Medical and Dental Consultants’ Association of Nigeria
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   2016| January-February  | Volume 19 | Issue 1  
    Online since January 12, 2016

 
 
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REVIEW ARTICLE
The burden and management of neonatal jaundice in Nigeria: A scoping review of the literature
BO Olusanya, FB Osibanjo, CA Mabogunje, TM Slusher, SA Olowe
January-February 2016, 19(1):1-17
DOI:10.4103/1119-3077.173703  PMID:26755212
Neonatal jaundice is a leading cause of hospitalization in the first week of life worldwide. If inappropriately managed, it may result in significant bilirubin-induced mortality and disability. We set out to describe the epidemiology of neonatal hyperbilirubinemia as well as the practices and challenges in the care of infants with significant neonatal hyperbilirubinemia (SNH) in Nigeria, as basis for policy intervention and research priorities. We systematically searched PubMed, Scopus, EMBASE, Cumulative Index to Nursing and Allied Health Literature, WHO Library Database, African Index Medicus, African Journals Online, and local journals for studies published between January 1960 and December 2014. We included studies, without restriction on methodological design that provided evidence on the incidence/prevalence, etiological /risk factors and adverse outcomes of hyperbilirubinemia, care-seeking practices, diagnosis and treatment, as well as follow-up evaluation of infants with SNH in Nigeria. A total of 558 studies were identified from all sources out of which 198 (35.5%) were finally selected. SNH accounted for about one in five neonatal admissions and has been associated consistently with substantial case fatality and neuro-developmental sequelae such as cerebral palsy and auditory impairments, especially among out-born babies. Glucose-6-phosphate dehydrogenase (G6PD) deficiency, prematurity/low birth weight, infection, and ABO incompatibility were most frequently, and Rhesus disease rarely, associated with SNH. Late presentation at appropriate health facilities was common and resulted in high rates of acute bilirubin encephalopathy (ABE), kernicterus and avoidable exchange transfusions. Uniform practice guidelines, including developmental assessment and surveillance of infants with SNH, were rare at all levels of healthcare delivery. In summary, since 1960, SHN persists as a major contributor to neonatal mortality and developmental disabilities in Nigeria. The underpinning maternal, perinatal and neonatal factors as well as systems-based constraints are not insurmountable. Systematic and sustained interventions are warranted to curtail the disproportionate and perennial burden of this condition in this population.
  23,559 1,973 33
ORIGINAL ARTICLES
Caesarean delivery: An experience from a tertiary institution in north western Nigeria
CN Daniel, S Singh
January-February 2016, 19(1):18-24
DOI:10.4103/1119-3077.164350  PMID:26755213
Objective: To assess the overall caesarean section (CS) rate, indications and outcomes in a tertiary hospital in North-western Nigeria. Materials and Methods: A cross-sectional study carried out over a period of two years. All patients who had caesarean section at any time within the day were noted and followed up till discharge. The socio-demographic data, types of CS, anaesthesia, indications, abdominal wall and uterine incisions, cadre of surgeon and feto-maternal outcomes were documented in a proforma. Statistical analysis was carried out using the EPI INFO 3.5.1 (CDC Atlanta Georgia, USA). Result: The caesarean section rate was 11.3% (504/4462) of total deliveries. The highest rate of 44.6% (225/504) was among the primipara. The most common age group involved was 25 to 29 years. The emergency rate was 57.1% (288/504), while elective CS constituted 42.9% (216/504) of cases. The most common indication for emergency CS was obstructed labour 25.7% (30/288) and previous CS 39.8% (86/216) for elective CS. The complication rate was 13.3% (67/504) and the main complication was haemorrhage 59.7% (40/67). Complications were more with emergency CS compared to elective surgery (χ2 = 6.633, df = 1, P < 0.01) and with junior residents (χ2 = 15.9, df = 1, P < 0.001). There were 10 maternal and 60 perinatal deaths. Conclusions: The rate of caesarean section has been increasing gradually. There is need to improve on facilities and manpower in order to reduce morbidity and mortality.
  7,030 704 8
Medication education program for Indian children with asthma: A feasibility stud
C Grover, N Goel, C Armour, PP Van Asperen, SN Gaur, RJ Moles, B Saini
January-February 2016, 19(1):76-84
DOI:10.4103/1119-3077.173716  PMID:26755223
Objective: It is postulated that children with asthma who receive an interactive, comprehensive, culturally relevant education program would improve their asthma knowledge (AK), asthma control, and adherence compared with children receiving usual care. The aim of this study was to develop, implement, and evaluate the efficacy of a culturally relevant asthma education intervention for children with asthma and their parents in India. Methods: Children with asthma (7–12 years) and their parents were recruited from an outpatient clinic in a Chest Diseases Hospital in New Delhi, and were randomly assigned to either an intervention or usual care group. At baseline, outcome data collected included pediatric asthma caregiver quality of life (PACQL, primary outcome), AK, asthma control, adherence, inhaler technique, action plan ownership, and goal achievement. These data were collected again at 1 and 6 months after baseline. Outcomes were compared within and between groups using ANOVA techniques. Results: Forty parent-child pairs were recruited. Of these, 24 pairs of children with asthma and their parents received the educational intervention. The PACQL significantly improved from baseline to 6 months in the intervention (5.87 ± 0.94–7.00 ± 0.03) versus the usual care group (5.90 ± 0.52–6.34 ± 0.56) (P < 0.001). Other outcomes such as the parents' and child's AK, child's asthma control and inhaler technique were significantly improved in the intervention group across the study. All the participants possessed a written asthma action plan at the end of the intervention. Eighty-five goals were set by children with asthma across all the visits and were achieved by completion. Conclusion: An asthma educator delivered interactive program simultaneously involving children with asthma and their parents, improved quality of life, empowered and promoted better self-management skills.
