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   2015| July-August  | Volume 18 | Issue 4  
    Online since May 13, 2015

 
 
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REVIEW ARTICLES
Health care financing in Nigeria: Implications for achieving universal health coverage
BSC Uzochukwu, MD Ughasoro, E Etiaba, C Okwuosa, E Envuladu, OE Onwujekwe
July-August 2015, 18(4):437-444
DOI:10.4103/1119-3077.154196  PMID:25966712
The way a country finances its health care system is a critical determinant for reaching universal health coverage (UHC). This is so because it determines whether the health services that are available are affordable to those that need them. In Nigeria, the health sector is financed through different sources and mechanisms. The difference in the proportionate contribution from these stated sources determine the extent to which such health sector will go in achieving successful health care financing system. Unfortunately, in Nigeria, achieving the correct blend of these sources remains a challenge. This review draws on relevant literature to provide an overview and the state of health care financing in Nigeria, including policies in place to enhance healthcare financing. We searched PubMed, Medline, The Cochrane Library, Popline, Science Direct and WHO Library Database with search terms that included, but were not restricted to health care financing Nigeria, public health financing, financing health and financing policies. Further publications were identified from references cited in relevant articles and reports. We reviewed only papers published in English. No date restrictions were placed on searches. It notes that health care in Nigeria is financed through different sources including but not limited to tax revenue, out-of-pocket payments (OOPs), donor funding, and health insurance (social and community). In the face of achieving UHC, achieving successful health care financing system continues to be a challenge in Nigeria and concludes that to achieve universal coverage using health financing as the strategy, there is a dire need to review the system of financing health and ensure that resources are used more efficiently while at the same time removing financial barriers to access by shifting focus from OOPs to other hidden resources. There is also need to give presidential assent to the national health bill and its prompt implementation when signed into law.
  69 102,663 5,898
ORIGINAL ARTICLES
The prevalence of early childhood caries and its associated risk factors among preschool children referred to a tertiary care institution
OO Olatosi, V Inem, OO Sofola, P Prakash, EO Sote
July-August 2015, 18(4):493-501
DOI:10.4103/1119-3077.156887  PMID:25966721
Objective: The aim was to determine the prevalence of early childhood caries (ECC) and its association with infant feeding and oral health-related behavior among preschool children aged 6-71 months in Lagos. Materials and Methods: This was a descriptive cross-sectional study in which 302 children aged 6-71 months were selected from four pediatric outpatient clinics in Lagos, Nigeria. A structured questionnaire was used to obtain information regarding oral hygiene practices, dietary habits, breast and bottle feeding, birth weight of child and socioeconomic status of the family, from mothers of the children. The status of dental caries was recorded according to the World Health Organization criteria. Results: The prevalence of ECC among 302 children aged 6-71 months was 21.2% while the mean deft was 0.735. Multivariate logistic regression analysis showed the correlation of ECC with the associated risk factors. ECC was significantly higher in children who were bottle-fed at night. Method of tooth cleaning other than using fluoridated toothpaste significantly increased the prevalence of ECC. Breastfeeding for duration of 3-6 months showed significantly lesser caries prevalence. Caries significantly increased with age. Conclusion: Early childhood caries is a multifactorial disease in which prolonged duration of breastfeeding, nocturnal bottle feeding, and use of cleaning methods other than fluoridated toothpaste are risk factors for ECC. Oral health promotion programs should be targeted at mothers, pediatricians, nurses, caretakers at day care centers and primary care health workers.
  14 7,090 1,295
Assessment of hygiene habits and attitudes among removable partial denture wearers in a university hospital
U Cakan, E Yuzbasioglu, H Kurt, HB Kara, R Turunç, A Akbulut, KC Aydin
July-August 2015, 18(4):511-515
DOI:10.4103/1119-3077.154224  PMID:25966724
Aims: The aim of this study was conducting a survey of hygiene habits and use of removable partial dentures (RPDs) and correlate them with the social conditions of the interviewees. Methods: A total of 145 RPD wearers were interviewed by experienced clinical staff using a structured questionnaire. A Chi-squared test was performed to evaluate statistical significance between the variables, and the level of significance was P < 0.05. Results: A total of 72 (49%) patients reported that they had not been well informed by the dentists. Brushing was the most frequent cleaning method (57.6%). 77 (53.1%) patients did not take off their dentures at night. The frequency of cleaning dentures and using cleansing tablet was significantly higher in females than in males (P < 0.05). The frequency of denture cleaning, cleaned parts of denture, use of cleansing tablet, removal of dentures at night, frequency of tooth brushing, does not show any significant difference according to age, educational status or duration of denture usage (P > 0.05). RPD wearers did not clean their dentures and natural teeth satisfactorily and had limited knowledge of denture cleansing and oral hygiene maintenance. Conclusions: Hygiene habits and attitudes may be affected by gender, but education level and hygiene attitudes may not always present positive correlation. Dentists should thoroughly inform patients about the harmful effects of overnight wearing and motivate to clean metal parts of RPD's and cleansing tablet use in order to minimize the abrasive effect of widely preferred cleaning method of brushing with toothpaste.
