Nevin Manimala

Zhonghua Nei Ke Za Zhi. 2022 May 1;61(5):537-542. doi: 10.3760/cma.j.cn112138-20211010-00685.

ABSTRACT

Objective: To evaluate whether underdilated stent could reduce the occurrence of hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) creation. Methods: A total of 197 patients with decompensated liver cirrhosis, who had underwent TIPS creation at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, were analyzed retrospectively, including 110 males and 87 females with age 25-79 (54±11) years old. Uncovered and covered stents with 8 mm diameter were implanted in all subjects, and then dilated by balloon catheters with 6 mm or 8 mm diameter. The patients were divided into two groups, including underdilated group (6 mm, n=105) and control group (8 mm, n=92).Kaplan-Meier curves were used to illustrate cumulative rate of HE, and the differences were assessed with the log-rank test. Multivariate analyses with a Cox regression model were conducted to explore the risk factors for HE. Results: During a median follow-up period of 29 (12-54) months, 16 (15.2%) patients developed HE in the underdilated group and 27 (29.3%) patients in the control group. There was a significant difference in the cumulative rate of HE (P=0.014), but no statistical differences were found in terms of variceal rebleeding, shunt dysfunction and survival between the two groups (P=0.608, P=0.659, P=0.968). In multivariated analysis, group assignment (underdilated vs. control, HR=0.291, 95%CI 0.125-0.674, P=0.004) was identified as an independent risk factor for HE after TIPS creation. Conclusion: Underdilated TIPS could reduced the risk of HE compared with completely dilated TIPS, with comparable risk of variceal rebleeding, shunt dysfunction and mortality. And it is worthy of applying this technique to a large sample of patients in clinical practice.

PMID:35488604 | DOI:10.3760/cma.j.cn112138-20211010-00685

Niger Postgrad Med J. 2022 Apr-Jun;29(2):167-172. doi: 10.4103/npmj.npmj_23_22.

ABSTRACT

BACKGROUND: Dental anomalies are craniofacial abnormalities in the size, structure or number of the teeth. This study was conducted to assess the prevalence of dental anomalies among children aged 0-16 years attending the Paediatric Dental Clinic at the Lagos University Teaching Hospital, Lagos, Nigeria.

METHODS: A cross-sectional design was used and data were obtained from the dental records of the Dental Clinic from January 2014 to August 2019 by two calibrated examiners, who are co-authors of the manuscript. To test for statistical differences, Chi-squared test was utilised for the categorical variables. The prevalence of the different dental anomalies was estimated and presented with frequencies. P < 0.05 was considered statistically significant.

RESULTS: Among the 6175 patients’ dental records reviewed, 50.85% (n = 3150) were male and the highest proportion of 45.4% (n = 2807) were aged between 6 and 10 years, with a mean age of 8.62 ± 3.85 years. A total of 1090 (17.52%) had dental anomalies; 465 (7.53) anomalies were in the maxilla, 263 (4.6) were in the mandible while 360 (5.83) were in both. The most common anomaly was hypoplasia 550 (9.06%), followed by retained primary tooth 546 (8.84%) and hypodontia 84 (1.36%). Dentinogenesis imperfecta 1 (0.02) and transposition 1 (0.02) were the least prevalent anomalies. Retained primary teeth (5.8%) and the cusp of Carabelli (0.4%) were slightly more prevalent among males. However, females had a higher prevalence of natal/neonatal teeth (0.4%), fusion/germination (0.4%), hypodontia (1.5%) and peg-shaped lateral incisors (0.9%).

CONCLUSION: Dental anomalies’ prevalence in this study was 17.52%, with a higher occurrence of anomalies in the maxilla. Hypoplasia was the most prevalent anomaly, after which was retained primary tooth, then hypodontia. Prompt diagnosis and preventive interventions are crucial for the appropriate management of these dental anomalies.

PMID:35488587 | DOI:10.4103/npmj.npmj_23_22

Niger Postgrad Med J. 2022 Apr-Jun;29(2):161-166. doi: 10.4103/npmj.npmj_7_22.

ABSTRACT

OBJECTIVES: Associations between the occurrence of dentine hypersensitivity (DH) and dental fluorosis (DF) have been suggested. Testing this association requires studies among populations with both conditions. This study aimed to determine the association between DF and the experience of DH among a population endemic for DF.

