Nigerian Journal of Clinical Practice

Immune thrombocytopenic purpura detected as a result of dental examination: A case report

G Ertas — 2025-04-08

Immune thrombocytopenic purpura (ITP) is an autoimmune hematological disorder characterized by mucocutaneous bleeding. Although patients usually suffer from mild mucosal bleeding, visceral bleeding may occur depending on the severity of thrombocytopenia. Therefore, early diagnosis and treatment are of vital importance. In this case report, the diagnosis and treatment process of a patient diagnosed with ITP following acute oral bleeding will be presented. A 38‑year‑old male patient presented to the dentist with severe gingival bleeding for 2 days. Intraoral and extraoral examinations revealed spontaneous gingival bleeding, hemorrhagic bullae, and purpura. The patient was immediately referred to hematology with a prediagnosis of severe thrombocytopenia and laboratory investigations revealed a platelet count of 2.000/mm3. Treatment was started for the patient who had a high risk of life‑threatening bleeding. After treatment, the patient’s platelet count improved and all lesions healed. The high potential of early signs of ITP in the intraoral region makes it necessary for dentists to have knowledge about the mechanism and clinical manifestations of this disease. In this case report, the importance of dentists’ awareness of hematological diseases such as ITP in the early diagnosis of the disease and the prevention of possible complications are emphasized.

Recent advances in nephrology: The research gaps and the need for greater emphasis on incorporating hard clinical endpoints

EN Okafor — 2025-04-08

Current limitations exist in the availability of specific therapies for preventing acute kidney injury (AKI). Managing AKI poses challenges, particularly as interventions are often initiated only after a substantial increase in serum creatinine or a gradual decline in urine output. However, relying on these parameters raises concerns due to their insensitivity to acute changes. The timely detection of patients at risk of kidney disease through the diagnostic utility of biomarkers is essential for the prompt implementation of active interventions. Despite the initial optimism surrounding the discovery of AKI biomarkers, their integration into the routine care of at-risk patients lags behind and is underutilized, even after validations. Therefore, the utilization of biomarkers holds promise in promptly diagnosing AKI and improving patient outcomes. Despite notable technological advancements in various medical subspecialties, survival rates among acute and chronic kidney disease (CKD) patients have not witnessed significant improvement compared to other disciplines. While HIV infection and AIDS were once considered a death sentence, advancements in HIV treatment have allowed for control and longer-acting management. However, a definitive cure for CKD remains elusive. Nephrology research faces challenges, including the imperative to enhance both the quality and quantity of research. The number of randomized controlled trials in nephrology is notably lower compared to other subspecialties, with many yielding negative results. Studies evaluating hard clinical endpoints are also limited. This review provides an overview of recent advances in nephrology and the need for greater emphasis on incorporating hard clinical endpoints that could impact clinical practice.

Challenges with trabeculectomy at University of Nigeria Teaching Hospital Ituku‑Ozalla Enugu, Nigeria: Ophthalmologists’ perspectives

SN Onwubiko — 2025-04-08

Background: Black Africans are more vulnerable to primary open angle glaucoma, which runs a catastrophic course. Primary trabeculectomy with anti-metabolites has been recommended as the suitable therapeutic option. Yet, a low glaucoma surgical rate (GSR) has been documented in Nigeria. Aim: To evaluate the challenges with performing trabeculectomy at the University of Nigeria Teaching Hospital (UNTH) Ituku-Ozalla, Enugu from the Ophthalmologists' perspectives with a view to improving the GSR in Nigeria. Methods: A cross-sectional study design with a qualitative method was adopted for this study in July 2023. It involved 18 participants (ophthalmologists) from UNTH, comprising the (12) senior registrars for the focus group discussion, and a purposive sample of 6 consultants for the in-depth interviews. Discussions and interviews were recorded and transcribed. The transcripts were analysed using the Braun and Clarke guide to thematic content analysis. Results: Poor surgical skill acquisition, with the consequent inadequate transfer of skills to trainees was the major challenge. Availability of better alternatives, the inherent lack of vision improvement following trabeculectomy and inability to pay for surgery, which translated to low uptake of trabeculectomy by patients were also important findings. Improved glaucoma surgical training, health insurance, hospital subsidy, public health education and individual patient’s counselling were the recommendations to improve the GSR. Conclusion: In UNTH Enugu, providers, patients, and glaucoma disease factors were identified as challenges with trabeculectomy. Strategies to address them especially, simulation-based glaucoma surgical training for trainers and trainees are advised to improve the situation.