  12 5,126 872
Red cell alloimmunization in multi-transfused patients with sickle cell anemia in Benin City, Nigeria
NI Ugwu, OA Awodu, GN Bazuaye, AE Okoye
July-August 2015, 18(4):522-526
DOI:10.4103/1119-3077.154204  PMID:25966726
Background: Sickle cell anemia (SCA) is an inherited hemoglobin disorder characterized by chronic anemia and occasional crises. Clinical features are variable. While some individuals are relatively stable and rarely require blood transfusion, others often require blood transfusion. Multiple blood transfusion is associated with complications including alloimmunization, infections, and iron overload. Aims and Objectives: The study aimed at determining the prevalence of red cell alloimmunization among multi-transfused patients with SCA. Materials and Methods: A cross-sectional study of adult SCA patients who have received multiple blood transfusion and those who have never received blood was done. Antibody screening and identification were carried out using gel technology with commercially made panel of cells. Results: A total of 145 SCA subjects were studied. They were made up of 86 test group (those that had received two or more units of blood) and 59 control group (those that had never received blood transfusion). Prevalence of red cell alloantibody among multi-transfused patients with SCA was found to be 9.3%. Alloantibodies identified were mainly against Rhesus antigens contributing 87.5% (anti-E 37.5%, anti-C 25%, anti-D 12.5%, anti-e 12.5%). A combination of Kell and Lutheran blood group antigens contributed 12.5%. No antibody was detected among the control group. Conclusion: Blood transfusion is associated with the development of alloantibodies. Routine blood grouping for multi-transfused patients with SCA should be extended to include other blood group antigens in addition to Rhesus D and ABO antigens.
  11 4,256 482
Epidemiology of active epilepsy in a suburban community in Southeast Nigeria: A door-to-door survey
PO Nwani, MC Nwosu, LA Asomugha, KO Enwereji, EO Arinzechi, AO Ogunniyi
July-August 2015, 18(4):527-533
DOI:10.4103/1119-3077.151789  PMID:25966727
Context: Epilepsy is one of the most common neurologic conditions afflicting an estimated 65 million people the world over. Current community-based data on the prevalence of active epilepsy in Africa are sparse. Aims: This study was aimed at determining the prevalence and profile of active epilepsy in a suburban community in Southeast Nigeria. Methods: It was a two phase cross-sectional descriptive study. In the first phase, those with possible active epilepsy were identified in a door-to-door survey using a modification of the World Health Organization Neuroscience research protocol. In the second phase, cases of active epilepsy were identified and the clinical forms of epilepsy diagnosed based on the International League against Epilepsy guidelines 1993. Results: A total of 6,800 persons was screened in the first phase of the study. There were 29 cases (16 males and 13 females) of active epilepsy. The point prevalence of active epilepsy was 4.3/1,000 (95% confidence interval (95% CI): 2.7-5.9) for the total population, 4.9/1,000 (95% CI: 2.5-7.3) for males and 3.7/1,000 (95% CI: 1.7-5.7) for females. The age-adjusted prevalence for the total population was 4.1/1,000 (US Population 2000). Classified using clinical criteria only, generalized seizures occurred in 62.1% (n = 18) while partial seizures occurred in 37.9% (n = 11) of cases. Conclusions: The prevalence of active epilepsy in Southeast Nigeria is comparable to that found in developed and some developing countries but less than that reported in suburban Southwest Nigeria about three decades ago.
  10 6,010 440
Co-infections of hepatitis B and C with human immunodeficiency virus among adult patients attending human immunodeficiency virus outpatients clinic in Benin City, Nigeria
CK Ojide, EI Kalu, E Ogbaini-Emevon, VU Nwadike
July-August 2015, 18(4):516-521
DOI:10.4103/1119-3077.151790  PMID:25966725
Background: Hepatitis B and C viral co-infections with human immunodeficiency virus (HIV) are known to affect progression, management, and outcome of HIV infection. This study was aimed to access the prevalence of hepatitis B and C co-infections in HIV-infected adult patients in the University of Benin Teaching Hospital with a view of understanding the gravity of this problem in the local population. Methods: The descriptive cross-sectional study was carried out on 342 HIV-infected adult patients on highly active antiretroviral therapy attending HIV Outpatients Clinic of University of Benin Teaching Hospital, between April and September, 2011. Patients' sera were screened for hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (HCV) using immunochromatographic-based kits. Clinical stage of HIV and CD4+ cell counts were equally evaluated. Data were analyzed using SPSS version 17. Results: Of the 324 HIV-infected patients screened, 53 (15.5%) were positive for HBsAg, 24 (7.0%) positive for hepatitis C virus antibodies (HCV-Ab), while 2 (0.6%) were positive for both viruses. Seroprevalence of HBsAg was higher in male (17.8%) than in female (14.7%) (χ2 = 0.49, P = 0.49), while the reverse is the case for HCV-Ab; 7.1% for female and 6.7% for male (χ2 = 0.02, P = 0.88). Seroprevalences of HBsAg and HCV-Ab were also higher among patients in World Health Organization disease stages 3-4 and patients with CD4+ cell count ≤200 cell/ml compared to those in stages 1-2 and with CD4+ cell count >200 cell/ml. Conclusion: Co-infection with hepatitis B virus and HCV among HIV/acquired immune deficiency syndrome (AIDS) patients is still a problem in our environment. Screening for these viruses among HIV/AIDS patients will allow for early detection and proper management.
