bluuebunny/crossref_metadata_2025 huggingface dataset:
Obstructive sleep apnea in patients with severe asthma
Authors: Al-Lawati Fatema , Al-Mubaihsi Saif M. , Jayakrishnan B. , Rizvi Sayed , Al-Abri Mohammed A.
Published: April 2022

INTRODUCTION:

Asthma and obstructive sleep apnea (OSA) are common respiratory disorders that can coexist and cause sleep disturbances. The strength of this association and the impact of OSA on asthma severity and control remain unclear. The study aims to estimate the prevalence of OSA in patients with severe asthma in Oman and to examine whether the severity of OSA contributed to the level of asthma control.

METHODS:

Adult patients with confirmed diagnosis of severe asthma who attended the respiratory clinic in a tertiary hospital in Oman over a period of 19 months were enrolled in the study. Eligible participants were screened by asthma control test (ACT) and Berlin questionnaire (BQ). Patients with high risk for OSA were subjected further to level 3 sleep study. The prevalence of OSA in patients with severe asthma and the associations between the severity of OSA and asthma control were calculated.

RESULTS:

We identified 312 adult asthma patients on Global Initiative for Asthma step 4 or 5 management out of 550 who were screened. The mean age of the study population was 56.59 ± 12.40 years and the mean body mass index (BMI) 40.30 ± 12.24 kg/m2. The prevalence of OSA in asthma patients with severe asthma was found to be 32.4%. Out of the 138 well-controlled asthma patients (ACT ≥20), 35 had high risk of OSA based on BQ, and 32 were confirmed to have OSA (23%). Of the 174 uncontrolled patients, 80 patients had high risk of OSA and 69 patients were confirmed to have OSA (39.65%). Severe OSA was seen in 63.8% and 9.4% in uncontrolled and controlled asthma patients, respectively (P = 0.002). The median respiratory event index in the uncontrolled group was 43, and it was significantly higher than 12.5 in the controlled group (P < 0.001).

CONCLUSIONS:

The prevalence of OSA was high (32.37%) in patients with severe asthma. Uncontrolled severe asthma was significantly associated with severe OSA.
Evaluation of risk stratification and adherence to venous thromboembolism prophylaxis among hospitalized obstetric women
Authors: Mattar Ghadeer , Al Sahafi Nada , Al Hazmi Lujain , Al Hazmi Nadia , Abozeid Hanaa Elsayed , Sultan Intessar
Published: April 2022

BACKGROUND:

Venous thromboembolism (VTE) is associated with substantial mortality as well as morbidity and is largely preventable among hospitalized obstetric women. However, thromboprophylaxis is underutilized in most hospitalized patients.

OBJECTIVES:

To evaluate VTE risk and adherence to local thromboprophylaxis protocol among hospitalized pre- and postnatal women.

METHODS:

This retrospective study was conducted at East Jeddah Hospital, Jeddah, Saudi Arabia, in 2020. The electronic record database of the hospitalized pregnant Saudi women during the years 2018 and 2019 was reviewed. Based on the local hospital protocol, the risk stratification was reassessed by researchers, and the hospital adherence to the prophylaxis was reviewed separately for antenatal and postnatal women.

RESULTS:

One thousand and ninety-five electronic records (539 antenatal and 556 postnatal) were reviewed. The postnatal group showed a significantly higher risk compared with an antenatal group (62.2% vs. 11.7%) (P = 0.000). There was a highly significant difference between risk categories assessment by the physicians and the researchers in both groups (P = 0.000). Thromboprophylaxis was overutilized in the low risk (5% heparin and 41.4% heparin and mechanical devices for antenatal and 17.08% heparin and 6.1% heparin and a mechanical device for the postnatal group) and underutilized in intermediate groups (50% no prophylaxis in antenatal and 51.5% mechanical devices in the postnatal group). There was less adherence to documentation in postnatal as compared to antenatal group (83.6% vs. 95%, P = 0.000) for risk documentation and 85.3% versus 91.5% for physician signature (P = 0.001). Thromboprophylaxis was ordered for 21.3% of antenatal (12.2 heparin, 3.5% mechanical, and 5.6% both) and 23.7% of postnatal patients (16.5 heparin, 2% mechanical, and 5.2% both). There were no reported VTE events or bleeding complications.

CONCLUSION:

There was a considerable VTE risk among hospitalized obstetric patients which peaked during the postnatal period. Physicians showed good compliance to local VTE protocol with no reported VTE events or drug-induced bleeding. However, the implementation of prophylaxis is associated with both under and overutilization. There is a need for increasing the physicians’ awareness of optimizing VTE risk assessment and documentation for hospitalized obstetric patients.
Management of male pattern hair loss (androgenic alopecia) through Ayurveda multimodal approach
Authors: Patil Sunny , Chaudhari Swapnil , Baghel A. S.
Published: April 2022

Male pattern hair loss or Androgenic Alopecia (AGA) is one of the most prevalent forms of hair loss among men. The general symptoms include progressive thinning of the scalp hair and reduction in hair density. Hair loss is typically seen as a receding front hairline or loss of hair on vertex of the scalp or a combination of both. Although considered a relatively minor medical condition, AGA can lead to cosmetic as well as psychosocial distress in a person. Even though many conventional therapies have been evolved, there is no satisfactory cure for this condition. In this study, a case of AGA managed by Ayurveda Shamana (∼pacification) therapy is being presented. The prescribed treatment protocol comprised the drugs having Keshya (∼drug or intervention good for hair), Rakta shuddhikara (∼drug or intervention having potency of purifying blood), and Rasayana (∼rejuvenation) properties. The criterion for assessment was based on the Severity of Alopecia Tool scale. The observations made before and after the treatment showed promising results in the management of AGA without causing any adverse effects.
Mucocele of Appendix
Authors: Hassan Yaqoob , Wani Ishfaq Ahmad , Farooq Shiekh Imran
Published: April 2022

Background:

Appendiceal mucocele is a rare surgical emergency caused by intraluminal accumulation of mucoid material due to obstruction. Proper diagnosis and adequate surgical management are paramount to prevent the complications. Objectives: The aim of this study is to report on our management of appendiceal mucocele and highlighting the importance of proper pre-operative workup to reach a definitive diagnosis as a possible means of avoiding the associated grave complications.

