capparis spinosa (C. spinosa) in maintaining the viability of human periodontal ligament (PDL) cells using a real-time cell analysis method. Materials and Methods: Periodontal ligament cells were obtained from healthy human third molars extracted for orthodontic purposes. The storage media tested were: Dulbecco's Modified Eagle Medium (DMEM), C. spinosa, Hank's Balanced Salt Solution (HBSS), and light milk. A real-time cell analyzer system was used to evaluate cell viability. After seeding cell suspensions into the wells of the E-plate 96, PDL cells were treated with each of tested media and monitored for every 5 min for 26 h. Statistical analysis of the data was accomplished using one-way analysis of variance complemented by the Tukey test. The level of significance was set at P < 0.05. Results: Dulbecco's Modified Eagle Medium (control) and C. spinosa groups had significantly higher cell index values compared with the HBSS and light milk (P < 0.05). Although, C. spinosa showed better results than DMEM (control), but this difference was not found statistically significant. Conclusion: Capparis spinosa can be a suitable, alternative storage medium for avulsed teeth.
  1,643 352 1
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