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Volume 19 | Issue 4
Page Nos. 431-572
Online since Wednesday, June 1, 2016
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Association of pre-eclampsia with metabolic syndrome and increased risk of cardiovascular disease in women: A systemic review p. 431
IC Udenze
DOI:10.4103/1119-3077.180055 PMID:27251955
Background and Objectives: Cardiovascular disease (CVD) is the leading cause of death in women globally. Preeclampsia has been linked to increased risk of developing heart disease later in life. The best approach for the prevention of CVD after preeclampsia is yet unclear. Studies assessing CVD risk post preeclampsia have included metabolic risk factors that define the metabolic syndrome (MS). This review quantifies the association between preeclampsia and CVD in the context of metabolic risk factors that define the MS. Materials and Methods: PubMed database was searched for relevant articles from 1999 to March 2015. The search phrase was "preeclampsia and MS." After two levels of screening by title and abstract, case–control, cohort, and cross-sectional studies that included at least 50 subjects were selected. Results: Twenty-four articles that reported the prevalence or odds for MS and its components following a history of preeclampsia and the prevalence of preeclampsia in women with prepregnancy MS were selected. A total of 9 case–control, 11 cohort, and four cross-sectional studies were included. The prevalence of MS ranged from 10.9% to 27.3% after a preeclamptic pregnancy. About 88% of the case–control studies showed a statistically significant difference in prevalence of MS post preeclampsia whereas 75% of the cohort studies reported prevalence values >10% for the prevalence of MS post preeclampsia. The odds for developing MS post preeclampsia ranged from 1.23 to 3.60 and 83% of the studies reported an odds ratio >2. The prevalence of developing preeclampsia in women with prepregnancy MS ranged from 26.7% to 45% compared to 4.7% to 17% among controls. Conclusion: The prevalence and odds for developing MS after a preeclamptic pregnancy are high suggesting that MS may be involved in the pathogenesis of CVD following preeclampsia. This will provide evidence on the potential health benefits of a modifiable CVD risk screening program for women with a history of preeclampsia.
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Effects of combined general anesthesia and thoracic epidural analgesia on cytokine response in patients undergoing laparoscopic cholecystectomy p. 436
S Ozcan, AB Ozer, MA Yasar, OL Erhan
Background: Severe postoperative pain is not often experienced in laparoscopic cholecystectomy. Anesthesia, surgery, and pain are stressful and cause different reactions in neuro-immuno-endocrine systems. Many factors such as the pharmacological effect of the drugs used, as well as the type and depth of anesthesia, can affect these reactions. Objective: The aim of this study was to evaluate the effect of the combination of general anesthesia and thoracic epidural analgesia (TEA) on cytokine reaction in laparoscopic cholecystectomy. Study Design: Prospective, randomized clinical comparative study. Materials and Methods: Sixty adult patients scheduled for elective laparoscopic cholecystectomy were divided into four groups. Group saline (Group S), group fentanyl (Group F), group bupivacaine (Group B), and group levobupivacaine (Group L) were infused with saline, saline and fentanyl, bupivacaine and fentanyl, and levobupivacaine and fentanyl, respectively, via epidural catheter before surgical incision. Results: There were no differences among groups in the demographic features, heart rate, mean arterial pressure, and peripheral oxygen saturation values. Group L had lower visual analogue scale value compared to the other postoperative groups (P < 0.01). In all groups, interleukin-6 (IL-6), IL-8, and IL-10 levels started to increase at 2 h and returned to the basal level at 24 h. IL levels increased in most of the epidural saline-administered group compared to other groups (P < 0.05). Conclusion: Combined general anesthesia and TEA provided pain control and hemodynamic stability more efficiently during the first 24 h of the intraoperative and postoperative period by suppressing cytokine levels. However, we determined that this effect was more obvious with the local anesthetic and opioid combination.
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W/M serrated osteotomy for infantile Blount's disease in Ghana: Short-term results p. 443
F Hollman, J Korpisah, AH Ismail, PJJM Rompa, P Moh, LW van Rhijn, HM Staal
Purpose: The W/M serrated high tibial osteotomy is a not frequently described surgical technique for simultaneously correcting the varus and torsional deformity in patients with Blount's disease. Without the need for internal fixation, this surgical treatment is well suited for developing countries. This study describes the short-term results of the bilateral and unilateral W/M serrated osteotomy in patients with infantile Blount's disease. Methods: Between May 2008 and January 2013, 52 patients were treated with uni- (n = 22) or bi-lateral (n = 30) W/M serrated osteotomy of the proximal tibia due to a tibial varus deformity in two district hospitals in Ghana. Other causes than infantile Blount's disease were excluded from the analysis. Pre- and post-operative clinical and radiological measurements were done, and complications were monitored up to 12 weeks after surgery. Results: Seventeen patients (five males, 12 females; mean age 4.9 [standard deviation: 2.10]) were included, which underwent a total of 25 W/M serrated osteotomies. The femorotibial angle was corrected from 34.1° ([mean] range: 6–68°) to − 7.1° ([mean] range: −28–5°). Only one patient had developed a wound infection, and all reached full consolidation. Conclusions: The W/M serrated osteotomy seems a profitable alternative technique for treating the varus and torsional deformity in patients with Blount's disease in the circumstances of developing countries. The short-term outcomes are good and promising with a low complication rate and good consolidation. Long-term follow-up results of these patients are needed to observe possible complications. Level of Evidence: IV, therapeutic case series.
