Nigerian Journal of Clinical Practice最新文献

Background: Benign prostatic hyperplasia unresponsive to medical treatment is an important problem for elderly patients. Although the gold standard surgical treatment is monopolar transurethral resection of the prostate (MTURP), postoperative complications are still a concern.

Aim: The aim of this study was to determine which transurethral prostate resection (TURP) methods are more effective and safer in elderly patients.

Methods: Patients who underwent TURP in our clinic between 2012 and 2021 were analyzed retrospectively and divided into three groups according to their ages. Patients were treated with MTURP (n = 169) and bipolar transurethral resection of the prostate (BTURP) (n = 1152). Pre- and post-operative data for age groups were compared according to TURP methods.

Results: The resection speed in the BTURP method was statistically significantly faster in groups 2 and 3 (P < 0.05). Although not statistically significant (P > 0.05), there was a numerically smaller decrease in hemoglobin (Hb) value in group 2 and a numerically greater decrease in post-voiding residual (PVR) volume in groups 1 and 3 in the BTURP method. The increase in maximum urine flow (Qmax) was significantly higher only in group 2 (P = 0.032), but it was numerically higher in all groups in the BTURP method.

Conclusion: The results of this study showed that BTURP was at least as effective and safe as MTURP in geriatric patients and also better in terms of Hb decrease, resection speed, Qmax increase, and PVR volume decrease.

Background: Type 2 diabetes is a common chronic disease that continues to increase in prevalence globally and is a major healthcare burden. Diabetes and hypertension frequently occur concurrently, and the use of antihypertensive agents is common in diabetic patients. One antihypertensive agent, verapamil, has tentatively shown potentially positive effects on glycemic control in assorted pre-clinical models.

Aim: To evaluate the effect of verapamil on glycemic control in hypertensive type 2 diabetic patients.

Methods: Type 2 diabetic hypertensive patients were recruited from King Fahad Medical City, Riyadh, KSA, to receive oral verapamil therapy. Blood pressure and glycometabolic parameters, including fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), C-peptide, and homeostatic model assessment insulin resistance (HOMA-IR), were monitored at baseline and after 6 months of verapamil therapy.

Results: Thirty-five patients (16 male, 19 female) with a mean age of 57.2 years were recruited. The use of verapamil was associated with non-significant decreases in HbA1c, FPG, C-peptide, and HOMA-IR. However, a sub-group of 17 participants showed a decrease in HbA1c that was ≥0.5%. Univariate logistic regression showed that baseline BMI, HOMA-IR, and C-peptide were significantly (P < 0.05) associated with HbA1c reductions of ≥0.5%.

Conclusion: Verapamil is metabolically neutral and allows the stabilization of glycometabolic parameters in type 2 diabetic individuals. Additional research exploring the mechanism behind the variable response to verapamil therapy is warranted.

Background: Drawing is an effective tool for evaluating dental anxiety and communicating with children.

Aim: The aim of this study was to evaluate children's drawings as a measure of dental anxiety with two different assessment methods and their possible relationship with age, gender, and previous dental visits before and after education.

Methods: A total of 129 children aged 4-6 years old were requested to draw a picture of the dentist and dental office perception before and after a 20-minute dental education at selected Kindergartens. Drawings were evaluated according to Child Drawing: Hospital (CD: H) and Massoni methodologies.

Results: The difference in drawing groups between before and after oral health education was found to be statistically significant which meant children had less anxiety after education (P = 0.001). A statistical difference was observed in the scores before and after the education in the group of children who had previous dental visits and those who did not (P = 0.001). Statistically significant differences were observed in both groups of children who had previous dental visits and those who did not (P = 0.002).

Conclusion: Oral health education at younger ages is effective in overcoming dental anxiety and improving the positivity of dental perception. Drawing is a suitable assessment tool for learning about the child's notions and feelings.

Context: Pregnancy may exacerbate the frequency and severity of some dental problems. However, most pregnant women avoid going to the dentist.

Aims: To examine the oral hygiene and dental care behaviors of women during pregnancy, to measure their knowledge levels, to reveal their oral and dental health literacy status, and their beliefs about treatment.

