Category: Nevin Manimala

Niger J Clin Pract. 2023 Feb;26(2):194-200. doi: 10.4103/njcp.njcp_424_22.

ABSTRACT

BACKGROUND: Abnormalities of glucose metabolism are associated with abnormal left ventricular geometry (LV) independent of atherosclerosis. Abnormal LV geometry, a predictor of premature cardiovascular events, indicates presence of subclinical target organ damages. Screening for abnormal LV geometry in diseases of abnormal glucose metabolism is desirable as part of their management protocol.

AIM: To assess the left ventricular geometry in normotensive type II diabetic patients. Cross-sectional, descriptive, hospital-based study. One hundred normotensive type II diabetic patients drawn from the Endocrinology and Family Medicine Clinics of a tertiary hospital were age- and gender-matched with 100 apparently healthy controls. Participants meeting the criteria and informed consent proceeded for clinical evaluation, biochemical assessment, electrocardiography, and echocardiography using the American Society of Echocardiography guideline.

MATERIALS AND METHODS: Data were analyzed using the Statistical Package for Social Sciences [SPSS] version 25.0 (Chicago Illinois, USA).

RESULTS: Mean age of study and control groups was (55.56 ± 9.89 versus 55.47 ± 10.7) years (χ2 = 0.062, P = 0.951). The mean duration of diabetes illness was 6.57 ± 6.26 years. Prevalence of abnormal LV geometry was 51% (study) versus 18% (control) FT, P < 0.001). Concentric remodeling was the predominant geometry in 36% of study versus 11% of controls, followed by eccentric hypertrophy in 11% (study) versus 4% (control) and concentric hypertrophy in 4% (study) versus 3% (control). Geometry was normal in 49% of study against 82% in the controls (FT, P < 0.001). Significant association existed between LV geometry and duration of diabetes (χ2 = 10.793, P = 0.005).

CONCLUSION: Abnormal LV geometry is highly prevalent in normotensive diabetic patients.

PMID:36876608 | DOI:10.4103/njcp.njcp_424_22

Niger J Clin Pract. 2023 Feb;26(2):169-176. doi: 10.4103/njcp.njcp_186_22.

ABSTRACT

BACKGROUND: Procedural complications and workload have been reported as sources of stress in dentistry.

AIM: To investigate the impact of endodontic workload and allocated treatment time of dentists on perceived stress and frequency of complications.

MATERIAL AND METHODS: The online survey included questions to evaluate the average number of root canal treatments per week, stress levels during root canal treatment, frequency of single-visit root canal treatments, time spent on single-visit treatments, frequency of endodontic complications per week, preference for management of complication, and proposed solutions.

RESULTS: A negative correlation was found between endodontic workload and perceived stress, which was statistically significant at slight and moderate stress levels (P < 0.05). Amongst the clinicians who feel “very stressful” during the treatment, the clinicians who allocate only 20 minutes or less per treatment had the highest frequency, and their numbers were significantly higher than clinicians who spent 20-40 minutes per treatment (P < 0.05). Amongst the clinicians who experience instrument separation 4-6 times/week, the number of clinicians who spent 40-60 minutes or more than 60 minutes per root canal treatment was significantly lower in comparison to the number of clinicians who spent 20-40 minutes (P < 0.05).

CONCLUSION: Increasing the quality of dental equipment and reducing the time pressure on dentists might result in lesser stress levels of clinicians and fewer endodontic complications.

PMID:36876605 | DOI:10.4103/njcp.njcp_186_22

Niger J Clin Pract. 2023 Feb;26(2):162-168. doi: 10.4103/njcp.njcp_35_22.

ABSTRACT

BACKGROUND: Dental students’ burnout has been repeatedly reported in the literature; however, there is little information about the contributing factors in different contexts and settings.

AIMS: This study aimed to investigate the correlation between burnout among undergraduate dental students and sociodemographic (specifically gender), psychological (resilience), and structural factors (dental environment stress).

SUBJECTS AND METHODS: An online cross-sectional survey questionnaire was distributed among a convenience sample of 500 undergraduate Saudi dental students. The survey included questions about sociodemographic factors (gender, level of education, academic achievement, type of school [public or private], and living arrangements). The study also included items that allowed assessment of students’ burnout using the Maslach Burnout Inventory (MBI) and assessment of student environmental stress and resilience using the Dental Environment Stress Scale (DESS) and the Brief Resilience Scale (BRS). Descriptive statistics, univariate, and linear regression analyses were performed.

