Medical and Dental Consultants’ Association of Nigeria
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   2017| February  | Volume 20 | Issue 2  
    Online since January 13, 2017

 
 
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ORIGINAL ARTICLES
Fluoride release/recharging ability and bond strength of glass ionomer cements to sound and caries-affected dentin
E Kucukyilmaz, S Savas, F Kavrik, B Yasa, MS Botsali
February 2017, 20(2):226-234
DOI:10.4103/1119-3077.178917  PMID:28091442
Objectives: The aim of this in vitro study was to evaluate the microtensile bond strength (μTBS) of different glass ionomer cements (GICs) on sound/caries-affected dentin and to assess the fluoride release/recharging ability. Methods: After creating artificial caries lesions, teeth with sound and caries-affected dentin were assigned to be restored with one of the GICs: Ketac N100; GC Equia; GCP Glass Fill, and tested using a microtensile test. Ten of each material were prepared, and fluoride ion-release was measured at 10 different intervals. After 1.23% acidulated phosphate fluoride-gel immersion, fluoride re-release was then measured at the same intervals. Results: In sound dentin, GC Equia exhibited significantly higher μTBS value (P < 0.05). The mean μTBS of Ketac N100 to caries-affected dentin was significantly lower than the other materials (P < 0.05). All materials showed maximal fluoride release at 24 h, GC Equia released the most fluoride. Conclusion: The bond strength of GICs is affected by tooth substrate. High-viscosity GICs show higher initial fluoride release as well as greater fluoride recharge capacity.
  5 3,075 567
Impact of visual inspection with acetic acid plus cryotherapy “see and treat” approach on the reduction of the population burden of cervical preinvasive lesions in Southeast Nigeria
CO Chigbu, AK Onyebuchi, EF Nnakenyi, CC Egbuji
February 2017, 20(2):239-243
DOI:10.4103/1119-3077.187315  PMID:28091444
Objective: The aim of this study is to determine the impact of visual inspection with acetic acid (VIA) plus immediate cryotherapy on the prevalence of VIA-detected cervical squamous intraepithelial lesion (SIL). Methods: Women in four rural communities in Southeast Nigeria were screened with VIA. Women who tested positive to VIA were offered either immediate cryotherapy or large loop excision of the transformation zone based on predetermined eligibility criteria. Cervical biopsies were taken before cryotherapy and examined by consultant histopathologists. All participants were rescreened 1 year later. The main outcome measures were population prevalence of cervical precancers before and after intervention, cure rates, and over-treatment rates. Results: A total of 653 women participated in the study. The prevalence of cervical SIL before the intervention was 8.9% (58/653). The prevalence 1 year later was 1.4% (9/649). This gave an 84.3% reduction in the population prevalence of SIL. The reduction in cervical SIL prevalence was statistically significant (P = 0.0001). The prevalence of high-grade SIL reduced significantly from 4.1% (27/653) preintervention to 0.5% (3/649) 1 year postintervention (P = 0.0001). This gave an 87.8% reduction in the population prevalence of high-grade SIL. Cryotherapy provided a cure rate of 87.9% (95% confidence interval: 76.82–94.33). Conclusion: Population cervical cancer prevention using VIA plus immediate cryotherapy leads to significant reduction in the population prevalence of cervical SIL. This has the potential of being an acceptable supplement to cervical cytology for cervical cancer prevention in low-income populations.
  4 2,493 241
Depression and posttraumatic stress disorder among road traffic accident victims managed in a Tertiary hospital in Southern Nigeria
JE Asuquo, BE Edet, IE Abang, EA Essien, OG Osakwe, EJ Aigbomain, KC Chigbundu
February 2017, 20(2):170-175
DOI:10.4103/1119-3077.196114  PMID:28091432
Background: Psychological responses to traumatic events vary widely across different cultures but studies in the developing countries are scant. The objective of this study is to determine prevalence of depression and posttraumatic stress disorder (PTSD) among patients involved in road traffic accident (RTA) compared with that of the general population using a matched control group. Materials and Methods: The study design was case control and employed the convenient sampling technique. All consecutive attendees of the trauma clinic of a Tertiary Hospital who had been involved in RTA in the previous year and met inclusion criteria were recruited to participate in the study. Controls were drawn from patient relatives attending other clinics in the same hospital. The final sample comprised of 46 cases and controls, totaling 92 participants. A Sociodemographic questionnaire, the PTSD, and depression modules of the Mini International neuropsychiatric interview were administered to both groups by trained research assistants. The data were analyzed using IBM SPSS version 22. Statistical significance was set at 0.05. Results: The prevalence of PTSD among cases was 41.3% compared with 13% among controls, whereas the prevalence of depression among cases was 63% compared with 30.4% among the controls. Both of these findings were statistically significant (P < 0.002). Sociodemographic variables such as age, sex, marital status, religion, level of education, and occupation did not have statistically significant relationship with neither PTSD nor depression. Conclusion: Mental disorders such as PTSD and depression are common in victims of RTA. They would benefit from comanagement with mental health specialists.