Settings and design: The study was conducted for a period of 1 month with pregnant women over the age of 18 who presented to the obstetrics outpatient clinic and agreed to participate in the study and who had no known anomalies or complications.

Methods and material: A survey was completed by face-to-face interviews with 317 pregnant women of different ages and gestational weeks. Participants were asked questions regarding their sociodemographic characteristics, pregnancy characteristics, oral hygiene-related beliefs, behaviors, and knowledge levels.

Statistical analysis used: The data obtained in the study were analyzed with SPSS 21.0 program. Since the kurtosis and skewness values were between +3 and -3, parametric tests were used.

Results: In total, 317 pregnant women between the ages of 18 and 43 participated in the study. The most common beliefs are listed as; babies receive the necessary calcium from the teeth, antibiotics given during dental treatment harm the baby, and panoramic radiography taken during treatment harms the baby. 91.5% of the participants did not visit the dentist after planning a pregnancy, and 89% of them did not visit the dentist during pregnancy. The most common reason not to visit the dentist is not having a dental problem. The rate of knowing that dental infections during pregnancy will affect the baby is 50.5%.

Conclusions: In the present study, it is seen that pregnant women do not have adequate oral hygiene. The reasons were listed as various false beliefs and lack of sufficient knowledge. Health professionals should provide information about oral hygiene to pregnant women and direct them to the dentist.

Background: Studies have been conducted to evaluate changes in hemodynamics, postoperative bleeding, and pain in pediatric dental patients receiving general anesthesia (GA). However, a limited number of studies have evaluated the effects of local anesthetics (LA) on tooth extraction procedures during GA. There is no consensus in the literature regarding LA application in the perioperative period for dental treatments performed within the scope of GA.

Aim: This study aimed to determine the retrospective physiologic effects of fluctuations in vital signs and postoperative bleeding in children who did or did not receive LA for tooth extraction under GA.

Methods: A retrospective evaluation of 77 patients aged 5.16 ± 1.85 years who had the extraction of primary posterior teeth with or without LA under GA were reviewed in the post-anaesthesia care unit (PACU) for postoperative bleeding and the effects of intraoperative LA on fluctuations in postoperative parameters such as mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (SpO2), respiratory rate (RR), and the end-tidal carbon dioxide (EtCO2). These were compiled from the patient records of the procedures.

Results: Significant differences between the baseline and peak MAP (P < 0.001), HR (P = 0.011), and EtCO2 (P = 0.002) were noted in children without LA compared to those who had LA. In addition, substantial variations were observed between the baseline and peak values for MAP (P < 0.001) and HR (P = 0.037) in children who had tooth extraction in the mandibular region. Statistically significant differences were noted between the baseline and peak values for patients who did not receive LA before the extraction of the first primary molar in terms of MAP (P < 0.02) and EtCO2 (P = 0.032). Similarly, significant differences in MAP (P < 0.02) and EtCO2 (P = 0.034) were noted in the extraction of the second primary molar. In addition, there was a significant difference in bleeding based on the number of tooth extractions in those who did not receive LA (P = 0.020).

Conclusion: This study showed that in children who underwent tooth extraction under GA, additional LA application minimized changes in HR, MAP, and EtCO2, whereas a lack of LA application produced significant fluctuations from baseline to peak values of HR, MAP, and EtCO2. In addition, LA application reduced postoperative bleeding.

Background: Kidney transplantation is one of the life-saving therapies for patients with end-stage renal disease, which affects a person's psychological, social, and physical well-being. How transplanted patients perceive their illness and their body can affect their physical and psychological recovery.

Aim: This qualitative study was designed to evaluate self-esteem and body image in kidney transplant patients.

Methods: The study involved 16 female renal transplanted patients. Data were collected using a two-part interview form developed by the investigators in accordance with the literature. We used Lundman's method to transcribe the interviews and coded the data from the interviews. The results of the study were discussed using the themes. The first three interviews were entered into MAXQDA, and then, additional interviews were analyzed.

