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   2018| October  | Volume 21 | Issue 10  
    Online since October 8, 2018

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Severe falciparum malaria in children in Enugu, South East Nigeria
BO Edelu, IK Ndu, OO Igbokwe, ON Iloh
October 2018, 21(10):1349-1355
DOI:10.4103/njcp.njcp_140_18  PMID:30297570
Introduction: Severe malaria remains one of the leading causes of morbidity and mortality in sub-Saharan Africa and parts of Asia despite several efforts in prevention and management. The prevalence and pattern of presentation may vary from one location to another and from one age group to another. Objectives: This study was undertaken to review the prevalence and pattern of severe malaria among children presenting in the two tertiary hospitals in Enugu, south-east Nigeria. Methods: The case records of children presenting with malaria in the two tertiary hospitals in the state were retrieved and the necessary information were obtained using a structured questionnaire. Results: The children aged from 1 month to 184 months (15 years), with a median age of 36 months and mean age of 49.2 ± 42.7 months. About two-thirds (68/102, 66.7%) of the children were under the age of 5 years, with only 6 of them (8.8%) being 6 months and below. There were significantly more males than females (χ2 = 6.48, P = 0.01); with a M:F ratio of 1.55:1. The peak of presentation was from August and November. Prostration, respiratory distress and severe anaemia were the commonest features of severe malaria, while shock, acute renal failure and abnormal bleeding were the least presenting features Of all the features, only severe anaemia was significantly related to age, (χ2 = 5.027, P = 0.02). Sixty-one (59.8%) of the children had one or more co-morbidities. There were 2 deaths, giving a case fatality rate of 1.96%. Conclusion: Early presentation will significantly reduce blood transfusions, prolonged admission and death in children with severe malaria.
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Rheumatoid arthritis in temporo-mandibular joint: A review
G Savtekin, AO Sehirli
October 2018, 21(10):1243-1246
DOI:10.4103/njcp.njcp_117_18  PMID:30297553
This article summarizes the temporomandibular joint (TMJ) rheumatoid arthritis (RA). In particular, TMJ-RAs are collected in a short summary by examining every aspect of RA; the treatment of TMJ-RA is also briefly mentioned. TMJ-RA is usually characterized by bilateral pain, tenderness and swelling, and limitation of jaw movements. Due to these symptoms, patients may experience limitations in their daily activities, such as eating, speaking, and swallowing. MEDLINE and Scopus databases were searched electronically using the terms “temporomandibular joint” and “rheumatoid arthritis.” The electronic search includes articles or books published in English and December 2017. A search of the reference lists of selected articles was also carried out.
  2,622 559 -
Digital evaluation of the dimensional accuracy of four different implant impression techniques
TB Ozcelik, I Ozcan, O Ozan
October 2018, 21(10):1247-1253
DOI:10.4103/njcp.njcp_284_17  PMID:30297554
Aims: The aim of this study was to compare the dimensional accuracy of four different implant impression techniques of a mandibular edentulous model with five parallel implants. Materials and Methods: Five dental implants were placed in an edentulous mandibular model in parallel. A total of forty impressions were obtained using four different impression techniques. In Group 1 (G1) and Group 2 (G2), closed tray impressions with and without plastic caps, respectively, were used. In Group 3 (G3) and Group 4 (G4), open tray impressions with a direct splinted technique and an improved direct splinted technique, respectively, were used. All the impressions were poured with Type IV dental stone. Master model and study casts were scanned with a laser optical scanner and aligned by observing the superpositions of the anatomical landmarks using a software program. Statistical Analysis Used: Fifty measurements of the apical, coronal, and angular discrepancies of the master and study casts were obtained (n = 50) and statistically analyzed using a one-way analysis of variance and post hoc (least significant difference ) and Friedman's tests. Results: The lowest accuracy was obtained from G2 when the angular (1.48°), coronal (0.32 μm), and apical (0.14 μm) deviations were tested (P < 0.05), whereas no statistically significant differences were found among the other groups (P < 0.05). Conclusions: In cases with five parallel mandibular implants, improved accuracy was achieved using the direct splinted technique, the improved direct splinted technique, or the closed tray impression technique with snap on plastic caps.
  1,313 342 -
Dental anxiety and oral health-related quality of life in children following dental rehabilitation under general anesthesia or intravenous sedation: A prospective cross-sectional study
SE Guney, C Araz, RE Tirali, SB Cehreli
October 2018, 21(10):1304-1310
DOI:10.4103/njcp.njcp_150_18  PMID:30297563
Purpose: The study aimed to investigate dental anxiety and oral health-related quality of life among children undergoing dental rehabilitation under general anesthesia (GA) and intravenous sedation (IVS). Materials and Methods: Participants were 99 healthy children aged 3–5 or 6–12 years operated under GA or IVS. Dental anxiety before treatment and 1 month postoperatively were measured using the Frankl behavior scale (FBS), the venham picture test (VPT), the early childhood oral health impact scale (ECOHIS), and the children's fear survey schedule-dental subscale (CFSS-DS). Data were analyzed using Student's t-test and Mann–Whitney U-test. Results: ECOHIS scores decreased in all groups. VPT scores increased in the 3–5-year-olds treated under GA (P = 0.003). Postoperative CFSS-DS anxiety scores were lower in IVS groups. FBS scores were significantly higher for both age groups (P < 0.001). There was no effect of numbers of extracted or treated teeth. Conclusions: Dental rehabilitation under GA and IVS improved the quality of life and dental behavior. In the 6–12-year-olds, there was no statistically significant difference between children undergoing dental operations under GA and those undergoing dental operations under IVS. Dental anxiety decreased in 3–5-year-olds after treatment under GA but not after IVS.