  3 2,496 357
Serum obestatin and omentin levels in patients with diabetic nephropathy
M Zorlu, M Kiskac, EM Güler, İ Gültepe, E Yavuz, K Çelik, A Kocyigit
February 2017, 20(2):182-187
DOI:10.4103/1119-3077.181350  PMID:28091434
Introduction: Diabetic nephropathy is the leading cause of chronic kidney disease and accounts for almost 45% of all new patients requiring renal replacement therapy. Omentin and obestatin, two novel proteins were suggested to be associated with insulin resistance, type 2 diabetes and cardiovascular risk factors. Thus, we postulated that they may also have an association with diabetic nephropathy which is known to be an independent cardiovascular risk factor. In order to investigate such an association we compared serum omentin and obestatin levels in type 2 diabetic patients with normoalbuminuria (NA) and macroalbuminuria (MA). Materials and Methods: A total of 81 type 2 diabetic patients were separated into two groups according to their proteinuria status; patients with NA (n = 39) and patients with MA (n = 42). Two groups were compared in terms of serum omentin and obestatin levels. Results: While s erum omentin levels did not differ among two groups (P = 0.407), serum obestatin levels were significantly higher in MA group (P = 0.001). Conclusion: The results of this study showed that higher serum levels of obestatin were associated with macro albuminuria suggesting that obestatin may have a role in underlying pathogenic mechanisms that leads to diabetic nephropathy.
  2 2,232 356
MRI-based detailed evaluation of the anatomy of the human coccyx among Turkish adults
H Tetiker, M İ Koşar, N Çullu, U Canbek, İ Otağ, Y Taştemur
February 2017, 20(2):136-142
DOI:10.4103/1119-3077.198313  PMID:28091426
Aim: The human coccyx varies considerably in shape and size. The objective of this study was to investigate the morphology and morphometry of the coccyx on pelvic magnetic resonance imaging in asymptomatic individuals among Turkish adults. Materials and Methods: This study was conducted retrospectively on the pelvic magnetic resonance images of 456 adult patients without a history of trauma in the coccyx region. The coccygeal vertebrae count, number of bone segments, and intercoccygeal and sacrococcygeal joint fusions were determined from the sagittal plane images. In addition, the length and angles (the sacrococcygeal angle, intercoccygeal joint angle, and sacrococcygeal joint angle) were measured. Statistical Analysis Used: Data were analyzed using the T-test or Mann-Whitney U-test, the ANOVA, or Kruskal-Wallis tests, and the chi-square test was used for the categorical variables. Results: The coccyx is formed by four, five, or three vertebrae in a decreasing ratio. The coccyx is composed of one to five bone segments; one bone segment was found in 2.8% of the cases. Intercoccygeal joint fusions been observed predominantly in the last intercoccygeal joint, with or without sacrococcygeal joint fusion. The coccyx was found to be longer in adult males than in adult females. The sacrococcygeal angle might be anteverted or retroverted. Conclusion: The findings are contrary to the conventional knowledge in that the vertebrae shaping the coccyx were completely fused and consisting of a single bone in very few cases. Better understanding of the anatomical variation of the coccyx may be useful for clinicians evaluating patients presenting with conditions in the coccygeal region.
  2 9,320 790
CASE REPORTS
Oro-dental characteristics of three siblings with Papillon–Lefevre syndrome
OE Gungor, H Karayilmaz, H Yalcin, M Hatipoğlu
February 2017, 20(2):256-260
DOI:10.4103/1119-3077.181365  PMID:28091448
Papillon–Lefevre syndrome (PLS) is a rare autosomal recessive disorder, showing oral and dermatological manifestations in the form of aggressive periodontitis, leading to the premature loss of both primary and permanent teeth at a very young age and palmar-plantar hyperkeratosis. It was first described by two French physicians, Papillon and Lefevre in 1924. Immunologic, genetic, or possible bacterial etiologies have been thought to account for etiopathogenesis of PLS. Severe gingival inflammation and periodontal destruction occurred after the eruption of primary teeth. This condition should warn the physicians and dentists as a one of the important sign for the diagnosis of PLS. There have been over 250 cases reported in literature about PLS, but a few of these were in the same family. This study presents oro-dental characteristics, dental treatments, and follow-up of three siblings (age of sisters are 13, 6, and 4 years) with PLS, which is rarely seen in the same family.
  1 3,063 379
Crouzon syndrome with multiple supernumerary teeth
GS Torun, A Akbulut
February 2017, 20(2):261-263
DOI:10.4103/1119-3077.187332  PMID:28091449
Crouzon syndrome (CS) is an autosomal dominant disorder characterized by craniofacial deformities caused by the early closure of cranial sutures. It is diagnosed by the presence of a flat sphenoid bone, protrusion of eyeballs (exophthalmos), and midfacial hypoplasia. Although hypodontia is usually present in cases with CS, supernumerary teeth are rarely seen. A 16-year-old male patient with CS was referred to our clinic. He had a high forehead, beaked nose, hypertelorism, palpebral ptosis, and asymmetrical orbits. Bilateral multiple supernumerary teeth were observed in his upper and lower jaws. Early diagnosis of CS is helpful in dental and craniofacial treatment. Because of multiple facial and oral problems, this patient required a multidisciplinary treatment approach.