Comparison of Saudi child versus parent-report of child tooth-brushing practices p. 449
F Salama, I Abobakr, N Al-Khodair, M Al-Wakeel
Objective: This cross-sectional study compared Saudi children's tooth-brushing practices as reported by children and parents and then matched the agreement of reports. Materials and Methods: A sample of 100 Saudi parents and their children of ages 8–12 years participated in this cross-sectional investigation. A self-administered structured questionnaire regarding the current tooth-brushing practice and habits at home was filled by the child. The same questionnaire was filled independently by parents. Results: Mothers were more likely to teach children about tooth-brushing and fathers were minimally helping children during tooth-brushing. Mothers were the first to teach the children and approximately 33% of the children started brushing their teeth by age 5. Children and parents reported that children clean their teeth using a tooth-brush (73.74% and 76.77%), miswak (5.05% and 5.05%), or both (21.21% and 18.18%), respectively. Conclusions: There was some agreement between reported tooth-brushing practice of children and their parents. It is important to question both the child and parent regarding oral hygiene practice and compare their answers to get more broad knowledge about their practices. Approximately, one-third of the children started brushing their teeth by age 5, which differs from recommended oral hygiene practices.
Day surgery is effective and safe for patients with great saphenous vein varices who meet American Society of Anesthesiologists I-II grading p. 455
Y Xiong, Q Xu, Y Wang, M Zhu, J Wang, Q Guo
Background and Aim: Since the concept of "Day Surgery"; (DS) was firstly put forward in 1995, DS for great saphenous vein varices (GSVV) becomes more and more dominant in worldwide, but it is accepted only in a limited population in China. Hence in the present retrospective study, patients who received DS and regular surgery are compared to assess the effectiveness and safety of DS for GSVV. Patients and Methods: From 2011 to 2013, 452 patients who received DS and 372 patients who received inpatient surgery (IS) were collected from hospital main clinical database. Baseline characteristics, prognosis, and 12-month-long follow-up were compared. Results: Mean age in DS group was 52.76 ± 4.89, 53.42 ± 5.52 in IS group. During follow-up after surgery, incidence of deep vein thrombosis (DVT), saphenous nerve injury (SNI), wound infection, and recurrence in DS and IS groups was 0.9% versus 0.8%; 2% versus 3%; 3.3% versus 3.8%; and 1.3% versus 1.1%, respectively. Moreover, there was no significant difference in incidence of DVT, SNI, wound infection, and recurrence between groups (P = 0.904; 0.376; 0.719; and 0.742). However, average hospital stays in DS group was 1 day, compared to 4.2 days in IS group. Moreover with respect to average medical cost (dollar), it was 780.33 dollars and 1021.06 dollars in DS and IS group, respectively. Conclusion: DS for GSVV is an effective and safe procedure, which was the same as IS. However compared with IS, DS could decrease the average medical cost for patients and hospital stays obviously. Hence DS for GSVV is a win-win procedure for patient and health care.
Are blood pressure values compatible with medication adherence in hypertensive patients? p. 460
A Uludag, EM Sahin, H Agaoglu, S Gungor, YH Ertekin, M Tekin
Background and Aim: In the management of hypertension (HT), maintaining the medication adherence with treatment is as important as starting treatment. Studies have shown that the majority of patients taking medication do not reach their target values. This study aimed to investigate the relationship between the patient medication adherence and blood pressure (BP) values and reflection to general well-being. Material and Methods: The study included 259 primary HT patients. The patients with BP measurements completed the Medication Adherence Self-Efficacy Scale-Short Form 13 and the World Health Organization-5 (WHO-5) well-being index. A Holter device was attached, and 24 h BP monitoring was completed. Results: The mean points for medication adherence scale was 29.2 ± 10.3 (1–40) and mean WHO-5 points was 13.7 ± 4.6 (4–25) for patients. Clinical mean systolic BP was 140.0 ± 12.6 and diastolic 84.8 ± 9.0 mm Hg, while 24 h mean BP was systolic 119.5 ± 10.6 and diastolic 73.3 ± 8.1 mm Hg. While there was negative correlation between medication adherence scale scores and clinical systolic BP (r = −0.171; P = 0.006), there was no correlation with other BP readings. There was no correlation with the WHO-5 score and clinical readings, though there was a positive correlation between ambulatory mean systolic and diastolic BP (r = 0.141; P = 0.023 and r = 0.123; P = 0.049, respectively). There was positive correlation between the patient's medication adherence scores and the WHO-5 scores (r = 0.141; P = 0.023). Conclusion: When clinicians assess medication adherence of patients, they should benefit from objective BP measurements and scales. Subjective and objective findings are important while making clinical decision.