RESULTS: The response rate was 67% (male = 119, female = 216). Univariable analysis showed that gender, level of education, and DESS and BRS scores correlated significantly (P <.05) with MBI scores. Adjusted multiple linear regression lends further support to that the MBI scores negatively correlated with the BRS score but positively correlated with the DESS score (β = -0.29, P <.001; β = 0.44, P <.001, respectively).

CONCLUSIONS: Within the limitations of this study, the findings demonstrated that increases in resilience correlated significantly with decreases in burnout and increases in environmental stress correlated significantly with increases in burnout among dental students. However, gender had no influence on burnout.

PMID:36876604 | DOI:10.4103/njcp.njcp_35_22

Niger J Clin Pract. 2023 Feb;26(2):153-161. doi: 10.4103/njcp.njcp_1636_21.

ABSTRACT

BACKGROUND: Ultrasound-guided bilateral erector spinae plane block is also a technique for providing analgesia after a cesarean section.

AIM: We hypothesized that bilateral erector spinae plane block applied from the transverse process of T9 who underwent elective cesarean section could provide effective postoperative analgesia.

PATIENTS AND METHODS: Fifty parturients who were scheduled to undergo elective cesarean section under spinal anesthesia were included in the study. Group SA (n = 25) was categorized as the group in which spinal anesthesia alone (SA) was performed, and Group SA+ESP (n = 25) was categorized as the group in which SA + ESP block was performed. All patients were given a solution containing 7 mg isobaric bupivacaine + 15 μg fentanyl intrathecally through spinal anesthesia. In the SA + ESP group, the bilateral ESPB was performed at level T9 with 20 ml 0.25% bupivacaine + 2 mg dexamethasone immediately after the operation. Total fentanyl consumption in 24 h, the visual analogue scale for pain, and time to the first analgesic request were evaluated postoperatively.

RESULTS: The total fentanyl consumption in 24 h was statistically significantly lower in the SA + ESP group than the SA group (279 ± 242.99 μg vs. 423.08 ± 212.55 μg, respectively, P = 0.003). The first analgesic requirement time was statistically significantly shorter in the SA group than the SA + ESP group (150.20 ± 51.83 min vs. 197.60 ± 84.49 min, respectively, P = 0.022). Postoperative VAS scores at 4^th, 8^th, and 12^th h at rest were statistically significantly lower in group SA + ESP than in group SA (P = 0.004, P = 0.046, P = 0.044, respectively). VAS scores during the postoperative 4^th, 8^th, and 12^th h cough were statistically significantly lower in group SA + ESP than in group SA (P = 0.002, P = 0.008, P = 0.028, respectively).

CONCLUSION: Ultrasound-guided bilateral ESP provided adequate postoperative analgesia and significantly decreased postoperative fentanyl consumption in patients having cesarean section. Also, it has a longer analgesia time than the control group, and it has been shown to delay the first analgesic requirement.

PMID:36876603 | DOI:10.4103/njcp.njcp_1636_21

Niger J Clin Pract. 2023 Feb;26(2):145-152. doi: 10.4103/njcp.njcp_1628_21.

ABSTRACT

BACKROUND: Treatment of geriatric intensive care patients is tiring and difficult for intensive care physicians due to comorbidities, accompanying acute illnesses and vulnerabilities.

AIM: The aim of our study was to determine other factors affecting mortality and morbidity with age in geriatric intensive care patients.

PATIENTS AND METHODS: A total of 937 geriatric intensive care patients were divided into three groups as young-old (65-74 years), middle-old (75-84 years), and oldest-old (85 years and more). Demographic characteristics such as age, gender, and comorbid diseases (oncological malignancy, chronic renal failure, sepsis, chronic anemia, hypertension, diabetes mellitus, chronic obstructive pulmonary disease, pulmonary embolism) were recorded. The number of patients who needed a mechanical ventilator, developed decubit ulcers, underwent percutaneous tracheostomy, and renal replacement therapy were recorded. In addition, the number of central venous catheter insertions for patients, Acute Physiology and Chronic Health Evaluation II scores (APACHE II), hospitalization days, and mortality rates were recorded and compared.

RESULTS: In the comparison between the groups in terms of gender, in the 65-74 years’ age group, male gender was higher, while in the age group of 85 years and more, the female gender was found to be statistically higher. Among comorbid diseases, the rate of oncological malignancy was found to be statistically significantly lower in patients aged 85 years and more. Comparing the APACHE II scores of the patients as per the groups, scores were found to be statistically significantly higher in the oldest-old group. APACHE II Score, central venous catheter application, chronic obstructive pulmonary disease, chronic renal failure, sepsis, oncological malignancy, and renal replacement therapy were shown to be statistically significant as factors affecting death. The factors affecting the survival or hospitalization time of the patients of decubit ulcer, mechanical ventilator, percutaneous tracheostomy, chronic obstructive pulmonary disease, Sepsis, APACHE II Score, and age were shown to be statistically significant.