  1 3,588 386
ORIGINAL ARTICLES
A 10 years autopsy-based study of maternal mortality in Lagos State University Teaching Hospital, Lagos, Nigeria
FA Faduyile, SS Soyemi, FE Emiogun, JO Obafunwa
February 2017, 20(2):131-135
DOI:10.4103/1119-3077.180076  PMID:28091425
Background: Maternal mortality is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy. Nigeria is among the six countries that record over 50% of all maternal deaths in the world. There are few papers on autopsy based causes of maternal mortality. This paper is to present the causes of maternal mortality that had postmortem done in our center. Materials and Methods: This is a 10-year retrospective study of all maternal deaths seen in our center from January 01, 2005 to December 31, 2014. Lagos State University Teaching Hospital is the only state-owned tertiary center and the main referral center in Lagos State. Autopsy records are taken from the death register and other information were extracted from the postmortem reports. Results: Most maternal deaths 98/328 (29.9%) were seen in the age group 26–30 years which was followed by 31–35 years (24.7%). Postpartum hemorrhage was the most common cause of death followed by eclampsia. Direct causes accounted for 60% of maternal deaths with hemorrhage as the most common while cardiovascular related diseases are the most common indirect cause of death. Conclusion: The leading causes of death in this study, hemorrhage, cardiovascular disease and eclampsia are highly avoidable and treatable. We recommend that thorough cardiovascular management should be instituted during antenatal care, and the government should focus more on an emergency response such as availability of adequate blood and blood products in the hospitals.
  1 4,210 537
Evaluation of surface characteristics of rotary nickel-titanium instruments produced by different manufacturing methods
U Inan, M Gurel
February 2017, 20(2):143-146
DOI:10.4103/1119-3077.164342  PMID:28091427
Background: Instrument fracture is a serious concern in endodontic practice. Objective: The aim of this study was to investigate the surface quality of new and used rotary nickel-titanium (NiTi) instruments manufactured by the traditional grinding process and twisting methods. Materials and Methods: Total 16 instruments of two rotary NiTi systems were used in this study. Eight Twisted Files (TF) (SybronEndo, Orange, CA, USA) and 8 Mtwo (VDW, Munich, Germany) instruments were evaluated. New and used of 4 experimental groups were evaluated using an atomic force microscopy (AFM). New and used instruments were analyzed on 3 points along a 3 mm. section at the tip of the instrument. Quantitative measurements according to the topographical deviations were recorded. The data were statistically analyzed with paired samples t-test and independent samples t-test. Results: Mean root mean square (RMS) values for new and used TF 25.06 files were 10.70 ± 2.80 nm and 21.58 ± 6.42 nm, respectively, and the difference between them was statistically significant (P < 0.05). Mean RMS values for new and used Mtwo 25.06 files were 24.16 ± 9.30 nm and 39.15 ± 16.20 nm respectively, the difference between them also was statistically significant (P < 0.05). Conclusion: According to the AFM analysis, instruments produced by twisting method (TF 25.06) had better surface quality than the instruments produced by traditional grinding process (Mtwo 25.06 files).
  1 2,826 364
Influence of Helicobacter pylori infection on the prevalence and patterns of upper gastrointestinal symptoms in Nigerians with diabetes mellitus
A Oluyemi, E Anomneze, S Smith, O Fasanmade
February 2017, 20(2):188-193
DOI:10.4103/1119-3077.183257  PMID:28091435
Background: Infection with Helicobacter pylori infection is widespread in our environment. However, whether this fact has any bearing on the prevalence and pattern of symptoms referable to the upper gastrointestinal (GI) system in our population of diabetes mellitus (DM) patients has not been much studied. Aim: We embarked on this study to evaluate if H. pylori infection played any significant role in the prevalence and patterns of upper GI symptoms in type 2 DM patients in Lagos, Nigeria. Materials and Methods: A case–control design was employed. One hundred consecutive, consenting, and ambulant type 2 DM patients were recruited from the Lagos University Teaching Hospital and 100 age- and sex-matched nondiabetic controls were drawn from medical outpatient clinics of the same hospital. All subjects were investigated for a marker of active infection with H. pylori via stool antigen testing, had anthropometric measurements taken, and completed a structured questionnaire administered to elicit for the presence of various upper GI symptoms over the preceding 3 months prior to the time of the study. The controls were further tested for DM. For analysis, the symptoms were divided into dyspepsia, gastroesophageal reflux (GER), and others. Results: H. pylori infection status was neither significantly associated with dyspepsia in either cases or controls (χ2 [1] = 2.198, P = 0.138) nor significantly associated with the symptomatic suggestion of GER in either cases or controls (χ2 [1] = 3.742, P = 0.053). Moreover, the same held for the other upper GI symptoms in cases or controls (χ2 [1] = 0.157, P = 0.203). H. pylori infection was detected in 18% of DM patients and 13% of controls, but there was no statistical significance in this difference (χ2 [1] = 0.954, P = 0.329). Conclusion: Infection with H. pylori does not appear, from the results of this study, to influence the prevalence and patterns of upper GI symptoms in patients with DM in Nigeria.