Materials and Methods:

The patients of mucocele of appendix encountered over the period of five years in our department were managed and reported.

Results:

We present a series of three cases of appendiceal mucocele and included two females and one male patient with a median age of 41.67 years. Clinical examination, biochemical parameters, and imaging studies showed features of acute appendicitis. A 65-year-old female patient, presented with signs and symptoms of acute appendicitis was admitted and on exploratory laparotomy, showed inflamed globular cystic mass of appendix 10 cm × 6 cm × 4 cm, with dilated base and subjected to right hemicolectomy. A 35-year-old male patient was operated for appendicitis and diagnosed with mucocele appendix of 6 cm × 1 cm × 1 cm. Another patient, 25-year-old female was subjected to diagnostic laparoscopy in view of recurrent pain in right iliac fossa. A diagnosis of mucocele of appendix was made and removed via endobag.

Conclusion:

Appendiceal mucocele with acute presentation remains a rare diagnosis. Proper pre-operative workup to reach a definitive diagnosis is imperative for adequate surgical management to prevent the associated post-operative grave complications. Pre-operative diagnosis helps in decision making for the selection of the appropriate surgical procedure and alarms the operating surgeon for meticulous surgical dissection, adequate removal of mesoappendix with utmost cautious to prevent the mucus spillage into the peritoneal cavity.
Coronavirus Disease-2019 Infection among Children
Authors: Shrivastava Saurabh RamBihariLal , Shrivastava Prateek Saurabh
Published: April 2022

The emergence of the coronavirus disease-2019 (COVID-19) pandemic has changed the dynamics of almost everything across the globe. The available evidence and the reported trends suggest that the COVID-19 infection among children and adolescents generally manifests in the form of less severe illness and has less incidence of mortality as compared with the adult population. Although it is an encouraging thing that COVID-19 manifests in children in mild forms, we cannot ignore the very fact that the symptoms of the disease might be ignored owing to their mild nature. Children do play a role in the transmission of COVID-19 infection to other individuals, as outbreaks of the infection were reported in schools or summer camps. In conclusion, children are quite susceptible to the COVID-19 infection and also have the potential to transmit the causative virus to others. Even though the precise risk to acquire or transmit the infection by children is quite variable due to a number of factors, including the levels of community transmission, there is an immense need to strictly adhere to the infection prevention and control measures to minimize the incidence of infection or complications among them.
Comparative Evaluation of Cell Block Histopathology and Conventional Smear Cytology in FNAC of Clinically Suspected Cervical Lymph Node Malignancy
Authors: Bhunia Chanchal , Chatterjee Sankha , Kundu Dipankar , Bhattacherjee Sharmistha
Published: April 2022

Introduction:

Cervical lymphadenopathy is a common clinical presentation in various departments of clinical practice. Fine needle aspiration cytology (FNAC) is usually the first choice to diagnose superficial cervical lymphadenopathy. However, FNAC sometimes does not yield information for precise diagnosis, and the risk of false-negative and indeterminate diagnosis is always present. In order to overcome these problems, cell block technique has been resorted to make the best use of the available material.

Objective:

The aim of this article is to evaluate whether there are any diagnostic advantages of cell block histopathology over conventional smear cytology by corroborating with excisional biopsy.

Materials and Methods:

A descriptive study with cross-sectional design was performed among 106 cases with clinical suspicion of malignancy. FNAC was performed without anesthesia, and the aspirated material was flushed on slides and then fixed immediately. The remaining materials were processed into cell blocks followed by HE staining. The data obtained were analyzed using SPSS (IBM Statistics, Version 20.0, SPSS, Chicago, IL, USA) statistical software. Ethical approval was obtained from the Institutional Ethics Committee, and informed consent was taken from all the participants before the procedure.

Results:

Out of the 106 cases, 101 (95.28%) cases were diagnosed as malignant lesions and 5 (4.72%) cases diagnosed as non-malignant lesions. The majority of the patients were in the 40–59 year age group and were males. The sensitivity of cytology to provide specific diagnosis in malignant lesions was 90.57%, whereas those of cell block histopathology and cell block histopathology with cytology were 94.34% and 98.11%, respectively.

Conclusion:

Cell block as an adjunct to FNAC can be a useful diagnostic technique in cervical lymphadenopathy. Compared with FNAC, it gives more accurate diagnostic architecture and apparent histopathological features.
Epidemiological and Clinical Characteristics of Burn Injuries among Hospitalized Patients in Babylon Province
Authors: Obaid Elaf M. , Baiee Hasan A.
Published: April 2022

Background:

Burns form the fourth most common cause of injury after road traffic injuries, falls, and interpersonal conflicts and are usually correlated with devastating physical, mental, social, and financial harms, particularly in low and middle-income countries like Iraq.