  1,323 309 -
Preoperative Vitamin D levels and respiratory complications of general anesthesia
N Tas, T Noyan, O Yagan, V Hanci, E Canakci
October 2018, 21(10):1278-1283
DOI:10.4103/njcp.njcp_102_18  PMID:30297559
Aims: This research aims to investigate whether there is a correlation between the respiratory complications occurring in patients under general anesthesia and preoperative Vitamin D levels. Settings and Design: The study was a prospective observational study. Materials and Methods: This study included 95 adult cases. The cases had total 25-hydroxyvitamin D (25OHD) levels identified in blood samples before the operation. Patients given routine general anesthesia and were assessed in terms of respiratory complications during anesthesia induction, extubation, anesthesia recovery, and the first 24-h postoperative. Statistical Analysis Used: The Shapiro–Wilk test, Student's-t-test, one-way ANOVA test, Pearson correlation coefficient, and Chi-square tests were used. Results: The mean 25OHD vitamin level identified in the preoperative period was 13.00 ± 6.57 ng/mL, with 25OHD vitamin levels found to be significantly low in female cases compared to male cases (P < 0.05). There was a statistically significant negative relationship between age and 25OHD vitamin levels identified (P = 0.045). When assessed in terms of surgery types, there was no significant difference found in Vitamin D levels in terms of surgery type. When examined for complications in the induction, extubation period, and postoperative recovery period, there was a significant difference identified between 25OHD vitamin levels and these complications (P < 0.01). Conclusions: This research observed that patients with low preoperative 25OHD vitamin levels encountered respiratory complications related to general anesthesia more often. Especially, in the early postoperative period, there is a very significant difference between complications and low 25OHD vitamin levels.
  1,356 153 -
A community-based surveillance of gastrointestinal helminthiasis among pregnant women in Ibadan, South West Nigeria
AI Ayede, FA Bello, AO Kehinde
October 2018, 21(10):1368-1373
DOI:10.4103/njcp.njcp_196_17  PMID:30297573
Background: Intestinal helminthiasis is a major public health problem in Africa. Helminthic infection in pregnant women causes loss of appetite, poor nutrient absorption, gastrointestinal impairment, iron deficiency, and iron deficiency anemia resulting in low birth weights and preterm births. The main aim of this study is to assess the prevalence of helminthic infections in pregnant women in rural and peri-urban communities of Ibadan. Materials and Methods: A cross-sectional descriptive study was carried out at the antenatal clinics of 12 selected primary health centers and mission homes in Ibadan, Nigeria. Open- and closed-answer questionnaires were administered to 604 consenting pregnant women, who provided fresh stool samples for microscopy. Helminthic quantification was carried out by the Kato-Katz technique. Proportions were compared using Chi-squared with IBM® SPSS® Statistics 21 for analysis. Statistical significance was set at P < 0.05. Results: Eighty-nine stool samples (14.7%) were positive for helminthiasis. Most had roundworms (13.6%); 13 (2.2%) had hookworms. The mean arithmetic eggs per gram of feces were 2,124 and 248, respectively. No participant had a heavy intensity infection; nearly all were of low intensity. Participants (P = 0.005) and their husbands (P = 0.005) who had higher education were less likely to have helminthiasis. Conclusion: These communities are classified as Category III, having a low prevalence and low intensity infection. Therefore, prophylactic anti-helminthic treatment in pregnancy is not recommended. The inverse relationship with education may be a function of better living conditions. Better hygiene should be advocated.