  3,753 607 12
Apical extrusion of debris using reciprocating files and rotary instrumentation systems
I Uzun, B Güler, T Özyürek, T Tunç
January-February 2016, 19(1):71-75
DOI:10.4103/1119-3077.173715  PMID:26755222
Background: To compare the preparation time and amount of apically extruded debris after the preparation of root canals in extracted human teeth using the reciprocating files and rotary nickel-titanium systems. Procedure: Sixty extracted human mandibular premolars were used. The root canals were instrumented using reciprocating (WaveOne, Reciproc, SafeSider) or rotary motion (Typhoon, ProTaper Universal, Mtwo), and the debris produced was collected in glass vials. The remaining debris was assessed using a microbalance and statistically analyzed using the one-way ANOVA and Duncan multiple range tests at a significance level of P < 0.05. The time required to prepare the canals with different instruments was also recorded. Results: The Reciproc group produced significantly less debris when compared to the Typhoon group (P < 0.05), and instrumentation with the single-file systems was significantly faster than in the multi-file systems (P < 0.05). The WaveOne group extruded significantly more debris per unit of time than the other groups, with the exception of the Typhoon group (P < 0.05). Conclusion: According to our study, all systems caused apical debris extrusion. However, the Reciproc group was associated with less debris extrusion when compared to the other groups.
  3,582 770 4
The efficiency of routine endotracheal aspirate cultures compared to bronchoalveolar lavage cultures in ventilator-associated pneumonia diagnosis
H Yagmurdur, AH Tezcan, O Karakurt, F Leblebici
January-February 2016, 19(1):46-51
DOI:10.4103/1119-3077.164327  PMID:26755218
Objective: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in İntensive Care Units (ICUs) and its mortality rate varies from 24% to 50%. The most important factor in decreasing the mortality is administering adequate antibiotics as early as possible. In this study, we investigate the efficiency of routine endotracheal aspirate (EA) cultures to identify the etiology of VAP earlier. Materials and Methods: Fifty-nine patients who were accepted to our ICU with acute cerebrovascular disease with mechanical ventilation (MV) requirement were chosen for this study over a 12-month period. The patients intubated in our ICU were included in the study to exclude prior colonization. Upon ICU admission, the patient's; age, sex, comorbidities, diagnosis, acute physiology and chronic health evaluation II score, and sequential organ failure assessment (SOFA) score were recorded. When bronchoalveolar lavage (BAL) was performed, the SOFA score, temperature, leukocyte count, C-reactive protein levels, PaO2/FiO2ratio, PCO2, clinical pulmonary infection score value, length of MV, and presence of antimicrobiological treatments were recorded. Routine microbiological analysis was performed by EA (pre-VAP EA) twice weekly in all patients until the endotracheal tube was removed. When VAP was suspected, fiberoptic bronchoscopy examination with BAL was performed. A diagnosis of VAP was established when the BAL quantitative culture grew at least one microorganism at a concentration ≥104 cfu/mL. Results: VAP was diagnosed in 41 (69%) of the 59 patients based on BAL culture results. Among 41 positive BAL cultures, pre-VAP EA identified the same microorganism with the same antibiotics resistance pattern in 23 (56%) patients. Regarding only late-onset VAP, pre-VAP EA identified the same microorganisms found by BAL culture in 17 (63%) of the 27 cases. Among 18 BAL culture negative patients, 7 (39%) patients had negative prior pre-VAP EA culture results. Acinetobacter baumannii was the most frequently isolated microorganism from BAL cultures (n = 21, 51%). The diagnostic value of pre-VAP EA results in predicting A. baumannii VAP documented with the following values (sensitivity: 62%; specificity: 95%, positive predictive value: 87%, negative predictive value: 82%). Conclusion: VAP patients should be treated with international guidelines, but if pre-VAP EA cultures identify multidrug resistant pathogens, the initial antibiotic therapy should cover these microorganisms. Thus, quantitative EA cultures are a useful noninvasive diagnostic tool in critically ill patients suspected of having pneumonia especially in the case of VAP.
