Nigerian Journal of Clinical Practice最新文献

Background: Video-based learning is used in surgical education due to its flexibility and cost-effectiveness. Endoscopic submucosal dissection (ESD) is a technically challenging procedure, and YouTube is an important source of educational videos on this topic. The laparoscopic video educational guide and scoring (LAP-VEGaS) system can objectively evaluate the educational quality of these videos.

Aim: To evaluate the educational quality of the most-viewed ESD videos on YouTube using the LAP-VEGaS score and to examine the relationship between quality and participation metrics.

Methods: On August 01, 2024, the 20 most popular videos were selected based on view count by searching for "endoscopic submucosal dissection" on YouTube. Two independent evaluators scored the videos using LAP-VEGaS (0-18). Videos scoring 9 or higher were classified as high quality (HQ; n = 12), while those scoring below 9 were classified as low quality (LQ; n = 8).

Results: The average number of views for the videos was 20,567 ± 38,269, the time elapsed since upload was 2751 ± 1264 days, the duration was 537 ± 301 s, and the average LAP-VEGaS score was 9.1 ± 5.2. HQ videos were longer (579 ± 295 s vs. 434 ± 190 s; P ≈ 0.08) and had a higher like rate (0.984 ± 0.02 vs. 0.94 ± 0.07; P < 0.05). Strong positive correlations were observed between likes and view rate (r = 0.979; P < 0.001) and video power index (r = 0.984; P < 0.001). Moderate correlations were found between the LAP-VEGaS score and duration (r = 0.515; P = 0.021) and similarity ratio (r = 0.492; P = 0.035).

Conclusion: The educational quality of popular ESD videos is heterogeneous, and unlike the number of views, interaction metrics, such as the like/view ratio and video duration, more reliably reflect educational value. Therefore, objective evaluation tools such as LAP-VEGaS are recommended to facilitate the selection of HQ content by educators and learners.

Background: Pediatric circumcision is a common procedure, and effective pain control is essential for recovery and comfort. The optimal anesthesia technique remains debated.

Aim: To compare the efficacy and safety of sedation-only anesthesia versus sedation combined with local lidocaine infiltration anesthesia in children undergoing circumcision.

Methods: In this prospective study, 140 boys aged 1-6 years were randomly assigned to receive either intravenous sedation alone (Group I) or sedation plus local anesthesia (Group II). Both groups received a standardized sedative regimen: midazolam, propofol, fentanyl, and ketamine. Postoperative pain was assessed at 1 and 3 hours using the FLACC scale. Complications were recorded.

Results: Median FLACC scores at both 1 hour (Group I: 2.0 [0-6], Group II: 2.0 [0-6]) and 3 hours (Group I: 1.0 [0-4], Group II: 1.0 [0-3]) showed no significant difference (P > 0.05). However, local complications such as ecchymosis and edema were more frequent in the group receiving local anesthesia (Group II: 7.1%) compared to the sedation-only group (Group I: 15.7%).

Conclusions: Sedation-only anesthesia using midazolam, propofol, fentanyl, and ketamine provides effective postoperative pain control for pediatric circumcision, with fewer local complications than when combined with local infiltration anesthesia.

Background: Edentulism remains a prevalent condition worldwide, significantly compromising masticatory efficiency, quality of life, and oral health. Various implant-retained and implant-supported prosthetic options have been developed to address mandibular edentulism, yet their biomechanical performance under functional loading remains incompletely understood.

Aim: To compare stress distribution among seven prosthetic designs for the edentulous mandible: two-implant bar and locator overdentures; four-implant bar and locator overdentures; an anterior fixed-posterior removable prosthesis retained with clasps; its precision-attachment variant; and an All-on-Four fixed prosthesis.

Materials and methods: A 3D finite element model of a D2-quality mandible (2-mm cortical, 1-mm mucosa, remaining cancellous bone) was created. Standard implants (4.3×11 mm) and distal-tilted (30°) long implants (4.3×14 mm) were simulated. A 100-N load was applied on the mandibular first molar vertically and obliquely. Literature-based material properties were assigned. Outcomes were implant von Mises stress and cortical bone maximum and minimum principal stresses.

