Medical and Dental Consultants’ Association of Nigeria
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   2016| March-April  | Volume 19 | Issue 2  
    Online since February 9, 2016

 
 
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ORIGINAL ARTICLES
Awareness, knowledge and perception of chronic kidney disease in a rural community of South-West Nigeria
R Oluyombo, OE Ayodele, PO Akinwusi, OO Okunola, BA Gbadegesin, MO Soje, A Akinsola
March-April 2016, 19(2):161-169
DOI:10.4103/1119-3077.175960  PMID:26856275
Background: Awareness and education on kidney disease impact on its effective management and will reduce the significant economic and public health burden. Knowledge of CKD and risk factors increases the perception of being at high risk and increasing health seeking behavior. We conducted a cross-sectional descriptive study to assess the level of awareness, knowledge and conventional risk factors of CKD in the community to strategize on preventive modalities using the information gathered from this population. Methods: We used a pretested structured questionnaire to draw information on sociodemography, knowledge and risk factors of CKD from 563 residents aged >18 years. Results: A total of 454 residents completed this study, mainly farmers, with a mean age of 45.8 ± 19.0 years and male: female ratio of 0.8:1. Only 33.7% had heard of kidney disease with 59.3% from the media and 35.3% from health workers; the level of knowledge of CKD was good in 27.1%. The majority (67.0%) do not know the correct location of the kidneys. Only 10.6% could mention at least one function of the kidneys with only 24.5% agreeing that NSAIDs can cause kidney disease. A laboratory test for kidney function was known by 4.4%; 45.9% and 47.8% believe that CKD can be cured by spiritual means and herbal concoctions respectively. Only 11.1% agreed that CKD can be hereditary. Abdominal obesity and cigarette smoking were seen in 14.6% and 16.6% respectively. Hypertension was seen in 26.5% while 17.8% actually knew they were hypertensive. Diabetes mellitus was found in 3.4%. None of the patients with CKD who had diabetes or hypertension was aware of kidney disease. Conclusion: There are a misconception and low level of awareness and knowledge of CKD, including those with risk factors, in the community. Efforts should be made to create awareness and educate people on CKD and prevention of its risk factors.
  7 5,375 877
Retrospective evaluation of patients at follow-up with acute poisoning in Intensive Care Unit
S Yaylaci, AB Genç, MV Demir, H Cinemre, A Tamer
March-April 2016, 19(2):223-226
DOI:10.4103/1119-3077.164340  PMID:26856285
Objective: Poisonings are among the major causes of emergency visits and intensive care hospitalizations. The aim of our study is to evaluate intoxicated patients at follow-up and treated in the Intensive Care Unit (ICU) in terms of demographic characteristics, type of poisonings and results of treatment. Materials and Methods: Patients at follow-up aged 17 or older admitted with intoxication to the ICU between January 1, 2009 and December 31, 2011 were included in the study. Age, gender, presenting symptoms, duration of hospitalization, type of poisoning, the way of poisoning, medical history, seasons, hospitalization costs, treatment and prognosis of the patients were analyzed. Results: Totally, 153 (8.9%) out of 1375 follow-up patients in the ICU had acute intoxication. The mean age of intoxicated patients was 29.4 ± 11, 68% of them were female, 78.4% of them were under 35 years old, and intoxication was most common in the 17–25 age group. 114 of them (94.1%) were suicidal. The most common cause of poisoning was drug-poisoning by 88.2%, and most common presenting symptoms were nausea and vomiting by 71.2%. Mean length of stay was 2.4 ± 1.6 days, and the average cost of hospitalization was 761 ± 884 Turkish Liras or 271 ± 315 USD. 5 patients (3.3%) were intubated because of respiratory failure. There was no mortal case. Conclusion: Suicide attempts are prominent in acute poisoning, and the young female population is at higher risk. It was found that drugs, particularly antidepressants and antipsychotic agents were the most common cause of poisoning. The high cost of treatment of acute intoxication cases is a major cause of economic burden. Clinicians should be more careful when prescribing such drugs.
  6 1,472 319
Self-perceived oral health and whole salivary immunoglobulin G levels in habitual gutka-chewers and nonchewers
FA Alshehri, AA Al-Kheraif, KM Aldosary, F Vohra, H Malmstrom, GE Romanos, F Javed
March-April 2016, 19(2):272-277
DOI:10.4103/1119-3077.164337  PMID:26856294
Objective: To assess self-perceived oral health and whole salivary immunoglobulin G (IgG) levels among habitual gutka-chewers and nonchewers (controls). Materials and Methods: Fifty gutka-chewers and fifty controls were included. Demographic data and self-perceived oral health status (pain in teeth, pain on chewing, bleeding gums (BG), bad breath, loose teeth and daily oral hygiene protocols) were collected using a questionnaire. Unstimulated whole saliva (UWS) was collected and unstimulated whole salivary flow rate (UWSFR) was determined. Whole salivary IgG levels were determined using standard techniques. Odds ratios were calculated for oral symptoms and group differences in protein levels were compared using one-way analysis of variance (α± <5%). Results: BG was more often reported by gutka-chewers than controls (P < 0.05). There was no significant difference in UWSFR and self-perceived pain in teeth, pain on chewing, bad breath and loose teeth among gutka-chewers and controls. IgG levels were significantly higher among gutka-chewers than controls (P < 0.01). Among gutka-chewers, whole salivary IgG levels were comparable individuals with and without self-perceived oral symptoms. Among controls, IgG levels in UWS were significantly higher among individuals who had BG than those who did not (P < 0.05). Conclusions: Self-perceived oral health is worse and whole salivary IgG levels are higher in gutka-chewers compared to controls.