  3,195 857 7
Testicular volume of healthy term neonates: Determination of normative values among Igbo babies in South-Eastern Nigeria
UN Chikani, MU Ibekwe, JM Chinawa, GN Adimora
January-February 2016, 19(1):85-90
DOI:10.4103/1119-3077.173704  PMID:26755224
Background: Testicular volume (TV) in neonates has some predictive values of clinical importance. Establishing the normal values of TV among term newborn males of every population is important as differences exist among different populations. Much is not known on TV among Igbo newborns. Aim: The aim of this study was to determine the normative values of TV in apparently healthy term Igbo newborn males in Enugu, South-Eastern Nigeria and its relationship with gestational age (GA), birth weight (BW), and birth length (BL). Subjects and Methods: This was a hospital-based, cross-sectional and descriptive study. Eight hundred and eleven apparently healthy term Igbo male neonates within the first 3 days of life were studied. The TV was measured with Prader Orchidometer (ZKL-135-H), ESP Model. Smoothed centiles (3–97th percentile values) for TV by GA were determined. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 17.0 (Chicago). P < 0.05 were regarded as statistically significant. Results: The mean TV was 1.74 ± 0.62 ml ranging from 1 to 3 ml. The TV increased with increasing GA (P = 0.00). Pearson's correlation test between TV and birth length (r = 0.301, P = 0.001), as well as with BW (r = 0.247, P = 0.001) were significant. A linear regression demonstrated correlation between TV and birth length (P = 0.0001, r2 = 0.091). Conclusion: The mean TV among male Igbo newborn is 1.74 ± 0.62 ml. Also, the first smoothed percentile values for TV by GA for Nigerian Igbo babies is created.
  3,709 238 1
Socioeconomic inequities and payment coping mechanisms used in the treatment of type 2 diabetes mellitus in Nigeria
IL Okoronkwo, JN Ekpemiro, OE Onwujekwe, AC Nwaneri, PN Iheanacho
January-February 2016, 19(1):104-109
DOI:10.4103/1119-3077.173711  PMID:26755227
Aim: Given the enormous economic burden of diabetes in Nigeria and in sub-Saharan Africa, the study was designed to determine how different population groups cope with payment for type 2 diabetes mellitus (DM). Materials and Methods: A total of 292 exit interviews were conducted with patients who attended the outpatient diabetic clinic in a specialist public health facility in southeast Nigeria. The monthly expenditures and strategies that were used to cope with payments for diabetic treatment were determined. A socioeconomic status (SES) index was used to divide the respondents into SES quartiles (Q1 (poorest), Q2, Q3, Q4 (least poor)). The coping mechanisms were disaggregated by SES. Results: The mean monthly expenditure for the treatment of diabetes was ₦56,245.11 ($356). Expenditures were mostly incurred through out-of-pocket payments. The most common coping strategy utilized was household savings (99.0%) followed by support from family members (85.3%). All SES groups used more than one payment coping method. Borrowing, skipping of appointments, and stopping children education were significantly significant (P < 0.05). Conclusion: The mean monthly direct cost in the treatment of type 2 diabetes among the study group was high. There were SES inequities in the use of coping mechanisms, with the poorest SES group (Q1) being worse off than other groups. The financial risk protection mechanisms such as health insurance that will reduce the economic burden of type 2 diabetes on households and provide universal health coverage to people suffering from DM more especially to the disadvantaged group should be developed and implemented.
  3,134 505 8
Pulmonary function tests in patients with Parkinson's disease: A case-control study
LF Owolabi, M Nagoda, M Babashani
January-February 2016, 19(1):66-70
DOI:10.4103/1119-3077.173714  PMID:26755221
Background: In Parkinson's disease (PD), morbidity and mortality are commonly caused by respiratory disorders from pulmonary function impairments. Aim: The study aims to evaluate pulmonary functions in a cohort of patients with PD in comparison with age- and sex-matched control. Methods: Pulmonary function test (PFT) was conducted using the Spirolab Spirometry kit, and results of forced vital capacity (VC), forced expiratory volume 1 (FEV1), FEV1/VC, and peak expiratory flow rate (PEFR) were obtained from 78 PD patients and 78 healthy controls. Results: A total of 78 patients and 78 age- and sex-matched control comprising 60 (76.9%) males and 18 (23.1%) females were evaluated. The mean age ± standard deviation of the patients were 62.32 ± 8.67 and 62.31 ± 8.66, respectively; the difference in their age was not statistically significant (P = 0.993). The majority (38.5%) of the patients was in stage II of Hoehn and Yahr of PD. Vital capacity (VC) in PD patients and control was 2.481 and 3.106; the difference was statistically significant (P < 0.0001). The mean FEV1 in PD patients and control were 1.887 and 2.494; the difference was statistically significant (P < 0.0001). The mean FEV1/VC percent in PD patients and control were 75.812 and 80.303; the difference was statistically significant (P < 0.0001). The mean PEFR in PD patients and control were 45.58 and 67.46; the difference was statistically significant (P < 0.0001). Considering PD arm of the study, with the exception of FEV1/VC, there was significant negative correlation between all the parameters of PFT and patients age (VC, FEV1, PEFR, r = −422 and P = 0.0001, r = −391 and P = 0.0001, and r = −0.244 and P = 0.031, respectively). Conclusion: In this study, the values of the evaluated PFTs (VC, FEV1, FEV1/VC, and PEFR) parameters were significantly lower in PD compared with age- and sex-matched control.
