Category: Nevin Manimala

Niger J Clin Pract. 2023 Jan;26(1):116-124. doi: 10.4103/njcp.njcp_1725_21.

ABSTRACT

BACKGROUND: The versatile combination of emdogain or enamel matrix derivative (EMD), recombinant human platelet-derived growth factor-BB (rhPDGF-BB), and demineralized freeze-dried bone allograft (DFDBA) has not been utilized in the treatment of intrabony defects yet.

AIM: The present study attempted to investigate the efficacy of a combination of simple, uncomplicated nature of modified minimally invasive surgical technique (M-MIST) with EMD, rhPDGF-BB, and DFDBA in the surgical management of intrabony defects and to assess the possible favorable effects for a period of 6 months.

PATIENTS AND METHODS: Thirty healthy subjects were included in the present double-blind, randomized controlled, two-arm parallel study. The test group was treated with M-MIST by using rhPDGF-BB, EMD, and DFDBA, and the control group was treated with M-MIST by using rhPDGF-BB and EMD.

RESULTS: Differences between the mean values of primary clinical parameters including relative attachment level, probing depth, and gingival recession at baseline and those at 6 months after surgery were statistically significant in both groups. Inter-group comparison for clinical attachment level gain, probing depth reduction, and change in the position of gingival margin revealed no statistically significant differences. Inter-group comparison revealed significant differences in linear bone growth (LBG) and percentage bone fill (% BF) but no significant differences in the residual defect depth and change in the alveolar crest position.

CONCLUSION: The additional use of DFDBA provides superior benefits in terms of LBG and % BF in intrabony defects. This improvement might be attributed to the use of an osteoinductive scaffold.

PMID:36751833 | DOI:10.4103/njcp.njcp_1725_21

Niger J Clin Pract. 2023 Jan;26(1):109-115. doi: 10.4103/njcp.njcp_1828_21.

ABSTRACT

BACKGROUND: Kidney involvement in coronavirus disease 2019 (COVID-19) pathology has been supported by high frequency of angiotensin-converting enzyme 2 (ACE2) expression on renal cells and reports of acute kidney injury. However, the association between host viral load and kidney function is not clear.

AIM: In this study, plasma levels of renal markers (urea nitrogen, creatinine, and estimated glomerular filtration rate (eGFR)) and electrolytes (sodium, potassium, chlorine, and bicarbonate) were assessed in relation to SARS-CoV-2 viral load of COVID-19 patients.

PATIENTS AND METHODS: This cross-sectional study involved 144 consenting COVID-19 patients admitted to the Ogun state COVID-19 isolation center between May and December 2020. All participants presented with mild respiratory symptoms and did not require ICU admission or ventilation support. Data included reverse transcriptase polymerase chain reaction (RT-PCR) cycle threshold (C_T) value, blood urea nitrogen (BUN), creatinine, sodium, potassium, chlorine, bicarbonate measurements, and glomerular filtration rate. Reference intervals were used as comparators, and multiple linear regression model was fitted. Statistical significance was set at P < 0.05.

RESULTS: BUN level and creatinine were elevated in 4 (2.8%) and 42 (29.2%) patients, respectively, with lowered eGFR observed in 37 (25.7%) patients. Hyponatremia and hypokalemia were observed in 35 (24.3%) and 21 (14.6%) patients, respectively, while hypochloremia was observed in 21 (14.6%) patients. Lowered bicarbonate was observed in 29 (20.1%) patients. Linear regression showed statistically significant association (R² = 0.340, P = 0.032) between RT-PCR C_T value and eGFR (β = 0.006, P = 0.017) as well as HCO₃ (β = -0.262, P = 0.036).

CONCLUSION: COVID-19 patients with mild respiratory symptoms exhibited renal abnormalities, electrolytes, and acid-base imbalances which were partly associated with SARS-CoV-2 viral load.

PMID:36751832 | DOI:10.4103/njcp.njcp_1828_21

Niger J Clin Pract. 2023 Jan;26(1):95-101. doi: 10.4103/njcp.njcp_511_22.

ABSTRACT

BACKGROUND AND AIM: This study aimed to evaluate the effects of bleaching agents on the fracture resistance of endodontically treated teeth using different intraorifice barrier (IOB) materials.