Results: The lowest implant and bone stresses occurred in the anterior fixed-posterior clasp-retained design. Non-rigid connections (bar, locator, clasp) reduced implant stresses compared with precision attachments and fully implant-supported designs. Four-implant overdentures showed higher crestal stress than two-implant counterparts, likely due to greater framework rigidity and distal implant proximity to the load. Precision-attachment hybrid and All-on-Four configurations generated higher stresses at the implant neck and crestal cortical bone. Oblique loading produced higher stresses than vertical across all models.

Conclusion: Within the limits of an idealized, fully osseointegrated FEA, the anterior fixed-posterior clasp-retained prosthesis provided the most favorable stress distribution, supporting consideration of cost-effective, tissue-supported, non-rigid designs for selected mandibular edentulous cases. Increasing implant number did not uniformly reduce stresses; design rigidity and implant position were more influential than implant count. Clinical studies are warranted to validate these simulations.

Background: Thyroid hormones impact cardiac function and structure. Atherosclerosis, heart failure, and cardiac arrhythmias (especially atrial fibrillation) may occur depending on the degree of thyroid dysfunction. Asymmetric dimethylarginine is the main endogenous inhibitor of nitric oxide synthase, and it may increase in cardiovascular pathologies. The carotid intima media thickness is a predictive parameter for cardiovascular diseases.

Aim: This study assessed biventricular systolic and diastolic functions, the carotid intima media thickness, and asymmetric dimethylarginine levels in female adolescents with hypothyroidism.

Methods: The 71 participants were divided into a hypothyroid group (n = 37) and a control group (n = 34). All participants underwent laboratory blood tests (asymmetric dimethyl arginine [ADMA], complete two-dimensional, pulse, and tissue Doppler echocardiography examinations) and carotid intima-media thickness measurements.

Results: The hypothyroidism group had significantly higher total cholesterol (TC), low-density lipoprotein, glucose, homeostasis model assessment of insulin resistance, and ADMA values (0.47 ± 0.03 vs. 0.27 ± 0.03 µmol/L) than the control group. The control group's end-systolic and end-diastolic diameters of the left ventricle were larger, and the study group's ejection fraction was higher, but their ventricular global diastolic function and ventricular masses did not differ. The carotid intima-media thickness was significantly higher in the hypothyroidism group (0.39 ± 0.007 vs. 0.36 ± 0.003 mm). The hypothyroid group's global biventricular systolic and diastolic functions were normal, but the study group's ratio of the mitral peak early diastolic wave to the peak late diastolic wave (E/A) was significantly higher, while the control group had significantly higher tricuspid E/A ratios. The hypothyroid group showed a positive correlation of thyroid-stimulating hormone with TC, low-density lipoprotein cholesterol, and left ventricular ejection fraction, as well as a negative correlation with free thyroxine (r = 0.71, P = 0.01; r = 0.73, P = 0.01; r = 0.69, P = 0.01; and r = -0.58, P = 0.01, respectively).

Conclusions: Hypothyroidism in female adolescents may alter their myocardial geometry and function. Significantly higher asymmetric dimethylarginine levels and carotid intima-media thickness in patients with Hashimoto's thyroiditis may reflect endothelial dysfunction.

Background: C-shaped canals are a complex root canal variation, most frequently observed in mandibular second molars. Their atypical anatomy can make root canal treatment more difficult and may lead to complications if not properly identified. The use of Cone Beam Computed Tomography (CBCT) offers superior visualisation of canals morphology compared to conventional radiography. While the prevalence of C-shaped canals has been reported in various populations, there is limited data regarding their prevalence and configuration in the Malaysian's multiracial population. Understanding these morphological variations is essential for treatment planning and improving clinical outcomes.

Aim: This cone beam computed tomography (CBCT) study aimed to determine the prevalence and configuration of C-shaped canals in permanent mandibular and maxillary second molars among the Malaysian population using the Modified Melton's classification.

Methods: A total of 274 CBCT images involving 605 second maxillary (n = 269) and second mandibular molars (n = 336) were obtained from Oral Radiology Unit, Faculty of Dentistry, Universiti Sains Islam Malaysia. For each tooth, the canal configurations were evaluated at three different levels: 'coronal', 'middle', and 'apical'. The canal configurations were subsequently classified according to the Modified Melton's classification. The prevalence and canal configuration correlation between sex, ethnicities, and tooth positioning were determined using odds ratio (P = 0.05).