  2,715 504 5
Comparative evaluation of mineral trioxide aggregate and bioaggregate as apical barrier material in traumatized nonvital, immature teeth: A clinical pilot study
N Tuloglu, S Bayrak
January-February 2016, 19(1):52-57
DOI:10.4103/1119-3077.164332  PMID:26755219
Background: Clinical research examining the use of mineral trioxide aggregate (MTA) as an apical barrier material are limited, and no studies have so far examined the clinical performance of BioAggregate as apical barrier material in nonvital immature teeth. Aim: This study was aimed to provide a comparative evaluation of the clinical and radiographic success of MTA and BioAggregate as an apical barrier material in children with traumatized nonvital, immature permanent maxillary incisors. Subjects and Methods: A total of 26 maxillary incisor teeth in 20 children aged 7–11 were chosen for this study. Teeth were randomly divided into two groups according to the material to be applied, and the apical barrier was performed. Following treatment, for 24-month, teeth were clinically and radiographically evaluated once every 3- and 6-month, respectively. Results: All teeth treated with MTA and BioAggregate were clinically and radiographically successful throughout the 24-month follow-up period. Conclusions: Similar success was achieved in the apical barrier that using BioAggregate and MTA. BioAggregate would be considered suitable materials for apical barrier technique and can be used as an alternative to MTA.
  2,716 486 5
Finite element analysis of thermal stress distribution in different restorative materials used in class V cavities
MS Guler, C Guler, F Cakici, EB Cakici, S Sen
January-February 2016, 19(1):30-34
DOI:10.4103/1119-3077.173702  PMID:26755215
Purpose: Cervical lesions are restored with class V preparation. The aim of this study was to use a three-dimensional finite element method to carry out a thermal analysis of the temperature and stress distributions of three different restorative materials used for class V cavities of maxillary molar teeth. Materials and Methods: A maxillary left first molar tooth was modeled and a class V cavity was prepared on the cervical 1/3 of the buccal surface. This cavity was restored with three different materials (Group I: Resin composite, Group II: Glass ionomer cement, and Group III: Amalgam). Loads of 400 N were applied at an angle of 90° to the longitudinal axis of the tooth on the restorative material at 5 and 55°C temperatures. Von Mises and thermal stress distributions were evaluated. Results: In all groups, the von Mises stress values increased with temperature. The highest von Mises stress distribution was observed at 55°C in Group II (144.53 MPa). The lowest von Mises stress distribution was observed at 5°C in Group III (70.81 MPa). Conclusion: Amalgam is the most suitable restorative material for class V restorations because of minimal stress distribution.
  2,643 514 6
Neuroimaging findings in pediatric patients with seizure from an institution in Enugu
CA Ndubuisi, WC Mezue, SC Ohaegbulam, MC Chikani, M Ekuma, E Onyia
January-February 2016, 19(1):121-127
DOI:10.4103/1119-3077.173712  PMID:26755230
Background: Pediatric seizures in developing countries are often poorly investigated and consequently poorly managed. Sociocultural misconceptions, financial difficulties, and lack of facilities are often blamed. This study studies the structural intracranial abnormalities associated with pediatric seizures and the proportion of these structural lesions that may benefit from surgery. Methods: Prospective study of 311 pediatric patients referred with seizure disorders, for computed tomography and magnetic resonance imaging to the Memfys Hospital for Neurosurgery, Enugu, between 2003 and 2014. All patients had contrast studies. Angiography was done for selected cases. Demography, imaging findings, and potential benefits of surgery were analyzed using descriptive and inferential statistics. Result: Analysis of 311 patients representing 21% of all pediatric head scans. Male to female ratio was 1.2:1.0. Definite structural lesion was identified in 53.4%. Lesions that may benefit from surgery were identified in 27.7% of all cases representing 51.8% of abnormal scan findings. Under-5 had the least scan rate of 25.1% compared with 42.4% in the adolescents. Although the older age groups had more abnormal findings, the proportion of abnormal to normal scan findings was the highest (1.7:1.0) in the under-5. Under-5 age group had more lesions that may benefit from surgery (P = 0.001). Intracranial tumor was diagnosed in 10.6%, vascular abnormalities (10.3%), hydrocephalus (5.8%), brain abscess (2.9%), and chronic subdural hematoma (2.6%) (P = 0.001). Conclusion: Structural lesions are common and diverse in pediatric seizures. Significant proportion of these patients may benefit from surgery, and these benefits override financial and sociocultural considerations.
  2,638 334 2
Biomechanical analysis of titanium fixation plates and screws in sagittal split ramus osteotomies
F Atik, MS Ataç, A Özkan, Y Kılınç, M Arslan
January-February 2016, 19(1):140-144
DOI:10.4103/1119-3077.164331  PMID:26755233
Objective: The aim of the study was to evaluate the mechanical behavior of three different fixation methods used in the bilateral sagittal split ramus osteotomy. Materials and Methods: Three different three-dimensional finite element models were created, each corresponding to three different fixation methods. The mandibles were fixed with double straight 4-hole, square 4-hole, and 5-hole Y plates. 150 N incisal occlusal loads were simulated on the distal segments. ANSYS software ((v 10; ANSYS Inc., Canonsburg, PA) was used to calculate the Von Mises stresses on fixative appliances. Results: The highest Von Mises stress values were found in Y plate. The lowest values were isolated in double straight plate group. Conclusions: It was concluded that the use of double 4-hole straight plates provided the sufficient stability on the osteotomy site when compared with the other rigid fixation methods used in this study.
