Nigerian Journal of Clinical Practice

Exploring the Efficacy of Hypochlorous Acid as a Cost Effective Environmental Decontaminant in Dentistry: A Scoping Review

R. Ahmed, S. Ahmed — Fri, 16 May 2025 00:00:00 +0000

Dental procedures result in the production of bioaerosols that contaminate various environmental surfaces in the dental clinic. In order to maintain a safe environment in the dental clinic and prevent cross contamination, it is important to find alternative disinfection methods and agents to ensure effective decontamination. Hypochlorous acid (HOCl) is a cost-effective antimicrobial agent that can be used for infection control. The purpose of this scoping review is to provide evidence from the literature supporting the routine use of HOCl as a biodecontamination and disinfection agent in dental clinics. An electronic search was completed on the following databases: PubMed, Web of Science, Scopus, Wiley, and Science Direct. The studies were included based on their titles, abstract, and relevance to HOCl and the ability to render pathogens deactivated after exposure to HOCl vapor. The search focused on studies in the past 5 years. The search resulted in a total of 15 articles being selected after exclusions based on duplications, title, and abstract assessment. The articles included studies that used various HOCl concentrations and expanded on the inactivation of several pathogens. The reviewed studies highlight HOCl’s broad-spectrum antimicrobial efficacy, with significant reductions in severe acute respiratory syndrome coronavirus 2, methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and Clostridioides difficile, reinforcing its role in optimizing disinfection protocols across healthcare and occupational settings. The articles selected provided clear evidence that under correct and established parameters, HOCl can provide a cheaper safer alternative to most disinfectants. Further studies are recommended on applications methods in clinical settings.

The Effect of Primigravida Pregnant Women’s Spiritual Orientation on Their Childbirth Self‑Efficacy Perceptions: A Cross‑Sectional Survey Study

A. Kanbur, S.E. Sayar — Fri, 16 May 2025 00:00:00 +0000

Background: Spirituality is an important aspect of health that can provide the individual with hope and relaxation along with meaning in life. Spirituality has an antistress effect during pregnancy. Aim: The study was conducted to examine the effect of primiparous pregnant women’s spiritual orientation on their childbirth self‑efficacy perceptions.

Methods: A correlational survey model was used in the study. The research was conducted in a maternity hospital in eastern Türkiye between February and August 2021. 262 pregnant women who met the research criteria were included in the study. Collecting the data were used, Descriptive Information Form, Spiritual Orientation Scale, and Childbirth Self‑Efficacy Inventory.

Results: The mean spiritual orientation score of the pregnant women was 104.52 ± 9.95, and the mean childbirth self‑efficacy total score was 253.10 ± 32.32. A significant positive relationship (r = 0.158, P = 0.011) was found between spiritual orientation and childbirth self‑efficacy. Spiritual orientation significantly and positively predicted childbirth self‑efficacy (β = 0.15, P < 0.05). Spiritual orientation explains 2.5% of the total variance in childbirth self‑efficacy perception (R2 = 0.025, adjusted R2 = 0.021, F = 6.624, P < 0.05).

Conclusion: In pregnant women, spiritual orientation increases childbirth self‑efficacy. It is of great importance to consider and support spirituality in improving pregnant women’s childbirth self‑efficacy.

The Effects of “Oral Administration of Breast Milk Droplets” and “Palatal Stimulation with a Finger” Methods on Feed Tolerance in Preterm Newborns Fed via an Orogastric Tube: Randomized Controlled Trial

C. Tunç, A. Kokcu Dogan — Fri, 16 May 2025 00:00:00 +0000

Background: Infants should be provided with effective feeding skills with evidence-based care practices to ensure nutritional tolerance and maximize the growth and development in preterm infants. Aim: This study aimed to examine the effects of “oral administration of breast milk droplets” and “palatal stimulation with a finger” methods on feed tolerance in preterm newborns fed via an orogastric tube.

Methods: This randomized controlled trial was conducted in the neonatal intensive care unit of a private hospital. The study included 90 premature newborns born at the 28th–36th gestational weeks and admitted to intensive care. We applied breast milk droplets inside the oral cavity of newborns (30) in one of the intervention groups and stimulated the palate of newborns (30) by using a finger in the other. We performed these interventions every 3 hours for 5 minutes at the feeding times of the newborns for 7 days. Babies in the control group were not applied any intervention. We used SPSS (Statistical Package for Social Sciences) 22.0 for Windows software for statistical analyses.

