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   2017| September  | Volume 20 | Issue 9  
    Online since October 26, 2017

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Predictors of male condom utilization in Plateau State, Nigeria
MP Chingle, PA Odunze, A Mohammed, TT Bitto, OY Sodipo, AI Zoakah
September 2017, 20(9):1079-1087
DOI:10.4103/njcp.njcp_56_17  PMID:29072229
Background: Nigerian men play major roles in the reproductive decision-making process, including issues concerning fertility. Despite efforts made by the government to reduce the incidence of HIV by using condom as a means of dual protection, the utilization of male condom is still relatively low in Nigeria. This study aimed to assess the condom utilization and predictors of condom use among male respondents in Plateau State. Methodology: An analysis of secondary data of the 2013 Nigeria Demographic Health Survey dataset was done. Data were collected through a cross-sectional study using multistage cluster sampling technique from 393 consenting males aged 15–49 years in Plateau State using a semistructured, closed-ended questionnaire. Survey data quality was ascertained using field check tables during data entry. The dataset was analyzed using SPSS version 21.0 software (SPSS, IBM Corp, Armonk, NY, USA). Condom utilization prevalence rate was calculated for the 393 males, while predictors were determined by logistic regression. P ≤ 0.05 was considered statistically significant. Results: Mean age of the respondents was 31.05 ± 9.395 years. Most (90.3%) of the respondents were aware of at least one of the various family planning methods. The prevalence of condom use among them was 15.5% with the 20–29 years' age group having the highest proportion (28.8%). Significant associations were found between condom use and age, level of wealth, level of education, marital status, knowledge of contraception, occupation, and religion. Predictors of condom use include level of wealth (middle class), not being married, and primary level education. Conclusions: The prevalence of male condom use is low in Plateau State. The predictors of condom use are level of wealth, being unmarried, and primary level of education. Having only a primary level of education and been in the middle class reduces the likelihood of using condoms while being unmarried increases it.
  7,173 322 1
Cancer patients and oncology nursing: Perspectives of oncology nurses in Turkey
S Kamisli, D Yuce, B Karakilic, S Kilickap, M Hayran
September 2017, 20(9):1065-1073
DOI:10.4103/njcp.njcp_108_16  PMID:29072227
Background and Aim: Burnout and exhaustion is a frequent problem in oncology nursing. The aim of this study is to evaluate the aspects of oncology nurses about their profession in order to enhance the standards of oncology nursing. Materials and Methods: This survey was conducted with 70 oncology nurses working at Hacettepe University Oncology Hospital. Data were collected between January–April 2012. Each participant provided a study form comprising questions about sociodemographic information; about difficulties, positive aspects and required skills for oncology nursing; and questions evaluating level of participation and clinical perception of oncology nursing. Results: Mean age of nurses was 29.9 ± 5.7 years. More than half of the participants were married (51.4%) and 30% had at least one child. Percent of nurses working in oncology for their entire work life was 75.8%. Most frequently expressed difficulties were exhaustion (58.6%), coping with the psychological problems of the patients (25.7%), and frequent deaths (24.3%); positive aspects were satisfaction (37.1%), changing the perceptions about life (30%), and empathy (14.3%); and required skills were patience (60%), empathy (57.1%), and experience (50%). For difficulties of oncology nursing, 28.3% of difficulties could be attributed to job-related factors, 30.3% to patient-related factors, and 77% of difficulties to individual factors. The independent predictors of participation level of the nurses were self-thoughts of skills and positive aspects of oncology nursing. Conclusion: According to the findings of this study, nurses declared that working with cancer patients increase burnout, they are insufficient in managing work stress and giving psychological care to patients, but their job satisfaction, clinical skills and awareness regarding priorities of life has increased.
  5,183 883 5
A survey of the perception of the quality of and preference of healthcare services amongst residents of Abeokuta South Local Government, Ogun State, Nigeria
AS Oredola, OO Odusanya
September 2017, 20(9):1088-1097
DOI:10.4103/njcp.njcp_228_16  PMID:29072230
Background: The choice of healthcare facilities by individuals is determined in part by their taste, satisfaction with services, and the perceived quality of care provided. The aim of the study was to explore the healthcare preferences of residents of Abeokuta South Local Government Area (LGA) and their perception of quality of services received, and to determine the factors influencing their choice of healthcare facilities. Materials and Methods: A descriptive cross-sectional study design was used to assess perception of clients regarding quality of healthcare received and their choice of healthcare service delivery. Data were collected using a pre-tested interviewer-administered questionnaire, and analysis was done using SPSS version 17. Statistical significance was set at P <0.05. Results: The mean age of respondents was 45.7 ± 11.7 years. Government-owned general hospitals were preferred for common health problems such as body pain and fever. Overall, about 73% of the respondents preferred government-owned facilities. Determinants of the preference of the government facilities were reduced cost (P< 0.001) and effectiveness of care (P= 0.024), whereas private facilities were preferred more significantly because of short waiting time and good attitude of staff (P = < 0.001). Almost 78% of the respondents were satisfied with the quality of care received. Conclusions: Government-owned general hospitals were the preferred source of health services and the quality of healthcare services received was generally perceived to be high.