MRI‑based evaluation of pituitary size and volume in children with idiopathic growth hormone deficiency

İ Kaba — 2025-04-08

Background: Growth hormone deficiency (GHD) is the most common cause of pathological short stature of endocrine origin. Among the causes of pathological short stature, pathologies in the hypothalamic–pituitary region, especially the pituitary gland, have an important place, and imaging the region with pituitary magnetic resonance imaging (MRI) is a frequently used method in the diagnosis process and guides the diagnosis and treatment process. It is known that hypoplasia or aplasia of the pituitary gland, which plays a role in the synthesis and release of many hormones in addition to GH, causes short stature. Aim: This study aims to evaluate pituitary size and volume as potential diagnostic markers in children with idiopathic growth hormone deficiency (IGHD) compared with healthy controls. Methods: The study included children who presented to our hospital’s pediatric endocrinology outpatient clinic with complaints of short stature/growth retardation and was diagnosed with IGHD, for whom MRI of the pituitary had been performed. Pituitary MRI examinations were retrospectively reviewed to measure the, adenohypophysis height, anterior–posterior diameter, width, and volume, and these measurements were compared with those of an age‑.and gender‑matched control group. Results: A total of 55 patients diagnosed with IGHD were included, with a mean chronological age of 9.8 ± 3.4 years, of whom 58.2% (n = 32) were male. The control group consisted of 42 healthy children with a mean chronological age of 9.3 ± 3.4 years, with 47.6% (n = 20) being male. No significant differences in age and gender were found between the groups (P = 0.523, P = 0.306, respectively). Although the adenohypophysis height, anterior–posterior diameter, width, and volume of patients with IGHD were lower than those in the control group, no statistical differences were observed between the two groups (P > 0.05). There were no differences in pituitary size and volume based on gender in either group (P > 0.05). A positive correlation was found between pituitary height, width, and volume with age, insulin‑like growth factor‑1 (IGF‑1) standard deviations (SD), and insulin‑like growth factor binding protein‑3 (IGFBP‑3) SD (P < 0.05), whereas no correlation was found between stimulated peak GH levels and pituitary size and volume (P > 0.05). Conclusion: We found that the size and volume of the adenohypophysis in patients with IGHD are not different from those of healthy peers; however, they showed a correlation particularly with IGF‑1 and IGFBP‑3 standard deviations.

The value of nuchal translucency (NT) ultrasonography for fetal malformation screening

L Zhang — 2025-04-08

Background: Early detection of fetal malformations is crucial for timely intervention and management in obstetric care. Existing screening methods may have limitations, prompting the exploration of novel approaches to improve detection accuracy. Aim: This retrospective study explores an efficient fetal malformation screening method, aiming to provide a reference for obstetric examination. Methods: A total of 511 puerperae who underwent standardized ultrasound examinations in our hospital’s first trimester from December 2020 to August 2022 were enrolled. Ultrasound was used to detect the thickness of the nuchal translucency (NT) in all puerperae during prenatal examination. The clinical values of detection indices in maternal prenatal physical examination were analyzed. Results: A total of 511 puerperae were investigated, and 12 malformed fetuses were detected, presenting a fetal malformation rate of 2.35%, including 3 cases of head and neck hydrocele, 2 cases of megacystis, 3 cases of anencephaly, and 4 cases of omphalocele. Among 499 normal fetuses, NT thickness > 3.0 mm accounted for 3.41%, while among the 12 malformed fetuses screened, NT thickness > 3.0 mm accounted for 75.00%, and there was a statistical difference between the two groups (Chi‑square = 124.374, P < 0.05). Using ultrasound for fetal malformation screening revealed that the fetus with NT thickness value above 3.0 mm performed better in ultrasound screening (>3.0: AUC of 0.904; >3.5: AUC of 0.928; >4.0: AUC of 0.944 vs. >2.0: AUC of 0.863; >2.5: AUC of 0.878). Conclusion: The findings underscore the critical clinical significance of NT thickening as a promising ultrasound soft index for screening fetal malformations. Beyond aiding in clinical diagnosis and ostpartum treatment, the potential applications of these findings hold immense practical value. They pave the way for enhanced prenatal and postnatal care practices, emphasizing the translation of research outcomes into tangible benefits for healthcare providers and expectant parents alike.