Results: The number of defecations, frequencies of residuals, body weight, and abdominal circumference were significantly different between the groups (P < 0.05). The increments in body weight and reductions in abdominal circumference were significantly different between the groups in the study (P < 0.05).

Conclusion: Palatal stimulation with a finger acted on feed tolerance more favorably than the oral administration of breast milk droplets or no intervention in preterm infants fed via OGT. We suggest primarily that palatal stimulation with a finger and secondarily the oral administration of breast milk droplets as the two methods to be employed to overcome feeding intolerance, which is a significant problem in premature infants

In‑Vitro Comparison of Screw Loosening, Fracture Strength and Failure Mode of Implant‑Supported Hybrid‑Abutment Crowns and Screwmentable Crowns Manufactured with Different Materials

İ. Çötert, M. Ulusoy, A.G. Türk — Fri, 16 May 2025 00:00:00 +0000

Background: Hybrid‑abutment crowns and screwmentable crowns offer a fusion of the benefits from both screw and cement‑retained restorations, potentially enhancing the overall performance of the restoration.

Aim: This study aimed to evaluate the screw loosening and fracture strength of hybrid-abutment crowns and screwmentable crowns made with two different materials.

Methods: Forty single- crown were made on titanium implants and divided into four groups (n = 10) [SM-Ti: Screwmentable titanium-porcelain crowns on stock titanium abutment; SM-Zr: Screwmentable zirconia-porcelain crowns on stock zirconia abutment; AC-Ti: Titanium-porcelain abutment crowns; AC-Zr: Zirconia-porcelain abutment crowns.] Specimens were torqued with 30 NCm and thermocycled between 5℃ and 55℃ in 20‑second cycles for 5000 cycles. Removal torque values (RTV) were measured. Following the RTV measurement, the screws were changed with fresh screws and torqued again. Afterwards, specimens were loaded to fracture and fracture strengths were recorded, failure modes were examined. Statistical Analysis Used: Analysis of variance and Bonferroni test was performed.

Results: The AC-Ti group displayed the highest mean torque loss (%20.09 ± 6.49) and the SM-Ti group displayed the lowest (%9.59 ± 8.84). Only the difference between AC‑Ti and SM‑Ti groups was found statistically significant, there are no significant differences between other groups. The fracture strengths are 385.84 ± 27.68 N, 313.18 ± 39.97 N, 272.69 ± 35.03 N, and 156.71 ± 19.83 N for AC-Ti, AC-Zr, SM-Ti, and SM-Zr groups, respectively and all differences were found to be statistically significant. Failures occurred as deformation in titanium components, whereas fractures were observed in zirconia components.

Conclusion: Screw loosening was observed only in the AC-Ti group. No significant difference was observed among the torque loss values in the remaining groups. Titanium and zirconia materials do not exert any influence on screw loosening after thermal aging for hybrid-abutment crowns. Moreover, when assessing fracture strength, hybrid- abutment crowns exhibit superior strength and durability compared to screwmentable crowns.

Evaluation of the Relationship between Serum 25(OH) Vitamin D Levels and Cardiac Functions in Adolescent Athletes

Ö. Güneş, H. Altın — Fri, 16 May 2025 00:00:00 +0000

Background: Vitamin D is a prohormone necessary for the optimal functioning of the locomotor and circulatory systems in humans. As a caveat, vitamin D metabolism is crucial for maintaining musculoskeletal and cardiovascular health for overexercising people, like athletes. Our study intended to explore the relationship between serum 25-hydroxy vitamin D (25(OH) D) levels and left ventricle/right ventricle (LV/RV) systolic and diastolic function in adolescent athletes using 2D Doppler studies. Methods: In our cross-sectional study, 100 adolescent athletes were divided into two groups: vitamin D insufficiency (25(OH)D<20 ng/mL) and vitamin D sufficiency (25(OH)D>20 ng/mL) with 30 males and 20 females in both groups. A detailed physical examination and basic biochemical tests were performed; serum 25(OH)D levels were determined, and an echocardiographic evaluation was performed. Results: We found that decreased serum 25(OH)D levels were associated with impairment in many indicators of cardiac function, such as left ventricular-right ventricular-interventricular septum peak systolic velocity (Sm) and Tei index, inflow peak early diastolic velocity and inflow peak late diastolic velocity ratio (E/A), annulus early diastolic myocardial peak velocity (E′), and E/E′ ratio. Conclusions: To protect cardiac functions in adolescent athletes, we suggest screening serum 25(OH) D levels during certain periods, such as fall and winter, and vitamin D supplementation if necessary