Objectives:

To investigate the epidemiological and clinical characteristics of burn injury patients, to measure the mortality rate (case fatality rate) for burns, and to explain the main determinants of deaths among hospitalized burn injury patients.

Patients and Methods:

This was an observational descriptive cross-sectional study conducted on all acute burn injury cases who were admitted to the biggest teaching hospital in Babylon Province, Iraq. Data were collected from patients themselves or their companions and from patients’ hospital records using a pretested questionnaire designed for collecting the requested information that included demographic data, burn characteristics, burn determinants, and burn outcomes.

Results:

A sample of 120 patients with burn injuries were investigated. The mean age ± standard deviation was 18.9 ± 17.9 years. The mean age of burn death victims was 24.5 ± 17.66 years. The young age group (15–24 years) represented the highest proportion. Male to female ratio was 1:1.4. Most of the patients had low educational and income levels. The case fatality rate was 26.6% (32/120). The majority of cases were from rural areas; 67% of suicidal burn deaths had more than 50% of total body surface area. Intentional burn death victims had significantly severe burns (third-degree burn and high body surface area) as compared to accidental burn death victims. There was a statistically significant difference as regards the mode of burns between the intentional and accidental burn deaths; all intentional death victims were burnt with flame.

Conclusions:

The case fatality rate of burn injuries was high, females outnumbered males, the majority of the victims had low educational and income levels, and suicidal burn deaths were significantly associated with severe burn as compared to the accidental ones.
Assessment of Knowledge about Hypertension among Hypertensive Patients in Babylon Province
Authors: Mahdi Helen Ali , Al-Humairi Ameer Kadhim
Published: April 2022

Background:

Hypertension is one of the most common health problems in the world and it is considered as the most common risk factor for different heart diseases such as coronary heart disease, stroke, renal disease, and peripheral vascular disease. Knowledge plays an important role in controlling hypertension among patients with hypertension and in preventing the long-term complications of hypertension.

Objectives:

To assess the knowledge among patients with hypertension in Al-Hilla city.

Methods:

This study was a “descriptive cross-sectional study” involving about 303 patients with hypertension older than 18 years who came to health-care centers and hospitals; the patients were assessed by a designed questionnaire through the interview method. The data were collected from April to July 2021.

Results:

The mean age of patients with hypertensive was 54.89 ± 10.42; females represented 51.2%, whereas males represented 48.8%. Good knowledge about hypertension was 36.0%, average knowledge about hypertension was 42.9%, and poor knowledge about hypertension was 21.1%. There is a relationship between the age and duration of hypertension with knowledge, and there is a significant association between the study variables (age, sex, marital status, educational level, residence, employment status, socioeconomic level, duration of hypertension, family history of hypertension, measurement of hypertension) in our study and knowledge.

Conclusion:

This study in Babylon Province shows that the highest proportion of patients with hypertension have average knowledge about hypertension (42.9%); there is a significant association between age, duration, and study variables (age, sex, marital status, educational level, residence, employment status, socioeconomic level, duration of hypertension, family history of hypertension, measurement of hypertension) with knowledge.
Thyroid Function Disorders in Patients with Chronic Kidney Disease
Authors: Sinjari Hussein Yousif , Ibrahim Jassim Muhammed
Published: April 2022

Background:

Various thyroid functional test abnormalities are commonly observed in chronic kidney disease (CKD) due to alterations in thyroid hormone synthesis, metabolism, and regulation.

Objectives:

The study aims at investigating the prevalence of thyroid function disorders in patients with CKD and its association with the degree of renal failure.

Methods:

A cross-sectional study was performed on patients with CKD, at the Nephrology unit, Hawler Teaching Hospital, Erbil, Iraq from 1 July 2020 to 31 December 2020. Demographic features such as age, sex, and body mass index (BMI) were recorded; blood tests were done, including serum-free triiodothyronine (FT3), free thyroxin (FT4), thyrotropin (TSH), and creatinine. The CKD-EPI (epidemiological) equation was used to estimate glomerular filtration rate (eGFR).The participants were classified according to their thyroid function, age, BMI, and eGFR. The association of thyroid dysfunction with gender, age, BMI, and eGFR was studied.

Results:

A total of 104 patients with CKD enrolled in the current study: Half of them were on conservative treatment, and the other half were on a chronic hemodialysis (HD) program. Fifty four (51.9%) of them were male, mean age was 53.99 ± 14.59 years, mean BMI was 25.19 ± 3.14 kg/m2, and most of them (63.5%) were overweight. According to eGFR classification, most of the participants (70.2%) were at stage 5 CKD, 20.2% at stage 4, and 9.6% at stage 3. From the study population, it was observed that 34 out of 104 (32.7%) participants presented with thyroid function disorders. Among them, 22 (21.2%) patients presented with subclinical hypothyroidism, seven (6.7%) had overt hypothyroidism, three (2.9%) hyperthyroidism, and two (1.9%) subclinical hyperthyroidism. Hypothyroidism (clinical and subclinical) was positively associated with increasing age and advanced CKD.

Conclusion:

Thyroid function disorders are common among patients with CKD. Hypothyroidism, the most prevalent one, was positively associated with increasing age, low eGFR, and in patients on HD therapy.
Chronic Total Occlusion Anatomy and Characteristics of Coronary Collaterals and Angiographic Features Predicting the Success of Chronic Total Occlusion Intervention
Authors: Rayees Shiekh , Khandy Aashaq Hussain , Nabi Tauseef , Manzoor Sajaad
Published: April 2022

Background and Objective:

Angiographic assessment of chronic total occlusion (CTO) anatomy and collateral characteristics of coronary arteries are necessary for CTO intervention.