  2,431 500 2
Radiation pneumonitis in non-small-cell lung cancer patients treated with helical tomotherapy
B Yao, YD Wang, QZ Liu
January-February 2016, 19(1):25-29
DOI:10.4103/1119-3077.173709  PMID:26755214
Objective: In this study, we investigated the incidence of radiation pneumonitis (RP) in non-small-cell lung cancer (NSCLC) patients undergoing helical tomotherapy (HT) and the clinical and dosimetric factors associated with it. Materials and Methods: We analyzed data from the treatment protocols of 62 NSCLC patients. The median total radiation dose was 64 Gy (range 57.6–66 Gy) at 1.8–2.2 Gy/fraction. Thirty-four of these patients underwent HT alone and 28 underwent HT in combination with chemotherapy. Treatment-related pneumonitis was graded according to the Common Terminology Criteria for Adverse Events, version 3.0. Results: We found that RP grades 1, 2, 3 and 5 occurred in 29 (46.8%), 23 (37.1%), 8 (12.9%), and 2 (3.2%) patients, respectively. Using univariate analyses, we found that a grade ≥3 RP was associated with poor performance status (PS), age, planning target volume, mean lung dose, and relative V5through V25, in increments of 5 Gy (P < 0.005). We determined that PS and V5V15were the most significant factors associated with grade ≥3 RP using multivariate analysis. Conclusions: We found that poor PS and V5–V15 were the risk factors associated with grade ≥3 RP in NSCLC patients treated with HT. Thus, for NSCLC patients treated with HT, the volume of total lung with low-dose region (V5–V15) should be carefully regulated and the use of HT should be restricted in patients with Eastern Cooperative Oncology Group ≥2.
  2,429 436 5
Patients attitudes to vaginal examination and use of chaperones at a public hospital in South Africa
OU Amaechina, J Moodley, H Ramnarain
January-February 2016, 19(1):110-114
DOI:10.4103/1119-3077.173713  PMID:26755228
Background: Obstetrics and gynecology units in public hospitals in South Africa (SA) are often overloaded with patients. Most physical examinations/consultations in these units involve vaginal examination (VE) and often because of the rapid turnover of patients the pelvic examination may be performed hurriedly without due consideration being given to the psychosocial aspects of such procedures. Objective: This study surveyed the attitudes of patients to VE and the use of chaperones. Methods: A descriptive cross-sectional survey of patients attending obstetrics and gynecology clinics at a public hospital in SA was carried out. A structured questionnaire was used to collect sociodemographic data such as age, ethnic group, gravidity, feelings toward VE, and preferences about the gender of the examining doctor, as well as the presence of a chaperone. Results: Most women (68%) were aged between 20 and 35 years. The respondents stated that the most intimate examination was VE in 48.3% and abdominal in 25% of cases; 19.0% and 1.5% of respondents felt that breast and rectal examinations, respectively, was the most intimate. On the response to the statement “there is no need for chaperone during VE;” 54% of the participants were in support of chaperone while 45.1% were against chaperone. Women aged 20–35 years, preferred a nurse as their chaperone; younger women, aged ≤19 years preferred their mother as a chaperone. Conclusion: In an SA public hospital, women are more likely to regard VE as the most intimate examination. Women are equivocal on the use of a chaperone and if it was necessary; nurses are their preferred choice except for teenagers, who preferred their mothers.
  2,431 260 1
Oxidative stress among subjects with metabolic syndrome in Sokoto, North-Western Nigeria
AA Sabir, LS Bilbis, Y Saidu, A Jimoh, SO Iwuala, SA Isezuo, AU Kaoje, SA Abubakar
January-February 2016, 19(1):128-132
DOI:10.4103/1119-3077.173705  PMID:26755231
Background: Oxidative stress is known to play a role in the pathophysiology of metabolic syndrome and its components. Racial differences may exist in the level of markers of oxidative stress and antioxidants in patients with metabolic syndrome. Aim: The aim of this study was to determine the oxidative stress and antioxidants status in subjects with metabolic syndrome in Sokoto, North-Western Nigeria. Methods: A cross-sectional community-based study was carried out. Two hundred subjects (96 males and 104 females) were recruited for the study using a multi-stage sampling technique. Demographic data were obtained from the participants. Evaluation of anthropometric variables, blood pressure, blood glucose levels, lipid profiles, plasma insulin levels, total antioxidant status, and oxidative stress markers was performed. Results: The subjects with metabolic syndrome had significantly higher malondialdehyde as compared to those without metabolic syndrome (236.4 [92.2] vs. 184 [63.2] nmol/l). The antioxidant enzymes (superoxide dismutase, glutathione peroxidase and catalase) were significantly lower in subjects with metabolic syndrome than in those without metabolic syndrome (11.3 [4.2] vs. 13.9 [4.1] U/ml, 160[42] vs. 220[32] U/ml, and 2.12 [0.2] vs. 2.42 [0.2] U/ml, respectively). Similarly, the antioxidant Vitamins (A, C, and E) levels were significantly lower in subjects with metabolic syndrome than in those without metabolic syndrome (7.1 [4.1] vs. 7.7 [4.2] μmol/L, 225 [55.3] vs. 227.6 [62.3] μmol/L, and 75.9 [13.9] vs. 82.8 [18.6] mg/dl, respectively). There was a positive correlation between components of metabolic syndrome and free radicals. Conclusion: Significantly increased oxidative stress and diminished antioxidant defenses were found among Nigerians with metabolic syndrome.