  1 2,765 256
Radiopacity of bulk fill flowable resin composite materials
T Yildirim, MK Ayar, MS Akdag, C Yesilyurt
February 2017, 20(2):200-204
DOI:10.4103/1119-3077.178919  PMID:28091437
Objectives: The purpose of this study was to evaluate the radiopacity of currently marketed bulk fill flowable dental composite materials (Beautifil Bulk Flowable, SDR Flow, Filtek Bulk Fill Flow, and x-tra Base Bulk Fill). Materials and Methods: Six specimens of each material with a thickness of 1 mm were prepared, and digital radiographs were taken, using a CCD sensor along with an aluminum stepwedge and 1 mm-thick tooth slice. The mean gray level of each aluminum stepwedge and selected materials was measured, using the equal-density area tool of Kodak Dental Imaging software. The equivalent thickness of aluminum for each material was then calculated by using the stepwedge values in the CurveExpert version 1.4 program. Results: The radiopacity of bulk fill flowable composites sorted in descending order as follows: Beautifil Bulk Flowable (2.96 mm Al) = x-tra base bulk fill (2.92 mm Al) = SureFil SDR Flow (2.89 mm Al) > Filtek Bulk Fill Flow (2.51 mm Al) (P < 0.05). Conclusions: As all materials had a radiopacity greater than dentin and enamel; their adequate radiopacity will help the clinicians during radiographic examination of restorations. Clinical Significance: Bulk fill composite materials have greater radiopacity, enabling clinicians to distinguish the bulk fill composites from dentin and enamel.
  1 2,820 487
Nocturnal enuresis in school-aged children with sickle-cell anemia: Any relationship with hyposthenuria?
CI Eneh, AN Ikefuna, HU Okafor, SN Uwaezuoke
February 2017, 20(2):215-220
DOI:10.4103/1119-3077.187326  PMID:28091440
Background: Reports show that children with sickle-cell anemia (SCA) have a tendency for nocturnal enuresis when compared with their counterparts with normal hemoglobin. Although nocturnal enuresis in SCA has been attributed to several factors including tubular and even bladder dysfunction, its relationship with hyposthenuria has been questioned in some studies. Aim: The study aims to determine the relationship of hyposthenuria with nocturnal enuresis seen in school-aged children with SCA. Subjects and Methods: A cross-sectional study of seventy school-aged children with SCA, who met the study criteria and seventy age- and gender-matched controls was conducted at the Sickle-cell Clinic, University of Nigeria Teaching Hospital in Enugu, Southeast Nigeria. The diagnosis of enuresis among the subjects and controls was based on the Diagnostic and Statistical Manual of Mental Disorders-IV criteria while urine specific gravity (USG) was determined on dipstick urinalysis. The frequencies of categorical variables were compared using Chi-square test or Fisher exact test as appropriate and the means of continuous variables with Student's t-test. The level of statistical significance was taken as P< 0.05. Results: The prevalence of hyposthenuria was 4.5% and 8.3% among enuretic and nonenuretic subjects respectively, 6.7% and 10.9% among enuretic and nonenuretic controls and 4.5% and 6.7% among enuretic subjects and controls, respectively. The differences were not statistically significant. The mean ± standard deviation USG was significantly higher in the subjects than in the controls (1.02 ± 0.01 vs. 1.01 ± 0.01, P = 0.013) and enuretic subjects than enuretic controls (1.02 ± 0.01 vs. 1.01 ± 0.01, P = 0.007). The prevalence of nocturnal enuresis was significantly higher in male subjects compared to female subjects (odds ratio [OR] [95% confidence interval (95% CI)] =8.14 (2.12, 31.24), χ2 = 12.21, P< 0.001) and male controls (χ2 = 5.57, P = 0.018). Enuretic subjects had a significantly higher prevalence of parental history of childhood enuresis (OR [95% CI] =10.39 [2.45, 44.05], P< 0.002) than the enuretic controls. The relationship between the enuretic subjects and controls with respect to age of attainment of urinary control, family size, socioeconomic class, and sibling history of enuresis were not statistically significant. Conclusions: Nocturnal enuresis in children with SCA may not be related to hyposthenuria. However, male gender and parental history of childhood enuresis are significant risk factors.
  1 2,120 219
Process and outcome measures of quality of care at the diabetes outpatient clinic, University College Hospital, Ibadan
JO Adeleye, MA Kuti
February 2017, 20(2):221-225
DOI:10.4103/1119-3077.187310  PMID:28091441
Objective: The study aims to assess the quality of care provided at a diabetes outpatient clinic of a tertiary hospital in Nigeria using quality indicators approved by the National Diabetes Quality Improvement Alliance (NDQIA). Materials and Methods: The medical records of patients who had visited the clinic at least two times within a 12 months period preceding the index visit were reviewed during a 5 month period. Process measure indicators, approved by the NDQIA (evaluating the functioning of the clinic) and outcome measures, published by the American Diabetes Association, (evaluating the health status of the attending patients) were retrieved from the medical records. Results: The 332 records reviewed showed that the most consistently performed process measures were blood pressure and weight measurement (>90%). Foot examination was done infrequently (10.5%). Less than 50% had at least an annual low-density lipoprotein cholesterol (LDL-C) and hemoglobin A1c testing done. The mean (standard deviation) HbA1C (%), LDL-C (mg/dL) systolic blood pressure (SBP) (mmHg), and diastolic blood pressure (DBP) (mmHg) were 7.6 (2.0), 107.3 (31.5), 134.3 (20.8), 79.5 (11.0), respectively. HbA1C >8.0%, LDL-C >130 mg/dL, SBP >130 mmHg, and DBP >90 mmHg) were observed in 34.8%, 21.1%, 40.4%, and 23.8%, respectively. Conclusion: Although the organization of the outpatient services allowed for good performance with regards to “free” services such as blood pressure and weight measurement, it performed suboptimally for foot examinations. Performance indicators that required payment were consistently underperformed. Regular assessment of the quality of care may help in the identification of opportunities for improvement in the organization and delivery of care.