Association of placental thickness with birth weight and other neonatal anthropometries: A prospective cohort study

EI Iloghalu — 2025-04-08

Background: Placental growth is concordant with fetal growth and any impairment would negatively impact fetal development and subsequent birthweight that is vital for newborn survival. Aim: The aim of the study was to determine the relationship between placenta thickness and birth weight. Patients and Methods: This prospective cohort study carried out at the University of Nigeria Teaching Hospital Enugu, Nigeria, involved 80 consecutive pregnant women with thick placenta (>4 cm) and another 80 in the control group with normal placenta thickness (2.5‑4 cm) and matched for parity and maternal weight between 38 and 40 weeks of gestation. Both groups were followed up until delivery and the neonatal parameters were measured. Data analysis was descriptive and inferential at 95% confidence levels using Statistical Package for the Social Sciences software version 20. Results: The mean placental thickness at recruitment were 5.3 ± 0.7 cm and 3.7 ± 0.2 cm among the study and control groups, respectively. The study group had significantly higher birthweight, head circumference, and crown‑heel length compared to the control group (P < .05). There was a positive linear correlation between placental thickness and birth weight, head circumference, and crown‑heel length. Conclusion: This study demonstrated that sonographic measurement of placental thickness antenatally is a reliable predictor of birth weight and other neonatal anthropometric parameters.

Bicuspid aortic valve among children presenting in two health institutions in Enugu, South‑East Nigeria

JM Chinawa — 2025-04-08

Background: Bicuspid aortic valve (BAV) is the most common congenital heart defect. However, this is under‑reported. It is not without associated cardiac anomalies. Aim: This study was aimed at documenting the prevalence of BAV in two referral health institutions and to determine the various types and associated cardiac anomalies. Methods: This was a descriptive study carried out in two referral health institutions. One thousand and five echocardiography was carried out in children with suspected cardiac diseases over a nine‑year period. Results: Data was analyzed with IBM statistical software version 20. The prevalence of children with BAV is 1.7%. The most common type of BAV is the presence of left coronary and non‑coronary sinuses. The most common associated lesion among children with BAV is atrial septal defect 7 (41.2%), followed by significant tricuspid regurgitation three (17.7%) and aortic stenosis three (17.7%). The mean cardiac structure diameters were not different when compared with age‑.and gender‑matched controls (Children without BAV). Conclusion: Though BAV is the most common congenital heart disease, its rarity is proven in this study. It is also noteworthy that the cardiac defect is associated with valvar anomalies.

Impact of the COVID‑19 Pandemic on Suicide Attempts: A comparative and retrospective study from a forensic medicine centre in Antalya, Türkiye

F Aslan — 2025-04-08

Background: Understanding the dynamics of suicide attempts during the pandemic, especially in vulnerable subgroups, is crucial for effective prevention strategies. Aim: The primary objectives were to analyse the prevalence of suicide attempts during the pre‑pandemic and pandemic periods, explore demographic shifts, and assess the impact of specific pandemic stressors on suicide attempts from both forensic and clinical perspectives. Methods: Two distinct periods were considered: the pre‑pandemic period spanning January 2018 to February 2020 and the pandemic period from March 2020 to June 2021. Data collection involved retrospective analysis of forensic reports for cases of suicide attempts during the specified periods. Results: During the pandemic period, a decrease in frequency of total suicide attempts was observed compared to the pre‑pandemic period. The median age of suicide attempters was lower during the pandemic (29 vs. 25, z = ‑5.420, P < 0.001), with increased rates among adolescents and young adults. Foreign nationals experienced significantly lower suicide attempt rates during the pandemic (χ²(1) = 21.298, P < 0.001). Suicide methods showed pandemic‑related shifts, with significantly increased use of prescription medications (χ²(10) = 41.299, P < 0.001). Individuals with a prior psychiatric diagnosis demonstrated a decrease in suicide attempts during the pandemic (χ²(1) = 44.635, P < 0.001). Conclusion: The findings underscore the need for nuanced suicide prevention strategies that consider age, gender, and household dynamics. Future research, ideally longitudinal and multi‑centred, is warranted to comprehensively understand the prolonged effects of the pandemic on suicide behaviour.