  8 6,011 8,228
Pattern of femoral fractures and associated injuries in a Nigerian tertiary trauma centre
UE Anyaehie, OC Ejimofor, FC Akpuaka, CU Nwadinigwe
July-August 2015, 18(4):462-466
DOI:10.4103/1119-3077.151761  PMID:25966715
Background: The femur is the strongest and largest bone in the human body. It therefore requires high-energy trauma for it to fracture unless there is an ongoing pathology that weakens the bone. Femoral fractures are thus associated with significant pain, deformities, bleeding and varying degrees of injuries. The aim of this study is to determine the pattern of femoral fractures and the associated injuries in our region while recommending possible means of averting these injuries. Materials and Methods: A 10-year retrospective study was done in National Orthopedic Hospital Enugu from 1994 to 2003. The demographic data, etiology, the part of femur affected and associated injuries were collated from the hospital records/folders. The analysis was performed using descriptive statistics in Microsoft Excel 2007. Results: A total of 562 cases were reviewed, 63.7% of all the patients were males and the most common etiological factor was road traffic accidents. The site of fracture varied with age and etiology with 26.5% occurring at the mid-shaft with an average age of 27.2 years and 16% occurring at the neck of femur, more in the elderly, with 55.6% following minor falls and trips. The most common associated injury was soft tissue injuries requiring secondary wound closure. Conclusion: Femoral fractures are common and the pattern varies with age and the mechanism of injury. They are associated with other injuries that may be life-threatening.
  8 6,664 635
Obstetric outcomes of human herpes virus-2 infection among pregnant women in Benin, Nigeria
EI Kalu, CK Ojide, A Chuku, II Chukwuonye, FE Agwu, VU Nwadike, FC Korie, GOC Okafor
July-August 2015, 18(4):453-461
DOI:10.4103/1119-3077.154210  PMID:25966714
Objective: This study investigated the obstetric outcomes of herpes simplex virus (HSV-2) infection among pregnant women. Materials and Methods: In this prospective cohort study, a total of 674 consenting pregnant women attending ante-natal clinic in the University of Benin Teaching Hospital and Central Hospital Benin were recruited between November 2011 and December, 2012. The women were screened for HSV-1, and HSV-2 using glycoprotein-G-based type-specific Enzyme Linked Immunosorbent Assay on archived blood samples; and were followed up to the delivery period and postnatal clinic. The HSV-2-seronegative participants underwent second blood sampling for HSV-2 IgG and IgM assay during the delivery period. The patients were thus categorized into "HSV-2 seropositive", "HSV-2-seronegative," and "incident HSV-2 infection" cohorts. The pregnancy outcomes were assessed by review of hospital records. Data analysis was with SPSS version 16 software. Results: Of 674 pregnant women surveyed, 312 (46.3%) were HSV-2 seropositive; while 362 (56.7%) were HSV-2 seronegative. Comparing the "HSV-2 seropositive" and "HSV-seronegative" groups, there were no significant differences in occurrence of low birth weight (LBW), prematurity, spontaneous abortions, and stillbirth events (P = 0.96; 0.95; 1.0; and 0.77, respectively). Comparing the "incident HSV-2 infection" with the "HSV-2 seronegative" groups, the relative risks of occurrence of LBW deliveries, preterm deliveries, and stillbirths were 12.6, 25.1, and 4.5, respectively. Conclusion: First episode HSV-2 infection among pregnant women in Benin, Nigeria is associated with an increased risk of occurrence of spontaneous abortion, LBW delivery, stillbirths, and preterm delivery.