Materials and Methods:

This was a hospital-based observational study of 100 coronary angiograms (CAG) with CTOs. CTO anatomy and collateral characteristics of coronary arteries were studied for predicting anterograde and retrograde CTO intervention.

Results:

Right coronary artery (RCA) CTO was the most common (62%), followed by left anterior descending (LAD). More than two-thirds of RCA and LAD CTO lesions were >20 mm and half were in mid-segment. Left circumflex artery (LCX) and RCA lesions were more frequently calcified. LAD CTOs often had blunt stump; LCX CTOs frequently had bending >45°. The mean J-CTO score was lowest in RCA CTOs (2.0 ± 1.19). There were 10 different types of collaterals in RCA CTOs, 8 in LAD CTOs, and only 4 in LCX CTOs. The most common RCA CTOs collateral was LAD septal to the right posterior descending artery (RPDA) (69.4%) and in LAD CTOs, the most common was septal collaterals from the RPDA to LAD (40.9%). RCA CTOs had a higher percentage of septal collaterals, less tortuosity, and favorable entry and exit angle when compared with other two arteries.

Conclusion:

RCA CTOs were the most common. Angiographic features in CTO lesions vary among three major coronary arteries. The RCA CTOs had lesser mean J-CTO score, more number of septal collaterals, less tortuous collaterals, and favorable entry and exit angle. RCA CTOs were better accessible for anterograde and retrograde intervention.
Implications and Relative Importance of GSTP1, GSTM1, and GSTT1 Polymorphisms in the Prevalence and Severity of Prostate Cancer in an Eastern Indian Population
Authors: Roy Suparna , Dasgupta Anindya , Mondal Tanusree , Mandal N. Soumendra , Karmakar Dilip
Published: April 2022

Background:

Several mutations including the single nucleotide polymorphisms (SNPs) in the GSTP1 and deletional mutations of GSTM1 and GSTT1 isoforms of the glutathione S transferase gene are of significant importance in the etiology and severity of prostate cancer (Pca) with varying degrees of association in different population groups. We investigated the association of these mutations with the prevalence and severity of the Pca in an urban population of Eastern India.

Materials and Methods:

In the present case–control study, deletional mutations of the GSTM1 and GSTT1 were detected by their presence or absence in the gel electrophoresis after the polymerase chain reaction (PCR). The A to G SNP of the GSTP1 gene resulting in Ile105Val was detected using Restriction Fragment Length Polymorphism after PCR. Severity of Pca was assessed by International Society of Urological Pathology (ISUP) grading. Polymorphic variations obtained were correlated to the prevalence and severity of Pca.

Results:

The Chi-square tests showed a significantly greater prevalence of all three mutations in the case group. However, the post hoc ANOVA and multiple logistic regression analysis revealed that only the A to G SNP of the GSP1 gene among the three mutations showed significant association with the severity of the Pca as indicated by the ISUP gradings.

Conclusion:

The results indicated that although the A to G transitional SNP of the GSTP1 and the deletional SNPs of GSTM1 and GSTT1 acted all as important factors for increasing the prevalence of Pca, the A to G SNP of the GSTP1 gene resulting in Ile105Val only contributed to the severity and spread of the disease in our study population.
The Modified Suprapubic Prostatectomy Technique is Associated with Improved Hemostasis and Decline in Blood Transfusion Rate after Open Suprapubic Prostatectomy Compared to the Freyers Technique
Authors: Obi AO , Okeke CJ , Ulebe AO , Ogbobe UU
Published: April 2022

Background:

Open suprapubic prostatectomy is attended by significant perioperative haemorrhage and need for blood transfusion.

Aim:

To share our experience on how the adoption of a modified suprapubic prostatectomy technique has led to improved hemostasis and decline in the blood transfusion rate after open suprapubic prostatectomy in our center.

Patients and Methods:

This was a retrospective study comparing two open prostatectomy techniques. The patients in group 1 had Freyer's suprapubic prostatectomy while the patients in group 2 had a modified suprapubic prostatectomy technique. The groups were compared for the effectiveness of hemostasis using change in packed cell volume, clot retention, blood transfusion, and requirement of continuous bladder irrigation.

Results:

Both groups were similar concerning age, body mass index (BMI), total prostate-specific antigen (PSA), prostate volume, presence of comorbidities, duration of surgery, and duration of follow-up. The clot retention rate was 34% in group 1 versus 16.4% in group 2, P = 0.030. The clot retention requiring bladder syringe evacuation occurred in 32.1% of the patients in group 1 versus 14.8% in group 2, P = 0.048. The mean change in the packed cell volume (PCV) in group 1 was 8.0 ± 5.3 versus 6.9 ± 3.5 in group 2, P = 0.175. The blood transfusion rate in group 1 was 40.0% versus 13.3% in group 2, P = 0.040. The complication rate in group 1 was 67.2% versus 41.9% in group 2, P = 0.004. A general decline in blood transfusion was noted from January 2011 to December 2019.

Conclusion:

The modified suprapubic prostatectomy technique was associated with better hemostasis compared to the standard Freyer's prostatectomy technique. It should be a worthwhile addition to the numerous modifications of the original Freyer's suprapubic prostatectomy technique.
Predictive Value of Doppler Cerebroplacental Ratio for Adverse Perinatal Outcomes in Postdate Pregnancies in Northwestern Nigeria
Authors: Ismail A , Ibrahim AL , Rabiu A , Muhammad Z , Garba I
Published: April 2022

Background:

Postdate pregnancy is a very common obstetric condition, increasing the risk of perinatal morbidity and mortality from uteroplacental insufficiency.