Histopathological evaluation of Mesna application at different concentrations on middle ear mucosa of rats in early and late stages

E Köroğlu — 2025-04-08

Background: The aim of this study was to determine the safe concentration of Mesna, which is widely used in otologic surgeries, by examining the early and late effects on middle ear mucosa, at different concentrations. Methods: Fifty‑nine healthy ears of 32 rats were included in the study. The rats were divided into eight groups and Mesna at 25%, 50%, and 100% concentrations along with 100% saline were applied. On the third day of the experiment, animals in the first four groups were sacrificed to assess early effects, and on the twentieth day, animals in the last four groups were sacrificed to assess late effects. The middle ear mucosa samples were dissected and delivered blindly to the pathology department. Results: Thirty‑one rats completed the study. The histopathological effects of Mesna when applied in 25% and 50% concentrations were similar to those of saline in the early period. However, the application of 100% Mesna caused severe inflammation and a statistically significant difference was observed (P = 0.004). Furthermore, vascular proliferation was significant in this group (P = 0.014). There was no significant difference between the groups in terms of late effects. Conclusion: In clinical practice, using up to 50% concentration of Mesna can be said to be reliable in obtaining a faster and more efficient chemical dissection. However, an inflammation of the middle ear mucosa was observed in the early period following the application of 100% concentration. Therefore, further studies are needed on its safe use in this concentration.

Effect of aging procedures on phase transformation of posterior 3‑unit zirconia frameworks used in fixed partial dentures

M Bülbül — 2025-04-08

Background: Zirconia is an essential material for dentistry, and its properties should be investigated in all aspects. Aim: The primary objective of this study was to assess the impact of aging procedures on the phase transformation of posterior 3‑unit zirconia frameworks used in fixed partial dentures. Setting and Designs: The study considered three aging procedures: Group T underwent thermocycling with 20,000 cycles between 5°C and 55°C for 30 seconds, Group M experienced mastication cycles with 500,000 cycles at 1.3 Hz and 49 N force, and Group T + M was subjected to consecutive thermocycling (20,000 cycles/5– 55°C/30 s) and mastication cycles (500,000 cycles/1.3 Hz/49 N). Methods: E ach group comprised 12 specimens from manufactured presintered zirconia blocks (inCoris ZI, Sirona, Salzburg, Austria). The evaluation of phase transformation was performed through X‑ray diffraction (XRD) analysis. Statistical Analysis: The obtained data were subjected to statistical analysis using one‑way ANOVA and the Tukey tests (α = 0.05). Results: The study revealed statistically significant differences in the effects of aging processes on phase transformation in zirconia frameworks (P < 0.05). Group T + M demonstrated the highest phase transformation compared to other groups (P < 0.05). Moreover, significant differences were observed between the distal connector and pontic regions (P < 0.05). Conclusion: All aging processes applied to zirconia increased the amount of monoclinic phase.

Study of lip anthropology in young adult males and females in Jazan, Saudi Arabia