  4 1,047 159
CASE REPORTS
An unusual foreign body in the maxillary sinus: Dental impression material
Y Deniz, AZ Zengin, R Karli
March-April 2016, 19(2):298-300
DOI:10.4103/1119-3077.164367  PMID:26856299
Foreign bodies in paranasal sinuses are very rare and most of them are encountered in the maxillary sinus. These foreign bodies may be organic or inorganic and can enter the maxillary sinus through an oro-antral fistula. The oro-antral fistula is formed by a break in the bony segment of the maxillary sinus floor and usually arises subsequent to maxillary premolar and molar extractions. A 63-year-old female patient evaluated for a nonhealing, left, toothless palate lesion and chronic headache occurring over 4 years. Radiography and computed tomography revealed bone discontinuity in the left floor of the maxillary sinus and calcifications within the antrum. A blue foreign body, later identified as dental impression material, was removed by intranasal endoscopy. A careful oral examination is recommended prior to prosthetic restorations. In addition, paranasal sinus foreign bodies should be surgically removed to prevent secondary soft tissue reactions.
  3 2,160 289
ORIGINAL ARTICLES
Evaluation of correct knowledge of key danger signs in pregnancy among antenatal clinic attendees at a tertiary health facility in Nigeria
IO Morhason-Bello, AF Fagbamigbe, TO Mumuni, OA Adesina, AR Abdus-Salam, A Ifemeje, OA Ojengbede
March-April 2016, 19(2):227-232
DOI:10.4103/1119-3077.164347  PMID:26856286
Context: Test of knowledge of pregnant women on key danger signs as a marker to assess the quality of information shared during health education at the antenatal clinic (ANC) is desirable. Aim: The aim was to assess correct knowledge of danger signs among pregnant women who attend ANC. Settings and Design: A cross-sectional design conducted among pregnant women at the ANC of the University College Hospital, Ibadan, Nigeria. Materials and Methods: A pretested structured questionnaire that contains sociodemographics, past obstetrics history, and a list of test questions to assess correct knowledge of danger signs was administered to each consenting participant. Statistical Analysis Used: Descriptive and bivariate analyses were performed. The knowledge score of key danger signs in pregnancy (KDSP) was measured on a scale of 0–7 and participants were scored as having poor (0–2), fair (3–4), or good (5–7) knowledge. The reliability of the questionnaire to assess knowledge score was determined with Cronbach's alpha. Statistical significance was set 5%. STATA 12.0 Software was used. Results: The mean age of respondents was 30.28 ± 4.56 with the majority (75.1%) of respondents aged 26–35 years. The Cronbach's alpha was 0.871. In general, the knowledge score was good and the associated factors on bivariate analysis were younger age (P = 0.028), Islamic religion (P = 0.048), ethnicity (P = 0.03), professional occupation (P = 0.01), and previous attendance of health talk on KDSP (P < 0.0001). Conclusion: There was a high knowledge score of KDSP, but some still have some misconceptions that need to be addressed.
  3 2,124 294
Using cone beam computed tomography to examine the prevalence of condylar bony changes in a Turkish subpopulation
MO Borahan, M Mayil, FN Pekiner
March-April 2016, 19(2):259-266
DOI:10.4103/1119-3077.164336  PMID:26856292
Background/Purpose: The aim of this study was to characterize the condylar bone changes in the temporomandibular region using cone-beam computed tomography (CBCT) and to determine the prevalence of these changes in a population. Materials and Methods: CBCT images of the temporomandibular joints (TMJs) of 795 patients (426 females, 369 males) were retrieved from the computer database. The cross-sectional, coronal and sagittal views of 1-mm-thick sections of the TMJ were generated using CBCT. Age, gender, and bone changes on both condyles were recorded, and data were analyzed using a Chi-square test and McNemar's test to evaluate comparisons between qualitative data (IBM Corp., Armonk, NY). Results: No bone changes were observed in 78.4% (n = 623) of the TMJ samples obtained from the right side. Osteoarthritic changes were observed in 17.9% (n = 142) and developmental changes in 2.6% (n = 21) of the cases. On the left side, osteoarthritic changes were observed in 11.6% (n = 142) of the cases while developmental changes were observed in 2.6% (n = 21). Moreover, 82.4% (n = 655) of the TMJ samples showed no changes. When the age groups were compared in samples obtained from both right and left TMJs, the prevalence of bone changes increased by the age of 60 years and older. Conclusion: The prevalence of degenerative condylar bone changes increased with increasing age and was more frequent in women and right condyle.