  1,336 97 -
Frequency of audiological complaints in patients with fibromyalgia syndrome and its relationship with oxidative stress
TT Koca, M Seyithanoglu, S Sagiroglu, E Berk, H Dagli
October 2018, 21(10):1271-1277
DOI:10.4103/njcp.njcp_95_18  PMID:30297558
Aim: Central sensitization-related neuroaudiological symptoms are frequently seen in patients with fibromyalgia syndrome (FMS). This study aimed to evaluate the audiological signs and symptoms in patients with FMS and explore their relationship with oxidative stress markers. Methods: This prospective controlled cross-sectional study compared the serum myeloperoxidase, superoxide dismutase, glutathione peroxidase (GPx), nitric oxide (NO), and malondialdehyde (MDA) concentrations in 44 patients with FMS diagnosed according to the 2010 American College of Rheumatology criteria and 44 healthy volunteers. FMS severity was assessed using the visual analog scale and Fibromyalgia Impact Questionnaire. An audiological assessment including vocalizations, vertigo, balance problems, and hearing problems was done to all participants. Results: The two groups were of similar age (P = 0.24), gender (P = 0.40), and weight distribution (P = 0.6). Vertigo, tinnitus, hearing, and balance complaints (P = 0.01/P = 0.00/P = 0.00/P = 0.01) were significantly higher in the FMS group. All subunits and total scores of dizziness handicap inventory were significantly higher (P = 0.00/P = 0.00/P = 0.01/P = 0.01) in the FMS group. An antioxidant GPx and oxidant parameters such as NO and MDA were found to be significantly higher (P = 0.00/P = 0.01/P = 0.02). The hearing assessments at frequencies between 250 and 12,000 Hz showed a significant difference between the two groups (high hearing frequencies in the FMS group) in audiometry. No significant difference was found between the two groups in terms of the presence of stabilo-acoustic reflex, intraaural pressure, and compliance (P = 0.18/P = 0.33/P = 0.41) in tympanogram. Conclusions: Patients with FMS have high levels of oxidative stress markers (GPx, NO, and MDA), highly frequent audiological symptoms with high hearing frequencies in audiometry, independent of disease severity.
  1,217 184 -
Chemical analysis of uroliths: A two-center study of doctors' practice and perspective in South-East, Nigeria
IA Meka, UC Dilibe, MC Ugonabo, UU Ogbobe
October 2018, 21(10):1265-1270
DOI:10.4103/njcp.njcp_250_18  PMID:30297557
Introduction: Urolithiasis is a global disease condition secondary to a variety of factors, and sometimes associated with serious complications. Determination of stone composition is important in delineating causative factors. Knowledge of causative and precipitating factors aids patient management and prevention of recurrence. Objective: The authors' aim was to evaluate the practice and perspective of doctors regarding chemical analysis of stones in management of urolithiasis. Materials and Methods: This comparative cross-sectional study was done between December 2016 and May 2017 in two teaching hospitals in South-East, Nigeria. Data were collected using self-administered questionnaires. Results: In all, 88 doctors with mean (standard deviation) age of 37.3 (9.5) years participated in the study. Urinary bladder stones were the most frequently managed, 51 (58.0%); 45 (51.1%) participants do not routinely send stones for chemical analysis. All respondents (100%) agreed that stone analysis is beneficial to patient management. Conclusion: This study showed that in spite of all respondents affirming that chemical analysis of uroliths is beneficial to patient management, more than half of respondents do not routinely send stones for analysis.
  1,151 105 -
The accuracy of risk malignancy index in prediction of malignancy in women with adnexal mass in Basrah, Iraq
JN Al-Asadi, SK Al-Maliki, F Al-Dahhhan, L Al-Naama, F Suood
October 2018, 21(10):1254-1259
DOI:10.4103/njcp.njcp_424_16  PMID:30297555
Background: Adnexal masses indicate a variety of gynecological and nongynecological disorders, which may be benign or malignant. Early detection of malignancy is crucial to a proper planning of treatment and improvement of survival. Objective: To determine the accuracy of risk of malignancy index (RMI) in prediction of malignant adnexal mass. Subjects and Methods: This was a prospective multicenter study which included 101 women with adnexal masses. RMI2 with cutoff value of 200 was used to discriminate between benign and malignant tumors. Histopathological examination was used to confirm the final diagnosis. Results: Out of the studied women, 20.8% proved to have malignant tumors. The RMI showed a sensitivity of 100%, a specificity of 96.2%, a positive predictive value of 87.5%, and a negative predictive value (NPV) of 100%. The RMI identified malignant cases more accurately than any individual criterion in diagnosing ovarian cancer. The receiver operating characteristic analysis showed that the area under the curve of the RMI, CA 125, ultrasound, and menopausal status were significantly high with values of 1.0, 0.99, 0.86, and 0.85, respectively. Conclusion: The RMI is a simple sensitive, practical, and reliable tool in preoperative discrimination between benign and malignant adnexal masses that can facilitate selection of cases for timely referral to oncology center.
