Backround: The fiduciary duty of a managing physician makes paediatric discharges against medical advice (DAMA) particularly challenging as children lack the legal power or authority to make their health decisions. Aim: It is aimed in the present study to determine the prevalence of paediatric DAMA in a mission tertiary hospital. Methods: This was a prospective descriptive study carried out from June 2018 to May 2019 among paediatric inpatients at the Bowen University Teaching Hospital, Ogbomoso, Nigeria whose parent/ care giver signed DAMA, despite adequate counselling. Data was analysed using SPSS version 23. Results: The prevalence of DAMA in the study was of 4.1%, and the neonatal group accounted for the largest bulk of DAMA. Birth asphyxia was the commonest diagnosis among this group. There was a slight female predominance among the patients whose parents signed DAMA. Financial constraint was the commonest reason [13(30.2%)] given for DAMA and none of the children whose parents signed DAMA was enrolled on the National Health Insurance Scheme (NHIS). Conclusion: Rate of DAMA in a private mission tertiary hospital was lower than previously reported from government tertiary hospitals in the present-day Nigeria.

Backround: Ultrasonography is difficult to distinguish between endometrial pathologies and often requires curettage. ARFI (Acoustic Radiation Force-Based Elasticity Imaging) is a new ultrasonography elastography method. Using ARFI, it is possible to obtain information about the likelihood of the tissue benign or malignant. Aim: The aim of this study is to evaluate the contribution of ARFI to differentiate endometrial pathologies in hysterectomy specimens. Subjects and Methods: Our study was prospectively, January–May 2017, performed in randomly 45 cases of 41–91 years of age (mean 58.3 years) who have decided to have hysterectomy. Hysterectomy was performed for uterine prolapse and endometrial hyperplasia in elderly patients and menorrhagia in young patients. Pathology results were compared with ARFI values and endometrial thickness. ANNOVA test was used for the comparison of ARFI values. Results: Pathology revealed 14 cases of endometrial atrophy, 11 cases of proliferative phase, 10 cases of polyp, 6 cases of endometrial hyperplasia, and 4 cases of endometrium cancer. There is a statistically significant difference between mean ARFI values of endometrium, subendometrium, and myometrium of the groups (P < 0.05). There was a statistically significant difference between the mean endometrial thickness of the groups (P < 0.05). Conclusion: Endometrium ARFI contributes to the differential diagnosis of endometrial pathologies. Subendometrial and myometrial ARFI values decrease in polyps and increase in hyperplasia. Our study shows that the addition of subendometrium ARFI to gray-scale sonography before deciding on invasive procedures in endometrial pathologies may improve diagnostic accuracy. We concluded that further in vivo studies will establish the usefulness of this technique for preoperative diagnostic measures.

Background: Several studies have demonstrated an association between obesity, periodontitis, and exercise. Aims: This study aimed to investigate the effects of regular exercise on obese women with periodontal disease, using serum, saliva, and gingival crevicular fluid (GCF) samples. A before–after study design was adopted to evaluate the effects of 12 weeks of regular exercise on obese women grouped according to periodontal status, without a control group (no exercise). The study sample comprised of 15 patients without periodontitis (NP group) and 10 patients with chronic periodontitis (CP group), from whom periodontal parameters were measured and serum, saliva, and GCF samples were collected. Body mass index (BMI), anthropometric measurements, somatotype-motoric tests, and maximal oxygen consumption (VO₂max) were recorded at baseline and after exercise. Subjects and Methods: Med Calc was used for statistical analysis. Results: After exercise, a significant decrease in BMI and a significant increase in VO₂max were observed in both groups. A significant decrease in probing depth and clinical attachment loss, serum leptin, GCF tumor necrosis factor-α(TNF-α) and leptin, and a significant increase in GCF resistin were observed in the CP group. A significant decrease in serum TNF-α and leptin levels and a significant increase in serum resistin and GCF TNF-α, leptin, resistin, and adiponectin levels were observed in the NP group. Significant correlations between bleeding on probing and levels of interleukin-1β and leptin in GCF were observed in the CP group. Conclusions: This study showed that regular exercise exerts different impacts with respect to clinical and biochemical aspects of periodontal and systemic conditions in obese women.