  1 2,283 172
CASE REPORTS
Prosthetic rehabilitation of a patient with a resected right temporomandibular joint
M Dinçel, H Kocaağaoğlu, H Ö Gümüş, H Albayrak
February 2017, 20(2):252-255
DOI:10.4103/1119-3077.181384  PMID:28091447
This case report presents the prosthodontic rehabilitation of a patient with a resected right mandible, caused by an accident. Right condyle, ramus, and the posterior part of ramus were affected by the accident. These structures were resected, and the mandible was positioned toward the surgical area and a facial asymmetry was occurred. The patient was treated with a bar-retained maxillar denture with a guide ramp and an implant-supported fixed mandibular prosthesis.
  - 2,032 140
LETTER TO EDITOR
Smartphone photomicrography: A quick, easy, useful technique for the clinician
H Yahya, GI Ayuba
February 2017, 20(2):264-265
DOI:10.4103/1119-3077.198312  PMID:28091450
  - 1,184 172
ORIGINAL ARTICLES
Caudal analgesia for herniotomy: Comparative evaluation of two dose schemes of bupivacaine
DD Akpoduado, CO Imarengiaye, NP Edomwonyi
February 2017, 20(2):205-210
DOI:10.4103/1119-3077.183250  PMID:28091438
Objective: There is currently a wide range of volume schemes for bupivacaine caudal anesthesia. This study evaluated the quality of caudal analgesia achieved with a dosing scheme of 0.75 ml/kg compared with 0.5 ml/kg of 0.25% plain bupivacaine for herniotomy. Methods: After the institutional approval, American Society of Anesthesiologists I–II patients aged between 1 and 6 years scheduled for unilateral inguinal herniotomy with consenting parents/guardian were recruited. The subjects were randomized to receive 0.5 ml/kg (Group 1) or 0.75 ml/kg of 0.25% bupivacaine. Anesthesia was maintained solely with halothane 0.5–1% in 100% oxygen. Postoperatively, pain was assessed using the objective pain scale (OPS). A favorable pain score was defined as <4 (8 point scale) or <5 (10 point scale). The primary outcome was the proportion of subjects with favorable pain scores. Results: Fifty-six patients were enrolled and there was no difference in sociodemographic parameters, preoperative hemodynamic variables, or duration of surgery. Proportions of subjects with favorable OPS scores showed marked differences from 45 min and peaking at 180 min (11 [39%] favorable scores in Group 1 compared to all [100%] favorable scores in Group 2, P< 0.0001). Mean time to first analgesic requirement was 126 ± 34.2 min in Group 1 compared to 249 ± 23.7 min in Group 2 (P < 0.0001). There was no difference in the incidence of adverse events between groups. Conclusion: This study shows that 0.75 ml/kg of 0.25% plain bupivacaine is superior to the use of 0.5 ml/kg of the same concentration for postherniotomy caudal analgesia with low side effect profile.
  - 2,880 233
Is epineurectomy necessary in the surgical management of carpal tunnel syndrome?
U Tiftikci, S Serbest
February 2017, 20(2):211-214
DOI:10.4103/1119-3077.187312  PMID:28091439
Background: In this study, it was aimed to determine whether median nerve epineurectomy is beneficial in the surgical management of carpal tunnel syndrome (CTS). Materials and Methods: The study enrolled 72 patients including 34 patients without epineurectomy (Group A) and 38 patients with epineurectomy (Group B). Surgery was performed in patients with severe electrodiagnostic CTS findings, CTS duration >1 year and flattening along with hypervascularization in median nerve. All patients were assessed by visual analog scale, two-point discrimination test as well as subjective and objective findings at baseline and on the months 1, 3, and 6 after surgery. Results: The mean age was 58.3 years (42–75 years) in 38 patients who underwent an epineurectomy, whereas it was 61.5 years (41–82 years) in 34 patients who did not have an epineurectomy. The groups were similar with regard to age, gender, duration of symptoms, and preoperative physical findings. Mean visual analog scale (VAS) scores were 1.7 in Group A and 1.8 in Group B. Again, these differences were not significant, on physical examination, the average two-point discrimination in the distribution of the median nerve was 4.9 mm (range: 3–11 mm) in Group A and 5.3 mm (range: 3–10 mm) in Group B. In postoperative evaluations, there was a better improvement in visual analog scale scores, two-point discrimination test and subjective symptoms including dysesthesia, pain and nocturnal pain within first 3 months; however, there was no marked difference in objective and subjective findings on the 6th month. No complication or recurrence was observed. Conclusion: We believe that median nerve epineurectomy is unnecessary in the surgical management of primary CTS since it has no influence on the midterm outcomes.
