Πέμπτη, 11 Απριλίου 2019

Clinical Practice

Do genetic polymorphisms affect susceptibility to periodontal disease? A literature review
VE Toy, MO Uslu

Nigerian Journal of Clinical Practice 2019 22(4):445-453

The pathogenesis of periodontal disease is not solely based on microbial dental plaque but is the result of the multifactorial and complex interaction between infection and host response. Many studies in the literature have demonstrated the differences between individuals in terms of host immune response and the presence of genetic components in numerous pathological conditions. Therefore, periodontitis may be defined as a complex genetic disorder with a phenotype formed by the genetic structure and environmental factors in the affected individual. So, determination of the genetic susceptibility profile associated with periodontitis might be very precious for developing novel diagnostic techniques and individual treatment strategies. To clarify the possible role of genetic polymorphisms in periodontal diseases, we searched PubMed for studies published on the subject since 1997 up to June 2018 and obtained data from original studies, meta analyzes, and systematic reviews. We included only case–control studies with large study populations. 


Correlation between intravesical prostatic protrusion and international prostate symptom score among Nigerian men with benign prostatic hyperplasia
BU Eze, TU Mbaeri, KC Oranusi, JA Abiahu, AM Nwofor, JC Orakwe, OO Mbonu

Nigerian Journal of Clinical Practice 2019 22(4):454-459

Background: Intravesical prostatic protrusion (IPP) is a noninvasive test that can predict bladder outlet obstruction in patients with benign prostatic hyperplasia (BPH). Objective: The objective of this study was to determinethe correlation between IPP and International Prostate Symptom Score (IPSS) in patients with BPH. Patients and Methods: A cross-sectional prospective study of new patients with symptomatic BPH who presented to the urology clinics of NAUTH, Nnewi. Ethical approval and informed consent were obtained. Participants had abdominal ultrasonography measurements of IPP from midline sagittal image of the prostate (at bladder volume ≥100 mL) using Prosound SSD3500 with abdominal probe frequency of 3.5 MHz. IPP was divided into three grades (grade I: 0–4.9mm, grade II: 5.0–9.9 mm, and grade III: ≥10.0 mm). Data were analyzed using SPSS version 20. The data were subjected to analysis of variance, and Pearson's correlation was used to assess correlation where necessary. P value < 0.05 was considered significant. Results: In all, 101 men with a mean age of 67.09 ± 10.93 years were included in the study. The average IPSS, storage symptoms IPSS (IPSS-S), voiding symptoms IPSS (IPSS-V), Quality of Life (QoL) index, and IPP were 17.05 ± 7.62, 7.81 ± 5.17, 9.24 ± 3.16, 4.75 ± 1.59, and 13.50 ± 7.47 mm, respectively. There were significant differences between the mean IPSS (P = 0.000), mean IPSS-S (P = 0.000), and mean IPSS-V (P = 0.002) among the three grades of IPP. There were significant positive correlations between IPP and IPSS (P = 0.000), IPSS-S (P = 0.000), IPSS-V (P = 0.000), and IPSS QoL index (P = 0.000). Conclusion: There were significant positive correlations between IPP and IPSS, IPSS-S, IPSS-V, and IPSS QoL index. 


Relationship between self-efficacy and pain control in Iranian women with advanced knee osteoarthritis
N Mirmaroofi, A Ghahramanian, M Behshid, F Jabbarzadeh, TC Onyeka, M Asghari-Jafarabadi, J Ganjpour-Sales