  5,511 304 1
Conservative surgical treatment of the jaw cysts in children: Case study of five patients
G Gurler, S Yilmaz, C Delilbasi, E Dilaver, E Yuzbasioglu, A Patir-Munevveroglu
September 2017, 20(9):1216-1220
DOI:10.4103/1119-3077.217244  PMID:29072251
Aims: Conservative treatment of jaw cysts establishes low surgical complication risk and protects vital anatomical structures such as inferior alveolar nerve, maxillary sinus and permanent tooth germs. Marsupialization and decompression have been widely used in children. The aim of this study was to evaluate the results of the conservative treatment of jaw cysts in five children. Materials and Methods: This article presents case series of marsupialization in jaw cysts associated with impacted teeth in five children. A total of nine impacted teeth within the cystic lesions were observed. Results: Complete resolution of all cystic lesions and simultaneous eruption of six impacted teeth within the cyst were managed. The other two teeth were erupted orthodontically and one had to be extracted. Conclusions: Marsupialization is effective for the treatment of cystic lesions in growing patients as it preserves vital anatomical structures and enables eruption of the impacted teeth within the cyst.
  5,351 458 3
Impact of oral antibiotics on health-related quality of life after mandibular third molar surgery: An observational study
RO Braimah, KC Ndukwe, JF Owotade, SB Aregbesola
September 2017, 20(9):1189-1194
DOI:10.4103/1119-3077.183235  PMID:29072245
Aim: To compare the impact of antibiotics on health-related quality of life (QoL) outcomes following third molar surgery. Materials and Methods: The study population consisted of 135 subjects that required surgical extraction of mandibular third molar under local anesthesia and met the inclusion criteria. The subjects were randomized into three study groups of 45 subjects each: Group A - extended amoxicillin/clavulanic acid (GlaxoSmithKline Beecham England), 1 gram pre-operatively and then 625 mg BD for 5 days Group B - prophylactic amoxicillin/clavulanic acid (GlaxoSmithKline Beecham England) 1 gram pre-operatively only, and Group C - prophylactic levofloxacin 1 gram pre-operatively only. Patients were assessed pre- and post-operatively on days 1, 3, 5, 7, and 14 using the United Kingdom oral health-related QoL (OHRQoL) questionnaire. Results: This study showed that surgical removal of impacted teeth exerted a negative influence on patient's QoL across various physical, social, and psychological aspects of life. Comparing the three groups, Group A showed a slightly better QoL score; although, there was no statistically significant difference among them. Studies have shown better clinical recovery following administration of antibiotics after third molar surgery. Conclusion: There was a significant deterioration in OHRQoL in the immediate postoperative period, particularly postoperative days 1 and 3 following third molar surgery. QoL was also observed to be slightly better in Group A than Groups B and C, although this was not statistically significant.
  4,987 753 7
Comparison of the EndoVac system and conventional needle irrigation on removal of the smear layer in primary molar root canals
B Buldur, A Kapdan
September 2017, 20(9):1168-1174
DOI:10.4103/1119-3077.181351  PMID:29072242
Objective: This study aimed to compare the EndoVac system and conventional needle irrigation in removing smear layer (SR) from primary molar root canals. Materials and Methods: Fifty extracted human primary second molar roots were instrumented up to an apical size of 0.04/35 and randomly divided into two main groups; Group 1: EndoVac system (n = 25) and Group 2: Conventional needle irrigation (n = 25) and three subgroups (a) NaOCl + ethylenediaminetetraacetic acid (EDTA) (n = 20) (b) ozonated water (OW) + EDTA (n = 20) and (c) saline (control, n = 10). After a standardized final irrigation protocol performed for all teeth, scanning electron microscope images were taken at ×1000 magnification for each thirds of each root canal. Data were analyzed by the weighted kappa, Kruskal–Wallis, and Wilcoxon signed rank tests. Results: EndoVac was more effective than conventional needle in the removal of SR from the apical third of the root canal system (P < 0.05). The OW + EDTA regimen provided similar SR removal compared with NaOCl + EDTA. Conclusions: EndoVac has better performance than conventional needle irrigation in the removal of the SR in the apical thirds of the primary molar root canals. As a final irrigation regimen, the OW + EDTA regimen is as effective as the NaOCl + EDTA regimen.
