bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of endotracheal tube size on nasal and laryngeal morbidity during awake fiberoptic nasotracheal intubation: A Randomized controlled trial
Authors: Vinayagam Stalin , Arikrishnan Thirumurugan , Kundra Pankaj , Saxena Sunil Kumar 
Published: April 2022

Background and Aims:
Awake fibreoptic nasotracheal intubation is associated with adverse airway and hemodynamic complications. The aim of this study was to evaluate the role of endotracheal tube size on nasal and laryngeal morbidity during awake fibreoptic-guided nasotracheal intubation.

Material and Methods:
Eighty patients recruited to undergo awake fibreoptic intubation were randomly allocated to Group C (standard size endotracheal tube) and Group S (small size endotracheal tube followed by exchange to standard size using Airway Exchange Catheter under general anesthesia). Nasal morbidity was assessed by incidence of epistaxis, olfactory acuity, and mucociliary clearance. Patient discomfort during intubation was assessed using grimace score and hemodynamic parameters were recorded. Postoperatively, the incidence of nasal and laryngeal injury was recorded using nasendoscopy and telelaryngoscopy, respectively.

Results:
Demographic profile between the two groups was comparable. Epistaxis was noted in 47.5% of patients in group C as compared to 12.5% in group S. Postoperative olfactory acuity was decreased [2 (1-4) vs 4 (2-5)] and saccharin clearance time was prolonged (314 s vs 134 s) in Group C as compared to Group S. (P-value <0.001) Higher grimace score [2 (1-3) vs 1 (0-2)] and increased hemodynamic response was demonstrated in Group C. (P-value <0.001) Incidence of nasal injury [2 (1-4) vs 1 (0-2)] and laryngeal injury [1 (0-2) vs 0 (0-2)] was more in Group C as compared to Group S.

Conclusion:
Awake fibreoptic nasotracheal intubation with small size endotracheal tube followed by exchange to standard size under general anesthesia reduces nasal, laryngeal, and hemodynamic complications.
Comparison of intrathecal bupivacaine-fentanyl and bupivacaine-butorphanol combinations for joint replacement surgeries
Authors: Sharma Aakriti , Kumari Anita , Gupta Ruchi , Kaur Shubhdeep , Arora Deepika , Kaur Keerat 
Published: April 2022

Background and Aims:
The objective of the study was to compare duration of analgesia of fentanyl versus butorphanol as adjuvants to bupivacaine in spinal anesthesia.

Material and Methods:
A prospective, randomized, double-blinded study conducted in 80 patients of 18–75 years age group and American Society of Anesthesiologists Grades I and II undergoing joint replacement surgeries. A total of 40 patients in each Group A and Group B received 0.5% bupivacaine 3 ml with 25 mcg fentanyl and 25 mcg butorphanol respectively, in a total volume of 3.5 ml made with saline. Duration of analgesia, number of rescue analgesia, sensory, and motor block characteristics were compared between the two groups. Statistical analysis was done using t test and Chi-square test with SPSS 19.0 software.

Results:
Mean duration of analgesia was found more in Group B in comparison to Group A (P < 0.05). A number of doses of analgesic required postoperatively were more in Group A compared to Group B (P < 0.001). Time required for onset of sensory and motor block was comparable in both the groups. However, two segment regression of sensory block was slower in Group B compared to Group A (P < 0.05).

Conclusion:
We conclude that addition of butorphanol 25 μg as an adjuvant to 0.5% hyperbaric bupivacaine provided prolonged duration of analgesia compared to 25 mg fentanyl.
Online Faculty Development
Authors: Filipe Helena P. , Golnik Karl C. , Geary Amelia , Buque Amelia , Mack Heather G. 
Published: April 2022

PURPOSE:
Faculty development for procedural specialists aims at developing both their medical education and surgical competence. This has been challenging during the COVID-19 pandemic, especially in under-resourced settings and African Lusophone ophthalmology community has been no exception. The Mozambican College of Ophthalmology (MOC) and the Continuing Professional Development Committee of the International Council of Ophthalmology (ICO) established a collaboration to enhance simulation-based clinical teaching competence in cataract surgery.