Background: Neglectful feeding and physical activity (PA) practices by parents are associated with development of adulthood obesity. The Arab world has reported an alarming increase of adulthood obesity and childhood neglect by parents, yet have not studied the association between the two variables. Aims: The objectives of this study were to evaluate two parental negligence parameters (feeding style and social activity) associated with adulthood obesity and to identify the level of parental negligence on a customized parent neglect scale. Methods: In total 450 adult subjects 18-30 were screened for body mass index (BMI) values. 240 subjects fulfilling the criteria for the study were divided into two groups normal weight (N Gp) (n = 150) and overweight/obese (Ov/Ob Gp) (n = 90) groups. A questionnaire was formulated through a dual moderator focus group discussion, which was then tested in a prepilot and a pilot study (qualitative) to determine its validity (content and criterion) and reliability (repeated measurement) before distributing to the parents of both groups. Physical activity and screen time were also recorded for the subjects and their parents. Chi square test for association/difference between two categorical variables and Pearsons correlation coefficient for BMI correlation were employed. Results: Parenting parameters like maternal age, consanguineous marriage, breastfeeding duration, formula food introduction, and maternal smoking were significantly different between studied groups. Higher physical inactivity was observed among parents (father/mother 53%) and subjects (80%). The higher amount of screen time (73% ≥ 60-100 h/week) was found in the Ov/Ob Gp that significantly differed with the other group. Maternal BMI was positively related to the subjects BMI. Parents of obese subjects were found negligent in feeding style and very negligent for social activity on a parent neglect scale as compared to the parents of the normal weight subjects. Conclusion: Parents are responsible for developing healthy eating habits and competitive social behavior among their children. Parents need to practice the same to influence changes in their children during their early childhood, as well as when their children grow into adults. Negligent parenting in the studied parameters were found to increase the risk of developing adulthood obesity and should be considered as a potential marker for adult obesity.

Background: For the benefits of less postoperative pain, early recovery and discharge, and better cosmesis, laparoscopic surgery is rapidly gaining acceptance amongst surgeons as a better alternative to traditional open procedures. In January 2015, bookings for laparoscopic surgery became a more regular feature on our operation list. Aims: We reported the indications, management outcome, and challenges in patients who had laparoscopic surgery in our institution. This is to document the trends in our surgical practice. Methodology: This is a descriptive study of 137 patients who had laparoscopic surgery for general surgical indications in our institution over a period of 5 years. Patients data as collected from the records department were evaluated for demographic characteristics, medical comorbidities, type of procedures done, and perioperative outcome. Data analysis was performed using Statistical Package for Social Sciences (SPSS). Results: A total of 137 Patients had laparoscopic general surgery between January 2015 and December 2019. There were 48 males and 89 females with a male-to-female ratio of 1:1.9. The mean age of the patients was 38.8 ± 3.4 years (range 16–87 years). Laparoscopic cholecystectomy (35%) and laparoscopic appendicectomy (29.9%) were the most common procedures performed. Five (3.7%) cases were converted to open surgery. Superficial surgical site infection (5.8%) following laparoscopic appendicectomy was the most common postoperative complication. There was no 30-day postoperative mortality. Conclusion: Laparoscopic surgery is safe and can be applied to wide variety of general surgical conditions in developing countries. Minimal postoperative morbidity of laparoscopy is a major benefit to the patients.

Background: Chronic renal failure can cause anxiety, stress, and decrease the life quality. Therefore, this may lead to sleep bruxism, temporomandibular disorders (TMDs), and related health problems. Aim: This study evaluated the incidence of sleep bruxism and TMDs in patients undergoing hemodialysis and compared it with that of healthy individuals. Subjects and Methods: A total of 137 patients (68 hemodialysis patients and 69 healthy individuals) participated in this study. They all filled out a form about age, sex, educational status, marital status, sleep disorders, sleep bruxism, temporomandibular problems, and ice/hard things chewing habits. We performed a muscle examination and used a questionnaire to evaluate the causes of TMD. Parafunctional habits and emotional stress status were examined with these YES/NO question forms. Teeth attritions and six common symptoms (limited mouth opening, deviation/deflexion, clicking, muscle sensitivity, pain, and presence of linea alba) of TMDs and sleep bruxism were evaluated via a clinical examination. The level of significance was determined at P < 0.05. Results: Parafunctional habits such as sleep bruxism (55.1%) (P = 0.010), emotional stress (69.1%) (P = 0.006), sleep disorders (47,1%) (P = 0.000), unilateral chewing (54.4%) (P = 0.040), gum-chewing (45.6%) (P = 0.000), ice chewing (23.5%) (P = 0,000), and hard things biting habits (7.4%) (P = 0.028) were statistically higher in the hemodialysis group than the control group. Deviation/deflexion and presence of linea alba were more frequent in the hemodialysis group than the control group. Conclusions: It can be concluded that hemodialysis patients are more sensitive to TMDs, sleep bruxism and related dental health problems than healthy individuals.

