Nigerian Journal of Clinical Practice (Niger J Clin Pract) 2018 | Dec | Volume 21 | Issue 12

REVIEW ARTICLE
	Conservative treatment for deep carious lesions in primary and young permanent teeth	p. 1549
	FA Alsadat, AA El-Housseiny, NM Alamoudi, AM Alnowaiser DOI:10.4103/njcp.njcp_202_18   The management of deeply carious lesion could be accomplished conservatively by two techniques: an indirect single-step and stepwise techniques. The former involves incomplete removal of carious dentin and then application of a well-sealed permanent restoration. While the latter involves incomplete removal of caries and then reentry after a period to remove the residual caries, after changing its environment. The aim of this article was to review the dental literature concerning the conservative methods available to treat deeply carious teeth. A literature search was done using electronic databases "PubMed," "Google Scholar," and "Cochrane Database" for articles in English. Several keywords were used: conservative treatment, deep caries, deeply carious lesion, indirect pulp capping (IPC), and stepwise excavation. This review mentions two operative methods for conservative treatment of deeply carious lesions, namely, IPC, including criteria for case selection and success and failure of the deeply carious lesion, and an account on various used materials. Both single-step and stepwise IPC techniques could be used for managing deeply carious lesions with maintaining pulp vitality; more longitudinal studies are needed to determine which technique is preferable to be used.
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ORIGINAL ARTICLES
	Treatment of class II malocclussion: A comparative study of the effects of twin-block and fatigue resistant device	p. 1557
	A Gulec, M Goymen DOI:10.4103/njcp.njcp_110_18   Aim: This is a retrospective cephalometric study aimed to compare the treatment effects of Twin-Block (TB) appliance with The Forsus Fatigue Resistant Device (FRD) appliance in class II division I patients in a composite of peak and post peak growth of period time. Materials and Methods: The experimental sample consisted of the lateral cephalograms of 40 patients who were treated with either TB appliance (n = 15), FRD (n = 15) or the untreated control ones. In treatment groups lateral cephalograms taken before therapy as initial records (T1) and at the completion of functional therapy (T2) were used. The control group comprised 10 children with untreated skeletal Class II malocclusions. The normality of distribution of continuous variables was tested by Shaphiro wilk test. Oneway ANOVA and LSD test in parametric; Kruskall Wallis and all pairwaise multible comparison tests in non-parametric samples were used for comparing differences among 3 groups. Results: Cephalometric analysis revealed that both TB and FRD appliances stimulated mandibular growth (P < 0.05) and no restriction was seen in maxilla in both groups (P > 0.05). The unwanted mandibular proclination was seen more in FRD group (P ≤ 0.001). Soft tissue didn't imitate the hard tissue (P > 0.05). Conclusion: FRD group produced skeletal effects as much as TB group in peak and post peak period of growth with still more mandibular incisor proclination.
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	Resin infiltration technique and fluoride varnish on white spot lesions in children: Preliminary findings of a randomized clinical trial	p. 1564
	F Eren Giray, MA Durhan, E Haznedaroglu, B Durmus, IO Kalyoncu, I Tanboga DOI:10.4103/njcp.njcp_209_18   Aim: To clinically assess the efficacy of resin infiltration versus fluoride varnish for arresting white spot lesions (WSLs) on permanent teeth in children. Subjects and Methods: Among the children referred to the our University, Faculty of Dentistry, Department of Pediatric Dentistry, 23 aged between 8–14 with 81 anterior WSLs were included in the study. The participants were randomly assigned to either the resin infiltration group or the fluoride varnish group. WSLs were assessed using a laser fluorescence device (DIAGNOdent pen, Kavo, Germany) and were characterized at baseline, immediately following resin infiltration application and at a 6-month follow-up. For the statistical analyses, the IBM SPSS Statistics 22 (IBM SPSS, Turkey) program was used to assess the findings of the study. Results: Participant retention was 100% at 6 months. There was no significant difference between the two groups when baseline DIAGNOdent (DD) values were compared (P > 0.05). The reduction in 6-month follow-up DD values were statistically significant in both groups relative to baseline values. The 6-month values of the resin infiltration group were statistically lower than those of the fluoride varnish group (P= 0.028, P < 0.05). Conclusions: Resin infiltration and fluoride varnish are clinically feasible and efficacious methods for the treatment of anterior WSLs. The inhibition of caries progression by resin infiltration should now be considered an alternative to fluoride treatment.