Results: The patients' ages ranged from 12 to 72 years old, with a mean age of 29.47 ± 11.53 years. The patients were female (76.6%) with Malays or Bumiputera (78.8%) predominance. The prevalence of C-shaped canals found was 10.1% (n = 44), and all were presented in second mandibular teeth. The most frequent C-shaped canals configuration found was C3-C3-C3 (29.5%). C-shaped canals were presented more likely when the patient is Chinese than other ethnicities with an odds ratio of 3.18 (95% CI, 1.562-6.488; P = 0.001) and in fused roots than multirooted roots (OR = 173.43; 95% CI, 65.077-462.195; P < 0.001). Sex was not associated with the prevalence of C-shaped canals in this study.

Conclusions: The prevalence of C-shaped canals of the mandibular second molar in the Malaysian subpopulation in this study was 10.1% with the most frequent configuration of C3-C3-C3 at 29.5%. The Chinese ethnicities and tooth with fused roots were more frequently associated with the incidence of C-shaped canals. Identification of the C-shaped canal morphology allows the clinician to modify the canal preparation and obturation techniques to obtain a good endodontic treatment outcome, while also preventing any iatrogenic or procedural errors.

Background: Head trauma was the significant public health issue and a common cause of emergency department visits. Cranial computed tomography (CT) was widely used in its evaluation; however, overuse-particularly in mild cases-raises concerns about patient safety and healthcare efficiency.

Aim: This study aimed to evaluate the appropriateness of cranial CT use in head trauma patients, its relationship with Glasgow Coma Scale (GCS) scores, and the prevalence of potentially avoidable imaging.

Methods: This retrospective study included 1,000 patients presenting with head trauma, who underwent cranial CT. Data collected included demographics, trauma mechanism, GCS score, CT findings, and indication for imaging. CT necessity was assessed using the Canadian CT Head Rule and New Orleans Criteria. CTs performed in patients with GCS 13-15, normal findings, and no guideline-based indications were classified as potentially avoidable.

Results: Of all patients, 65% were male, with a mean age of 42.1 ± 20.7 years. Mild trauma (GCS 13-15) was present in 77.5% of cases. Intracranial pathology was detected in 35.9% overall, with higher rates in patients with moderate and severe trauma. Unnecessary CT imaging was found in 57% of all cases, and in 80.2% of mild trauma cases. A statistically significant association was found between lower GCS scores and intracranial findings (P < 0.001).

Conclusion: Cranial CT was often overused in mild head trauma without adherence to clinical guidelines. Promoting the use of decision support tools and raising awareness among clinicians and patients are crucial for reducing potentially avoidable imaging, radiation exposure, and healthcare burden.

Background: Acute kidney injury (AKI) and the need for renal replacement therapy (RRT) are major complications in critically ill patients. The C-reactive protein (CRP)/albumin ratio (CAR) is a readily available biomarker reflecting systemic inflammation and nutritional status, but its predictive value for renal outcomes in the intensive care unit (ICU) remains uncertain.

Aims: To assess whether the CAR measured within the first 12 hours of ICU admission can predict the development of AKI and the need for RRT in critically ill patients.

Methods: This retrospective observational study was conducted in a tertiary intensive care unit and included 204 ICU patients without acute or chronic kidney failure at admission. CRP and albumin levels were measured within 12 hours of ICU admission. Patients with conditions affecting albumin levels were excluded. AKI and RRT development during ICU stay were recorded. Statistical analyses included the Mann-Whitney U test, Chi-square test, receiver operating characteristic (ROC) analysis for diagnostic performance, and multivariate logistic regression for independent predictors.

Results: AKI occurred in 55.9% and RRT was required in 21.6% of patients. Patients requiring RRT had lower albumin levels and higher acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores. Although CAR was slightly elevated in patients with AKI or RRT, it was not independently associated with these outcomes (RRT: OR 0.97, AUC 0.575; AKI: OR 1.03, AUC 0.643).

Conclusions: The CRP/albumin ratio was not an independent predictor of AKI or RRT. Its clinical usefulness may improve, when combined with established illness severity scores for renal risk stratification in ICU patients.

