Medical and Dental Consultants’ Association of Nigeria
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   2018| June  | Volume 21 | Issue 6  
    Online since June 11, 2018

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Is Low-level laser therapy and gaseous ozone application effective on osseointegration of immediately loaded implants?
IR Karaca, G Ergun, DN Ozturk
June 2018, 21(6):703-710
DOI:10.4103/njcp.njcp_82_17  PMID:29888715
Purpose: The purpose of this study was to investigate the effects of biostimulation lasers and ozone therapy on osseointegration of immediately loaded implants. Materials and Methods: A total number of 100 implants (DTI Implant Systems) were applied to 25 patients evenly. Temporary crowns were applied to each patient on the same session as the surgery. Implants were divided into four treatment groups (Group 1: low-level laser therapy (LLLT) group, Group 2: ozone therapy group, Group 3: different protocol of ozone therapy group, and Group 4: control group) each with 25 implants. The irradiations were performed with a gallium-aluminum-arsenide diode low-level laser (Laser BTL-4000) to Group 1. Ozone therapy was performed using an ozone generator (OzoneDTA) with an intraoral probe to Group 2 and Group 3. Results: In this study, the overall implant survival rate was 92% after a 6-month observation period. The implant stability quotient values were found significantly higher in Group 1 (LLLT group) and Group 3 (different protocol of ozone therapy group) than the other groups (P < 0.05). There was no significant difference in Group 2 (ozone therapy group) and the control group (P > 0.05). Conclusions: Our results suggest that both LLLT and ozone therapy with prolonged application time are promising methods to enhance bone healing around immediately loaded implants and increase implant stability; however, there is a need for more studies on this subject for these methods to become routine applications.
  3 1,674 435
Maxillomandibular advancement for obstructive sleep apnea
M Düzlü, M Yilmaz, F Karaloglu, R Karamert, VC Goksu, SA Kahraman, YK Kemaloglu
June 2018, 21(6):716-720
DOI:10.4103/njcp.njcp_176_17  PMID:29888717
Objective: We aimed to present our clinical experience with maxillomandibular advancement (MMA) for the treatment of obstructive sleep apnea (OSA) syndrome and to compare our results with literature data. Materials and Methods: The patients who were operated for OSA in the last 10 years were included in the study. A detailed patient's charts review was retrospectively performed. Inclusion criteria were to be available with preoperative and postoperative polysomnography data. Results: There were totally 7 cases who underwent MMA procedure for OSA in our clinic. The mean age was 38.6 ± 8.1 years. Surgical success was achieved in all cases (100%). The mean preoperative and postoperative apnea–hypopnea indexes were 63.3 ± 35.2 and 7.5 ± 3.4, respectively (P < 0.05). The most common complication was inferior alveolar nerve deficit following bilateral sagittal split osteotomy. The facial numbness was temporary in 4 (57.1%), and permanent in one case (14.3%). Conclusion: Our surgical results in MMA is compatible with literature data. MMA is the choice of treatment in severe OSA in case of positive airway pressure therapy intolerance.
  2 1,434 156
Assessment of apical transportation caused by nickel–titanium rotary systems with full rotation and reciprocating movements using extracted teeth and resin blocks with simulated root canals: A comparative study
M Alrahabi, MS Zafar
June 2018, 21(6):772-777
DOI:10.4103/njcp.njcp_200_17  PMID:29888726
Objectives: We compared apical transportation in the WaveOne and ProTaper Next systems, which are rotary nickel–titanium systems with reciprocating and continuous rotation movements, respectively, using manual measurements obtained from resin blocks with simulated root canals and double digital radiographs of extracted teeth. Materials and Methods: We used 30 resin blocks with simulated root canals and 30 extracted teeth for this study. The same endodontist performed root canal shaping using the WaveOne or ProTaper Next system. We assessed apical transportation by measuring the amounts (in mm) of material lost 1 mm from the apical foramen in the resin blocks and by using double digital radiography for the extracted teeth. Significant differences between groups were assessed using t-tests. P < 0.05 was considered statistically significant. Results: The amount of apical transportation differed significantly between the two systems when resin blocks were used for assessment (P < 0.05), but there were no significant differences when extracted teeth were used (P < 0.05). Conclusions: In the current study, there was no significant difference in apical transportation between natural teeth prepared using WaveOne and those prepared using ProTaper Next. However, significant differences were observed between the two systems with resin blocks. These findings indicate that the use of resin blocks is not an accurate method for apical transportation evaluation.