METHODS: This was a cross-sectional study conducted in 2021 over 6 months among 428 adult patients. Participants’ demographics were collected, followed by verbal screening for DH and oral examinations. Clinical assessment for DH was carried out by tactile and evaporative methods. The presence and severity of DF were also assessed using the Thylstrup and Fejerskov Index. Data analysis included Chi-square and correlation statistics to assess the presence and strength of associations.

RESULTS: The overall prevalence of DH was 31.1%. A higher proportion (41.1%, P < 0.001) of participants with DF had DH than those without DF. The association between DH and DF was minimal but statistically significant (r = 0.174, P < 0.001). Among those with DF, the prevalence of DH was highest in participants with severe fluorosis (50%, P = 0.740). The proportion of sensitive teeth to the teeth examined was significantly higher (P < 0.0001) for participants with DF (289/4167, 6.9%) than participants without DF (267/6758, 4%). This proportion was also highest for severe DF (20/254, 7.9%, P = 0.572) than the mild and moderate forms.

CONCLUSION: DH was more prevalent among individuals with DF. The prevalence of DH was not dependent on the severity of DF.

PMID:35488586 | DOI:10.4103/npmj.npmj_7_22

Niger Postgrad Med J. 2022 Apr-Jun;29(2):151-154. doi: 10.4103/npmj.npmj_757_21.

ABSTRACT

BACKGROUND: The anterior fontanelle (AF) tension has been a traditional clinical method of indirect assessment of intracranial pressure (ICP). How does this time-tested bedside assessment technique compare with an objective ventricular cerebrospinal fluid (CSF) opening pressure?

OBJECTIVE: To determine the correlation of palpation anterior fontanometry and CSF opening pressure in early childhood hydrocephalus.

MATERIALS AND METHODS: Children diagnosed with hydrocephalus who were planned for CSF diversion using ventriculo-peritoneal (V-P) shunt were prospectively studied over 18 months. The AF tension was assessed by palpation preoperatively and graded. The CSF opening pressure was measured using sterile disposable plastic manometers after ventricular cannulation intraoperatively.

STATISTICAL ANALYSIS: Data obtained were analysed using SPSS version 21. Student’s t-test, Mann-Whitney U test and ANOVA were used to determine associations based on normality tests. A P < 0.05 was considered significant for associations.

RESULTS: Fifty-two children were operated on with AF patency rate of 88.5%. Their age ranged between 2 weeks and 18 months with a mean age of 7.1 ± 5.1 months. The fontanelle tension was tense, full and normal in 63.0%, 26.1% and 10.9% of patients, respectively. The mean CSF opening pressure of 20.5 ± 8.5 cm of H₂O was higher than the expected ICP for the age group (t-test 4.754, P = 0.000). All 28 patients with CSF opening pressure >15 cm of H₂O had a tense fontanelle, but 10.9% of children with raised ICP have normal AF tension.

CONCLUSION: The mean ICP increases as palpation AF tension increases, but a normal AF tension does not rule out raised ICP.

PMID:35488584 | DOI:10.4103/npmj.npmj_757_21

Niger Postgrad Med J. 2022 Apr-Jun;29(2):146-150. doi: 10.4103/npmj.npmj_716_21.

ABSTRACT

BACKGROUND: Total knee arthroplasty (TKA) is performed worldwide. TKA is performed to relief pain, correct deformities and improve mobility in patients with debilitating diseases of their knee joints. Templating is done as pre-operative planning for TKA. Certain parameters, such as shoe size, had been studied as predictor (s) for implant size. This study aimed to determine if the tibial length (TL) can also be as a predictor of a tibial component of TKA.

MATERIALS AND METHODS: TL and tibial plateau width (TPW) measurements were done on dry adult tibiae. Proximal tibiae were traced on tracing paper, to obtain anterior-posterior and lateral tracings. Length of tracings confirmed with measurement on dry bones. A TKA template, converted to 100% scale was used to estimate the tibial baseplate by two orthopaedic surgeons.

RESULTS: A total of 51 matured, non-sexed, non-paired tibiae were studied. There was a statistically significant positive relationship between the TL and the TPW (P = 0.0001). Furthermore, a statistically significant positive relationship was also observed between the TL and the tibial implant baseplate (P = 0.0001). The study showed that a particular range of tibia length will accommodate certain sizes of the tibial implant baseplate.

CONCLUSION: The tibia length can be used as a predictor of the size of tibial baseplate of TKA.

PMID:35488583 | DOI:10.4103/npmj.npmj_716_21

Niger Postgrad Med J. 2022 Apr-Jun;29(2):123-130. doi: 10.4103/npmj.npmj_739_21.

