Nigerian Journal of Clinical Practice最新文献

Aim: This pilot study aimed to evaluate the impact of bimaxillary orthognathic surgery on olfactory function.

Methods: A total of 12 adult patients (7 male, 5 female; mean age 24.5 ± 5.6 years) who underwent bimaxillary orthognathic surgery for Class III malocclusion were included. Olfactory function was assessed preoperatively (T0), 1 month postoperatively (T1), and 3 months postoperatively (T2) using the T-Nasal Obstruction Symptom Evaluation (T-NOSE) scale for nasal obstruction symptoms and the Sniffin' Sticks Threshold, Discrimination, Identification (TDI) test for olfactory performance.

Statistical analysis used: Statistical analysis was performed using repeated measures analysis of variance with a significance level of P < 0.05. Pairwise comparisons were conducted using Bonferroni-corrected post-hoc tests to control for multiple comparisons.

Results: The T-NOSE scale showed a significant reduction in nasal obstruction symptoms between T0 and T2 (P < 0.05). The Sniffin' Sticks TDI scores significantly improved between T0 and both T1 and T2 (P < 0.05). Specifically, the threshold test showed statistically significant differences between the preoperative and both postoperative time points (T0-T1 and T0-T2). Although no statistical significance was found in the Discrimination and Identification subtests, a trend toward improvement was observed post-surgery.

Conclusion: Bimaxillary orthognathic surgery appears to have a positive influence on olfactory function, as observed by improvements in both subjective (T-NOSE scale) and objective (Sniffin' Sticks TDI) measures. However, these observations should be interpreted with caution due to the small sample size and limited follow-up period.

Background: Pyloric stricture in children after ingestion of corrosive substances is a serious public health issue bordering on poor parental supervision, inappropriate storage of harmful corrosives in the home, and poor socioeconomic status. It is worthy of note that in the two reported cases where the corrosives were acids the pylorus was affected sparing the esophagus and stomach.

Objective: To highlight the danger of use of recycled water and beverage bottles for storage of corrosive substances in the home and to indicate that surgical bypass of the pylorus is often inevitable when stricture occurs.

Case summaries: We report 2 patients aged 3 years and 7 months, respectively, who drank corrosive substances stored in recycled water and beverage bottles. In both patients, pyloric stricture occurred after 6 weeks with severe systemic complications. Diagnosis was established by upper GI-contrast radiography, and the treatment with gastro-jejunostomy was satisfactory in both cases.

Conclusion: Pyloric stricture from ingestion of corrosive substance inappropriately stored in the home is a cause of significant morbidity and potential mortality. Bypass surgery is satisfactory but efforts at prevention are highly recommended.

Background: Parallel to the global obesity epidemic, the incidence of gestational diabetes mellitus (GDM) has been increasing, constituting a significant public health concern.

Aim: In our study, we aimed to research the ability to determine the risk factors for GDM with anthropometric measurements of pregnant cases.

Methods: This study was conducted cross-sectionally and prospectively. Body weight (BW) and body mass index (BMI) before pregnancy; BW, BMI, neck circumference (NC), waist circumference, and hip circumference (HC) at ≤14 gestational weeks; BW and BMI values, 75 g oral glucose tolerance test (OGTT) at 24-28 gestational weeks, were analyzed.

Results: From 415 participant pregnant cases in the first trimester, 101 pregnant cases completed the study. Participants were divided into two groups as those diagnosed and not diagnosed with GDM. The BW (P = 0.034) before pregnancy; BW (P = 0.021), BMI (P = 0.003), NC (P = 0.035), HC (P = 0.026) and neck circumference/height ratio (NHtR; P = 0.040) in the first trimester and BW (P = 0.008) and BMI (P = 0.013) in the OGTT period were statistically significantly higher for those with GDM compared to those without GDM. In the logistic regression analysis model, pre-pregnancy BW (Cox and Snell Nagelkerke R2: 0.127, OR 95%, Cl: 0.849 (0.740-0.975), P = 0.020) and first trimester BW (Cox and Snell Nagelkerke R2: 0.127, OR 95%, Cl: 0.849 (0.740-0.975), P = 0.023) were identified to be independent determinants of GDM. A 1 unit increase in pre-pregnancy BW increased the risk of GDM by 0.849 times (P = 0.020), while a 1 unit increase in first trimester BW increased the risk of GDM by 1.158 times (P = 0.033).

Conclusion: Pre-pregnancy BW and BMI values and first trimester NC, NHtR, BW, and BMI values may be reliable measurement methods to predict GDM.

Background: Pharmacogenetics has become increasingly important in pharmaceutical practice.

Aim: This study assessed pharmacists' knowledge, perceptions, and confidence regarding the application of pharmacogenetics in Saudi Arabia. It also explored their readiness to integrate pharmacogenetics into practice and identified barriers to implementation.