MATERIALS AND METHODS: The endodontic treatment was performed for 160 mandibular premolars, and then, the teeth were divided into four groups according to the IOB: Ionoseal, Biodentine, ProRoot MTA, and TheraBase. Then, these teeth were subdivided into four subgroups (n = 10) based on the bleaching agents as distilled water (control), hydrogen peroxide 35% (HP), sodium perborate (SP), and carbamide peroxide 37% (CP). The access cavities were restored with composite resin after applying the bleaching agents for 7 days. The fracture resistance test was performed using a universal testing machine. Data were statistically analyzed, and the significance level was set at 5%. A scanning electron microscope was used to evaluate the effect of bleaching agents on the surfaces of IOBs.

RESULTS: The highest fracture resistance values were observed in Biodentine groups with significant differences compared to Ionoseal and ProRoot MTA (P <.05). The distilled water groups showed significantly the highest fracture resistance compared to SP and HP groups (P <.05). There was no significant difference between SP, HP, and CP groups (P >.05). It was demonstrated that the morphological surface of the intact IOBs (control) was different from the surface of IOBs treated with bleaching agents.

CONCLUSION: The intracoronal bleaching procedures affected negatively the fracture resistance of the endodontically treated teeth.

PMID:36751830 | DOI:10.4103/njcp.njcp_511_22

Niger J Clin Pract. 2023 Jan;26(1):90-94. doi: 10.4103/njcp.njcp_401_22.

ABSTRACT

BACKGROUND: Although spinal anesthesia can be applied in different patient positions, the most frequently used positions are sitting and lateral positions. It is known that different patient positions during spinal anesthesia have effects on hemodynamic parameters, postdural puncture headache, and intraocular pressure.

AIM: The study aimed to determine the effect of spinal anesthesia performed in either sitting or right lateral position on postspinal headache and intraocular pressure during elective cesarean section.

PATIENTS AND METHODS: The study was a randomized controlled study of 104 eligible pregnant women scheduled to undergo elective cesarean section. The women were randomized into two groups. Spinal anesthesia was performed either in the sitting (Group S, n = 53) or the right lateral position (Group L, n = 51). Heart rate and blood pressure were recorded throughout the operation. The participants were informed and monitored for postspinal headaches. Intraocular pressure before and after the operation was measured with Icare PRO. The obtained data were statistically compared between the two groups.

RESULTS: There was no difference between the groups in terms of demographic data. Postdural puncture headache was observed in five patients in Group S and one patient in Group L (P =0.04). There was no difference between the groups in terms of intraocular pressure (P >.05). Heart rate was not significantly different between the groups; however, there was a significant difference in average blood pressure in 1, 5, 30, and 40 minutes (P <.05). The number of trials administered to patients for spinal anesthesia was significantly higher in Group L (P =0.01).

CONCLUSION: Spinal anesthesia performed in the sitting position for cesarean section caused a higher postspinal headache than in the right lateral position, but the position did not affect intraocular pressure.

PMID:36751829 | DOI:10.4103/njcp.njcp_401_22

Niger J Clin Pract. 2023 Jan;26(1):59-64. doi: 10.4103/njcp.njcp_210_22.

ABSTRACT

BACKGROUND AND AIM: The aim of this study was to evaluate radiographically the prevalence of mandibular nutrient canals (NCs) in patients with/without periodontal bone loss with aging and to correlate the number of NCs with the severity of bone loss using cone-beam-computed tomography (CBCT).

PATIENTS AND METHODS: CBCT examinations of 208 patients were evaluated retrospectively of all patients, 114 had periodontal bone loss, whereas 94 patients were control subjects. Alveolar bone loss investigations were performed according to the Progressive Rate Index.

RESULTS: NCs were observed in 55% of the control group and 86% of the periodontitis patients. NCs were more prevalent in the elderly age group with periodontal bone loss. In the study group, the NCs were statistically more frequent than in the control subjects (P > 0.05).

CONCLUSION: Statistical analysis showed a significant difference between the age groups and the prevalence of NCs increased in patients with periodontal alveolar bone loss with aging (P < 0.05).

PMID:36751825 | DOI:10.4103/njcp.njcp_210_22

Niger J Clin Pract. 2023 Jan;26(1):55-58. doi: 10.4103/njcp.njcp_170_22.

ABSTRACT

BACKGROUND AND AIM: Bilirubin can have a toxic effect on the brain, so newborns must be carefully checked to identify those who may develop significant hyperbilirubinemia and bilirubin encephalopathy (kernicterus). The study aimed to determine if cord blood albumin could be utilized to predict the onset of significant newborn jaundice in healthy-term babies.