  3 1,708 359
Comparative sonographic evaluation of the anteroposterior dimensions of the pancreas in diabetics and nondiabetics
JO Agabi, AO Akhigbe
March-April 2016, 19(2):175-181
DOI:10.4103/1119-3077.175969  PMID:26856277
Background: The pancreas is an insulin-producing gland and is prone to varying degrees of destruction and change in patients with diabetes mellitus (DM). Various morphological changes including reduction in the pancreas dimensions have been described in DM. Objectives: To determine pancreatic anteroposterior (AP) dimensions in diabetics by sonography and compare with nondiabetics. To also evaluate the correlation of the AP dimensions with patient's anthropometry, as well as the duration of the disease in comparison with nondiabetics. Materials and Methods: This is a comparative cross-sectional study involving 150 diabetics with 150 sex and age matched healthy normoglycemic group used as controls. Sonographic measurements of the AP dimensions of the pancreatic head, body, and tail of both study groups were performed with the use of 3.5 MHz curvilinear array transducer of a SonoAce X4 ultrasound machine. Data were analyzed using Statistical Package for Social Sciences version 17 (SPSS Inc., Chicago, IL, USA). A statistical test was considered significant at P ≤ 0.05 and 95% confidence interval. Results: Pancreas AP dimensions were significantly smaller in diabetics compared to those of the controls. The mean dimensions were 1.91 ± 0.26 cm, 0.95 ± 0.12 cm, and 0.91 ± 0.11 cm for the head, body, and tail, respectively, in diabetics and 2.32 ± 0.22 cm, 1.43 ± 0.19 cm, and 1.34 ± 0.20 cm in the control (P < 0.001 in all cases). The dimensions were also significantly smaller in the Type 1 diabetics compared to Type 2 (P < 0.001 in all cases). The mean duration of illness for the Types 1 and 2 diabetics were 3.09 ± 1.38 and 3.78 ± 3.12 years, respectively. Longer duration of illness was associated with smaller pancreas body and tail dimensions, while pancreas head dimension was not significantly affected by the duration of illness. Conclusion: Diabetics have smaller pancreas AP dimensions compared to the normal population.
  3 1,961 240
Correlation of the association of serum lactate, random blood sugar, and revised trauma score as predictors of outcome in hemodynamically unstable abdominal emergencies
E Allwell-Brown, OO Afuwape, O Ayandipo, T Alonge
March-April 2016, 19(2):196-200
DOI:10.4103/1119-3077.175967  PMID:26856280
Background: Elevated levels of serum lactate and glucose during resuscitation have been demonstrated to be predictors of morbidity and mortality in hemodynamically unstable patients with surgical abdominal conditions. However, the rate of return to normal levels of both lactate and blood glucose may be better predictors of mortality and morbidity. The aims of this study are: (I) To determine the pattern of serum lactate and glucose changes in patients with surgical abdominal conditions requiring resuscitation within 48 hours of presentation. (II) To correlate the predictive capability of these two independent parameters. (III) To correlate the predictive values of these parameters with the revised trauma score (RTS). Patients and Method: This is a prospective observational study conducted over three months. The patients admitted by the general surgery division requiring resuscitation from shock was included in this study. Resuscitation was carried out with crystalloids. The estimation of serum lactate and glucose levels was done at presentation (0 hours), 12, 24 and 48 hours after admission. The revised trauma score (RTS) was calculated for each patient at presentation and at 12, 24 and 48 hours subsequently. The patients were followed up four weeks or when death occurred within four weeks of presentation. Results: Forty four patients were recruited in the study. There were seven mortalities. The mean serum levels of Plasma glucose and lactate of all the patients were elevated at presentation in the emergency department. Conclusion: Survival was better with a return to normal serum lactate within 12 hours. On the other hand the random plasma glucose (RPG) levels may not be useful in prognosticating patients. However a combination of serum lactate, RTS (at 24 and 48 hours) and RPG at 48 hours may improve predictive parameters in trauma related cases.
  2 1,247 247
Ischemic priapism in South-East Nigeria: Presentation, management challenges, and aftermath issues
FO Ugwumba, HC Ekwedigwe, KN Echetabu, AD Okoh, I Nnabugwu, ES Ugwuidu
March-April 2016, 19(2):207-211
DOI:10.4103/1119-3077.175968  PMID:26856282
Context: Ischemic priapism is the more common variety of priapism and often presents late. Outcome is largely dependent on the duration of ischemia. Aims: To determine the etiology, presentation, management, and outcome of ischemic priapism. Settings and Design: Retrospective analysis of consecutive cases presenting to three hospitals offering specialist urological services in South-East Nigeria from January 2000 to December 2010. Patients and Methods: Fifteen patients were assessed for clinical data and outcome. Statistical Analysis Used: The data were analyzed descriptively and inferentially using Statistical Package for Social Sciences (SPSS version 16, SPSS Inc., Chicago IL, USA) with P < 0.05. Results: Mean age was 30.5 years (standard deviation [SD] =1.63), range: 14–79 years. Onset to presentation interval ranged from 6 h to 28 days. Eight patients (53.3%) had sickle cell disease (SCD). Four patients (26.7%) had unidentified causes. The 8 SCD patients had stuttering priapism on several occasions previously. Six patients (40%) had taken oral herbal medications as treatment prior to presentation. Initial resuscitative measures were intravenous hydration, aspiration, and irrigation with normal saline in 13 patients. Glanulo-cavernous shunt (Al-Ghorab) was performed in all the patients. Detumescence was immediate in 14 and delayed in 1 patient. Three patients had transient recurrence of tumescence, while one had to be reshunted. Erectile dysfunction (ED) occurred in 7 patients (46.7%). Occurrence of ED increased significantly in patients presenting 24 h after onset of symptoms ([P = 0.032] Fishers exact test). Mean duration of follow-up was 21.9 weeks (SD = 4.1), range: 3–156 weeks. Conclusions: Low flow priapism is common in our environment, and approximately half will occur in SCD patients who have had stuttering priapism previously. Timely diagnosis and treatment will reduce the probability of severe ED. In our experience, the Al-Ghorab shunt provides rapid relief. Enlightenment is vital in reducing ischemia time. Emphasis on preventive measures in SCD patients is vital.