  5,056 566 7
Evaluation of drug utilization pattern for patients of bronchial asthma in a government hospital of Saudi Arabia
MM Rafeeq, HAS Murad
September 2017, 20(9):1098-1105
DOI:10.4103/njcp.njcp_378_16  PMID:29072231
Background: Bronchial asthma is a social and economic healthcare burden. Drug utilization studies are important tools to assess current prescription practices against standard guidelines and help in rationalizing the management. Materials and Methods: This retrospective cross-sectional study was designed to evaluate the pattern of drug utilization in bronchial asthma patients in a government hospital of Saudi Arabia. Retrospective prescribing information of patients of all ages and both sexes diagnosed with bronchial asthma being treated with at least one of the anti-asthmatic medications was utilized. Demographic details, brand/generic name, indication, route, dosage, frequency, and date of starting the drug were recorded. Prescriptions were examined for order, number, and therapeutic class of drugs in addition to poly-pharmacy and appropriateness. Patients having other respiratory disorders such as chronic obstructive pulmonary disorder (COPD), bronchitis, emphysema, or any comorbidity such as diabetes, hypertension, and peptic ulcer were excluded. The Statistical Package for the Social Sciences was used for statistical analysis. Results: A total of 380 prescriptions were studied. Patients were aged from 4 months to 79 years, with 55.3% males and 44.7% females. Pediatric prescriptions were 47.4%. Bronchodilators followed by steroids were the most common drug groups. Salbutamol and budesonide were the most common from each group, respectively. 89.5% of the patients were having at least two drugs. Number of drugs per prescription averaged 3.18 ± 1.22, however, no correlation was found between different age groups and number of drugs. 61.3% drugs were administered by inhalational route and 34.8% by oral route. Approximately 77.2% prescriptions were found to be appropriate. Conclusion: Prescription pattern was mainly in accordance with standard guidelines with some knowledge and technical gaps in prescription writing methodology.
  3,534 448 2
Spontaneous retropharyngeal emphysema: A case report
T-H Chi, C-C Hung, R-F Chen, C-H Yuan, J-C Chen
September 2017, 20(9):1213-1215
DOI:10.4103/njcp.njcp_3_16  PMID:29072250
Retropharyngeal emphysema is usually secondary to trauma, iatrogenic injury, and obstructive respiratory diseases. Without prompt and adequate treatment, severe complication such as airway compromise may occur. Spontaneous retropharyngeal emphysema, defined by the presence of free air in the retropharyngeal space without any precipitating cause, is a rare clinical condition in pediatric otolaryngology. The predominant symptoms are sore throat, odynophagia, dysphagia, and neck pain. Here, we report a case of spontaneous retropharyngeal emphysema.
  3,446 204 -
Retrospective morphometric analysis of the infraorbital foramen with cone beam computed tomography
S Dagistan, Ö Miloǧlu, O Altun, EK Umar
September 2017, 20(9):1053-1064
DOI:10.4103/1119-3077.217247  PMID:29072226
Objective: The aim of our study is to examine the morphometric characteristics of the infraorbital foramen (IOF) and its anatomic localization by using cone-beam computerized tomography (CBCT). Materials and Methods: In our study, the anatomic characteristics of the IOF were identified by studying retrospectively the CBCT images of one hundred twenty-five (125) patients. These characteristics were assessed statistically in terms of age, gender, and right-left side. Results: In our study, 42% of them had IOF in circular form and 58% in oval form. Of them 66.90% of those in oval form were in oblique direction, 28.30% of them were in vertical direction, and 4.80% of them were in horizontal direction. The mean vertical diameter of the IOF was found as 3.71 ± 0.61 mm and its mean horizontal diameter was found as 3.17 ± 0.56 mm. The mean distance of IOF to midline were measured as 25.10 ± 2.17 mm, distance to upper edge of the orbita was measured as 41.91 ± 2.77 mm, distance to infraorbital edge was measured as 5.63 ± 1.77 mm, distance to the lateral nasal wall was measured as 9.32 ± 2.68 mm, distance to spina nasalis anterior was measured as 17.97 ± 3.99 mm, thickness of the soft tissue on the foramen was measured as 11.52 ± 2.40 mm, and distance between the right and the left IOF was measured as 50.20 ± 3.90 mm. Accessory foramen was found in 56.60% ratio. Conclusion: This study reveals that CBCT may guide for local anesthesia applications and for other invasive procedures in order to prevent the damage of the neurovascular structures during maxillofacial surgery by identifying the distances of anatomic points such as IOF having surgically importance.
  3,079 543 3
The role of the nasal and paranasal sinus pathologies on the development of chronic otitis media and its subtypes: A computed tomography study
M Damar, AE Dinç, D Erdem, S Bişkin, S Ş Eliçora, Y Ç Kumbul
September 2017, 20(9):1156-1160
DOI:10.4103/njcp.njcp_124_16  PMID:29072240
Objective: This objective of this study is to evaluate the presence and the coincidence of common nasal and paranasal sinus pathologies in adults suffering from chronic otitis media (COM) and its subtypes. Materials and Methods: The study group comprised 354 ears of 177 patients who underwent tympanoplasty with or without mastoidectomy from January 2013 to February 2015 due to uni/bilateral COM. Chronic suppurative otitis media, intratympanic tympanosclerosis (ITTS), cholesteatoma, and tympanic membrane with retraction pockets constituted subtypes of COM. The control group consisted of 100 ears of 50 adult patients with aural diseases other than middle ear problems. All patients were evaluated for the evidence of mucosal disease on paranasal sinuses, the presence of concha bullosa (CB), and the angle of nasal septal deviation (NSD) and thickness of the medial mucosa of the inferior turbinate were measured by coronal computed tomography images. Results: The incidence and the angle of NSD were found significantly higher in patients with COM (P = 0.028, P = 0.018; respectively). When ears with unilateral and bilateral COM compared in term of sinonasal pathologies, CB was found higher in patients with unilateral COM (P = 0.040). The presence of CB was significantly higher in ITTS when compared to other subtypes (P = 0.028). Conclusions: Our study suggests that obstructive nasal pathologies such as NSD and CB may play a role in the pathogenesis of especially unilateral COM. However, there was no correlation between COM and inflammatory pathologies such as sinusitis.
