Nigerian Journal of Clinical Practice最新文献

Background: While we attempt to restore occlusion in completely edentulous patients there is a consensus among clinicians to articulate the cast using average value and avoid performing facebow transfer. Various studies question the application of facebow transfer in the fabrication of removable complete denture fabrication.

Aim: This study was therefore aimed to study the effect on condylar guidance with casts mounted by the facebow method, Bonwill's method, and radiographic method.

Methods: A cross-sectional study was performed using casts of edentulous patients attending the Department of Prosthodontics. After establishing a tentative jaw relationship using wax occlusal rims in the edentulous participants, the casts were mounted by Bonwill's method and the facebow transfer method to a semi-adjustable articulator. Protrusive records of the subjects were used to program the articulator to obtain the condylar guidance values. Digital lateral cephalographs were made both in centric and protrusive jaw relationships. The mandibular condyles were then traced and overlapped to obtain radiographic values. The condylar guidance values obtained by Bonwill's method, facebow method and radiographic method were compared using Wilcoxon's signed rank test and Mann-Whitney U test. The SPSS Statistics for Windows (Version 21.0. Armonk, NY, USA:IBM Corp.), and, at a probability value of 0.05, the significance of every statistical test was predetermined.

Results: Ten edentulous 45-70 year olds participated in the study. The mean discrepancy between radiography and facebow methods was 12.8° for the right side and 12.7° for the left (P < 0.005). The difference between radiography and Bonwill's methods was significant (P < 0.005), with a mean difference of 34.3° for the right side and 34.7° for the left side. The difference between Bonwill's method and the facebow method was significant (P < 0.005), with a mean difference of 21.5° for the right side and 22° for the left side.

Conclusion: The condylar guidance values obtained by clinical methods (Bonwill's and Facebow) were significantly lesser (P < 0.005) compared to the values obtained by radiographic method.

Background: Skin tones may be predictive of anterior tooth shade. An analysis of the relationship of skin tone to anterior tooth shade within a population may facilitate the prescription of complete dentures with optimal esthetics and realism.

Aim: This study aimed to assess the relationship between skin tones and shades of upper anterior teeth among a diverse Nigerian adult population.

Methods: The study was conducted between February and December 2022 among consecutive healthy adults recruited from dental clinics of five teaching hospitals in four cities located across four geopolitical zones of Nigeria. Skin tones were recorded using the National Immigration Service (NIS) Skin Color scale. The Vitapan Classic® shade guide was used to record the tooth shade of the upper central incisors and canines. Bivariate and multivariate tests of associations were performed, and predictive probabilities were developed.

Results: A total of 1070 adults with a mean age of 30.8 ± 10 years participated in the study. NIS skin tones 6 (29.8%) and 5 (27.7%) were the most common, while hues A (48.7% in incisors and 48.4 % in canines) and B (41.1% in incisors and 40.1% in canines) were predominant. The values of the incisors and canines were positively related to skin tone (P = 0.001) and age (P = 0.001 for incisors and P = 0.003 for canines). Hue was also significantly associated with skin tone for canines (P = 0.01) and gender (P = 0.001). Regression models showed increasingly darker skin tones were positively related to duller values for incisor teeth (β = 0.173, OR =1.19, P < 0.001). The values for canines were more likely to be >2 (β = 0.118, OR =1.12, P = 0.01), but without significant positive relationship to increasingly darker skin tones (β = -0.99, OR =0.91, P = 0.22).

Conclusion: Skin tones were associated with upper anterior tooth shade. There was a positive relationship between skin tones and the shades of upper anterior teeth. Skin tones could guide the clinician in shade selection during complete denture prescriptions.

Background: Although Tideglusib cytotoxicity studies and its effects on human dental pulp-derived stem cells (DPSCs) have been examined in previous studies, there is no study investigating the expression of type 1 collagen and type 3 collagen by Tideglusib.

Aim: The purpose of this study is to examine the effect of Wnt signaling activation using Tideglusib execution on human DPSC to determine its potential efficacy in collagen expression.

Methods: Stem cell isolation was performed from five human third molar wisdom tooth pulps. DPSCs identified in only one sample were treated with 50 nM Tideglusib for 24 h and 1 week. Axin-2, type 1 and type 3 collagen expressions were evaluated by Western blot analysis. DPSCs without treatment served as a negative control. The Mann-Whitney U test was used for statistical analysis.