  - 2,288 210
Preoperative and intraoperative continuous use of dexmedetomidine on hyperalgesia after patients' remifentanil anesthesia
M Yang, J Zhang, F Zhang, H Fang
February 2017, 20(2):244-247
DOI:10.4103/1119-3077.196063  PMID:28091445
Objective: Analyze clinical use of dexmedetomidine to relieve prognosis of remifentanil anesthesia recovery and analyze intervention effect. Materials and Methods: Choose 3600 cases of cerebral functional area operation patients treated in different hospitals during June 2011 and December 2015 for general analysis, group the patients by considering relevant parting of anesthesia recovery by American Society of Anesthesiologists, and divide the patients into dexmedetomidine group and control group according to different use of drugs. The two groups of patients are anesthetized, patients' anesthesia wake-up time and wake-up success rate are recorded, and effect of two types of anesthesia wake-up way are compared. Results: There exists no significant statistical difference in wake-up success rate of the two groups of patients, wake-up time has small difference, but anesthesia recovery quality of dexmedetomidine group is higher, which is conducive to physical rehabilitation of patients and minimize the effects of anesthetics on patients. Conclusion: In clinical surgery, after use of remifentanil anesthesia on patients, use of dexmedetomidine for anesthesia recovery can minimize adverse effects of drugs on patients and thus is worthy to be effectively promoted in clinics.
  - 1,730 280
Correlation between athlete training intensity and cardiac performance
T Xiao, Y Zhang
February 2017, 20(2):248-251
DOI:10.4103/1119-3077.196064  PMID:28091446
Objective: An effective analysis of correlation between training intensity of athletes and cardiac performance is done to develop scientific and reasonable exercise program and to promote health of athletes. Methods: During December 2013-December 2015, 3600 students from different sports schools were selected for the test. All the athletes were randomly grouped, that is half-hour running group, one-hour running group and 90 -minute running group, which are named A, B, C groups respectively. The three groups of athletes received 5 days of testing per week, and took rest in the remaining two days, maintaining a total of 10 days. Exercise intensity of personnel accepting test was detected by RPE, and effective analysis was made on cardiac function change before and after test of three groups of the college students. Results: Resting heart rates of B, C group students were considerably decreased after exercise. In comparison of falling range of group C and group A, there is a statistically significant difference, P <0.05. Conclusion: By strengthening athletes' training intensity, we can effectively enhance athletes' cardiac performance. t As a result, athletes' body becomes healthier, which is conducive to athletes' physical and mental development.
  - 1,714 200
Molecular characterization of exon 28 of von Willebrand's factor gene in Nigerian population
ED Ezigbo, EO Ukaejiofo, TU Nwagha
February 2017, 20(2):235-238
DOI:10.4103/1119-3077.197002  PMID:28091443
Background: Polymorphisms in von Willebrand factor (VWF) gene are an important contributor to the expression of VWF gene and differences in ethnic distribution of these single nucleotide polymorphisms (SNPs) exists. Aims: Our objective was to molecularly characterize the exon 28 of the VWF gene in the three major ethnic groups of Nigeria. Subjects and Methods: We recruited 90 subjects, 45 had a history of bleeding. Questions included those used in the Zimmerman Program for the Molecular and Clinical Biology of von Willebrand disease (VWD), and the bleeding scores were calculated using the Molecular and Clinical Markers for the Diagnosis and Management of type 1 VWD scoring system. Full blood count, coagulation profile, VWF:antigen level and VWF:collagen-binding activities were carried out. Data were analyzed using GraphPad Prism (5.03). GraphPad Software, Inc USA. The BigDye terminator chemistry was used to determine the nucleotide sequences of VWF gene (exon 28). Results: Eight SNPs were identified, rs 216310 (T1547), rs 1800385 (V1565L), rs1800384 (A1515), rs1800383 (D1472H), rs 1800386 (Y1584C), rs 216311 (T1381A), rs 216312 (intronic) and rs 1800381 (P1337). Conclusion: The SNPs rs 216311, rs 1800383 and rs 1800386 associated significantly with bleeding in study subjects. rs1800386 occurred in all with bleeding history, no ethnic variations were noted.
