Nigerian Journal of Clinical Practice最新文献

Background: INTELLIVENT-Adaptive Support Ventilation (I-ASV; C6; Hamilton Medical; Bonaduz, Switzerland) is a closed-loop ventilation mode that continuously controls the patient's ventilation and oxygenation. It sets the minute ventilation, PEEP, and oxygen levels based on the targets set by the clinician and on physiological input from the patient.

Aim: The aim was to compare I-ASV and PSV modes regarding weaning in intensive care patients.

Methods: A total of 140 patients who were over the age of 18 years, did not have a neuromuscular disease, and had been ventilated for at least 48 hours were reviewed. Using the sequential method, patients who met the requirements for weaning were put into two groups: I-ASV and PSV (pressure support ventilation).

Results: The mean age of the I-ASV group (n = 70) and the PSV group (n = 70) was 49.11 ± 17.74 and 49.92 ± 22.00, respectively. In the group using I-ASV, FiO2 was 30.12 ± 10.04%, inspiratory pressure (Pinsp) was 8.71 ± 2.78 cm H2O, and Ppeak value was 11.67 ± 2.78 cm H2O, which were significantly lower than those in the PSV mode (P < 0.001). The PEEP value was significantly lower in the PSV mode (P < 0.001). However, asynchrony-tachycardia was significantly higher in the I-ASV group (28 (20%)) compared to the PSV group (11 (7.9%)) (P < 0.003).

Conclusion: I-ASV mode had no effect on weaning duration compared to PSV mode but decreased PEEP, FiO2, Pinsp, and Ppeak values in weaning patients.

Objective: This study investigates the association between the presence of diverticula in the colon and esophagus and the occurrence of hiatal hernia, seeking to understand potential shared pathophysiological underpinnings and risk factors.

Methods: A cross-sectional study was conducted at a tertiary care center, including patients aged ≥18 years who underwent both gastroscopy and colonoscopy over 2 years. Exclusion criteria were prior gastrectomy or colectomy, incomplete medical records, and non-consent. The presence of hiatal hernia, colonic, and esophageal diverticulosis was identified via endoscopy. Logistic regression analysis assessed the associations, adjusting for age and sex.

Results: Among 3563 participants, males showed a higher prevalence of hiatal hernias compared to females (76.1% vs. 23.9%, P < 0.001). Hiatal hernia patients had a mean age of 51.28 years, slightly higher than those without (49.62 years, P = 0.034). A significant association was found between hiatal hernias and colonic diverticulosis (11.8% vs. 1.8%, P < 0.001), as well as between hiatal hernias and esophageal diverticulosis (2.4% vs. 0.3%, P < 0.001). Adjusted logistic regression revealed a 5-7 times higher likelihood of colonic diverticulosis in patients with hiatal hernias (odds ratio = 5.64, 95% confidence interval: 3.60-8.83; P < 0.001).

Conclusion: The study demonstrates a notable association between hiatal hernias and the presence of both colonic and esophageal diverticula, suggesting common pathophysiological processes. These findings highlight the need for further research into shared risk factors and mechanisms underlying these conditions, potentially guiding improved management strategies for affected patients.

Background: Nowadays, the increasing importance of mother-infant contact, the significant impact of mother and baby's sleep quality, and the positive effects on breastfeeding are factors that make breastfeeding sleep important.

Aim: The aim of this study was to examine the effect of mothers' breastsleeping behavior on attachment and postpartum sleep quality.

Methods: This study is cross-sectional. The research was conducted with 202 mothers. The data of the study were collected using a descriptive information form, the Maternal Attachment Scale (MAS), and the Postpartum Sleep Quality Scale (PSQS). Data were analyzed using the Statistical Package for the Social Sciences (SPSS) (IBM SPSS Statistics for Windows, version 22.0. Armonk, NY: IBM Corp.) for Windows 22.0 software.

Results: There was no statistically significant difference between the groups in terms of the MAS score and PSQS score of mothers who breastsleep and mothers who did not. No statistically significant difference was found when the mothers' socio-demographic characteristics, breastsleeping-related characteristics, maternal attachment, and sleep quality mean scores were compared (P > 0.05).

Conclusion: The literature is very limited in assessing the effects of breastsleeping on mothers' sleep quality and attachment. This study found that breastsleeping did not affect maternal sleep quality and attachment.

Background and aim: Tongue base reduction surgery is the only minimally invasive technique that can be performed under local anesthesia as an outpatient procedure, especially to treat obstructive sleep apnea caused by hypopharyngeal obstruction. Studies reported that various devices could be used for tongue base reduction, but comparisons of these methods are limited in the literature. Our study aimed to compare the histological effects of tongue base reduction methods performed with the Celon radiofrequency, monopolar cautery, Coblator, and Sutter devices on the tissue.

Methods: This study included 23 female rats (aged 4-8 months). Rats were divided into five groups. Tongue base reduction was performed with monopolar cautery in the first group (5 rats), then Celon radiofrequency in the second group (5 rats), the Coblator in the third group (5 rats), and the Sutter in the fourth group (5 rats). The fifth group was the control group, which comprised three rats. The rats' tongues were resected for histological examination 1 week after procedures.