Exploring the Role of Sonication Fluid Culture in Periprosthetic Joint Infection: A Comparative Study with Conventional Methods

M. Erem, E. Selçuk, M. Ozcan, G. Ozturk, C. Eryıldız — Fri, 16 May 2025 00:00:00 +0000

Objective: The aim of this study is to evaluate and compare the diagnostic effectiveness of sonication fluid culture (SFC) compared to conventional methods in identifying the causative microorganisms in periprosthetic joint infections.

Methods: In this study, three cultures were evaluated for diagnosing periprosthetic joint infection intraoperative periprosthetic tissue culture, implant culture, and SFC. The sensitivity, specificity, and predictive values were calculated for each method, using the 2018 definition of periprosthetic hip and knee infection and clinical evaluation as references. Of the 92 patients who had implants removed, 49 were for mechanical reasons and 43 for infection.

Results: Positive cultures were obtained in 13 out of 49 patients with mechanical issues and 31 out of 43 with infections. The sensitivity of periprosthetic tissue cultures (53.5%) is slightly higher than SFC (48.8%), suggesting better detection of positive cases. However, SFC’s specificity (83.7%) is higher, indicating more accurate identification of negative cases compared to periprosthetic cultures (73.5%). However, SFC identified additional pathogens in patients with negative periprosthetic tissue and implant cultures. Examination of the infected knee and hip prostheses showed that SFC enhanced pathogen detection, particularly in patients with negative implant cultures. Despite this, SFC was not statistically superior to other methods.

Conclusion: This study supports the combined use of periprosthetic tissue culture and SFC for identifying causative microorganisms in implant infections. Despite not being statistically superior, SFC provides additional pathogen detection, especially when other methods fail, thereby enhancing overall diagnostic accuracy.

Use of the CHA2 DS2 ‑VASc Score to Predict Concurrent Critical Coronary Artery Stenosis in Patients with Severe Carotid Artery Disease

O. Baran, Y. Yilmaz, S. Inci, Z. Cetinkaya, S. Kelesoglu — Fri, 16 May 2025 00:00:00 +0000

Background: There is a significant correlation between the severity of atherosclerosis in one arterial region and the occurrence of atherosclerotic disease in other regions. Identifying and managing vascular disease in patients with multifocal arterial disease is often complex. The CHA2 DS2 -VASc score encompasses several cardiovascular risk factors and was initially used to assess the risk of thromboembolism, stroke, and death in patients with atrial fibrillation. In recent years, this score has been proposed to predict the prognosis of various cardiovascular diseases. Aim: The study aimed to investigate the prevalence of concomitant coronary artery disease (CAD) and the correlation between the CHA2 DS2 -VASc score and CAD in patients who were scheduled for carotid stenting due to carotid artery stenosis (CAS) but had no history of CAD. Methods: A total of 452 patients were included in the study, 213 with symptomatic CAS and 239 with asymptomatic CAS. The patients were separated into two groups: those with and without. Results: One hundred forty-eight (32.7%) of 452 patients had critical CAD. Multivariate logistic regression analysis showed that a high CHA2 DS2 -VASc score (OR: 4.283, 95% CI: 2.903–6.321, P < 0.001) was an independent predictor of the development of CAD. Receiver operating characteristic curve (ROC) analysis showed 64.9% sensitivity and 82% specificity in detecting CAD of the CHA2 DS2 ‑VASc score at >4 cutoff [Area under ROC curve = 0.781 (95% CI: 0.724–0.838), P < 0.001]. Conclusion: When our results were analyzed, a CHA2 DS2 ‑VASc score of >4 was highly significant in predicting severe CAD.

Analysis of the Histopathological Characteristics and Expression of RIPK1 and NF‑ κB in Cervical Cancer in Kumasi, Ghana

B.M. Duduyemi, E.K. Addae, K. Bedu‑Addo, E. Atta Manu, F.R. Ngongou — Fri, 16 May 2025 00:00:00 +0000

Background: Cervical cancer is the second most common cancer in Kumasi, Ghana. The fact that survival rates are low, despite the advances made in clinical management necessitates exploration of alternatives to improve survival.

