Nigerian Journal of Clinical Practice最新文献

Background: The primary place of metastasis happens to be the central compartment lymph nodes (CLNs) in papillary thyroid cancer (PTC). However, the role of prophylactic CLND in the treatment of clinically lymph node-negative (cN0) cases remains controversial.

Aim: The aim of the study is to examine the risk factors predictive of central compartment lymph node metastasis (CLNM) in patients with PTC who underwent prophylactic CLND in cN0 patients.

Methods: Two hundred and sixty-four patients who underwent total thyroidectomy (TT) + prophylactic CLND between January 2012 and December 2016 for cN0 PTC were included in this study. Age, sex, histopathological diagnosis, tumor size, the number of harvested CLNs, multifocality, tumor localization, tumor bilaterality, the presence of chronic thyroiditis (CT), lymphovascular invasion (LVI), and extracapsular extension (ECE) were evaluated as the risk factors affecting CLNM.

Results: CLNM was found in 102/264 patients (38.6%). There was a statistically significant difference between the two groups in terms of age, gender, tumor size, the number of harvested CLNs, tumor multifocality, and the presence of LVI. Logistic regression analysis was performed to investigate the effects of these variables, which were found to have statistically significant difference between the groups, on the occurrence of CLNM. Age, gender, tumor size, and LVI were found to cause CLNM.

Conclusion: CLNM rate is high in PTC. Because prophylactic CLND is still a controversial topic, it may be an option for surgeons planning to perform selective CLND, to pay attention to certain risk factors.

Aim: To minimize discomfort in the occlusal region and safeguard the opposing tooth, CAD-CAM materials should have wear characteristics that are comparable to those of real teeth. This research aimed to assess, using digital scans, the volumetric changes resulting from post-functional wear in prosthetic restorations made with various ceramic blocks that enable single-session applications in CAD-CAM systems.

Materials and methods: Three types of ceramic blocks were performed: hybrid (Lava Ultimate), feldspathic (Vita Mark II), and lithium disilicate (IPSe.max Cad). Digital scans were acquired from 10 patients from each group, and the volumetric losses in 6 months of wear were calculated in 3-Matic software. Additionally, a statistical analysis was performed to determine the correlation between the materials' hardness and wear volume losses.

Results: Volume loss was measured with IPSe.max Cad, Vita Mark II, and Lava Ultimate, from low to high. A statistically significant difference (P < 0.05) occurred between the IPS e.max Cad and Lava Ultimate groups; however, no such difference was observed between the other groups (P > 0.05). In addition, the materials' hardness was determined to have a significant impact on their wear behavior (P < 0.05).

Conclusion: IPSe.max Cad outperformed other ceramic blocks with little wear because the wear amount of these blocks, which are commonly used in prosthetic dental treatment applications, directly influences long-term clinical effectiveness.

Background: International migration of health workers is not a new phenomenon, but has been on the increase in recent times and may not change soon. This study assessed the migration intention of clinical students studying Dental Surgery in a Nigerian institution. It specifically assessed the reasons behind the intention and the plan to return afterwards.

Methods: This was a cross-sectional descriptive study of 136 clinical dental students at the University of Nigeria, Nsukka. Data on socio-demographic profile, migration intention, reasons for migration, and intention to return was collected using self-administered questionnaires. Prevalence of migration intention and the association between age, sex, class level, and intention to migrate was conducted using Chi square test. All the associated factors were considered significant if P < 0.05. Logistic regression analysis was conducted to determine factors that are associated with migration before housemanship.

Results: There were 61 (44.9%) male and 75 (55.1%) female study participants giving a response rate of 136 (90.7%) out of 150 questionnaires shared. Their age ranged from 21 to 32 years and the mean age was 24.32 ± 2.0 years. One hundred and fourteen (83.8%) of the study participants had the intention of migrating after graduation. Lack of facilities 105 (77.2%) and poor management of the health sector 104 (76.5%) were the major reasons for migrating.

Conclusion: Majority of the students have the intention of migrating to other countries and a quarter do not intend to return. Poor management of health sector and the desire to gain clinical experience were major factors that affected migration intention.

Background: The prevalence of chronic diseases is becoming a global health problem requiring urgent treatment and intervention to achieve quality improvement. The number of mortality, and poor adherence have increased over time among elderly.

Aims: To identify factors associated with adherence among elderly with chronic diseases with focus on beliefs about medicine in underserved populations, Indonesia.

Methods: An observational multicenter cross-sectional survey was conducted among elderly who diagnosed with chronic diseases and received medication for over six months, and attended healthcare centers. We applied binary logistic regression to assess associations of sociodemographic factors, medication beliefs, and adherence.