  2,351 321 8
CASE REPORTS
Peripheral gangrene in a case of severe dengue
BT Nair, RK Sanjeev, SB Tarikjot
January-February 2016, 19(1):150-152
DOI:10.4103/1119-3077.164366  PMID:26755235
We report the case of a 10-year-old male who developed gangrene of his fingers and toes following severe dengue fever complicated by disseminated intravascular coagulation (DIC). Child developed bilateral dry gangrene of fingers and toes. All the peripheral pulses of the affected limbs were palpable. The child had no history of taking B-blockers, ergot alkaloids or other related medications. Color Doppler of peripheral arterial and venous systems of all limbs indicated normal flow. Blood was positive for D-dimers and fibrin degradation products. The patient was managed with broad spectrum antibiotics, fluid resuscitation, low molecular weight heparin, blood transfusions, fresh frozen plasma and other supportive measures. Peripheral gangrene seen in DIC associated with dengue is very rare and carries a higher mortality.
  2,339 272 -
ORIGINAL ARTICLES
Virologic responses and tolerance of peginterferon alfa plus ribavirin treatment for patients with chronic hepatitis C virus infection in different age categories
Z Yang, Y Lu, Q Xu, X Chen
January-February 2016, 19(1):133-139
DOI:10.4103/1119-3077.173708  PMID:26755232
Objective: This study aimed to evaluate the effect of age on the treatment comprising peginterferon plus ribavirin administered to patients with chronic hepatitis C (CHC). Materials and Methods: A total of 314 patients with CHC treated with peginterferon plus ribavirin were classified into three categories according to age. The efficacy and safety outcomes were compared between groups. Results: Elderly patients yielded significantly lower rapid virological response and sustained virological response (SVR) (31.3% and 35.4%, respectively, P < 0.05) rates than younger patients. The discontinuation rate of the patients aged ≥ 60 years were significantly higher (29.2%, P = 0.004) than that of the younger patients. The elderly patients suffered from adverse events, such as fatigue (P = 0.005), neutropenia (P = 0.013), jaundice (P = 0.013), hepatocellular carcinoma (P = 0.013), and gastric cancer (P = 0.018), more frequently than the younger patients. In multivariable analysis, age was a negative factor that affected the SVR of the patients with CHC (odds ratio [OR] =0.983, 95% confidence interval [95% CI] =0.967–1.0, P = 0.05). The SVR rate of the patients with hepatitis C virus (HCV) genotype non-1 was significantly higher than that of the patients with HCV-1 (OR = 0.559, 95% CI = 0.349–0.895, P = 0.015). An early virological response could be considered as a powerful positive predictor to obtain an SVR (OR = 2.353, 95% CI = 1.411–3.922, P = 0.001). Conclusions: Increasing age negatively affected the efficacy of peginterferon and ribavirin therapy in the treatment of patients with CHC. Elderly patients experienced poorer treatment tolerance and adherence, and as a result, treatment efficacy is poor.
  2,000 435 1
Clinical features of emergency department patients with depression who had attempted to commit suicide by poisoning
JH Wee, JH Park, SP Choi, SH Woo, WJ Lee, BH So, KN Park
January-February 2016, 19(1):41-45
DOI:10.4103/1119-3077.164329  PMID:26755217
Background: Many patients present to the emergency department (ED) complaining of intentional poisoning. Of those, some have major depressive disorder (MDD) in their medical history. The aim of this study was to investigate the prevalence of MDD patients who were treated for poisoning in the ED. Materials and Methods: A retrospective review was performed on 268 patients who were treated with poisoning between July 2007 and November 2011. Of these patients, we only included those who were over 18 years of age. Information regarding age, gender, cause, time of ingestion, type of drug, history of attempting suicide, and outcome, among other characteristics, was collected and compared to patients who did not have MDD. Results: A total of 244 patients were included in this study. Of those, 52 patients (21.3%) had a history of MDD. Compared to non-MDD patients, a majority (34.6% vs. 19.8%) of those in the MDD group had a history of suicide attempts (P = 0.027), and 34 (65.4% in the MDD group vs. 34.4% in the non-MDD group) took more than two types of drugs (P < 0.001). There were no differences in age, sex, time of ingestion or disease severity between MDD and non-MDD patients. Conclusion: In poisoning patients with MDD, physicians in the ED must consider that they have a higher tendency to show suicidal behavior and to have ingested multiple types of drugs.