CONCLUSION: Our study showed that not only age has an effect on mortality and morbidity in geriatric intensive care patients but also comorbidities and intensive care treatments of the patients are also effective in this process.

PMID:36876602 | DOI:10.4103/njcp.njcp_1628_21

Niger J Clin Pract. 2023 Feb;26(2):133-137. doi: 10.4103/njcp.njcp_600_20.

ABSTRACT

BACKGROUND: Diabetes is a common systemic disease in the world. Acute complications of diabetes may cause sudden unexpected deaths. Analysis done in vitreous fluid which is more protected and less contaminated by bacteria comparing to blood will produce more accurate results.

AIM: Thus, we aimed to diagnose diabetes by comparing glucose levels of post mortem blood and vitreous fluid in death cases.

MATERIALS AND METHODS: A total of 17 New Zealand-type rabbits were divided into hyperglycemia (8), hypoglycemia (8), and control group (1). Rabbits were monitored for 5 days after experimental diabetes induction, and samples were taken at the point of death. Later rabbits were left in their environment, and samples were taken again at the post mortem first day. Mean blood glucose levels of hyperglycemia and hypoglycemia group were in diabetic range.

RESULTS: Blood glucose levels of hyperglycemic rabbits were measured as 512 ± 52,1 mg/dl, while vitreous glucose levels were 518,3 ± 76,8 mg/dl at the point of death. After one day, levels were measured as 433,9 ± 59,3 mg/dl and 329,8 ± 86,6 mg/dl. Blood glucose levels of hypoglycemic rabbits were measured as 39 ± 3,8 mg/dl, while vitreous glucose levels were 53,4 ± 13,9 mg/dl at the point of death. After one day, levels were measured as 36 ± 4,2 mg/dl and 1,6 ± 0,6 mg/dl. After analysis, there was a statistically significant difference between day 0 and 1 vitreous levels of hypoglycemia group.

CONCLUSION: It can be clearly seen that vitreous fluid samples should be taken in judicial cases with sudden unexpected deaths like diabetes. This will contribute to identification cause of death.

PMID:36876600 | DOI:10.4103/njcp.njcp_600_20

J Magn Reson Imaging. 2023 Mar 6. doi: 10.1002/jmri.28670. Online ahead of print.

ABSTRACT

BACKGROUND: The volume doubling time (VDT) of breast cancer was most frequently calculated using the two-dimensional (2D) diameter, which is not reliable for irregular tumors. It was rarely investigated using three-dimensional (3D) imaging with tumor volume on serial magnetic resonance imaging (MRI).

PURPOSE: To investigate the VDT of breast cancer using 3D tumor volume assessment on serial breast MRIs.

STUDY TYPE: Retrospective.

SUBJECTS: Sixty women (age at diagnosis: 57 ± 10 years) with breast cancer, assessed by two or more breast MRI examinations. The median interval time was 791 days (range: 70-3654 days).

FIELD STRENGTH/SEQUENCE: 3-T, fast spin-echo T2-weighted imaging (T2WI), single-shot echo-planar diffusion-weighted imaging (DWI), and gradient echo dynamic contrast-enhanced imaging.

ASSESSMENT: Three radiologists independently reviewed the morphological, DWI, and T2WI features of lesions. The whole tumor was segmented to measure the volume on contrast-enhanced images. The exponential growth model was fitted in the 11 patients with at least three MRI examinations. The VDT of breast cancer was calculated using the modified Schwartz equation.

STATISTICAL TESTS: Mann-Whitney U test, Kruskal-Wallis test, Chi-squared test, intraclass correlation coefficients, and Fleiss kappa coefficients. A P-value <0.05 was considered statistically significant. The exponential growth model was evaluated using the adjusted R² and root mean square error (RMSE).

RESULTS: The median tumor diameter was 9.7 mm and 15.2 mm on the initial and final MRI, respectively. The median adjusted R² and RMSE of the 11 exponential models were 0.97 and 15.8, respectively. The median VDT was 540 days (range: 68-2424 days). For invasive ductal carcinoma (N = 33), the median VDT of the non-luminal type was shorter than that of the luminal type (178 days vs. 478 days). On initial MRI, breast cancer manifesting as a focus or mass lesion showed a shorter VDT than that of a non-mass enhancement (NME) lesion (median VDT: 426 days vs. 665 days).

