Nigerian Journal of Clinical Practice https://www.ajol.info/index.php/njcp <p>The <em>Nigerian Journal of Clinical Practice</em> is the official publication of the Medical and Dental Consultants Association of Nigeria (MDCAN) established in 1997 and published regularly twice yearly in June and December. Its purpose is to promote clinical and academic excellence in Medicine and Dentistry and allied sciences.</p><p>Other websites associated with this journal: <a title="http://www.njcponline.com/" href="http://www.njcponline.com/" target="_blank">http://www.njcponline.com/</a></p><p><em>Nigerian Journal of Clinical Practice </em>has been admitted into the latest Journal Citation Reports with an Impact factor of 0.168 (as of June 2011)</p> Medical and Dental Consultants' Association of Nigeria (MDCAN) en-US Nigerian Journal of Clinical Practice 1119-3077 Copyright for articles published in this journal is retained by the journal. Evaluation of Corticophobia in Asthmatic Patients https://www.ajol.info/index.php/njcp/article/view/215611 <p><strong>Background:</strong>&nbsp;Inhaler corticosteroids (ICS) are the most commonly used antiinflammatory drugs in the treatment of asthma. Although systemic adverse effects are minimal, patients hesitate to use ICS for a long time because of corticophobia. There is no study evaluating corticophobia via Likert-type appendix among the asthmatic patients.&nbsp;<strong>Aim:</strong>&nbsp;In this study, it was aimed to evaluate the fears and beliefs about ICS in asthmatic patients.&nbsp;<strong>Subjects and Methods: </strong>Between December 2017 and January 2018, 150 stable asthmatic patients were included in the study. Demographic data (age, education, smoking history, etc.) and asthma-related data (pulmonary function test, drug use) were recorded. The appendix of TOPICOP study applied to the patients with asthma which was composed of 10 questions (five questions about fear of ICS and five questions about beliefs of ICS).&nbsp;<strong>Results:</strong> The rate of ICS maintain in stable asthmatic patients was found to be 66.6%. According to the survey results, 68% of the patients believed that ICS may lead to weight gain, 52% believed that ICS may lead to infection, 73% believed that ICS may pass into bloodstream, and 67.3% believed that ICS may damage the lungs. It was also found that 90.7% needed to be informed about ICS and 67.3% wanted to cut the ICS drug as soon as possible. <strong>Conclusion:</strong>&nbsp;We found that treatment adherence may increase, if physicians allocate more time to asthma patients to inform about ICS beneficial effects at the initiating of ICS treatment and control visits.</p> H.I. Yakar A . Kanbay Copyright (c) 2021-10-06 2021-10-06 23 8 1033 1038 In which Rosacea Patients should <i>Demodex</i> in the Eyelashes be Investigated? https://www.ajol.info/index.php/njcp/article/view/215612 <table class="articlepage" border="0" width="100%"> <tbody> <tr> <td colspan="2" width="100%"><strong>Aim:</strong>&nbsp;The aim of this study was to investigate the relationship between the presence of&nbsp;<em>Demodex</em> on the face and within the eyelash follicles in patients with rosacea. <strong>Subjects and Methods:</strong>&nbsp;This prospective cross-sectional study included 80 participants, 40 patients with rosacea and 40 individuals with no rosacea as controls. The presence of&nbsp;<em>Demodex</em> on the face was assessed by standard superficial skin biopsy. Sixteen eyelashes were epilated from each patient and control.&nbsp; <strong>Results:</strong>&nbsp;The rate of&nbsp;<em>Demodex</em> infestation and severe infestation on the face in patients with rosacea was significantly higher than the control group. <em>Demodex</em>&nbsp;count within the eyelash follicle was significantly higher in patients with erythematotelangiectatic type rosacea than the control group. There was no increase in blepharitis in rosacea patients but when blepharitis was present, the rate of the presence of&nbsp;<em>Demodex</em>&nbsp;was higher in this group. There was a statistically significant relationship between the presence of&nbsp;<em>Demodex</em>&nbsp;within the eyelashes and itchy eyes in people without blepharitis.&nbsp;<strong>Conclusion:</strong> When at least one <em>Demodex</em>&nbsp;is found on the face in rosacea patients, the eyelashes should be examined for effective treatment of the mite. Itchy eyes may be an important sign of the presence of&nbsp;<em>Demodex</em>&nbsp;in people without blepharitis.</td> </tr> </tbody> </table> A. Ogrum S. Alim Copyright (c) 2021-10-06 2021-10-06 23 8 1039 1043 Accuracy of Fluid Delivery Devices for the Neonate: Are the Measures Assured? https://www.ajol.info/index.php/njcp/article/view/215613 <p><strong>Aims:</strong> To describe the clinical characteristics, colonoscopic features, histological findings, dysplasia patterns, and clinical outcome of endoscopically detected colonic polyps in the Saudi population. <strong>Methods:</strong>&nbsp;This retrospective record review was conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, on patients who underwent colonoscopy between 2005 and 2015. Patients with colorectal cancer were excluded. Data were analyzed using SPSS software.&nbsp;<strong>Results:</strong> Among 211 patients recruited, 66.8% were males and 66.2% were Saudi. Single polyps were detected in 45.5% of cases, while 29.9%, 18%, and 6.6% had 2, 3, and 4 polyps, respectively. Regarding the size, 81%, 17%, and 2% of the polyps were &lt;1 cm, 1–2 cm, and &gt;2 cm, respectively. The endoscopic examination revealed that 16.4% of the polyps were pedunculated, 82.6% were sessile, and 1% were sessile and pedunculated. About 45%, 30%, 21%, and 6.6% of the polyps were located at the rectum/sigmoid, left colon, right colon, and transverse/ascending colon, respectively. Histologically, 68.6% of polyps were adenomatous and 21.3% were non-adenomatous. Mild dysplasia was detected in almost half of the studied sample (42.3%) while moderate and severe grades of dysplasia were demonstrated in 19.2% and 38.5% of the examined polyps. Surgical intervention was required in 8.1% of cases. <strong>Conclusion:</strong>&nbsp;Single small-sized sessile polyps of adenomatous type and mild dysplasia are the most common polyps in the Saudi population. Sigmoid/rectum is the most common site affected, and the outcome of polyps is generally favorable.