MMH Bakri — 2025-04-08

Background: The lips serve crucial functions for the face, including facial expression, speech, eating, and esthetics. Surgeons who repair or reconstruct facial deformities often rely on the anatomy and dimensions of these structures. Objective: This study aimed to collect diverse data on lip morphology. Design: Cross‑sectional study. Settings: College of Dentistry, Jazan. Methods: The current study included randomly selected Saudi adults with complete dentition with ages ranging from 18 to 30 years. The lips or their surrounding areas of patients with abnormalities, malformations, deformities, inflammation, trauma, or surgical scars (cleft lip operations) were omitted. Main Outcome Measures: Average lip size of male and female population in Jazan, KSA. Sample Size: 400 (200 males and 200 females). Results: The mean height of the upper vermilion was 14.38 mm in males and 13.78 mm in females. The height of the upper lip (Sn‑Sto) was measured, with males having a mean value of 24.05 ± 4.02 mm (range, 15–32 mm) and females having a mean value of 20.66 ± 4.12 mm. The difference between the sexes was statistically significant. The medial vertical height of the cutaneous lower lip (Li‑SI) of females had a mean value of 10.63 ± 1.59 mm, and that of males had a mean value of 11.55 ± 2.25 mm. The height of the lower lip of males was 20.28 ± 5.2 mm and that of females was 16.95 ± 3.03 mm, and the differences were statistically significant. Conclusion: Significant differences in lip measurements between males and females (indicating sexual dimorphism) were observed. Additionally, the upper vermilion tends to be thinner than the lower vermilion in both sexes, with this being the most prominent feature of the region. Furthermore, the height of the cutaneous upper lip was greater than that of the cutaneous lower lip, and the medial vertical height of the upper lip was greater than that of the lower lip in both sexes.

Exploring nurses’ perceptions of patients in the workplace: The case of difficult patients

N Bilgic — 2025-04-08

Background: Communication is a vital aspect of life. It is vital that all healthcare professionals maintain reliable communication with their patients. Aim: This study aimed to exploring how nurses perceive "difficult patients" in their work environments and their approaches to these patients. Methods: This is a cross‑sectional study. Data were collected from nurses who participated in the study via social media platforms between March 15 and June 15, 2021. In addition to the introduction section, the data were gathered using the “Difficult Patients and Communication Form” and the “Difficult Patients Questionnaire.” Results: Of 359 participating nurses, 274 (75.2%) reported encountering difficult patients. On average, they scored three (3) points on the Difficult Patient Questionnaire (DPQ) and its sub‑dimensions, indicating that nurses face challenges in communicating with patients perceived as difficult. The majority of nurses identified patients who were non‑communicative (73%, n = 200), refused treatment and cooperation (52.9%, n = 145), or had emotional problems (35.8%, n = 98). Nurses aged 51 and over showed statistically significant differences in the Patient Difficulty and Staff Discomfort subscales and in total scores on the Patient Difficulty Scale (P < 0.05). These nurses also reported encountering difficult patients less frequently, whereas those in both the private and public hospitals encountered them more often. Most nurses reported experiencing communication difficulties primarily in clinical settings (62.4%, n = 171) and during nursing practice (44.9%, n = 123). Data Access Statement: The research data supporting this publication are available from Google Drive. Conclusion: Nurses frequently encountered patients with difficulties. To manage such interactions, patients should be actively involved in the care process in order to help align their expectations. Additionally, in‑service training can be offered to nurses to enhance their communication and problem‑solving skills when dealing with challenging patients.

Assessing the efficacy and safety of shorter versus extended adjuvant treatment duration for stage iii low‑risk colon cancer: A comparative analysis

NO Kalkan — 2025-04-08

Background: In recent years, reducing adjuvant treatment period from 6 months to 3 months in low‐risk stage 3 colon cancer has shown no decline in efficiency and fewer adverse effects, particularly neuropathy. Aim: We examined the efficacy and side effects of 3‐ and 6‐month adjuvant chemotherapy regimens in low‐risk stage 3 colon cancer patients. Methods: Twelve oncology centers retrospectively scanned operated, low‐risk, stage 3 (T1‐3, N1) colon cancer patients. Capecitabine and oxaliplatin (CAPOX) were given to all 3‐month adjuvant chemotherapy patients, while 6‐month patients received FOLFOX orCAPOX. Two adjuvant treatment groups compared DFS (disease‐free survival) and side effects. Results: In total, 204 patients were included in our study and the patients’ median age was 56 years. Regarding treatment duration, 40.6% of patients (n:83) were treated for 3 months and 59.4% (n:121) were treated for 6 months. The 24‐month DFS was numerically high in the 6‐month treatment arm, but the difference was not statistically significant (91% vs 84%, respectively; HR: 0.7 95 CI% 0.3–1.58, p: 0.38). During the treatment time, both in all grades (30% vs 54.5%) and in grade 3 (6% vs 15%), neuropathy was significantly higher in the 6‐month treatment arm. After the end of the treatment, the average persistent neuropathy frequency after 12 months of follow‐up was significantly higher in the 6‐month treatment arm, and all of them were at grade 1–2 (12% vs 31%, respectively). Conclusion: In adjuvant treatment of low-risk stage 3 colon cancer, 3-month CAPOX and 6-month FOLFOX/CAPOX had similar 2-year DFS.The neuropathy was significantly lower in the 3-month treatment arm.