  7 4,706 446
Pattern of hormone receptors and human epidermal growth factor receptor 2 status in sub-Saharan breast cancer cases: Private practice experience
CC Nwafor, SO Keshinro
July-August 2015, 18(4):553-558
DOI:10.4103/1119-3077.156905  PMID:25966732
Introduction: Breast cancer is the most common cancer among women globally. With immunohistochemistry (IHC), breast cancer is classified into four groups based on IHC profile of estrogen receptor (ER)/progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2/neu) expression, positive (+) and/or negative (−). The IHC classification correlates well with intrinsic gene expression microarray categorization. ER-positive tumors may benefit from being treated with selective ER modulators and aromatase inhibitors, whereas patients with HER2/neu positive tumors have been shown to experience a significant survival advantage when treated with humanized monoclonal antibodies against HER2/neu. Objective: To determine ER/PR, HER2/neu expression and their association with histological prognostic markers in female breast carcinomas seen in a private diagnostic laboratory based in Lagos. Materials and Methods: Immunohistochemistry reports of breast cancer patients, which were diagnosed by histopathology section of a private diagnostic laboratory based in Lagos, Nigeria from August 2009 to August 2014. Results: About 18.7% of breast cancers had IHC (ER, PR and HER2) done on them and were all females. The mean age of all subjects was 49.5 years (standard deviation, 13.2; range, 29-78 years). Most (95.8%) of the breast cancers were of invasive ductal carcinoma type, with 77.4% of them been >5 cm. IHC pattern was as follows: ER/PR+, HER2− = 19 (39.6%), ER/PR−, HER2− (triple negative [TN]) = 14 (29.2%), ER/PR+, HER2+ = 9 (18.8%), ER/PR−, HER2+ = 6 (12.5%), corresponding to Lumina A, TN/basal-like, Lumina B and HER2 over expressed respectively. Conclusion: Triple negative breast cancers are common in our environment and affect young females most and could be contributory to the poorer prognosis of breast cancer in our environment.
  6 3,290 412
Bladder perforations in children
U Bakal, M Sarac, T Tartar, F Ersoz, A Kazez
July-August 2015, 18(4):483-488
DOI:10.4103/1119-3077.151752  PMID:25966719
Context: Bladder perforations in children occur due to several different reasons. Aim: In this clinical series study, we focused on bladder perforations due to the pelvic injury, and our aim also was to create awareness for a rare type of bladder injuries. Setting and Design: This was a retrospective study of the patients who were treated in our clinic for bladder perforation between 2006 and 2011. Subjects and Methods: We reviewed the documents of childhood bladder perforations, and demographic and clinical characteristics of the patients were obtained. No statistical analyses were used because of the limited number of cases. Results: There were ten patients who suffered from bladder perforation in 5-year period; 5 were male, and 5 were female. The mean age of the patients was 4.35 years. Four patients (40%) experienced iatrogenic perforation and six patients (60%) experienced perforation due to the accident. Common symptoms were hematuria, abdominal tenderness, and inability to urinate. Three patients were diagnosed via emergency laparotomy, without any radiological examinations performed before surgery. Four patients suffered from the intraperitoneal perforation, three patients suffered from extraperitoneal injury and three of them both of intraperitoneal and extraperitoneal injuries. Mean recovery time for patients was 15 days. One patient developed a urinary tract infection and one newborn died due to accompanying morbidities. Nine patients were discharged from the hospital. Conclusion: If the patients had a pelvic injury, surgeons must pay attention for the bladder perforation. Isolated bladder perforations are rare, and they are generally associated with iatrogenic injuries. Clinicians should pay attention to findings such as anuria, inability to insert a urinary catheter, and free fluid in the abdomen in order to diagnose the bladder perforation in newborns. Novice surgeons should pay more attention to avoid causing iatrogenic bladder perforation during inguinal hernia repair.
  5 3,326 339
Effects of azithromycin versus metronidazole-amoxicillin combination as an adjunct to nonsurgical periodontal therapy of generalized aggressive periodontitis
E Ercan, BC Uzun, G Ustaoglu
July-August 2015, 18(4):506-510
DOI:10.4103/1119-3077.154221  PMID:25966723
Objective: This study evaluated the short-term clinical benefits of two systemic antibiotic regimes added to the nonsurgical periodontal treatment of generalized aggressive periodontitis. Materials and Methods: The patient records were reviewed and 45 patients were selected and divided into the following three groups: Scaling and root planning (SRP) only; SRP plus azithromycin (AZT group); and SRP plus metronidazole and amoxicillin (M + A group). The periodontal indexes were recorded at baseline and 3-month posttherapy. Results: The periodontal parameters were improved in all groups 3-month posttherapy. The scores were decreased more in the AZT and M + A groups than the controls, but this difference did not reach significance. In addition, the decrease in the plaque index from baseline to 3-month in the AZT group was not significant. Conclusion: Nonsurgical therapy reduces the probing depth, clinical attachment level, and clinical inflammation findings. This healing tendency was observed in the AZT group despite the baseline plaque scores. Therefore, AZT might be active against the bacteria in dental biofilms.
