Can clomiphene citrate resistance be predicted by RDW-CV levels in infertile women with PCOS? Nurullah Peker, Serhat Ege, Muhammet Hanifi Bademkiran, Edip Aydin, Talip Karacor, Mehmet Obut, Esref Arac, Elif Agacayak, Talip Gul Nigerian Journal of Clinical Practice 2019 22(11):1463-1466 Objective: To identify whether red blood cell distribution width coefficient of variation (RDW-CV) and mean platelet volume (MPV) levels can predict clomiphene citrate resistance (CC-R) in infertile, anovulatory females with polycystic ovarian syndrome (PCOS). Methods: A total of 89 infertile patients who were admitted to a tertiary center diagnosed with non-obese PCOS were included in this study. The patients were divided into two groups: the first group comprised 53 non-obese patients with PCOS and CC-R, and the second group included 36 non-obese patients with PCOS and CC-S. RDW-CV, RDW-SD, and MPV values, along with routine whole blood count parameters were compared between the groups. Results: RDW-CV values were found to be significantly higher in the patients with CC-R compared to those with CC-S (P < 0.05). The sensitivity, specificity, positive, and negative predictive values were found to be 69%, 58.1%, 34.5%, and 12.5%, respectively, at an RDW-CV level of 12.85. The odds ratio was calculated as 3.077 (95% CI 1.245–7.603) in terms of the cut-off point. Conclusion: We think that RDW-CV which is a marker of inflammation is a simple, cheap, and accessible marker for the prediction of CC resistance.

Assessment of internet usage for health-related information among clients utilizing primary health care services NC Bilgin, MT Kesgin, S Gucuk, B Ak Nigerian Journal of Clinical Practice 2019 22(11):1467-1474 Objective: This study aimed to identify the frequency and goals of Internet usage to access health-related information among primary health care service clients. Methods: The study was conducted in a primary health care centre with a sample of 788 adults. The data were collected through a questionnaire developed by the researchers. Results: The results showed that 81% (n = 640) of the participants used the Internet. All Internet user participants reported that they used the Internet to access health-related information. Of the participants, 67% reported that they used the Internet primarily to obtain information about diseases with 94% reporting that they found the online information reliable and 92% reported that they did not confirm the information they obtained online. The frequency of Internet use to obtain health-related information increased with increase in the level of education of participants. Participants with higher education found the online information to be more reliable and comprehensible. The results showed that while the use of Internet to obtain health-related information was high, the information presented online was not always checked for accuracy. Conclusion: Hence, provision of current and evidence-based information on health-related websites is crucial to preserve community health care.

Evaluation of shear bond strength of zirconia-based monolithic CAD-CAM materials to resin cement after different surface treatments B Altan, S Cinar, B Tuncelli Nigerian Journal of Clinical Practice 2019 22(11):1475-1482 Objective: To compare the shear bond strength of resin cement to zirconia-based monolithic CAD-CAM materials subjected to different surface treatments. Methods: 2 brands of monolithic zirconia blocks (Vita YZ HT, Sirona inCoris TZI), yttrium-stabilized tetragonal zirconia (IPS e.max ZirCAD) and zirconia-reinforced lithium silicate ceramic (Vita Suprinity) were divided into six groups according to the surface treatment received: no treatment (control), HF acid etching, sandblasting, sandblasting + Er:YAG laser irradiation, Er:YAG laser irradiation and CoJet. Composite resin cylinders were bonded to blocks with self-adhesive resin cement (Theracem). Shear bond strength was evaluated after thermocyling. Failure modes were examined using SEM. Data was analyzed statistically by using 2-way ANOVA and post-hoc Tukey's test (P < 0,05). Results: The bond strength was significantly affected by the surface treatment and the type of CAD-CAM blocks (P < 0,001). Surface treatment with CoJet revealed significantly higher bond strength compared to sandblasting in Y-TZP and monolithic zirconia specimens. Conclusions: Monolithic zirconia blocks showed higher bond strength values compared to Y-TZP zirconia block in sandblasting and CoJet groups. HF acid etching is more effective than sandblasting and CoJet for Vita Suprinity.

Sonographic gastric content evaluation in patients undergoing cataract surgery A Kaydu, E Gokcek Nigerian Journal of Clinical Practice 2019 22(11):1483-1488 Background: Perioperative pulmonary aspiration of gastric contents is a serious complication and causes mortality and morbidity. The study aimed to assess the gastric content of patients undergoing cataract surgery by performing bedside ultrasonography. The secondary aim was to conduct a survey of hospital staff about fasting for cataract surgery. Subjects and Methods: This single-center, cross-sectional study included 65 patients who underwent cataract surgery. The quantitative and qualitative measurements of the gastric content and antral area were performed by gastric ultrasonography in the right lateral decubitus position. The incidence of risk to the stomach was defined according to different threshold levels: content >0.8 ml/kg and 1.5 ml/kg and cross-sectional antral area >340 mm2. A questionnaire was provided to anesthesiologists and ophthalmologists about fasting for cataract surgery. Results: The mean age was 69.48 ± 11.10 years. The mean gastric antrum cross-sectional area (CSA) was 11.08 ± 6.42 cm2. The predicted gastric volume was 103.39 ± 94.79 ml and 1.37 ± 1.20 ml/kg. The antral area CSA and gastric volume/kg decreased as the fasting time increased. About 98.5% of the patients exceeded the high-risk stomach antral cut-off CSA defined as 340 mm2. Gastric content exceeded 0.8 ml/kg in 58.33% of patients and exceeded 1.5 ml/kg in 41.67% of patients. Gastric content in patients was found to be 65.0% solid, 20.0% liquid, and 15.0% empty. All seven ophthalmologists did not apply fasting protocols for cataract surgery. Conclusion: Point of care ultrasonography is a useful, noninvasive tool in determining gastric content and volume. As majority of the patients presented with a full stomach for cataract surgery, we recommend that ophthalmologists and anesthesiologists follow preoperative fasting guidelines for cataract surgery.