Results: While the highest amount of fibrosis was seen in the Sutter group, fibrosis was also relatively high in the Coblator group. A significant difference was observed in all groups when compared with the control group regarding tissue thickness. While the average tissue thicknesses of the monopolar, celon rf, and Coblator groups were almost the same, tissue reduction was more marked in the Sutter group.

Conclusion: Although we observed that all the methods used were safe, the method that produced the most fibrosis and tissue reduction was the Sutter method.

Background: Reverse shoulder arthroplasty (RSA) is used commonly for a wide range of indications. The complications after the total shoulder replacements have been reported to be related with the prosthesis design. The type of the humeral stem is a consideration to reduce complication. Radiographic changes are seen at a high rate with new-generation press-fit stems.

Aim: This study aims to reduce proximal humeral bone loss after RSA could have been achieved with adjustable humeral stem when compared with monoblock stem.

Methods: A retrospective analysis was made of 52 patients treated with RSA using a press-fit humeral stem prosthesis. The patients were separated into two groups according to the type of humeral stem. The first group included 26 patients (18 females, 8 males) who underwent RSA using adjustable humeral stem. The second group included of 26 patients (17 females, 9 males) for whom monoblock humeral stem was used. Clinical and radiological evaluations were made based on the information obtained at 1, 3, 6, 12, and 18 months postoperatively. The follow-up duration was at least 18 months.

Results: There was no statistical difference between the adjustable and monoblock groups in respect to gender, age, height, and weight. According to the functional measurements at the final follow-up, no statistically significant difference was determined between the groups with respect to the Constant, UCLA, Oxford, DASH, and VAS values. In terms of radiographic changes, both groups were seen to have been similarly affected. It was found that, irrespective of the stem type used, the humeral side radiographic adaptation was found to be high, which negatively affected the functional results (P < 0.05).

Conclusion: The increased radiographic stress shielding adaptation leading to humeral osteolysis was found to have a negative effect on the functional results with the press-fit technique irrespective of stem design.

Background: Maternal dyslipidemia is one of the consistent metabolic changes during pregnancy. There is a controversy as to whether maternal lipid disturbances in early pregnancy are associated with adverse maternal and perinatal outcome.

Aim: To determine the effects of maternal dyslipidemia on maternal and perinatal outcomes.

Methods: A prospective observational cohort study of eligible pregnant women attending antenatal clinic (ANC) at two tertiary hospitals in Southeast Nigeria. The attendees blood samples were collected for lipid profile analysis and those who met the criteria for dyslipidemia constituted the study (exposed) group, while those with normal lipid levels were the control (unexposed group). Both groups were followed up throughout pregnancy and in labor to determine the pregnancy and perinatal outcomes.

Results: Compared with pregnant women with normal lipid profile, those with dyslipidemia were at higher risk of low birth weight (LBW) (RR: 9.40, CI 95%: 1.3-70.2, P = 0.005), intrauterine fetal death (IUFD) (RR: 5.98; 95% CI: 0.8-46.9; P = 0.04), still birth (RR: 6.84, CI 95%: 8.9-52.7, P = 0.03), and birth asphyxia (RR: 10.26, CI 95%:1.4-76.0, P = 0.003).

Conclusion: Maternal dyslipidemia is associated with some adverse perinatal outcomes such as LBW, IUFD, still birth, and birth asphyxia. These findings would guide in the care of pregnant women with dyslipidemia.

Background: The mentioned advantages of bulk-fill composite resin and high-viscosity glass ionomer restorative materials have increased their use in restorative dentistry in recent years; accordingly, the bonding of these materials to dental tissues and their mechanical properties have become more important.

Aim: This study aimed to evaluate the effects of different application methods on Vicker's hardness and shear bond strength of three different restorative materials.

Methods: In this in-vitro study; Teflon molds were used for the microhardness test. In the control group, reinforced high-viscosity glass ionomer, high-viscosity glass ionomer, and flowable bulk-fill composite resin were applied by the manufacturer's instructions. In other groups, preheating, ultrasonic activation, and both preheating and ultrasonic activation were applied, respectively (n = 14). Microhardness values of the upper surfaces of the specimens were measured with Vicker's hardness measuring device. For the shear bond strength test, 84 intact human molar teeth were used. The teeth were sectioned two in the mesiodistal direction (n = 14). The materials were applied to the dentin using the same placement protocols as those used in the hardness test. After the specimens were maintained at 37°C for 24 h, the shear bond strength test was performed using a universal test device.

Statistical analysis used: The data were analyzed using SPSS 26.0 at a 95% confidence level. The Mann-Whitney test was also used for the statistical analysis of the data (P = 0.05).