Background: Vision screening in children of preschool age (age 3-5 years) gives the opportunity for timely detection of amblyopia. The tools that would be used for screening must have high rates of testability in these young children, and must have high enough sensitivity and specificity to be reliable and cost effective. Aims: To assess the performance of the Lea symbols chart as a screening tool in children aged 3 to 5 years attending primary schools in Kwara State, Nigeria. Methods: Visual acuity (VA) of 464 children selected from 12 schools by a multistage sampling procedure was checked using the Lea symbols chart by trained Lea screeners. Children meeting the referral criteria and untestable children had a comprehensive eye examination. Testability rates, sensitivity, specificity, positive, and negative predictive values were analyzed based on age and gender, with corresponding significance values generated. Results: Testability rates among 5 year olds were as high as 99.1%, decreasing significantly to 95.5% in 4 year olds and 85.7% in 3 year olds (p value < 0.001). Visual acuity performance improved with age (p value 0.002) but was unrelated to gender. The Lea symbols chart had an overall specificity of 77.4% (63.2% among 3 year olds and 83.5% among 5 year olds). At VA thresholds of 6/12 for 5 year olds and 6/15 for 3-4 year olds, the screening tool became 87.7% specific among 3 year olds and 94.3% specific among 5 year olds (overall 92.5%). Conclusion: The Lea symbols chart was found to be a useful screening tool in this environment, especially among 5 year olds. The reduced specificity among 3-4 year olds may prompt further research into the appropriate VA thresholds for 3-4 year olds to reduce the burden of unnecessary comprehensive eye evaluations resulting from too many false positive results.

Background: Chronic kidney disease (CKD) is a common late complication in liver-transplanted patients who have received long-term therapy with calcineurin inhibitors (CNIs). Aims: To analyze kidney disease progression after liver transplantation Methods: We analysed the clinical data of adult single-organ liver transplant recipients performed at our centre between October 2003 and September 2009. The patients with the estimated glomerular filtration rate (eGFR) greater than 60 ml/min/1.73 m² before surgery were included in the study. Results: 69 patients with complete follow-up data were analysed. We found that eGFR at 1 or 2 years after liver transplantation correlated well with eGFR at 5 years. In addition, our results showed that patients whose eGFR declined below 60 at 2 years after liver transplantation would develop an irreversible renal injury in the following years. At 2 years, 12 patients had an eGFR less than 60, which were maintained in 11 patients at 5 years (Sensitivity = 11/12, 91.67%; Specificity = 57/58, 98.28%, Youden's index = 89.95%). The annual rate of eGFR reduction of the tacrolimus group was greater than that of the tacrolimus sparing group based on the value-time variation curve in our study. Moreover, the tacrolimus concentration influenced the CKD progression at 1 and 2 years with an under the ROC curve of 0.73 and 0.78 when Youden's index was at its maximum and the tacrolimus concentrations were 8.55 and 5.96 ng/ml, respectively. Conclusion: We confirmed that eGFR at 2 years after liver transplantation is useful for observing a meaningful change in eGFR and renal damage. Obtaining the appropriate serum concentration of an early decrease of the dose of CNIs and transforming non-nephrotoxic immunosuppressants would help improve renal function to prevent CKD progression and end-stage renal disease (ESRD).

