Nigerian Journal of Clinical Practice最新文献

Background: The need of a neurostimulator for a successful nerve block was questioned in different block types after ultrasound had become standard.

Aim: To determine the effect of neurostimulator use on block success in the costoclavicular block (CCB).

Methods: Sixty patients undergoing upper limb surgery were enrolled in the study. Patients using ultrasound and injection pressure manometer were divided as Group USP, and those using ultrasound, injection pressure manometer, and neurostimulator were divided as Group USPN. After block was applied, sensory and motor block levels were measured on a numeric scale. The block was considered successful when the desired score was reached or general anesthesia was not required intraoperatively. The number of successful and unsuccessful blocks for each group was summed up. The successful block rate was compared as the primary objective. Block application time, time to readiness for surgery, the number of needle passes, diaphragm paralysis rate, and complication rate were compared as secondary goals.

Results: Block success rate was 90% (27/30) in Group USP and 96.7% (29/30) in Group USPN. There was no statistical difference in terms of block success rate. Block application time was significantly shorter in Group USP (207.2 ± 32.7 s) when compared to Group USPN (280.9 ± 70.1 s). Other secondary outcomes were similar.

Conclusion: Neurostimulator use did not affect block success in the CCB. Neurostimulator utilization prolonged block application time explicitly and did not change the complication rate. Ultrasound and injection pressure manometer are sufficient for a safe and successful CCB.

Background: Tracheostomy is an important life-saving surgical procedure that could be used to secure the lower airway. It can however serve as a source of airway compromise when fragments from it are deposited. This condition must be diagnosed early enough, and appropriate intervention should be done to forestall potential morbidity and mortality.

Case report: A 56-year-old tracheostomized patient presented to the accident and emergency department with a 4-hour history of sudden onset choking cough and labored breathing. The shaft of his tracheostomy tube (TT) was fractured and subsequently aspirated while he was attempting to remove and clean the inner tube that morning. He has used the TT for about 6 years and lost to follow-up clinic visits. The chest radiograph showed the metallic foreign body lodged within the trachea. He had an emergency rigid bronchoscopy via the tracheostomy stoma, and the object was retrieved. All respiratory symptoms subsequently resolved, and a check radiograph showed normal findings.

Conclusion: Tracheostomy tube fracture and aspiration should be ruled out in every tracheostomized patient with sudden onset acute respiratory symptoms. Otolaryngologists must always emphasize the need for proper handling of TT, regular follow-up, and tube replacement when due.

Background: Tuberculosis of the spine, a common manifestation of extra-pulmonary tuberculosis is characterized by vertebral destruction, paradiscal involvement, abscess collection and varying degrees of neurologic affectation. The primary disease caused by mycobacterium tuberculosis complex infects the lungs, lymph nodes of the mediastinum and gastrointestinal tract/ viscera with spinal involvement being secondary and caused by haematogenous spread. Tuberculous paraplegia arises as a complication of spinal involvement.

Aim: To determine the outcome of operative intervention in tuberculous paraplegia. Methodology: This was a retrospective study involving 10 patients with tuberculous spinal involvement with varying degrees of neurological deficit as defined by both Tuli and ASIA grading. The VAS score, ESR, ASIA grade (both pre-op and post op), Tuli's grade (pre-op and post op) were used to analyze the therapeutic effects of the surgery.

Results: The mean pre-operative VAS score was 5.9 ±1.8, which significantly decreased to 2.2 ±1.3 six weeks post operatively. The mean pre-operative ESR and CRP was 78.9 ± 11.3mm/hr and 83 ± 13.5 respectively; which both showed a statistically significant decrease post-operatively, p<0.05. All cases achieved an increase of more than one ASIA grade post-operatively.

Conclusion: Early surgical intervention is beneficial in patients with tuberculous spinal disease with neurologic involvement.

Objective: The present study aims to investigate the potential impact of celiac disease (CD) on hearing functions and assess the effect of a gluten-free diet (GFD) on this condition.

Materials and methods: The study included 55 children with CD (110 ears) and 25 healthy controls (50 ears) matched for age and gender. The CD group was divided into adherent (n = 31) and nonadherent (n = 24) to GFD. Participants underwent tympanometry and pure tone audiometry assessments covering frequencies from 500 to 4000 Hz.