Aim: This study reviews the histopathological and molecular characteristics of cervical cancer in relation to Receptor Interacting Protein Kinase 1 (RIPK1) and Nuclear Factor kappa B (NF-κB), which are involved in the regulation of inflammation, cell death and cell survival.

Materials and Methods: The study reviewed 135 consecutive cases diagnosed from January 2015 to December 2016 in our centre. Clinicodemographic data were abstracted and suitable formalin fixed paraffin embedded (FFPE) tissue blocks were selected for tissue microarray construction and subsequent immunohistochemical assessment of RIPK1 and NF-κB expression. A statistical analysis of the data was done using SPSS version 26.

Results: The mean age of the cases was 58.93 years with a standard deviation of 17.88. The histological type of most (96.3%) of the cases was the Squamous cell carcinoma (SCC). Majority (49.63%) of the cases were of histological grade 3, followed by grade 2 with 33.32% and grade 1 with 17.04% of cases. Both RIPK1 and NF-κB were highly expressed (56.6% and 69.3%, respectively) among the case. RIPK1 expression was significantly associated with NF-κB expression (P = 0.001).

Conclusion: The significant co‑expression of RIPK1 and NF-κB in the high-grade carcinomas suggest they are active in signalling pathways that supress apoptosis and enhance survival and/ or proliferation.

A Randomized Trial of Stair‑Step Letrozole versus Traditional Letrozole for Subfertile Women with Polycystic Ovary Syndrome

S . Karakaya, Y. Kumtepe, R.A. Al, G.N.C. Senocak, E.P.T. Yılmaz — Fri, 16 May 2025 00:00:00 +0000

Background: Traditional letrozole or clomiphene treatment is started on cycle days 3 to 5, following a spontaneous menses or progestin- induced bleeding. If ovulation does not occur, the dose is increased following a progestin-induced bleeding. An alternative stair step protocol has been described, and if ovulation does not occur in this protocol, a higher dose is used without inducing withdrawal bleeding. There is no randomized trial comparing the traditional and stair-step letrozole protocols yet. Aim: To compare the efficacy of traditional and stair‑step protocols for ovulation induction using letrozole in women with polycystic ovary syndrome (PCOS).

Methods: A total of 200 eligible women were given 5 mg/ day letrozole, and those 80 who did not respond were randomized in a 1:1 ratio to stair-step or traditional letrozole therapy for up to 10 mg/day. For the traditional protocol, higher doses of letrozole were used in each new cycle if no ovulation occurred. For the stair-step protocol, higher doses of letrozole were given 7 days after the last dose if no dominant follicles were seen on ultrasonography. The PCOS was defined according to modified Rotterdam criteria. Participants were 18 to 35 years of age, had a body mass index of <40 kg/m2 , had at least one patent fallopian tube, had a normal uterine cavity, and had normal spermiogram results.

Results: The median follicle development time was significantly longer in the traditional protocol group than in the stair-step protocol group (41 days, 95% CI (40–42) vs 25 days, 95% CI (25–26); log rank 64; P < 0.001). Between traditional and stair step groups, the cumulative ovulation ratio (37/40 [%93] vs 36/40 [%90]; P = 1), endometrial thickness (9 [5–13] vs. 9 [5–11]; P = 0.005), mature follicule development (36/40 [%90] vs 36/40 [%90]; P = 0.549), pregnancy rates (3/40 [%8] vs 2/40 [%5]; P = 1), and antiestrogenic side effects were similar.

Conclusions: The stair-step protocol shortens the treatment time without causing any detrimental effects on ovulation outcome.

Clinicopathologic Profile and Pelvic Magnetic Resonance Imaging Pattern of Prostate Cancer in Southeast Nigeria

Fri, 16 May 2025 00:00:00 +0000

Background: Prostate cancer (PCa) is the most frequently diagnosed malignancy in men. It is the commonest cancer in Nigerian men. Multiparametric magnetic resonance imaging (mpMRI) is essential in the evaluation of patients with PCa.

Aim: To evaluate the clinicopathologic profile and pelvic MRI pattern of prostate cancer patients.