  2 3,958 308
Influence of different final irrigation regimens and various endodontic filling materials on vertical root fracture resistance
DD Sungur, E Altundasar, E Uzunoglu, Z Yilmaz
March-April 2016, 19(2):267-271
DOI:10.4103/1119-3077.164334  PMID:26856293
Aim: The aim of this study was to evaluate the influence of different endodontic materials and final irrigation regimens on vertical root fracture (VRF) resistance. Materials and Methods: Eighty human teeth were prepared then assigned into two groups (n = 40) according to the final irrigations. G1: 5 mL, 5.25% sodium hypochlorite (NaOCl), G2: 5 mL, 2% chlorhexidine gluconate (CHX). Each group was assigned into four subgroups according to the obturation system used (n = 10): A: iRoot SP/single gutta-percha cone (SGP), B: Only iRoot SP, C: Mineral trioxide aggregate (MTA)-Fillapex/SGP, D: AH26/SGP. The specimens were embedded in acrylic molds and subjected to compressive loading at a rate of 1 mm min until VRF occurred. Data were analyzed via three-way ANOVA tests. Results: The statistically significant difference was found among groups (P < 0.05). The G1A and G1B and G1D revealed significantly higher-VRF values than G1C (P = 0.023). The roots filled with MTA-Fillapex revealed lower-VRF values than the other subgroups (P < 0.05). Groups irrigated with NaOCl had significantly lower-VRF values than the groups irrigated with CHX (P < 0.05). Conclusion: Final irrigation regimens could alter VRF resistance of root canals filled with different obturation technique and root canal sealers.
  2 2,029 523
Assessment of intraoral image artifacts related to photostimulable phosphor plates in a dentomaxillofacial radiology department
A Gulsahi, CK Secgin
March-April 2016, 19(2):248-253
DOI:10.4103/1119-3077.164338  PMID:26856290
Objective: The aim of the present study was to evaluate the presence, frequency, and causes of artifacts in intraoral images obtained using photostimulable phosphor (PSP) plates. Materials and Methods: A total of 11,443 intraoral images, including 4291 periapical and 7152 bitewing images, acquired over a 6-month period as well as over a month 1-year after the initial imaging were evaluated by a single observer and image artifacts only related to the PSP system were recorded. Before the study, an experienced dentomaxillofacial radiologist and a research assistant assessed a set of image artifacts and agreed on the causes of these artifacts. All unidentified artifacts were reassessed by both researchers before the final decision. The data were analyzed using the statistical software SPSS 11.5. Results: The total number of images with one or more artifacts was 2344 (20.4%). Of these, 2008 were of adult patients and 336 were of pediatric patients. While movement of the phosphor plate in the disposable pocket was the most common cause of the observed image artifacts in the children, non-uniform image brightness was the most frequently observed artifact in the case of the adults. Conclusion: The percentage of images with artifacts in the 6th month was lower than that during the 1st month. More significantly, the lowest percentage was obtained 1-year after the initial imaging, owing to the increase in familiarity with the system. Understanding the reasons for the image artifacts and studying ways of preventing are of high clinical importance.
  1 2,155 270
Frequency of relapse among Nigerian children with steroid-sensitive nephrotic syndrome
CI Esezobor, TA Ladapo, FE Lesi
March-April 2016, 19(2):254-258
DOI:10.4103/1119-3077.164326  PMID:26856291
Background: The clinical course of steroid-sensitive nephrotic syndrome (SSNS) among Nigerian children has rarely been reported; this makes prognostication difficult. Objectives: The objective was to determine the frequency of relapses including frequent relapses (FR) and steroid-dependence (SD) in a cohort of Nigerian children with SSNS. A secondary objective was to identify clinical and demographic factors associated with relapse in these children. Methods: Medical records of children with SSNS in a Tertiary Hospital in Nigeria were reviewed. Children with onset of nephrotic syndrome (NS) at age <1-year, follow-up period <12 months and secondary causes of NS were excluded. The relapse status of each child was determined in the 1st and 2nd year after diagnosis and the proportions with no relapse, FR and SD were calculated. Results: Fifty children (68% males; median [range] age at onset of NS 4.8 [1.1–14.9] years) were followed-up for 31.1 (12.1–79.8) months. In the 1st and 2nd year of follow-up, 23 (46%) and 24 (70.6%) children experienced relapse, respectively. In the 1st-year, 0% and 10% had FR and SD while in the 2nd year 2.9% and 11.8% had FR and SD, respectively. Age at onset of NS, gender, time to first remission, serum creatinine or presence of hypertension or microscopic hematuria was not associated with 1st or 2nd year relapse. Conclusion: About half and two-thirds of children with NS in our center experience relapse in the 1st and 2nd year of follow–up, respectively; much fewer proportions experienced FR and SD in these periods. None of the commonly reported demographic and clinical factors was associated with NS relapse.