The effects of different irrigation protocols on removing calcium hydroxide from the root canals p. 465
Y Üstün, T Aslan, B Sagsen, AN Dinçer
Objective: The aim of this study was to evaluate the efficiencies of different irrigation protocols and solutions in the removal of calcium hydroxide (Ca[OH]2). Materials and Methods: Sixty-eight maxillary incisors were used. Root canals were prepared and filled with Ca(OH)2. Two control (n = 4) and six experimental groups (n = 10) were adjusted: Group 1:1% peracetic acid (PAA) + master apical file (MAF); Group 2: 17% ethylenediaminetetraacetic acid (EDTA) + MAF; Group 3: 9% 1-hydroxyethylidene-1,1-bisphosphonate (HEBP) + MAF; Group 4: 1% PAA + ultrasonic activation (UA); Group 5: 17% EDTA + UA; Group 6: 9% HEBP + UA. The cleanliness of root canal thirds were evaluated with scanning electron microscopy. Statistical analysis were performed (α = 0.05). Results: At coronal thirds; PAA + UA was superior to EDTA + MAF, HEBP + MAF; and PAA + MAF was superior to EDTA + MAF, HEBP + MAF (P < 0.05). At middle thirds; PAA + MAF and PAA + UA were superior to EDTA + MAF and EDTA + UA; and, PAA + UA was superior to HEBP + MAF (P < 0.05). There were no significant differences among the rest of the experimental groups (P > 0.05). Conclusion: Complete removal of Ca(OH)2could not be achieved by none of the irrigants at all root thirds.
Prevalence and associations of symptomatic renal papillary necrosis in sickle cell anemia patients in South-Eastern Nigeria p. 471
AJ Madu, AE Okoye, IC Ajuba, KA Madu, C Anigbo, K Agu
Aim: To assess the prevalence and associations of symptomatic renal papillary necrosis (RPN) in sickle cell anemia patients. Patients and Methods: The case notes of homozygous hemoglobin (Hb) S patients diagnosed with RPN were retrospectively assessed. Diagnosis was based on microscopic hematuria and positive ultrasound findings. Their steady state diastolic blood pressure, Hb, leukocyte count, platelet count, serum direct bilirubin, and aspartate transaminase, were obtained by automated analyzers. These were evaluated for any relationship with the occurrence of RPN. Results: Two hundred and twenty patients were assessed aged 6–55 years with a median age of 24 years. The prevalence of symptomatic RPN was found to be 2.3%. RPN was positively associated with the female gender (Chi-square P value 0.001), but not with any other clinical or laboratory variable. However, other predictors of disease severity were positively associated with RPN such as age, diastolic blood pressure 0.180 (P = 0.016), serum aspartate transaminase, serum bilirubin 0.145 (0.027), Hb, and leukocyte count − 0.155 (P = 0.003). Conclusion: The prevalence of symptomatic RPN is low in this group of homozygous S patients and occurs more commonly in females. Improvement in care for these patients will reduce these chronic complications.
Conventional trans-tibial versus anatomic medial portal technique for femoral tunnel preparation in anterior cruciate ligament reconstruction; comparison of clinical outcomes p. 475
S Zehir, E Sahin, M Songür, M Kalem
Aim: Method of femoral tunnel preparation in anterior cruciate ligament (ACL) reconstruction is controversial. In this study, we aimed to determine if there is any difference between the clinical outcomes of two most commonly used drilling techniques; which are conventional trans-tibial (TT) drilling of femoral tunnel and anatomic preparation of femoral tunnel through medial portal (MP), in patients who underwent ACL reconstruction. Material and Methods: One hundred and twenty-nine male patients who underwent ACL reconstruction between 2010 and 2012 were included in the study. Single-bundle reconstruction with a quadrupled autologous hamstring graft was performed in all patients. Femoral tunnel was drilled by the conventional TT technique in 58 patients (Group 1) and through MP in 71 patients (Group 2). Functional evaluation was made about 12 months postoperatively. Functional evaluation included the Lysholm Knee Scale, International Knee Documentation Committee Scoring (IKDC), and Tegner Activity Level Scale were used for assessment. The anteroposterior stability was assessed using KT-1000 arthrometer and the pivot shift test for assessment of rotational stability. Results: Interval between injury and surgery was similar between two groups (median 8.0 vs. 10 weeks, for TT vs. MP, respectively). One hundred twenty-five patients attending the final follow-up examination (96.8%) were evaluated. The results of Lysholm, IKDC, and Tegner scales were found to be similar. According to KT-1000 arthrometer results, MP group revealed slightly better results than TT group. Regarding pivot shift, MP group showed significantly better stability than TT group (P < 0.001). Conclusion: The anatomical single-bundle femoral tunnel preparation in the reconstruction of the ACL seems as effective as the conventional technique in terms of functional stability in the midterm. The technique better preserved the rotational stability in non-professional athletes.