</p> P.E. Okoro I.F. Gbobo P.W. Igwe D.U. Umeh C.A. Okoro P . Nwiwu Copyright (c) 2021-10-06 2021-10-06 23 8 1044 1047 Clinicopathological Characterization of Colonic Polyps https://www.ajol.info/index.php/njcp/article/view/215614 <p><strong>Aims:</strong> To describe the clinical characteristics, colonoscopic features, histological findings, dysplasia patterns, and clinical outcome of endoscopically detected colonic polyps in the Saudi population. <strong>Methods:</strong> This retrospective record review was conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, on patients who underwent colonoscopy between 2005 and 2015. Patients with colorectal cancer were excluded. Data were analyzed using SPSS software. <strong>Results:</strong> Among 211 patients recruited, 66.8% were males and 66.2% were Saudi. Single polyps were detected in 45.5% of cases, while 29.9%, 18%, and 6.6% had 2, 3, and 4 polyps, respectively. Regarding the size, 81%, 17%, and 2% of the polyps were &lt;1 cm, 1–2 cm, and &gt;2 cm, respectively. The endoscopic examination revealed that 16.4% of the polyps were pedunculated, 82.6% were sessile, and 1% were sessile and pedunculated. About 45%, 30%, 21%, and 6.6% of the polyps were located at the rectum/sigmoid, left colon, right colon, and transverse/ascending colon, respectively. Histologically, 68.6% of polyps were adenomatous and 21.3% were non-adenomatous. Mild dysplasia was detected in almost half of the studied sample (42.3%) while moderate and severe grades of dysplasia were demonstrated in 19.2% and 38.5% of the examined polyps. Surgical intervention was required in 8.1% of cases. <strong>Conclusion:</strong> Single small-sized sessile polyps of adenomatous type and mild dysplasia are the most common polyps in the Saudi population. Sigmoid/rectum is the most common site affected, and the outcome of polyps is generally favorable.</p> Y.A. Qari Copyright (c) 2021-10-06 2021-10-06 23 8 1048 1053 The Prevalence and Determinants of Complementary Medicine Use for Nigerian Children in the Turkish Republic of Northern Cyprus https://www.ajol.info/index.php/njcp/article/view/215615 <table class="articlepage" border="0" width="100%"> <tbody> <tr> <td colspan="2" width="100%"><strong>Background:</strong>&nbsp;Complementary and alternative medicine (CAM) is extensively used in the pediatric population. Environments and the nature of diseases have an impact on the type of CAM therapies used in children.&nbsp;<strong>Aims:</strong>&nbsp;This study aims to determine the prevalence and determinants of CAM use among Nigerian children living in the Turkish Republic of Northern Cyprus (TRNC).&nbsp;<strong>Subjects and Methods:</strong>&nbsp;A quantitative, descriptive and cross-sectional study was conducted among 50 parents living in the TRNC. The parents were selected by the snowball sampling technique. Data were collected using a self-administered, NAFKAM International-CAM-Questionnaire (I-CAM-Q). The data were analyzed using SPSS version 20. Chi-square test was used to analyze the associations of CAM use with values of&nbsp;<em>P</em>&nbsp;&lt; 0.05 considered statistically significant.&nbsp;<strong>Results:</strong> The mean ages of the parents and children were 30 ± 5.56 years and 3 ± 2.17 years, respectively. It was discovered that 34 (68%) out of 50 children had used CAM in the previous 12 months. The most commonly used CAM products were vitamins/minerals (82.4%) and herbs/herbal products (55.9%). While praying for health (61.8%) and relaxation techniques (50.0%) were the most used CAM practices. A majority of the parents perceived that CAM use was beneficial (85.3%). Approximately 10% of the children were prescribed CAM recommendation/treatment by physicians. The most used sources of information were relatives (36%) and friends (14.7%). Parents (58%) indicated that they did not disclose their use of CAMs for their children to a physician/nurse. <strong>Conclusions:</strong>&nbsp;CAM is used prevalently in this population and the use of CAM is primarily focused on improving well-being. CAM usage for children increases with parental use. Further qualitative research is needed to understand the parental belief in the use of CAMs for children.</td> </tr> </tbody> </table> G.O. Christopher C. Ozturk Copyright (c) 2021-10-06 2021-10-06 23 8 1054 1060 Atopy in HIV‑Infected Children Attending the Pediatric Antiretroviral Clinic of LAUTECH Teaching Hospital, Osogbo https://www.ajol.info/index.php/njcp/article/view/215617 <table class="articlepage" border="0" width="100%"> <tbody> <tr> <td colspan="2" width="100%"><strong>Background:</strong> Atopy is poorly researched in HIV children living in the developing countries. There is no previous report on this subject in Nigeria and this pioneering study is undertaken to create an awareness of the burden of this disease among health practitioners. <strong>Aims:</strong>&nbsp;The aim of this study was to document the atopic diseases present among HIV-infected children attending the antiretroviral (ARV) clinic of a Nigerian tertiary hospital.&nbsp;<strong>Methods:</strong>&nbsp;Information was obtained from consecutive consenting caregiver/HIV-infected child attending the pediatric ARV clinic, by the use of a proforma specifically designed for the study. The data obtained were analyzed using Statistical Package for the Social Sciences (SPSS) software program, version 16.0.