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	Midfacial fractures: A retrospective etiological study over a 10-year period in Western Romanian population	p. 1570
	PA Tent, RI Juncar, T Lung, M Juncar DOI:10.4103/njcp.njcp_256_18   Introduction: Midfacial fractures are extremely important oral and maxillofacial problems because they take varied forms and are frequently accompanied by major long-term esthetic or functional complications. Their etiology and epidemiology vary significantly in the literature, and the main causes are varied by population. The aim of this study is to identify the main traumatic etiology of midfacial fractures, along with the main categories of affected patients in our geographical area, in order to establish the need for measures that can prevent fractures in the future. Materials and Methods: We conducted a retrospective study over a 10-year period in 379 patients. Data were extracted from the patients' charts, and the following variables were taken into consideration: sex, age, environment of origin, education level, and traumatic etiology. Results: Midfacial fractures most frequently affected the 20–29 years age group (31.93%), male sex (n = 333, 87.86%, M:F = 7.23:1), patients from urban areas (n = 206, 54.35%), and patients without education (46.70%). The most frequent etiology was interpersonal violence (44.85%), followed by fall trauma (16.62%) and road traffic accidents (15.30%). Statistical correlations evidenced that urban environment favors midfacial fractures caused by interpersonal violence and road traffic accidents or sports injuries, while in rural areas, domestic accidents and animal attacks are predominant (P = 0.000). Conclusions: The overwhelming incidence of interpersonal violence in our population is currently a major public health problem. Implementing laws and initiating national programs for the prevention of interpersonal violence would lead to a considerable reduction of midfacial fractures in the Western Romanian population.
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	Effects of dietary habits and sedentary lifestyle on breast cancer among women attending the oncology day treatment center at a state university in Turkey	p. 1576
	H Toklu, NH Nogay DOI:10.4103/njcp.njcp_238_18   Background: Certain lifestyle factors affect the risk of developing breast cancer. Especially, diet and physical activity play a primary role in preventing breast cancer. However, the results of studies on this subject in different societies are still conflicting. Objective: The objective of this study is to determine the effects of dietary habits and sedentary lifestyle on breast cancer risk among women attending the Oncology Day Treatment Center at a state university in Turkey. Materials and Methods: This case-control study was conducted in the Oncology Day Treatment Center at a state university in Turkey between December 1st, 2016 and June 1st, 2017. The case group consists of 65 women diagnosed with breast cancer, and the control group consists of 65 women without any chronic disease. The Mediterranean diet score was used to assess the dietary habits of the participants, and the International Physical Activity Questionnaire Short Form was used to assess the physical activity (sedentary lifestyle) of the participants. The Shapiro–Wilk W test was used to check for normality within the distribution of scale scores. Categorical data were compared using the Chi-square test. Multivariate binary regression analysis was conducted (P < 0.05). Results: The proportion of participants who received a higher score from the Mediterranean diet score was significantly lower in the case group than in the control group. The proportion of physically inactive individuals in the case group was higher than those in the control group. Body mass index (BMI) at the age of menopause was significantly higher in the case group than the control group. Those who frequently use a deep-frying cooking method to cook red meat have a 6.77 times higher breast cancer risk than those who use a stewing method. Comparing those who do not consume olive oil, or who consume olive oil rarely, once or twice a week compared with those who consume olive oil daily, it was found that the case group has 4.5 times higher risk than the control group. Conclusions: Cooking red meat by a deep-frying method, lack of physical activity, having a higher BMI particularly during the postmenopausal period, and nonadherence to the Mediterranean diet are risk factors of breast cancer.