  4 4,125 768
CASE REPORTS
Comprehensive dental management in a Hallermann-Streiff syndrome patient with unusual radiographic appearance of teeth
O Erken Gungor, B Guzel Nur, H Yalcin, H Karayilmaz, E Mihchi
July-August 2015, 18(4):559-562
DOI:10.4103/1119-3077.156910  PMID:25966733
Hallermann-Streiff syndrome (HSS) is a genetic disorder characterized by proportionate dwarfism, birdlike facies, hypotrichosis, skin atrophy, dyscephaly, bilateral microphthalmia, congenital cataracts, a narrow, weak, beaked nose, a hypoplastic mandible, and orodental anomalies. Occurrence is sporadic and distinct patterns of inheritance have not been found. This case report describes the dental management of a 3-year-old girl patient with HSS, who had unusual radiographic appearance of teeth. Furthermore, dental treatments and a 30-month follow-up period of the patient with this rare tooth structure malformation have been presented.
  3 4,719 441
Machete-cut injuries are occurring in the maxillofacial region in Zaria, Nigeria
OA Chukwudi, A Rowland, O Uche
July-August 2015, 18(4):569-572
DOI:10.4103/1119-3077.156911  PMID:25966735
Five cases of machete cut injuries to the maxillofacial region seen over a period of 8 months (January-September, 2012), at the Maxillofacial Unit of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, are presented. The severity of the injuries is evident from the extent of tissue disruption as shown in the pictures. The immediate threats to life in the cases were hemorrhage and airway obstruction. Surgical repairs were performed under local anesthetic infiltration in three cases while the rest were performed under general anesthesia. There was no nerve repair done due to lack of facilities, although, adequate apposition of soft and hard tissues were achieved. Four patients had rapid postoperative recovery in our facility while one absconded after wound debridement and repair was achieved. Two patients who had nerve injuries were followed-up to monitor recovery of the injured nerves. There was no tetanus, gangrene, pseudoaneurysm or death recorded in our cases. There is a need for relevant authorities to check the occurrence of this kind of injury, especially as the weapon used is a house-hold tool, which is readily available and accessible to all and sundry.
  3 3,223 233
Diagnosis of acute myeloid leukemia in a dental hospital; report of a case with severe gingival hypertrophy
M Misirlioglu, MZ Adisen, S Yilmaz
July-August 2015, 18(4):573-576
DOI:10.4103/1119-3077.151803  PMID:25966736
Acute myeloid leukemias (AMLs) are aggressive hematopoietic neoplasms that, if untreated, can lead to death within days. Owing to its high morbidity rate, early diagnosis and appropriate medical therapy is essential. Oral lesions may be the presenting feature of acute leukemias and are, therefore, important diagnostic indicators of the disease. Erythematous or cyanotic gingival hyperplasia with or without necrosis is reported to be the most consistent symptom leading to a diagnosis of acute leukemia that directs the patient to seek early dental consultation. This report refers to a patient with AML that was provisionally diagnosed in the dental hospital due to severe gingival enlargements.
  3 6,003 504
ORIGINAL ARTICLES
Holdaway's analysis of the nose prominence of an adult Nigerian population
GI Isiekwe, OO daCosta, IL Utomi, OO Sanu
July-August 2015, 18(4):548-552
DOI:10.4103/1119-3077.151791  PMID:25966731
Background: Facial beauty is a function of harmonious balance among all parts of the face, and the nose plays a dominant role in this because of its location exactly in the middle of the face. Therefore, an evaluation of the nasal form and its position relative to other facial structures should play an important part in the assessment of patients before orthognathic surgery, rhinoplasty or orthodontics. Aim: The aim was to establish normative values for the nose prominence of an adult Nigerian population using Holdaway's soft tissue cephalometric analysis. Methodology: Lateral cephalometric radiographs of 100 adults aged 18-25 years, with normal occlusion and a harmonious facial appearance were analyzed. The nose prominence was assessed using Holdaway's analysis. Twenty radiographs randomly selected, were retraced to assess for errors. Data analysis included descriptive statistics, Student's t-tests and analysis of variance using the Statistical Package for Social Sciences. Results: The mean value recorded for the nose prominence of the study population was 3.49 mm (standard deviation [SD], 3.26 mm), with a range of −5.0 mm to 15.0 mm. Mean values obtained for females were 3.73 mm (SD, 2.88 mm) and males 3.19 mm (SD, 3.70 mm). No statistically significant gender difference was observed (P > 0.05). In addition, no significant difference was observed between the nose prominence values recorded for different age-groups (P > 0.05). Conclusion: Normative values were established for the nose prominence of an adult Nigerian population. The values obtained for Nigerians in this study are comparatively lower than that reported for other populations. These values would aid in treatment planning for orthognathic surgery, rhinoplasty and orthodontics in Nigerians.