Results: The levels of type 1 collagen and Axin-2 in the test group were significantly higher than those in the control group at 24 h (P = 0.000, P = 0.001, respectively). Compared to the control group, a slight increase in type 3 collagen expression was observed in the test group at 24 h (P value = 0.063). Application of 50 nM Tideglusib for 1 week revealed marked decreases in type 1 and type 3 collagen expressions (P = 0.029, P = 0.038, respectively). In contrast, there was a significant increase in the level of Axin-2 (P = 0.000) compared to the control group.

Conclusion: The fact that Wnt signaling pathway activation obtained by Tideglusib application on DPSCs confirmed by the finding in the increase of Axin-2 at short and long-term evaluation periods which is resulted in the increase in the type 1 collagen expression at 24 h and decrease at 1 week together with the decrease in type 3 collagen expression at 1 week warrants further studies to evaluate the effect of Tideglusib on extracellular matrix expression.

Background: Ovarian cancer exhibits a significant prevalence and incidence on a global scale. Low-grade or high-grade epithelial-type ovarian cancer can be classified by using the dualistic model. Inflammation has been associated with AKNA protein by cancer researchers. The potential of AKNA as a cancer biomarker is supported by its significance and association with ovarian carcinoma. Uninvestigated is this enormous potential.

Aim: This study examines the correlation between AKNA expression in low-grade and high-grade ovarian tumors and its utility as a predictive biomarker for ovarian cancer.

Methods: This study examined a total of thirty-one samples, which were classified into three groups: cyst, low-grade, and high-grade ovarian carcinoma. The departmental archive was accessed for the following information: age, tumor size, nuclear grade, mitosis, ovary volume, implant tumor status, lymph vascular invasion status, lymph node metastasis, and tumor-infiltrating lymphocyte. The expression of AKNA was determined using IHC staining. The information was collected and analyzed via analysis of variance.

Results: The AKNA H-score shows the mean difference between all three groups (P < 0.001). Cysts had the highest AKNA expression, followed by low-grade and high-grade ovarian carcinoma.

Conclusion: Higher-grade ovarian cancer expressed less AKNA compared to cysts or low-grade forms of the disease. This considerable difference suggests that AKNA might predict ovarian cancer tumor grade.

Background: A chest radiograph is the most commonly requested and performed imaging for diagnosis and screening including medical examination.

Aim: The study aimed to determine the prevalence and pattern of incidentalomas in radiographs of cases presenting for pre-employment medical examination.

Methods: This was a retrospective review of chest radiographs conducted for patients presenting for pre-employment medical examination from January to December 2022. Relevant data including sociodemographic characteristics, clinical details and chest radiograph reports were retrieved using study proforma from all patients with complete medical data were analyzed using statistical package for social sciences (SPSS) version 23 with the level of statistical significance set as P <0.05 taken as statistically significant.

Results: Three hundred and eleven chest radiographs of subjects aged 20-49 years were evaluated, of which 22 (7.1%) incidentalomas were found. Most were females (55%). Of these incidentalomas, 12 (54.6%) were in the cardiovascular system, while the skeletal and pulmonary systems accounted for eight (36.4%) and two (9.1%), respectively. In all participants, clinically significant findings were eight (2, 6%), comprising of cardiomegaly five (1.6%), leash of vessels in the upper zone one (0.3%), blunt costophrenic angle one (0.3%), and right-sided aortic arch one (0.3%). Age and gender have no statistical significance in the incidental findings.

Conclusion: Although the incidence of clinically significant incidentalomas appears low in our environment where beliefs and lack of adequate healthcare financing prevent the majority from seeking timely medical attention, chest radiograph remains an invaluable tool for pre-employment medical examination. Some underlying medical conditions could be picked up, further investigation sought to save life, and it serves as a baseline with which future findings may be compared.

Background: Burnout in the health care industry is a potential hazard that has reached epidemic proportions mostly among doctors in practice and training. Burnout has enormous consequences on doctors, patients, and health care institutions.

Aim: This study aimed to determine the prevalence and predictors of burnout among resident doctors in Enugu State, Nigeria.