Results: Six main themes and 15 subthemes were generated based on the thematic analysis of the interviews with participants about body image and self-esteem. Themes included body acceptance, changes in body image, deterioration of social relationships, changes in self-esteem, spousal concerns, and organ perceptions. This study collected detailed data on body image, self-esteem, social relationships, and spouse/partner relationships after kidney transplantation.

Conclusion: The change in participants' body image and self-esteem after kidney transplantation caused having negative feelings regarding sexual life, relationships, and social life and feeling unfamiliar with the transplanted organ.

Objectives: This study aims to assess the diagnostic accuracy of an artificial intelligence (AI) system employing deep learning for identifying dental plaque, utilizing a dataset comprising photographs of permanent teeth.

Materials and methods: In this study, photographs of 168 teeth belonging to 20 patients aged between 10 and 15 years, who met our criteria, were included. Intraoral photographs were taken of the patients in two stages, before and after the application of the plaque staining agent. To train the AI system to identify plaque on teeth with dental plaque that is not discolored, plaque and teeth were marked on photos with exposed dental plaque. One hundred forty teeth were used to construct the training group, while 28 teeth were used to create the test group. Another dentist reviewed images of teeth with dental plaque that was not discolored, and the effectiveness of AI in detecting plaque was evaluated using pertinent performance indicators. To compare the AI model and the dentist's evaluation outcomes, the mean intersection over union (IoU) values were evaluated by the Wilcoxon test.

Results: The AI system showed higher performance in our study with a precision of 82% accuracy, 84% sensitivity, 83% F1 score, 87% accuracy, and 89% specificity in plaque detection. The area under the curve (AUC) value was found to be 0.922, and the IoU value was 76%. Subsequently, the dentist's plaque diagnosis performance was also evaluated. The IoU value was 0.71, and the AUC was 0.833. The AI model showed statistically significantly higher performance than the dentist (P < 0.05).

Conclusions: The AI algorithm that we developed has achieved promising results and demonstrated clinically acceptable performance in detecting dental plaque compared to a dentist.

Background: The burden of perinatal asphyxia remains high in our environment and when asphyxia is severe, vital organs are affected, with resultant multiorgan hypoxic-iscahemic injury to the heart, the brain, adrenals and other organs.

Study aim: To evaluate for myocardial injury in asphyxiated term neonates with hypoxic ischaemic encephalopathy using serum cardiac troponin-I (cTnI).

Methods: The study was a hospital-based descriptive cross-sectional study involving sixty term asphyxiated neonates and sixty gestational age-and sex-matched controls. The subjects were term neonates with five-minute Apgar score ≤ 6 and HIE while the controls were healthy term neonates with five-minute Apgar score > 6. Five-minute Apgar score was utilized to classify asphyxia into mild, moderate and severe asphyxia. The degree of encephalopathy was determined by modified Sarnat and Sarnat criteria. The serum cTnI was measured in subjects and controls at 12-24 hours of life using Enzyme-linked immunosorbent assay technique. The serum bilirubin levels were also measured in participants to exclude hyperbilirubinemia.

Results: The median serum cTnI levels was significantly higher in the subjects (0.56ng/mL; 0.25-0.94ng/mL) than in the controls (0.50ng/mL; 0.00-0.67ng/mL), respectively; p=0.001. Similarly, the median serum cTnI level in HIE stage II (0.56ng/mL; 0.38-0.72ng/mL) or III (0.56ng/ml; 0.50-0.94ng/mL) was also significantly higher than the median value in HIE stage I (0.38ng/mL;0.25-0.72ng/mL) or in controls (0.50ng/mL; 0.00-0.67ng/mL); p<0.001. There was significant positive correlation between serum cTnI levels and severity of HIE in asphyxiated neonates (rs = 0.505, p < 0.001).

Conclusion: serum cTnI levels were elevated in severely asphyxiated neonates with HIE. The concentration of serum cTnI demonstrated significant positive correlation with HIE severity. Hence, the presence of HIE in asphyxiated neonates should prompt an evaluation for myocardial injury using serum cTnI. Any derangement noted should warrant instituting cardiovascular support in order to improve outcome and reduce asphyxia-related mortality.