  3 4,410 395
Maternal views and experiences regarding repeat Caesarean section
BA Olofinbiyi, RO Olofinbiyi, OP Aduloju, BP Atiba, OD Olaogun, OR Ogundare
July-August 2015, 18(4):489-492
DOI:10.4103/1119-3077.156883  PMID:25966720
Objective: The aim was to determine maternal views and experiences regarding repeat caesarean section. Methods: A pretested and validated semi-structured questionnaire was administered to women with prior cesarean section by trained research assistants and resident doctors; anonymity and confidentiality were strictly observed. The questionnaire comprised information reflecting patients' sociodemographic structure, level of education, number of previous cesarean section, maternal complications following previous cesarean and opinions about acceptance and refusal of cesarean section. Results: Two hundred and twenty-seven women participated in the study out of which 157 (69.2%) would accept a repeat cesarean section and 70 (30.8%) would not accept. Significant proportion of respondents above 35 years of age would refuse a repeat cesarean section (58.6%). Religious belief (39.7%) and pain (26.5%) were the most common reasons for refusal of cesarean section. Conclusion: Appreciable proportion of women with previous caesarean section will decline a repeat cesarean section. Re-orientation, reappraisal and appropriate corrective action in the areas of religious belief and postoperative pain management will positively influence our women's acceptance of a repeat cesarean section.
  3 4,130 379
Effects of edentulism in obstructive sleep apnea syndrome
R Oksayan, O Sökücü, M Uyar, T Topçuoglu
July-August 2015, 18(4):502-505
DOI:10.4103/1119-3077.154203  PMID:25966722
Objectives: The purpose of this study was to investigate the effects of edentulism in obstructive sleep apnea syndrome (OSAS) patients. Materials and Methods: The study patients' were selected from the Gaziantep University Sleep Clinic and Orthodontic Department archives between the years of 2009 and 2011. Study groups were determined according to age and edentulism, and the overall study population consisted of 42 (21 male, 21 female) OSAS patients. Data from 14 edentulous (Group I), 14 older dentate (Group II), and 14 middle-aged dentate OSAS patients (Group III) were compared in this study. Polysomnographic parameters, which were measured and analyzed included: Sleep time, sleep efficiency, sleep stage 1, sleep stage 2, sleep stage 3, percentage of rapid eye movement sleep, apnea-hypopnea index, oxygen saturation and arousal index. The Kruskal-Wallis and Mann-Whitney U statistical tests were used for comparing the differences between the three groups and subgroups. Results: Sleep time parameters showed significant differences between the groups (P < 0.05). Differences occurred between Group I and Group III in the sleep time parameter (P < 0.05), while the edentulous subjects showed lower mean sleep time values when compared to the older and middle-aged dentate groups. Conclusion: According to our results, edentulism may not impact polysomnography parameters, with the exception of the sleep time parameter. Important attention should be given to edentulous individuals during sleep with their dentures to prevent OSAS complications. The use of dentures may prevent or protect patients from the predisposing factors of OSAS.
  3 2,955 381
Knowledge of conversion disorder in children by pediatricians in a developing country
AC Ndukuba, RC Ibekwe, PC Odinka, RC Muomah, SO Nwoha, C Eze
July-August 2015, 18(4):534-537
DOI:10.4103/1119-3077.154198  PMID:25966728
Introduction: Conversion disorder (CD) in children presents the clinician with a diagnostic and treatment dilemma. Mistaking a physical condition for CD carries serious consequences for the child while continued investigation in line with physical disease in a child with CD also may expose the child to serious harm. Materials and Methods: One hundred and seventy-four consenting doctors who attended a national conference of pediatricians were administered a 10 item questionnaire developed by the researchers. Results: Only 5 (2.9%) of participants had good knowledge (scored above the mean plus one standard deviation of the score obtained by the psychiatry residents. Gender, rank, years of experience, availability of psychiatric service in center and duration of the psychiatry posting as the medical student could not differentiate those with good/fair knowledge from those without. However, those who have referred children for psychiatric assessment (P = 0.015), those who believe that children can have CD (P = 0.000) and those who are fairly confident that they could diagnose CD in children (P = 0.000) had better knowledge of CD. Conclusion: Pediatricians have poor knowledge of CDs in children. Those that know that children could have the condition have confidence that they can identify children with the condition and have referred with mental health problems to psychiatrists have better knowledge than those who did not.