PATIENTS AND METHODS: A cohort study was carried out in AL-Zahraa teaching hospital in AL-Najaf city during the period from January 1 to November 1, 2020. A randomized 100 full-term healthy neonates were enrolled. A blood sample was drawn by milking the cord and sent for serum albumin estimation. Patients were then followed up on the third and fifth days of life for total serum bilirubin (TSB).

RESULTS: Out of 100 healthy-term neonates that were included in this study, 60 of them had low cord blood albumin (<2.8 g/dl), and 40 of them had normal cord blood albumin (≥2.8 g/dl) with an age range of 1-5 days. There is a statistically significant difference between low cord blood albumin and significant neonatal jaundice on the third day with a 5 times more risk of developing significant jaundice than neonates with normal cord blood albumin.

CONCLUSION: Cord blood albumin levels are sensitive to predicting subsequent neonatal jaundice in the healthy term newborn.

PMID:36751824 | DOI:10.4103/njcp.njcp_170_22

Niger J Clin Pract. 2023 Jan;26(1):49-54. doi: 10.4103/njcp.njcp_2025_21.

ABSTRACT

BACKGROUND: Atopic dermatitis (AD) is a chronic, inflammatory, and itchy skin condition that develops in early childhood in the majority of cases.

AIM: The objective of this study is to determine factors associated with atopic dermatitis among children aged 6 months to 14 years seen at the General Out-Patients Clinics of a tertiary hospital in north central Nigeria as well as predictors of having AD.

PATIENTS AND METHODS: This was a descriptive cross-sectional study of 490 eligible children recruited using the systematic random sampling technique. The data collected were analyzed using statistical package for social sciences, version 22. Descriptive and inferential statistics was performed to determine the relationship between independent variables and having AD.

RESULTS: The factors significantly associated with AD from this study include: male sex (χ = 4.78, P = 0.029), Being in nursery school (χ = 77.60, P = 0.000), Nupe ethnicity (χ = 49.06, P = 0.000), mothers and fathers Educational level (χ = 27.80, P = 0.000), having personal or family history of atopy (χ = 31.30, P = 0.000). After all variables that are significant was adjusted; Nursery level of education (OR = 4.076, 95% CI = 1.679-9.891, P = 0.002), Mother’s Level of education (OR = 0.664, 95% CI = 0.442-0.998, P = 0.049), and personal or family history of atopy (OR = 5.585-E12, 95% CI = 5.585-E12-5.585-E12, P = 0.000) were independent predictors of AD.

CONCLUSION: Our data suggest that AD has a specific pattern of inheritance in children and this was predicted by: nursery level of education, mother’s level of education, and family or personal history of atopy. Knowledge of this will provide a better caring strategy for predicting and preventing AD earlier in at risk children.

PMID:36751823 | DOI:10.4103/njcp.njcp_2025_21

Niger J Clin Pract. 2023 Jan;26(1):31-35. doi: 10.4103/njcp.njcp_1827_21.

ABSTRACT

BACKGROUND: Perioperative blood loss and the need for blood transfusion following total knee arthroplasty (TKA) has been a source of concern for many arthroplasty surgeons and patients over the years. Tranexamic acid (TXA) is increasingly being used by surgeons in limiting perioperative blood loss and the subsequent need for transfusion during TKA.

AIM: This study aims to determine the efficacy of TXA in preventing perioperative blood loss, transfusion needs of patients that underwent TKA, complications, and its financial implications of its use in our institution.

PATIENTS AND METHODS: The study was a clinical comparative audit of perioperative blood loss and transfusion needs in primary TKA patients. The study population was divided into two groups of equal numbers (n = 40). Group A, who did not receive perioperative TXA, had TKA prior to the adoption of TXA in our institution, whereas group B, who received TXA, had TKA after TXA was adopted.

RESULTS: The mean postoperative hemoglobin was 9.49 g/dl for group A and 10.15 g/dl for group B (P = 0.021). The mean postoperative blood drainage was 888.25 ml for group A and 821.67 ml for group B (P = 0.397). The number of patients transfused in group A was 17 (42.5%) against 7 (17.5%) in group B. The mean postoperative transfusion volume was 270 ml and 101.25 ml for group A and B, respectively (P = 0.014). The mean total transfusion volume was 450 ml and 277 ml in group A and B, respectively (P = 0.063).