  3,059 503 3
Oral and dental health in children with chronic liver disease in the Turkey Northeast
O Baygin, M Cakır, N Ucuncu
September 2017, 20(9):1182-1188
DOI:10.4103/1119-3077.183259  PMID:29072244
Background: It is important to be aware of oral and dental problems in the early period in children with chronic liver disease (CLD) to prevent late complications. Therefore, we aimed to analyze the oral and dental health status in children with CLD. Methods: The three groups of children (3–18 years old); Group 1 (disease group, n = 31) patients with CLD, Group 2 (disease control group, n = 17) patients with chronic renal failure, and Group 3 healthy children (control group, n = 35). Examination of oral and dental structures were made, and then salivary parameters were analyzed. Antegonial index were calculated from panoramic X-rays. Results: Enamel hypoplasia was found in 54.8%, 41.1%, and 31.4% of the children in the Groups 1, 2, and 3, respectively (P1-3 < 0.05). High salivary buffer capacity was found in 45.2% and 70.6% of the patients in Groups 1 and 2, respectively, and 45.7% of the children in healthy group, (P1-2 and P2-3 < 0.05). Factors associated with enamel hypoplasia in patients with CLD were male gender (64.7% vs. 21.4%, P < 0.05) and the presence of malnutrition (41.1% vs. 7.1%, P < 0.05). Conclusion: Pediatric hepatologists must be aware of the dental problems in children with CLD. Enamel hypoplasia is common in children with CLD, and it may predispose to dental caries.
  3,123 366 -
Changes in periodontal and microbial parameters after the space maintainers application
M Aydinbelge, K Cantekin, G Herdem, H Simsek, D Percin, OM Parkan
September 2017, 20(9):1195-1200
DOI:10.4103/1119-3077.180070  PMID:29072246
Aim: This study aims to evaluate the clinical and microbiological changes accompanying the inflammatory process of periodontal tissues during treatment with space maintainers (SMs). Materials and Methods: The children were separated into fixed (Group 1, n = 20) and removable (Group 2, n = 20) appliance groups. A full periodontal examination, including probing pocket depth (PPD), bleeding on probing (BOP), and plaque index (PI), was performed. Anaerobic microorganisms in the crevicular fluid were detected with the culture method. Clinical and microbial evaluations were performed before (T0) applications. as well as at three (T1), and 9 months intervals (T2) after the application of the fixed or removable appliances. Results: The PI, PPD, and BOP scores at the testing sites of both groups increased significantly from before treatment (T0) to the 9 months' time frame (T2) (P < 0.05), The presence of anaerobic bacteria in the subgingival dental plaque increased from T0 (n = 13, 65%) to T1 (n = 16, 80%) in the fixed SM group, but not statistically significant. The same values were obtained in T1 and T2 (n = 16, 80%). Conclusion: Although, the results of this study demonstrate that the application of fixed or removable SM appliances in children induced an increase of clinical periodontal parameters, anaerobic microbiota consisting of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella forshia were not observed in any of the samples in short-term. Further long-term and comprehensive investigations are necessary.
  3,078 352 2
Comparison of medial and posterior surgical approaches in pediatric supracondylar humerus fractures
E Sahin, S Zehir, S Sipahioglu
September 2017, 20(9):1106-1111
DOI:10.4103/njcp.njcp_104_16  PMID:29072232
Objectives: The aim of the current study was to compare the clinical results of pediatric supracondylar humerus fracture cases requiring open reduction through medial approach with posterior approach. Patients and Methods: Retrospective cohort of 67 cases of pediatric supracondylar fractures was reviewed. Thirty-three patients (20 males, 13 female, average age: 8.3 ± 3.131) were treated with medial approach were compared with 34 patients (19 males, 15 females, average age: 7.5 ± 3.146) treated with posterior exposure. Median follow-up period of the first group was 35.04 months (range: 17–76 months) and of the second group was 36.04 (range: 16-65 months). Radiological evaluation included Baumann angle, carrying angles, and lateral humero-capitellar angles. Functional and cosmetic evaluation was assessed with range-of-motion measurements and the criteria defined by Flynn et al. Results: No differences between groups were noted regarding gender, age, and follow-up periods. Operative time was significantly shorter in medial approach group [60.0 ± 14.5 vs. 75.8 ± 17.6 min (P = 0.002)]. Radiological measurements (Baumann, humero-capitellar, and carrying angles) were also similar between groups. When evaluated patients according to Flynn's criteria, for medial group, 31 cases (93.9%) had good–perfect result regarding ROM loss, whereas for posterior group 33 cases (97%) had good–perfect result. Regarding carrying angle change and posterior group were slightly better than medial group (perfect result observed in 91.1% vs 81.8%, respectively). The differences did not show statistical significance. Conclusion: In the treatment of supracondylar humerus fractures in children, both surgical approaches revealed similar functional and radiological outcomes with shorter operative time when medial approach was utilized.