Effects of alpha-tocopherol on gingival expression of inducible nitric oxide synthase in the rats with experimental periodontitis and diabetes p. 480
M Hatipoglu, NÖ Alptekin, MC Avunduk
Background: The aim of this study was to investigate effects of α-tocopherol and/or insulin on the number of gingival inducible nitric oxide synthase (iNOS) positive cells in rats with experimental periodontitis with or without streptozotocin (STZ)-induced diabetes. Materials and Methods: A total of 60 Sprague-Dawley rats were divided into three groups: Group I: The group without diabetes; Group II: The group with STZ-induced diabetes; Group III: The group with STZ-induced diabetes receiving insulin therapy. All animals received anesthesia, and 3/0 silk suture was inserted around the mandibular molar teeth. All groups were divided into subgroups receiving saline (Groups IA, IIA, IIIA) and α-tocopherol injection (Groups IB, IIB, IIIB). After a period of 3 weeks, all rats were sacrificed, and the number of gingival iNOS positive cells was analyzed using image analysis software. Results: Applying α-tocopherol suppressed the number of gingival iNOS positive cells in Groups IB, IIB, and IIIB compared to application of saline (Groups IA, IIA, and IIIA) (P < 0.05). Numbers of gingival iNOS positive cells were found to be similar in the Groups I and III (P > 0.05). Conclusions: Within limitations of the current study, this is the first study one may suggest that α-tocopherol may reduce oxidative damage in the gingiva of the rats with periodontitis with or without STZ-induced diabetes and increase effects of insulin.
Salivary glucose as a diagnostic tool in Type II diabetes mellitus: A case-control study p. 486
M Dhanya, S Hegde
Background and Objectives: The prevalence of diabetes mellitus is increasing steadily in India. Understanding blood glucose level is the key to both diagnosis and management of diabetes mellitus. However, there is an on-going need for improvements in noninvasive, point-of-care tools for the diagnosis and prognosis of diabetes. Assessing a relationship between the blood glucose level and its concentration in other body fluids such as the saliva can help in developing a conservative method for blood sugar assessment replacing venous blood sampling. Diabetes mellitus is known to cause changes in salivary composition. Hence, this study was undertaken to evaluate the relationship of blood glucose level with salivary glucose in diabetic and nondiabetic patients. Materials and Methods: The study sample included 100 diabetic patients and 100 nondiabetic patients aged above 35 years of age. Fasting blood and salivary glucose levels were measured in the two groups. Pearson's correlation coefficient was used to assess the correlation of blood glucose with salivary glucose in the two groups. Results: The results of the study revealed an increase in the level of fasting salivary glucose in diabetics compared to that of nondiabetic patients. It also showed a highly significant positive correlation between fasting salivary glucose and serum glucose in both diabetic patients and in controls. Conclusion: From this study, it can be concluded that fasting salivary glucose level can be used as a noninvasive diagnostic, as well as a monitoring tool to assess the glycemic status of Type II diabetes mellitus patients.
Bacterial contamination of hemodialysis water in three randomly selected centers in South Western Nigeria p. 491
OO Okunola, JO Olaitan
Background: Hemodialysis (HD) is the most common method of renal replacement therapy for patients with either acute kidney injury in the failure stage or end stage kidney failure in Nigeria. The number of dialysis centers in Nigeria has risen exponentially from 10 centers two decades ago to more than 120 centers in 2015. The number of patients needing renal replacement therapy in the country in the form of HD has also risen close to a projected 2000/year. The outcome from HD in Nigeria is poor as a result of a myriad of interwoven factors such as complications of cardiovascular diseases and suboptimal dialysis dose primarily due to economic factors. These are often complicated by episodes of dialysis water related bacteremia, possibly as a result of the apparent lack of a standardized guideline or protocol for monitoring dialysis water treatment system which is the driving force of dialysis units. Objectives: This is a multicenter laboratory-based study designed to determine the microbiological quality of samples of HD water and dialysate in randomly selected dialysis units in three major government teaching hospitals in Nigeria. Methodology: Water samples were aseptically and serially collected from three HD units. The samples were taken from 6 points at each center coded A, B, and C over a 6-month period. Results: The water system in the three dialysis centers were grossly contaminated with Gram-negative aerobic bacteria such as Pseudomonas species and Moraxella species at all the points in the three centers. Conclusion: Conventionally, water treatment is a major determinant of morbidity and mortality in HD units, and the microbial quality is a major factor involved. There is evidence of bacterial contamination in the dialysis units sampled in this study. There is thus the compelling need for periodic microbiological monitoring of water after each treatment step. A uniform national guideline as part of an effective quality assurance protocol in infection surveillance is also advocated for dialysis units in Nigeria.