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	Effect of different framework materials of resin-bonded bridges on load to fracture values and stress distribution	p. 1585
	Ilgi Baran, Merve Arslan, Hamiyet Gungor DOI:10.4103/njcp.njcp_281_18   Purpose: The aim of this study was to compare in vitro fracture strengths (FSs) of metal- and fiber-reinforced frameworks of resin-bonded bridges and to evaluate stress distribution with finite element analysis (FEA). Materials and Methods: Totally 80 extracted maxillary central and maxillary canine teeth were used for in vitropart of this study as two groups; metal-reinforced framework (n = 20) [(metal-supported resin-bonded bridge (MR-RB)] and fiber-reinforced frameworks (n = 20) [fiber-reinforced resin-bonded bridge (FR-RB) were prepared for three unit resin-bonded bridges. All bridges were loaded from lateral pontic at 1 mm/min crosshead speed and fracture values were recorded. Mann–Whitney U-test was used for statistical analysis, and fracture patterns were evaluated visually. FEA was carried out in the second part of the study, and stress distribution of MR-RB and FR-RB structures was analyzed using one of the models from in vitro specimens as main model. Results: The mean FSs of MR-RB and FR-RB were 637.47 ± 151.91 N and 224.86 ± 80.97 N, respectively. Fiber-reinforced specimens were found to distribute stress more homogeneous and connectors in each framework were the regions where stress concentrated mostly. Conclusion: In vitro FSs of MR-RB and the stress concentration of the point that the forces were applied were higher as compared to other parts of the restoration. Furthermore, in contrast to FR-RB specimens, retainer tooth fractures were observed in MR-RB specimens.
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	The prognastic efficiencies of modified early warning score and mainz emergency evaluation score for emergency department patients	p. 1590
	FS Akgun, C Ertan, N Yucel DOI:10.4103/njcp.njcp_58_18   Background: Recently, there is an increasing interest for scoring systems to evaluate the critically ill patients by means of the severeness of their disease and their availibility for discharge in the emergency departments and intensive care units. Our aim in this study is to evaluate the efficiency of the mEWS and MEES scoring systems in assessing the severeness of the disease and predicting the mid term prognosis of the patients hospitalized following their emergency care in our emergency room. Material and Method: Patients, who attended to Inonu University Department of Emergency Medicine and hospitalized following their emergency care were included to our study. The effects of age, sex, triage categories, mEWS and MEES scores on the site of hospitalization and mortality was evaluated. Statistical analyses were performed by SPSS for Windows version 16.0. The data was summarized as means, standart deviation and percents. Univariate and multiavriate analyses were performed for risk factor calculations. Results: The mean age of the patients was 58±19 and 584 (56%) were male. Triage group 1 patients accounted for 21 of all (2%), while 646 (61%) were in group 2 and 384 (37%) were in triage group 3. Of all patients, 341 (32%) were hospitalized to ICU. While discharged patients accounted for 89% (935 patients) of the study group, 116 patients (11%) died at the hospital. The GCS, AVPU and mEWS values were statistically significant by means of patient mortality (P < 0.0001), but the delta MEES value was not (P < 0.127). Conclusion:The results of our stuy suggests that mEWS evaluation is an effective and reliable tool for predicting outcome and hospitalization areas of ED patients. Our results also displayed that the easily available GCS and AVPU scales are reliable guides in patient management. MEES values, on the other hand, are not convenient for ED use.
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	Molecular characterization of methicillin-resistant Staphylococcus aureus isolates from rural community settings in Trinidad and Tobago	p. 1596
	FP Vire, PE Akpaka, C Unakal DOI:10.4103/njcp.njcp_269_18   Aims: To determine the virulence and antimicrobial resistant genes in methicillin resistant Staphylococcus aureusisolates recovered from patients attending two rural health centers in Trinidad and Tobago. Settings and Design:Cross-sectional observational analysis of patients from two local health centers located in communities in northern region of the country. Materials and Methods: Nasal and wound swabs from 300 patients were analyzed using standard and molecular techniques. Multiplex polymerase chain reaction was used to detect 16S rRNA, mec A, Staphylococcal chromosomal cassette SCC mec types, pvl, alpha hemolysin (hla), and Toxic Shock Syndrome Toxin 1 (tst 1) genes. S. aureus ATCC 33591 and Staphylococcus epidermidis ATCC 12228 were used for quality control, respectively. Results: Over a quarter (26.7%, 80/300) of the surveyed patient's samples grew bacterial isolates of which 45% (36/80) were S. aureus and 44.4% (16/36) were mecA-positive. Majority (62.5%, 10/16) possessed the pvl gene, whereas 25% (4/16) possessed the alpha hemolysin (hla) gene. None of the methicillin-resistant Staphylococcus aureus (MRSA) isolates possessed the tst 1 gene. Also, 18.8% (3/16) isolates possessed both virulence genes, pvl and hla. Although the SCCmec types IV and V were detected, but none of the SCCmec I, II, and III were harbored by the isolates. Conclusions: SCCmec type IV and the pvl genes were common among the MRSA isolates from the community. The hla gene was found infrequently, but none of the isolates possessed the tst 1 gene. Knowledge of this is important for robust surveillance of such cases from the community in the country.