  2,057 332 1
Beneficial effects of hesperidin following cis-diamminedichloroplatinum-induced damage in heart of rats
H Oguzturk, O Ciftci, A Cetin, K Kaya, OM Disli, MG Turtay, S Gürbüz, N Basak
January-February 2016, 19(1):99-103
DOI:10.4103/1119-3077.173707  PMID:26755226
Background: Increased oxidative stress and histopathological damage have been implicated in the cardiotoxicity that limits the clinical therapy of cisplatin (CP) as an anti-cancer drug. Objectives: This study aimed to investigate the protective effect of hesperidin (HP) against CP-induced cardiotoxicity in rats. Materials and Methods: Rats were divided into four groups (n = 7/group), and the first group served as the control group. Animals in Group CP and Group CP + HP received a single dose of CP (CP - 7 mg/kg); animals in Group HP and Group CP + HP received 50 mg/kg/day HP with gavage for 14 days. At the end of day 14, cardiac tissue samples were histologically and biochemically examined. Results: In this experimental study, thiobarbituric acid reactive substances levels in the cardiac tissue were significantly higher in the CP group, whereas glutathione (GSH), superoxide dismutase (SOD), and CAT levels were significantly lower in this group. On the other hand, GSH and SOD levels in the CP + HP group were similar to the control group. There was no significant difference in cardiac CAT levels between Group CP and Group CP + HP. Conclusion: Hesperetin treatment leads to a decrease in oxidative stress, and associated histological damage. The findings of the current study suggest that HP has a protective effect against CP-induced cardiotoxicity.
  1,970 339 8
Comparative periodontal status of human immunodeficiency virus-positive patients and controls in a dedicated human immunodeficiency virus clinic in Nigeria
KA Umeizudike, PO Ayanbadejo, KO Savage, SO Nwhator, AS Akanmu, O Ogunleye
January-February 2016, 19(1):35-40
DOI:10.4103/1119-3077.164330  PMID:26755216
Background: There are diverse reports on the prevalence and severity of chronic periodontitis in human immunodeficiency virus (HIV) positive persons. Few studies have been carried out in developing countries in Sub-Saharan Africa. This study was aimed at comparing the prevalence and severity of chronic periodontitis of HIV-seropositive patients with that of HIV-seronegative persons using the community periodontal index (CPI). Methodology: This was a comparative study of the periodontal status of 110 HIV-positive subjects and 110 age and gender-matched HIV-negative controls attending a dedicated HIV Clinic in a Teaching Hospital in Lagos, Nigeria. The CPI and simplified oral hygiene index score were used in the periodontal examination. Highest CPI scores and percentages of CPI sextants assessed the prevalence and severity of chronic periodontitis respectively. Logistic regression was used in adjusting demographic differences in the study population. P ≤ 0.05 was considered as significant. Results: A significant proportion of the HIV-positive patients 61 (55.5%) and the HIV-negative controls 53 (48.7%) had shallow pockets (4–5 mm) (CPI code 3). The prevalence of deep pockets (≥ 6mm) (CPI code 4) was higher among HIV-positive patients 9 (8.2%) than the controls 4 (3.5%) (P = 0.079). HIV-positive patients had a greater percentage of CPI codes 3, 4 and fewer CPI code 0 sextants than controls (P = 0.000). Both groups had comparable oral hygiene status (P = 0.209). Using a logistic regression analysis, HIV-positive status and lower education accounted for the greater severity of chronic periodontitis. Conclusion: HIV-seropositive patients had more severe chronic periodontitis than the HIV-seronegative controls, which was independent of lower education.
  1,966 301 2
CASE REPORTS
Co-morbid obsessive compulsive and hypochondriac disorders complicated by tardive dyskinesia in a Nigerian man
NC Aghukwa
January-February 2016, 19(1):145-149
DOI:10.4103/1119-3077.164359  PMID:26755234
The objective was to report a case of obsessive-compulsive disorder (OCD) with comorbid somatic symptoms that was complicated by movement disorders. A literature search on related issues was done online with Google Scholar, followed by a chronological report of the index case. This case presents a 52-year-old man who presented with intrusive, disturbing, and unreasonable thoughts at the mid adolescent time. Following these were complaints of multiple somatic symptoms which the patient labeled with different disease terms. The illness affected his academic, occupational, social, and marital role obligations. And lately, in the illness due to underlying predispositions, developed drug-related movement problems that worsened his state of handicap. This case attempts to point out the importance of early detection and cautious use of medications in patients, who present with OCDs with or without other psychiatric co-morbidities.
  1,994 217 -
Osteoblastoma originating from frontoethmoidal sinus causing personality disorders and superior gaze palsy
B Cekic, IE Toslak, S Yildirim, R Uyar
January-February 2016, 19(1):153-155
DOI:10.4103/1119-3077.173706  PMID:26755236
Osteoblastoma is a rare, solitary benign tumor that is usually situated in axial skeleton mainly in vertebra. It is rarely seen in ethmoid and frontal sinuses. A 40-year-old man who had osteoblastoma originated from frontal and ethmoidal sinuses that extends up to frontal lobe and gave rise to personality disorders by compressing the frontal lobe, and caused superior gaze palsy by compressing the superior rectus muscle. We present this rare case with clinical, radiological and histopathological findings.