  1 948 136
Effects of auditory and audiovisual presentations on anxiety and behavioral changes in children undergoing elective surgery
Z Hatipoglu, E Gulec, D Lafli, D Ozcengiz
June 2018, 21(6):788-794
DOI:10.4103/njcp.njcp_227_17  PMID:29888729
Background: Preoperative anxiety is a critical issue in children, and associated with postoperative behavioral changes. Aims: The purpose of the current study is to evaluate how audiovisual and auditory presentations about the perioperative period impact preoperative anxiety and postoperative behavioral disturbances of children undergoing elective ambulatory surgery. Materials and Methods: A total of 99 patients between the ages of 5–12, scheduled to undergo outpatient surgery, participated in this study. Participants were randomly assigned to one of three groups; audiovisual group (Group V, n = 33), auditory group (Group A, n = 33), and control group (Group C, n = 33). During the evaluation, the Modified Yale Preoperative Anxiety Scale (M-YPAS) and the posthospitalization behavioral questionnaire (PHBQ) were used. Results: There were no significant differences in demographic characteristics between the groups. M-YPAS scores were significantly lower in Group V than in Groups C and A (P < 0.001 and P < 0.001, respectively). PHBQ scores in Group C were statistically higher than in Groups A and V, but, no statistical difference was found between Groups A and V. Conclusion: Compared to auditory presentations, audiovisual presentations, in terms of being memorable and interesting, may be more effective in reducing children's anxiety. In addition, we can suggest that both methods can be equally effective for postoperative behavioral changes.
  1 1,403 287
Reconstruction of complex soft-tissue defects around the knee using the proximally based sural Island fasciocutaneous flap
KO Opara, IC Nwagbara
June 2018, 21(6):726-730
DOI:10.4103/njcp.njcp_174_17  PMID:29888719
Background: Complex soft tissue defects around the knee are not common. They pose significant reconstructive challenges; hence, several methods have been tried. In this study, the use of proximally based sural island fasciocutaneous flap is evaluated. Aim: The aim of this study is to report our experience with the use of proximally based sural island fasciocutaneous flap in the reconstruction of complex soft tissue defects around the knee. Patients and Methods: This was a prospective study. All patients that presented to the unit with complex soft tissue defects around the knee between December 2012 and November 2014 were included in this study. Data on age, sex, etiology, anatomical location of the defect, and flap size were noted and analyzed using descriptive statistics. Follow-up was for a minimum of 6 months. Results: There were 15 cases: 11 males and 4 females. Their ages ranged from 6 years to 47 years with an average age of 29 years. Ten of the defects resulted from road traffic accidents, while five were missile injuries. The anterior and lateral surfaces of the knee were more often involved, while the posterior surface was least involved. The flap sizes ranged from 8 cm × 6 cm to 16 cm × 12 cm, and the pedicle length ranged from 6 cm to 12 cm. All 15 flaps had full survival. A total of 13 patients had their donor sites skin grafted primarily with 96%–100% graft take. The other two patients had their donor sites closed directly. Conclusion: The proximally based sural island fasciocutaneous flap is a simple and reliable method of reconstruction for soft tissue defects around the knee.
  1 1,105 171
Type II enteropathy-associated t-cell lymphoma: A case report and literature review
L Zhao, Y Yang, Y Zhang
June 2018, 21(6):812-815
DOI:10.4103/njcp.njcp_280_17  PMID:29888733
Type II enteropathy-associated T-cell lymphoma (Type II EATL) is a rare peripheral T-cell lymphoma of the gastrointestinal tract. Here, we report a case of Type II EATL, in which the patient with repeated diarrhea was diagnosed as ulcerative colitis and amebic infection at the beginning, but her symptom had no improvement after therapy. The diagnosis of Type II EATL was confirmed by the repeated biopsies and immunohistochemistry. This case suggests that Type II EATL is difficult to diagnose due to lack of specific symptoms and endoscopic features. It reminds us that for patients with increased intraepithelial lymphocytes and thickened bowel wall, lymphoma should be highly suspected and biopsy should be repeated if necessary.