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	A comparative evaluation of smear layer removal by using different Er:YAG lasers parameters: An İn-vitro scanning electron microscopic study	p. 1602
	Z Gorus DOI:10.4103/njcp.njcp_317_18   Introduction: The purpose of this in-vitro study was to investigate the effect of irrigation activation methods using different laser parameters on microhardness and push-out bonding strength of root canal dentin. This study evaluates and compares the efficacy of different laser parameters in smear layer removal using the scanning electron microscopic image analysis. Materials and Methods: In this in-vitro study, 60 newly extracted human teeth with extraction indications were used. Later, the teeth were randomly divided into three groups (n = 20). In Group 1, irrigation was performed using 2 Er:YAG laser (Fotona Laser AT Fidelis Plus III, Slovenia) with 0.6 W, 15 Hz, and 40 mJ parameters. In Group 2, irrigation was performed at 0.3 W, 15 Hz, and 20 mJ. In Group 3 (control group), conventional syringe irrigation method was performed without activation. After irrigation activation, horizontal sections were taken from the teeth, sections from the coronal, middle, and apical triplets were selected and subjected to the Vicker's microhardness test. The Kruskal–Wallis and Wilcoxon signed-rank tests were performed on the obtained data. Results: There was no statistically significant difference between the control group and the laser group (P > 0.05). As a result of the push-out bonding strength test performed on the coronal and apex regions of laser treated and untreated groups, the values of the coronal region were found to be higher than the apex region, and it was found that the bonding strength of the coronal part of the laser group was increased (P < 0.05). The change in parameters between the laser groups did not produce a statistically significant difference between the groups (P > 0.05). Conclusion: According to this study the laser group increases the bonding strength without a negative change in microhardness. In this study the further research is needed on this subject.
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	Evaluation of tooth wear and associated risk factors: A matched case–Control study	p. 1607
	C Atalay, G Ozgunaltay DOI:10.4103/njcp.njcp_203_18   Aim: The aim of this case–control study was to compare the associated risk factors between adults with tooth wear (TW) and age- and sex-matched controls without TW. Methods: Fifty participants with TW and 50 age- and sex-matched controls participated in this study. A questionnaire was prepared to assess oral healthcare and consumption of erosive food and drinks. All participants completed the diet analysis forms. Saliva characteristics were evaluated with GC Saliva-Check BUFFER test. Examiners measured the TW of case patients, using the TW index. Data were statistically analyzed using Chi-square and Mann–Whitney U-tests (P < 0.05). Results:Individuals in the case group brush their teeth more often (P < 0.05). The difference in erosive food consumption between the case and control groups was significant (P < 0.05). There was no erosive effect of acidic food when consumed as a main meal or a snack (P > 0.05). Although there was no difference between stimulated saliva flow rate and buffering capacity between groups, the difference between the resting saliva flow rates and pH values was significant (P < 0.05). Although some wear was seen on buccal/labial surfaces of teeth, cervical and occlusal/incisal surfaces were scored higher. No TW was observed on palatal/lingual surfaces. The cervical surfaces of mandibular premolars and incisal surfaces of anterior teeth were most affected. Conclusion: Of the factors investigated, TW in the case group was correlated with consumption of acidic foods, lower salivary flow rate, and pH.