Methods: A pre-validated questionnaire consisting of six sections was used: demographics; pharmacogenetic training and counseling; knowledge, perception, and confidence toward pharmacogenetic application; preferred learning methods for future pharmacogenetic education; and perceived barriers to implementation.

Results: The survey was conducted in August 2023 and included 757 participants. Male pharmacists constituted the majority of respondents (62.8%), and the median age was 34 years. The median scores were 3 for knowledge (71% demonstrated good knowledge), 5 for perception (79% expressed positive perceptions), and 2 for confidence (only 44% reported high confidence). Pharmacists who had counseled patients on pharmacogenetic testing results were significantly more likely to have higher knowledge [odds ratio (OR): 2.376, 95% confidence interval (CI): 1.181-4.778], more positive perceptions (OR: 4.331, 95% CI: 1.514-12.392), and greater confidence. In contrast, pharmacists working in general or other specialty areas had lower perception scores (OR: 0.531, 95% CI: 0.305-0.924). High confidence was also associated with older age and prior pharmacogenetic training.

Conclusion: These findings suggest that pharmacists in Saudi Arabia are ready to incorporate pharmacogenetics into practice and that patient counseling plays a key role in enhancing their knowledge, perceptions, and confidence.

Background: Orthodontic treatment relies on accurate dental arch models for diagnosis and treatment planning. Traditional plaster model preparation, though widely used, is associated with potential inaccuracies, patient discomfort, and inefficiency.

Aims: This study aimed to compare the accuracy, time consumption, and patient comfort between conventional plaster model preparation and intraoral 3D scanning for orthodontic dental arch modeling.

Materials and methods: This comparative study included 60 participants. Each underwent both plaster model fabrication and intraoral 3D scanning. Model accuracy was evaluated using 3D root-mean-square error after registration. The time required for each method and patient comfort levels (rated as comfortable, generally comfortable, or uncomfortable) were recorded and statistically analyzed.

Results: The accuracy of intraoral 3D scanning (0.050 ± 0.001 mm) was not significantly different from that of plaster models (0.050 ± 0.011 mm) (P = 0.406). However, intraoral scanning was significantly faster (8.297 ± 0.554 min vs. 20.240 ± 1.516 min, P < 0.001) and resulted in significantly higher patient comfort (P < 0.001).

Conclusion: Intraoral 3D scanning technology demonstrates comparable accuracy to traditional plaster modeling while offering substantial advantages in operational efficiency and patient comfort, positioning it as a superior standard for dental arch modeling in orthodontics.

Background: Human papillomavirus (HPV) infection is a leading cause of anogenital warts and cervical cancer. Despite the proven effectiveness of the HPV vaccine in preventing HPV-related diseases, vaccine uptake remains suboptimal.

Aim: This study aims to assess pediatricians' knowledge, attitudes, and practices regarding HPV-related diseases and vaccination to identify factors influencing vaccine recommendations.

Methods: A cross-sectional, questionnaire-based study was conducted with 198 pediatricians. The survey comprised questions related to demographic characteristics, knowledge of HPV-related diseases and vaccines, and attitudes of pediatricians toward HPV vaccination. Statistical analyses included the Chi-square test, one-way ANOVA, and logistic regression to identify predictors of vaccine recommendation.

Results: Among the participants, 84.8% recommended the HPV vaccine, with 45% doing so consistently. Pediatricians who recommended the vaccine had significantly higher knowledge scores than those who did not (P < 0.05). Key barriers to recommending the vaccine included insufficient knowledge (51.7%) and the absence of the HPV vaccine in the National Vaccination Schedule (34.5%). Logistic regression revealed that adequate knowledge of HPV-related diseases (β = 1.84, P = 0.021) and the belief in the necessity of the vaccine (β = 0.95, P < 0.001) were significant predictors of recommending HPV vaccination.

Conclusion: Pediatricians with higher knowledge levels are more likely to recommend HPV vaccination. Enhancing pediatricians' knowledge through targeted training and education programs may improve vaccine uptake, contributing to the prevention of HPV-related cancers.

Background: Asthma is a common chronic respiratory condition affecting children all over the world. Challenges are encountered to access and implement standard asthma management in different countries and geo-locations.

Aim: To assess and compare the management of childhood asthma in urban and rural settings in Enugu State, Nigeria."

Methods: This study was conducted in Enugu State. The minimum sample size was calculated to be 480 with an attrition rate of 10%. The multistage sampling method was used to select two local government areas - Enugu-North (urban) and Awgwu (rural) and further selected two schools each from each of the geo-locations. Ethical approval was obtained for the study. Data was analyzed using Statistical Package for the Social Sciences (SPSS) version 23 with mainly Chi-square statistics and P < 0.05.