  1 2,331 263
Contraceptive knowledge and practice among senior secondary schools students in military barracks in Nigeria
UC Chimah, TO Lawoyin, AL Ilika, CC Nnebue
March-April 2016, 19(2):182-188
DOI:10.4103/1119-3077.175970  PMID:26856278
Background: Many adolescents lack adequate health education coupled with low contraceptive use. As a result of this, they may experience the negative health consequences of early, unprotected sexual activity as well as its social and economic implications. Objective: To determine the level of knowledge of contraceptives and its use among senior secondary schools students in Ojo military barracks, Lagos. Methodology: A cross-sectional study of 400 senior secondary schools students in Ojo military barracks, Lagos, selected using the multistage sampling technique was done. Data were collected using pretested, self-administered structured questionnaires. The data were analyzed using Statistical Package for Social Sciences version 17 (International Business Machine USA). Tests for statistical significance were carried out using Chi-square tests for proportions. P < 0.05 was considered significant. Results: The response rate was 100%. Majority of them 391 (97.8%), were in the adolescent age group (10–19 years). The mean age was 15 ± 2.4 for males and 15 ± 2.2 for the females. Two hundred and seventy (67.5%) of them had correct knowledge of the use of condoms while 48 (31.1%) of the sexually active respondents have ever used any form of contraceptive with no statistically significant difference between the male and female respondents (P = 0.338). The most common barrier to contraceptive methods as reported by 131 (85.1%) of respondents was their being too embarrassed to source for the commodities. Conclusions: There was a fairly high level of knowledge and relatively low use of contraceptives. We recommend that efforts should be intensified to promote the safe sexual practice and contraceptive use in this age group.
  1 8,684 630
The role of neoangiogenesis and vascular endothelial growth factor in the development of carpal tunnel syndrome in patients with diabetes
AN Deger, H Deger, F Taser
March-April 2016, 19(2):189-195
DOI:10.4103/1119-3077.175971  PMID:26856279
Objective: Carpal tunnel syndrome (CTS) is an entrapment neuropathy which is caused by the disruption of blood supply in the median nerve under transverse carpal ligament. Systemic factors facilitate the formation of the syndrome. In this study, neovascularization in the subsynovial tissue and proliferative activity in the stroma are analyzed within the cases of diabetic and idiopathic CTS. Materials and Methods: Subsynovial connective tissue samples of 30 diabetes mellitus patients with CTS and 30 patients with idiopathic CTS were evaluated. Vascular endothelial growth factor (VEGF), CD31, CD34, Factor VIII-related antigen, and smooth muscle actin (SMA) was used to make a comparative study of neovascularization. Proliferative index was assessed using anti-Ki-67 antibody. Results: As a result of the proliferation of endothelial elements, de novo blood vessel formations in the subsynovial tissue were assessed by vascular markers. Significant neovascularization was seen in diabetic group for VEGF, CD31, SMA (P < 0.01); and for CD34 (P < 0.05) when compared with idiopathic CTS group. In addition, more intense positive staining for CD34, SMA (P < 0.01); and for VEGF (P < 0.05) was found at isolated stromal cells of diabetic CTS group against idiopathic CTS group. Significantly high proliferative index in subsynovial connective tissue with Ki-67 was observed the diabetic group (P < 0.01). Conclusion: VEGF expression has an importance within CTS pathogenesis. Increased ischemia-reperfusion damage, neoangiogenesis, and VEGF expression has an important role frequently CTS occurrence in diabetic patients. Our study supports enhancement in VEGF expression similar to changes in diabetic nephropathy and retinopathy in the neovascularization within the subsynovial connective tissue in the cases of diabetes.
  1 1,690 322
Knowledge and practice of prophylaxis of deep venous thrombosis: A survey among Nigerian surgeons
EB Kesieme, BJ Arekhandia, IM Inuwa, IC Akpayak, EE Ekpe, OA Olawoye, A Umar, NS Awunor, EC Amadi, IJ Ofoegbu
March-April 2016, 19(2):170-174
DOI:10.4103/1119-3077.175961  PMID:26856276
Background: Venous thromboembolism is a potentially dangerous condition that can lead to preventable morbidity and mortality among surgical patients. Objectives: We aimed to determine the knowledge and practice of surgeons practising in Tertiary Hospitals in Nigeria about prophylaxis of deep vein thrombosis (DVT). Materials and Methods: Eight Tertiary Institutions were selected from institutions in the geopolitical regions of the country by simple random sampling using balloting method. A semi-structured questionnaire was administered, and the response was obtained from 105 out of 254 surgeons. Results: The mean knowledge score was 5.81 ± 1.67, and only 33.3% have good knowledge about DVT prophylaxis. No statistical difference was observed between the different groups of surgeons. The mean practice score was 5.19 ± 1.8 and only 20% of surgeons have a good practice of DVT prophylaxis. The majority (90.5%) have encountered DVT whereas 83.5% have encountered pulmonary embolism in their practice. Most commonly encountered risk factors include prolonged immobility, advanced age, and pelvic surgery. Only 13.3% have used Well's score in the clinical evaluation of their patients. The prophylactic modality adopted varies, but most surgeons (77%) utilized both the pharmacological and mechanical methods. Low molecular weight heparin is the commonly used chemoprophylactic agent while a combination of early ambulation and limb physiotherapy is the most commonly preferred mechanical method of thromboprophylaxis. Conclusion: There is a deficiency in the knowledge and practice of DVT prophylaxis among surgeons in Nigeria. There is a need to improve both the knowledge and practice by introducing institutional guidelines or protocol for DVT prophylaxis for surgical patients.