Dentists' knowledge of occlusal splint therapy for bruxism and temporomandibular joint disorders p. 496
C Candirli, YT Korkmaz, M Celikoglu, SH Altintas, U Coskun, S Memis
Aims: The aim of this study was to investigate dentist's approaches to the use of splint therapy for myofascial pain, bruxism, and temporomandibular joint (TMJ) disorders and to assessment of treatment modalities. Materials and Methods: A 12-item questionnaire was developed to determine dentists' knowledge of TMJ disorders and approaches for occlusal splint treatments. The researchers spoke with each dentist included in the study at his/her clinic or by telephone to assess their immediate knowledge and approach to the TMJ disorders. Chi-squared test was performed to analyze the values. The confidence interval was set as 95%. Results: A total of 370 dentists working in Turkey were participated in this study. The most common splint application reason for occlusal splint treatment was bruxism (77.8%) while TMJ pain was very rare (%1.4). The use of hard splint ratios for 0–5 years of professional experience was 57.0%, 42.4.0%, and 26.8% for the experience of 5–15 years and over 15 years groups, respectively (P < 0.001). While the dentists' with sufficient knowledge soft splint application rates were 11.6%, hard splint application rates were 43.4% for the dentists with sufficient knowledge. Occlusion adjustment rate of dentists who practice in all three groups was under 16.0%. Conclusions: The knowledge of the dentists about TMJ disorders and occlusal splint therapy were found to be insufficient. Their knowledge decreased with increasing experience.
Physician and nurse knowledge about patient radiation exposure in the emergency department p. 502
WJ Lee, SH Woo, SH Seol, DH Kim, JH Wee, SP Choi, WJ Jeong, SH Oh, YY Kyong, SW Kim
Background: Imaging methods that use ionizing radiation in emergency departments (EDs) have increased with advances in radiological diagnostic methods. Physician and nurse awareness of the radiation dose in the ED and the associated cancer risks to which the patients are exposed were surveyed with a questionnaire. Methods: A total of 191 subjects in six EDs participated in this study. ED physicians and ED nurses were asked about the risks and the radiation doses of imaging methods ordered in the ED. The differences between the two groups were compared using Student's t-test for continuous variables. A Fisher's exact and Chi-squared tests were used for categorical variables. Results: A total of 82 ED physicians and 109 ED nurses completed the questionnaire; 38 (46.3%) physicians and 8 (7.3%) nurses correctly answered the question about the chest X-ray radiation dose. A question about the number of chest X-rays that is equivalent to the dose of a pelvic X-ray was answered correctly by 5 (6.1%) physicians and 9 (8.3%) nurses (P = 0.571). Questions regarding abdominal computed tomography (CT), chest CT, brain CT, abdominal ultrasonography, and brain magnetic resonance imaging were answered correctly more frequently by the physician group than the nurse group (P < 0.05). The risk of developing cancer over a lifetime due to a brain CT was correctly answered by 21 (25.6%) physicians and 30 (27.5%) nurses (P = 0.170). A similar question regarding abdominal CT was correctly answered by 21 (25.6%) physicians and 42 (38.5%) nurses (P = 0.127). Conclusions: Knowledge of the radiation exposure of radiology examinations was lower in nurses than physicians, but knowledge was poor in both groups. ED physicians and nurses should be educated about radiation exposure and cancer risks associated with various diagnostic radiological methods.
Clinical profile, knowledge, and beliefs about diabetes among patients attending a Tertiary Health Centre in Lagos: A cross-sectional survey p. 508
SO Ogundele, AO Dada, OR Mosuro
Introduction: Diabetes affects 347 million people worldwide; more than 80% of the affected live in low- or middle-income countries. Patients' beliefs about their medical conditions are important in helping physician focus on beliefs that needed to be changed or reinforced. The overall aim of this study was to improve the standard of care of patients with diabetes. Methods: The study designed was a cross-sectional survey; adults with diabetes attending diabetic clinic of LASUTH took part in the survey. Participants were asked to fill a structured questionnaire which was used to assess clinical patterns, beliefs, and practice about diabetes. Results: One hundred and fifty patients with diabetes took part in the study. This study showed that more females presented with diabetes compared with males, type 2 diabetes is commonerthan type 1 and there is a highassociation of the disease with hypertension or being overweight. More than half of the participants do not know the cause of diabetes, 13% believed that disease is curable, and 30% admitted to use alternative medications in addition to the anti-diabetic medications prescribed by the physicians. Conclusion: Knowing patients' beliefs and knowledge about diabetes is important to impart overall care for them. Health education about a disease should be planned to address beliefs and knowledge of patients about their medical condition to address misinformation and misconceptions about their disease conditions.