A randomized study comparing mini PCNL and RIRS for renal stones between 8 mm and 15 mm – A single institutional experience

KM Chavannavar — 2025-04-08

Background: Renal stone disease presents a persistent challenge in urology, necessitating advancements in minimally invasive techniques for enhanced patient outcomes. Retrograde intrarenal surgery (RIRS) and mini percutaneous nephrolithotomy (mPCNL) have emerged as contemporary modalities to address intermediate‑sized renal stones (8–15 mm) with precision and reduced invasiveness. Aims: To provide a comparative analysis of RIRS and mini PCNL in managing intermediate sized renal stones. To evaluate stone clearance rates, operative metrics, complications, and patient reported outcomes was integral to identifying optimal treatment strategies. Methods: Participants randomized to RIRS or mPCNL groups, with stone clearance rate as the primary outcome. Secondary measures included operative time, complication profiles, pain management, and the need for additional procedures. Results: The demographic data were comparable in our study. The stone size was 11.282 ± 1.7996 mm in mPCNL group and 11.248 ± 2.0340 mm in RIRS group. The fluoroscopy time was 49.40 ± 2.515 s in the RIRS group and 77.28 ± 2.466 s in the mPCNL group. There was a statistically significant variance in the operative time. After a month, the stone‑free rates were 96% and 90% in the mPCNL and RIRS groups, respectively. Conclusion: Our study emphasizes the importance of tailored treatment approaches based on patient characteristics. The overall operative time is higher in RIRS group, while the fluoroscopy time, complications, hemoglobin fall, and mean duration of hospital stay are higher in PCNL group. However, the stone clearance rates in both procedures have been remarkable. It is prudent to leave it to the discretion of the operating surgeon to choose the appropriate procedure for a given patient considering the variables.

Pediatric perioperative mortality in Southeastern (SE) Nigeria—A multicenter, prospective study

EP Nwankwo — 2025-04-08

Background: The perioperative mortality rate is a key indicator of the quality of surgical services in low and middle-income countries (LMIC). Objective: To determine the perioperative mortality rate of pediatric surgical conditions and the predictive factors in Southeastern Nigeria. Methodology: A prospective, multicenter study of peri-operative mortalities occurring in children under 18 years in five tertiary hospitals in Southeastern Nigeria over nine months was conducted. All-cause and case-specific in-hospital peri-operative mortality rates, as well as predictive factors, were identified. The mortality rate was expressed as percentages with a 95% confidence interval. The data were analyzed using SPSS 26. Results: A total of 775 patients underwent anesthesia or surgery, with 28 deaths. The 30-day perioperative mortality rate was 3.61% (95% CI = 2.41- 5.18); 1.94% (95% CI = 1.09-3.17 within 24 hours, and 1.17% (95% CI = 0.91- 2.91) from 24 hours to 30 days after the procedure. The mortality rate was 100% for gastroschisis and ruptured omphalocele, with overwhelming sepsis being the major cause of death (53.6%). Significant determinants of mortality were a higher ASA status (AOR)=13.944, 95% CI=1.509-128.851, p=0.020, sedation without ventilatory support (AOR)=15.295, 95% CI=3.304-70.800, p=0.001, and associated comorbidities (AOR)=65.448, 95% CI=11.244-380.962, p=0.001. Conclusion: The pediatric peri-operative mortality rate in Southeastern Nigeria is high for gastroschisis. Associated comorbidities, higher ASA status, and sedation without ventilatory support were significant predictors of mortality.