&nbsp;<strong>Results:</strong>&nbsp;Seventy patients were studied and their ages ranged between 2 and 17 years. These 70 were constituted by 34 (48.6%) boys and 36 (51.4%) girls. Ten (14.3%) of the 70 studied, had atopic diseases. Nine (12.9%) patients had allergic conjunctivitis and 1 (1.4%) had allergic rhinitis. The single patient with allergic rhinitis also had bronchial asthma. No case of atopic eczema, or food allergy was recorded. Atopic disease conditions were more commonly recorded among the male sex and those whose parents have atopic diseases (<em>P</em>&nbsp;&lt; 0.05). Atopic diseases were also more common among children without advanced HIV diseases and those with eosinophilia. Cosmetic and psychological embarrassment from eye discoloration and itching were the negative impacts on the quality of living.&nbsp;<strong>Conclusion:</strong>&nbsp;Allergic conjunctivitis is common in HIV-infected Nigerian children. Atopies are more common in boys and children with parental atopies.</td> </tr> </tbody> </table> O.A. Oyedeji A.A. Afolabi A.O. Odeyemi V.O. Kayode E. Agelebe Copyright (c) 2021-10-06 2021-10-06 23 8 1061 1067 The Effect of Operator‑induced Variability on the Physical Properties of ProRoot MTA https://www.ajol.info/index.php/njcp/article/view/215619 <table class="articlepage" border="0" width="100%"> <tbody> <tr> <td colspan="2" width="100%"><strong>Aims:</strong>&nbsp;The aim of this study was to compare the influence of operators on the microhardness and compressive strength of mineral trioxide aggregate (MTA).&nbsp;<strong>Materials and Methods:</strong> Forty dental specialists were asked to prepare a series of MTA samples. The tested material was ProRoot MTA (DentsplyMaillefer, Switzerland). Each participant prepared one sample to a consistency they considered acceptable for use in practice (improvised group) and another one according to the manufacturer's recommended water-to-powder (WP) ratio (pre-weighed group). The samples were incubated at 37°C and 95% humidity for 4 days. Parameters evaluated in this study were microhardness and compressive strength. <strong>Results:</strong> Operators mixed MTA samples with varying WP ratios. However, there was no significant difference between the microhardness and compressive strength values of MTA samples between the improvised, the pre-weighed and the control groups. MTA was mixed in a thicker consistency than the manufacturers recommended ratio (0.33) by 62.5% of the operators. <strong>Conclusion:</strong> According to the results of this study, even though the WP ratios that were utilized in the clinical setting vary, microhardness and compressive strength values of MTA was not significantly affected.</td> </tr> </tbody> </table> M. Aytore Kosar F.B. Basturk D. Turkaydin M.H. Nekoofar Copyright (c) 2021-10-06 2021-10-06 23 8 1068 1072 Retention of Luting Agents Used for Implant‑Supported Restorations: A Comparative <i>In‑Vitro</i> Study https://www.ajol.info/index.php/njcp/article/view/215620 <p><strong>Aims:</strong>&nbsp;The aim of this study was to compare the retention of different luting agents used with implant-supported restorations.&nbsp;<strong>Materials and Methods:</strong> A total of 90 custom metal frameworks and copings were prepared and divided into six different luting agent groups (<em>n</em> = 15/group): polycarboxylate cement (PC), resin-modified glass-ionomer cement (RMGIC), two self-adhesive resin cements (SARC), copper-ion zinc-phosphate cement (CZPC), and non-eugenol temporary resin cement (TRC). After sandblasting with 50 μm Al<sub>2</sub>O<sub>3</sub>, the copings were cemented on frameworks and stored in artificial saliva for 48 h at 37°C and thermocycled between 5–55°C for 37,500 cycles. Samples were subjected to tensile testing by a universal testing machine, and data were statistically analyzed. <strong>Results:</strong>&nbsp;The differences between the retention values of types of cement were significant (<em>P</em> &lt; 0.05). The maximum retention value was calculated for CZPC (755,12 ± 55 MPa) while the lowest value was for TRC (311,7 ± 61Mpa).&nbsp;<strong>Conclusion:</strong>&nbsp;Neither of the tested cement had superiority over another to ensuring retention. The types of cement presented were meant to be a discretionary guide for the clinician in deciding the amount of the desired retention between castings and abutments.</p> A. Aladag M.H. Sahan N.O. Akkus R. Aktas Copyright (c) 2021-10-06 2021-10-06 23 8 1073 1078 Comparative Study of Nutritional Status of Children and Adolescents with Sickle Cell Anemia in Enugu, Southeast Nigeria https://www.ajol.info/index.php/njcp/article/view/215680 <p><strong>Background:</strong>&nbsp;Poor growth and nutritional status are common features of sickle cell anemia (SCA) in children. The rising trend of obesity in children in developing countries has been reported despite a huge burden of undernutrition in these settings. In SCA, overweight/obesity is being increasingly reported.&nbsp;<strong>Aims:</strong> To evaluate the nutritional status and its determinants in children with SCA and to compare the same with hemoglobin AA (HbAA) controls of similar age, gender, and socioeconomic status. <strong>Methods:</strong>&nbsp;The study was a cross-sectional analytical study involving 175 subjects and controls aged 1–18 years who met the inclusion criteria. Weight and height were measured and body mass index (BMI) was calculated.&nbsp;<em>Z</em> scores were computed for the anthropometric measurements using the World Health Organization (WHO) standard reference. Hemoglobin concentration was determined using HemoCue Hb201<sup>+</sup>&nbsp; Analyzer.&nbsp; <strong>Results:</strong>&nbsp;Subjects had significantly lower&nbsp;<em>Z-</em> scores for weight, height, and BMI compared with controls. Stunting, wasting, and overweight/obesity were observed in 10.9%, 24.6%, and 5.1% of subjects compared with 2.3%, 5.7%, and 9.7% respectively in controls. Wasting, stunting and overweight/obesity in SCA were significantly associated with age while overweight/obesity was significantly associated with upper social class (<em>P</em>=0.001).