The prevalence of cervical ribs in Enugu, Nigeria p. 513
SN Ezeofor, NR Njeze, MN Aghaji, AC Onuh, EN Obikili
Background: Cervical rib is an important cause of nontraumatic thoracic outlet neurovascular compression. This study was undertaken as there is no known documented report on its prevalence in the study environment. Aims: To evaluate the prevalence of cervical ribs and its variation with sex and age among patients presenting at radiological facilities for a chest radiograph. Settings and Design: Retrospective evaluation of plain posterior-anterior view chest radiographs done in radiological facilities in Enugu, Southeast, Nigeria. Subjects and Methods: Evaluated in this study were all 6571 chest radiographs consecutively obtained between 2009 and 2012 in three randomly selected radiological facilities in Enugu. Statistical Analysis Used: SPSS version 17 software was used in data analysis. Chi-square and student t-tests were used to test for the significance of findings at 95% confidence level. Results: This study reports the overall prevalence of cervical ribs as 48 (0.7%) with a significantly higher rate in females 43 (1.1%) when compared to males 5 (0.2%) (P = 0.000). In 27 (0.4%) cases, the cervical ribs were bilateral; whereas in 21 (0.3%) cases, they were unilateral with 8 (0.1%) on the left and 13 (0.2%) on the right. There was no age-related variability with prevalence (P = −0.813). Conclusions: The prevalence of cervical rib in the study population is low and within the known range as seen in other geographical regions of Nigeria.
The histological study of osseous regeneration following implantation of various bone graft biomaterials p. 517
H Alan, EMZ Farahani, S Tunik, G Kavak
Background: While various biomaterials are used for bone regeneration, the relative comparative efficiency of them has not been thoroughly investigated. Purpose: This study evaluated histopathological events during osseous healing after implantation of following bone grafts: Demineralized freeze-dried cortical bone powder (DFDB), natural coral implants, calcium sulfate-based putty containing demineralized bone matrix (CaS-DBM), and pure-phase beta tricalcium phosphate ceramic granules (β-TCP). Materials and Methods: Fifty-six Wistar Albino rats were used for this study. The postimplantation osseous healing was evaluated at 3rd, 6th weeks after the operation. Results: DFDB did not induce bone formation in 3 weeks period, but it showed a highly osteoinductive effect at the end of 6th week period. The effects of coral implants on bone formation both at 3 and 6 weeks period were much higher than the DFDB. CaS-DBM showed higher bone formation than β-TCP at 3rd, 6th weeks. It was found that coral and CaS-DBM had a more beneficial impact on early bone healing compared to β-TCP and DFDB. All these graft biomaterials are useable in human bone defects. The main difference in the ossous healing properties of these materials is observed early postimplantation with the delayed healing outcome being similar.
The use of special stains in liver biopsy interpretation: Implications for the management of liver disease in Nigeria p. 523
N Orah, O Rotimi, FB Abdulkareem
Context: The evaluation of a liver biopsy requires the use of stains other than routine hematoxylin and eosin (H and E) to highlight many important features. Aims: Most Nigerian Histopathology Departments do not routinely perform special stains (personal communication by authors). This study aims to re-evaluate a set of liver biopsies which has been diagnosed solely on H and E stains by performing a standard set of special stains on them. Settings and Design: This is a retrospective analysis. Materials and Methods: The formalin fixed paraffin embedded blocks of liver biopsies reported in two histopathology laboratories between 2008 and 2013 were retrieved. These were stained with H and E and the following standard special stains for liver tissue histology – Perl's Prussian blue, reticulin, Sirius red, Shikata orcein, and periodic acid-Schiff with diastase. The stained slides were re-analyzed. Statistical Analysis Used: No formal statistical analysis was performed, but results are summarized and tabulated by summary statistics, where appropriate. Results: Seventy-four liver biopsy paraffin blocks were received in the laboratories. Fifty-three (71.6%) were suitable for analysis out of which 51 (68.9%) had their clinical details retrievable. In 29 cases (56.9%), Perl's stain was positive for iron pigment within the hepatocytes with 17 (58.6%) of these being Grade 1, 7 (24.1%) Grade 2, and 5 (17.2%) Grade 3. Shikata orcein revealed hepatitis B viral surface antigen in 15 (29.4%) of the cases while copper-associated protein was demonstrable in 6 (11.8%) of the cases. The discovery of stainable iron implies some degree of disturbance of iron metabolism, and a Grade 3 stainable iron requires investigation for genetic hemochromatosis. The demonstration of copper-associated proteins suggests biliary disease in a noncirrhotic liver which also requires further investigation. Conclusion: This study confirms the need to routinely perform special stains in reporting liver biopsies to fully investigate and manage patients and their relatives.