Methods: This was a retrospective study performed between July 2020 and June 2024. The study population was derived from men with histologically diagnosed PCa who subsequently had mpMRI for cancer staging. From the medical records, age, prebiopsy PSA, Gleason score (GS) and other relevant information were obtained.

Results: The records of 458 subjects were retrieved. A total number of 229 subjects had their prebiopsy PSA recorded while 158 subjects had their GS recorded. The mean age of the subjects was 66.38 ± 8.46 years, while the mean and median prebiopsy PSA were 49.37 ± 59.81 ng/ml and 33ng/ml, respectively. The mean GS of the subjects was 7.72 ± 1.29. The prostate capsule was the most commonly invaded structure (65.4%). The prevalence of bone metastasis was 22.8%, and the spine was the most commonly affected bone. Stage 3 and stage 4 disease were the most predominantly observed (58.4% and 32%, respectively). There was a statistically significant but weak correlation between tumor stage and GS.

Conclusion: The subjects’ clinicopathologic profile and pelvic MRI findings show that patients commonly present with advanced prostate cancer in our environment.

Assessing Determinants of Enrollees’ Satisfaction with Quality of Health Services within the State Social Health Insurance Scheme: An Application of Modified SERVQUAL Model

S. Onyemaechi, U. Ezenwaka, C. Okeke, T. Ibeziakor, C. Okuakaji, O. Osifala — Fri, 16 May 2025 00:00:00 +0000

Background: Patient satisfaction is an important indicator to measure the quality of healthcare and provider performance. Understanding enrollees’ satisfaction with the quality of health services provided by Anambra State Health Insurance Scheme is crucial for its effectiveness.

Aim: This study assessed health insurance enrollees’ satisfaction with the quality of care and its determinants in Anambra State, Nigeria.

Methods: This was a cross-sectional study that involved 447 enrollees selected from health facilities using a multistage sampling technique. Data was collected using a 25-item structured close-ended patients’ satisfaction questionnaire adapted from the SERVQUAL model. Data analysis was done using SPSS version 25. Logistics regression analysis was done to identify determinants of overall satisfaction. The level of significance was set at a P value <0.05.

Results: The overall level of satisfaction with services rendered was 80.6%. Enrollees were satisfied with tangibility (87.2%), reliability (89.3%), responsiveness (80.3%), assurance (90.2%), empathy (87.5%), and affordability (81.4%). Significant factors associated with the enrollees’ satisfaction across the six dimensions of care assessed were facility ownership (AOR = 1.42; CI 0.24–0.74; P < 0.00) and geographical location (AOR = 1.33; CI 0.14– 0.78; P < 0.01). Age (AOR = 2.86; CI 1.55–5.29; P < 0.00) was the only demographic characteristic associated with satisfaction with care.

Conclusion: The quality of care was satisfactory across dimensions of care assessed. However, enrollees’ satisfaction was positively influenced by facility‑related factors. Managers and healthcare providers should focus on continuous quality improvement efforts in public and rural facilities to improve the quality of services and enrollees’ retention within the health insurance scheme.

Performance of Serum Neutrophil–Gelatinase Associated Lipocalin (NGAL) in the Diagnosis of Pregnancy‑Related Acute Kidney Injury (PRAKI) in Delta, State Nigeria: A Prospective Study

E.P. Orhewere, A.B. Odonmeta, O.A. Adejumo, O.C. Okoye — Fri, 16 May 2025 00:00:00 +0000

Background: Pregnancy-related acute kidney injury (PRAKI) is associated with poor maternal and perinatal outcomes if not promptly recognized. Diagnosis of PRAKI is currently based on serum creatinine, which delays diagnosis and, inevitably, treatment.

Aims: To determine the performance of serum NGAL in the diagnosis of PRAKI among women in the peripartum period and determine the normal serum NGAL levels in nonpregnant women.

Methods: A prospective study involving 162 pregnant women who presented in labor in two hospitals in Delta State and 150 nonpregnant controls. Serum creatinine and NGAL were assayed using blood samples collected from study participant at 0, 6, 12, 24, and 48 hours and 7 days postdelivery. Diagnosis of PRAKI was based on both serum creatinine and NGAL. The diagnostic performance of NGAL was determined by performing a receiver operation curve and determining the area under the curve (AUC).