Objective: To investigate of effects of using phase-contrast video technique on education in oral hygiene training. This one blind, parallel randomized controlled trial was conducted in a tertiary clinic. Fifty-three patients who presented to the orthodontics department aged 12–20 years were divided into two groups randomly by computer-generated assigned codes to receive oral hygiene education. The participants were blinded to type of education method. Before orthodontic therapy, the control group was trained only by the conventional method, while the test group was trained by phase-contrast video microscopy method in addition to conventional method. Some images and videos of moving microorganisms in dental plaque were shown to the patients in test group on a computer monitor. Subjects and Methods: The bacterial count, plaque index, and gingival index scores were compared. Measurements were obtained in baseline and follow-ups which were repeated with 1-month intervals after the training. Results: The plaque index scores (1.05 ± 0.1 vs. 1.43 ± 0.2; P < 0.001) and gingival index scores (0.90 ± 0.1 vs. 1.14 ± 0.2; P < 0.001) in test group was statistically lower than those in control group at the end of the study. The gingival index scores reduced by 39% in test group vs. 14% in control group. The number of bacteria significantly decreased in the group trained with phase-contrast video microscope technique (8,059,133 ± 3016 vs. 10,830,600 ± 4919; 0.018). Conclusions: The training with phase-contrast microscopy has a more positive effect than the traditional method in oral hygiene education.

Aims: This study aimed to compare the serum thiol-disulfide homeostasis, total antioxidant status (TAS), and total oxidant status (TOS) in patients with pseudoexfoliation glaucoma (PEG) patients, primary open-angle glaucoma (POAG) patients, and healthy individuals (control). Methods: Ninety subjects were included in this study. Three groups were separated as PEG, POAG, and control. All groups were chosen to be similar in terms of age and gender. Blood samples were obtained following an overnight fasting state and were collected on the ice at 4°C. The serum samples were separated from the cells by centrifugation at 3000 rpm for 15 min and were stored at -80°C. Serum samples analyzed for TAS and TOS, native thiol, total thiol, disulfide, and native thiol/disulfide ratio. Results: TAS and TOS levels of PEG patients were 1.2892 ± 0.0905 mmol/L; 5.0191 ± 2.7722 μmol/L, respectively. TAS and TOS levels of POAG patients were 1.2741 ± 0.1252 mmol/L; 4.1674 ± 1.7723 μmol/L, respectively. TAS and TOS levels of the control group were 2.3414 ± 0.1409 mmol/L; 4.0931 ± 0.1107 μmol/L, respectively. The TAS level was significantly lower in PEG and POAG groups compared to control. TOS level showed no significant differ ¬ ence between PEG, POAG, and control groups (P > 0.05). The mean serum total thiol and native thiol levels were significantly lower in patients with PEG compared to POAG and control group; there was no significant difference between the POAG and control group (P > 0.05). The mean serum disulfide level was significantly lower in patients with PEG compared to POAG (P = 0.018). Conclusion: Low levels of TAS were observed in patients with glaucoma, which was likely a response to the increased oxidative stress observed in these patients. While total thiol and native thiol levels were higher in the PEG group, the disulfide level was higher in the POAG group. TAS and TOS levels showed no significant difference between POAG and PEG groups.

Aims: In this study, using Beck depression inventory (BDI), we aimed to determine alterations in the emotional state of patients who had impacted third molars (M3) extracted owing to postoperative pain, edema, and trismus.In this prospective clinical trial, which was conducted at Tokat Gaziosmanpasa University, Faculty of Dentistry, Department of Maxillofacial Surgery Clinic, we studied 60 patients (30 males and 30 females), who were 18–47 years old (the mean of 25.6 years of age). The patients with M3 with moderate preoperative pain intensities, edema, and maximal mouth opening (MMO) data were recorded, and BDI was applied to determine their emotional states. The patients were re-evaluated using BDI to detect alterations in their emotional state owing to pain intensity, edema, and trismus on postoperative second and seventh day. Subjects and Methods: Descriptive statistical analysis, Chi-square, and independent t-test were utilized to interpret the obtained data. Results: According to our findings, a statistically significant relationship was observed between BDI scores and gender on the second postoperative day (P = 0.004), and between MMO and BDI scores on the second and seventh postoperative day (P = 0.012, P = 0.045). Pain intensity scores on the postoperative sixth hour and seventh day were significantly correlated with BDI scores on the postoperative second and seventh day (P = 0.000/ P = 0.000/P = 0.002/P = 0.004/P = 0.010/P = 0.017/P = 0.001/P = 0.000).Conclusions: Our results suggest that the pain and trismus owing to the M3 surgery were significantly correlated with an increase in the postoperative BDI scores.