Various scoring systems for predicting mortality in Intensive Care Unit p. 530
T Evran, S Serin, E Gürses, H Sungurtekin
Context: Various scoring systems have been developed to predict mortality and morbidity in Intensive Care Unit (ICU), but different data has been reported so far. Aims: This retrospective clinical study aims to evaluate predictability of Acute Physiology and Chronic Health Evaluation II (APACHE II), APACHE IV, Simplified Acute Physiology Score III (SAPS III) scoring systems regarding with mortality. Settings and Design: Sixteen bed surgical-medical ICU in university hospital. Materials and Methods: The study comprised 487 patients older than 18 years treated in ICU for at least 24 h. Age, gender, body weight, initial diagnosis, clinic of referral, intubation, comorbidities, APACHE II, APACHE IV, Glasgow coma scale, SAPS III scores, length of hospitalization before referral to ICU, length of stay in ICU, mechanical ventilation were recorded. Results: Most of the patients (54.6%) were consulted from operating room. The most frequent diagnosis was acute respiratory failure. Total mortality rate was 26%. Mortality rate was higher in patients admitted from wards other than surgery (48%) (P < 0.005). In the presence of comorbidities, mortality rate was higher with comorbidities than without (P < 0.05). Regression analysis indicated a significant positive relationship between length of stay in ICU, length of mechanical ventilation and high mortality risk in patients referred from emergency service (P < 0.05). Accuracy rates of predicting mortality were 81%, 79%, and 81% for APACHE II, APACHE IV, and SAPS III, respectively. Conclusions: The investigated scoring systems are similar in sensitivity and specificity mortality prediction whereas the accuracy was higher for SAPS III and APACHE II than APACHE III in our patient population.
Evaluation of gingival crevicular fluid transforming growth factor-β1 level after treatment of intrabony periodontal defects with enamel matrix derivatives and autogenous bone graft: A randomized controlled clinical trial p. 535
ÖB Agrali, BE Kuru, A Yarat, L Kuru
Aim: The present study aimed to evaluate the effects of enamel matrix derivatives (EMD) either alone or combined with autogenous bone graft (ABG) applied to intrabony defects in chronic periodontitis patients on clinical/radiographic parameters and gingival crevicular fluid (GCF) transforming growth factor-β1 (TGF-β1) level and to compare with open flap debridement (OFD). Materials and Methods: A total of 30 deep intrabony defects in 12 patients were randomly treated with EMD + ABG (combination group), EMD alone (EMD group), or OFD (control group). Clinical parameters, including plaque index, gingival index, bleeding on probing, probing depth, relative attachment level, and recession were recorded at baseline and 6 months postsurgery. Intrabony defect fill percentage was calculated on the standardized radiographs. TGF-β1 level was evaluated in GCF just before surgery and 7, 14, 30, 90, 180 days after surgery using enzyme-linked immunosorbent assay. Results: All treatment procedures led to significant improvements at 6 months (P < 0.01). Gain in attachment level (P < 0.01) and radiographic defect fill (P < 0.05) of the combination and EMD groups were found to be significantly higher than those of the control group, while the use of EMD either with ABG or alone was observed to produce significantly less recession than the OFD (P < 0.05). Conclusion: The findings suggest no clinical and radiographic differences between the combination and EMD groups whereas GCF TGF-β1 level demonstrates an increase during the healing phase and is positively affected from EMD.
Bilateral concomitant intravitreal anti-vascular endothelial growth factor injection: Experience in a Nigerian tertiary private eye care facility p. 544
O Okoye, O Okonkwo, O Oderinlo, K Hassan, A Ijasan
Objectives: To evaluate the indication and safety profile of same-session bilateral intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF). Methods: This is a retrospective case series of all the patients that received same-session bilateral intravitreal anti-VEGF in Eye Foundation Hospital, Ikeja, Lagos, from March 2013 to March 2015. Data retrieved from the patients' medical records includes demographics, indications for injections, complications, and systemic comorbidities. Results: During the study period, a total of 442 injections were performed on 126 eyes of 63 patients (M:F ratio; 1.4:1) whose mean age was 55.7 ± 15.6 standard deviation years. The modal age group was 51–70 years. All the patients received injection Bevacizumab (Avastin; Genentech Inc., South San Francisco, California, USA-1.25 mg). The most common primary indication for initiating bilateral intravitreal therapy was diabetic macular edema 23 (36.5%). Mean follow-up period was 40.6 days (range: 1–364 days). A combined diabetes mellitus and hypertension accounted for most of the systemic comorbidities 28 (44.4%). Subconjunctival hemorrhage was the only complication seen in these patients with 6 (9.5%) occurring intraoperatively and 9 (14.3%) postoperatively. There was no association between intraoperative complication and age (P = 0.66) or gender (P = 0.96). Furthermore, there exist no association between postoperative complication and age (P = 0.49) or gender (P = 0.99). Conclusions: No major systemic or ocular adverse events were noted. Given that there are potentially serious complications following anti-VEGF injection, further study with a larger number of patients will be necessary to definitively prove the safety of this treatment modality.