Methods: This was a mixed-method study of 420 resident doctors in tertiary hospitals in Enugu State, Nigeria. Data were collected using Oldenburg Burnout Inventory and in-depth interviews of chief resident doctors of selected departments. Data were analyzed using IBM statistical package 23.0 and Nvivo 11. Test of significance was set at 0.05.

Results: The mean age of participants was 34.11 ± 5.08 years. The prevalence of burnout groups among resident doctors was 84.3% in the burnout group, 4.8% in the disengagement group, 6.9% in the exhaustion group, and 4.0% in the non-burnout group. Gender (OR = 1.861, C.I = 1.079-3.212), duration of training (OR = 1.740, C.I = 1.008-3.005), and working hours (OR = 2.982, C.I = 1.621-5.487) were the predictors of burnout; only working hours (OR = 0.279, C.I = 0.091-0.0862) was the predictor of disengagement; and gender (OR = 0.248, C.I = 0.107-0.579) was the predictor of exhaustion. Heavy workloads, long working hours, migration, poor working environment, job insecurity, poor remuneration, and management style were identified factors of burnout.

Conclusion: There was high prevalence of burnout among resident doctors, predicted by gender, duration of training, and working hours. Interventions are needed to reduce burnout, prevent the "brain drain", and improve resident doctors' overall well-being.

Background: OME is an accumulation of serous or mucoid fluid in the middle ear cavity with an intact tympanic membrane and without any sign of acute infection.

Aims: This study aimed to determine the prevalence of otitis media with effusion among preschool and school-age children aged 1-10 years in private and public schools in Calabar municipality and the correlations between otoscopic findings and Jerger's diagnostic criteria among study participants.

Methods: This school-based descriptive cross-sectional study used a multistage sampling technique to recruit participants. The Institutional Ethical Committee approved the study. Consent and assent were obtained from parents/guardians of children aged < 6 years and >7 years, respectively. A structured questionnaire was used to obtain sociodemographic characteristics, symptoms, and possible risk factors for otitis media with effusion. In addition, ear, nose, and throat (ENT) examinations and tympanometry were performed for each participant. Jerger's type B and C tympanograms were the diagnostic criteria for otitis media with effusion. The data were analyzed using IBM SPSS version 25, and the threshold for statistical significance was set at P < 0.05.

Results: The overall prevalence of OME was 13.8%, with P values ≤ 0.001, P = 0.597, and P = 0.007 for daycare (45.85%), public schools (14.7%), and females, respectively. Jerger type B tympanograms had a strong positive correlation with middle ear fluid (r = 0.777) on otoscopy, Jerger type C tympanograms with dull TM (r = 0.687), and retracted TM (r = 0.774).

Conclusion: Otitis media with effusion was more prevalent among preschool children aged 1-2 years in public schools and among female children in Calabar municipalit. The otoscopic results of otitis media with effusion were consistent with Jerger's diagnostic criteria in our study.

Background: Acute rheumatic fever is an immunologically delayed autoimmune sequel of throat infection caused by group A streptococcus. The aim of this study was to evaluate endocan levels in patients with acute rheumatic fever and compare with the control group.

Aim: The aim of this study was to evaluate endocan levels in patients with acute rheumatic fever and compare with the control group.

Methods: Twenty-three children with acute rheumatic fever (11 men, 12 females; mean age 13 ± 2.7 years; range 5 to 15 years) and a healthy control group of 31 children (16 men, 15 females; mean age 13.8 ± 2.4 years; range 5 to 15 years) were recruited. The sedimentation rate, C-reactive protein, antistreptolysin-O titres, and endocan levels were examined in each group.

Results: Before anti-inflammatory therapy, endocan levels in the acute rheumatic fever group were not statistically significant to those in the control group, respectively (200.64 ng/L, 120.71 ng/L, P = 0.208). After anti-inflammatory therapy, endocan levels were significantly higher in the acute rheumatic fever group than in the control group, respectively (260.87 ng/L vs. 120.71 ng/L, P < 0.01). A significant difference was found in endocan levels before and after anti-inflammatory therapy in the group of acute rheumatic fever, respectively (200.64 ng/L vs. 260.87 ng/L, P = 0.033). Endocan levels after anti-inflammatory therapy were statistically higher in the severe carditis group compared to those of the mild carditis group, respectively (344.56 ng/L vs. 191.01 ng/L, P < 0.01).