Results: Urban participation rate was 65.1%, while rural was 93.9%. Equal sex distribution was noted in the urban setting, while a male preponderance of 2.4:1 was noted in rural. The mean age in urban was 8.53 ± 1.5 years, while in rural, it was 10.04 ± 2.0 years. Doctor or Nurse's diagnosis of asthma was low (urban - 35.7%; rural - 10.7%). Counseling on patients' asthma condition-urban (60.7%) compared to rural (11.1%). The written asthma management plan was 17.9% urban and 0% rural. Use of inhalation short-acting beta-agonist was 21.4% urban and 3.7% rural. Inhalation corticosteroid was 0% in both settings. Oral corticosteroid, spacer device, nebulizer, and controller medications were only in urban 21.4%, 17.9%, 28.6%, and 14.3%, respectively. Regular follow-up visits were 14.3% in urban and 7.4% in rural.

Conclusion: Standard asthma management adherence was poor, especially in the rural setting. A scale-up intervention training and awareness are needed for healthcare providers and the public. Materials and medications should be made available, accessible, and affordable for both geo-locations.

Background: Asphyxia by hanging is caused by the constricting force of a ligature encircling the neck, with gravity pulling the body downward. Postmortem examinations should focus on cartilaginous and soft tissues in the neck region.

Aim: The present study aims to demonstrate the effect of various variables such as age, sex, height, weight, and BMI on postmortem findings in cartilaginous and bone tissues in the neck region.

Materials and methods: The study is a retrospective descriptive study covering 248 cases of death by hanging.

Results: The mean age of the cases was 39.8 years, and 69.8% (n = 173) of the cases were male. Thyroid cartilage fracture was observed in 98 (39.5%) cases and hyoid bone fracture in 80 (33.3%) cases. Hyoid bone fractures were 4.4 times more frequent in women (P < 0.05). Although there was no significant difference between the number of thyroid cartilage fractures and sex (P = 0.274). There was a significant difference in terms of weight (P = 0.004) in cases with thyroid fracture and in weight (P = 0.001) and height (P = 0.037) in cases with hyoid fracture. A significant difference was observed in BMI in the occurrence of thyroid cartilage fractures (P < 0.05).

Conclusion: This study is one of the largest series in the literature and is an important study that reveals the statistical significance of neck cartilage and bone tissues in autopsy results. When investigating neck cartilage and bone fractures in cases of death by hanging, the attending physician should consider the physical condition of the individual.

Corneal perforations following an acute suppurative ulcerative keratitis are usually technically challenging to fix, particularly when the corneal defects are very large. We present an alternative surgical technique using a combined tenon patch graft (TPG) and a conjunctival flap. A 33-year-old male presented with 8 and 10 mm paracentral corneal defects in the right and left eyes, respectively, following a 3-week history of bilateral suppurative ulcerative keratitis. A tenon's tissue was harvested from each eye and sutured to cover the perforation, and a conjunctival pedicle flap was then created and advanced over the tenon graft. Parenteral and topical medications were administered postoperatively. Serial clinical follow-up was conducted to document healing. At first day postsurgery, the uncorrected visual acuity (UCVA) was 6/60 and the anterior chamber was formed. At discharge, conjunctivo-tenon graft/flap was intact, the eyeball was stable, and UCVA was 6/36 and 6/24 in the right eye and left eye, respectively. By 3 months postsurgery, the globe and conjunctivo-tenon graft/flap had further stabilized with UCVA of 6/18 and 6/12, respectively. At 6 months, the conjunctivo-tenon graft/flap was stable with UCVA of 6/18 and 6/12, respectively. With spectacle lenses correction, the vision was 6/9 (right eye) and 6/6 (left eye). Combined autologous TPG and conjunctival advancement pedicle flap is a viable alternative in restoring the structural and functional integrity of an eye following a peripherally located large corneal perforation.

Background: Violence by intimate partners is a serious public health problem that negatively affects women's physical, emotional, and social well-being. In Turkey, factors such as traditional gender roles, economic inequalities, and cultural norms contribute to the continuation of this form of violence. Understanding how such experiences influence women's psychological strength is essential for effective support and prevention strategies.

Aim: This study aims to determine the relationship between domestic violence against women, the factors affecting it, and levels of psychological resilience among women in Turkey.

Patients and methods: We conducted this research with 425 women residing in Tunceli, Turkey. In this cross-sectional, relational study, data were collected using a personal information form, the Violence Against Women Scale (SVAWS), and the Brief Resilience Scale (BRS). The relationship between scores obtained from the scales was determined through correlation and linear regression analyses. Cronbach's alpha coefficient was calculated to assess the reliability of the scales.

Results: The average age of the women who participated in the study was 41.22 ± 12.93 years. Approximately one in four women (24.5%) experienced violence, with the primary reasons for violence being financial problems (40.4%) and issues caused by family members of the couple (28.8%). A significant negative correlation was found between the SVAWS and BRS scores (r = -0.228, P < 0.01). Additionally, there was a significant negative relationship between all subdimensions of the violence scale and psychological resilience.

Conclusion: The study found that as the level of violence experienced by women increased, their level of psychological resilience decreased.