  2,621 411 5
Evaluation of digital model accuracy and time-dependent deformation of alginate impressions
MG Cesur, IK Omurlu, T Ozer
September 2017, 20(9):1175-1181
DOI:10.4103/1119-3077.197012  PMID:29072243
Objectives: The aim of this study was to evaluate the accuracy of digital models produced with the three-dimensional dental scanner, and to test the dimensional stability of alginate impressions for durations of immediately (T0), 1 day (T1), and 2 days (T2). Materials and Methods: A total of sixty impressions were taken from a master model with an alginate, and were poured into plaster models in three different storage periods. Twenty impressions were directly scanned (negative digital models), after which plaster models were poured and scanned (positive digital models) immediately. The remaining 40 impressions were poured after 1 and 2 days. In total, 9 points and 11 linear measurements were used to analyze the plaster models, and negative and positive digital models. Time-dependent deformation of the alginate impressions and the accuracy of the conventional plaster models and digital models were evaluated separately. Results: Plaster models, negative and positive digital models showed significant differences in nearly all measurements at T (0), T (1), and T (2) times (P < 0.01, P < 0.05, and P < 0.001). Arch perimeter measurements did not differ at T (0) and T (1) times (P > 0.05), but they demonstrated statistically significant differences at T (2) time (P < 0.05) between the models. Conclusions: This study showed that measurements on negative digital models offer a high degree of validity when compared to measurements on positive digital models and plaster models; differences between the techniques are clinically acceptable. Direct scanning of the impressions is practicable method for orthodontists.
  2,607 414 3
An audit of endometrial hyperplasias at the Lagos University Teaching Hospital
OO Dawodu, NZ Ikeri, AA Banjo
September 2017, 20(9):1074-1078
DOI:10.4103/njcp.njcp_274_16  PMID:29072228
Introduction: There has been much controversy and confusion surrounding the endometrial hyperplasias stemming from the use of a wide variety of terminologies and also from the pathophysiologic mechanisms underlying the various entities. The current classification by the World Health Organization (WHO) published in 2014 clarifies these issues. Objective: The aim of this study, therefore, was to audit and standardize cases of endometrial hyperplasia diagnosed in our institution from 2007 to 2011. Materials and Methods: The slides and request forms of cases diagnosed as endometrial hyperplasias at the Department of Anatomic and Molecular Pathology from January 1, 2007, to December 31, 2011 were retrieved, reviewed, and reported according to the WHO 2014 classification scheme. Results: Hyperplasia without atypia accounted for the vast majority of cases (95.5%) and was the most common in the 5th decade. Concordance rates of 74.5% and 100% were found between endometrial hyperplasias without atypia and atypical hyperplasias with their previous diagnoses, respectively. Conclusion: The WHO classification scheme standardizes and simplifies the terminology used in the diagnosis of endometrial hyperplasias, while reflecting, at the same time, the current understanding of genetic changes that provide information necessary for prognostication and treatment.
  2,721 275 -
Oxidative stress markers and genetic polymorphisms of glutathione S-transferase T1, M1, and P1 in a subset of children with autism spectrum disorder in Lagos, Nigeria
Y Oshodi, O Ojewunmi, TA Oshodi, GT Ijarogbe, OC Ogun, OF Aina, FEA Lesi
September 2017, 20(9):1161-1167
DOI:10.4103/njcp.njcp_282_16  PMID:29072241
Background: The role of oxidative stress has been identified in the development of autism spectrum disorder (ASD), and polymorphisms of glutathione S-transferase have been associated with some diseases linked to oxidative stress. Hence, we evaluated the serum levels of oxidative stress markers and investigated genetic polymorphisms of glutathione S-transferase associated with autism. Materials and Methods: Forty-two children clinically diagnosed with ASD using the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) criteria and a clinical interview were included in the study. Twenty-three age-matched controls without any known genetic/developmental disorder were also recruited. Oxidative stress markers along with the genetic polymorphisms of glutathione S-transferase were determined. Results: Reduced glutathione in ASD patients was significantly lower than the control (P = 0.008), whereas other oxidative stress markers measured were not significantly different in both the control and case populations. The frequencies of GSTT1 and GSTM1 null genotypes were lower among the controls compared with the cases, however, no association risk was observed. The observed risk of carrying Val/Val genotype among the cases was approximately six times that of the controls. Conclusion: Individuals with ASD showed a significant diminished level of reduced glutathione, however, the distribution of GSTT1, GSTM1, and GSTP1 polymorphisms was not found to be associated with autism in this study population.