  1,032 198 -
A profile of individuals accompanying patients in the emergency department: An analysis of 5046 cases
S Yeniocak, H Topacoglu
October 2018, 21(10):1260-1264
DOI:10.4103/njcp.njcp_86_17  PMID:30297556
Background: There has been no comprehensive study on identifying the sociocultural characteristics and the factors affecting the number of relatives and/or friends accompanying patients. The purpose of this study was to identify these sociocultural characteristics and the factors affecting this. Materials and Methods: The research was designed as a cross-sectional, one-to-one interview study. A study population representing one in three patients aged over 18 years and presenting consecutively to the emergency department over a 1-month period was constituted with systematic sampling. A sample size of at least 4483 patients was planned with a 1% margin of error and 90% power. Results: Two thousand nine hundred and fifty (58.5%) of the 5046 patients included in the study were male. Patients' mean age was 38.4 ± 17.4 years (median 34 years). At least one friend or relative accompanied 3690 (73.1%) patients, and the mean number of accompanying individuals was 1.50. A higher level of accompaniment and a higher mean number of accompanying individuals were determined in patients presenting to the emergency department outside working hours, with altered mental state, attending hospital for the first time, with chronic disease, requiring hospitalization, in illiterate patients, in patients who had not studied at university, in patients aged 65 or over, and in patients presenting to hospital and the emergency department for the first time compared to other parameters (<0.01 for all). Conclusion: The number of people accompanying patients increases with sociocultural factors such as gender, age, literacy, and education level. In addition, similar increase can be observed with patients coming to emergency department by ambulance or having a chronic disease or arrive with lost consciousness.
  1,037 190 -
Crohn's disease with positive Ziehl–Neelsen stain: Three case reports
D Zhou, Q Ouyang, M Xiong, Y Zhang
October 2018, 21(10):1387-1390
DOI:10.4103/njcp.njcp_31_18  PMID:30297577
Because of the similarity of the clinical symptoms, endoscopic, and pathological features, the differential diagnosis between Crohn's disease (CD) and intestinal tuberculosis (ITB) remains difficult, especially in a high-incidence area of tuberculosis (TB). Here we reported three patients with positive Ziehl–Neelsen stain in endoscopic mucosal biopsy specimens. They had a poor response to anti-TB therapy but a good response to immunosuppresses, infliximab, or surgery, and were finally diagnosed as CD. It was not clear that they were CD concomitant with mycobacteria infection or CD induced by mycobacteria infection. Further studies including more clinical cases and related animal models are needed. Our cases highlight the importance of considering the presence of CD in patients with positive Ziehl–Neelsen stain, which were failure to respond to anti-TB treatment.
  1,058 135 -
Effect of chitosan on sealer penetration into the dentinal tubules
B Kesim, AK Burak, Y Ustun, E Delikan, A Gungor
October 2018, 21(10):1284-1290
DOI:10.4103/njcp.njcp_127_18  PMID:30297560
Objective: The objective of this study is to compare the effectiveness of final irrigation with chitosan, ethylenediaminetetraacetic acid (EDTA), and citric acid (CA) on a resin-based sealer (AH plus sealer [Dentsply DeTrey, Konstanz, Germany]) penetration into dentinal tubules using confocal laser scanning microscopy. Materials and Methods: Seventy recently extracted human mandibular premolars were instrumented and irrigated with sodium hypochlorite (NaOCl), then divided into four groups according to the final irrigation regimen used: (1) the EDTA group: 17% EDTA + 2.5% NaOCl, (2) the CA group: 10% CA + 2.5% NaOCl, (3) the chitosan group: 0.2% chitosan + 2.5% NaOCl, and (4) the control group: 2.5% NaOCl. All teeth were obturated using the cold lateral condensation technique with gutta-percha and AH Plus sealer labeled with fluorescent dye. The apical 2 mm of specimen was discarded, and slices were obtained for apical, middle, and coronal thirds of the root with 1 mm intervals. Maximum, mean, and percentage of sealer penetration (SP) inside tubules were measured using confocal laser scanning microscopy. Results: The percentage of SP was significantly higher in chitosan, EDTA, and CA group than control group for coronal thirds (P < 0.05), whereas there was no significant difference among all groups for middle and apical thirds. Chitosan and EDTA showed increased mean values of SP depth for middle thirds (P < 0.05). In all sections, the maximum depth of SP was significantly lower in EDTA group than other groups (P < 0.05). Conclusions: Chitosan, EDTA, and CA significantly improved the percentage of SP for coronal thirds.
  1,026 166 -
Metastatic squamous cell cancer with unknown primary origin in the mediastinal lymph node
M Agca, A Kosif
October 2018, 21(10):1384-1386
DOI:10.4103/njcp.njcp_149_18  PMID:30297576
Metastatic tumors with unknown primary origin are a group of heterogeneous tumors with undetectable primary tumor site on admission. They have the common properties of rapid and aggressive progression and unpredictable metastases. They form 3%–5% of all cases with cancer and the fourth-most common cause of cancer-related deaths. The histological type of these tumors is commonly (90%) adenocarcinoma, whereas 5% are squamous cell carcinomas. Metastasis is observed in the liver, lungs, and bones. Mediastinal lymph node metastasis is extremely rare. They have a poor prognosis and the mean survival is shorter than a year. The case we have presented is a rare case due to its mediastinal lymph node involvement among tumors with unknown origin and squamous cell histological subtype.