Background: Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disease. The prevalence of IBS is estimated to be 11.2% worldwide and even though it is not a life-threatening condition, it affects the quality of life and results in an economic burden on the healthcare system. According to the Rome III criteria, IBS is described as abdominal pain that improves with defecation and the onset of the pain is associated with a change in stool frequency or consistency that cannot be explained by any biochemical or structural abnormality. Aim: To document the epidemiology of IBS and its associated risk factors in the central region of Saudi Arabia. Materials and Methods: A cross-sectional study conducted in the central region of Saudi Arabia, carried out by distributing an online self-administered semi-structured questionnaire. The questionnaire was distributed online in social media and websites. The sample size was 426 participants with a precision of ± 5% and 95% confidence interval (CI). The questionnaire included demographic characters such as age, gender, occupation, and marital status. The questionnaire also included body mass index (BMI), smoking, family history of IBS, Rome III criteria for diagnosing IBS, and Hospital Anxiety and Depression Scale (HADS) for anxiety and depression. Results: A total of 426 (230 [54%] male and 196 [46%] female) participants were enrolled in the study. According to Rome III criteria, 130 had IBS and the prevalence was 30.5%. Univariate analysis showed that gender, anxiety, depression, and low physical activity are statistically significant variables with symptomatic IBS (P < 0.05). Conclusion: In this study, a high prevalence of IBS in the Central Saudi Arabia population was observed along with the presence of some modifiable risk factors, yet, the sample size was small which shows the need for more studies in this area particularly on the general population.

Background: Nigeria ranks second globally with a HIV/AIDS prevalence of 3.2%. HIV infected children are surviving to adolescence because of anti-retroviral therapy, but many do not know why they need to take these medicines. Disclosure is critical to long-term disease management, yet, if, how and when caregivers and or health professionals disclose to children is not well known in resource-limited settings. The barriers to disclosure remain largely undocumented. Objectives: To determine the prevalence and age of HIV disclosure to children in Abuja, Nigeria and identify caregivers perspectives as well as barriers to disclosure. Methods: A cross-sectional study was done June–July 2016 using a structured questionnaire, convenience sampling and quantitative methods at the infectious disease clinics of National Hospital Abuja. A sample of 164 caregivers of HIV-positive children aged 5–16 years receiving antiretroviral therapy for at least 1 year were enrolled. Results: Prevalence of full disclosure was 24.5%, partial disclosure 22.7%, with overall prevalence of 47.2%. Mean age at full disclosure was 11.87 years. Bivariate analysis showed significant difference between disclosure and child's level of education (χ² for trend 26.710, P < 0.001), support for disclosure (χ² 4.399, P = 0.036) and if caregiver held the opinion that children should have disclosure done (Pearson's χ² 30.174, P < 0.001). However, on logistic regression, only the age of the child (P < 0.001, 95% CI 1.176–1.499) and the caregiver's opinion (P = < 0.001, 95% CI 4.914–2.542) remained significant. Various barriers to disclosure were identified. Conclusion: The prevalence of full disclosure is low and several barriers prevent early disclosure. Caregiver's and HCWs need empowerment with culturally appropriate skills and platforms to increase disclosure rates, which may help improve adherence.

Background: Osteoarthritis secondary to osteonecrosis of the femoral head is a common presentation in patients with sickle cell disease. Functional limitations with or without deformities from these complications of sickle cell disease often require Total Hip Arthroplasty (THA) to improve outcome. Aim: The aim of this study was to evaluate the postoperative outcome of THA for secondary osteoarthritis from osteonecrosis of the head of the femur in patients with sickle cell disease. Methodology: A retrospective study of outcome of THA in sickle cell disease patients between January 2010 and December 2015 is presented. Primary outcome was measured using the rates of complications and the Harris Hip scores at 6 weeks, 12 weeks, 6 months, and yearly. Results: A total of 68 THA in 56 patients with sickle cell disease was reviewed. The age range was 13–68 years, with a mean of 30.9 years. There were 15 males and 41 females (M: F ratio = 1:3). Approaches to the hip were direct lateral (64.3%), anterolateral (1.8%), and posterior (33.9%). 12 (21.4%) patients had bilateral total hip arthroplasty, and 44 (78.6%) had unilateral total hip arthroplasty. No patient required adductor tenotomy. Superficial surgical site infection was recorded in 7 (12.5%) patients. The postoperative functional outcome, measured by the Harris Hip score, was good or excellent in all patients, except 2 (2.9%) who required revision surgery following unacceptable results after primary hip arthroplasty. Conclusion: THA is a viable and effective treatment modality for sickle cell disease patients with osteonecrosis and secondary hip osteoarthritis. The choice of surgical approach does not affect the outcome.