Nigerian Journal of Clinical Practice 2019 22(4):460-468

Objectives: This study aimed to determine the relationship between pain of osteoarthritis (OA) and body mass index (BMI), age, pain control strategy, self-efficacy for pain control, exercise, and functional activities in a cohort of Iranian women. Subjects and Methods: In total, 150 women with advanced knee OA, candidates for arthroplasty in Tabriz, in the Northwest of Iran were enrolled into the study. A convenience sampling method was used, and data was collected using demographic form, short-form McGill pain questionnaire, pain self-efficacy questionnaire, self-efficacy for exercise, and functional activities scales. Results: The present pain intensity of 74.7% of women was described as excruciating with mean (±SD) score 9.58 (±0.77) in the visual analogue scale. The majority of the women had a low self-efficacy for pain, exercise, and functional activities with means of 31.8, 17.28, and 57.63 respectively. There was a significant inverse relationship between sensory and affective components of pain and self-efficacy for pain control and functional activities (P < 0.001). The sensory and affective components of pain was related to age (P < 0.05), pain control self-efficacy (P < 0.01), and BMI (P < 0.05). A great majority of the women (79.33%) used complementary medicine (CM) for pain management. Those who used CM reported lower pain and higher self-efficacy (P < 0.01). Conclusion: The findings of this study suggest that life style modification and pain management education of women with OA and nurses on non-pharmacological interventions as well as integration of these into nursing care is essential. 


Investigation of the reliability of light-curing units in Sivas City, Turkey
D Eren, F Tutkan

Nigerian Journal of Clinical Practice 2019 22(4):469-477

Background: The number of studies investigating the physical properties of light-curing units used in city centers in terms of the light intensity, presence of residues fractures at the tips, how long they have been used, and hardness measurements of the composite resins polymerized by these is limited. There is no such study in Turkey and Sivas province. The objective of this study is to examine the light-curing units used in Sivas city center and determine the reliability of light-curing units by measuring the surface hardness of composite samples polymerized with these devices. Materials and Methods: The power of the light-curing units that used in all private clinics in Sivas city center was measured. Then, the Vickers surface hardness measurements of the composite resin samples polymerized with these devices were made, and they were statistically evaluated. Results: The light intensity was found to be below from the acceptable value of 400 mW/cm2 in 10.7% of the devices. It was observed that with increasing years of usage, the light intensity of light-curing units decreased (P < 0.05). Conclusion: It was observed that as the power of light-curing units increased, the hardness values of the bottom and top surfaces increased significantly. 


Postoperative analgesia after total abdominal hysterectomy: Is the transversus abdominis plane block effective?
ZC Suner, D Kalayci, O Sen, M Kaya, S Unver, G Oguz

Nigerian Journal of Clinical Practice 2019 22(4):478-484

Background: Analgesic protocol is needed following gynecologic surgery to ensure early mobilization, decrease the duration in the post-anesthetic care unit and hospitalization, and provide patient comfort. Transversus abdominis plane (TAP) blocks are used in the treatment of acute postoperative pain after lower abdominal surgery. TAP block may be a better choice of postoperative pain control. In the present study, the efficacy of ultrasound-guided TAP block on pain control and postoperative opioid consumption was evaluated in patients undergoing a total abdominal hysterectomy. Methods: Fifty patients undergoing total abdominal hysterectomy were included in this study. Patients were divided into TAP block (n = 25) and control groups (n = 25). Both groups postoperative patient-controlled analgesia (PCA) was planned during 24 h postoperatively. Patients were assessed 1, 2, 4, 6, 12, 18, and 24 h postoperatively using the Visual Analog Scale (VAS), Ramsey Sedation Score, PCA demand, morphine consumption, first analgesic requirement time, and adverse reactions. Results: When compared with the control group, the time to first analgesic requirement in the TAP block group was significantly lower (P < 0.05). The amount of additional analgesia also differed significantly (P < 0.001). In the TAP group, the VAS was significantly lower at 2, 4, 6, 12, 18, and 24 h postoperatively compared to the control group (P < 0.05). There was no statistically significant difference in adverse reactions. Conclusion: TAP block can effectively treat postoperative pain as part of multimodal analgesia in patients undergoing total abdominal hysterectomy. 