Results: The prevalence of AKI using creatinine-based KDIGO criteria was 22.2% and 50% using serum NGAL. The optimal diagnostic accuracy for serum NGAL was at the 12th hour, using a cut off of 142 ng/dl determined by Youden’s index. The reference range for nonpregnant women was 12.77 – 135.67 ng/dl. The sensitivity and specificity of serum NGAL at a cut off 142 ng/ ml were 77.2% and 75.4% (AUC = 0.79), respectively while using 135.67 ng/ml (upper limit determined from nonpregnant women) as cut‑off, sensitivity was 77.78% and specificity was 70.63%. Conclusion: Serum NGAL is a promising marker for early diagnosis of PRAKI with high sensitivity and specificity.

Determinants of Exercise Capacity in Children and Adolescents with Asthma: A Comparative Case‑Control Study

M. Kaya, H. Ucgun, B.G. Karaaslan, A. Kiykim, H.D. Kulli — Fri, 16 May 2025 00:00:00 +0000

Background: Asthma is a chronic disease that may affect exercise capacity. Despite the variety of existing tools for assessing exercise capacity, whether patients with asthma have lower exercise capacity than healthy controls and its potential determinants are still poorly understood.

Aim: The primary aim of this study was to identify potential determinants of exercise capacity. The secondary aim was to compare exercise capacity, pulmonary function, and muscle strength of children and adolescents with asthma with healthy controls.

Methods: Volunteers aged 7–17 participated in the study and were divided into two groups: the asthma (n = 60) and the healthy control (n = 40). Asthma control questionnaire, six-minute walk test, pulmonary function test, maximum inspiratory (MIP) and expiratory (MEP) pressure measurements, and 30-second sit-to-stand test (30-STST) were performed.

Results: The study showed that exercise capacity and respiratory and peripheral muscle strength were significantly lower compared to controls (P < 0.001, P = 0.031, P = 0.001, P = 0.025, respectively). Another critical finding was MIP, 30-STST, and MEP were the determinants of exercise capacity in children with asthma (R² = 0.403, P < 0.001).

Conclusion: Clinicians should not ignore that exercise capacity may be reduced in children and adolescents with asthma and add assessment and training of respiratory and peripheral muscle strength in pulmonary rehabilitation programs.

Evaluation of Static Pupillary Parameters in Pediatric Patients with Vitamin B₁₂ Deficiency

Z.Y. Öztorun, G.Y. Biçer, K.R. Zor, F. Kardaş — Fri, 16 May 2025 00:00:00 +0000

Background: Automatic pupillometry device enables important information about pupillary function. Neurological manifestations such as autonomic dysfunction and ophthalmological disorders are observed in vitamin B12 deficiency (VB12D).

Aim: To assess the static pupillary functions using a pupillometry device in pediatric patients with VB12D.

Methods: The study included 40 children with VB12D and 40 healthy children in the control group. The measurements were made with an automated pupillometry under static conditions. The static measurements were performed at scotopic, mesopic, and photopic light intensities. The differences between the patient and control groups were analyzed with static measurements.

Results: Pupillary diameters of the patient and control groups under scotopic, mesopic, and photopic conditions were observed and there was a statistically significant difference under the mesopic and photopic conditions. Under mesopic conditions: The mean pupil diameter was found to be 5.92 ± 0.69 mm in the VB12D group and 5.18 ± 0.91 mm in the control group (P = 0.003). Under photopic conditions, the mean pupil diameter was found to be 5.13 ± 0.77 mm in the VB12D group and 4.53 ± 0.96 mm in the control group (P = 0.001). Under scotopic conditions, the mean pupil diameter was 6.46 ± 0.68 mm in the VB12D group and 6.37 ± 0.93 mm in the control group. There was no statistically significant difference between the patient and control groups in the measurements under scotopic conditions (P = 0.63).

Conclusion: Pediatric patients with VB12D have significantly larger pupil diameters in photopic and mesopic conditions than healthy children. The results suggest that there is an autonomic system dysfunction in children with VB12D, especially when the parasympathetic system is negatively affected. Pupillary contraction is reduced in children with VB12D. Decreased pupillary myosis function is observed. Pupillary size is larger in vitamin B12‑deficient children under photopic and mesopic conditions.

An Assessment of the Relationship Between Fetal Growth Restriction and Maternal Serum Markers of Systemic Inflammation (NLR, SIRI, SII, and PIV)

A. Akay, Y. Akdaş‑Reis, S. Yilmaz‑Ergani, K. Hajiyeva, Y. Engin‑Üstün — Fri, 16 May 2025 00:00:00 +0000

Background: The processes involved in inflammatory regulation are crucial during pregnancy.