Background: Diabetes mellitus (DM) and depression are common chronic disease states of public health importance with huge burden and the potential to impact many aspects of life. They are said to be related though this relationship is not fully understood. The presence of depression among patients with DM is associated with poor glycemic control, complications, and poor self-care. Method: This was a descriptive cross-sectional study conducted at the Diabetes Clinic of the Jos University Teaching Hospital. Three hundred and ten (310) patients with diabetes mellitus were recruited consecutively. The depression module of the Mini International Neuropsychiatric Interview (M.I.N.I.) version 5.0 was used to ascertain depression among these patients. Other demographic data were obtained using a questionnaire. Blood pressure, weight, and height were also measured and the body mass index (BMI) calculated. Results: One hundred and eighty four (59.35%) of the study population were females and the mean age (SD) of the study population was 54 ± 12 years. The mean age (SD) of the females was 53 ± 11 years and that of the males was 54 ± 12 years with no significant statistical difference (P = 0.35). Two hundred and forty nine (80.32%) of the study population were urban dwellers with 140 (45.16%) earning less than N500, 000 (794 USD) yearly. Current major depression was found in 35 (11.3%) patients, among whom 7 (2.3%) had recurrent depression. The presence of DM complications (OR: 3.50, 95% CI 1.16–10.61) and a positive family history of depression (OR: 4.03, 95% CI 1.32–12.29) were found to be correlates of current major depression. Conclusion: The prevalence of current major depression among patients with diabetes mellitus in this study is high. We recommend that all patients with DM should be screened for depression and treated appropriately to reduce its consequences.

Background: Cardiac autonomic neuropathy (CAN) resulting from seizures has been implicated in sudden unexpected death in epilepsy in persons with epilepsy (PWE), however, there are no previous studies of CAN in PWE from Nigeria. Objectives: This study sought to determine the frequency and pattern of CAN in adult PWE in a tertiary hospital in South-western Nigeria and to determine the relationship between seizure variables and CAN. Methods: A cross-sectional study of 80 adult PWE and 80 matched controls aged between 18 and 60 years was carried out between March 2012 and June 2013 at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Demographic and clinical data were obtained from all the study participants. Anxiety was excluded using the Hamilton Anxiety Scale. Those with conditions that could affect autonomic function, such as chronic renal failure, heart failure, Parkinson's disease, diabetes mellitus, anxiety, and psychiatric disorders and pregnant women were excluded. Five bedside cardiovascular reflex tests were performed on each subject after baseline heart rate and blood pressure (BP) had been recorded. Results: The mean age of onset of epilepsy was 19 ± 10 years, whereas the mean duration of epilepsy was 10 ± 8 years. The mean seizure frequency was 14 ± 30 per month (median three seizures per month). Of the 80 patients evaluated, 42 (52.5%) had CAN, whereas none of the controls had CAN. Majority (69%) of the PWE with CAN had purely parasympathetic dysfunction, whereas 3% had purely sympathetic dysfunction and 10% had combined autonomic dysfunction. The PWE in this study had significantly lower tilt ratios and diastolic BP change with Isometric Hand grip as well as significantly higher systolic BP change on standing than the controls. Patients who had more than four seizures per month had higher odds of CAN than those with less frequent seizures (odds ratio 0.275, P value 0.023). Also, patients who had received treatment for less than 10 years were found to have greater odds of CAN than those who had received treatment for a longer period (odds ratio 11.676, P value 0.046). Conclusion: CAN is common in adult PWE in South-Western Nigeria and the major predictors are short duration of treatment and frequent seizure episodes. Routine screening of these patients may help with early detection of autonomic dysfunction and provide an opportunity for intervention.