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	Morbidity pattern and interferon gamma level in sickle cell anemia patients with autosplenectomy	p. 1615
	CI Okongwu, FA Fasola, AJ Adekanmi, AA Onifade DOI:10.4103/njcp.njcp_217_18   Introduction: In sickle cell anemia patients (SCA), the spleen suffers multiple occlusion of its microvasculature causing ischemia and subsequently autosplenectomy. Among the functions of the spleen is the production of gamma interferon (IFN-γ) which has several immunological roles. This function could be impaired in these patients. Therefore, this study aimed at determining the extent to which autosplenectomy affects the immunity of SCA patients as reflected by the level of IFN-γ, frequency of infections, and crises (vaso-occlusive, hemolytic, aplastic) in these patients. Materials and Methods: Forty SCA patients in steady state condition were recruited into the study. A self-administered questionnaire was completed by all patients, and venous blood sample was analyzed for IFN-γ levels. All patients underwent abdominal ultrasound scan. Results: Autosplenectomy was observed in 20% of the sickle cell patients. Bone pain was the most frequent type of crisis in the study population; this occurred in 100% and 85% of patients with autosplenectomy and those without autosplenectomy, respectively. Infection rates of more than once a year was reported in 87.5% of SCA patients with autosplenectomy compared with 50% of SCA patients without autosplenectomy. There was no significant difference in IFN-γ plasma levels between SCA patients with autosplenectomy and those without autosplenectomy. Conclusion: This study showed a higher prevalence of infection and bone pain crisis among SCA patients with autosplenectomy than in SCA patients without autosplenectomy. It also showed comparable level of IFN-γ in the 2 groups of patients. Patients with autosplenectomy may benefit from early institution of drugs such as hydroxyurea to improve quality of life.
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	Anal melanoma: Outcomes of current surgical approaches	p. 1622
	S Kaya, M Kement, YE Altuntas, O Altin, A Seker, S Mazmanoglu, L Kaptanoglu, N Bildik, HF Kucuk DOI:10.4103/njcp.njcp_254_18   Aim: In this study, we aimed to evaluate the clinical characteristics and outcomes of the patients with anal melanoma (AM), who underwent surgical treatment. Materials and Methods: This study was conducted in Kartal Training and Research Hospital between January 2010 and December 2017. All patients, who underwent surgical resection with a diagnosis of AM, were enrolled. Results: A total of 10 patients were examined, 8 of them were females, and their average age was 69.2 years (range, 47–85 years). Abdominoperineal resection (APR) was performed in five (50%) patients, and local excision (LE) was performed in other five (50%) patients. Three patients (30%) had stage I disease, two (20%) had stage II disease, and five (50%) had stage III disease. All five patients in APR group had stage III disease. In the comparison of the survival period after surgery, the mean survival period of the APR group was 6.2 months (range, 1–16 months) while that of the LE group was 19.6 months (range, 7–43 months). Conclusion: LE with adjuvant radiation seems to offer good locoregional control without reducing the survival and may be an option of treatment for patients with small, superficial AM. However, APR should be offered for patients with locally advanced disease or as a salvage following recurrence.
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	Assessing knowledge, attitudes, and practices of healthcare workers regarding medical waste management at a tertiary hospital in Botswana: A cross-sectional quantitative study	p. 1627
	B Mugabi, S Hattingh, SC Chima DOI:10.4103/njcp.njcp_270_17   Background: Medical waste management (MWM) is of concern to the medical and general community. Adequate knowledge regarding management of healthcare waste is an important precursor to the synthesis of appropriate attitudes and practices of proper handling and disposal of medical waste by healthcare workers (HCWs). Aims and Objectives: This study was designed to investigate knowledge, attitudes, and practices of doctors, nurses, laboratory technicians, and housekeeping staff, regarding MWM at a tertiary hospital in Gaborone, Botswana. Materials and Methods: This was a cross-sectional quantitative study using a self-administered questionnaire involving 703 participants. Data were analyzed using SAS software. Descriptive statistics were used to summarize the data. Responses for attitude of respondents were analyzed using nonparametric tests. Results: The completion rate for this study was 90% with (632/703) questionnaires analyzed. Majority of respondents were nurses 60% (422/703), followed by housekeeping staff 24.3% (171/703), doctors 10.95% (77/703), and laboratory technicians 4.7% (33/703). The study showed that 66.9% (423/632) of respondents had some training in MWM, and 90.5% (572/632) claimed to have knowledge regarding the consequences of poor MWM, particularly health risks. There was a significant agreement among the respondents that segregation of medical waste should be done at the point of generation (mean score = 4.43 out of 5). Majority of respondents reported that the healthcare facility had a color-coding system (mean score = 4.59) and identified "lack of knowledge of the dangers of improper waste management by HCWs" as the major obstacle to MWM. Conclusion: This study showed that MWM practice at this facility was above average, although improvements were required in accessing waste disposal points and availability of personal protective equipment. Ongoing training should be provided to HCWs on MWM, with more attention to knowledge of regulatory requirements, and involvement of HCWs in development of MWM policies to enhance compliance.