Aim:

To determine the predictive values of Doppler cerebroplacental ratio (CPR), that is, the ratio between middle cerebral artery (MCA) and UA pulsatility indices (UA PI), and other potential velocimetric predictors of adverse perinatal outcomes in women with postdated pregnancies.

Patients and Methods:

A prospective cohort study was conducted on consenting 212 low-risk pregnant women beyond 40 weeks' gestational age. The pulsatility indices of MCA, UA, and CPR as well as non-stress tests (NST) and amniotic fluid index (AFI) were measured and recorded. The women were divided into two groups based on the presence or absence of adverse perinatal outcome defined as: meconium stained liquor, meconium aspiration syndrome, perinatal asphyxia, cesarean section for suspected fetal distress, and perinatal death.

Results:

Of the 200 women whose data were available for analysis, 40 (20%) of them had adverse perinatal outcome and 160 (80%) had normal perinatal outcome. The CPR showed statistically significant difference in predicting adverse perinatal outcome (P < 0.001). CPR had a better predictive value than UA-PI and outperformed MCA-PI and NST for adverse perinatal outcomes. The sensitivity, specificity, negative predictive value (NPV), and accuracy of prediction of adverse perinatal outcomes by CPR were 90%, 81.25%, 97.01%, and 83%, respectively.

Conclusion:

The Doppler CPR shows the highest diagnostic accuracy in prediction of adverse perinatal outcome in pregnant women after 40 weeks' gestation than UA PI and velocimetric indices when used as stand-alone test.
Prevalence of Hyperuricemia and the Relationship between Serum Uric Acid Concentrations and Lipid Parameters among King Abdulaziz University Hospital patients
Authors: Ghamri RA , Galai TA , Ismail RA , Aljuhani JM , Alotaibi DS , Aljahdali MA
Published: April 2022

Background:

Several studies have associated uric acid with dyslipidemia. However, no previous studies have examined patients without chronic illness.

Aim:

The aim of this study is to assess the relationship between serum uric acid concentration and lipid profile parameters and to estimate the prevalence of hyperuricemia in the city of Jeddah.

Patients and Methods:

A retrospective study was conducted on 1206 patients who undergone laboratory blood testing over a 3-year period (2018–2020) at King Abdulaziz University Hospital, which was ethically approved. We used a predesigned checklist to collect data from electronic hospital records using Google Forms. Bivariate analysis, tables, and graphs were used to represent and identify the relationships between variables. A P value of <0.05 was considered significant.

Results:

Our study revealed a prevalence of 12% for hyperuricemia in the study population. Males were more frequently affected than females (8.13% vs. 3.73%, respectively). There was no association between serum uric acid concentration and lipid profile parameters, including total cholesterol (P = 0.92), triglyceride (P = 0.42), high-density lipoprotein (P = 0.47), and low-density lipoprotein (P = 0.66). There was a strong association between serum uric acid concentration and high body mass index (P < 0.001), older age (P = 0.002), male sex (P < 0.001), and nationality (P < 0.001). Furthermore, there was an association between sex and mean erythrocyte sedimentation rate (P = 0.02) and mean triglyceride concentration (P = 0.02).

Conclusion:

We observed a low prevalence of hyperuricemia, and our results indicate no association between serum uric acid concentration and lipid profile parameters.
Retrospective Evaluation of Peripartum Hysterectomy Patients
Authors: Gülücü S , Uzun KE , Ozsoy AZ , Delibasi IB
Published: April 2022

Background:

Peripartum hysterectomy (PPH), which means surgical removal of the uterus during pregnancy or postpartum period, is a life-saving procedure performed as a last resort to stop obstetric serious bleeding.

Aim:

Evaluation of the prevalence, risk factors, indications, associated complications, and neonatal outcomes of PPH performed in our clinic.

Patients and Methods:

A total of 35 patients who underwent PPH in our clinic between 2013 and 2020 were analyzed retrospectively. Clinical and demographic characteristics of patients, age, gestational week, delivery type, type of hysterectomy performed, length of hospital stay, PPH indications, additional procedures and complications during PPH, maternal and fetal mortality, neonatal characteristics, intensive care unit (ICU) need after PPH, and blood transfusion amount and time were recorded. Patients with PPH were subdivided and studied in subgroups: Emergency - elective surgery, total - subtotal hysterectomy.

Results:

PPH was performed in 35 (3.2/1000) patients who gave birth during the study period. The most common indication for hysterectomy was placental invasion anomaly (57.1%, n = 20), and the most performed operation was total hysterectomy (68.6%, n = 24). Bilateral hypogastric artery ligation (14.3%, n = 5) was the most common alternative procedure performed before hysterectomy, and the most common complication was bladder injury (22.9%, n = 8). Blood transfusion was performed in 94.3% (n = 33) of the patients due to acute blood loss. The mean newborn weight was 2788.79 ± 913.37 g, and the 1st and 5th-minute APGAR scores were 6.71 ± 2.25 and 7.56 ± 2.35, respectively.

Conclusion:

Before PPH, uterine integrity should be preserved using medical and surgical methods, but if success is not achieved, hysterectomy is the last life-saving step. It should be kept in mind that in patients with anemia and increased gravidity, the risk of bleeding may be high in the first 24 h after birth and therefore PPH may be required. It would be more appropriate for patients with placentation anomalies to be operated in experienced centers due to possible complications, increased blood transfusion, and intensive care requirement.
Can the Hydrogel Form of Sodium Ascorbate be Used to Reverse Compromised Resin Infiltrant Penetration After Bleaching?
Authors: Sadikoğlu İS , Arıcı M , Kemaloğlu H , Türkün M , Caymaz MG
Published: April 2022

Aims:

The aim of this study was to investigate the effects of an antioxidant on the bleaching-induced reduction in the penetration depth of infiltrant resins.