  - 1,019 187
Hypereosinophilic atopic transverse myelitis
FA Fasola, OW Aworanti
June 2018, 21(6):816-819
DOI:10.4103/njcp.njcp_209_17  PMID:29888734
Atopic transverse myelitis is a rare disorder that is defined as a localized myelitis of an unknown cause in patients with either high immunoglobulin E (IgE) level or mite-specific IgE or coexistent atopic disease. It is a cause of intramedullary cord lesions, but its diagnosis does not need tissue confirmation. We report a case of a patient who presented with bladder and anal incontinence, paresthesia, and lower limb weakness. Neither IgE level nor mite-specific IgE level could be determined due to lack of fund; however, magnetic resonance imaging (MRI) of the thoracolumbar region showed hypotense-isotense lesion within the spinal cord at T4 vertebral level, suggestive of transverse myelitis. Blood cell count showed hypereosinophilia. Therefore, a diagnosis of atopic transverse myelitis based on high eosinophil count and MRI was made. Patient was commenced on prednisolone and had good response to treatment. Complete blood count is a cheap simple diagnostic tool in resource-poor country to distinguish atopic transverse myelitis from other causes of intramedullary cord lesions.
  - 1,088 112
The role of electrophysiological examination in the diagnosis of carpal tunnel syndrome: Analysis of 2516 patients
A Cirakli, EK Ulusoy, Y Ekinci
June 2018, 21(6):731-734
DOI:10.4103/njcp.njcp_25_17  PMID:29888720
Objective: The aim of the present study was to assess the correlation between patient history, physical examination, and electrophysiological method of assessment in patients with clinical suspicion of carpal tunnel syndrome (CTS). Patients and Methods: Results of electrophysiological examinations performed from 2009 to 2016 on 3151 hands of 2516 patients who had symptoms that clinically suggested CTS were examined retrospectively. Patients were assessed in terms of age, gender, direction of nerve compression, and presence and degree of CTS as determined electrophysiologically. Kolmogorov–Smirnov test, Levene's test, and Chi-square test were used for statistical analyses. Level of significance was accepted as P < 0.05. Results: Of the 2516 patients, 1838 (73.1%) were female and 678 (26.9%) were male. Average age was 48.60 ± 14.83 years, and 1858 (73.8%) of the patients had complaints in only 1 hand, whereas 658 (26.2%) had complaints in bilateral hands. CTS was detected in 1383 patients (54.9%; female/male: 1019/364) and average age was 52.16 ± 13.84 years. No statistically significant association was found between CTS and gender. Nerve compression was found in 1 hand of 71.5% (1328) of females and 28.5% (530) of males, and this result was found to be statistically significant. No significant association was found between degree and direction of nerve compression. Conclusion: Only 54.9% of the patients with clinical suspicion were found to have CTS. Given complexity of the hand and a large number of potential pathologies, electrophysiological examination is necessary for definitive diagnosis to avoid unnecessary surgical interventions.
  - 1,139 189
A 3-year study of deferasirox therapy in sickle cell disease patients in Basra, Southern Iraq
AM Mohsin, MK Hassan
June 2018, 21(6):735-742
DOI:10.4103/njcp.njcp_162_17  PMID:29888721
Background: Patients with sickle cell disease (SCD) may require repeated transfusions, which inevitably lead to iron overload (IOL). Aims: This study aims to assess the effectiveness and safety of oral deferasirox (DFX) in patients with SCD and transfusional IOL. Patients and Methods: A descriptive study has been performed on patients with SCD who have completed at least 3 years on DFX. Height and weight were checked every 3–6 months. The efficacy was assessed based on serum ferritin (SF) levels. The safety was assessed based on adverse events (AEs), alanine aminotransferase (ALT), and serum creatinine (S. Cr) levels. Results: A total of 102 patients (61 males and 41 females) were recruited. Their mean daily iron intake was 0.13 ± 0.06 mg/kg. SF levels declined significantly from 2434.1 ± 132.9 ng/ml at the start of the study to 1655.8 ± 154.2 ng/ml at the end of the study (P < 0.05), with significant decreases observed after increasing the DFX dose to ≥ 30 mg/kg/day. ALT (12.8 ± 9.9 vs. 12.1 ± 7.1 U/L) and S. Cr (72.4 ± 9.2 vs. 74.1 ± 7.9 mmol/L) levels did not show significant differences from the start to the end of the study (P > 0.05). Thirty-eight patients (37%) developed AEs. The most common were abdominal pain (24.5%), diarrhea (8.0%), and nausea (7.8%). AEs were predominantly transient and mild to moderate in nature. Conclusions: This study has revealed that DFX is a safe, tolerable, and effective drug for reducing IOL in SCD patients, though it is associated with mild and transient adverse events.