Results: Among 574 chronic patients selected from three primary healthcare centers, more than two-thirds showed non-adherence to medication. Additionally, over half were female (63.9%), have comorbidity (57.5%), and non-Papuans (54.4%). Multivariate analysis showed that being old (adjusted OR, aOR: 1.028 [95% CI, 1.009-1.046]), beliefs on BMQ-concern (aOR: 1.091 [95% CI, 1.002-1.187]), and had income less than 5K IDR(aOR: 3.630 [95% CI, 1.441-9.148] increased the likelihood of adherence. Being Moslem (aOR: 0.535 [95% CI, 0.302-0.949] decreased the likelihood of adherence.

Conclusions: In conclusion, to improve adherence levels, healthcare providers must repeat the concern on side effects of medication during visiting healthcare facility. In addition, healthcare providers should be able to identify religious practices or ritual practices are found in their area. These might affect to their behavior on taking medication. Additionally, empowering health providers including pharmacist may help patients to provide structural and functional support for those with chronic diseases.

Background: The prevalence of tuberculosis (TB) in elderly populations is increasing, primarily due to age-related comorbidities that affect treatment tolerance and clinical outcomes.

Aim: This study investigated the incidence and types of adverse drug reactions (ADRs) in aging individuals with active pulmonary TB addressed by first-line anti-TB drugs and to assess their impact on clinical outcomes.

Methods: A retrospective analysis was conducted on 375 elderly individuals with active pulmonary TB. The incidence and types of ADRs to anti-TB drugs were assessed, and quality of life (QOL) was measured using the WHOQOL-BREF scale both pretreatment and posttreatment. Risk factors for ADRs were examined using univariate and multivariate logistic regression analyses.

Results: Among the study participants, those with congestive heart failure were more common in the 70-80 age group, while neurological diseases were more prevalent in those over 80 years old. The overall incidence of ADRs increased with age, peaking at 56.76% in individuals aged 80 and older. The most common ADRs included gastrointestinal, neurological, and dermatological reactions. Advanced age, male sex, respiratory failure, and higher rifampicin dosages were identified as significant risk factors for ADRs. Although posttreatment QOL improved across all age groups, the improvement was less pronounced in the oldest group.

Conclusion: In elderly TB patients, factors, such as age, sex, respiratory failure, and drug dosage, significantly influence the incidence of ADRs. Tailored treatment strategies and enhanced monitoring are essential to optimize treatment outcomes and improve QOL in this vulnerable population.

Background: Health literacy plays a pivotal role in enabling individuals to access, comprehend, and apply health-related information to make informed decisions. In maternal and newborn health, adequate health literacy is essential for promoting healthy behaviors and outcomes.

Aim: This study aimed to evaluate the health literacy levels of pregnant women and their readiness for newborn hygienic care, and to examine associations with sociodemographic characteristics.

Methods: This cross-sectional study included 716 pregnant women aged 18-50 years who applied to the Gynecology and Obstetrics Outpatient Clinics of Konya City Hospital between January and July 2023. Data were collected using a sociodemographic questionnaire, the Health Literacy Scale - Short Form, and the Scale for Pregnant Women's Readiness for Newborn Hygienic Care. Data were analyzed using SPSS.

Results: Higher health literacy levels were observed among participants with secondary or higher education, urban residence, nuclear families, and healthy lifestyle behaviors. Similarly, greater readiness for newborn hygienic care was associated with having children, a healthy diet, and prior education on baby care. A significant positive correlation was found between health literacy and readiness scores.

Conclusion: The study highlights a positive relationship between health literacy and preparedness for newborn care among pregnant women. These findings emphasize the importance of targeted educational interventions to enhance maternal health literacy and improve newborn care practices. Integrating health literacy components into prenatal education may contribute to better maternal and child health outcomes.

Objective: This study aimed to evaluate the diagnostic accuracy of serum calprotectin as a potential biomarker in patients with acute appendicitis and to assess its correlation with clinical and laboratory parameters.

Methods: A prospective case-control study was conducted over a 1-year period, including 60 consecutive emergency department patients with confirmed acute appendicitis and 30 healthy volunteers. Serum calprotectin levels were measured and compared in both groups. The relationship between calprotectin levels and Alvarado scores, appendix diameter (measured by imaging), and white blood cell (WBC) counts was analyzed using the Pearson correlation test.

Results: The mean serum calprotectin level was significantly elevated in patients with acute appendicitis compared to healthy controls (626.2 ± 74.8 pg/mL vs. 40.6 ± 8.0 pg/mL, P < 0.001). No significant correlation was observed between serum calprotectin levels and Alvarado scores (r = -0.202, P = 0.122), appendiceal diameter (r = -0.182, P = 0.164), or WBC count (r = 0.033, P = 0.803). Receiver operating characteristic curve analysis revealed that serum calprotectin had a high diagnostic performance, with a cutoff value of 41.85 pg/mL yielding 95% sensitivity and 99.96% specificity (AUC: 0.957).

