Nigerian Journal of Clinical Practice最新文献

Background: Acute kidney injury (AKI) and the need for renal replacement therapy (RRT) are major complications in critically ill patients. The C-reactive protein (CRP)/albumin ratio (CAR) is a readily available biomarker reflecting systemic inflammation and nutritional status, but its predictive value for renal outcomes in the intensive care unit (ICU) remains uncertain.

Aims: To assess whether the CAR measured within the first 12 hours of ICU admission can predict the development of AKI and the need for RRT in critically ill patients.

Methods: This retrospective observational study was conducted in a tertiary intensive care unit and included 204 ICU patients without acute or chronic kidney failure at admission. CRP and albumin levels were measured within 12 hours of ICU admission. Patients with conditions affecting albumin levels were excluded. AKI and RRT development during ICU stay were recorded. Statistical analyses included the Mann-Whitney U test, Chi-square test, receiver operating characteristic (ROC) analysis for diagnostic performance, and multivariate logistic regression for independent predictors.

Results: AKI occurred in 55.9% and RRT was required in 21.6% of patients. Patients requiring RRT had lower albumin levels and higher acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores. Although CAR was slightly elevated in patients with AKI or RRT, it was not independently associated with these outcomes (RRT: OR 0.97, AUC 0.575; AKI: OR 1.03, AUC 0.643).

Conclusions: The CRP/albumin ratio was not an independent predictor of AKI or RRT. Its clinical usefulness may improve, when combined with established illness severity scores for renal risk stratification in ICU patients.

Background: Sexual harassment allegations against physicians undermine trust in healthcare and present significant ethical and legal challenges. While such issues are widely discussed in the context of professional conduct, systematic analyses of judicial decisions-particularly in non-Western settings-remain limited.

Aim: This study aims to analyze Turkish Supreme Court decisions involving sexual harassment allegations by physicians toward their patients, focusing on identifying patterns, associated risk factors, and ethical implications.

Methods: A total of 46 Supreme Court judgments (2009-2024) were identified using the Lexpera database, employing keywords such as "harassment by physician" and "harassment during medical examination." Each case was evaluated according to physician specialty, nature of the act (penetrative vs nonpenetrative), examination context, witness presence, and judicial outcomes (conviction, acquittal, or reversal).

Results: Most incidents occurred in public hospitals, and the majority of patients were female. Physicians most frequently accused belonged to family medicine, obstetrics and gynecology, and radiology specialties. Documentation of informed consent and the presence of witnesses was rare. Allegations often involved genital examinations performed without explicit consent. While 69.7% of local court decisions resulted in convictions, only 39.4% were upheld by the Supreme Court.

Conclusion: Clear communication, standardized informed consent procedures, and the presence of witnesses during sensitive examinations are essential in preventing both misconduct and false accusations. These findings underscore the ethical importance of transparency and institutional safeguards and highlight the need for proactive policies to protect both patients and physicians.

Background: Urinary retention (UR) can lead to both anatomical and functional derangement in the urinary system. Chronic kidney disease occurs when there is renal damage.

Aim: This study aims to determine the relationship between chronic UR (CUR), retained urine volume, and renal function among men with chronic and acute-on-chronic UR.

Methods: The study was a hospital-based prospective study of Nigerian men presenting with chronic or acute-on-chronic UR. Diagnosis of UR was made based on history and physical examination. The estimated glomerular filtration rate (eGFR) was calculated using the serum creatinine level. Retained urine volume was measured after an aseptic urethral catheterization. Spearman's rank correlation test was used for correlation analysis between CUR, retained urine volume, and renal function. A P value of < 0.05 was accepted as statistically significant.

Results: Fifty-six men met the inclusion criteria. Most of the patients were in the age range of 80-89 years. A total of 20 (35.7%) had acute-on-chronic UR, while 36 (64.3%) had CUR. The mean retained urine volume was 1500 ± 748.0 mL and 1100 ± 515.0 mL for the chronic and acute-on-chronic UR groups, respectively. Obstructive nephropathy occurred in 88.6% of the participants with CUR. There was a significant negative relationship between the eGFR and the volume of retained urine (r = -0.397, P = 0.002).

Conclusion: A high prevalence of obstructive nephropathy was observed among men with chronic and acute-on-chronic UR in this study.

Background: Split-thickness skin grafting (STSG) is a veritable reconstructive option for covering skin and soft tissue defects but donor site management remains a challenge. Attempts to improve STSG donor site care have been made using different methods and various dressing agents; however, there is no consensus on the standard method of donor site care.

Aim: This study aims to compare STSG healing rate using early versus late exposure of donor site dressing methods.

Methods: This study was conducted in Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Southeast, Nigeria. Forty patients were recruited for the study and assigned to two groups of 20 patients each by a simple random sampling method. Group A had late exposure of the donor site dressing, whereas Group B had early exposure of the donor site dressing. The percentage re-epithelialization rate on the 14th day and the duration for complete re-epithelialization for both groups were calculated. The results were analyzed using International Business Machine Corporation, Statistical Package for the Social Sciences, Chicago Illinois, USA. (IBM SPSS) Statistics for Windows version 26.