  - 894 117
The effects of smoking cessation on visceral adiposity index levels
S Pekgor, C Duran, K Marakoglu, I Solak, A Pekgor, MA Eryilmaz
June 2018, 21(6):743-751
DOI:10.4103/njcp.njcp_245_17  PMID:29888722
Background: Known to cause important metabolic disturbances, weight gain becomes a major health problem after smoking cessation. Visceral adiposity index (VAI) is becoming increasingly popular in the detection of cardiometabolic risks in several disorders and general population. Here, we aimed to investigate the effects of quitting smoking on VAI levels. Materials and Methods: Of 350 participants included into the cigarette cessation program, 70 (20%) completed the study and were enrolled into the analyses. VAI levels were calculated at the baseline and 3rd month after cigarette cessation. Results: Thirty-eight (54.3%) out of 70 participants were male. While the mean age was found as 42 ± 1.0 years, mean starting age of smoking was found to be 16.87 ± 0.45 years, and mean smoking time was 23.07 ± 1.18 years. While VAI levels were found higher in men at the baseline, VAI levels were found similar in both genders at the end of the study. Higher VAI levels were found in those smoking >20 cigarettes/day, compared to those smoking ≤20 cigarettes/day. Although weight, waist circumference, body mass index (BMI), and high-density lipoprotein cholesterol levels increased, VAI levels were found to decrease significantly at the 3rd month. In subgroup analyses, VAI levels were seen to decrease significantly only in men (P = 0.005). Furthermore, VAI levels were found to decrease (P < 0.001) in those with BMI ≥25 kg/m2, whereas no significant change was observed in those with BMI <25 kg/m2. Conclusions: Although body weight increases significantly after quitting smoking, VAI levels, an indicator of cardiovascular risks, decrease significantly, especially in men or obese patients.
  - 1,235 176
Epidemiology of injuries seen in a nigerian tertiary hospital
NO C Onyemaechi, OE Nwankwo, RA Ezeadawi
June 2018, 21(6):752-757
DOI:10.4103/njcp.njcp_263_17  PMID:29888723
Background: The study aimed to describe the pattern of injuries among patients presenting at a tertiary care hospital in Enugu southeast Nigeria. Patients and Methods: A retrospective review of records of all injured patients seen in our hospital over a 12-month period was done. Results: A total of 789 patients had complete medical records and were included in the study. Road traffic accident (RTA) was the most common cause of injury. Lacerations/abrasions, fractures, and traumatic brain injury (TBI) were the most frequently seen injuries. The injury severity score (ISS) of the patients ranged from 1 to 50 with a mean score of 8.9 ± 3.5. RTAs were responsible for 90.8% of patients with ISS >15. Patients with ISS >15 contributed to 64.1% of all deaths. The mortality rate was 4.5%. Most deaths resulted from RTA and were associated with TBI (P = 0.001). Conclusion: Lacerations and fractures were the most common injuries. RTA was the leading cause of injury. TBI was the most common cause of injury-related death.
  - 3,421 340
Antibiofilm efficacies of cold plasma and er: YAG laser on Staphylococcus aureus biofilm on titanium for nonsurgical treatment of peri-implantitis
M Ulu, T Pekbagriyanik, F Ibis, S Enhos, UK Ercan
June 2018, 21(6):758-765
DOI:10.4103/njcp.njcp_261_17  PMID:29888724
Objectives: The aim of the present study was to compare antibiofilm efficacies of the laser in contact and noncontact application modes and cold atmospheric plasma (CAP) on Staphylococcus aureus biofilm grown on sandblasted, large grit, acid-etched (SLA) titanium discs as an in vitro model of biofilm eradication on dental implant materials. Methods: S. aureus biofilm was matured on titanium discs for 7 days then, treated with contact and noncontact Er:YAG laser and CAP. Antibiofilm efficacy of laser and plasma treatments were evaluated with colony counting and safranin assays. Surface characteristics of titanium disc were analyzed with scanning electron microscopy and surface roughness measurements. Temperature distribution over titanium discs were presented for the thermal safety assessment of laser and plasma treatments. Results: CAP resulted in 6-log inactivation of S. aureus biofilm, whereas biofilm inactivation was determined as 1 and 2.7-log for noncontact and contact laser treatments, respectively. Laser and plasma treatments did not cause any alterations on the roughness of titanium discs. Contact laser treatment caused a focal temperature increase up to 58°C, whereas plasma treatment led a uniform temperature distribution on the disc within safe limits. Conclusion: CAP showed superior antibiofilm activity on 7-day-old S. aureus biofilm grown over SLA titanium discs, compared to contact and noncontact laser treatment without temperature increase and any damage to the surface of titanium discs.