ABSTRACT

BACKGROUND: The clinical uses of ultrasonography have varied and increased over time, especially the ability of ultrasonographic measured parameters to predict the outcomes of labour. The proper understanding of the association between these ultrasonographic parameters, mode of delivery, adverse maternal and foetal outcomes will further improve patient counselling as well as the planning of intrapartum care.

AIM: The study explored the ultrasonographic measurement of foetal head circumference (HC) and cheek-to-cheek diameter (CCD) at term as predictors of labour outcomes.

METHODOLOGY: Eligible pregnant women at term were recruited from the antenatal clinic and had obstetric ultrasound scans done with HC and CCD measured. Maternal and foetal outcomes were measured and included progress in labour, obstetric lacerations, mode of delivery and suspected foetal distress. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 20.

RESULTS: One hundred and thirty-two patients were recruited into the study. Foetal HC measurements ≥35 cm were closely associated with caesarean delivery odds ratio – 2.40 (95% confidence interval – 1.02-5.66. P = 0.046). Neither CCD nor CCD/HC ratio was predictive of the modes of delivery. The occurrence of perineal lacerations and poor progress of labour were observed more frequently with increasing HC and CCD.

CONCLUSIONS: HC performed well in predicting caesarean delivery as well as perinatal outcomes among parturients. The ultrasonographic measured HC (≥35 cm) is associated with a higher incidence of both obstetric interventions for poor progress of labour and adverse perinatal outcomes in comparison to CCD. The association between HC and labour dystocia was found to be linear. The CCD did not perform well as a predictor of the mode of delivery.

PMID:35488580 | DOI:10.4103/npmj.npmj_739_21

Niger Postgrad Med J. 2022 Apr-Jun;29(2):89-95. doi: 10.4103/npmj.npmj_11_22.

ABSTRACT

CONTEXT: Coronavirus disease (COVID-19) has led to over 2,589,638 deaths globally as of March 2021 and speedy discovery of vaccines. Nigeria started the phase one COVID-19 vaccination in March 2021 using the Oxford AstraZeneca vaccine. Reports of severe adverse events with the Oxford AstraZeneca vaccine resulted in its suspension in some countries necessitating the need to determine its safety.

AIMS: To assess the prevalence, types and severity of the adverse events following COVID-19 vaccination in Rivers State, Nigeria.

SETTINGS AND DESIGN: A cross-sectional study design was adopted.

SUBJECTS AND METHODS: Simple random sampling method was used to select a total of 428 adults from recipients of the first dose of COVID-19 vaccine within 28 days of vaccination. A questionnaire adapted from World Health Organisation was interviewer-administered through phone calls; responses were recorded on Kobo Toolbox.

STATISTICAL ANALYSIS USED: Descriptive analysis of variables was done and the association between adverse events and age, allergy and medical history were determined. The level of statistical significance was predetermined at a P < 0.05.

RESULTS: In this study, 50.5% of respondents reported post-vaccination adverse events out of which 10 (4.6%) were severe (30% of the severe cases were life-threatening, 60% were hospitalised and 10% were placed on bed rest). The most common side effects were fever (73.0%), pain at the injection site (41.2%), fatigue (33.3%), body ache (17.5%) and headache (13.8%). No significant association was observed between the incidence of severe adverse events and participants with allergies or medical history.

CONCLUSIONS: The adverse events associated with the COVID-19 vaccine were largely mild and resolved within a few days. Further research is required to classify adverse events into categories.

PMID:35488575 | DOI:10.4103/npmj.npmj_11_22

Niger Postgrad Med J. 2022 Apr-Jun;29(2):82-88. doi: 10.4103/npmj.npmj_777_21.

ABSTRACT

CONTEXT: Indonesia has a large population with a large number of motorised vehicles, so it cannot be separated from traffic accidents.

AIMS: This study aimed to determine and analyse the advanced level risk factors for road traffic accidents (RTA) in rural and urban areas based on data from the Basic Health Research 2018 (Riskesdas).

METHODS: This study used Riskesdas data sourced from the National Institute of Health Research and Development, Ministry of Health, Indonesia, which was collected from 34 provinces in Indonesia using a cross-sectional method. The statistical data consisted of 59,423 respondents aged over 15 years old, who had experienced a road traffic injury and lived in rural or urban areas. The data variables analysis was socio-demographic, lifestyle, smoking status, alcohol consumption, mental disorders, nutritional status and use of helmets on motorcycle riders and passengers.