Results: The early exposure dressing method showed a faster re-epithelialization rate with a mean value of 98.15 (±4.92) compared with late exposure dressing methods with a mean rate of 70.95 (±13.22), which was statistically significant with a P value of 0.001. The duration for complete re-epithelialization was 13.80 (±4.63) days for the early exposure method and 29.40 (±6.25) days for the late exposure method. This is statistically significant with P < 0.001.

Conclusion: Management of STSG donor site by early exposure of the donor site dressing is associated with increased re-epithelialization rate and shortened duration for complete donor site healing.

Background: Oxygen-inhibited layer (OIL) is formed due to inadequate polymerization of resin composite (RC), which compromises its physical and mechanical properties.

Aim: This study focuses on analyzing the impact of different OIL control surface treatments on the color stability and microhardness of enamel shade RC.

Methods: Discs (n = 240) were prepared out of two different types of nanohybrid enamel shade RCs, G-aenial A'CHORD (group AC) and Beautifil II Enamel (group BT). After allotting 60 samples each for the two experiments on color stability using spectrophotometer and surface microhardness using Vickers microhardness tester, they were further divided into four subgroups of 15 each based on the OIL control surface treatments: glycerin (G), mylar strip (M), finishing and polishing (FP), and no treatment (NT).

Results: Group AC showed the least ∆E (color difference) values in subgroup M with statistical significance (one-way ANOVA; P = 0.001). However, group BT showed lesser ∆E in subgroups M and G (one-way ANOVA; P = 0.001). Between groups, AC showed significantly lower ∆ E and a higher mean hardness value (HV) than BT. The subgroup FP of both groups exhibited relatively high values (Tukey post-hoc; P = 0.001). The subgroup M showed the least ∆ E, and the subgroup FP showed the highest HV in both groups.

Conclusion: G-aenial A'CHORD showed relatively superior color stability and microhardness than that of Beautifil II Enamel. Finishing and polishing improved the microhardness of both the enamel shade RCs.

Background: Toxoplasma gondii is a common parasitic infection agent that, in its chronic phase, forms persistent tissue cysts in neuronal cells, potentially leading to neurological and behavioral alterations.

Aim: To investigate the role of chronic toxoplasmosis in human substance abuse and investigate its effect on dopamine levels, which is associated with substance abuse.

Materials and methods: The study was designed with a substance abuse group comprising 90 patients with substance addiction and a control group consisting of 75 individuals without substance addiction. The substance abuse group consisted of patients who were addicted to alcohol, cannabis, cocaine, heroin, or amphetamines. Anti-Toxoplasma gondii IgG and dopamine levels in the blood sera and anti-T. gondii immunoglobulin G (IgG) levels in the blood samples taken from the participants were analyzed via enzyme-linked immunosorbent assay.

Results: T. gondii IgG was detected in 52 (57.8%) of 90 patients in the substance abuse group and 22 (29.3%) of 75 patients in the control group. There was a statistically significant relationship between T. gondii positivity and substance addiction (P = 0.001). However, no correlation was found between T. gondii positivity and the subgroups for the addiction type, criminal offense, imprisonment, or suicide attempt. Dopamine levels were statistically different between the groups. In the pairwise comparison of the groups, the dopamine levels in the T. gondii-positive substance abuse group were lower than in the other three groups, and this was statistically significant.

Conclusion: In conclusion, the prevalence of T. gondii was higher in those with substance addiction than in those without. The fact that T. gondii alters dopamine levels was among the results. Since T. gondii can affect some behaviors of the host through changes in neurotransmitter levels, it was concluded that there is a significant relationship between T. gondii infection and substance abuse.

Background: Pregnancy and parity induce physiologic adaptations in maternal calcium and bone metabolism, yet their specific effects on mandibular trabecular architecture remain insufficiently characterized. Evidence on craniofacial bone across parity is limited and conflicting, underscoring the need to clarify whether parity relates to mandibular bone quality.

Aims: The main aim of this study was to evaluate the effect of parity on mandibular bone architecture using fractal dimension analysis (FDA).

Methods: Ninety-five healthy female subjects aged between 18 and 63 years were included in the study. Participants were divided into three groups based on the number of children: nulliparity (NP), multiparity (MP), and grand multiparity (GMP). Panoramic radiographs of the participants were analyzed by selecting three regions of interest (ROIs), each measuring 60 × 60 pixels: ROI-1, mandibular condyle; ROI-2, mandibular angle; and ROI-3, mandibular premolar region (1 mm below the root apex of the right first premolar).

Results: No statistically significant differences were observed in the fractal dimension (FD) values of the mandibular condyle, mandibular angle, or mandibular premolar regions among the NP, MP, and GMP groups (P = 0.935; P > 0.05; P = 0.961 > 0.05; P = 0.870 > 0.05).

Conclusion: This is the first study to assess the effect of parity on the mandibular bone. Investigating the relationship between parity and mandibular bone structure is important for understanding bone-related diseases such as periodontitis. The findings of this study indicate that parity does not influence the quality or architectural characteristics of the mandibular bone in women.