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	Vitamin D deficiency in patients with stages 1 and 2 chronic kidney disease in Southern China	p. 1639
	M Feng, J Lv, FT Huang, R Huang, Q Qiu, Y Tang, AP Xu DOI:10.4103/njcp.njcp_158_18   Aim: We aim to investigate the incidence and associated factors of vitamin D deficiency, a seldom reported factor, in patients with stages 1 and 2 chronic kidney disease (CKD) in southern China. Methods: We conducted a single-center observational study. Hospitalized patients over 14 years old, who were diagnosed with stages 1 and 2 CKD and had their serum 25-hydroxyvitamin D [25 (OH) D] measured, were included. Patients were divided into vitamin D deficient and non-deficient groups depending on the cutoff serum 25 (OH) D value of 37 nmol/L. Clinical and biochemical parameters were evaluated for associated factors of vitamin D deficiency by logistic regression. Results: A total of 118 patients were included, of which 62 (52.5%) were vitamin D insufficient and 47 (39.8%) were vitamin D deficient. Using multivariate binary logistic regression analysis, high serum level of gamma-glutamyl transpeptidase (GGT) (OR = 5.163; 95%CI, 1.105-24.130; P = 0.037), dyslipidemia (OR = 3.083; 95%CI, 1.029-9.243; P = 0.044), 24-hour urinary protein excretion (UPE) ≥3.5 g/24 hrs (OR = 5.010; 95%CI, 1.316-19.074; P = 0.018), and treatment with glucocorticoids (OR = 2.973; 95%CI, 1.093-8.084; P = 0.033) were independently associated with vitamin D deficiency. In addition, among different types of nephropathy, minimal change disease (MCD) had the highest incidence (85.7%) of vitamin D deficiency. Conclusion: Poor vitamin D status is common in patients with stages 1 and 2 CKD in southern China. The incidence of vitamin D deficiency is 39.8%. High serum GGT level, dyslipidemia, 24-hour UPE ≥3.5 g/24 hrs, and treatment with glucocorticoids are independent associated factors of vitamin D deficiency.
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	Diagnostic value of serum glial fibrillary acidic protein and S100B serum levels in emergency medicine patients with traumatic versus nontraumatic intracerebral hemorrhage	p. 1645
	I Aydin, A Algin, MK Poyraz, O Yumrutas DOI:10.4103/njcp.njcp_431_17   Background: Glial fibrillary acidic protein (GFAP) is a brain-specific astroglial protein that is released into the blood soon after traumatic brain injury by mature astrocytes. S100B is rapidly released into the cerebrospinal fluid and bloodstream after brain damage. We compared the serum concentrations of these proteins in patients with severe head trauma (bleeding and/or fracture) or nontraumatic intracerebral hemorrhage and healthy individuals. Materials and Methods: The study included 63 patients (33 males and 30 females) with traumatic cerebral hemorrhage and/or cranial bone fractures or nontraumatic cerebral hemorrhage and 30 healthy control subjects. The reasons for attending the emergency department were as follows: fall from a height (n = 32), traffic accident (n= 18), nontraumatic intracerebral hemorrhage (n = 6), animal kick to the head (n = 4), and blow to the head (n = 3). Results: Of the 63 patients included in the study, 33 (52.4%) were male and 30 (47.6%) were female. Of the 30 healthy controls, 12 (40%) were male and 18 (60%) were female. The average age of the patients was 27 years (range, 1 month to 86 years) and the average age of the control group was 21 years (range, 18–30 years). The mean serum GFAP concentrations were 86.37 ng/mL in the patients and 38.07 ng/mL in the controls (P < 0.05). The mean serum S100B concentrations were 428.37 pg/mL in the patients and 103.44 pg/mL in the controls (P < 0.05). Eight (12.7%) patients died in the hospital; of those, the mean GCS score was 4.6, and the mean GFAP and S100B levels were 127.8 ng/mL and 860.6 pg/mL, respectively. Conclusion: The GFAP and S100B concentrations were significantly higher in patients with traumatic or nontraumatic brain injury than in healthy individuals, indicating that serum levels of these biomarkers may provide an alternative to computed tomography for the diagnosis of brain injury.