  1,022 127 -
Impact of cowpea fortified cookies on anthropometric and micronutrient status of primary school children: A randomized, single-blind controlled trial
Rufina N B Ayogu, Tochukwu P Onah
October 2018, 21(10):1341-1348
DOI:10.4103/njcp.njcp_72_18  PMID:30297569
Background: Micronutrient deficiencies are public health problems among school children. Food-to-food fortification may reduce the prevalence of these deficiencies. Aim: To assess the impact of cowpea (Vigna sinensis) fortified cookies on weight, height, body mass index (BMI), hemoglobin, serum vitamin A, and zinc status of primary school children aged 6–12 years. Methods: A randomized single-blind controlled trial was conducted for 4 weeks among 17 pupils who were voluntarily recruited and randomly assigned to experimental (Group A) and control (Group B) groups. Group A was fed wheat cookies incorporated with cowpea in a ratio of 60:40, while Group B received 100% wheat cookies. Data were collected through questionnaire, anthropometry, and biochemical analysis. Statistical analysis involved descriptive statistics and t-test. Significance was set at P < 0.05. Results: The study involved 17 school children out of which 10 (58.8%) were boys and 7 (41.2%) were girls; 12 (70.6%) were 10–12 years old and 4 (23.5%) were in lower primary (1–3). Group A had increases in hemoglobin (15.5%), serum ferritin (28.3%), serum zinc (38.9%), weight (3.0%), BMI (3.4%), and serum vitamin A (26.3%); only increases in hemoglobin, serum ferritin, and vitamin A attained significance (P < 0.05). Though there was increase in weight (6.1%), BMI (5.4%), hemoglobin (5.0%), serum ferritin (16.4%), zinc (20.8%), and vitamin A (17.5%) of Group B, these increases were not significant (P > 0.05). Group A had significantly (P < 0.05) higher serum ferritin (51.3 μg/L) than Group B (44.7 μg/L). Conclusion: Consumption of cowpea fortified cookies had significant positive effects on hemoglobin, serum ferritin, and vitamin A levels of school children and should be encouraged at household and industrial levels.
  1,017 109 -
Cancer-testis antigen GAGE-1 expression and serum immunoreactivity in hepatocellular carcinoma
NX Chao, LZ Li, GR Luo, WG Zhong, RS Huang, R Fan, FL Zhao
October 2018, 21(10):1361-1367
DOI:10.4103/njcp.njcp_73_18  PMID:30297572
Aim: To explore the use of cancer-testis antigen G antigen 1 (GAGE-1) in the diagnosis and potential therapeutic targeting of hepatocellular carcinoma (HCC), we measured the expression of GAGE-1 protein levels in HCC tissues and its serum immunoreactivity in HCC patients. Materials and Methods: We detected the expression of GAGE-1 protein in HCC by immunohistochemistry (IHC). We then analyzed the clinical significance of GAGE-1 expression in HCC with respect to clinicopathological parameters. We observed positive anti-GAGE-1 antibody reactivity in HCC patient serum, liver cirrhosis patients (LC), hepatitis B patients (HB), and normal human individuals (NHS) by enzyme-linked immunosorbent assay. Results: The IHC results showed that the positive rates of GAGE-1 protein expression in cancer tissues and adjacent tissues were 43.3% (26/60) and 5% (3/60), respectively. The expression level of GAGE-1 protein in HCC tissues was significantly higher than that in tumor-adjacent tissues (P < 0.05). Positive GAGE-1 protein expression was not correlated with clinicopathological parameters (P > 0.05). Positive serum anti-GAGE-1 antibody reactivity in HCC patients, LC, HB, and NHS was 23.33% (14/59), 13.1% (8/61), 3.3% (2/60), and 3.4% (2/59), respectively. The frequency of anti-GAGE-1 antibody-positive sera in HCC patients and LC was significantly different than that in HB and NHS (P < 0.01), but no significant differences were found between HCC patients and LC (P = 0.485) or between HB and NHS (P = 0.410). Positive anti-GAGE-1 antibody reactivity was not correlated with clinicopathological parameters (P > 0.05). Conclusion: These data illustrate that the GAGE-1 protein exhibits moderate cancer-restricted pattern of expression and immunogenicity, laying the foundation for the application of GAGE-1 in immunotherapy and for the diagnosis of HCC.
  922 180 -
Intrauterine insemination in ovulatory infertile patients
C Soysal, U Ozmen
October 2018, 21(10):1374-1379
DOI:10.4103/njcp.njcp_64_17  PMID:30297574
Aim: Although there are many studies in literature comparing intrauterine insemination (IUI) and timed intercourse, there are only a few studies examining the use of clomiphene citrate (CC) in ovulatory infertile patients. The aim of this study was to compare IUI following CC-induced ovulation and timed intercourse following CC-induced ovulation in ovulatory infertile patients. Methods: Hundred patients who had IUI or timed intercourse following ovulation induction (OI) via CC between 2012 and 2014 are prospectively scanned. Both groups were consisted of 50 patients. Both in groups 1 and 2 patients, the treatment with clomiphene citrate was started on the 3rd day of the menstrual cycle with a dose of 50 mg/day and was continued for 5 consecutive days. On the 13th day of the cycle, the patients were called for examination and folliculometry tests were performed via transvaginal ultrasonography. Human chorionic gonadotropin (HCG, a prepared syringe containing 250 μg/0.5 ml [6,500 IU equivalent] choriogonadotropin alpha) was given to all patients with a sufficient size follicle (18–20 mm). Group 1 patients were recommended to have coitus regularly for a week after the HCG treatment. In group 2, IUI was performed 36 h after the HCG treatment. Results: Clinical pregnancy was provided in 28 patients in 100 patients. In group 1, the pregnancy rate per person was 6%, the pregnancy rate per cycle was 2.3%, and live birth rate was 6%. In group 2, the pregnancy rate per person was 22%, the pregnancy rate per cycle was 8.3%, and live birth rate was 23%. A statistically significant difference was observed between groups 1 and 2 in terms of pregnancy per person rate, pregnancy per cycle rate, and live birth rate. Conclusion: In the patients who had OI via CC, the pregnancy rates obtained with IUI were statistically significantly higher than timed intercourse.