&nbsp; <strong>Conclusions:</strong>&nbsp;Poor growth and nutritional status are still prevalent while overweight and obesity are emerging comorbidities among children with SCA in our environment. Regular nutritional assessment of children with SCA should be encouraged while those at risk of under/over-nutrition should receive adequate nutritional rehabilitation to prevent possible complications.</p> O.M. Ukoha I.J. Emodi A.N. Ikefuna E.O. Obidike M.O. Izuka C.B. Eke Copyright (c) 2021-10-07 2021-10-07 23 8 1079 1086 Diagnostic Accuracy of Random Plasma Glucose and Random Blood Capillary Glucose in Detecting International Association of Diabetes and Pregnancy Study Groups‑ Defined Hyperglycemia in Early Pregnancy https://www.ajol.info/index.php/njcp/article/view/215681 <p><strong>Background:</strong> Maternal hyperglycemia first diagnosed in pregnancy, previously referred to as gestational diabetes mellitus is associated with health consequences for both the mother and her fetus/baby, not only in the short term but also in the long term. Early screening helps to identify women with overt diabetes or those with early onset GDM. <strong>Aims:</strong> The aim of this study was to determine the diagnostic performance of two screening tests (Random plasma glucose, Random capillary glucose) in relation to 75g Oral glucose tolerance test (OGTT) done before 24 weeks gestation. <strong>Methods:</strong>&nbsp;This prospective longitudinal cohort study was carried out between 1<sup>st</sup>&nbsp;February, 2017 and 31<sup>st</sup> July, 2017, at two teaching hospitals in Nigeria. Two hundred and eighty one (281) pregnant women who met the inclusion criteria were selected and screened with both random plasma glucose (RPG) and random capillary glucose (RCG) before 24 weeks of pregnancy. They were then made to undergo 75g OGTT a week later. The diagnostic performance of the screening tests were determined. <strong>Results:</strong>&nbsp;A total of 270 women had 75g OG.&nbsp;<strong>Conclusion:</strong>&nbsp;Random plasma glucose and Random capillary glucose performed poorly compared to 75g-OGTT in detecting hyperglycemia in early pregnancy.</p> A.S. Adefisan B.N. Olagbuji A.A. Adeniyi I.P. Ade‑Ojo S.M. Ghazalli B.A. Olofinbiyi Copyright (c) 2021-10-07 2021-10-07 23 8 1087 1094 Sonoelastographic Evaluation of the Masseter Muscle before and after Mandibular Setback Surgery https://www.ajol.info/index.php/njcp/article/view/215682 <p><strong>Aims:</strong> The purpose of this study is to compare the thickness and elasticity of the masseter muscle before and after&nbsp; orthognathic surgery in patients with class III skeletal deformity and to investigate the relationship between the sonographic changes in the masseter muscle and the amount of mandibular setback.&nbsp;<strong>Subjects and Methods:</strong> The study group consisted of 14 patients with skeletal class III malocclusions who had orthognathic surgery. The control group consisted of 14 patients who had dental and skeletal class I occlusion. Muscle thickness measurements were performed with B-mode and high-frequency linear scanning probe of the ultrasound device. Elastography feature and muscle hardness ratio were obtained by applying compression and decompression on muscles at rest and during maximum contraction in the transverse plane. Patients were categorized into two groups according to the mandibular setback as &lt;5 mm and ≥5 mm.<strong>&nbsp;Results:</strong>&nbsp;The masseter muscle thickness after surgery was found statistically increased bilaterally in both at rest and during contraction for the study group (<em>P</em> &lt; 0.05). No difference was found between preoperative orthognathic measurements and postoperative measurements for elasticity index ratio measurements&nbsp; &nbsp; &nbsp; (<em>P</em> &gt; 0.05).&nbsp;&nbsp;<strong>Conclusion:</strong>&nbsp;We believe that in the present study important findings have been emphasized for further research aiming to investigate the possible relationship between masticatory alterations and surgical outcomes after orthognathic surgery.</p> M. Etöz A.E. Demirbaş K.G. Topsakal A. Etöz M.O. Kaya A, Alkan Copyright (c) 2021-10-07 2021-10-07 23 8 1095 1102 Effects of Blood Contamination and Hemostatic Agents on Bond Strength in Primary Teeth Dentin https://www.ajol.info/index.php/njcp/article/view/215683 <p><strong>Background:</strong>&nbsp;Contamination is a common problem in pediatric restorative dentistry and there are a few studies that investigate blood contamination, hemostatic agents, and tooth dentin.&nbsp;<strong>Aim:</strong>&nbsp;The purpose of this study was to evaluate the effects of blood contamination and hemostatic agents on the bond strength of two different bonding systems with the dentin of primary teeth.&nbsp;<strong>Materials and Methods:</strong>&nbsp;Buccal and lingual dentin surfaces of 40 primary second molar teeth were used for this study. Specimens were divided into 4 groups according to the contamination and hemostatic agents (Blood-B, Ankaferd Blood Stopper-A, ViscoStat-V, Control-C) and then every group was further divided into two subgroups according to the bonding systems (Clearfil SE Bond-I, All Bond Universal-II,&nbsp;<em>n</em>&nbsp;= 10 per group). A bulk-fill composite resin was built-up on the surfaces. The specimens were tested in the micro shear mode at a crosshead speed of 1 mm/min on a universal test machine. Statistical analysis was performed with ANOVA and Tukey's tests at&nbsp;<em>P</em>&nbsp;&lt; 0.05.