METHODS:
Ten Mozambican ophthalmologists experienced in teaching cataract surgery participated in a group mentoring assisted 6 month/11 flipped-learning online experience on curriculum design, which included practice-based and social learning strategies, continuous bidirectional feedback, individual and group reflection opportunities, and the demonstration of declarative and procedural competencies. Program evaluation consisted of pre and post-test knowledge assessment; individual homework, informed by curated reading and a recorded lesson; feedback surveys for each module and one month after the program's conclusion, and a longitudinal project on creating a simulation-based education session on one step of cataract surgery.

RESULTS:
Participants a) highlighted the opportunity to advance their scholarly teaching skills as facilitators; b) showed an increase in knowledge post-test, expressed commitment to improve their learning experiences´ design, include interactive educational methods, and provide constructive feedback; and c) formed a sustained community of practice of ophthalmologists educators (CoP).

CONCLUSION:
This online faculty development program, assisted by group mentoring, held during the COVID-19 pandemic, facilitated the development of a CoP and was effective in enhancing teaching competence in curriculum design to apply in simulation-based learning environments.
The Impact of COVID-19 Pandemic on Ophthalmic Referrals within a Tertiary Academic Center in Oman
Authors: Al Busaidi Aisha , Mal Washoo , Rafei Mohammed A. , Al-Yaqoobi Amina , Panchatcharam Sathiya , Al-Mujaini Abdullah S. 
Published: April 2022

PURPOSE:
To investigate the impact of coronavirus infection disease-19 (COVID-19) pandemic on ophthalmic referrals within an academic tertiary center in Oman.

METHODS:
Retrospective chart review of internal referrals received and evaluated by the ophthalmology department between March 1and August 31, 2020 (COVID-19 period) compared to a corresponding period in 2019 (pre COVID-19). Data included patient demographics, referral details, ocular diagnosis, intervention, and discharge plan.

RESULTS:
Referral volume significantly decreased by 58.2%; from 2019 prepandemic to 510 (P = 0.001), with the lowest in April and May 2020. Patient demographics did not differ significantly, but “urgent” referrals reduced by 96.2% (P < 0.001). Main reasons for referrals were reduced vision and screening in both periods. During pandemic, referrals for screening purposes increased from 30.3% to 37.9% (P = 0.013) and for reduced vision decreased from 30% to 23.3% (P = 0.021). Dry eye syndrome increased in frequency during 2020 (from 2.9% to 7.3%, P = 0.002) but cataracts and conjunctivitis both decreased (from 4.7% to 2.1%, P = 0.046 and from 2.3% to 0.3%, P = 0.013, respectively). Ocular trauma remained stable (from 0.8% to 0.3%, P = 0.456), but the proportion of chemical injuries increased by 13.7% (P = 0.025). There was a drastic decrease in interventions from 37% to 26.1% (P < 0.001) and an increase in discharge rate from 61.2% to 75.8% (P < 0.001).

CONCLUSION:
The impact of COVID-19 pandemic on ophthalmic referrals within a tertiary academic centre in oman referral reductions and changes in pattern and characteristics as an epiphenomenon of COVID-19 reflect the extent of impact specifically in an Omani context. This information is vital for planning proper resource utilization, the adoption of innovative care delivery, and improving referral system pathways.
Magnitude and Determinants of Computer Vision Syndrome among College Students at a Saudi University
Authors: AlDarrab Abdulrahman , Khojah Abdulaziz A. , Al-Ghazwi Mohammed H. , Al-Haqbani Yazeed J. , Al-Qahtani Naif M. , Al-Ajmi Mohammed N. , Alenezi Saad H. , Almasoud Mohammmed K. , Al-Yahya Abdulaziz F. 
Published: April 2022

PURPOSE:
To review students’ perceived symptom-based computer vision syndrome (CVS) and its determinants and to suggest preventive measures.

METHODS:
This cross-sectional survey was conducted in 2021 at a university in Central Saudi Arabia. The presence and severity of symptoms related to CVS were investigated. The total CVS symptom score was the outcome variable. The CVS score was correlated to participants’ demographics, visual habits when using digital devices, and knowledge about CVS. Due to skewed distribution, a nonparametric method was used for analysis.