  - 1,953 202
Acute kidney injury in Lagos: Pattern, outcomes, and predictors of in-hospital mortality
BT Bello, AA Busari, CO Amira, YR Raji, RW Braimoh
February 2017, 20(2):194-199
DOI:10.4103/1119-3077.183258  PMID:28091436
Context: The pattern of acute kidney injury (AKI) differs significantly between developed and developing countries. Aims: The aim of th study was to determine the pattern and clinical outcomes of AKI in Lagos, Southwest Nigeria. Settings and Design: A retrospective review of hospital records of all patients with a diagnosis of AKI over a 20-month period. Subjects and Methods: Records of 54 patients were reviewed. Information retrieved included, bio-data, etiology of AKI, results of laboratory investigations, and patient outcomes. Statistical Analysis Used: Continuous data are presented as means while categorical data are presented as proportions. The Student's t-test was used to compare means while Chi-square test was used to compare percentages. Logistic regression analysis was used to determine the factors that predicted in-hospital mortality. Results: Twenty-seven (50%) of the patients were male. The mean age of the study population was 39.7 years ± 16.3 years. Sepsis was the etiology of AKI in 52.1% of cases. Overall, in-hospital mortality was 29.6%. Patients who died had a shorter mean duration of hospital stay (9.2 days vs. 33.9 days [P < 0.01]), lower mean serum bicarbonate (19.5 mmol/L vs. 22.9 mmmol/L [P = 0.02]), were more likely to be admitted unconscious (82.4% vs. 17.6% [P = 0.01]) and to have been admitted to the Intensive Care Unit (37.5% vs. 7.9% [P = 0.01]). In addition, when dialysis was indicated, patients who did not have dialysis were more likely to die (58.3% vs. 41.7% [P = 0.02]). Conclusions: The pattern of AKI in this study is similar to that from other developing countries. In-hospital mortality remains high although most of the causes are preventable.
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Clinical evaluation of microhybrid composites in noncarious cervical lesions: 24-month results
D Tuncer, Ç Çelik, K Yamanel, N Arhun
February 2017, 20(2):176-181
DOI:10.4103/1119-3077.178913  PMID:28091433
Objective: To evaluate the clinical performance of two different microhybrid resin composites in noncarious cervical lesions (NCCLs) after 24 months. Subjects and Methods: Ninety-seven NCCLs were restored with either TPH Spectrum (n = 48) or Filtek Z250 (n = 49) using an etch-and-rinse adhesive in 20 patients. The restorations were clinically evaluated using modified United States Public Health Service criteria for retention, color match, marginal discoloration, marginal adaptation, surface texture, anatomic form, postoperative sensitivity, and secondary caries. The restorations were assessed 1 week after placement (baseline) and after 6, 12, and 24 months. Restoration survival rates were calculated using the Kaplan–Meier procedure estimator, and a log-rank test was used to compare the survival distributions (P < 0.05). Statistical analysis was undertaken using Pearson's Chi-square test and Fisher's exact test to assess differences among the restorative materials (P < 0.05). Cochran's Q-test was employed for evaluating differences in the same restorative material between recall periods. Results: The retention rates were 100% at 6 months, 89.6% and 91.8% at 12 months, and 85.4% and 89.8% at 24 months for TPH and Z250, respectively. TPH showed a statistically significant difference in marginal discoloration between the baseline and 24 months results (P < 0.05). Both TPH and Z250 showed statistically significant differences in marginal adaptation between the baseline and 24 months results (P < 0.05). Conclusion: Over the 24-month period, both microhybrid resin composites demonstrated acceptable clinical results in NCCLs.
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Refractive aim and visual outcome after phacoemulsification: A 2-year review from a Tertiary Private Eye Hospital in Sub-Saharan Africa
O Oderinlo, AO Hassan, FO Oluyadi, AO Ogunro, ON Okonkwo, MO Ulaikere, O Ashano
February 2017, 20(2):147-152
DOI:10.4103/1119-3077.183249  PMID:28091428
Aim: To review the short-term visual outcome of phacoemulsification in adults with uncomplicated cataracts in Eye Foundation Hospital, Lagos, Nigeria. Materials and Methods: A retrospective review of records of patients that had phacoemulsification between January 2012 and December 2013 in Eye Foundation Hospital, Lagos, Nigeria, was done. Preoperative visual acuity, refractive aim, intraoperative complications, postoperative unaided, and best-corrected visual acuity at 1 and 3 months were analyzed. Only eyes of adults that had phacoemulsification for uncomplicated cataracts were included in the study, all pediatric cataracts and eyes with ocular comorbidities were excluded. Common ocular comorbidities excluded were corneal opacity/corneal scar, glaucoma, uveitis, pseudo exfoliation syndrome, moderate and severe nonproliferative diabetic retinopathy, macula edema, proliferative diabetic retinopathy, eye trauma, age-related macular degeneration, previous corneal surgery, glaucoma surgery, and previous or simultaneous vitreoretinal surgery. Results: A total of 157 eyes of 119 patients who met the inclusion criteria were analyzed. There were 60 (50.4%) females and 59 (49.6%) males, with age range from 31 to 91 years and a mean of 65.3 ± 11.10 years. Only eyes with available data were analyzed at 1 and 3 months postoperatively. In 112 eyes (85.7%), the refractive aim was met, 21 eyes (14.3%) did not meet their refractive aim, 20 eyes (12.7%) were excluded, the refractive aim could not be determined from the records as surgeons did not specify, and in 4 eyes, the required information was missing from the case files. An unaided visual acuity of 6/18 and better was achieved in 134 eyes (85.4%) at 1 month and 126 eyes (85.9%) at 3 months whereas best-corrected vision of 6/18 and better was achieved by 145 eyes (92.4%) at 1 month and 146 eyes (98.0%) at 3 months. Conclusion: Surgical outcomes after phacoemulsification are comparable with international benchmarks for good outcomes, with 85.4% of eyes achieving within 1 D of spherical equivalent of the refractive aim, 92.4% and 98.0% of eyes also achieving best-corrected visual acuities of 6/18 and better at 1 and 3 postoperative months, respectively. Unaided vision of 6/18 and better was also achieved in 85.4% and 85.9% at 1 and 3 postoperative months, respectively.