&nbsp;<strong>Results:</strong>&nbsp;Significant differences have been detected in the micro shear bond strengths only between the Ankaferd Blood Stopper (ABS) (AI = 13.72 ± 4.47 and AII = 9.12 ± 4.4) and control groups (CI = 22.78 ± 10.86 and CII = 16.49 ± 6.55) without regards to the bonding systems. The highest scores were obtained in the control groups. Clearfil SE Bond showed better performance than All Bond Universal in all groups.&nbsp;<strong>Conclusion:</strong>&nbsp;It was determined that only the ABS contamination groups showed statistically significant decreases in the bond strengths when compared with control groups.</p> Y. Erdoğan H. Karayılmaz M. Ünal Ö. Güngör Z.Z. Çiftçi Copyright (c) 2021-10-07 2021-10-07 23 8 1103 1109 Dental and Soft Tissue Changes Following Extraction of Second Premolars in Females with Bimaxillary Protrusion: A Retrospective Study https://www.ajol.info/index.php/njcp/article/view/215684 <table class="articlepage" border="0" width="100%"> <tbody> <tr> <td colspan="2" width="100%"><strong>Background:</strong>&nbsp;Bimaxillary protrusion is a condition wherein esthetic concerns are the main reason behind seeking orthodontic treatment.&nbsp;<strong>Aim:</strong> The aim of this retrospective cephalometric study was to evaluate the soft tissue profile and dental changes among female Saudi bimaxillary protrusion patients treated with extraction of all second premolars followed by retraction of the anterior teeth. <strong>Subjects and Methods:</strong> Pre and posttreatment cephalometric radiographs of adult female patients (ages 18–30 years) who underwent orthodontic therapy for Class I bimaxillary protrusion were obtained. Data were analyzed with SPSS<sup>®</sup>&nbsp;software. A paired&nbsp;<em>t</em>-test and Pearson's correlation coefficients were conducted with the statistical significance set at 95% (<em>P</em>&nbsp;value &lt; 0.05).&nbsp;<strong>Results:</strong>&nbsp;At posttreatment, there was an overall decrease in the mean values among the majority of the soft tissue and dental cephalometric angles and linear measurements. Among soft tissue variables, there was a marginal increase in the upper lip length by 1.49 mm (<em>P</em>&nbsp;&lt; 0.001), and the nasolabial angle increased markedly by 7.64° (<em>P</em>&nbsp;&lt; 0.001). Similarly, a marked increase in retroclination by 5.95° (<em>P</em>&nbsp;&lt; 0.001) was observed among the dental variables. Conversely, no significant changes were noted in the lower incisors. Pearson's correlation analysis revealed a significant correlation between all the different dental variables. Within the soft tissue variables, there was a significant positive correlation between changes in the upper lip protrusion, lower lip protrusion, upper lip thickness, and the distance from the upper and lower lips to the S-line.</td> </tr> </tbody> </table> N.D. Alqahtani A. Alqasir T. Al‑Jewair K. Almoammar S.F. Albarakati Copyright (c) 2021-10-07 2021-10-07 23 8 1110 1119 The Impact of Playing Wind Musical Instruments on the Dental Arch Dimensions in a Male West African Population https://www.ajol.info/index.php/njcp/article/view/215685 <p><strong>Background:</strong>&nbsp;Dental arch dimensions are important considerations in orthodontic treatment planning and monitoring.&nbsp;<strong>Objective:</strong>&nbsp;This study aimed to compare the dental arch dimensions in wind and non-wind instrument players (WIP and non-WIP).&nbsp;<strong>Methods:</strong>&nbsp;This was a cross-sectional study which compared a group of 50 male subjects aged 18–45 years that had been playing wind instruments for a minimum of 2 years with a control group matched for age in the same environment. The arch dimensions were assessed for both groups by measuring their dental casts using a digital caliper. Data was analyzed using statistical Software Package for Social Sciences (SPSS Inc, Chicago, IL) version 17. Statistical significance level was set at&nbsp;<em>P</em>&nbsp;&lt; 0.05.&nbsp;<strong>Results:</strong>&nbsp;The mean number of years of playing wind instrument among the WIP was 9.26 ± 6.21 years. All the maxillary arch dimensions were larger in the WIP group except for the palatal depth while the mandibular arch parameters in the non-WIP group were larger than the WIP group except the mandibular arch length. The differences were not statistically significant (<em>P</em>&nbsp;&gt; 0.05). The mean maxillary inter-canine width (37.48 ± 1.12 mm), inter-molar width (57.27 ± 1.99 mm), arch length (29.80 ± 2.2.09 mm), and palatal depth (22.21 ± 2.33 mm) for class B instrument (Saxophone and clarinet) players were larger than either the class A instrument (Trumpet and trombone) players or the non-WIP group. These differences were not statistically significant (<em>P</em>&nbsp;&gt; 0.05).&nbsp;<strong>Conclusions:</strong> Playing a wind instrument as well as the type of instrument played, duration, and frequency of play did not significantly affect dental arch dimensions.</p> T.E. Adeyemi O.D. Otuyemi Copyright (c) 2021-10-07 2021-10-07 23 8 1120 1126 Knowledge, Utilization, and Accessibility of Child Welfare Card among Caregivers in a Tertiary Center in South West Nigeria https://www.ajol.info/index.php/njcp/article/view/215689 <table class="articlepage" border="0" width="100%"> <tbody> <tr> <td colspan="2" width="100%"><strong>Background:</strong> The Child Welfare Card (CWC) contains the records of a child's immunization and information on the other aspects of the child's health, including growth curves and home treatment of diarrheal disease to mention a few. How easily retrievable these records are and what influence the cards have on parents/caregivers regarding the child's nurture are uncertain in our environment. <strong>Aim:</strong>&nbsp;The present study was aimed at assessing the parents/caregivers' knowledge and utilization of CWCs as well as the health-providers' accessibility of the card in the hospital.