Aim: The aim of this study was to evaluate the effect of the different rotational speeds and creating a glide path on cyclic fatigue resistance of XP-endo Shaper® (XPS) (FKG Dentaire SA, La Chaux-de-Fonds, Switzerland) at intracanal temperature. Materials and Methods: Ninety-six XPS files were divided into 6 groups [directly used at 1000 rpm (G1) or 3000 rpm (G4), with glide path at 1000 rpm (G2) or 3000 rpm (G4), without glide path at 1000 rpm (G3) and 3000 rpm (G6)]. All the instruments were rotated in a stainless-steel artificial canal with a 75° angle of curvature, 7.5 mm radius of curvature, and 1.3 mm inner diameter until the fracture occurred. The number of cycles to failure (NCF) and the length of the fractured (LF) segments were evaluated. Weibull analysis, one-way ANOVA, and Tukey multiple comparison tests were performed with the significance level set at 0.05. Results: NCF of 3000 rpm groups was statistically higher than that of 1000 rpm groups (P < 0.05). And time to fracture was found statistically higher in 1000 rpm as compared to 3000 rpm. The mean LF of the instruments was statistically insignificant (P > 0.05). There was no statistical difference within the groups subjected at 1000 rpm and 3000 rpm files used with or without a glide path (P > 0.05).Conclusion: Within the limitations of this in vitro study, it was determined that XPS can be used safely even at 3000 rpm speed with or without glide path.

Objectives: To evaluate the knowledge level of individuals who attended a first aid training update program, and to determine the factors affecting their approaches in such cases. Methods: This is a descriptive cross-sectional study. The sample of the research consists of 747 individuals (laypersons) who applied to the first aid training update organized in an institution in Istanbul providing health education between 01.02.2018 and 01.08.2018, and who agreed to participate in the research. These first aid trainings are provided by healthcare professionals who have first aid certificate of authority within the scope of first aid regulation. Data were collected using the “Participant Information Form” and the “Basic First Aid Knowledge Level Evaluation Form”. Results: The participants administered first aid within the three years of time following their basic first aid training course (24.6%). They administered first aid primarily in emergency cases of fainting (29.6%) and the majority of them (95.7%) did not perform cardiopulmonary resuscitation during their basic first aid effort. Of the participants, 73.9% answered incorrectly the question: “The letter 'A' in the abbreviation ABC of basic life support administration stands for airway”. In our study, it was also found that there was a significant relationship between the total knowledge score and the number of trainings update and first aid intervention in the last three years (P < 0.05, P < 0.001, respectively). Conclusions: It was determined that individuals had a high level of knowledge about basic first aid and one-quarter of the participants had administered first aid in the last three years. In order for individuals not to lose their knowledge and skills gained through first aid training; updating training and providing first aid training programs to individuals in society can be a guide for bystanders who provide faster and sufficient first aid in cases of emergency.

Background: Birth preparedness and complication readiness (BPCR) is a strategy with specific interventions to reduce pregnancy related morbidity and mortality. Aim: The study assessed the predictors of optimal birth preparedness and complication readiness among parturient in a tertiary health institution in Nigeria. Subject and Methods: This descriptive cross-sectional study was conducted among parturient at the labor and post-natal wards of University of Nigeria Teaching Hospital Enugu over a 6 months period. Demographic information and predictors of BPCR were analyzed by descriptive statistics and logistic regression respectively with P value of < 0.05 considered statistically significant. Results: Of the 420 parturient, 330 (78.6%) and 90 (21.4%) were booked and unbooked respectively. Majority (74.2%) of the booked and about half of the unbooked parturient were knowledgeable about BPCR. Most (92.4%) of the booked parturient were optimally birth prepared at delivery as against 22.2% of the unbooked. Higher parity (adj OR = 3.79; 95% CI = 1.46–9.82, P = 0.01), tertiary educational level (adj OR = 2.98; 95% CI = 1.23–7.20, P = 0.02), regular antenatal visit (adj OR = 2.68; 95% CI = 1.06–6.76, P = 0.04), information received on birth preparedness before delivery (adj OR = 0.21; 95% CI = 0.07–0.61, P = <0.01), and booked status (adj OR = 0.02; 95% CI = 0.01-0.05, P = <0.001) where significant predictors of optimal BPCR. Conclusion: Encouraging female education, regular antenatal visits, and participation in health talk is advocated to improve BPCR and ultimately reduce maternal and perinatal mortality/morbidity among women in southeast Nigeria.