  1 3,131 461
Influence of different surface treatments on push-out bond strengths of fiber-reinforced posts luted with dual-cure resin cement
H Arslan, LB Ayranci, D Kurklu, HS Topçuoglu, C Barutcigil
March-April 2016, 19(2):218-222
DOI:10.4103/1119-3077.175962  PMID:26856284
Objectives: The objective was to evaluate whether fiber postsurface conditioning with air abrasion or erbium:yttrium-aluminum-garnet (Er:YAG) laser would influence the bond strength of dual-cure resin cement to the fiber-reinforced (FRC) posts. Materials and Methods: Twenty-one FRC posts were divided into three groups according to surface treatment methods as follows: An untreated control group air abrasion with Al2O3group, and Er:YAG laser treated group with 150 mJ parameter. Fiber posts were then built up to dual-cure resin cement. Eighteen specimens were set and sectioned perpendicularly along the long axis of the post using a saw. Two disks (thickness of 2 mm) were obtained from each specimen (n = 12). Remaining three posts were stored for scanning electron microscopic evaluation. Push out test was performed on the each specimen and the values were recorded as MPa. The data were analyzed using one-way analysis of variance and Tukey post-hoc tests (P < 0.05). Results: The bond strength values for the groups were as follows: Control (15, 28 MPa), air abrasion group (19, 73 MPa), and Er:YAG group (17, 84 MPa). Air abrasion affected the bond strength significantly (P < 0.05). Conclusion: Air abrasion attained higher bond strengths when FRC posts were luted to dual-cure resin cement. Additional studies should be designed with different types and parameters of laser devices to understand the effect of these devices on bond strength.
  1 1,418 327
Effects of sevoflurane and propofol on S100β and neuron-specific enolase protein levels during cardiopulmonary bypass
AF Erdem, YN Sahin, N Dogan, Z Umudum, F Bayar, C Bulut, HA Alici, B Erkut, M Cesur, M Ceviz
March-April 2016, 19(2):278-283
DOI:10.4103/1119-3077.164346  PMID:26856295
Aim: Cardiopulmonary bypass (CPB) is associated with the release of S100β and neuron-specific enolase (NSE) indicating cerebral cell injury. The purpose of the present study was to evaluate the effect of propofol and sevoflurane on S100β and NSE levels in patients undergoing coronary artery bypass grafting (CABG). Materials and Methods: Twenty male patients undergoing CABG were randomly allocated into two groups. One group received sevoflurane (GS) and the other received propofol (GP). Arterial blood samples for analysis of S100β and NSE levels were taken preoperatively (T1), 30 min after initiation of CPB (T2), at the end of CPB (T3), 1 (T4), 6 (T5) and 24 h (T6) postoperatively. Results: S100β level was significantly higher compared to all analyzed times at T3 in both groups (P < 0.001). S100β level was significantly higher in GP than GS only at T2 (P = 0.002). NSE level was significantly higher at T3, T4 and T5 than T1 in the GP (P = 0.001, 0.002 and 0.023, respectively), while a significant increase was seen at T3 and T4 in GS group (P = 0.001 and 0.047, respectively). Conclusion: Our findings showed that both S100β and NSE levels similarly increased during CPB and immediately after CPB during sevoflurane and propofol based anesthesia.
  1 1,607 282
CASE REPORTS
Phlegmasia cerulea dolens in a long distance driver
JC Mwita, MB Mwandri, M Cox
March-April 2016, 19(2):290-292
DOI:10.4103/1119-3077.175966  PMID:26856297
Phlegmasia cerulea dolens (PCDs) is a rare and serious complication of massive deep venous thrombosis of the lower extremities, which has a high mortality rate. It is characterized by the sudden onset of severe leg pain, massive edema, cyanosis, venous gangrene, compartment syndrome and arterial compromise, often followed by pulmonary embolism and death. We report one case of a long distance driver who presented with PCDs, complicated by fatal pulmonary embolism.
  - 1,529 165
Giant primary synovial sarcoma of the anterior mediastinum: A case report and review of literature
FI Ukekwe, N Ezemba, DB Olusina, U Igbokwe, C Ngene
March-April 2016, 19(2):293-297
DOI:10.4103/1119-3077.175965  PMID:26856298
Primary synovial sarcoma is a very rare tumor of the mediastinum, which is unreported in the entire subcontinent of West Africa, and presents daunting challenges from diagnosis to management with lack of standard management strategies. We present a case of primary monophasic synovial sarcoma of the anterior mediastinum, in a 22-year-old Nigerian lady who presented with cough, chest pain, and pleural effusion. Chest X-ray (CXR) and computed tomography on admission showed a left-sided huge mass in the left anterior mediastinum with no metastasis to the contralateral pleural cavity. Complete resection of the mediastinal tumor was done and histologic and immunohistochemical analyses confirmed a diagnosis of monophasic synovial sarcoma. However, 10 months postoperation she represented with chest pain, productive cough and a repeat CXR showed multiple left pulmonary nodules. She received two cycles of docetaxel and gemcitabine chemotherapy, but declined further treatment until her demise 8 months later.