Assessment of muscular stiffness in children with Duchenne muscular dystrophy using real-time elastography

G Güngör — 2025-04-08

Background: Imaging modalities, such as ultrasonography (USG), can be used to evaluate and monitor the musculoskeletal system during the clinical progression of Duchenne muscular dystrophy (DMD). Aim: This study aimed to measure passive muscle stiffness in children with Duchenne muscular dystrophy and to compare these measurements with those of healthy children. Methods: Patients with DMD were evaluated clinically (age, clinical functional score, timed Gover score), serum creatine kinase level, B-mode ultrasonography, and real-time tissue elastography imaging. Results: A total of 64 boys were included in this study. The medial and lateral gastrocnemius muscle strain ratio in patients with DMD was significantly bigger than that in the control group (medial; 1.66 ± 1.23 vs 0.81 ± 0.16, P < 0.001, lateral; 1.49 ± 0.52 vs 0.85 ± 0.16, P < 0.001). Conclusion: The strain ratios of the medial and lateral gastrocnemius muscles were greater in patients with Duchenne muscular dystrophy than in the controls, indicating that ultrasound elastography may be beneficial for diagnosis and follow-up.

The value of prognostic nutritional index in patients with deep neck space infection

FCS Kundi — 2025-04-08

Background: Antibiotic therapy is pivotal in deep neck space infections, yet inappropriate use and antibiotic resistance impact patient outcomes. Aim: This study aimed to evaluate the clinical significance of admission prognostic nutritional index (PNI) as a prognostic marker. Methods: Data from 81 hospitalized patients (mean age 33.9 years) with deep neck space infections confirmed by CT scans were analyzed (Nov 2020 ‑ Sep 2023). PNI, derived from serum albumin and lymphocyte count, was calculated. Primary outcome was antibiotic resistance; secondary outcome was length‑of‑stay. Results: Patients with antibiotic resistance (n = 24) had significantly lower PNI (mean 47.3, SD = 9.2) compared to the non‑resistant group (n = 57, mean 57.5, SD = 12.2), P < 0.001. Adjusted multivariable analysis showed PNI as a significant predictor of antibiotic resistance (OR = 0.908, 95% CI 0.837‑0.984, P = 0.004). ROC analysis established a PNI cut‑off of 51.5 with 59% sensitivity and 80% specificity. Linear regression revealed decreasing PNI associated with prolonged length‑of‑hospital stays (adjusted R‑squared = 0.40, P = 0.010). Conclusions: The study underscores PNI’s potential as a prognostic marker for deep neck space infections, particularly in predicting antibiotic resistance and length of hospital stay. Lower PNI values correlate with compromised nutritional and immune status, suggesting its clinical relevance for personalized treatment strategies.

Examination of pan‑immune‑inflammation value and lymphocyte‑monocyte ratio in sudden sensorineural hearing loss

V Akin — 2025-04-08

Background: Studies about inflammation indices are becoming increasingly common. Inflammation is thought to play an important role in the aetiopathogenesis of sudden sensorineural hearing loss. Aim: In this study, we aimed to compare sudden sensorineural hearing loss patients and patients in a control group in terms of pan‑immune‑inflammation value and lymphocyte‑monocyte ratio and to determine the relationship of these indices with sudden sensorineural hearing loss. Methods: The research was designed as a retrospective, case‑control study. The archival records of patients diagnosed with sudden sensorineural hearing loss between 1 January 2018 and 1 May 2023 were scanned. Within the scope of the study, age, gender, amount of hearing loss, hearing loss accompanied by vertiginous symptoms, hearing loss accompanied by tinnitus, full blood count results, pan‑immune‑inflammation value and lymphocyte‑monocyte ratio were analysed between the groups. Statistical analyses were performed using the independent samples t‑test, Chi‑square test and Pearson correlation analysis. Results: Leukocyte, neutrophil, platelet and pan‑immune‑inflammation values were found to be significantly higher in patients with sudden sensorineural hearing loss (P values: 0.023, <0.001, 0.010, <0.001, respectively). Lymphocyte and monocyte values were significantly lower (P values: <0.001, 0.006, respectively). There was no significant difference in terms of lymphocyte‑monocyte ratio (P = 0.455). There was no relationship between tinnitus, vertiginous symptoms and blood parameters. There was a positive correlation between neutrophil value and the amount of hearing loss (P = 0.036). Conclusion: In our study, the pan‑immune‑inflammation value was significantly higher in sudden sensorineural hearing loss patients. A statistically significant relationship was detected between high neutrophil values and the amount of hearing loss. These results can be evaluated on the basis of the inflammation‑ischaemia relationship in the aetiopathogenesis of sudden sensorineural hearing loss.