RESULTS:
Overall, 521 students were surveyed. The prevalence of CVS based on at least one symptom was 96% (95% confidence interval 94.3–97.7). The median score was 8.0 (interquartile range 4.0–12.0). Of the 24 possible CVS scores, 42 students (8%) had scores of 18 or more (severe CVS). Being female (Mann–Whitney [MW] P < 0.001), being older (Spearman P < 0.001), refractive error (MW P < 0.001), the presence of dry eye (MW P < 0.001), using devices other than a desktop computer (KruskalWallis) P = 0.03), and more than 6 h constantly working with a device (MW P = 0.001) were correlated with a higher CVS score. Older age, female, refractive error, and using digital devices for more than 6 h were the independent and significant predictors of CVS in college students.

CONCLUSION:
Most of the students suffered from mild-to-moderate CVS symptoms. Health promotion for prevention and periodic ophthalmic consultations are recommended. Identified predictors should be the focus when implementing strategies to combat CVS in the adolescent Saudi population.
Pertrochanteric Hip Fracture Fixation with 3 Hole and 4 Hole DHS Side Plates - A Retrospective Patient Record Review
Authors: Akinyemi Tosin Olusoga , Mannan Syed , Ayeni Funbi Anthony 
Published: April 2022

Introduction:
Dynamic hip screw fixation (DHS) with a 4-hole side plate and 4 bi-cortical screws is considered by many to be the standard implant for extracapsular hip fractures. The 4-hole side plate, however, has several disadvantages including longer incision, increase in operating time, bleeding and increased wound morbidity. Biomechanical studies have shown that most of the force in a 4-hole DHS fixation is borne by the proximal three screws. This study (specifically) compares the outcome of fixation using 3-hole and 4-hole DHS in extracapsular hip fracture fixations (with the hypothesis being that 3-hole plate is adequate even in unstable intertrochanteric fractures.

Patients and Methods:
A total of 72 consecutive patients who had DHS fixation with either a 3 hole or 4 hole DHS side plate and who were either directly operated or supervised by a single consultant were recruited. Fractures were classified using the AO fracture classification system as stable (AO/OTA 31A1–31A2.1) and unstable (31A2.2–31A3.3 subtypes) for ease of comparison. Failure was defined as metalwork breakage, nonunion, screw cut-out or pull out or any other complications of bone healing requiring a revision.

Results:
A total of 23 patients (68.1%) were female, whereas 49 patients (31.9%) were male. Fractures in 33 patients were classified as stable with the (AO/OTA 31A1–31A2.1) and unstable in 39 patients with (31A2.2–31A3.3 subtypes). Thirty-three (45.8%) patients had fixation with 3-hole side plate, whereas 39 (55.2%) patients had fixation with 4-hole side plate. In the 3 hole group, 17 patients had stable fractures, whereas 16 patients had unstable fracture configuration while in the 4-hole DHS side plate group, 16 patients had stable fracture configuration, whereas 23 patients had unstable fracture. The mean change in hemoglobin was lower for the 3-hole DHS group (3 hole-6.64 g/l versus 4Hole 12.41 g/l) (t = 1.732, P = 0.090, P ≤ 0.05). One patient in each group also had metalwork failure with screw cut-out through the head and the other being (screw breakage) complete failure of the screw necessitating conversion to total hip arthroplasty.

Conclusion:
Three-hole DHS plate offers comparable outcome with its 4-hole counterpart even with unstable intertrochanteric fractures, with slightly less blood loss and smaller scars.
Paediatric Cardiac Anaesthesia Perspective in Komfo Anokye Teaching Hospital Kumasi
Authors: Singh Sanjeev , Okyere Isaac , Singh Arti 
Published: April 2022

Background:
Infant mortality due to congenital malformations has an incident rate of 8 cases per 1000 live births. Due to Africa's inadequate health-care systems, congenital cardiac disease (CCD) remains a paediatric health-care issue. CCD patients undergo an open-heart operation (OHO) at the Komfo Anokye Teaching Hospital (KATH) in Kumasi.

Aim:
This study aimed to compare trends of cardiac anaesthesia protocols before and after 2014 and to assess the efficiency and quality of surgical care provided to children with CCD following the implementation of new cardiac anaesthesia protocols in 2014.