Background: Blood testing in the emergency department (ED) is critical for effective patient management. Hemolysis, a common preanalytical error, compromises laboratory results, increases workloads and resource utilization, and causes patient discomfort due to repeat testing.

Aim: This study evaluates the impact of Luer Lock adapters on hemolysis rates in ED blood samples, compared with the standard intravenous injector method. While prior studies suggest Luer Lock adapters reduce hemolysis, this investigation focuses on their performance in high pressure emergency settings, where hemolysis poses a persistent challenge to clinical decision making.

Methods: A prospective observational study was conducted at Ege University Hospital, including patients aged 18 and older requiring biochemistry testing. Blood samples were collected using both the standard injector method and BD Vacutainer Luer Lock® adapters. Hemolysis rates were assessed using the McNemar test, with statistical significance set at P < 0.05. A sample size of 210 was calculated, and data were analyzed using R software.

Results: Among 517 ED patients, the overall hemolysis rate was 12.4%. Hemolysis was more frequent with the Luer Lock method (12.4%) compared to the injector method (8.1%, P = 0.011). LDH hemolysis occurred in 98.4% of hemolyzed samples, and all potassium hemolysis cases coincided with LDH hemolysis. The Luer Lock method exhibited higher hemolysis rates for both LDH (12.2%) and potassium (5.2%) than the injector method (LDH 7.5%, potassium 2.1%, P < 0.001).

Conclusion: Contrary to previous findings, the Luer Lock adapter was associated with increased hemolysis rates. Addressing hemolysis requires consistent procedures, skilled staff, and future research on equipment and handling factors in clinical practice.

Background: This study compared the dimensions of the thyroid gland measured by the scintigraphic method with those measured by the ultrasonographic method. Additionally, the correlation between the technetium uptake level of the thyroid gland and the thyroid-stimulating hormone (TSH) values of the patient was investigated.

Aim: The aim of this study was to measure the uptake values and scintigraphic dimensions of the thyroid gland by using Technetium 99m pertechnetate and to investigate the relationship between these values in euthyroid and hyperthyroid states.

Methods: The data of patients referred to the Nuclear Medicine Clinic at the Health Sciences University Gulhane Training and Research Hospital for thyroid scintigraphy (TS) between January 2019 and December 2021 were examined. In total, 100 patients (67 female and 33 male) aged 18-77 (mean ± SD: 42.3 ± 15.6) years were examined. According to the thyroid scintigraphic appearances, the patients were classified into five groups: normal thyroid gland, hypoactive nodular thyroid gland, hyperactive nodular thyroid gland, diffuse hyperplastic thyroid gland, and mixed nodular thyroid gland. The region of interest (ROI) covering both thyroid lobes was drawn. The ROI covering both submandibular glands and background activity was also drawn, and count measurements from these two areas were compared.

Results: Following the thyroid scintigraphic evaluation of patients in the five groups, the following results were obtained: 13/100 (13%) were within normal ranges, 7/100 (7%) were hypoactive nodular, 31/100 (31%) were hyperactive nodular, 20/100 (20%) were diffuse hyperplasia, and 29/100 (29%) were mixed nodular. The thyroid/background activity ratio of cases reported as having a normoactive thyroid gland, with TSH values within normal limits, was calculated to be between 2.08 and 2.2 based on the scintigraphic images included in the study.

Conclusions: Tc-99m pertechnetate TS is a reliable method that can be used for various nuclear medicine applications, such as evaluating thyroid gland morphology and calculating its size.

Background: Dexamethasone is commonly used as an adjuvant to prolong analgesia in peripheral nerve blocks. However, there are a few studies available regarding its use in combination with mixed local anesthetics.

Aim: This study investigated the effect of adding perineural dexamethasone to an infraclavicular block containing a medium- and long-acting local anesthetic mixture on the time to the first analgesia request (sensory block duration) as the primary outcome, as well as sensory and motor block onset times, motor block duration, postoperative analgesic use, and the development of long-term chronic pain as secondary outcomes.

Materials and methods: This study included patients over 18 years of age and scheduled for upper extremity surgery. For patients in Group S, the block consisted of 10 mL of 0.5% bupivacaine, 5 mL of 2% prilocaine, and 5 mL of 0.9% saline solution. Patients in Group D received the same LA mixture with 2 mL of dexamethasone (8 mg) and 3 mL of 0.9% saline. Sensory and motor block level and Visual Analogue Scale (VAS) pain scores were recorded at postoperative 1, 12, and 24 hours. At least 6 months after surgery, the patients were contacted by phone and assessed for the presence of postoperative chronic pain, patient satisfaction, and whether they were receiving physical therapy.

Results: Sensory block duration was significantly longer in the dexamethasone group. VAS scores at postoperative 12 hours and analgesic use were lower in the dexamethasone group. Long-term postoperative chronic pain was observed in one patient that received dexamethasone, but the difference between the groups was not significant.

Conclusion: The addition of dexamethasone as an adjuvant to mixed local anesthetics in the infraclavicular block made a significant difference by reducing the need for postoperative analgesia.