Results: Patients with CD showed significantly higher air and bone conduction hearing averages compared to the control group at frequencies of 500, 1000, 2000, and 4000 Hz for air conduction, and at 500 Hz for bone conduction (P < 0.05). Celiac patients, those who fully adhered to GFD, had notably higher air conduction hearing averages at 500, 2000, and 4000 Hz compared to healthy controls (P < 0.05). However, there was no difference in bone conduction hearing averages between the two groups. In contrast, celiac patients who did not comply with GFD had statistically significantly higher air and bone conduction hearing averages than the control group (P < 0.05), at frequencies of 500, 1000, and 4000 Hz for air conduction, and at 500 and 1000 Hz for bone conduction (P < 0.05).

Conclusions: The study suggests that nonadherence to GFD may elevate the risk of hearing loss in children with CD. As a result, it is recommended to conduct hearing screenings for children with CD and underscore the importance of complying with GFD to mitigate further detrimental effects on hearing functions.

Background: Organ-confined prostate cancer is curable through surgical treatment by radical prostatectomy.

Aim: To report initial outcomes of open radical prostatectomy in Nigeria from 2014 to 2019.

Methods: Open radical prostatectomy in private hospital settings. Thirty-five patients underwent open radical prostatectomy in private hospital settings from 2014 to 2019. A retrospective study of the case notes was undertaken.

Results: The age range was 56-77 years (mean: 67.7 ± 5.6 years); presenting total PSA 7.3-32.0 ng/ml (mean: 16.2 ± 6.4); Gleason score range 6-10 and clinical stage T2c. Mean operation duration 192.4 ± 52.0 min. All patients received blood transfusion (average blood transfusion 4.58 ± 1.9 pints). The median length of hospital stay was 7 days and the catheterization duration was 16.6 days. The Gleason score ranges from 6 to 10. Biopsy and specimen histology Gleason scores correlated in all cases. Biochemical relapse within 1 year occurred in 12 (34.3%) patients. Adequate PSA control was achieved in 23 (65.7%) patients. Two cancer-related deaths occurred within 2 years of surgery. All patients voided well following removal of the catheter; persisting mild stress urinary incontinence resolved on conservative measures within 3-6 months. Anastomotic stricture occurred in one patient 1 (2.9%) in this present. Information on preoperative potency rate was unavailable; however, postoperation, 11 (31.4%) patients achieved erections sufficient for intercourse with oral therapy. All surviving 33 (94.3%) patients reported satisfactory performance status.

Conclusions: Open radical prostatectomy was successfully performed in all the patients. Reasonable, comparative functional, and oncological outcomes were achieved during the study period.

Background: The occipital spur (OS) can be described as an abnormal elongation of the external occipital protuberance (EOP). The cephalic index (CI) refers to the ratio of width to length in any skull.

Aim: The aim of the present study was to evaluate the frequency and types of OS. It also aimed to determine the mean CI and the distribution of skull types using cone beam computed tomography (CBCT). And to determine if there was a relationship between the cephalic index and the presence and types of OS.

Methods: CBCT scans from 523 patients were included in the study. OSs were classified as type 1 (flat), type 2 (crest), and type 3 (spine). Skull length and width were measured on axial sections and the CI was calculated. Based on the cephalic index (CI), skull types were classified as dolichocephalic (CI < 75), mesocephalic (75 < CI < 80), brachycephalic (80 < CI < 85), and hyperbrachycephalic (CI > 85).

Results: The most common cranial types in the study group were brachycephalic (44.7%), mesocephalic (28.3%), hyperbrachycephalic (21.2%), and dolichocephalic (5.7%). Regarding the presence of OS, 54.3% of the participants had no OS, 23.1% had flat type, 15.3% had crest type, and 7.2% had spin type OS. There was a statistically significant difference (P < 0.05) in the frequency of OS according to skull type.

Conclusion: This study, the first to evaluate CI and OS using CBCT, concludes that brachycephaly is the most common cranial type. OS is more common in mesocephalic and dolichocephalic skulls, at older ages, and in males.

Background: Fatigue is a common problem in patients with multiple sclerosis (MS) and is one of the most serious symptoms of the disease. Although many factors play a role in the etiology of fatigue in patients with MS, it has been reported that fatigue is caused by irregular or disrupted sleep patterns.

Aim: The purpose of the study was to examine the effects of lavender oil aromatherapy on the sleep and fatigue of MS patients.

Methods: The study was designed as a randomized controlled trial and was conducted in Turkey. The data of the study were collected using the Patient Description Form, Fatigue Severity Scale, and Pittsburgh Sleep Quality Index.