Materials and Methods:
Groups A and B were represented by the years before and after 2014. This was a retrospective study involving 118 patients who underwent OHO under general anaesthesia from 2007 to 2016 after obtaining Institutional ethical approval.

Results:
In Groups A and B, the mean length of hospitalization in days and cardiac care unit stay in days were (6.87 ± 3.51 and 4.20 ± 3.66) (P = 0.046) and (3.14 ± 2.37 and 1.96 ± 2.85) (P = 0.382), respectively. In Group B, ultrafast track extubations increased from 7.25% to 39.71% (P = 0.021), while patients mean mechanically ventilation time decreased by 82.34 ± 11.70–23.48 ± 7.94 h (P = 0.018). In the first 48 h, the chest tube's postoperative drainage reduced by 133 ± 28.46–95 ± 20.38 ml (P = 0.018) and haemorrhage leading to re-exploration decreased 11.77%–1.50% (P = 0.019). After 2014, postoperative haemorrhage, the chest tube's drainage, and re-exploration were statistically significantly reduced by tranexamic acid.

Conclusions:
This ten-year program primarily focused on selecting simple cases and simplifying anaesthesia protocols after 2014. Given the success of our OHO program at KATH Kumasi, there is a need for a paradigm shift to sustain OHO programs in other parts of Africa.
Prenatal Alcohol Intake and Knowledge of its Effect
Authors: Mbadugha Chisom Joy , Arinze Joyce Chinenye , Odoh Nneka Chekwube , Obiekwu Adaobi Lilian , Omotola Ngozi Joy , Okafor Chiamaka Jennifer 
Published: April 2022

Background:
Alcohol consumption during pregnancy is a major public health concern due to its noxious effect on both the mother and fetus.

Aim:
The study aim was to determine the prevalence of prenatal alcohol intake, knowledge of its effects, and associated factors among pregnant women attending antenatal clinic, Poly General Hospital, Enugu.

Materials and Methods:
A descriptive cross-sectional survey was adopted and simple random sampling was employed to select 248 pregnant women from the total population. Data were obtained using structured questionnaires, summarized using descriptive statistics, and presented in tables. Statistical analysis for associations between level of educational attainment, occupation of the pregnant woman, and knowledge of the effects of alcohol consumption was performed using Chi-square tests.

Results:
The prevalence of alcohol use during pregnancy was 40.3% with beer (48.8%) and palm wine (48.8%) being the major alcoholic beverages taken. Majority (59.7%) of the participants had good knowledge of the effects of alcohol consumption in pregnancy while less than half (33.9%) had good knowledge of the effect on the unborn baby. Previous drinking habits before pregnancy (3.48 ± 0.84) and unwanted pregnancy (3.17 ± 0.93) were the major perceived factor influencing their alcohol intake. Educational level was not significantly related to knowledge of alcohol effects on pregnancy.

Conclusion:
Regardless of the knowledge of the harmful effect of alcohol on the fetus and maternal health, a significant proportion of mothers continue to consume alcohol during pregnancy. Therefore, there is a need for widespread education of women of childbearing age focused on driving behavioural change with regards to alcohol intake in pregnancy.
Outcome of Delivery among HIV-Positive Women that Attended the Antenatal Clinic at the University of Benin Teaching Hospital, Benin City, Nigeria
Authors: Shehu Aisha Yibaikwal , Ogboghodo Esohe Olivia , Enaruna Nosakhare , Jamda Mustapha Abubakar 
Published: April 2022

Background:
Human immunodeficiency virus (HIV) has been reported to be associated with several adverse pregnancy outcomes. There are limited data on the extent by which HIV-positive pregnant women in this part of the world are affected.

Aim:
The aim of this study was to assess the pregnancy outcome of HIV-positive pregnant women who attended the antenatal clinic.

Materials and Methods:
A retrospective analysis of the case notes of HIV-positive women that enrolled in the prevention of mother-to-child (PMTCT) clinic from January 1, 2020, to December 31, 2020. All data collected were entered and analyzed using the IBM SPSS version 25.0 software.