  914 166 -
Benefits of anticitrullinated peptides examination in rheumatoid arthritis
G Belakova, V Manka, E Zanova, P Racay
October 2018, 21(10):1380-1383
DOI:10.4103/njcp.njcp_411_17  PMID:30297575
Background: Anti-citrullinated peptides antibodies (ACPA) are specific for rheumatoid arthritis and have been implicated in disease pathogenesis. ACPA examination is a new component of ACR/EULAR 2010 classification criteria for rheumatoid arthritis. ACPA positivity predicts a more erosive disease course with severe joint damage and extra-articular manifestations. Objectives: To evaluate the benefits of ACPA examination in patients with early undifferentiated arthritis and patients with rheumatoid arthritis. Methods: We examined patients with arthritis and tested them for ACPA positivity. In every individual patient we evaluated if ACPA examination was necessary to establish the diagnosis of rheumatoid arthritis, or to change treatment, or if the diagnosis could have been established without ACPA examination (ACR/EULAR 2010 classification criteria was met without ACPA scoring). Results and Conclusions: The study was placed in Slovak Republic. We examined 833 patients with arthritis. There were 43 patients, or 62% of a subgroup of 69 who were ACPA positive whose ACPA examination was not needed—ACR/EULAR criteria was met without ACPA scoring. This number represents 5.1% of the total number examined. There were 15 patients, or 22% of the subgroup and 1.8% of the total whose diagnosis was revised to rheumatoid arthritis due to ACPA positivity—ACR/EULAR criteria were met solely with ACPA scoring. There were 11 patients (16% and 1.3%) whose medication was changed due to ACPA positivity. ACPA examination is useful in 3.1% of all examined patients. When we correlate data on ACPA positive patients, 38% of the patients profit from ACPA examinations. Considering the relatively low price of ACPA testing, this examination should not be excluded.
  951 105 -
The effectiveness of erbium: Yttrium–aluminum–garnet laser on enamel conditioning: An In vitro study
D Odabasi, E Oruc, G Duruk
October 2018, 21(10):1317-1322
DOI:10.4103/njcp.njcp_118_18  PMID:30297565
Objectives: The purpose of this in vitro study was to investigate the effect of three different enamel surface conditioning procedures on the bonding strength of two resin-based filled fissure sealants. Material and Methods: Freshly extracted, 48 third molar teeth were used in this study. Teeth were randomly divided into three main groups as the phosphoric acid etched, erbium: Yttrium–aluminum–garnet (ER: YAG) laser etched, and the phosphoric acid plus ER: YAG laser-etched groups. The main groups further divided into two subgroups as Clinpro or Fissurit FX applied. After preparation of the enamel surfaces and application of the sealants, the samples were subjected to shear bond strength test. Results: According to statistical analysis with one-way ANOVA, the bonding strength values of the phosphoric acid groups were found significantly higher than those values obtained from the ER: YAG laser and ER: YAG laser plus phosphoric acid groups (P < 0.001). Conclusion: As a result of the study, it has been concluded that the laser application alone has no additional benefit to the acid application in terms of bonding strength.
  845 153 -
Comparing the interpretation of emergency department computed tomography between emergency physicians and attending radiologists: A multicenter study
R Guven, Ali Haydar Akca, C Caltili, MI Sasmaz, EK Kaykisiz, S Baran, L Sahin, A Ari, G Eyupoglu, V Kirpat
October 2018, 21(10):1323-1329
DOI:10.4103/njcp.njcp_22_18  PMID:30297566
Introduction: Computed tomography (CT) interpretation in the emergency department is one of the vital issues that should be carried out rapidly and accurately. The objective of this study was to examine the interpretation accuracy of emergency physicians (EPs) regarding CT scans at the emergency department for traumatic and nontraumatic purposes. Materials and Methods: The study that was carried out as a prospective, observational study was completed at four centers during 1 year. Results: Accuracy ratios of CT interpretations of EP regarding cranial injuries, thoracic injuries and vertebral spine injuries are above 95% in addition to the fact that the concordance's with the final result are perfect, the concordance with the final results of the CT interpretations of EP for abdominal injuries was moderate (<0.75). Accuracy ratios of the CT interpretations of EP for nontrauma patients were above 90% for brain hemorrhage and chest injuries and that the concordance with the final results was perfect (≥0.75). The CT interpretation accuracy rates of EP for spontaneous pneumothorax and aortic aneurysm/aortic dissection cases were 100%. CT interpretation rate of EP for pulmonary embolism was 89.4%, whereas the level of concordance with the final results was moderate (<0.75). Whereas the CT interpretation accuracy rates of EP for nontraumatic abdominal injuries varied between 83.3% and 93.1%, their levels of concordance with the final results were moderate (<0.75). Conclusions: The CT interpretations for abdominal traumatic patients in addition to pulmonary embolism and acute nontraumatic abdominal injuries should be carried out more carefully.