Conclusion: Our study showed that serum endocan levels increased during the subacute phase of acute rheumatic fever. We suggest that serum endocan level can be used as a new biomarker to identify the degree of cardiac involvement in acute rheumatic fever.

Background: Spontaneous pneumothorax in COVID-19 occurs infrequently but in up to 15% of patients dependent on mechanical ventilation (MV). Pneumothorax-related deaths account for 1% of all COVID-19-related deaths.

Aim: To determine factors associated with pneumothorax in COVID-19 patients and the effect of pneumothorax on early survival.

Methods: This was a retrospective study of 4799 COVID-19-positive hospitalized patients. The groups were homogenized using propensity score matching (PSM) in two groups comprising 67 COVID-19 patients each. The prevalence of pneumothorax was determined. Multiple logistic regression was used to determine factors associated with pneumothorax. P value < 0.05 was taken as significant.

Results: The prevalence of pneumothorax in COVID-19 patients was 1.6%. Lung disease, comorbidities, and oxygen support, which were significantly different between the two groups before PSM, were homogenized after PSM. In a univariate analysis, symptom duration (P ˂ 0.001), neutrophilia (P ˂ 0.001), lymphopenia (P ˂ 0.001), neutrophil-lymphocyte ratio (P = 0.003), ferritin levels (P = 0.012), D-dimer levels (P = 0.011), MV support (P ˂ 0.001), antibiotherapy (P ˂ 0.001), length of hospital stay (P = 0.009), and death (P = 0.002) differed significantly between the groups. Pneumothorax had a significant negative effect on survival (32.8% vs. 59.7%, P = 0.01). In a multivariate regression model, factors associated with pneumothorax were duration of symptoms (Adjusted Odds ratio (AOR) 1.68; 95% Confidence Interval (CI): 1.26-2.25; P = 0.001), mechanical ventilation (AOR 23.92; 95% CI: 4.12-138.72; P = <0.001), dual antibiotics (AOR 8.28; 95% CI: 1.56-43.86; P = 0.013), neutrophilia (AOR: 1.08; 95% CI: 1.02-1.14; P = 0.011), and lymphopenia (AOR: 0.92; 95% CI: 0.86-0.90; P = 0.022).

Conclusion: The presence of pneumothorax was associated with poor survival in COVID-19 patients. Patients with a prolonged time from symptom onset to treatment and those dependent on mechanical ventilation in intensive care were in the high risk group for the development of pneumothorax.

Background: The COVID-19 pandemic caused by SARS-CoV-2 is an unparalleled health risk, needing fast antiviral medication development. One of the most effective strategies for developing therapies against novel and emerging viruses is drug repurposing. Recently, systems biology approaches toward the discovery of repurposing medications are gaining prominence.

Aim: This study aimed to implement a systems biology approach to identify crucial drug targets as well as potential drug candidates against COVID infection.

Methods: Our approach utilizes differential gene expression in COVID conditions that enable the construction of a protein-protein interaction (PPI) network. Core clusters were extracted from this network, followed by molecular enrichment analysis. This process identified critical drug targets and potential drug candidates targeting various stages of COVID-19 infection.

Results: The network was built using the top 200 differently expressed genes in mild, moderate, and severe COVID-19 infections. Top 3 clusters for each disease condition were identified, representing the core mechanism of the network. Molecular enrichment revealed the majority of the pathways in the mild state were associated with transcription regulation, protein folding, angiogenesis, and cytokine-signaling pathways. Whereas, the enriched pathways in moderate and severe disease states were predominately linked with the immune system and apoptotic processes, which include NF-kappaB signaling, cytokine signaling, TNF-mediated signaling, and oxidative stress-induced cell death. Further analysis identifies 28 potential drugs that can be repurposed to treat moderate and severe COVID-19, most of which are currently used in cancer treatment.

Conclusion: Interestingly, some of the proposed drugs have demonstrated inhibitory effects against SARS-CoV-2, as supported by literature evidence. Overall, the drug repurposing method described here will help develop potential antiviral medications to treat emerging COVID strains.