&nbsp;<strong>Method:</strong>&nbsp;This study was a cross-sectional descriptive one that involved the parents/caregivers of children aged 60 months and below, attending the children's clinics and wards in a tertiary center. We collected the relevant information, including the sociodemographic data of the parents/caregivers, their knowledge, and assessed the utilization of CWC. The analysis of the categorical data was performed with the IBM Statistical Package for Social Sciences (S.P.S.S) version 23.0 for windows.&nbsp;<em>P</em>&nbsp;values &lt; 0.05 were considered significant.&nbsp;<strong>Results:</strong> Of the 377 parents/caregivers enrolled in the study, good knowledge of the contents of the CWC was demonstrated by 82 (21.8%) while 78 (20.7%) made the cards available to the health care providers. Eighty (21.2%) made adequate use of the cards at home. A greater number of parents/caregivers from the higher social class had good knowledge of the intervention contents of the CWC (<em>P</em>&nbsp;= 0.005). The accessibility of the cards to the health care-providers was significantly higher among the older parents/caregivers (<em>P</em>&nbsp;= 0.010), those with a good knowledge of CWC (<em>P</em>&nbsp;= 0.020) and parents/caregivers from higher social class (<em>P</em> = 0.001). Subjects with good knowledge were 2.4 times (OR = 2.4, 95% CI = 1.4-4.2) more likely to utilize the intervention contents in the CWC. <strong>Conclusion:</strong>&nbsp;The overall knowledge, utilization, and accessibility of the CWC were poor. Parents/caregivers with good knowledge were more likely to utilize the information on the CWC compared with participants with poor knowledge.</td> </tr> </tbody> </table> M.A. Alao Y.T. Olasinde E. Agelebe A.O. Asinobi A. Gbadero Copyright (c) 2021-10-07 2021-10-07 23 8 1127 1134 Clinical and Laboratory Profile of Patients with Epistaxis in Kano, Nigeria: A 10‑year Retrospective Review https://www.ajol.info/index.php/njcp/article/view/215690 <p><strong>Background:</strong> Epistaxis is a common cause of otorhinolaryngological clinic visits and admissions into accident and emergency. Severe epistaxis could remarkably alter the hemodynamic milieu of individuals and results into significant morbidity and occasional mortality. <strong>Aims:</strong>&nbsp;To review the clinical pattern and laboratory test results of individuals treated for epistaxis in a tertiary health care center in northern Nigeria.&nbsp;<strong>Methods:</strong>&nbsp;This study was a 10-year retrospective review of patients managed for epistaxis in the department of otorhinolaryngology, Aminu Kano teaching hospital, Kano, Nigeria. Case files of patients were retrieved, reviewed, and clinical and laboratory data were extracted. The data were analyzed using Statistical Product and Service Solution version 23.&nbsp;<strong>Results:</strong> A total of 256 were reviewed with 149 (58.2%) male and 107 (41.8%) female with M: F of 1.4:1. A mean age ± SD of 33.86 ± 20.06 years. Anterior epistaxis was the most prevalent, 126 (49.2%), and majority of the patients presented with severe epistaxis, 75 (29.3%). Most were treated with nasal packing, 93 (36.3%). Majority had abnormal full blood counts and clotting profile results, 158 (61.75) and 104 (40.6%), respectively. There was a significant association between patient's genotype and outcome. Anterior epistaxis and AA genotype were significant positive predictors of outcome. <strong>Conclusion:</strong> Coagulopathies, anaemia, and hemoglobinopathies are common findings among our patients with epistaxis.</p> A. Ajiya A. Adamu I.Y. Shuaibu Copyright (c) 2021-10-07 2021-10-07 23 8 1135 1140 Prognostic Impact of Pretreatment Thrombocytosis in Epithelial Ovarian Cancer https://www.ajol.info/index.php/njcp/article/view/215691 <table class="articlepage" border="0" width="100%"> <tbody> <tr> <td colspan="2" width="100%"><strong>Aims:</strong>&nbsp;This study was aimed at investigating the prognostic impact of pretreatment thrombocytosis in epithelial ovarian cancer (EOC) patients in Lagos, Nigeria.&nbsp;<strong>Methods:</strong>&nbsp;This was a retrospective cohort study involving the review of the clinical record of 72 patients with histologically confirmed EOC who were managed at the Lagos University Teaching Hospital, Lagos, Nigeria over a 7-year period from January 2010 to December 2016. Information on the sociodemographic data and platelet counts at diagnosis of EOC were retrieved from the patients' medical records. Descriptive statistics were then computed for all baseline patients' characteristics. Survival analyses were carried out using the Kaplan-Meier estimates. Multivariate analysis of these data was performed with the Cox proportional hazards model.&nbsp;<strong>Results:</strong>&nbsp;This study revealed that the prevalence of pretreatment thrombocytosis was 41.7% among the women with EOC. Fifty-three (73.6%) of the women had the advanced-stage disease (FIGO stage III-IV) while 52 (72.2%) had high-grade disease (II-III). The majority (66.7%) of the women had a serous histological type of EOC while 76.4% had documented recurrence. Pretreatment thrombocytosis was significantly associated with the women's parity (<em>P</em>&nbsp;= 0.009), serum carbohydrate antigen 125 levels (<em>P</em>&nbsp;= 0.018), median progression-free survival (PFS) (<em>P</em>&nbsp;&lt; 0.001), 3-year median overall survival (OS) (<em>P</em>&nbsp;&lt; 0.001), type of primary treatment (<em>P</em>&nbsp;= 0.002), extent of cytoreduction (<em>P</em>&nbsp;&lt; 0.001), presence of ascites (<em>P</em>&nbsp;= 0.002), International Federation of Gynecology and Obstetrics (FIGO) stage (<em>P</em>&nbsp;= 0.008), and histological type (<em>P</em>&nbsp;= 0.011). Pretreatment thrombocytosis was negatively associated with PFS (hazard ratio [HR] = 0.25; 95% CI 0.83, 0.75;&nbsp;<em>P</em>&nbsp;= 0.014) and 3-year OS (HR = 0.03; 95% CI 0.03, 0.27;&nbsp;<em>P</em>&nbsp;= 0.002).&nbsp;<strong>Conclusions:</strong>&nbsp;The study suggests that pretreatment thrombocytosis may be a useful predictor of survivals in EOC patients.