Riedel's thyroiditis in a black African: A case report and review of literature p. 549
OA Arowolo, FS Ige, O Odujoko, EA Agbakwuru
Riedel's thyroiditis is a rare cause of the enlargement of the thyroid gland. The etiology is not fully known. There has been no report of Riedel thyroiditis in our country. We report a case of a 61-year-old man with the disease as well as review the literature. We present the case of 61-year-old carpenter seen in our clinic with 2½ years history of painless anterior neck swelling associated with hoarseness of voice. He had multiple hard nodules on the left lobe of the thyroid gland with multiple cervical lymph nodes enlargement. No feature of hypothyroidism or thyroiditis. Clinical diagnosis of malignant goiter was made although Fine-needle aspiration for cytology did not suggest malignancy. He had surgery, findings included nonresectable hard multinodular left thyroid lobe from which a wedge biopsy was taken, Histology of the specimen revealed Riedel's thyroiditis. He was managed with oral Prednisolone and Tamoxifen with remarkable improvement in his clinical symptoms. Riedel's thyroiditis is a rare disease. It can easily mimic malignant goiter hence proper histological diagnosis will be necessary to differentiate. Review of medical literature showed that Riedel thyroiditis has not been reported in a black African patient inhabiting the sub-Sahara Africa. This was a report of Riedel thyroiditis in a black Nigerian patient that was successfully managed on oral glucocorticoid, tamoxifen and L-thyroxine.
Simultaneous oroantral communication closure, sinus-lifting, and particulate bone grafting and immediate dental implant perforation p. 556
MI Kara, S Yanik, F Sari, C Buyukkurt
The aim of this paper is to introduce an alternative technique for the treatment of oroantral communication (OAC). Closure of OAC, reconstruction of the posterior maxilla by sinus-lifting procedure with a particulate xenograft, and implant insertion were performed in the same operation. A lateral antral approach was used in the sinus elevations. The sinus membranes were elevated gently around the perforation area, and then a barrier membrane was used to close the perforation. Care was taken not to extend the perforation. Next, the maxillary sinus was filled with a particulate xenograft, and an implant was inserted simultaneously. Forty-seven and 40 months of clinical and radiographic follows-up revealed healthy and functional implants in the teeth area.
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Tension pneumoventricle: A report of two cases p. 559
CC Ani, BO Ismaila
Pneumocephalus is often a complication of head trauma and cranial surgeries. Massive intraventricular pneumocephalus is an uncommon entity. We report the cases of two patients presenting same day with a clinical diagnosis of open head injury following separate road traffic accidents whose computed tomography (CT) brain images confirm skull base and vault fractures with massive pneumocephalus and tension pneumoventricles. CT scan remains invaluable in proper evaluation of head injury, and its complications for early and appropriate intervention toward reducing morbidity and mortality.
Concomitant gentamicin-induced nephrotoxicity and bilateral ototoxicity p. 563
AA Akinbodewa, O Okunola
Co-occurrence of aminoglycoside-induced ototoxicity and nephrotoxicity is rare, possibly as a result of divergent mechanisms of tissue damage despite similarities in the anatomy of the inner ear and the proximal renal tubular epithelium. We present the case of a 63-year-old hypertensive woman who developed nonoliguric acute exacerbation of chronic renal failure and sudden onset of sensorineural deafness after receiving daily injections of gentamicin. Coexisting ototoxicity and nephrotoxicity from aminoglycosides can occur, though rare. Adverse effects of aminoglycosides are better prevented by a careful exercise of discretion by prescribers.
Endoprosthetic replacement of distal femoral tumors in Nigeria: A case series p. 567
OK Idowu, SU Eyesan, HD Badmus, SO Giwa, KB Badmos, FB Abdulkareem
In this observational study, three consecutive patients who were treated for distal femur tumours using endoprosthetic replacement between June 2013 and June 2014 were studied. The patients were within the ages of 28-47 years at the time of surgery. All three patients had modular endoprosthesis fixation and were evaluated using the Musculoskeletal Tumour Society (MSTS) Scoring System. Numerical values from 0 to 5 points were assigned for each of the following 6 categories: pain, function, emotional acceptance, use of supports, walking ability and gait. These values were added and the functional score was presented as a percentage of the maximum possible score. The results for each patient were graded according to the following scale: Excellent – 75-100%; good – 70-74%; moderate – 60-69%; fair – 50-59% and poor - <50%. Of the 3 patients evaluated, 2 had a diagnosis of Giant Cell Tumour (GCT) of the distal femur; the third patient was diagnosed to have plasmacytoma. All underwent wide local resection with modular endoprosthetic distal femur reconstruction. The MSTS functional scores calculated were 70%, 78%, and 52% respectively. Complications noted included wound dehiscence in two patients and thrombosis of the Pulmonary artery needing an arterial embolectomy in one of these two patients. The same patient also had a post-operative loss of motor and sensory function below the level of the ankle
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