  - 1,293 288
Association between serum heavy metals level and cancer incidence in darbandikhan and Kalar Area, Kurdistan Region, Iraq
BH Marouf
June 2018, 21(6):766-771
DOI:10.4103/njcp.njcp_384_16  PMID:29888725
Background: Exposure to heavy metals is considered as the main threat to human health and biological system. Darbandikhan Lake is one of the three large lakes in Kurdistan, Northern Iraq; it is currently at a high risk of pollution by sewage and municipal wastes. The current study was designed to highlight the potential association between concentration of heavy metals and carcinogenicity in people who live in Darbandikhan and the surrounding area. Materials and Methods: A case–control study was carried out on 29 cancerous patients and 25 healthy individuals from Darbandikhan, Kalar, and the surrounding area; the patients were admitted to the Hiwa Oncology Center in Sulaimani City. Determination of serum concentrations of copper (Cu), iron (Fe), cadmium (Cd), arsenic (As), chromium (Cr), lead (Pb), and zinc (Zn), was performed by an inductively coupled plasma atomic absorption spectrophotometer. Results: Serum concentration of Pb, Fe, and Cu was higher in cancer group compared with control in nonsignificantly different (P > 0.05) for Pb, whereas significantly (P < 0.05) for Cu and Fe. Higher serum Cd concentration was detected in control group compared with the cancer group. Differences not detected in Cr and As serum concentration analysis between both groups. Serum level of Zn was nonsignificantly higher in control group compared with the cancer group (P > 0.05). Conclusion: Discrepancies in the serum level of heavy metals of cancer group might reveal the involvement of heavy metal as a contributing factor of carcinogenicity in these areas.
  - 2,607 291
Ocular adnexal lymphomas: An eye care service experience in Turkey
B Kiziltas, C Baskan, R Duman, MS Dal
June 2018, 21(6):711-715
DOI:10.4103/njcp.njcp_133_17  PMID:29888716
Aim: This study aimed to evaluate the clinical and pathological features of ocular adnexal lymphoma (OAL) and the treatment results in an eye care service center in Turkey. Materials and Methods: The data sets of the patients diagnosed with OAL acquired between January 2008 and January 2016 were collected and analyzed. Results: Fifteen patients were included in our study. The mean age was 55.80 ± 17.85 years. The age range was 7–85 years. Most of the lesions originated from orbital tissue, and histopathological and immunohistochemistry examinations of the lesions were consistent with non-Hodgkin's lymphoma in 14 patients and Hodgkin's lymphoma in 1 patient. The most common subtype of OAL, accounting for 40% of cases, is extranodular marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) type. Conclusion: Most of our patients' histopathological and immunohistochemistry examinations are non-Hodgkin's type and also involve the orbits. Ocular adnexal lymphomatosis is not a rare disorder and could be treated if there is no systemic involvement at first diagnosis.
  - 874 138
Effect of cavity design on the fracture resistance of zirconia onlay ceramics
P Oyar, R Durkan
June 2018, 21(6):687-691
DOI:10.4103/njcp.njcp_424_17  PMID:29888712
Objective: The purpose of this study was to evaluate the fracture resistance and failure modes of onlay restorations prepared with different preparation designs. Materials and Methods: A total of 42 extracted, mandibular first molars (36, 46) were used and divided into six groups according to preparation design, as follows 1A: Anatomic preparation of cusps/rounded shoulder margin/occlusal groove; 1B: Flat preparation of cusps/rounded shoulder margin/occlusal groove; 2A: Anatomical preparation of cusps/occlusal groove; 2B: Flat preparation of cusps/occlusal groove; 3A: Complete anatomical reduction of cusps/rounded shoulder margin; 3B: Complete flat reduction of cusps/rounded shoulder margin groups; intact tooth: No preparation. Onlays were constructed with 0.5-mm copings of Zirconia ceramic. The copings were veneered with porcelain (IPS e. max Ceram). All samples were subjected to fracture resistance testing. Data were analyzed with Kruskal–Wallis and Bonferroni-Dunn tests. Results: Fracture resistance varied significantly according to preparation design. Among the anatomic occlusal preparation designs, fracture resistance was significantly lower in Group 3 when compared to Groups 1 and 2 (P < 0.05). Among the flat occlusal preparation designs, fracture resistance was significantly higher in Group 1 when compared to Groups 2 and 3 (P < 0.05). Conclusion: Preparation design affected the fracture resistance of onlay restorations. Cavities with flat occlusal preparation designs, a groove and shoulder margins (1B) resulted in the highest fracture resistance, whereas teeth prepared with a complete reduction of cusps and shoulder margins (3A) had the lowest fracture resistance.