  3 2,859 311
Use of fetal biometry in the assessment of gestational age in South East Nigeria: Femur length and biparietal diameter
CO Adiri, GE Anyanwu, KK Agwuna, EN Obikili, OJ Ezugworie, AU Agu, J Nto, SN Ezeofor
July-August 2015, 18(4):477-482
DOI:10.4103/1119-3077.151749  PMID:25966718
Background: Fetal growth is influenced by many factors such as race, socioeconomic status, genetics, geographical location, maternal diseases, and number of babies. Consequent upon these, fetal growth charts may vary from one location to another even within the same geographical entity. Objective: This study was designed to establish the fetal growth chart in antenatal women who had ultrasound scanning at the University of Nigeria Teaching Hospital, Enugu, South East Nigeria. Patients and Methods: This is a descriptive analysis of fetal biometric measurement of antenatal women. Four hundred and seventy pregnant women were studied. Results: The nomogram for the femur length (FL) and biparietal diameter (BPD) for the different weeks of gestation (from 13 th to the 40 th week) were established. Correlation coefficients between gestational age and the various fetal parameters were also reported. Growth charts using both FL and BPD were plotted. A regression model for prediction of fetal age using the fetal biometry was also deduced for the studied population. Conclusion: The fetal parameters used in this study were consistently smaller than reported values from European studies up to the 34 th week of gestation after which a catch-up growth till the 40 weeks was observed. Fetal parameters observed in this study were larger than most of the reported Asian values.
  2 9,210 419
Effects of ultrasonic and sonic scaling on surfaces of tooth-colored restorative materials: An in vitro study
D Erdilek, S Sismanoglu, B Gumustas, BG Efes
July-August 2015, 18(4):467-471
DOI:10.4103/1119-3077.151776  PMID:25966716
Objective: The effects of sonic and ultrasonic scalings (USSs) on the surface roughness of nanohybrid, flowable, and polyacid-modified resin composites and conventional glass ionomer cement were examined, and the effectiveness of repolishing on the scaled material surfaces was determined. Materials and Methods: The surface roughness of each sample was measured three times before and after each scaling and after repolishing, and the data were analyzed using repeated measuresanalysis of variance, Tukey's multiple comparisons, and paired t-tests by a statistical program. Results: Although sonic and USS both significantly increased the surface roughness of all the tooth-colored materials, USS roughened the surfaces of all the test materials more than SS did. Hence, USS may detrimentally affect tooth-colored restorative materials, especially conventional glass ionomers and compomers. Repolishing decreased the surface roughness of all the materials to near their baseline levels. Conclusions: On the basis of these results, the repolishing of restoration surfaces is strongly recommended after dental scalings.
  2 4,131 468
Obstetrics and gynaecology residents' knowledge of the informed consent process and its practice in their training institutions
PI Okonta
July-August 2015, 18(4):445-452
DOI:10.4103/1119-3077.151787  PMID:25966713
Introduction: The ethical principle of autonomy as expressed in the practice of informed consent is a core tenet of clinical practice and good patient physician relationship. Aim: The aim was to identify specific gaps in the knowledge of trainee obstetricians and gynecologists in Nigeria about the informed consent process and its content. It also sought to describe the practice of informed consent in their respective institutions. Materials and Methods: A survey of Residents in obstetrics and gynecology attending the revision course of the Faculty of obstetrics and gynecology of the national postgraduate medical college was done to determine their knowledge of the informed consent process and its practice in their institutions. Results: None of the residents was able to give responses that contained all five conditions for informed consent to be valid. Furthermore, only 3 (2.22%) Residents mentioned that the name of the surgeon to perform the surgery should be part of the information provided to patients during the informed consent process. Similarly, only 8 (5.93%) mentioned that consequences of not having the surgery should be part of the informed consent process. The concept of the 'emancipated minor' being competent to give consent was known by 38% of the residents. Conclusion: Although Residents in obstetrics and gynecology in Nigeria have some knowledge of the informed consent process, this knowledge is deficient in key areas such as competence to give consent, content and scope of information to be disclosed to patients for surgery. There is a need to teach residents the rudiments of informed consent and bioethics in general.
  2 6,263 512
Availability and functionality of sphygmomanometers at health care institutions in Enugu, Nigeria
CP Chijioke, TO Okolo, KI Nwadike, EC Ejim, FC Ekochin, GN Aronu, SI Ghasi, OU Chijioke
July-August 2015, 18(4):544-547
DOI:10.4103/1119-3077.156899  PMID:25966730
Objective: Our aim was to investigate the availability of functional blood pressure monitors at health care institutions in Enugu, Nigeria. Methods: During repeated surveys of 15 (primary, secondary and tertiary) health care institutions in Enugu between 2007 and 2012, records were made of the availability and functional status of sphygmomanometers in the clinics and wards. We also assessed the degree of agreement between measurements by institutional staff and measurements by trained observers using the same or the standard sphygmomanometer. Results: Apart from three institutions, there was inadequate availability of fully functional sphygmomanometers: 61 staff attending to outpatients were sharing 35 sphygmomanometers, 6 of which were faulty i.e. needing repairs. Wards invariably had only one or two functional sphygmomanometers, regardless of bed occupancy. Institutional staff ignored recommended guidelines for blood pressure measurement. The overall mean difference in blood pressure measurements between institutional staff and a trained observer (1.6 mmHg; 95% confidence interval, CI: -0.3 to 3.4; P = 0.1) was greater and more significant than the mean difference between the two observers (0.1 mmHg; CI: -1.5 to 1.7; P = 0.9) and the mean difference between institutional and standard sphygmomanometers (-0.2 mmHg; CI: -1.7 to 1.3; P = 0.8). Conclusion: There has been a notable lack of reporting on the availability of blood pressure measuring devices in third world health care institutions. Our surveys have shown inadequate availability of functional sphygmomanometers in the institutions, but satisfactory agreement between measurements by institutional staff and trained observers. In view of recent guidelines and recommendations, there is need to supplement office readings with mercury devices with oscillometric home or automated office blood pressure recording.