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	Evaluation of the content, quality, reliability and accuracy of YouTube videos regarding endotracheal intubation techniques	p. 1651
	Umut OCAK DOI:10.4103/njcp.njcp_207_18   Background: Today, the internet is widely used to obtain any type of information. The use of internet may facilitate healthcare professionals' education as well. Objectives: We aimed to evaluate the content, accuracy, reliability and quality of YouTube videos regarding intubation, one of the most important skills for healthcare professionals. Materials and Methods: Of the 54,000 videos found using the keyword 'intubation', the first 50 were included in the study. The sources were divided into three categories: academicians, healthcare professionals and medical. The view ratio, like ratio, and video power index were used to determine the popularity while Journal of American Medical Association (JAMA) benchmark criteria were used for reliability. The extent of the information was evaluated based on the scoring system provided by us. Results: The majority of the videos were uploaded by healthcare professionals (92%) including academicians. Twenty-seven (54%) videos had training purposes. The information point was highest in the academic group (4.6 ± 2.7); however, there was no significance between groups (P = 0.2). The mean JAMA score was highest in the academic group (1.9 ± 0.8), with a statistical significance (P = 0.00055). The JAMA score and information points were significantly higher in training videos compared to non-training videos (p=<0.001 and P = 0.003, respectively). Popularity ratios were similar between groups. Conclusion: Videos regarding medical skills should be accurate. Information on YouTube regarding intubation is limited and is of low quality. The establishment of an organization authorized to evaluate the content, quality, accuracy and reliability of the information on the internet regarding medical skills is warranted.
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	Evaluation and comparison of the film thicknesses of six temporary cements before and after thermal cycling	p. 1656
	HO Gumus, IL Kurtulus, E Kuru DOI:10.4103/njcp.njcp_382_17   Aim: Temporary cement can be applied for both permanent and temporary cementation of implant-supported fixed restorations. These cements must have certain physical and mechanical properties. Specifically, the film thickness directly affects the cement's clinical success. The aim of this study was to evaluate and compare the film thicknesses of six temporary cements before and after thermal cycling. Materials and Methods: Eighty-four metal copings with uniform holding loops were fabricated and divided into 12 groups of seven samples each. Six of these groups were subjected to a thermal cycling process. The copings were cemented to solid implant abutments (Implance Solid Abutment, 3.5-mm cervical diameter, 2 mm high, 6° taper, Implance Dental Implant System; AGS Medical, Trabzon, Turkey), using six different types of cement. The fitting surfaces were coated with the luting cements. After steeping in artificial saliva for 24 hours, the specimens were subjected to pull-out testing using an Instron machine. Specimens in the thermal cycling groups were subjected to 700 thermal cycles (36–55°C) prior to pull-out testing. Results: The Mann–Whitney U test revealed significant differences between the retention values of the thermal cycling (+) and thermal cycling (–) groups (U = 153.0, P < 0.01). The retention values of the groups subjected to thermal cycling were significantly lower than those of the cements that were not subjected to thermal cycling. Thermal cycling also affected the film thickness significantly (Wilcoxon signed rank test, Z = –5.533, P < 0.001). Conclusions: Thermal cycling affects the film thickness and retention of temporary cements significantly. The retention value was significantly higher for glass ionomer cement than for the other cements tested, and this cement also exhibited greatest film thickness.
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	Seroprevalence of anti-Toxoplasma gondii IgG antibody and risk factors among abattoir workers in Uyo, Southern Nigeria	p. 1662
	US Ekanem, AE Moses, EG Abraham, OO Motilewa, AN Umo, AI Uwah, EI Itina DOI:10.4103/njcp.njcp_44_18   Context: The asymptomatic nature of toxoplasmosis with its severe consequences, especially in populations with high HIV infection rate, makes it a disease of public health importance. Being a zoonosis, Toxoplasma gondiiinfection may be high among people who work with animals. Thus, there is the need to determine the prevalence of the infection among abattoir workers in Uyo, where HIV prevalence rate is in double digits, which could lead to reactivation of toxoplasmosis in those with immunosuppression. Aim: To determine the prevalence and associated risk factors of T. gondii infection in abattoir workers in Uyo. Settings and Design: A descriptive cross-sectional study that was conducted among persons who work with livestock and birds, in Uyo and its environs. Methodology: The study was conducted among 339 workers in abattoirs in Uyo and its environs. Data were collected using interviewer-administered questionnaire and detection of IgG antibodies to T. gondii using ELISA technique and HIV testing using the national algorithm. Data were analyzed using STATA statistical software version 20, and statistically significant level was set at P < 0.05. Results: The seroprevalence of T. gondii IgG antibodies among the study participants was 55.8%. At a univariate level, many factors were associated with T. gondii seropositivity; they were age, sex, level of education, ethnicity, occupation in the abattoir, type of animal exposure, always washing hands before eating in the workplace, and taking of raw/unpasteurized milk. However, after multivariate analysis, participants exposed to poultry, butchers/raw meat sellers, and those who had worked for more than 5 years in abattoirs were at a greater risk of being T. gondii IgG seropositive; odds ratio (OR) 5.46 [confidence interval (CI) 1.88, 15.86]; OR 1.89 (CI 1.14, 3.14), and OR 1.25 (CI 1.25, 6.42), respectively. Conclusion: T. gondii IgG seroprevalence is high among abattoir workers in Uyo, and there is a need for Akwa Ibom State government to establish enlightenment and prevention programs for these occupationally exposed and other populations at risk of infection.