Conclusion: Serum calprotectin demonstrates high diagnostic accuracy in differentiating acute appendicitis from healthy controls, suggesting its potential utility as a novel biomarker in clinical practice. Further large-scale studies are warranted to validate its role in distinguishing complicated versus uncomplicated cases and its integration into diagnostic algorithms.

Background and aim: Recent studies have demonstrated that hyoscine-n-butylbromide has an antiemetic effect. We aimed to compare the effects of hyoscine-n-butylbromide and ondansetron on postoperative nausea-vomiting (PONV) and pain after laparoscopic cholecystectomy.

Methods: In this randomized study, a total of 134 patients between 18 and 65 years, who underwent laparoscopic cholecystectomy, were divided into two groups, and their demographic data were recorded. After routine monitoring, induction was performed with propofol, fentanyl, and rocuronium, then sevoflurane, and remifentanil were used for maintenance. After gallbladder removal, IV infusion of 1000 mg paracetamol and 1.5 mg/kg tramadol was administered to the patients. Simultaneously, 20 mg hyoscine-n-butylbromide (HBB) in 100 ml saline was administered in Group-HBB, and 4 mg ondansetron infusion in 100 ml saline was administered in Group-O. The patients were followed up in terms of nausea and vomiting, and pain at the postoperative 15th and 30th minutes and at the 3rd, 6th, 12th, and 24th h.

Results: Total PONV rate was found to be 38%. In the 24-h follow-up of the patients, PONV was observed at least once in 26 (39.4%) patients in Group-HBB, and in 25 (36.7%) patients in Group-O, and there was no difference between the two groups. Scores of PONV, antiemetic use rates, VAS scores, and analgesic use rates were similar during the 24-h follow-up.

Conclusion: The effects of hyoscine-n-butylbromide and ondansetron on PONV and pain are similar in laparoscopic cholecystectomy. In laparoscopic cholecystectomies, hyoscine-n-butylbromide is a good alternative for PONV prophylaxis in eligible patients.

Purpose: Costoclavicular block is a regional anesthesia technique that involves targeting the brachial plexus in the proximal infraclavicular fossa. It can be applied via a lateral or medial approach. This randomized study aimed to compare the anesthetic efficacy and block dynamics of both approaches.

Materials and methods: Eighty-eight patients undergoing upper extremity surgery were randomly assigned to either the medial (Group M, n = 44) or lateral (Group L, n = 44) approach. The procedures were performed under ultrasound guidance. Both groups received 20 mL of local anesthetic (10 mL of 2% lidocaine and 10 mL of 0.5% bupivacaine) via an in-plane technique. In Group M, the needle was directed medially to laterally, and in Group L, it was directed laterally to medially, with the anesthetic injected at the three-cord midpoint. Block dynamics and complications were recorded. A blinded researcher assessed sensory and motor block onset every 5 minutes for 30 minutes. Surgeon-perceived anesthesia quality, additional analgesia needs, and patient satisfaction were recorded.

Results: Surgical duration, procedure type, and anesthesia onset time were similar (Group M: 5.79 ± 2.14 min; Group L: 5.56 ± 1.93 min). The ultrasound scanning time was longer in Group L, but the total block performance time was not significantly different (P > 0.05). In Group M, the needle-pleura distance was greater, and the motor block onset time was shorter (P < 0.05). No significant differences were found in terms of complications, additional analgesia needs, and patient and surgeon satisfaction (P > 0.05).

Conclusion: The medial approach demonstrates anesthetic efficacy comparable to that of the lateral approach.

Background: Chronic subdural hematoma (CSDH) is a condition that is frequently observed in the elderly population and may lead to severe neurological outcomes.

Aim: This study aims to comprehensively examine the treatment strategies by analyzing the effectiveness of surgical methods, patient outcomes, and recurrence rates in the management of CSDH.

Method: A retrospective analysis was conducted on 202 patients diagnosed and treated for CSDH at our clinic between January 2017 and January 2024. Data on patient demographics, history of trauma, anticoagulant medication use, surgical approaches, and postoperative complications were thoroughly analyzed.

Results: The most commonly employed surgical method was unilateral burr-hole craniostomy (56.9%), followed by bilateral burr-hole craniostomy (30.2%) and craniotomy (12.9%). The mean patient age was 63.06 ± 21.01 years. Moreover, 40.6% of patients had a history of trauma, and 39.1% were on anticoagulant therapy. The recurrence rate was 9.4%, with no significant differences between surgical methods. Postoperative mortality was found to be 2.0%.

Conclusion: Individualized surgical approaches and multidisciplinary treatment strategies play a critical role in the successful management of CSDH. While burr-hole craniostomy can be safely conducted in cases of noncomplex CSDH, craniotomy should be considered for complex CSDH characterized by large hematomas and prominent membrane structures or in cases of recurrence. Even though no significant differences in postoperative outcomes were observed regarding drain placement, subgaleal drains can be safely utilized in those undergoing burr-hole craniostomy.