Background: Sexual harassment allegations against physicians undermine trust in healthcare and present significant ethical and legal challenges. While such issues are widely discussed in the context of professional conduct, systematic analyses of judicial decisions-particularly in non-Western settings-remain limited.

Aim: This study aims to analyze Turkish Supreme Court decisions involving sexual harassment allegations by physicians toward their patients, focusing on identifying patterns, associated risk factors, and ethical implications.

Methods: A total of 46 Supreme Court judgments (2009-2024) were identified using the Lexpera database, employing keywords such as "harassment by physician" and "harassment during medical examination." Each case was evaluated according to physician specialty, nature of the act (penetrative vs nonpenetrative), examination context, witness presence, and judicial outcomes (conviction, acquittal, or reversal).

Results: Most incidents occurred in public hospitals, and the majority of patients were female. Physicians most frequently accused belonged to family medicine, obstetrics and gynecology, and radiology specialties. Documentation of informed consent and the presence of witnesses was rare. Allegations often involved genital examinations performed without explicit consent. While 69.7% of local court decisions resulted in convictions, only 39.4% were upheld by the Supreme Court.

Conclusion: Clear communication, standardized informed consent procedures, and the presence of witnesses during sensitive examinations are essential in preventing both misconduct and false accusations. These findings underscore the ethical importance of transparency and institutional safeguards and highlight the need for proactive policies to protect both patients and physicians.

Background: Urinary retention (UR) can lead to both anatomical and functional derangement in the urinary system. Chronic kidney disease occurs when there is renal damage.

Aim: This study aims to determine the relationship between chronic UR (CUR), retained urine volume, and renal function among men with chronic and acute-on-chronic UR.

Methods: The study was a hospital-based prospective study of Nigerian men presenting with chronic or acute-on-chronic UR. Diagnosis of UR was made based on history and physical examination. The estimated glomerular filtration rate (eGFR) was calculated using the serum creatinine level. Retained urine volume was measured after an aseptic urethral catheterization. Spearman's rank correlation test was used for correlation analysis between CUR, retained urine volume, and renal function. A P value of < 0.05 was accepted as statistically significant.

Results: Fifty-six men met the inclusion criteria. Most of the patients were in the age range of 80-89 years. A total of 20 (35.7%) had acute-on-chronic UR, while 36 (64.3%) had CUR. The mean retained urine volume was 1500 ± 748.0 mL and 1100 ± 515.0 mL for the chronic and acute-on-chronic UR groups, respectively. Obstructive nephropathy occurred in 88.6% of the participants with CUR. There was a significant negative relationship between the eGFR and the volume of retained urine (r = -0.397, P = 0.002).

Conclusion: A high prevalence of obstructive nephropathy was observed among men with chronic and acute-on-chronic UR in this study.

Background: Split-thickness skin grafting (STSG) is a veritable reconstructive option for covering skin and soft tissue defects but donor site management remains a challenge. Attempts to improve STSG donor site care have been made using different methods and various dressing agents; however, there is no consensus on the standard method of donor site care.

Aim: This study aims to compare STSG healing rate using early versus late exposure of donor site dressing methods.

Methods: This study was conducted in Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Southeast, Nigeria. Forty patients were recruited for the study and assigned to two groups of 20 patients each by a simple random sampling method. Group A had late exposure of the donor site dressing, whereas Group B had early exposure of the donor site dressing. The percentage re-epithelialization rate on the 14th day and the duration for complete re-epithelialization for both groups were calculated. The results were analyzed using International Business Machine Corporation, Statistical Package for the Social Sciences, Chicago Illinois, USA. (IBM SPSS) Statistics for Windows version 26.

Results: The early exposure dressing method showed a faster re-epithelialization rate with a mean value of 98.15 (±4.92) compared with late exposure dressing methods with a mean rate of 70.95 (±13.22), which was statistically significant with a P value of 0.001. The duration for complete re-epithelialization was 13.80 (±4.63) days for the early exposure method and 29.40 (±6.25) days for the late exposure method. This is statistically significant with P < 0.001.

Conclusion: Management of STSG donor site by early exposure of the donor site dressing is associated with increased re-epithelialization rate and shortened duration for complete donor site healing.