Materials and Methods:

White spot lesions (WSLs) were created on 105 bovine tooth samples, each measuring 6 × 4 × 4 mm. Five samples were randomly selected for the examination of lesion characteristics. The remaining 100 samples were then divided into four groups (n = 25). In Group I, the WSLs were treated with resin infiltration (RI) only. RI was performed on Group II immediately after bleaching. In Group III, an antioxidant was applied for 2 h after bleaching, and this was immediately followed by RI. The Group IV samples were treated with RI at the end of a 1-week waiting period after bleaching. The penetration depths were evaluated through confocal laser scanning microscopy.

Results:

The lowest penetration rate, which was approximately 57%, was observed in Group II. This was followed by Group III (87%), Group IV (90%), and Group I (92%). Group II, in which the samples were infiltrated immediately after bleaching, had the lowest mean penetration percentage. All the bleached groups exhibited significantly lower penetration percentages than the nonbleached group (Group I) (P < 0.05). Antioxidant application increased the penetration significantly (P < 0.05).

Conclusion:

Application of sodium ascorbate was found to reverse the reduced resin penetration depth and penetration percentages resulting from bleaching. The postponement of adhesive procedures after bleaching yielded similar results.
Skeleto-Dental Features among a Sample of Saudi Female Children Compared to British Standards
Authors: AlShayea EI , Almoammar K , Alsultan M , Albarakati SF
Published: April 2022

Aim:

This cross-sectional observational retrospective study aimed at assessing the cephalometric skeleto-dental features of class I, II, and III skeletal relationship of Saudi female school children sample and comparing the results to the established British Caucasian cephalometric standards.

Materials and Methods:

The sample consisted of 205 retrospective lateral cephalometric radiographs of female school children. The age range of the subjects were between 10 and 13 years old with a mean age of 11 ± 1 years. Several cephalometric and constructed points were identified. Angular, linear, and proportional measurements were obtained and analyzed. The skeleto-dental features of class II and class III were compared to class I of this sample and then compared with the established British Caucasian population. Different angular, linear, and proportional variables were investigated. Descriptive statistics and Student's t-test were used for data analysis.

Results:

The distribution of the skeletal relationship revealed that 68.3% of the sample showed class I relationship, 16.1% class II, and 15.6% class III. The result indicates significant differences among the different classes. A greater tendency towards class II facial pattern and more convex profile among Saudis were detected in the present study compared to Caucasians. Furthermore, The dento-alveolar relationship results showed more bi-maxillary protrusion among Saudi females compared to the British Caucasians.

Conclusion:

The results of the study can serve as a base-line for future investigations in Saudi Arabia. Furthermore, the results obtained can also be of great value in distinguishing the various skeleto-dental features in the different skeletal classes among the Saudi females, and in the clinical diagnosis and treatment planning.
Assessment of the Effects of Different Dental Restorative Materials on Radiotherapy Dose Distribution
Authors: Özseven Alper , Uğurlu Muhittin
Published: April 2022

Background:

One of the most specific effects of high-density dental restorative materials on head & neck cancer radiotherapy is generating variations on isodose distributions. These variations might have an impact on the accuracy and effectiveness of the radiation treatment. The aim of this study is investigating the possible dosimetric effect of six different restorative materials on isodose distributions in head & neck radiotherapy planning process.

Materials and Methods:

A special phantom was developed and twenty-one caries-free human third molars (a control group + six different restorative materials) were used for the measurements. After acquiring the computed tomography (CT) images, seven treatment plans were created. Hounsfield Unit (HU) numbers, horizontal line dose profile (HLDP) and vertical line dose profiles (VLDPs) were compared with the control group.

Results:

The amalgam sample deformed the HU numbers in CT images. The median HU value for the S4 material was considerably different than the other samples. The median values were quite close for the remaining samples. For the amalgam sample, the mean of the calculated median isodose values for HLDP and VLDP at 3.5 cm away from the isocenter line were lower than the mean of the control group 4.03% and 6.94%, respectively (for HLDP with tooth numbers of 36 and 38 P = 0.025 and P < 0.001, respectively; for VLDP P < 0.001). In C-S1 comparison results, the statistically significant differences were found for the measurement point at 1 cm away from the isocenter (P = 0.037, P = 0.002, and P = 0.018 for the tooth numbers 36, 37, and 38, respectively). In C-S2 and C-S6 comparisons, there was a statistically significant difference for tooth number 36 (P = 0.035 and P = 0.003, respectively).

Conclusions:

The findings of the present study showed that amalgam should not be used in head & neck cancer patients who are planned to have radiation therapy. A high viscosity glass ionomer cement (GIC) and a ceramic reinforced GIC sample can be used instead of amalgam to minimize the distorting effect on isodose distributions.
Evaluatıon of Pituıtary/Cranial Imagıng Results of Central Puberty Precocıous Cases
Authors: Kendirci HNP , Kaba İ , Fidan N
Published: April 2022

Background:

The activation of the gonadotropin-releasing hormone (GnRH) pulse generator before the age of 8 years in girls and 9 years in boys results in central precocious puberty (CPP). Previous studies have shown that the height of the pituitary gland in the CPP cases is higher than in the normal children.