STATISTICAL ANALYSIS: Multivariate logistic regression was used to analyse the most dominant risk factors related to RTA in rural and urban areas.

RESULTS: The prevalence of RTA in urban areas was 34.1%, while in rural areas was 28.2%. The factors related to traffic accidents in respondents from urban areas (P < 0.005) were sex (1.342 [1.217-1.480]), age (1.111 [1.067-1.156]) and use of helmets on motorcycle riders and passengers (0.662 [0.566-0.771]). Meanwhile, risk factors for respondents from rural areas (P < 0.005) were mental disorders (0.842 [0.743-0.955]), age (1.095 [1.040-1.154]) and use of helmets on motorcycle riders and passengers (0.682 [0.585-0.796]).

CONCLUSIONS: We found that the prevalence of RTA in urban areas was higher than in rural areas. The dominant risk factors related to RTA in Indonesia were age, sex, mental disorders and the use of helmets on motorcycle riders and passengers. This finding supports the importance of road safety education and the prevention of RTA needs to be done both in urban and rural areas.

PMID:35488574 | DOI:10.4103/npmj.npmj_777_21

Midwifery. 2022 Apr 11;110:103339. doi: 10.1016/j.midw.2022.103339. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to determine maternal attachment and mental health status in mothers of babies with infantile colic.

DESIGN: Cross-sectional online survey.

SETTING: The study was conducted on messaging and social media platforms, and groups related to mothers and babies.

PARTICIPANTS: 380 mothers, 107 of whom had babies with infantile colic and 273 of whom had healthy babies, participated in the study.

MEASUREMENT TOOLS AND FINDINGS: A Personal Information Form, the Maternal Attachment Inventory, and the Depression, Anxiety and Stress Scale were used to collect data. No statistically significant relationship was found between infantile colic status and maternal attachment. The depression, anxiety and stress scores of the mothers who had babies with infantile colic were significantly higher compared to the mothers with healthy babies (p<0.05). Additionally, as the depression scores of the mothers increased, their maternal attachment levels decreased (p <0.05).

KEY CONCLUSIONS: Maternal depression, anxiety and stress make it difficult for mothers to provide care for their babies. Therefore, health professionals should screen mothers who have babies with infantile colic in the postpartum period in terms of mental health. Besides, the mothers should be provided with support to assist them in coping with their Babies’ colic.

IMPLICATIONS FOR PRACTICE: Health professionals should be aware that infantile colic negatively affects the mental health of mothers and increases the frequency of follow-ups of these mothers in the postpartum period. More research is needed to examine the effects of infantile colic on maternal attachment.

PMID:35486961 | DOI:10.1016/j.midw.2022.103339

Menopause. 2022 May 1;29(5):580-589. doi: 10.1097/GME.0000000000001944.

ABSTRACT

OBJECTIVE: To compare the impact of micronized progesterone (MP) or medroxyprogesterone acetate (MPA) in combination with transdermal estradiol (t-E2) on traditional coagulation factors and thrombin generation parameters in postmenopausal women diagnosed with premature ovarian insufficiency or early menopause.

METHOD: Randomized prospective trial conducted in women diagnosed with premature ovarian insufficiency or early menopause and an intact uterus, recruited over 28 months. All participants were prescribed t-E2 and randomized to either cyclical MP or MPA using a web-based computer randomization software, Graph Pad. Thrombin generation parameters were measured at baseline and repeated after 3-months. Traditional hemostatic biomarkers were measured at baseline and repeated after 3, 6, and 12-months. Seventy-one participants were screened for the study, of whom 66 met the inclusion criteria. In total, 57 participants were randomized: 44 completed the thrombin generation assessment arm of the study, whilst 32 completed 12-months of the traditional coagulation factor screening component of the trial.

RESULTS: Thrombin generation parameters did not significantly change from baseline after 3-months duration for either progestogen component when combined with t-E2, unlike the traditional coagulation factors. Protein C activity, free Protein S, and Antithrombin III levels decreased with time in both treatment arms.

CONCLUSION: Fluctuations in traditional hemostatic biomarkers were not reproduced by parallel changes in thrombin generation parameters that remained neutral in both groups compared with baseline. The absence of statistically significant changes in thrombin generation for the first 3-months of hormone therapy use is reassuring and would suggest a neutral effect of both progestogens on the global coagulation assay.

PMID:35486948 | DOI:10.1097/GME.0000000000001944