</td> </tr> </tbody> </table> K.S. Okunade O. Dawodu M. Adenekan C.M. Nwogu O. Awofeso A.O. Ugwu O. Salako S. John‑Olabode O.F. Olowoselu R.I. Anorlu Copyright (c) 2021-10-07 2021-10-07 23 8 1141 1147 Effects of Artificial Aging on the Bond Strengths of Universal Dental Adhesives https://www.ajol.info/index.php/njcp/article/view/215692 <table class="articlepage" border="0" width="100%"> <tbody> <tr> <td colspan="2" width="100%"><strong>Aims:</strong> The effect of mechanical loading on the microtensile bond strength (μTBS) of universal adhesives to dentin was evaluated in this study. <strong>Methods and Materials:</strong>&nbsp;Human molar teeth had the occlusal dentin surfaces exposed and were allocated into ten groups (five experimental groups and five control groups) that used the following universal adhesive systems in self-etch mode: All-Bond Universal (ABU), Single Bond Universal (SBU), Gluma Bond Universal (GBU), Tetric N-Bond Universal (TBU), and Clearfil Universal Bond (CUB). Following the bonding procedures and build-ups, the specimens were either stored in water at 37°C for 24 h or were mechanically loaded (50 N for 60,000 cycles) prior to the μTBS test. Data were analyzed using the one-way analysis of variance (ANOVA) and Tukey's posthoc test (<em>P</em>&nbsp;= 0.05).&nbsp;<strong>Results:</strong>&nbsp;Both the adhesive type and mechanical loading had significant effects on the μTBS (<em>P</em>&nbsp;&lt; 0.05). The μTBS values of SBU and ABU were significantly higher than the values of the other adhesives (<em>P</em>&nbsp;&lt; 0.05). However, the μTBS values of ABU decreased significantly after mechanical loading (<em>P</em> &lt;0.05).&nbsp; <strong>Conclusions:</strong>&nbsp;With the exception of ABU, mechanical loading had no deleterious effects on the μTBS of the universal adhesive systems examined in this study.</td> </tr> </tbody> </table> A.R. Çetin H. Dinç Copyright (c) 2021-10-07 2021-10-07 23 8 1148 1154 Investigation of the Clonal Associations in <i>Acinetobacter baumannii</i> Strains Isolated from the Respiratory Samples of Patients in a Tertiary Research Hospital https://www.ajol.info/index.php/njcp/article/view/215693 <table class="articlepage" border="0" width="100%"> <tbody> <tr> <td colspan="2" width="100%"><strong>Objective:</strong>&nbsp;The&nbsp;<em>blaOXA</em> resistance genes and ISAba1 were examined in 70 samples from lower respiratory tract of hospitalized patients. <strong>Materials and Methods:</strong>&nbsp;Of the 67 isolates obtained, almost half (46.3%) of them were from endotracheal aspirate, and most were collected from the intensive care units of the reanimation (37.3%) and internal medicine (32.8%) units.&nbsp;<strong>Results:</strong>&nbsp;Three samples from the internal medicine intensive care unit had positive cultures. Of the multidrug resistant (MDR) samples, 70 isolates (&gt;50%) were moderately sensitive, while fewer (10%) were resistant to tigecycline. In contrast, 100% were sensitive to colistin. All strains were found to be positive for&nbsp;<em>blaOXA</em>-23-like and&nbsp;<em>blaOXA</em>-51-like genes, whereas no&nbsp;<em>blaOXA</em>-40-like and&nbsp;<em>blaOXA</em>-58-like genes were detected. The ISAba1 positivity rate was 90.0%. Pattern 5 was mainly identified among the 22 different patterns. Of note, 50% of Pattern 5 was found in the patients of the internal medicine intensive care unit, and a third was associated with ventilator-associated pneumonia. Importantly, the internal medicine unit's equipment was found to be culture positive. <strong>Conclusion:</strong>&nbsp;Findings obtained from this study suggest that isolates can easily spread through the hospital via isolate cross-contamination caused by health personnel. These contaminating isolates may be able to maintain their presence within the hospital for a long time.</td> </tr> </tbody> </table> S. Ozyurt U. Kostakoglu I.E. Yildiz A. Erturk E. Sonmez U. Sahin A.C. Cicek Copyright (c) 2021-10-07 2021-10-07 23 8 1155 1162 Demographic Profile and Endoscopic Findings among Patients with Upper Gastrointestinal Bleeding in Ahmadu Bello University Teaching Hospital, Zaria, North‑Western Nigeria https://www.ajol.info/index.php/njcp/article/view/215694 <p><strong>Background:</strong>&nbsp;Upper gastrointestinal bleeding (UGIB) is a common medical emergency that can result in significant morbidity and mortality.&nbsp;<strong>Aim:</strong>&nbsp;The aim of this study was to determine the demographic profile and etiology of UGIB in patients seen at Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, North-Western Nigeria.&nbsp;<strong>Subjects and Methods:</strong> This descriptive retrospective study was carried out at the Gastroenterology Unit of ABUTH Zaria. Data of patients referred for upper gastrointestinal endoscopy with UGIB from June 2017 to December 2019 were extracted from the endoscopy register and analyzed. <strong>Results:</strong>&nbsp;One hundred and forty-four patients had upper gastrointestinal (UGI) endoscopy done for UGIB during the period under review. Of these, 105 (72.9%) were males while 39 (27.1%) were females with male-to-female ratio of 2.7:1. The mean age of the patients was 43.5 ± 17.3 and their age ranges from 11 to 89 years. The modal age group was 40–49 years. The most common cause of UGIB was esophageal varices (67 [46.5%]) followed by erosive mucosal diseases: gastritis/duodenitis 43 (29.9%), esophagitis 12 (8.3%). Less common causes were peptic ulcer disease (PUD) in five (3.5%) patients, gastric tumor in two (1.4%), hiatus hernia in one (0.7%), and portal hypertensive gastropathy in one (0.7%). Thirteen patients (9.0%) had normal findings.&nbsp;<strong>Conclusion:</strong>&nbsp;Esophageal varices are the most common cause of UGIB among our patients and middle-aged male patients were the most commonly affected group.