Aim:

In this study, ıt was aimed to evaluate the pituitary gland volüme by MRI in CPP children, and explore the intracranial lesions among children with CPP.

Patients and Methods:

The study was performed with 50 children (41 girls, 9 boys) who had been diagnosed with CPP. Pituitary MRI was performed in every child after the diagnosis of CPP. Pituitary gland volüme in CPP children was compared with age/sex-matched control subjects. In addition, if available, cranial MRI of patients were evaluated for the presence of additional intracranial abnormalities or space-occupying lesions.

Results:

The mean chronological age at diagnosis was 7.1 ± 1.0 (2.4–7.9) years in girls and 7.4 ± 1.7 (3.7–8.8) years in boys. CNS imaging showed pathological findings in 17% (7/41) of the girl cases and 55.5% (5/9) of the boy cases. Pituitary volumes of girls aged 6.0–7.9 years and boys aged 8.0–8.9 years were found to be increased compared to the control group.

Conclusion:

In this study, we found that CNS imaging showed pathological findings in 17% of the girl cases, and 55.5% of the boy cases. Pituitary volumes of girls aged 6.0–7.9 years and boys aged 8.0–8.9 years were found to be increased compared to the control group.
Ricketts' E-line Profile Preferences Among Nigerian Orthodontists, Orthodontic Trainees, and a Young Undergraduate Students' Population
Authors: Otuyemi O , Afolabi D , Oyewole T
Published: April 2022

Aim:

This study compared the perceptions of orthodontists, orthodontic trainees, and young university undergraduate students in Nigeria regarding facial profile attractiveness and the need for orthodontic treatment.

Materials and Methods:

We used a photo-editing software to alter the lips on Ricketts' esthetic line (E-line) in a lateral silhouette to produce five silhouette profiles with 2 mm incremental changes in the upper and lower lips from the 'normal' position on the E-line (-4 mm/-2 mm to + 4 mm/+6 mm). Two hundred and thirty-two participants (consisting of six groups) ranked the five profiles on a 5-point Likert scale (least attractive, 1 to most attractive, 5). Participants also assessed whether orthodontic treatment was needed to improve facial esthetics. Data were analysed in SPSS 20. Intra-rater reliability was assessed using Cohen's Kappa. We tested the null hypothesis (P ≤ 0.05) that ranked preferences between groups using the Kruskal-Wallis test. Mann-Whitney U test was also used to assess pairwise comparisons between the groups.

Results:

Intra-rater reliability for facial profiles and treatment needs were moderately acceptable (perceptions ≥67.7%; treatment needs ≥67.0%). Perceptions between orthodontists and orthodontic trainees were not significantly different. However, orthodontists/trainees tended to rank the 'normal' Ricketts' E-line profile as most attractive, while students preferred more protrusive lips. Participants' age rather than sex significantly influenced esthetic preferences. About one-half of all participants (46.6%) ranked the 'normal' Ricketts' E-line as unacceptable; hence required orthodontic treatment to improve their facial attractiveness.

Conclusion:

Clinical/professional judgment and age significantly influenced participants' perceptions of facial attractiveness. Most participants preferred slightly protrusive lips.
Nigerian Resident Doctors' Work Schedule
Authors: Balogun SA , Ubom AE , Adesunkanmi AO , Ugowe OJ , Idowu AO , Mogaji IK , Nwigwe NC , Kolawole OJ , Nwebo EE , Sanusi AA , Odedeyi AA , Ogunrinde OV , Adedayo OO , Ndegbu CU , Ojo AS , Anele CO , Ogunjide OE , Olasehinde O , Awowole IO , Ijarotimi OA , Komolafe EO
Published: April 2022

Background and Aim:

The deleterious effects of Resident Doctors' (RDs') long duty hours are well documented. Driven by concerns over the physician's well-being and patient safety, the RDs' duty hours in many developed countries have been capped. However, in Nigeria and many African countries, there are no official regulations on work hours of RDs. This study evaluated the work schedule of Nigerian RDs and its impact on their wellbeing and patient safety.

Subjects and Methods:

A national survey of 1105 Nigerian RDs from all specialties in 59 training institutions was conducted. With an electronic questionnaire designed using Google Forms, data on the work activities of RDs were obtained and analyzed using the IBM SPSS software version 24. The associations were compared using Chi-squared test with the level of significance set at < 0.05.

Results:

The mean weekly duty hours (h) of the RDs was 106.5 ± 50.4. Surgical residents worked significantly longer hours than non-surgical residents (122.7 ± 34.2 h vs 100.0 ± 43.9 h; P < 0.001). The modal on-call frequency was two weekday on-calls per week (474, 42.9%) and two weekend on-calls per month (495, 44.8%), with the majority of RDs working continuously for up to 24 hours during weekday on-calls (854, 77.3%) and 48–72 hours during weekend on-calls (568, 51.4%), sleeping for an average of only four hours during these on-calls. The majority of RDs had post-call clinical responsibilities (975, 88.2%) and desired official regulation of duty hours (1,031, 93.3%).

Conclusion:

The duty hours of Nigerian RDs are currently long and unregulated. There is an urgent need to regulate them for patient and physician safety.
Posture-Induced Intraocular Pressure Changes among Patients with Primary Open Angle Glaucoma in a Nigerian Tertiary Hospital
Authors: Ireka OJ , Arinze OC , Ogbu N , Ogbonnaya CE , Nnadozie UU , Chuka-Okosa CM
Published: April 2022

Background and Aim:

To determine the effect of postural changes on intraocular pressure (IOP) among newly diagnosed patients with primary open-angle glaucoma (POAG).