Background: Educational environment (EE) affects transfer/acquisition of knowledge and skills needed in training medical students. Evaluation of EE by students is paramount to rating the EE of a medical school as well as evaluate effects of interventions. Assessing EE of medical schools is a current global trend. Objectives: To evaluate EE at the new medical school of the Chukwuemeka Odumegwu Ojukwu University Teaching Hospital Awka, Anambra State, Nigeria; calculate the total and subscale (Dundee Ready Educational Environment Measure) DREEM scores and assess differences in these scores amongst the different classes, age groups, and sexes. Methodology: This was a descriptive cross-sectional study using census survey. We administered DREEM questionnaire to 4^th, 5^th, and 6^th year medical students in the 2018/2019 academic session after ethical approval from Health Research and Ethics Committee (HREC). Data entry and analysis done using SPSS. ANOVA was used for association between level of study, age group, and total DREEM/Subscale scores. Test for association between sex and mean subscale/total score was done using independent sample t-test. P value <0.05 was adjudged significant. Cronbach's alpha for internal consistency was calculated. Results: Of 206 students, 185 filled in the questionnaire. Total DREEM score was 119.66, Students' perception of teachers 26.74, Students' academic self Perception 21.94, Students' Perception of Learning 30.75, Students' Social Self Perception 15.04, Students' Perception of Atmosphere 25.26. Three items scored above 3 while 11 items scored ≤2. Fourth year students significantly scored higher than others for all subscale and total DREEM score. No significant associations between age or gender and subscale or total DREEM scores. Cronbach's alpha for all scores was 0.91. Conclusions: The EE was not excellent but “more positive than negative.” Improvements are necessary in all domains of DREEM to ensure better quality of the educational environment.

Background: In midwifery practice, the education model used for skill acquisition is extremely important for the management of students' stress, anxiety and self-efficacy. Innovative practices aim to improve the students' cognitive, emotional and psychomotor skills, and new research needs to be performed to evaluate the results of such practices. Aims: The present study aimed to evaluate the effects of the education model and clinical practice features, such as practice time, laboratory practice and exam evaluation, on the students' state and continuous anxiety and self-efficacy status. Methods: This was a semi-experimental non-randomised study, including three steps. Research was conducted in two institutions. Sample selection was not made in the research. The sample consisted of two groups. Group 1 included students (n = 39), who get educated in 1^st institution. Group 2 included students (n = 40), who get educated in 2^nd institution. In the collection of research data; Introductory Information Form, Self- Efficacy Scale, Spielberger's State/Continuous Anxiety Inventory was used. Data were analysed by Shapiro Wilk Tests, numbers, percentages, Chi-square test, analysis of single factor variance in repeated measurements, repeated measures analysis of variance, t test in indepentdent samples. Results: A significant difference was found between the three data collection steps, regarding self-efficacy as well as state and continuous anxiety scores (P < 0.001). A significant correlation was found between the mean self-efficacy scores of each group (P < 0.001). Conclusions: The results indicate that students have a high level of self-efficacy using the daily life activities model, engaging in 8 hours of clinical practice, performing clinical practice under the supervision of a midwife or a nurse.

Background: To assess maxillary sinus findings using dental volumetric tomography before and after surgery in patients with dental implants in the maxillary posterior region with or without sinus floor elevation due to insufficient bone height. Materials and Methods: Cone-beam computerized tomography images taken for surgical planning before implantation and controlling after implantation were reviewed in 50 patients applied to the Department of Oral, Dental and Maxillofacial Surgery and Radiology of Dentistry Faculty at Ondokuz Mayıs University. Maxillary sinus diseases (focal mucosal thickening, polyp, mucous retention cyst, sinusitis) were evaluated. The relationship between dental implant and sinus floor augmentation procedures and maxillary sinus findings was statistically evaluated using the Chi-square test and Wilcoxon rank test. Results: In this study, 26 female (52%) and 24 male (48%) patients were examined. The mean age of all patients was 53.82 years (± 8.63). Focal mucosal thickening was most frequently observed in the study. There was no statistically significant correlation between implant applications and sinus pathologies with both internal and external elevation procedures and implant applications (P > 0.05). Conclusions: Sinus floor augmentation and dental implant applications seemed not to increase the risk of maxillary sinüs pathologies. However, it is suggested to carry out similar studies with more samples.

Metastatic lesions represent approximately 1% of all the intraoral lesions. They most commonly originate from lung and breast carcinomas, while the third most common source is the renal cell carcinoma. In this paper, we present the rare case of metastases of renal cell carcinoma in the mandibular gingiva of a 53-year-old male patient.