Effects of STZ‑induced diabetes on zinc, boron and antioxidant defense mechanisms in rats

F Demirkaya Miloglu — 2025-04-08

Background: Diabetes mellitus (DM), characterized by dysregulation of glucose metabolism, is a significant global health issue. This study aims to investigate the effects of DM, induced with streptozotocin (STZ), on serum zinc and boron levels as well as antioxidant defense mechanisms in rats. Materials and Methods: In this study, a rat model was utilized where rats, after an overnight fast, were administered a single intraperitoneal dose of STZ to induce type-1 diabetes. Diabetic status was confirmed three days post‑STZ administration with fasting blood glucose levels exceeding 300 mg/dL. Six rats were assigned to the STZ‑induced diabetic (DM group) and control groups (C group). Inductively coupled plasma mass spectrometry (ICP‑MS) was used to analyze serum samples treated with hydrogen peroxide and nitric acid. Furthermore, serum samples were analyzed using ELISA to measure total oxidant‑antioxidant status (TOS‑TAS). Results: The ICP‑MS method was validated with validation parameters including method linearity (10–500 ng/mL), precision (≤ 3.25% RSD), accuracy (≤ ±2.58% RE), and recovery (98.2 ± 4.53% for zinc and 101.4 ± 5.46% for boron). Our results showed significantly decreased serum levels of both zinc and boron in the DM group compared to the C group (P = 0.001), suggesting a possible link between trace element dysregulation and DM pathogenesis. The DM group showed a statistically significant increase in TOS (P = 0.006); and a decrease in TAS (P = 0.001) compared to the C group. Assessment of oxidative stress parameters demonstrated an imbalance in oxidative stress homeostasis in diabetic rats, further implicating the role of trace elements in DM‑associated complications. Conclusion: These findings contribute valuable insights into the complex interplay between trace elements and oxidative stress in DM.

Use of virtual simulation as a tool in surgical training: Survey of surgeons in South‑Eastern Nigeria

OR Okwesili — 2025-04-08

Background: Surgical training in developing climes is predominantly based on the apprenticeship model. The number of surgical residents has increased worldwide. Surgical residents now have limited clinical exposure and decreased operation opportunities. This challenge is overcome by the incorporation of simulation models in surgical training. It is necessary to evaluate the extent of utilization of simulation‑based surgical training in this digital era. Aim: The objective of this study was to evaluate the knowledge and exposure to use of simulation-based surgical training among surgeons in Southeastern Nigeria. Methods: The study was conducted among surgical residents and consultants in three teaching Hospitals in South‑eastern Nigeria. It was a descriptive cross‑sectional survey, and the calculated sample size was 213. A survey questionnaire was administered to 216 respondents, and data collected were analysed. Results: The majority of the respondents (75.9%) were males, and 52.3% of them were between 31 and 40 years. The respondents that have heard about any simulation‑based training were 85.2%, and the most known modality of simulation was synthetic simulators (37.04%), followed by animal‑derived simulators (26.45%) and cadaver‑derived simulators (23.81%). The majority of the respondents (53.7%) said that simulation was not used routinely in surgical training in Nigeria, but only used during workshops, courses, and conferences (56.1%). Only 27 respondents were aware of any hospital where virtual simulation was used in training. The lack of relevant equipment and its high cost were the major limitations of using simulation in surgical training. Conclusion: Virtual simulation is not readily available for surgical training in Nigeria mainly because it is expensive to procure. Other forms of simulation are used for training residents, but they are not used routinely.