  2 2,489 210
Assessment of the periapical health of abutment teeth: A retrospective radiological study
B Gumru, B Tarcin, E Iriboz, DE Turkaydin, T Unver, HS Ovecoglu
July-August 2015, 18(4):472-476
DOI:10.4103/1119-3077.151763  PMID:25966717
Aim: The aim was to examine the technical quality of root fillings and periapical status of root-filled and nonroot-filled teeth restored with crowns and bridge retainers through a retrospective analysis of orthopantomographs (OPTGs) in an adult Turkish subpopulation. Materials and Methods: In this study, the digital OPTGs of adult patients between the ages of 20 and 70 who appealed to the Endodontics Endodontics Department of the Dentistry Faculty at Marmara University (Istanbul, Turkey) for the first time to have their endodontic treatment needs met were used. The periapical health of all teeth restored with crowns and bridge retainers, and the technical quality of the root fillings on abutment teeth were evaluated by radiographic criteria. Results: The survey was carried out using the OPTGs of 1000 adult patients composed of 590 (59.0%) women and 410 (41.0%) men. 4656 (20.9%) of the totally examined 22280 teeth were with crowns and bridge retainers. 986 of the total abutment teeth were root-filled and 458 (46.5%) of them had apical periodontitis (AP) while 3670 of the total abutment teeth were nonroot-filled and 930 (25.3%) of them were with AP. The most commonly treated teeth were premolars (33.8%), followed by molars (26.2%), incisors (23.3%) and canines (16.7%). Technical quality was proved to be adequate in 27.5% of the root fillings. A higher frequency of AP was related to inadequate root fillings (P < 0.01). Conclusion: The frequency of root-filled abutment teeth with AP, nonroot-filled abutment teeth with AP, and technically inadequate root-fillings among teeth with crowns and bridge retainers was high in the selected adult population.
  1 3,319 386
Which is the most effective disinfection method in primary root canals: Conventional or newly developed ones?
A Kapdan, A Kustarci, T Tunc, Z Sumer, S Arslan
July-August 2015, 18(4):538-543
DOI:10.4103/1119-3077.154207  PMID:25966729
Background: The aim of the study was to evaluate the antimicrobial activity of the-potassium-titanyl-phosphate - the KTP laser and ozone in of primary root canals. Materials and Methods: Sixty primary incisor teeth were selected. The specimens were inoculated with 10 mL Enterococcus faecalis (E. faecalis). Groups: The KTP laser (1,5 W); gaseous ozone (150 s); sodium hypochlorite (NaOCl); saline group. Sterile paper points used to sample bacteria from the canals to tubes containing 5 mL of brain heart infusion broth. Then, 10 mL suspension was incubated in culture media for 24 h. Data were analyzed statistically using Kruskal-Wallis and Mann-Whitney U-test. Results: There were statistically significant differences between all groups (P < 0.05). Complete sterilization was achieved in the 2.5% NaOCl group. The number of bacteria were significantly reduced in experimental groups in comparison to the saline group. Conclusion: The KTP laser and ozone application provided a significant antibacterial effect in primary root canals; however, 2.5% NaOCl was superior.
  1 3,165 476
CASE REPORTS
Multiple tooth anomalies in a nonsyndromic patient with class II division 2 malocclusions: A case report and a literature review
E Isman, O Isman, AM Aktan, E Ciftci, T Topcuoglu
July-August 2015, 18(4):563-568
DOI:10.4103/1119-3077.154225  PMID:25966734
Reports in the literature about the craniofacial characteristics of patients with class II division 2 malocclusions show a lot of different patterns accompanied by palatally displaced upper incisors, congenital missing teeth, polydiastema, fusion, germination, tooth impaction, peg-shaped lateral incisors, persistent teeth, hypodontia, persistent deciduous teeth, transpositions, and supernumerary teeth. The following case report focuses on the description of the clinical characteristics observed on a patient with a very unusual conjunction of dental and skeletal anomalies mentioned above, as well as a literature review on the related issues. Extra-intra-oral examinations, radiographic evaluations, orthodontic consultation, and reviewing the literature concluded that this nonsyndromic patient that refused to receive all dental treatment approaches is special with its uniqueness.
  - 4,732 617
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