DATA CONCLUSION: A shorter VDT was observed in breast cancer manifesting as focus or mass as compared to an NME lesion.

LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: Stage 2.

PMID:36876593 | DOI:10.1002/jmri.28670

Paediatr Anaesth. 2023 Mar 6. doi: 10.1111/pan.14658. Online ahead of print.

ABSTRACT

BACKGROUND: Liberal fasting regimens, which support clear fluid intake up to 1 hour before surgery in children scheduled for elective surgery, are taking their place in guidelines. However, because of the lack of publications that investigate the gastric emptying time in preoperative obese children, the practice of 1-hour clear fluid fasting in obese children remained at the level of recommendation with weak evidence.

AIMS: The primary aim was to investigate whether there is a difference in gastric emptying times between obese and non- obese children after preoperative intake of 3 ml/kg clear liquid containing 5% dextrose by using ultrasound.

METHODS: A total of 70 children were included in the study in two groups, 35 obese and 35 non-obese, aged 6-14 years, who were scheduled for elective surgery. The baseline antral cross-sectional area measurements of the children in the groups were made using ultrasound. 3 ml/kg 5% dextrose was consumed. Ultrasound was repeated immediately after fluid intake and every 5 minutes until the antral cross-sectional area was at the baseline level.

RESULTS: The difference in median (IQR [range]) gastric emptying times (minutes) of non-obese [(35 (30.0-45.0 [20-60])] and obese children [(35 (30.0-40.0 [25-60])] were not statistically significant (median of differences 0.0, 95% CI 0.0 to 0.0; P=0,563). The antral cross-sectional area and weight- adjusted gastric volumes returned to the baseline level within 60 minutes after the intake of clear liquid with 3 ml/kg 5% dextrose in all children in both groups.

CONCLUSIONS: Obese and non-obese children have similar gastric emptying times, and these groups can be offered clear fluids containing 3 ml/kg 5% dextrose 1 hour before the surgery.

PMID:36876549 | DOI:10.1111/pan.14658

Folia Med (Plovdiv). 2022 Oct 31;64(5):782-786. doi: 10.3897/folmed.64.e67757.

ABSTRACT

The share of unwanted pregnancies and voluntary abortions among women from Central and Eastern Europe is still quite high, and Bulgaria is no exception to this statistic. This might be accounted for by the low frequency of use of contraceptives or their improper use. Our country is home to a variety of ethnic groups, with Roma being one of the most numerous, ranking third in population behind Bulgarians and Turks. This determines the influence of this ethnic group on the demographic indicators of the country.

PMID:36876529 | DOI:10.3897/folmed.64.e67757

Public Health Nutr. 2023 Mar 6:1-26. doi: 10.1017/S1368980023000411. Online ahead of print.

ABSTRACT

OBJECTIVE: Explore patterns of post-malnutrition growth (PMGr) during and after treatment for severe malnutrition, and describe associations with survival and non-communicable disease (NCD) risk seven years post-treatment.

DESIGN: Six indicators of PMGr were derived based on a variety of timepoints, weight, weight-for-age z-score (WAZ) and height-for-age z-score (HAZ). Three categorisation methods included: no categorisation, quintiles, and latent class analysis (LCA). Associations with mortality risk, and seven NCD indicators were analysed.

SETTING: Secondary data from Blantyre, Malawi between 2006 and 2014.

PARTICIPANTS: A cohort of 1024 children treated for severe malnutrition (weight-for-length z-score <70% median and/or MUAC<110 mm and/or bilateral oedema) at aged 5 to 168 months.

RESULTS: Faster weight gain during treatment (g/day) and after treatment (g/kg/day) were associated with lower risk of death (aOR 0.99, 95%CI 0.99 to 1.00; and aOR 0.91, 95% CI 0.87 to 0.94 respectively). In survivors (mean age 9 years), it was associated with greater hand grip strength (0.02, 95%CI 0.00 to 0.03) and larger HAZ (6.62, 95%CI 1.31 to 11.9), both indicators of better health. However, faster weight gain was also associated with increased waist:hip ratio (0.02, 95%CI 0.01 to 0.03), an indicator of later life NCD risk. The clearest patterns of association were seen when defining PMGr based on weight gain in g/day during treatment and using the LCA method to describe growth patterns. Weight deficit at admission was a major confounder.

CONCLUSIONS: A complex pattern of benefits and risks is associated with faster PMGr. Both initial weight deficit and rate of weight gain have important implications for future health.

PMID:36876519 | DOI:10.1017/S1368980023000411