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Isolated gallbladder rupture following blunt abdominal injury
HY Su, MC Wu, SC Chuang
March-April 2016, 19(2):301-302
DOI:10.4103/1119-3077.164352  PMID:26856300
Isolated traumatic gallbladder rupture subsequent to blunt abdominal injury is rare. Most literatures on the subjects consist of case reports. We reported a rare case of isolated gallbladder rupture and discussed the possible predisposing factors to gallbladder rupture.
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ORIGINAL ARTICLES
A comparison of the intensive care experiences of emergency and elective cardiac surgery patients
SB Göktas, T Yildiz, SK Nargiz, O Gur
March-April 2016, 19(2):284-289
DOI:10.4103/1119-3077.175963  PMID:26856296
Purpose: The study was planned to review the experiences of patients in the intensive care units (ICUs) and determine their states of awareness following an emergency or elective cardiac surgery. Materials and Methods: This was a multicenter and descriptive study. Approval was granted by the Institutional Ethics Committee and informed consent for participation in the study was obtained from all the patients. The study included a total of 300 patients who underwent emergency or elective cardiovascular surgery and were then transferred to the ICU. Data were gathered from the demographic data form and the intensive care experience scale, which was developed by the researchers and applied through face-to-face interviews with the patients. The independent-samples t-test, Mann–Whitney U (Exact) test, one-way ANOVA (Robust Test: Brown–Forsythe), and multivariate analysis of variance were used in the analysis of the data. Results: The study included 300 patients, comprising 108 (36%) females and 192 (64%) males. No difference was found between the groups in respect of total intensive care points of emergency (57.9 ± 4.92) and elective (56.6 ± 4.58) operations (P = 0.32). The environmental awareness level and patient satisfaction of the elective group were seen to be higher, and the emergency group reported more bad experiences. Patients who had undergone emergency cardiac valve surgery were more satisfied (P < 0.001) and remembered more (P = 0.001). Conclusion: Patients who had undergone urgent and elective cardiac surgery were seen to have had a relatively negative intensive care experience. When there was more environment awareness in patients with ICU experience, it was determined that as the duration of stay in the ICU lengthens out, the pessimistic experiences increased and ICU satisfaction decreases.
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Low back pain as seen in orthopedic clinics of a Nigerian Teaching Hospital
NI Omoke, PI Amaraegbulam
March-April 2016, 19(2):212-217
DOI:10.4103/1119-3077.175964  PMID:26856283
Background: Low back pain is not a specific disease though a common health concern worldwide. There is regional variation in its etiology and patterns of presentation. In West African sub-region, there are very limited data on this important aspect of low back pain. Objective: We aimed to determine the etiology and pattern of presentation of low back pain among patients seen in our orthopedic outpatient clinics. Materials and Methods: This was a retrospective review of database of all new patients with low back pain seen at the orthopedics clinics of Federal Teaching Hospital, Abakaliki between 2003 and 2013. Results: There were 2914 new patients seen in the orthopedic clinics –291 (10%) of them presented with low back pain. The female to male ratio was 1:1.04 and the mean age was 45.8 ± 1.67 years. The mechanical low back pain was involved in 82.1% of the patients, and the incidence was significantly higher in females than males (53.1% vs. 46.9%, P < 0.003). The males were significantly more afflicted than females by pain from spinal infections (58.3% vs. 41.7%) and tumors (92.3% vs. 7.7% P <0.003). Low back pain associated with radiculopathy was observed in 75 (25.7%) patients and the incidence was significantly higher in the married than the singles (30.2% vs. 13.9%, P < 0.005). Lifting of heavy object was the most common predisposing factor of low back pain. Hypertension and peptic ulcer disease were two top medical co-morbidities while osteoarthritis of hip and knee was the most common associated musculoskeletal disorders. Conclusion: Low back pain of mechanical origin (recurrent and chronic in a significant proportion of patients) is predominant in our environment. This pattern calls for prevention as well as the early and appropriate care of the patient with low back pain.
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Topical-intracameral anesthesia in manual small incision cataract surgery: A pilot study in a Tertiary Eye Care Center in Africa
NJ Uche, O Okoye, OI Okoye, O Arinze, NN Okoloagu
March-April 2016, 19(2):201-206
DOI:10.4103/1119-3077.175972  PMID:26856281
Background: Cataract remains a leading cause of blindness worldwide. Manual small incision cataract surgery (MSICS) is currently practiced as the technique of choice in Sub-Saharan Africa to reduce the backlog of cataract blindness. Optimal pain control during surgery remains a challenge to cataract surgeons. Aim: To evaluate the efficacy and safety profile of the use of aqueous topical/intracameral anesthesia in MSICS. Materials and Methods: In this hospital-based case series, consecutive patients presenting at the eye clinic with operable cataract and willing to have surgery were enrolled. Baseline sociodemographics (age, sex, and occupation), type of cataract by morphology, pain perception, and surgeons experience were recorded. Descriptive and comparative statistical analyses were performed. A P < 0.05 was considered statistically significant. Results: The surgeries were performed on 30 eyes of 16 (53.3%) males, and 14 (46.7%) females (sex ratio, 1:0.9) who were aged 60.3 ± 16.32 standard deviation (SD) (95% confidence interval [CI] of mean; 53.94–66.13) (range; 20–98 years). Using the visual analog scale, the mean pain score was 2.7 SD ± 2.215 (1.87–3.53 95% CI). There was no correlation between degree of pain perception and gender (P = 0.806) or age (P = 0.388). Patient's cooperation was excellent in 22 (73.3%) of patients. Intraoperative complications occurred in 3 (10%) of patients. Conclusion: The mean pain score in this study is low. There is no correlation between perception of pain with gender or age. Surgeons experience is excellent in most of the cases. This method of anesthesia in MSCIS is adequate for patient's comfort and safe cataract surgery.