Patients and Methods:

This was a cross-sectional observational study of 55 consecutive newly diagnosed patients with POAG attending Glaucoma clinics at a Federal Teaching Hospital in Abakaliki, Ebonyi state, from July to September 2017. Patients IOPs were measured in the sitting position, supine without a pillow, and supine with pillow positions using Perkin's handheld applanation tonometer. All data were analyzed with SPSS version 20.0

Results:

A total of 55 subjects were recruited comprising 30 (54.5%) males and 25 (45.5%) females, with a mean age of 50.13 ± 9.97 years and an age range of 30–79 years. The mean intraocular pressure was 27.54 ± 3.98 mmHg in the sitting position, 30.15 ± 4.41 mmHg in the supine with pillow position, and 35.22 ± 4.61 mmHg in the supine without pillow position. The mean difference of mean IOP of sitting compared to supine without the pillow was 7.68 ± 2.08 mmHg (P-value < 0.001, 95% CI: 7.12–8.24); sitting compared to supine with the pillow was 2.61 ± 1.49 mmHg (P-value < 0.001, 95% CI: 3.01–2.21), whereas supine without the pillow compared to supine with the pillow was 5.07 ± 2.24 mmHg (P-value 0.001, 95% CI: 4.47–5.68)

Conclusion:

IOP was lowest in the sitting position and highest in the supine without pillow position. There was a statistically significant reduction in IOP on the assumption of supine with pillow position compared to supine without pillow position. The use of thick pillows in supine positions (such as during sleep or relaxations) rather than lying supine without pillows may reduce IOP spikes in POAG patients. This may have a positive effect as regards treatment and progression of glaucoma.
Electrocardiographic QRS Axis Shift, Rotation and COVİD-19
Authors: Koç Ş , Bozkaya VÖ , Yikilgan AB
Published: April 2022

Background:

In patients with coronavirus disease-2019 (COVID-19), severe dyspnea is the most dramatic complication. Severe respiratory difficulties may include electrocardiographic frontal QRS axis rightward shift (Rws) and clockwise rotation (Cwr).

Aim:

This study investigated the predictability of advanced lung tomography findings with QRS axis shift and rotation.

Patients and Methods:

This was a retrospective analysis of 160 patients. Patients were divided into the following two groups: normal (n = 80) and low (n = 80) oxygen saturation. These groups were further divided into four groups according to the rightward and leftward axis shift (Lws) on the electrocardiographic follow-up findings. These groups were compared in terms of electrocardiographic rotation (Cwr, counterclockwise rotation, or normal transition), tomographic stage (CO-RADS5(advanced)/CO-RADS1–4), electrocardiographic intervals, and laboratory findings.

Results:

In patients with low oxygen saturation, the amount of QRS axis shift, Cwr, and tomographic stage were significantly higher in the Rws group than in the Lws group. There were no differences in the above parameters between the Rws and Lws groups in patients with normal oxygen saturation. Logistic regression analysis revealed that the presence of Cwr and Rws independently increased the risk of CO-RADS5 by 18.9 and 4.6 fold, respectively, in patients with low oxygen saturation.

Conclusion:

In COVID-19 patients who have dyspnea with low oxygen saturation, electrocardiographically clockwise rotation with a rightward axis shift demonstrated good sensitivity (80% [0.657–0.943]) and specificity (80% [0.552–>1]) for predicting advanced lung tomographic findings.

ClinicalTrialsgov Identifier:

NCT04698083.
Mitophagy and oral cancers
Authors: Chowdhury Ripon Md
Published: April 2022

Mitophagy is a progressive process that selectively targets weakened, old and damaged mitochondria, by an autophagic pathway, causing its destruction. Mitophagy maintains normal cellular physiology and tissue development, thereby controlling the cohesiveness of the mitochondrial pool. The mechanisms of mitophagy, tumorogenesis, and cell death are usually interrelated with each other and could be initiated by definite stressful conditions like hypoxia and nutrient starvation, which leads to the overall reduction in mitochondrial mass. This impedes the production of reactive oxygen species, and conserves nutrition, leading to cell survival in such extreme conditions. The inability to harmonize and regulate mitochondrial outcome in response to oncogenic stress can either stimulate or suppress tumorogenesis. Therefore, the relationship between mitophagy, tumorogenesis, and cell death plays an important role in the identification of potential targets of cell death and selective wiping out of cancer cells. This review portrays the mechanism of mitophagy, along with its role in cancers especially on oral cancers, and its importance in cancer therapeutics.
Palliative Sedation in End-of-Life Patients in Eastern Asia: A Narrative Review
Authors: Lee Seung Hun , Kwon Jung Hye , Won Young-Woong , Kang Jung Hun
Published: April 2022

Although palliative sedation (PS) is a common practice in the palliative care of cancer patients in Western countries, there is little related research on the practice in Korea. PS can be classified into several categories according to sedation level and continuity. PS is clearly distinct from euthanasia. While euthanasia is illegal and regarded as unethical in Korea, there is little ethical and legal controversy about PS in terms of the doctrine of double effect. Most studies have asserted that PS does not shorten the survival of terminal cancer patients. Since preference for PS heavily depends on stakeholder value, it should be preceded by shared decision-making through full communication among the patient, family members, and medical team. This is a narrative review article analyzing previous studies, especially from the three Eastern Asian countries, Korea, Japan and Taiwan, which share similar cultures compared with Western countries. Practical issues concerning PS—for example, prevalence, type and dosage of medications, salvage medication, timing of its initiation, and assessment—are described in detail.