  2,535 429 5
Knowledge and utilization of electrocardiogram among resident doctors in family medicine in Nigeria
GC Isiguzo, MO Iroezindu, AS Muoneme, BN Okeahialam
September 2017, 20(9):1133-1138
DOI:10.4103/njcp.njcp_374_16  PMID:29072236
Background: Electrocardiogram (ECG) is a simple, readily affordable, and noninvasive tool for the evaluation of cardiac disorders. There is a dearth of information on the utility of ECG in general practice in Nigeria. We assessed the knowledge and utilization of ECG among family medicine residents in Nigeria. Materials and Methods: A cross-sectional evaluation was conducted between November 2011 and May 2012 in four family medicine training centers in Nigeria. A self-administered questionnaire was used to obtain information from the resident doctors regarding their ECG requests, preferred source of interpretation, most common ECG diagnosis, and update of ECG knowledge. Results: Only 61 out of 120 questionnaires (50.8%) were returned. The respondents were mostly between 31 and 40 years (54.7%) and were predominantly males (73.8%) and senior residents (65.6%). Fifty-four (88.3%) respondents made <5 ECG requests/week, and the most common indication was hypertension (50%). ECG interpretation was either self-reported (41%), by a cardiologist (26.5%), or automated reports (21.3%). Self-reporting of ECG was more common among senior residents (P < 0.01). Left ventricular hypertrophy was the most common ECG diagnosis (55.8%). About 69% of respondents did not update their knowledge of ECG. Most respondents (50%) reported basic interpretation as the aspect of ECG for which further learning was desired. Teaching ECG to resident doctors in the update courses of the postgraduate medical colleges and continuing medical education (CME) activities was adjudged the best way to improve knowledge/utility (61.1%). Conclusion: The attitude to and utility of ECG among family medicine residents in Nigeria is poor. Improved knowledge, attitude, and utilization of ECG through curriculum revision, hands-on tutorials, and CMEs are highly recommended.
  2,612 227 2
Impalement injury to the abdomen: Report of a case
IA Udo, O Eta, C Sokwa, E Etuknwa
September 2017, 20(9):1210-1212
DOI:10.4103/njcp.njcp_465_15  PMID:29072249
Impalement presents a combination of injuries severe enough to cause the homeostatic mechanisms to malfunction or fail. It challenges the abilities of the managing team as well as the available medical resources. Its management is even more demanding in environments where health-care personnel, facilities for emergency care, and communications infrastructure are absent or poorly funded and equipped. The primary objective of managing impalement injuries is to prevent further injuries and preserve or restore homeostasis. Leaving the impaling object in situ until in the operating room is a time proven approach as it allows for managing life-threatening hemorrhage in the operating room. Adequate volume replacement, good visualization, debridement of injuries, and anti-infective measures are complementary. We present a case of type I abdominal impalement in a young man who sustained minimal visceral or neurovascular injuries and underwent exploratory laparotomy for his injuries; he developed a traumatic incisional hernia. He defaulted on the scheduled hernia repair.
  2,537 211 2
Prevalence of lupus anticoagulant in women with spontaneous abortion in Zaria
IN Ibrahim, AI Mamman, SE Adaji, A Hassan, AA Babadoko
September 2017, 20(9):1145-1149
DOI:10.4103/njcp.njcp_125_16  PMID:29072238
Introduction: Spontaneous abortion (SA) is a common complication of pregnancy. Presence of lupus anticoagulant (LA), one of the antiphospholipid antibodies, has been associated with SA in many studies, especially in Caucasians. This study was carried out to determine the prevalence of LA in women with SA in ABUTH, Zaria. Materials and Methods: A cohort of 100 consecutive women presenting with SA with no history of thrombotic episodes were enrolled into the study. Prothrombin time (PT), kaolin clotting time (KCT), and activated partial thromboplastin time (APTT) were conducted on samples of all the participants. Eight patients had prolonged APTT, and after a 50:50 mixture of their plasma with pooled control plasma, four (50%) had uncorrected APTT. Staclot® (a hexagonal-phase phospholipid) test and calculated Rosner index for prolonged KCT were used for the confirmation of LA in samples with uncorrected APTT after mixing studies. Results: We analyzed 100 women with one or more SA with a mean age of 31.0 ± 3.8 years. Nearly 4% and 3% of the participants were LA positive with Staclot® and KCT tests, respectively. Patients with LA were more likely to have had a past history of preeclampsia/eclampsia, small for gestational age deliveries, and previous SA (prevalence odds ratio [95% confidence interval]) of 1.9 (0.2, 20.1), 3.2 (0.3, 34.3), and 1.4 (0.1–13.6), respectively. The PT, APTT, and KCT were significantly prolonged in patients with LA (P ≤ 0.001 for each, respectively). Conclusion: LA may be one of the causes of SA and other adverse pregnancy outcomes such as preeclampsia/eclampsia and small for date deliveries. It is recommended that patients with prolonged APTT, uncorrected with 50:50 mixing study with pooled control plasma, should be evaluated further for LA.
  2,270 275 1
Effect of saliva decontamination procedures on shear bond strength of a one-step adhesive system
E Ülker, S Bilgin, F Kahvecioğlu, A İ Erkan
September 2017, 20(9):1201-1205
DOI:10.4103/1119-3077.187325  PMID:29072247
Aim: To evaluate the effect of different saliva decontamination procedures on the shear bond strength of a one-step universal adhesive system (Single Bond™ Universal Adhesive, 3M ESPE, St. Paul, MN, USA). Materials and Methods: The occlusal surfaces of 75 human third molars were ground to expose dentin. The teeth were divided into the following groups: Group 1 (control group): Single Bond™ Universal Adhesive was applied to the prepared tooth according to the manufacturer's recommendations and light cured; no contamination procedure was performed. Group 2: Bonding, light curing, saliva contamination, and dry. Group 3: Bonding, light curing, saliva contamination, rinse, and dry. Group 4: After the procedure performed in Group 2, reapplication of bonding. Group 5: After the procedure performed in Group 3, reapplication of bonding. Then, composite resins were applied with cylindrical-shaped plastic matrixes and light cured. For shear bond testing, a notch-shaped force transducer apparatus was applied to each specimen at the interface between the tooth and composite until failure occurred. The data were statistically analyzed using one-way ANOVA. Results: One-way ANOVA revealed significant differences in shear bond strength between the control group and experimental Groups 2 and 4 (P < 0.05). No significant difference was found for experimental Groups 3 and 5 when compared to the control group (P > 0.05). Conclusion: The present in vitro study showed that water rinsing is necessary if cured adhesive resin is contaminated with saliva to ensure adequate bond strength.