Results: Preheating the restorative materials significantly decreased the shear bond strength in the flowable bulk-fill composite resin group (11.77 ± 4.46 MPa) compared with that in the control group (12.14 ± 4.23 MPa) (P < 0.05) but significantly increased the shear bond strength in the reinforced high-viscosity glass ionomer group (3.91 ± 2.93 MPa) (P < 0.05).

Conclusions: It can be concluded that preheating before application may increase the shear bond strength of reinforced high-viscosity glass ionomer.

Background: Silver diamine fluoride (SDF) is employed in caries prevention and treatment; however, tooth discoloration post treatment is a significant disadvantage, which can be reduced using glutathione (GSH), a water soluble tripeptide.

Aim: To evaluate and compare the effect of glutathione biomolecule (GSH) and potassium iodide (KI) along with SDF on tooth discoloration and shear bond strength of glass ionomer cement (GIC) on the tooth surface.

Methods: Artificial caries were created on 48 extracted unblemished premolars and divided into four groups (SDF, SDF + KI, SDF + GSH, and Water). The solutions were applied according to the manufacturer's instructions, and the samples were incubated for 24 hours. The color assessment was recorded on days 1, 7, and 14 by using a spectrophotometer. Following the color assessment, all the treated samples were bonded with GIC. The shear bond strength was evaluated using a universal testing machine.

Results: Mixing SDF with GSH initially reduced tooth discoloration. Although there was an increase in the discoloration after 2 weeks, it was still less when compared to the SDF group. The application of GSH and KI post SDF application had no significant difference in the shear bond strength of GIC on the tooth surface.

Conclusions: The use of GSH along with SDF helps in reducing the discoloration without compromising the shear bond strength.

Background: The middle meningeal artery (MMA) is the leading supplier of the cranial dura and serves as a donor blood channel in craniotomy and cerebrovascular bypass procedures. However, the complex embryology of the MMA and population differences give rise to several anatomic variations that are of great importance in head injuries pertaining to the petrous and squamous parts of the temporal bone. Similarly, care must be taken to protect the artery during surgical operations that involve the maxillary artery and the vidian nerve.

Aim: To evaluate the morphometry and clinical correlates of the middle meningeal artery in the black population of South Africa.

Methods: The current study investigated the organization of the MMA in 100 adult dry human skulls (n = 50 males: n = 50 females) by tracing its grooves and measuring the length of the MMA, its frontal branch (FB), parietal branch (PB), the angle between FB and PB, and the angle of MMA from the foramen ovale (FO) bilaterally.

Results: In comparison to females, males had significantly longer left PB (P = 0.003) and a considerably larger right angle of the MMA from the FO (P = 0.018). Furthermore, the PB was significantly longer on the left side than the right side in the entire sample (P = 0.002). Other parameters had no significant differences in sex and side.

Conclusions: The longer PB and the larger angle of the MMA in males could be attributed to why there is a high incidence of chronic subdural hematomas and MMA aneurysms in males. The current study is the first to propose a possible explanation for the aforementioned findings with regard to the organization of the MMA.

Background: Macular holes are an infrequent association with rhegmatogenous retinal detachment, increasing the complexity of surgery and affecting outcome.

Aim: To report the visual outcome, macular hole (MH) closure, and retinal reattachment rate after vitrectomy with silicone oil plus different MH closure techniques for MH associated with rhegmatogenous retinal detachment and to compare the visual outcome between the techniques.

Materials and methods: A retrospective, comparative study. Review of pre and postoperative Snellen best corrected visual acuity (BCVA) and the logarithm of minimum angle of resolution (LogMAR) conversion for nine eyes of 9 consecutively treated macular hole in rhegmatogenous retinal detachment patients. Pre and postoperative optical coherence tomography (OCT) macula scans and retinal reattachment three months post silicone oil removal were assessed.

Results: Surgical techniques: Inverted internal limiting membrane flap (n = 4; 44.45%), internal limiting membrane (ILM) plug (n = 4; 44.45%), and autologous retinal transplant (n = 1; 11.1%). Outcome: Single-surgery retinal reattachment rate was 88.9% (8/9 eyes), and 100% with second surgery. Primary MH closure was 100%. One reopened MH with retinal re-detachment, post silicone oil removal, required additional surgery. The mean preoperative BCVA was 2.53 ± 0.93 LogMAR, and mean postoperative BCVA was 0.94 ± SD 0.43 LogMAR (P = 0.000). Mean change in Snellen line = 2.22 ± 1.72. The postoperative vision was the same as preoperative in 22.2% and improved in 77.8%. Mean postoperative vision for the inverted ILM flap group (n = 4) was 1.10 ± 0.62 LogMAR (P = 0.038), and for the ILM plug group (n = 4) 0.83 ± 0.23 LogMAR (P = 0.002). The surgical technique did not influence postoperative BCVA (P = 0.85). Only one eye had an outer retina on OCT evaluation. Complications were macular atrophy (55.6%), macular edema (44.4%), and epiretinal membrane (33.3%).

Conclusion: Single-surgery retinal reattachment rate and macular hole closure using any of the techniques is high, and none showed superiority.