Results: The mean FSS score in the experimental group was 6.86 ± 0.94 before the procedure and 3.42 ± 0.85 after the procedure, the mean PSQI score was 9.45 ± 1.23 before the procedure and 6.68 ± 2.87 after the procedure, and the difference in the mean scores between the two groups was found to be statistically significant (P < 0.001).

Conclusion: The results showed that aromatherapy with lavender essential oil has significant impacts on fatigue and sleep in MS patients. Lavender essential oil aromatherapy can be used by nurses as an independent nursing practice. It is an inexpensive, noninvasive, and reliable technique to manage fatigue in individuals with MS.

Background: Controlling Nutritional Assessment (CONUT) score has been shown to have a higher predictive value compared to other nutritional scores in acute coronary syndrome.

Aim: To determine the relationship between CONUT score and long-term mortality in patients with chronic coronary syndrome (CCS).

Methods: Between 2017 and 2020, 585 consecutive patients newly diagnosed and proven to have CCS by coronary angiography were included in the study. CONUT score and demographic and laboratory data of all patients were evaluated. The relationship between results and mortality was evaluated.

Results: The mean age of the patients was 64 years and 75% were male. Mortality was observed in 56 (9.6%) patients after a median follow-up period of 3.5 years. The median CONUT score was significantly higher in patients with mortality (P < 0.001). In multivariate regression analysis, the CONUT score was associated with mortality (Hazard ratio (HR): 1.63 (95% confidence interval (CI): 1.34-1.98 P < 0.001)). The area under curve (AUC) for long-term mortality estimation for the CONUT score was 0.75 (95% CI 0.67-0.82 P < 0.001). When the CONUT score value was accepted as 0.5, the sensitivity was 78% and the specificity was 60.

Conclusion: CONUT score was found to be predictive of mortality in long-term follow-up of patients with CCS.

Background and aim: Preeclampsia, a pregnancy complication associated with significant maternal and perinatal mortality and morbidity, has been found to be closely linked to dysfunction in the blood coagulation-fibrinolysis system. However, the relationship between hematologic data and severity and onset time of preeclampsia remains unclear. This study aimed to identify specific hematologic parameters in both preeclamptic and normotensive pregnant women and determine their potential significance in the pathogenesis of preeclampsia.

Materials and methods: A total of 112 patients with gestational hypertension disease were divided into two groups: early-onset preeclampsia (32 cases) and late-onset preeclampsia (80 cases). A control group of 82 normotensive pregnant women matched for age and parity was also selected. Blood samples were collected from all participants to test for specific hematologic parameters.

Results: Mild and severe preeclampsia were associated with lower hemoglobin level (P = 0.01 and P = 0.03, respectively), higher mean platelet volume (P = 0.01 and P = 0.01, respectively) and fibrinogen (P = 0.01 and P = 0.01, respectively), and shorter prothrombin time (P = 0.02 and P = 0.01, respectively) and activated partial thromboplastin time (P = 0.01 and P = 0.02, respectively).

Conclusion: These findings have provided evidence on the hematologic coagulative actors in the pathogenesis and severity of preeclampsia.

Background: Breast cancer is the type of cancer that is seen all over the world and ranks first among female cancers in terms of incidence and cause of death.

Objective: This research was conducted to determine the breast cancer risk level and breast cancer knowledge level in women living in Northern Cyprus.

Methods: The study, which was planned as a relational survey, was carried out as web-based. The research was completed with 657 adult female participants living in Northern Cyprus who volunteered to participate in the study. In order to collect data, the first section includes the introductory features, the second section includes the "Breast Cancer Risk Assessment Form" for determining breast cancer risk levels, the third section includes the "Comprehensive Breast Cancer Knowledge Test" to determine the breast cancer knowledge levels of the participants, and the fourth section includes the "Champion Health Belief Model Scale" was used.

Results: It was determined that 95.2% of women were in the low risk group for breast cancer. The knowledge test mean score is 12.05, and it can be said that the scores obtained are above the average (min:4- max:18). It was found that 55.7% of the women knew how to do Breast Self-Examination (BSE), but only 15.4% of them regularly performed BSE every month. It was found that 80.9% of the women never had mammography and their knowledge scores increased with increasing education level (p< 0.001) and there was a significant relationship between non-smokers and their knowledge levels (p< 0.01).

Implications for practice: Despite the high scores of women in knowledge tests, it was observed that the frequency of applying BSE and having mammography was very low. Regardless of the risk factors for breast cancer, the importance of regular check-ups and BSE for every woman should be taught to women by health professionals, and group trainings should be planned for women who do not have training on this subject.