Locked intramedullary nailing using the sign nailing device
IC Nwagbara

Nigerian Journal of Clinical Practice 2019 22(4):485-491

Objective: Locked intramedullary nailing is the treatment of choice not only in diaphyseal fractures of long bone but also in most metaphyseal and periarticular fractures. In this study, we set out to present our experience with the Surgical Implant Generation Network (SIGN)] technique of locked intramedullary nailing in long bones that do not require the use of image intensifier, fracture table, and power reamers. Patients and Methods: This was a hospital-based prospective descriptive study involving 54 consecutive patients seen over a 2-year period. All closed fractures of the femur and tibia/fibula seen within the period under review were included in the study. The patients were followed up for a minimum of 12 months. Fracture union was recorded when there was absence of pain at fracture site and X-ray shows presence of bridging callus in two orthogonal views. Results: Fifty seven fractures in 54 patients were managed in the period of the study. There were 46 [81%] femoral and 11 [19%] tibia/fibula fractures recorded in 47 [87%] males and 7 [13%] females with a male to female ratio of 6.7:1. Majority of the patients were within the 31--40 years age bracket (n = 25, 46%). All the fractures were as a result of motor vehicle accident. Thirty six (78%) of the femoral fractures were operated through the antegrade approach, whereas the rest (22%) were through the retrograde approach. Both proximal and distal locking were achieved in all cases. Fracture union was recorded in all but one case [98%]. Complications were observed in 8 cases, which included 5 cases of superficial infection, one case each of osteomyelitis, delayed union and nonunion. Conclusion: Locked intramedullary nailing using external jigs for screw placement as in the SIGN technique gives a good result and is recommended for use in the developing countries where image intensifiers are not readily available. 


Tibial fractures following participation in recreational football: Incidence and outcome
C Nwosu

Nigerian Journal of Clinical Practice 2019 22(4):492-495

Background: Football is responsible for 3.5%–10% of all injuries treated in hospital, but this may reflect the popularity of the sport rather than its dangers. Young people are particularly at risk of sports injury because of high levels of exposure at a time of major physiological change. Soccer players are susceptible to a variety of injuries due to contact, aggressive tackle, and high-speed collisions. Aims: The aim of this study was to determine the pattern of presentation, treatment, and outcome of tibial fractures following participation in recreational football activity; with the hope that knowledge gained from this study will help in preventing or reducing its occurrence. Patients and Methods: This is a retrospective study of all cases of tibial fractures following participation in recreational football presenting to the Orthopedic Unit of Federal Medical Center and Surgery Department of Sir Yahaya Memorial Hospital all in Birnin Kebbi, Kebbi State, north western Nigeria; from January 2012 to December 2017. Data were extracted from the accident and emergency register, operation register, and patients' case folders on biodata, diagnosis, mechanism of injury, associated injuries, type of surgical procedure, site of surgery, date of surgery, and postoperative complications. Data collected were analyzed using the Statistical Package for Social Sciences for Windows version 22. Results were presented with descriptive statistics. Results: In total, 37 patients were included in the study. All of them were males. The age range is from 14 to 33 years with mean age of 23.6. 17 (45.9%) of the patients are in the 21- to 30-year age group. The right tibia was affected in 34 (91.9%) patients. None of the patients used shin guard. The mechanism of injury in all the cases was direct contact. About 31 (83.8%) of the fractures were closed. Seven (18.9%) of these patients were discharged against medical advice. Nineteen (51.3%) patients were managed nonoperatively with plaster of Paris casts. Ten (27.1%) of these patients had internal fixation with locked intramedullary nail. Conclusion: Tibial fractures following football occur mostly in males especially adolescents and youths. The right tibia was commonly affected and most of the injuries are closed. The most common mechanism of injury was direct contact. 


The effect of microwave glazing on the surface properties of various porcelain materials
FA Sanal, M Kurt

Nigerian Journal of Clinical Practice 2019 22(4):496-502

Aim: The aim of this research was to investigate the effect of microwave glazing, conventional oven glazing, and polishing on surface roughness and wettability of porcelains. Materials and Methods: The initial surface roughness values (Ra0) of the prepared specimens for four different porcelains (Vita VM 9, VitaVM 13, Vita VMK 95, IPS e.maxCeram) were determined by profilometry. Then, the specimens were divided randomly into three groups as polishing, conventional oven glazing, and microwave glazing. Final surface roughness values were evaluated by profilometry (Ra1) and scanning electron microscopy. Wettability of glazed specimens were evaluated by contact angle goniometer. Results: Although microwave-glazed specimens had lower Ra1 values compared with the conventional oven-glazed ones for IPS e.maxCeram (P < 0.05), there were not any statistically significant differences between these two procedures in terms of Ra1 values for the other porcelains (P > 0.05). Microwave-glazed specimens had lower wettability values than conventional oven-glazed ones for Vita VM 9. Conclusions: Microwave glazing procedure may be considered as an alternative method because of the advantages of providing volumetric heating, time, and energy saving. 