  - 1,923 561
Syndesmotic screw fixation in tibiofibular diastasis
S Sipahioglu, S Zehir, UE Isikan
June 2018, 21(6):692-697
DOI:10.4103/njcp.njcp_5_17  PMID:29888713
Background: In chronic instability of syndesmosis, osteoarthritis and poor functional outcome were seen more prevalently. To avoid diastasis of ankle joint, the affected distal tibiofibular syndesmosis should be restored. We evaluated the clinical and radiological results of operative treatment of ankle fractures in patients who required syndesmotic stabilization. Materials and Methods: Twenty-one patients operated for ankle fracture were evaluated. Patients were followed up for 12 to 81 months, with a mean value of 49 months. Anteroposterior (AP), lateral, and mortise radiographs were taken at the follow-up period, and AP tibiofibular distance, lateral fibular distance, and medial mortise distance were measured on the preoperative, postoperative, and last follow-up radiographs. At the last follow-up, patients were evaluated clinically with Hannover scoring system. Results: The decrease in AP tibiofibular distance was statistically significant postoperatively in Weber Type B and C fractures. The mean preoperative AP tibiofibular distance which was 7.1 mm decreased to 3.6 mm after operation. There was no statistically significant relation between the amount of decrease and fracture type, either Weber B or C. At the same time, the AP tibiofibular distance did not change at the last follow-up. At the last follow-up clinical evaluation, patient scores were ranging from 74 to 94, with a mean value of 86, which was designated as a fair result. Conclusion: In ankle fractures, if diastasis of distal tibiofibular joint is present, syndesmosis should be fixed for both Weber Type B and C fractures. The most important predictor of good clinical outcome is accurate reduction of the syndesmosis.
  - 1,353 281
The use of sural island musculo fasciocutaneous flap, in the management of chronic osteomyelitis of the tibia
KO Opara, IC Nwagbara
June 2018, 21(6):698-702
DOI:10.4103/njcp.njcp_173_17  PMID:29888714
Background: The management of soft-tissue defects following surgery for chronic osteomyelitis of the tibia is challenging. It often requires complex reconstructive procedures, especially when the distal third of the tibia is involved. We present a relatively simple method of addressing these defects. Aim: This study aims to report our experience with the use of the sural Island musculo fasciocutaneous flap in the management of osteomyelitis of the tibia. Materials and Methods: Consecutive patients with osteomyelitis of the tibia requiring soft-tissue cover were managed using the sural Island musculo fasciocutaneous flap, and the outcome was analyzed. The study was prospective in nature. Results: There were 21 patients, 15 males and 6 females. Their ages ranged from 21 years to 62 years. Most (71%) were in the 3rd and 4th decades of life. Twelve patients had involvement of the distal third of the tibia, eight involved the middle third, while five patients had involvement of the proximal third. Most of the patients (17) developed osteomyelitis following open fractures of the tibia; thirteen of these were from road crashes and four from gunshot injuries. Four patients developed osteomyelitis through the hematogenous route. Flap sizes ranged from 8 × 7 cm to 16 × 11 cm. There was tip necrosis in 2 flaps and full survival in 19 flaps. The flaps with partial necrosis were managed by simple dressing. Fifteen patients (71%) had cessation of drainage within 4 weeks of surgery. Two patients presented with recurrence of infection within the period of follow-up. Mean follow-up period was 23 months. All donor sites were skin grafted primarily, with 95%–100% graft take. Conclusion: The sural Island musculo fasciocutaneous flap is a reliable source of richly vascularized soft tissue for the management of dead space and soft-tissue defects in chronic osteomyelitis of the tibia. It has the added advantage of providing sizeable tissue, with good reach to all segments of the tibia.
  - 1,056 186
Evaluation of fracture resistance in root canal-treated teeth restored using different techniques
T Aslan, B Sagsen, Ö Er, Y Ustun, F Cinar
June 2018, 21(6):795-800
DOI:10.4103/njcp.njcp_330_17  PMID:29888730
Objective: This study aimed to evaluate the effects of different coronal restoration techniques on fracture resistance of root canal-treated mandibular premolars with mesio-occluso-distal (MOD) cavities. Materials and Methods: A total of 105 mandibular premolars were selected and randomly distributed into seven groups (n = 15). MOD cavities were prepared except the control group. Root canal treatments were performed. Each tooth was embedded in acrylic resin. Groups were classified as follows; G1: intact teeth (control), G2: unfilled MOD cavity, G3: MOD + composite resin, G4: 10-mm-long fiber post + composite resin, G5: 5-mm-long fiber post + composite resin, G6: Ribbond in the occlusal surface + composite resin, and G7: horizontal fiber post + composite resin. Specimens were loaded using a universal testing machine until fracture occurs. Fracture loads were recorded and statistical interpretations were made (α = 0.05). Results: In Groups 1, 6, and 7, the greatest fracture resistance was shown and there were no significant differences among these groups (P > 0.05). No significant differences were detected among the Groups 3, 4, and 5 (P > 0.05), whereas the fracture resistances of Groups 1, 6, and 7 were significantly greater than these three groups (P < 0.05). Group 2 had the lowest fracture resistance of all groups (P < 0.05). Conclusion: Usage of horizontal post or occlusal Ribbond usage increased the fracture resistance of root canal-treated premolars with MOD cavities.