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CASE REPORTS
	Rhabdomyoblastic differentiation in rosai dorfman disease of the orbit in a 12-year-old male	p. 1670
	E Ezeanosike, OB Ezeanosike, SI Akpan, CN Ezisi DOI:10.4103/njcp.njcp_262_17   Extranodal Rosai–Dorfman disease involving the orbit has been reported severally with extensive discourse on management strategies. However, rhabdomyoblastic differentiation coexisting with the disease is yet unreported. We present the clinical and histopathological features of a 12-year-old boy presenting with both. A 12-year-old boy was referred to our Ophthalmic Plastic Surgical Service with a 5-year history of bilateral, progressively enlarging eyelid, orbital masses causing proptosis, and severe cosmetic blemish. He had suffered vision loss to the right eye following trauma 2 years prior to the onset of the disease. Computed tomography of the orbits revealed preseptal and intraorbital components of well-defined multi-lobulated masses in both orbits. No significant nodal involvement was noted. He underwent excision biopsy of the tumor in both eyes performed 1 month apart. A histopathologic diagnosis of the Rosai–Dorfman disease with focal areas of rhabdomyoblastic differentiation was made. He was treated postoperatively with a course of oral steroids with close observation for the rhabdomyoblastic differentiation. Rosai–Dorfman disease is an uncommon disease and has been reported to coexist with other pathologies. We highlight focal myoblastic differentiation within the excised tissues which may not necessarily warrant a diagnosis of rhabdomyosarcoma. Long-term follow-up of this patient is required to establish the safety of observation.
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	Recurrent oral squamous papilloma in a pediatric patient: Case report and review of the literature	p. 1674
	OO Orenuga, Oluwo A, RT Oluwakuyide, AB Olawuyi DOI:10.4103/njcp.njcp_407_17   Squamous papillomas are common lesions of the oral mucosa. They are benign proliferating lesions often painless, slow growing and with a cauliflower appearance. However, its clinical appearance which sometimes mimics exophytic carcinoma, verrucous carcinoma or condyloma acuminatum raises concern when it occurs in the oral cavity. Squamous papilloma occurs predominantly in 30- to 50-year old's. However, they may be seen in children <10 years and accounted for 8% of all oral tumors in children. There is no sex predilection. It has a predilection for the tongue and soft palate, but may occur on any other surface of the oral cavity. Oral squamous papillomas have been associated with infection by the human papilloma virus (HPV). The present report is a case of a recurrent squamous papilloma of the hard palate in a 5-year-old patient with a review of the literature.
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	Long-term follow-up and treatment of a patient with severe skeletal open bite using temporary anchorage devices	p. 1678
	WX Lv, S Chen, TM Xu, B Han DOI:10.4103/njcp.njcp_223_18   This case report presents the treatment and long-term follow-up of a patient with severe skeletal hyperdivergent open bite, Class II malocclusion, and a severely retruded chin. After failure of early treatment using high-pull headgear with a bite block during the early permanent dentition stage due to an unfavorable growth pattern, orthognathic surgery was proposed but rejected by the patient. Then, temporary anchorage devices were used to correct the occlusion and establish an acceptable overbite and overjet. The overall observation time was 8.5 years; the treatment time using fixed appliances was 3 years and 4 months. The achieved tooth position and occlusal relationship remained stable 2.5 years later without recurrence of the open bite.
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