The effect of pregabalin and ibuprofen combination for pain after third molar surgery
A Degirmenci, E Yalcin

Nigerian Journal of Clinical Practice 2019 22(4):503-510

Aim: The objective of this study was to compare the efficacy of different doses of pregabalin and intravenous ibuprofen with regard to pain management and analgesic consumption after third molar surgery. Materials and Methods: Ninety patients who had been scheduled for third molar surgery were assigned to four different treatment groups. The inclusion criteria consisted of the presence of fully or partially bony retentive asymptomatic mandibular third molars. These groups are included the following: (Group 1) premedicated with oral placebo and intravenous (IV) placebo, (Group 2) premedicated with oral placebo and 400-mg IV Ibuprofen, (Group 3) premedicated with 75-mg oral pregabalin and 400-mg IV ibuprofen, and (Group 4) premedicated with 150-mg oral pregabalin and 400 mg IV ibuprofen. Postoperative pain was assessed with visual analog scale (VAS) every hour for the first 12 hs following the surgery. Pain was then assessed at different time intervals during 7 days following the surgery. Kruskal–Wallis tests were used to compare the four groups in terms of VAS pain scores, analgesic consumption, and first rescue analgesic request time after the surgery. Results: At the end of the study, the results of 80 patients (20 patients per group) were analyzed. The group 4 had lower pain intensity compared with other groups at various time intervals. This difference is statistically significant in between the first 3–10 h (first day) and single-time intervals in second, third, fifth, and sixth postoperative days. Postoperative analgesic consumption was not statistically different between the groups. The first rescue analgesic request time after surgery was different between the pregabalin combination groups and group 2. No significant difference in the side effects was observed. Conclusion: These findings suggest that preoperative coadministration of 150-mg pregabalin and IV ibuprofen may be useful in improving pain control after third molar surgery. 


Prognostic value of neutrophil-to-lymphocyte ratio in castration resistant prostate cancer: Single-centre study of Nigerian men
JO Bello, OO Olanipekun, AL Babata

Nigerian Journal of Clinical Practice 2019 22(4):511-515

Background: Elevated neutrophil-to-lymphocyte ratio (NLR) has been suggested to be a useful prognosticator of overall survival (OS) in several cancers including castration resistant prostate cancer. However, its utility in black populations known to have benign ethnic neutropenia is unknown. We evaluated the prognostic value of NLR in Nigerian men with CRPC in terms of OS. Materials and Methods: We retrospectively analysed 58 patients with castration resistant prostate cancer who received androgen deprivation therapy (ADT) and docetaxel chemotherapy at our institution. Baseline NLR was calculated from available complete blood counts. NLR cut-off point value was determined based on receiver operator characteristic (ROC) curves for mortality. A multivariate analysis was performed to investigate the association between NLR and OS. Results: Based on the ROC curves, the NLR (AUC 0.85, 95% CI 0.74-0.97, P = 0.0001) cut-off point was determined to be 1.8. This cut-off point has a sensitivity of 92% and specificity of 70%. Median OS was 20 months (95% CI 14-27 months); the median OS in patients with NLR <1.8 and those with NLR of ≥1.8 was 40 months and 12 months respectively. Kaplan-Meier plots showed that a higher NLR of ≥1.8 correlated significantly with an increased risk of mortality, Log rank P = 0.001. Multivariate Cox regression analyses confirmed NLR as an independent prognostic biomarker for OS (HR = 1.49, 95% CI: 1.18-1.87). Conclusions: This study demonstrated that NLR is a useful prognostic biomarker in Nigerian men with CRPC and that elevated baseline NLR ≥1.8 is associated with poorer OS. 


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