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Video-assisted thoracic surgery in a Nigerian teaching hospital: Experience and challenges
BA Falase, AA Majekodunmi, S Ismail, MO Sanusi, OO Adeyeye
March-April 2016, 19(2):233-236
DOI:10.4103/1119-3077.164349  PMID:26856287
Background: Video-assisted thoracic surgery (VATS) is well established. Its application in Nigeria has however been limited and not been reported. The aim of this study was to describe our institutional experience and challenges with VATS. Materials and Methods: This was a retrospective cross-sectional study of all patients that underwent VATS in our institution between March 2008 and June 2013. Data were extracted from a prospectively maintained database. Results: Two hundred and sixty-one patients were assessed as potential VATS cases. VATS was initiated in 26 patients, but completed in 25 patients (9.6%) as there was one case of conversion of a planned VATS bullectomy due to the failure of one lung ventilation. There were 12 males and 13 females. Mean age was 40.7 ± 13.9 years. The indication was interstitial lung disease in 9 patients (36%), malignant pleural effusion in 6 patients (24%), spontaneous pneumothorax in 5 patients (20%), indeterminate pulmonary nodule in 2 patients (8%), pleural endometriosis in 2 patients (8%) and bronchogenic cyst in one patient (4%). Procedures performed were lung biopsy in 13 patients (52%), pleural biopsy and pleurodesis in 6 patients (24%), bullectomy and pleurodesis in 5 patients (20%) and excision of bronchogenic cyst in one patient (4%). Mean hospital stay was 4 ± 0.7 days. There were no complications and no mortalities. Conclusion: VATS is being performed in our institution with successful outcomes. The use of VATS in Nigeria is encouraged. The relatively high cost of VATS is, however, a major limitation to more widespread use.
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Frequency and clinical impact of ETV6/RUNX1, AF4-MLL, and BCR/ABL fusion genes on features of acute lymphoblastic leukemia at presentation
IC Ajuba, AJ Madu, C Okocha, OG Ibegbulam, I Okpala, OE Nna
March-April 2016, 19(2):237-241
DOI:10.4103/1119-3077.164351  PMID:26856288
Background: Variations in disease presentation and outcome of leukemia treatment has been associated with the presence of certain mutant genes. Three major translocations (ETV6-RUNX1, BCR-ABL, and AF4-MLL) in acute lymphoblastic leukemia (ALL) have been shown to affect treatment outcome. This study is aimed at assessing the relationship between these translocations and the presence of other indicators of disease severity (white cell count, hemoglobin concentration, platelet count, and hematocrit) in ALL. Patients and Methods: Forty chemotherapy naïve patients aged between 9 months and 54 years had their marrow samples analyzed for the prevalent mutations. Their clinical and laboratory details on presentation were also obtained. Results: Abnormal genes detected were BCR/ABL1 major transcript in 5 (12.5%), ETV6/RUNX1 in 2 (5.0%), MLL/AF4 none and none of the patients had more than one fusion gene. There was no relationship between the presence of these fusion genes and the clinical and laboratory features of ALL. An association exists between the fusion genes and ethnic origin of the patients (P = 0.005). There is no significant association between the abnormal fusion genes detected and some laboratory features of prognostic importance, which include total white blood cell count (P = 0.416) and FAB subtype (P = 0.576). Conclusion: Presence of fusion the genes BCR/ABL1, ETV6/RUNX1, and MLL/AF4 does not have any impact on the clinical and laboratory features of ALL at presentation.
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Effect of whitening toothpastes on bonding of restorative materials to enamel of primary teeth
FY Abdelmegid
March-April 2016, 19(2):242-247
DOI:10.4103/1119-3077.164333  PMID:26856289
Objective: The aim of this in vitro investigation was to measure shear bond strength (SBS) of a resin composite and a resin-modified glass ionomer to enamel of primary teeth after application of different whitening toothpastes (WTs). Materials and Methods: Eighty labial enamel surfaces of primary incisors were randomly distributed into 8 groups of 10 each according to the surface treatment and bonding material. G1 and G2, control (brushed with water without WT); G3 and G4, (brushed with Colgate Optic White WT [Colgate-Palmolive Company, New York, NY, USA]), G5 and G6, (brushed with Crest Pro-Health Whitening WT [Procter and Gamble, Cincinnati, OH, USA]) and G7 and G8, (brushed with Arm and Hammer Advance White Extreme Whitening with Stain Defense WT [Church and Dwight Co., Princeton, NJ, USA]). SBS was measured at a crosshead speed of 0.5 mm/min and the type of bond failure was assessed using a stereomicroscope. Results: There was significant difference between SBS of composite resin in groups 1, 3, 5, and 7 (P < 0.001), but no difference between resin-modified glass ionomer in groups 2, 4, 6, and 8 (P < 0.056). SBS of group 1 (control) was greater than groups 3, 5, and 7. There was a significant difference between group 1 and group 2 as well as group 7 and group 8 (P < 0.001). Conclusions: WTs affect SBS of resin composite, but not resin-modified glass ionomer to enamel of primary teeth. No difference of failure modes between different groups of tested materials.
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