  2,265 196 1
Pain intensity and its objective determinants following implant surgery and sinus lifting: A 1-year prospective study
B Atalay, M Ramazanoglu, EN Tozan, H Ozyuvaci
September 2017, 20(9):1139-1144
DOI:10.4103/1119-3077.217253  PMID:29072237
Objectives: The main goal of this study was to evaluate the relationship between postoperative pain and short-term implant survival. Objective parameters, such as implant-related factors (type, diameter, length) and the surgical approach were also assessed to correlate them with pain. Materials and Methods: This prospective, single-center study consisted of 144 patients scheduled for the surgical placement of one or more implants either with conventional surgery or with sinus-lifting together. All patients were asked to complete a questionnaire form of pain with a visual-analog scale (VAS, 1–10) for 7 days following surgery. The association of pain scores at each time-point was assessed on implant- and surgery-related factors. Results: The overall cumulative survival rate of 546 implants in 144 patients was 98.17 % (10 implants lost) after 1-year follow-up. No statistical difference was found in pain (VAS) scores between patients with loss and survived implants at any observation period. The length and diameter of placed implants and the presence of a sinus-lifting procedure did not influence the pain scores at any period (P > 0.05). In patients with bilateral sinus lifting, the decrease in pain scores was significant after 3 days (P < 0.05), whereas it was significant after 6 hours for the conventionally treated group (P < 0.01). Although no severe pain was reported at any time, this study found a significant difference in pain intensities among different implant brands. Conclusions: This study was able to show that increased postoperative pain is not a sign of early implant failure. In addition to this, the implant dimensions and presence of sinus lifting procedure did not influence the pain experience. However, the bilateral sinus lifting prolongs the recovery time.
  2,164 258 2
Occult metabolic bone disease in chronic pancreatitis
KVS Hari Kumar, AK Sood, M Manrai
September 2017, 20(9):1122-1126
DOI:10.4103/njcp.njcp_42_17  PMID:29072234
Background: Chronic pancreatitis (CP) leads to malabsorption and metabolic bone disease (MBD). Alcoholic CP (ACP) and tropical CP (TCP) are the two common types of CP. Objective: We investigated the presence of occult MBD in patients with CP and compared the same between ACP and TCP. Materials and Methods: In this cross-sectional, observational study, we included serial patients of CP in different stages and are grouped as ACP (Group 1; n = 67) and TCP (Group 2; n = 35). We determined serum calcium, phosphorus, alkaline phosphatase, 25-hydroxyvitamin D (25OHD), and intact parathyroid hormone (PTH) levels. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry in the neck of the left femur. MBD was defined by the presence of either low bone mass (Z-score <−2) or osteomalacia. The results were analyzed using appropriate statistical methods. Results: The study participants (85 males; 17 females) had a mean age of 40.8 ± 12.6 years, CP duration of 3.7 ± 4.7 years, and Body Mass Index of 22.5 ± 3.2 kg/m2. A total of 37 (36%) patients had MBD (osteomalacia in 31 and low bone mass in 6). The frequency of MBD was same in the TCP (16/35) and ACP (21/65) groups (P = 0.1940). Elevated PTH (>70 pg/mL) was seen in 14 patients with 25OHD deficiency and low calcium (<8.5 mg/dL) in 29 patients. BMD did not show a significant correlation with the duration of CP. Conclusion: Occult MBD is seen in a third of patients with CP and is similar irrespective of the etiology. The disease is silent and mandates active screening in all susceptible individuals.
  1,925 219 -
Reconstruction of lower extremity primary malignant and metastatic bone tumours with modular endoprosthesis
H Sezgin, A Çıraklı, H Göçer, N Dabak
September 2017, 20(9):1127-1132
DOI:10.4103/1119-3077.217243  PMID:29072235
Introduction: This study is aimed to assess the functional results of cases with lower extremity malignant and metastatic bone tumours that were treated with modular tumour resection prostheses. Materials and Methods: 49 patients were retrospectively examined. 27 (55.1%) patients had a primary bone tumour, and 22 (44.9%) had a metastatic bone tumour. Although most tumours located in the proximal femur were metastatic, tumours located around the knee were mostly primary malignant bone tumours. The functional assessments of our patients were made according to the Musculoskeletal Tumour Society (MSTS) scoring system. The Student's t-test and the Chi-square test were used for statistical analyses. Results: 30 (61.2%) of the patients were men, and 19 (38.8%) were women. The average age was 46.2 ± 1.9 years. Tumours were located in the proximal femur in 27 (55.1%) patients, distal femur in 16 (32.7%) patients and proximal tibia in 6 (12.2%) patients. 14 (28.6%) patients had a pathological fracture on admission. The average follow-up period of our patients was 27.4 ± 3.4 months, and the average MSTS score was 74.3 ± 13%. Complications developed at any time in 34.7% of the patients, and the most common symptoms were aseptic loosening (8.2%) and prosthesis infection (8.2%). Local relapse was found in one (2%) patient. The 5-year survival rate was 68.3% in patients with a primary tumour and 30% in patients with a metastatic tumour. Conclusion: Although endoprosthesis reconstruction had advantages of giving very good functional results in the early phases, it was found to cause mechanical complications, especially in patients with primary bone tumours during the mid and late phases.