  1,982 213 5
ORIGINAL ARTICLES
Effect of sodium ascorbate and delayed treatment on the shear bond strength of composite resin to enamel following bleaching
C Türkmen, N Güleryüz, PY Atalı
January-February 2016, 19(1):91-98
DOI:10.4103/1119-3077.164328  PMID:26755225
Background: The effect of bleaching on enamel surfaces, as well as exploring methods of preventing the weakening of bond strength of two different adhesives to bleached enamel surfaces. Objective: This study compared the shear bond strength (SBS) of two different adhesives on bleached enamel immediately after bleaching, with a 1-week delay, and following application of an antioxidizing agent after bleaching. Materilas and Method: The enamel surfaces of 140 incisors were divided into 14 groups. Two unbleached enamel groups (n = 20) were prepared as negative controls of the Adper Single Bond 2 total-etch and Clearfil Tri S Bond self-etch adhesives. The remaining surfaces were randomly divided into two bleaching groups treated with 35% Beyond Max (n = 60) and 38% Opalescence Xtra Boost (n = 60). Each bleaching group was then divided into two subgroups using the total and self-etch adhesive systems. Specimens were bonded immediately after bleaching, after treatment with 10% sodium ascorbate (SA) gel, or after 1-week of immersion in artificial saliva. All groups were restored with composite resin. After thermocycling, SBS was measured and data were analyzed. Results: In the control groups, there was no statistically-significant difference in SBS between self-and total-etch adhesives. Among all bleaching groups, no statistically-significant differences in SBS were noted, although the SA-treated delayed bonding (1-week) groups had the highest values. The lowest values were noted for the groups bonded immediately after bleaching.
  1,736 305 5
Graphical modeling for item difficulty in medical faculty exams
L Tomak, Y Bek, MA Cengiz
January-February 2016, 19(1):58-65
DOI:10.4103/1119-3077.173701  PMID:26755220
Background: There are different indexes used in the evaluation of exam results. One important index is the difficulty level of the item that is also used in this study to obtain control charts. This article offers some suggestions for the improvement of multiple-choice tests using item analysis statistics. Materials and Methods: The graphical modeling is important for the rapid and comparative evaluation of test results. The control chart is a tool that can be used to sharpen our teaching and testing skills by inspecting the weaknesses of measurements and producing reliable items. The research data for the application of control charts were obtained using the results of the fourth and fifth-grade student's exams at Ondokuz Mayis University, Faculty of Medicine. I-chart or moving range chart (MR) is preferred for whole variable data. Results: It is seen that all observations are within control limits for I-chart, but three points on MR-chart are settled on the LCL. Using X–-chart with subgroups, it was determined that control measurements were within the upper and lower limits in both charts. The difficulty levels of items were examined by obtaining different variable control charts. The difficulty level of the two items exceeded the upper control limit in R- and S-charts. Conclusion: The control charts have the advantage for classifying items as acceptable or unacceptable based on item difficulty criteria.
  1,582 189 -
The effect of colloid preload versus prophylactic ephedrine administration on QTc intervals during cesarean delivery: A randomized controlled study
IH Tör, M Aksoy, AN Aksoy, A Ahıskalıoglu, I Ince, H Kürsad
January-February 2016, 19(1):115-120
DOI:10.4103/1119-3077.173710  PMID:26755229
Aim: We aimed to investigate the effect of colloid infusion immediately before the spinal anesthesia, and the prophylactic intravenous (IV) infusion of ephedrine after injection of intrathecal bupivacaine on hemodynamic parameters, QT, The QT interval corrected for heart rate (QTc), and dispersion of QTc (QTcDisp) intervals in women undergoing the elective cesarean section. Materials and Methods: Sixty women scheduled for elective cesarean delivery with spinal anesthesia were allocated randomly to receive either IV fluid preloading with 0.5 L of 6% w/v hydroxyethyl starch solution immediately before the spinal anesthesia (colloid group, n = 30) or prophylactic IV infusion of 15 mg ephedrine (diluted with 10 ml saline, n = 30) over 1-min period after the injection of intrathecal bupivacaine (ephedrine group). Electrocardiography (ECG) tracings were recorded before anesthesia procedure at baseline (T0), 5 min (T1), 10 min (T2), 30 min (T3), 60 min (T4), and 120 min (T5) after the spinal anesthesia. Systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP), heart rate (HR), and peripheral oxygen saturation (SpO2) values were also recorded at the same time intervals. Results: There were no significant differences between groups with respect to MAP, HR, SpO2, QT, and QTc intervals at any time points (P > 0.05). When compared with the colloid group, the QTcDisp interval at T1was significantly longer in the ephedrine group (P < 0.05). Conclusion: Both methods have similar effects on the ECG and hemodynamic parameters during cesarean section. So, both methods may be used in patients undergoing elective cesarean delivery under spinal anesthesia.
  1,305 225 3
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