Results:
A total of 1817 women attended the antenatal clinic and 127 (6.9%) were HIV positive and enrolled in the PMTCT program. Out of the 127 HIV-positive women, only 102 (85.0%) utilized the delivery service. HIV was found to be more common among women within the age group of 30–39 years. Majority 105 (82.6%) of the women were aware of their HIV status before index pregnancy and were on treatment, 62 (60.78%) of the women had a vaginal delivery, whereas 34 (33.3%) had a caesarean delivery. A total of 6 (4.7%) women had a miscarriage. There was no maternal death. Of these pregnancies, 7 (5.5%) were stillbirths, 18 (18.8%) were preterm deliveries, and 10 (11.2%) had a low birthweight.

Conclusion:
Despite antiretroviral therapy, HIV-positive pregnant women had adverse pregnancy outcomes; therefore, they should be managed with a multidisciplinary approach to ensure good maternal and fetal outcomes.
A Systematic Review of Urethral Complications Following Male Circumcision
Authors: Muhammad Musa Yahaya , Agbo Christian Agbo 
Published: April 2022

Background:
Male circumcision is one of the most common elective surgical procedures worldwide. Adverse events affecting the urethra may occur following the procedure.

Aim:
The aim of this paper is to provide a review of the existing literature on urethral complications of male circumcision.

Materials and Methods:
A search of PubMed and Google Scholar was conducted between November 20, 2020, and November 30, 2020 and updated on January 12, 2021. Several keywords related to male circumcision were searched on the two databases. A further manual search of the reference lists of relevant papers was carried out. Studies that reported frequencies of urethral complications following circumcision were included in the analysis. A total of 83 candidate papers were identified and studied before arriving at 38 studies that contained sufficient information suitable for the analysis.

Results:
Overall, we found that the reported frequencies of urethral complications of male circumcision varied (range 0.01% to 39%; median 1.7%). Meatal stenosis (MS) and urethrocutaneous fistula (UCF) were by far the most frequently reported urethral complications of male circumcision with cases reported in 30 and 18 studies, respectively. Meatitis and urethral stricture were the other urethral complications found in our search.

Conclusion:
The urethral complications of male circumcision we found were UCF, MS, meatitis/meatal ulcer, and urethral stricture. Neonatal circumcision and circumcision by untrained providers are associated with higher incidences of urethral tragedies following male circumcision. The type of male circumcision provider is also a determinant of the frequency of complications.
An Assessment of Factors Motivating Patients to Seek Orthodontic Treatment in a South-Western Nigerian Teaching Hospital
Authors: Ndukwe Anne Nkechi , daCosta Oluranti Olatokunbo , Sanu Oluwatosin Oluyemi , Isiekwe Michael Chukwudi 
Published: April 2022

Background:
Motivation is a concept that describes the conscious or unconscious stimuli for the action toward a desired goal. The motivations for seeking an orthodontic treatment among the population are diverse. Identifying the underlying motivation for treatment is helpful in reducing dissatisfaction with orthodontic treatment outcome.

Aim:
This study aimed to assess motivating factors for seeking orthodontic treatment and to compare these factors between adolescents and adults attending a Nigerian teaching hospital.

Patients, Materials and Methods:
Self-administered questionnaires were distributed among 130 subjects (79 adolescents and 51 adults). The subjects were asked to assign a score to the motivating factors listed based on their relative importance using a 5-point Likert scale which ranged from 1 to 5, with 5 rated as very important and 1 rated as very unimportant. The choice of motivating factors was compared between the adolescents and adults and between sexes in each group. Data obtained were analyzed using IBM Statistical Package for Social Sciences (IBM SPSS) version 21.0. P ≤ 0.05 was considered statistically significant.

Results:
Improvement in dental appearance was the main motivating factor for almost all subjects and there was no statistically significant difference between adolescents (60.8%) and adults (68.6%), P = 0.591. A significantly higher (P < 0.001) number of the adults, (35, 68.6%) chose improvement in facial aesthetics as a motivating factor for orthodontic treatment compared with 29 (44.6%) adolescents. The least motivating factors which were chosen by adolescents were improvement in chewing (9, 13.8%) and relief of temporomandibular joint symptoms (4, 6.2%). There was no statistically significant difference in the choice of motivating factors between female and male in both the adolescent and adult groups.

Conclusion:
Aesthetic concerns were the most important motivating factors in adolescents and adults seeking orthodontic treatment.