  1,803 278 -
Effects of parental attitudes on the use of addictive substances in high school students
C Öztekin, T Şengezer, A Özkara
September 2017, 20(9):1112-1121
DOI:10.4103/njcp.njcp_116_16  PMID:29072233
Background: Substance abuse is a major public health problem including social and economic aspects. Although multidimensional data about substance abuse are limited in our country, the fact that Turkey is located at the crossroads of Europe and Asia with a young population creating a promising market brings out the necessity of maintaining high awareness on substance abuse. Smoking, alcohol, and substance use are important health problems of adolescence period and families play a major role on adaptation to the changes in growth and development period. The research on substance abuse and dependence emphasizes on protective or risk-enhancing effects of family. Aims: The aim of this study was to provide evidence on the interventions that could be implemented about substance use by evaluating the relationship between parental attitude and attitudes of high school students toward substance use. Study Design: This was a survey study. Materials and Methods: The study included randomly selected high school students who were willing to participate in the study from Ankara province. The students were applied the sociodemographic information questionnaire especially prepared for this research, the Addictive Substances Attitudes Scale for high school students, and the Parental Attitudes Scale. Results: In the study, data of 707 students, 311 boys and 396 girls, with a mean age of 16.1 years were evaluated. According to the obtained findings, the rate of students with a negative attitude toward addictive substances increases as parental attitude changes from authoritative attitude to democratic attitude. Conclusion: The present study demonstrated that parental attitudes are related with the attitudes of high school students toward addictive substances. Students mostly adopted a negative attitude toward substance use in case of democratic parental attitude. Therefore, to protect children from substance abuse, parents should be advised to adopt a democratic attitude characterized with sincere love and constructive control.
  1,797 264 2
Environmental factors that determine visual skill development of under-fives in a developing country
AO Jimoh, JO Anyiam, HA Abdulsalami, AJ Orugun, AM Yakubu
September 2017, 20(9):1150-1155
DOI:10.4103/njcp.njcp_438_16  PMID:29072239
Introduction: During the early years of life, children get most of their information by relying on their visual observation. Knowledge of visual skill development and environmental risk factors influencing it provides useful guide for early identification of children who may develop some form of visual impairment. Aim: The aim of this study is to describe the visual developmental pattern and determine the environmental risk factors associated with delay in the visual skill area of under-five children. Subjects and Methods: This was a cross-sectional study of 415 preschoolers aged 6–59 months. Visual function and visual comprehension were assessed using the Schedule of Growing Skills II tool (GL Assessment Ltd., London). Delay in the visual skill was defined as a developmental quotient in visual skill area below threshold point of 85%. Data were analyzed using descriptive statistics and logistic regression analysis with adjusted odds ratio (AOR) and 95% confidence interval (CI) (95% CI). Alpha value was set at P < 0.05. Results: Mean age of the children studied was 32.6 ± 15.9 months. The prevalence of delay in visual skill area was 17.1%. The odds of delay in visual skill were higher among children of first birth order (AOR 1.83; 95% CI 1.05–3.30), those who lived in large households (AOR 2.34; 95% CI 1.32–3.14), children whose mothers had secondary level education and below (AOR 2.21; 95% CI 1.31–3.83), and those whose fathers earned ≤$100 per month (AOR 1.75; 95% CI 1.01–3.03). Conclusion: Identification and management of environmental factors negatively affecting visual skill development will help improve on the visual skill area and invariably child development.
  1,780 176 -
Torsion of the spermatic cord: An exemplary early presentation
OY Oluyemi
September 2017, 20(9):1206-1209
DOI:10.4103/njcp.njcp_358_16  PMID:29072248
Torsion of the spermatic cord may lead to loss of the testis when presentation is delayed. In our environment, a high premium is placed on the male child and his ability to procreate. Hence, torsion of the spermatic cord is a true surgical emergency. Here, we report a case of torsion of the spermatic cord in a 19-year-old student that exemplifies early presentation and short presentation-detorsion time. Immediately after the operation, the clinical information in the patient's case file was summarized. A literature search was conducted on the subject matter, and the findings were compared with those of the present patient. The determinants of outcome include presentation time and the time between presentation and operation. Unfortunately, in many series, late presentation is still the norm. In the index patient, the presentation time was very short. In our environment, patients with torsion of the spermatic cord can present early and be operated promptly if we can provide public health education, mobile phones, commercial taxis, and good road networks.
  1,682 165 1