  824 121 -
Effect of green gold nanoparticles synthesized with plant on the flexural strength of heat-polymerized acrylic resin
P Oyar, FA Sana, B Nasseri, R Durkan
October 2018, 21(10):1291-1295
DOI:10.4103/njcp.njcp_388_17  PMID:30297561
Purpose: The aim of this study was to investigate the effect of gold nanoparticle on the flexural strength of polymethyl methacrylate (PMMA). Materials and Methods: PMMA specimens (65 mm × 10 mm × 3.3 mm) containing different sizes (45 nm, 55 nm, and 65 nm) and concentrations (0.05% and 0.2%) of gold nanoparticles were prepared, along with a control group containing no added nanoparticles. Flexural strength of all specimens was measured, and one-way ANOVA and Tukey–Kramer post hoc multiple comparisons tests were performed to identify statistical differences between groups. Results: The addition of gold nanoparticles increased the flexural strength of acrylic resin. Significantly greater increases were obtained with lower concentrations (0.05%) when compared to higher concentrations (0.20%). Conclusion: Differences in concentrations of gold nanoparticles added to PMMA have significantly different effects on PMMA flexural strength, whereas differences in sizes of gold nanoparticles added to PMMA do not significantly affect its flexural strength. Accordingly, adding gold nanoparticles to PMMA may enhance the mechanical properties of denture bases used in clinical practice.
  798 147 -
Effects of thoracic epidural or intravenous analgesia on the neutrophil-to-lymphocyte ratio in thoracotomy cases
M Alkan, FD Erkent, Ali Celik, A Gokce, M Arslan, Y Unal
October 2018, 21(10):1337-1340
DOI:10.4103/njcp.njcp_106_18  PMID:30297568
Background and Purpose: Postoperative pain is a significant problem in thoracotomy patients. Our aim in this study was to investigate the relationship between postoperative pain and neutrophil-to-lymphocyte ratio (NLR) which is a marker of acute inflammatory response. Materials and Methods: Thoracic epidural or intravenous analgesia was administered to thoracotomy patients who elected to undergo a planned surgery. Patients were divided into two groups according to the analgesia method applied postoperatively. Thoracic epidural analgesia was recorded as Group 1 and intravenous analgesia as Group 2. Whole blood counts were recorded from preoperative and postoperative 24th- and 48th-hour routine blood samples, and NLRs were recorded as retrospective file scanning. Postoperative 24th- and 48th-hour NLRs and preoperative NLR values were recorded. Results: Demographic data of the patients included in the study were similar except for age. Preoperative NLR was significantly higher in Group 1 at 3.50 (P = 0.004) than in Group 2 at 2.51. Postoperative NLRs were similar among both groups. Postoperative NLR values at both the 24th- and 48th-hour increased by4.9 times in Group 1 and 9.23 times in Group 2 from the 24th-hour preoperative period, when the preoperative NLRs were evaluated. The rate of increase in Group 1 was significantly lower than in Group 2 (P = 0.006). Conclusion: Postoperative NLR alterations when compared with preoperative values were related to the analgesic regimen used.
  816 127 -
An audit of the diagnosis and reporting of soft tissue sarcomas at the Lagos University Teaching Hospital
NZ Ikeri, AO Akinjo, OO Ajayi, AA Banjo
October 2018, 21(10):1330-1336
DOI:10.4103/njcp.njcp_340_17  PMID:30297567
Background: The effective management of patients with cancer is predicated on the right diagnoses and other relevant parameters included in the pathology report. This is particularly important in soft tissue pathology where arriving at the right diagnosis is often challenging. The aim of this study, therefore, was to perform an audit of sarcoma diagnosis and reporting in our institution. Methods: Slides of soft tissue sarcomas diagnosed in our institution over a 5-year period were reviewed with specialist soft tissue pathologists. Ancillary immunohistochemistry and fluorescent in situ hybridization were performed where necessary. The contents of the reports were assessed using a diagnostic checklist developed by the Association of Directors of Anatomic and Surgical Pathology. Results: Fifty-five of the 62 patients studied (88.7%) were correctly identified as sarcomas. However, the correct diagnoses were made in only 27 patients (43.6%). Kaposi sarcoma and dermatofibrosarcoma protuberans were the most recognized sarcomas, while leiomyosarcoma, myxofibrosarcoma, and malignant peripheral nerve sheath tumor were the least recognized sarcomas. The most reported parameters included the histologic type (100%) and size (89.7%), while the percentage of necrosis (0%) and the stage (0%) were the least reported parameters. Conclusion: A pattern based approach is important for the accurate diagnosis of soft tissue sarcomas. Some essential prognostic parameters and information needed for management were not included in the histopathology reports. The adoption of a structured reporting format and multidisciplinary team meetings will help to ensure the inclusion of such important information in the pathology report.