</p> M. Manko, A.K. Bello M.F. Mohammed P.O. Egbegbedia M. Daniyan A.M. Jabir S.K. Mustapaha M.M. Dauda Copyright (c) 2021-10-07 2021-10-07 23 8 1163 1166 Pattern of Presentation and Surgical Management of Spine Tumors in Southeast Nigeria over a 10‑Year Period https://www.ajol.info/index.php/njcp/article/view/215708 <p><strong>Background:</strong>&nbsp;Spine tumors could affect the bony elements and/or its neural contents. Clinical manifestations are underlined by their biological behaviors. Aim: This study aims to identify the pattern of presentation and surgical management of spine tumors in southeast Nigeria over a 10-year period.<strong>&nbsp;Patients and Methods:</strong>&nbsp;A retrospective analysis of patients who were managed surgically for the spine and spinal cord neoplastic lesions over a 10-year period. All patients had pre-and post-operative magnetic resonance imaging (MRI) and histological diagnosis. Relevant clinical, radiological, and histological data were extracted and analyzed using Statistical Package for the Social Sciences (SPSS) for windows version 21.&nbsp;<strong>Results:</strong>&nbsp;Four hundred and seventy-two spine procedures performed within the study period, 39 cases of histologically proven primary spinal cord tumors (PSCT) and non-PSCT were identified. These represented 8.3% of spine procedures. Seventeen were PSCT (3.6% of spine procedures), while 22 (4.7%) had non-PSCT, mean age for the PSCT group was 45 yrs and non-PSCT 59.5 years. A total of 56.5% of tumors are involved in the thoracic region, 43.7% in the cervical region. PSCT was likely to affect the cervical spine; while bony spine tumors, thoracic spine [odds ratio (OR) 4.9,&nbsp;<em>P</em>&nbsp;value 0.019]. A total of 84.6% of non-PSCT affected the bony spine, mainly the vertebral body. The histological result showed metastatic adenocarcinoma to be the most common tumor (33.3%). PSCT was likely to be benign than non-PSCT (<em>P</em> value &lt; 0.00001). Gross total resection (GTR) was done in 100% of PSCT, and 50% in non-PSCT. Thirteen (40.6%) patients improved and 11 (34.4%) patients remained the same. <strong>Conclusions:</strong>&nbsp;Metastatic adenocarcinoma was the most common tumor of the spine. There was restricted ability at a GTR for non-PSCT compared to PSCT. Grossly 75% had improved/same neurological status, as such adjudged as a good outcome.</p> M.C. Chikani M. Messi O. Okwunodulu W. Mezue S. Ohaegbulam C. Ndubuisi L. Iroegbu S. Nkwerem Copyright (c) 2021-10-08 2021-10-08 23 8 1167 1171 Multidrug‑Resistant Tuberculosis in Imo State, Southeast, Nigeria https://www.ajol.info/index.php/njcp/article/view/215710 <p><strong>Background:</strong> Multidrug-resistant tuberculosis (MDR-TB) is a global health challenge. The emergence of MDR TB has contributed remarkably to the spread of tuberculosis and also poses a threat, which if not effectively addressed may wipe out the achievements of previous efforts in controlling tuberculosis. <strong>Objective:</strong> This study was aimed at detecting MDR-TB among patients in a setting prevalent with tuberculosis and HIV in Southeast, Nigeria. <strong>Method:</strong>&nbsp;Sputum specimens collected from 740 suspected tuberculosis (TB) patients were screened for acid-fast bacilli (AFB). All the 111 AFB positive samples were subjected to culture on Lowenstein-Jensen (LJ) medium and Mycobacterium Growth Indicator Tube (MGIT) 960 TB system. The isolates were then confirmed as&nbsp;<em>Mycobacterium tuberculosis</em>&nbsp;using SD Bioline Rapid Diagnostic Tests before being subjected to drug susceptibility testing to first-line anti-TB drugs. MDR-TB was determined by isolates being resistant to both isoniazid and rifampicin. HIV testing was performed for participants included in the study using standard rapid diagnostic tests.&nbsp;<strong>Result:</strong>&nbsp;Out of the 111 AFB-positive sputum samples, 65 (58.6%) were culture-positive for&nbsp;<em>Mycobacterium tuberculosis.</em> MDR-TB was found in 2 ([3.1%] 95% CI = 0.0–7.3) of the culture-positive samples. The rate of TB and HIV coinfection was 7.7%. Maximum single-drug resistance was seen in ethambutol 12 ([18.5%] 95% CI = 9.0–27.9). <strong>Conclusion:</strong>&nbsp;The MDR-TB rate of 3.1% found in this study was relatively low and efforts should be intensified to keep it low.</p> I.I.E. Ahiarakwem I.M. Ekejindu C.N. Akujobi IN Aghanya Copyright (c) 2021-10-08 2021-10-08 23 8 1172 1177 Two-piece Mesostructure and Vertically oriented Locking Screws Design for Implant-assisted Prosthesis in the Esthetic Zone https://www.ajol.info/index.php/njcp/article/view/215716 <table class="articlepage" border="0" width="100%"> <tbody> <tr> <td colspan="2" width="100%">Restoration of the malaligned dental implants in the esthetic zone is a challenge for dental practitioner because of the difficulty in obtaining balance and harmony between position and color of the final prosthesis and the adjacent teeth. Mesostructure is a part of the prosthesis that located ontop of the dental implant and bearing the final prosthesis. It has a form of milled bar to bear an overdenture or as abutment used for the correction of malaligned dental implants. Such approach maintains screw-retained prosthesis option while allowing complete retrievability, improved accessibility, usage of thicker abutment screws, and acceptable esthetic outcomes. In this case report, a two-piece mesostructure was designed to correct the malposition of dental implants in the esthetic zone with 1-year follow-up system.</td> </tr> </tbody> </table> M.E. Sayed W.M. Ahmed C.A. Jurado A. Tsujimoto Copyright (c) 2021-10-08 2021-10-08 23 8 1178 1181 Erratum: Effects of Short Inter‑Pregnancy Interval on Maternal and Perinatal Outcomes: A Cohort Study of Pregnant Women in a Low‑Income Country https://www.ajol.info/index.php/njcp/article/view/215713 <p>No Abstract</p> S.S. Onwuka Copyright (c) 2021-10-08 2021-10-08 23 8 1182 1182