  - 1,410 268
Mammographic findings of breast cancer screening in patients with positive family history in South-East Nigeria
UR Ebubedike, EO Umeh, SN C Anyanwu
June 2018, 21(6):801-806
DOI:10.4103/njcp.njcp_55_18  PMID:29888731
Background: A positive family history of breast cancer is an important risk factor associated with the development of breast cancer in women. Early detection required regular screening in these women. Objective: To determine the mammographic findings of breast cancer screening in patients with a positive family history in Iyienu, Southeast Nigeria. Methodology: Forty-three consenting females with a positive family history of breast cancer who underwent mammographic screening at Radiology Department, Iyienu Mission Hospital, Anambra State, were enrolled in the study. Mammographic findings were compared with those of females with a negative family history. Results: The mean age was 49.6 years with a range of 35–69 years. The mammographic findings were asymmetric density, nipple retraction, tissue retraction, skin thickening, lymphadenopathy, and calcification within a mass with varying frequency for the right and left breasts. Conclusion: A significant statistical difference was found in lymphadenopathy and calcification for the right and left breasts, respectively, when compared with those without positive family history.
  - 1,693 135
Effect of home bleaching on surface of zinc phosphate cement: A scanning electron microscopic study
SA AlZain
June 2018, 21(6):807-811
DOI:10.4103/njcp.njcp_322_17  PMID:29888732
Context: The effect of home bleaching on surfaces of dental cements is controversial. Aim: The aim of this study was to microscopically evaluate and compare the effect of different concentrations of carbamide peroxide (CP) home bleaching agents on the surface of zinc phosphate cement. Materials and Methods: Forty 10 mm × 2 mm specimens of zinc phosphate cement were prepared following the manufacturer's directions. All specimens were immersed in artificial saliva at 37°C for 24 h. The specimens were equally divided into four groups (n = 10). One control group received no CP bleaching. Three experimental groups were exposed to 10%, 16%, and 22% of CP home bleaching agents. The bleaching agents were applied daily for 4 h for 14 days. Specimens were stored in artificial saliva at 37°C for 24 h and then examined under a scanning electron microscope. The surface micromorphology of the specimens was carefully evaluated and compared. Results: The zinc oxide particles in the specimens of the control group were tightly packed with well-defined plate-like crystals. When specimens were exposed to 10% CP gels, the particles became flat and irregular with few areas of eroded matrix. When 16% CP gel was used, the crystals became flatter and irregular with rounded edges. Bleaching with 22% CP gel showed little more erosion of the surface of the matrix of the cement. Fewer flat and irregular crystals were observed on the surface of the cement. Conclusions: At-home bleaching using 10%, 16%, and 22% CP may be safely used in the presence of zinc phosphate-luted crown restorations without adverse effects.
  - 859 108
The value of bedside ocular ultrasound assessment of optic nerve sheath diameter in the detection of increased intracranial pressure in patients presenting to the emergency room with headache
Y Canakci, O Koksal, VA Durak
June 2018, 21(6):778-782
DOI:10.4103/njcp.njcp_119_17  PMID:29888727
Introduction: Headache is one of the most important complaints in emergency room (ER) admissions, and the rate of the increase in intracranial pressure in these cases should not be overlooked. This study was performed to investigate the value of the measurement of optic nerve sheath diameter (ONSD) by ocular ultrasound in ER patients with the complaint of headache and increase in intracranial pressure regarding this. Materials and Methods: A total of 100 patients who applied to the ER with the complaint of headache were included in this prospective study. Fifty patients with increased ONSD (≥5 mm) and 50 patients with normal ONSD (<5 mm) were obtained. ONSD measurements were performed with 7.5–10 MHz linear probe and closed-eye technique. In addition to this, all patients underwent cranial computerized tomography (CT) examinations, and CT results were compared with the results of the ocular ultrasound. Results: The median right and left ONSD values were detected to be 4.3 mm (3.6–5.5 mm) and 4.4 mm (3.6–5.6 mm) in patients whose cranial CT results were within normal limits. However, the median right and left ONSD values were detected to be 5.5 mm (5.1–6.3 mm) and 5.5 mm (5.1–6.4 mm) in patients whose cranial CT examination results were abnormal. In all cases with abnormal CT findings, the right and the left ONSD measurements were significantly higher (P < 0.001). Furthermore, ONSD value in the ipsilateral side with the lesion was significantly higher than the contralateral side (P < 0.001). Conclusion: Bedside ocular ultrasound is a noninvasive and easily applicable method in ER for the detection and evaluation of intracranial hypertension with headache.