CONCLUSIONS: The use of TXA in TKA was shown to be beneficial in our study as it resulted in a statistically significant reduction in the postoperative transfusion volumes and higher postoperative hemoglobin levels.

PMID:36751820 | DOI:10.4103/njcp.njcp_1827_21

Commun Med (Lond). 2023 Feb 7;3(1):19. doi: 10.1038/s43856-023-00241-9.

ABSTRACT

BACKGROUND: The prognostic role of the cardiothoracic ratio (CTR) in chronic kidney disease (CKD) remains undetermined.

METHODS: We conducted a retrospective cohort study of 3117 patients with CKD aged 18-89 years who participated in an Advanced CKD Care Program in Taiwan between 2003 and 2017 with a median follow up of 1.3(0.7-2.5) and 3.3(1.8-5.3) (IQR) years for outcome of end-stage renal disease (ESRD) and overall death, respectively. We developed a machine learning (ML)-based algorithm to calculate the baseline and serial CTRs, which were then used to classify patients into trajectory groups based on latent class mixed modelling. Association and discrimination were evaluated using multivariable Cox proportional hazards regression analyses and C-statistics, respectively.

RESULTS: The median (interquartile range) age of 3117 patients is 69.5 (59.2-77.4) years. We create 3 CTR trajectory groups (low [30.1%], medium [48.1%], and high [21.8%]) for the 2474 patients with at least 2 CTR measurements. The adjusted hazard ratios for ESRD, cardiovascular mortality, and all-cause mortality in patients with baseline CTRs ≥0.57 (vs CTRs <0.47) are 1.35 (95% confidence interval, 1.06-1.72), 2.89 (1.78-4.71), and 1.50 (1.22-1.83), respectively. Similarly, greater effect sizes, particularly for cardiovascular mortality, are observed for high (vs low) CTR trajectories. Compared with a reference model, one with CTR as a continuous variable yields significantly higher C-statistics of 0.719 (vs 0.698, P = 0.04) for cardiovascular mortality and 0.697 (vs 0.693, P < 0.001) for all-cause mortality.

CONCLUSIONS: Our findings support the real-world prognostic value of the CTR, as calculated by a ML annotation tool, in CKD. Our research presents a methodological foundation for using machine learning to improve cardioprotection among patients with CKD.

PMID:36750687 | DOI:10.1038/s43856-023-00241-9

Sci Rep. 2023 Feb 7;13(1):2202. doi: 10.1038/s41598-023-29126-6.

ABSTRACT

Athletes who have undergone anterior cruciate ligament reconstruction (ACLR) often exhibit persistently impaired kinematics and strength. Core stability training appears to be effective for reducing high-risk landing mechanics and preventing primary anterior cruciate ligament (ACL) injuries; however, there have been few attempts to examine their effects in athletes who have undergone ACLR. This study aimed to investigate the effect of eight weeks of simple core stability training on core endurance, hip strength, and knee kinematics in ACLR athletes. Twenty-six male athletes (20-30 years old) with a history of ACL surgery with hamstring tendon autograft were randomly divided into training (n = 13) and control groups (n = 13). The training group performed core stability exercises for eight weeks before starting their team training; the control group did not receive any intervention. Both groups continued their regular team schedule. The core endurance, hip muscle strength, and knee kinematics were assessed by the McGill test, a hand-held dynamometer, and video-taping, respectively. Analysis of covariance test was used for data analysis. The training group showed a significant increase in core endurance, hip abductor and external rotator strength, knee flexion angle, and a significant decrease in the knee valgus angle during single-leg landing in post-training tests compared to their baseline tests (P < 0.05). Our results demonstrated that core stability exercise alters neuromuscular function to a level that is clinically acceptable and statistically significant. Because of the high incidence rate of secondary ACL injury after ACLR, it is recommended that athletes with a history of ACLR benefit from adding core stability exercises to warm-up routines or tertiary prevention programs even after completing post-operative rehabilitation. It is fast and not time-consuming to perform for athletes to reduce the risk factors of re-injury. Trial registration: This study was registered in the Iranian Registry of Clinical Trials with the number IRCT20190224042827N2, registered on 19 December 2019.

PMID:36750662 | DOI:10.1038/s41598-023-29126-6