  839 98 -
Primary principles in developing scale with Rasch analysis: Portfolio anxiety assessment
L Tomak, O Midik
October 2018, 21(10):1296-1303
DOI:10.4103/njcp.njcp_275_17  PMID:30297562
Background: Rasch model is a useful method for developing a new scale. This study aims to determine the fitting between data obtained from answers for a portfolio anxiety scale and Rasch model and describes how the scale can be modified to increase the fitting through different steps. Materials and Methods: A portfolio scale was applied to 171 students of the Faculty of Medicine, Ondokuz Mayis University. The partial credit model was used, and fit statistics were assessed to determine the fitting of the data to Rasch model. Person separation index (PSI) was used for reliability. Results: For a satisfaction subscale, the average item fit residual value was 0.47 and the average person fit residual value was −0.29. For the item–trait χ2 interaction, P = 0.655 and PSI = 0.81. For a writing anxiety subscale, the average item fit residual value was 0.08 and the average person fit residual value was −0.24. For the item–trait χ2 interaction, P = 0.698 and PSI = 0.73. For a reflection anxiety subscale, the average item fit residual value was 0.64 and the average item fit residual value was 0.64. For the item–trait χ2 interaction, P = 0.195 and PSI = 0.73. Conclusion: The validity and reliability of Rasch analysis portfolio scale were analyzed, and items that worked well were included in the study. The results show that Rasch model provides a more accurate analysis for developing and adapting scales. Both the fit statistics and fit graphs help improve the analyses.
  821 90 -
The effect of gender differences in protracted hiccups
O Eroglu
October 2018, 21(10):1356-1360
DOI:10.4103/njcp.njcp_101_18  PMID:30297571
Background: Although little importance is attached to hiccups, they may be associated with several diseases. The purpose of this study was to investigate the effects of gender differences on types of hiccups and the relation with diseases involved in the etiology. Materials and Methods: Patients presenting to the Kirikkale University Medical Faculty Hospital with hiccups were investigated retrospectively. Patients' age, sex, duration of hiccups, additional diseases, advanced imaging results, laboratory tests, and clinical follow-up were recorded. Patients were divided into two groups; Group transient hiccup (TH) consisted of subjects with a duration of hiccups less than 48 h, and Group protracted hiccup (PH) of patients with a duration exceeding 48 h. The Chi-square test was used for comparisons, and P < 0.05 were regarded as significant. Results: Eighty-four patients were enrolled, 44.1% (n = 37) in Group TH, and 55.9% (n = 47) in Group PH. Male patients comprised 67.5% (n =25) of Group TH and 89.4% (n = 42) of Group PH (P = 0.027). The conditions most associated with hiccups were gastrointestinal system (GIS) diseases. Correlation was determined between GIS diseases and male gender (P = 0.034), no relation between other system diseases and gender. Correlation was determined between GIS diseases and protracted hiccups (P = 0.037), but no relation between other system diseases and type of hiccups. Conclusion: Protracted hiccups are more common in males. This gender variation applies particularly to hiccups of GIS origin.
  796 101 -
Efficacy of using erbium, chromium-doped: Yttrium scandium gallium garnet laser-treated dentine in a dentine barrier test device
M Ulker, HE Ulker, MS Botsali, A Dundar
October 2018, 21(10):1311-1316
DOI:10.4103/njcp.njcp_134_18  PMID:30297564
Objectives: The aim of this study was to evaluate the efficacy of using erbium, chromium-doped:yttrium scandium gallium garnet (Er,Cr:YSGG) laser-treated dentine in a dentine barrier test device. Materials and Methods: The test materials (G-Bond™ and Vitrebond™) were applied onto laser-treated or laser-untreated dentine discs. After 24 h of exposure with perfusion of the test chamber, cell survival was evaluated based on enzyme activity and compared to a nontoxic control material. The mean of the control was set to 100% viability. Data were analyzed using the one-way analysis of variance and the Tukey's honest significant difference tests. Results: The responses of bovine pulp-derived cells after exposure to G-Bond and Vitrebond on Er,Cr:YSGG laser-treated and laser-untreated dentin were statistically different from negative control group (P < 0.05). Conclusion: Er,Cr:YSGG laser treatment was not successful enough in decreasing the cytotoxic effects of the dental materials. Different parameters of Er,Cr:YSGG laser or different laser types could be investigated as an alternative to minimizing the cytotoxic effects of dental materials.
  753 89 -