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Determinants of outcome of final undergraduate surgery examinations in a Nigerian University
O Onwuasoigwe, EE Onyia, M Mesi
June 2018, 21(6):783-787
DOI:10.4103/njcp.njcp_12_18  PMID:29888728
Background: Medical students' assessment is an important aspect of medical undergraduate training that requires periodic review to achieve objectivity and improve training. We reviewed the outcome and factors that influenced outcome of undergraduate students' final surgery examination. Materials and Methods: Final examination records of undergraduate medical students in surgery from a single institution for 5 years (2013–2017) were retrospectively reviewed. Scores of the students in continuous assessments (CA), multiple-choice questions (MCQs), essays, long case, short cases, orals, and objective structured clinical examinations (OSCE) were extracted as appropriate. The data were analyzed using SPSS® for Windows version 21. Results: A total of 960 candidates' results were analyzed over 5 successive years, 722 candidates (75.2%) were males, and 238 (24.8%) were females. The overall pass rate was 62.6%. Success rate in the clinical examinations was higher in females (84.5%) compared to males (72.7%). χ2 = 13.381, P < 0.001. MCQs section of the examinations had the highest failure rate (49.5%). Female gender (P < 0.001), passing CA (P < 0.001), and shorter duration-<9 years in medical school (P < 0.001) were strongly associated with passing the final surgery examination. Pass rate was 73.1% for females and 56.2% for males during the OSCE period. Conclusion: CA is the single most important determinant of success in final surgery examination, while MCQs constitutes the most difficult aspect of the examinations. Irrespective of method of assessment, females seem to do better than males.
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Surgical management of anorectal foreign bodies
H Cinar, M Berkesoglu, M Derebey, E Karadeniz, C Yildirim, K Karabulut, T Kesicioglu, K Erzurumlu
June 2018, 21(6):721-725
DOI:10.4103/njcp.njcp_172_17  PMID:29888718
Purpose: Anorectal foreign bodies (AFBs) inserted into anus constitute one of the most important problems needing surgical emergency due to its complications. We describe our experience in the diagnosis and treatment of AFBs retained in the rectosigmoid colon. Materials and Methods: Between the years 2006 and 2015, a total of 11 patients diagnosed with AFBs were admitted to an emergency room and general surgery clinics. They were diagnosed and treated in four different hospitals in four different cities in Turkey. Information on the AFBs, clinical presentation, treatment strategies, and outcomes were documented. We retrospectively reviewed the medical records of these unusual patients. Results: Eleven patients were involved in this study. All patients were male with their mean age was 49.81 (range, 23–71) years. The time of the presentation to the removal of the foreign bodies ranged between 2 h and 96 h with a mean of 19.72 h. Ten patients inserted AFBs in the anus with the purpose of eroticism but one patient's reason to relieve constipation. The objects were one body spray can, two bottles, three dildos, two sticks, one water hose, one corncob, and one pointed squash. Three objects were removed transanally after anal dilatation under general anesthesia. Eight of the patients required laparotomy (milking, primary suture, and colostomy). Five of the patients had perforation of the rectosigmoid colon. Abdominal abscess complicated extraction in one patient after the postoperative period. The hospitalization time of the patients was 6.18 (1–16) days. None of the patients died. Conclusions: A careful assessment is a key point for the correct diagnosis and treatment of AFBs. Clinical conditions of patients and type of AFBs are important in the choice of treatment strategy. If the AFBs are large, proximally migrated or the patients with an AFB have acute abdomen due to perforation, pelvic abscess, obstruction, or bleeding, surgery is needed as soon as possible. There are different types of surgical approaches such as less invasive transanal extraction under anesthesia and more invasive abdominal routes such as laparotomy or laparoscopy. The stoma can be done if there is colonic perforation. In the management of AFBs, the priority must be less invasive methods as possible.
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