Aim: This study aims to identify the association between fetal growth restriction (FGR) and neutrophil-to-lymphocyte ratio (NLR), systemic inflammatory response index (SIRI), Systemic immune‑inflammatory index (SII), and pan‑immune inflammatory value (PIV).

Methods: This retrospective case-control study was conducted between 2015 and 2021. The study group comprised cases diagnosed with FGR, while the control group was randomly selected from a healthy cohort of pregnancies. The levels of inflammatory markers were calculated from the blood count results of the cases. A comparison was conducted between the two groups’ obstetric and neonatal outcomes and serum inflammatory markers.

Results: A total of 1052 cases were included in the study, with 526 (50%) belonging to the FGR group. The mean age was found to be similar in both groups (P = .311). A significant increase in neutrophils, NLR, SIRI, SII, and PIV was observed in the FGR group (P < .05). The multivariate logistic regression analysis results demonstrated that elevated neutrophil, NLR, and SII values were independent risk factors for FGR (P < .001). No notable discrepancy was observed in these markers between the early and late FGR (P > .05). A significant inverse relationship was observed between neutrophils, NLR, and SII, and gestational age and fetal weight at birth (P < .05).

Conclusion: The findings indicated that elevations in neutrophils, NLR, and SII are independent risk factors for FGR. These markers reflecting maternal systemic inflammation, have been linked to FGR and associated poor neonatal outcomes.

Clinical Research on Modified Postural Drainage for Secretion Clearance in Infants with Wheezing Bronchitis

P. Li — Fri, 16 May 2025 00:00:00 +0000

Background: Wheezing bronchitis is common in infants and can lead to complications if not properly managed. Postural drainage is a standard technique for secretion clearance, but the optimal protocol remains debated.

Aims: This study aims to assess the clinical efficacy and safety of a modified postural drainage nursing protocol for secretion clearance in infants with wheezing bronchitis.

Methods: This prospective study included 104 infants (six months to three years) hospitalized with wheezing bronchitis between January 2023 and May 2024. Participants were randomly divided into two groups: observation (N = 52, modified protocol) and control (N = 52, conventional protocol). The modified protocol optimized drainage frequency, standardized position transitions, regulated rest periods, and included respiratory training. Key outcomes included the Modified Respiratory Sound Score (MRSS), symptom resolution, radiological improvements, and hospital stay duration.

Results: On Day four, MRSSs were significantly lower in the observation group (2.2 ± 0.4) compared to the control group (3.5 ± 0.5, P < 0.001). Rhonchi, wheezing, and cough resolved more quickly in the observation group (P < 0.001 for all). Chest X-ray absorption rates were higher (88.5% vs. 80.8%, P = 0.035), and hospital stays were shorter (6.5 ± 1.2 vs. 8.5 ± 1.5 days, P < 0.001). Adverse event rates were similar (21.2% vs. 25.0%, P = 0.641).

Conclusion: The modified protocol significantly improved secretion clearance, accelerated symptom resolution, and reduced hospital stays without compromising safety in infants with wheezing bronchitis.

A Simple but Often Neglected Technique for Managing Prolonged Urinary Leakage from Urethrovesical Anastomosis: The Side-Fenestrated Catheter Approach

F. Bicaklioglu — Fri, 16 May 2025 00:00:00 +0000

Urethrovesical anastomotic leakage (UVAL) is a well-documented early complication following radical prostatectomy. While low-volume leaks are often self-limiting, persistent high-volume leaks (>300 mL/day), where most urine bypasses the catheter, may require invasive interventions. We report the case of a 58-year-old male with prostate adenocarcinoma who developed high-volume UVAL after undergoing laparoscopic radical prostatectomy, which was unresponsive to conservative measures. A side-fenestrated catheter was placed under local anesthesia via cystoscopy on postoperative day 2, leading to rapid resolution of the leak. The patient was subsequently discharged on postoperative day 4 following drain removal. This case highlights the effectiveness of a simple, minimally invasive side-fenestrated catheter approach for managing UVAL, offering an alternative to more invasive interventions such as bilateral percutaneous nephrostomy, suprapubic catheter placement, or even surgical revision of the urethrovesical anastomosis.