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Chronic kidney disease in Chinese postmenopausal women: A cross-sectional survey
F Pei, Z Zhou, Y Li, Y Ren, X Yang, G Liu, Q Xia, Z Hu, L Zhang, M Zhao, H Wang
February 2017, 20(2):153-157
DOI:10.4103/1119-3077.198314  PMID:28091429
Introduction: Despite advances in the management of chronic kidney disease (CKD), there is ongoing uncertainty regarding the prevalence of CKD in postmenopausal women. This study was designed to investigate both CKD prevalence and related risk factors in a cohort of postmenopausal Chinese women. Materials and Methods: A cross-sectional survey was administered to a nationally representative sample of female Chinese participants, including a total of 47,204 subjects, among whom were 8573 self-reported postmenopausal women. CKD was defined as either an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2 body surface area or else the presence of albuminuria. All subjects completed a questionnaire that included items related to their lifestyles and medical histories. Data were collected on blood pressure, serum creatinine, urinary albumin, and urinary creatinine. Risk factors correlated with the presence of CKD were analyzed using logistic regression analysis. Results: Results showed that the adjusted prevalence of an eGFR of < 60 mL/min/1.73 m2 among this postmenopausal survey cohort was 5.3% (95% confidence interval: 4.7–6.1) and of albuminuria, 12.4% (11.7–13.1). The overall prevalence of CKD in this postmenopausal cohort was 16.6% (15.8–17.4). Factors associated with kidney pathology included nephrotoxic drug use, history of cardiovascular disease, hyperuricemia, hypertension, and diabetes (the lower limit of multivariable adjusted odds ratios > 1). Conclusion: The current study revealed a high prevalence of CKD in Chinese postmenopausal women. These results provide baseline data for disease prevention and treatment.
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Impact of informed consent on patient decisions regarding third molar removal
G Göçmen, O Atalı, O Gonul, K Goker
February 2017, 20(2):158-162
DOI:10.4103/1119-3077.164354  PMID:28091430
Purpose: We investigated whether the order in which patients learned about complication risks affected their anxiety about and willingness to undergo the removal of their third molar. Materials and Methods: In total, 171 patients (65 males, 106 females) were included in the study. The distributions of gender and the position of mandibular third molars were recorded. The Amsterdam Preoperative Anxiety and Information Scale and Spielberger's State–Trait Anxiety Inventory were used to evaluate anxiety. Associations of anxiety with timing (pre/post), gender, and the order in which the information was presented in the consent form were analyzed. Results: The most common angulations were horizontal (26.3%) and mesioangular (60.2%), and these were more common in women. All patients obtained significantly higher anxiety scores after reading the consent form. There was no significant difference in anxiety scores, according to the order of information. In total, 88 patients underwent surgery, whereas 83 postponed the extraction after reading the consent form. Women were significantly more anxious than men before the procedure. Patients showed lower anxiety levels after the procedure (P < 0.05). Conclusion: Increased anxiety was not associated with the order in which information was presented in the informed consent form. However, the informed consent form itself was a major contributor to increased patient anxiety. Further studies regarding the contents of consent forms and their effects on patient anxiety and decisions regarding third molar removal are needed.
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Determinants of quality of life among community-dwelling persons with spinal cord injury: A path analysis
END Ekechukwu, JO Ikrechero, AO Ezeukwu, AV Egwuonwu, L Umar, UM Badaru
February 2017, 20(2):163-169
DOI:10.4103/1119-3077.187328  PMID:28091431
Context: Recent advancement in technology and medical care has resulted in an increase not only in disability arising from spinal cord injury (SCI) but also its attendant challenges such as poor quality of life (QoL). Aim: To test a theoretical model of predictors of QoL among persons with SCI. Settings and Design: Study was conducted in the South Eastern Nigeria. A longitudinal study design was employed. Materials and Methods: A total of 64 persons with SCI discharged from in-hospital admission participated in this study. QoL, state self-esteem (SSE), social support satisfaction (SSS), and functional potentials (FPs) were assessed using short form health survey-12, SSE scale, social support questionnaire 6, and spinal cord independent measure III, respectively. Their motor function (MF) and sensory function (SF) were assessed using the motor and sensory subscales of American Spinal Cord Association impairment scale. Statistical Analysis Used: Data obtained were analyzed using path analysis. The level of significance was set at α = 0.05. Results: Most of the participants were male (92.3%) with incomplete type of SCI (65.4%). The selected variables (SSE, SSS, FP, MF, and SF) significantly predicted a large percentage (R2 = 0.861) of QoL. All the predictor variables except age had a direct significant effect on QoL (P < 0.05). The trimmed model revealed that SSS (β =3.04, P = 0.002) had the highest direct effect on QoL. Conclusions: This study revealed that the combined assessment of SSE, SSS, FP, MF, and SF can be used to predict QoL significantly. Moreover, psychosocial factors are as important as clinical (biological) factors in predicting the outcomes of SCI, especially their QoL. Thus, the study buttresses the need to emphasize on the biopsychosocial model in the rehabilitation of persons with SCI.
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