A comprehensive survey of natal and neonatal teeth in newborns G Bulut, H Bulut, R Ortac Nigerian Journal of Clinical Practice 2019 22(11):1489-1494 Objective: To evaluate clinical and histological characteristics and determine the incidence of natal/neonatal teeth in a large Turkish population. Subjects and Methods: Among 17,829 newborns, who were hospitalized at the Neonatal Clinic of a governmental Children's Hospital between 2005 and 2011, 27 neonates were diagnosed with erupted teeth, which were examined in terms of location, clinical appearance and mobility. Besides histological evaluation, a positive family history was also recorded. The variables were analyzed using Chi-square test. Results: Thirty-two natal/neonatal teeth were observed in 27 infants. The incidence of both natal and neonatal teeth was found to be 1:660, while the incidences were separately recorded as 1:1,048 and 1:1,782, respectively. The histological examination revealed a thin hypoplastic enamel layer and a normal dentin layer. There was no difference between the two genders in terms of natal/neonatal tooth type, positive family history and tooth morphology (p > 0.05); or between normal and conical shapes with regard to natal/neonatal tooth type, positive family history and tooth color (p > 0.05). Conclusions: This study exhibited a higher incidence in natal teeth than neonatal teeth. Macroscopic features were not found to be positively related to gender and tooth type.

Evaluation of the fissure sealants applied to erupting permanent molars in accordance to eruption stages: A prospective study BG Topal, Z Kirzioglu Nigerian Journal of Clinical Practice 2019 22(11):1495-1502 Background: The aim of this study is to evaluate the clinical success of different fissure sealants applied to erupting permanent first molars by taking into consideration the stages of tooth eruption. Materials and Methods: Two hundred healthy children between ages 5 and 8 with the inclusion criteria were examined. The erupting permanent first molars were evaluated and those at stage 3 or 4 were selected. An investigator placed three different fissure sealants (giomer, hydrophilic, and hydrophobic resin-based). At the end of 18 months, retention loss, development of new dental caries, localization of retention losses, marginal integrity, and marginal discoloration were evaluated. Results: The rate of tooth with total retention at stage 3 was significantly higher (P < 0.05). The development of dental caries in teeth at stage 4 was found to be significantly higher than that of stage 3 (P < 0.05). In terms of marginal integrity, the difference between stages of tooth eruption is similar (P > 0.05). Regarding marginal discoloration, fissure sealants applied at stage 3 were considered to be more successful than those applied at stage 4 (P < 0.05). Conclusions: We may conclude that the tooth eruption affects clinical success and giomer-based fissure sealants may not be an alternative for resin-based fissure sealants in erupting teeth.

First impression of teeth design on others: A facial and personality analysis in the Central Indian population N Bhat, SS Mantri, GV Iliev, FA Qahtani, S Godbole, SP Mantri, AS Bal Nigerian Journal of Clinical Practice 2019 22(11):1503-1508 Background: Facial features and personality types vary with different geographical boundaries, culture, and ethnicity. The impression created by teeth design differs with the face and personality of males and females. Aims: This study evaluated the dominant facial and personality types and their correlation among males and females in Central Indian population. Subjects and Methods: The full-face photographs of 120 people, with a broad smile and visible dentition, were calibrated to generate a facial map with digital software. The participants filled a personality questionnaire. Facial form and personality type were classified as a combination of strong, dynamic, delicate, and calm. Descriptive and inferential statistics using Chi-square and Kappa tests. Results: The dominant facial form was calm (66.67%, 71.67%) with the second dominant facial form being dynamic (50%, 51.67%) both for males and females respectively. While the dominant personality type was dynamic (50%), the second dominant personality type was calm (35%, 30%) for both males and females. Kappa analysis showed moderate agreement between the dominant facial and personality types (P = 0.41 in males, P = 0.10 in females). The software used was SPSS 22.0 version and P < 0.05 is considered as the level of significance. Conclusions: A varying number of combinations are essential in characterizing the face. The personality type has a predominance of one type over other. The interpretation of these combinations in dentistry can help to select appropriate tooth forms and design a harmonious smile.

Voluntary non-remunerated blood donation: Awareness, perception, and attitude among potential blood donors in Abakaliki, Nigeria NI Ugwu, WJ O Oti, CN Ugwu, CJ Uneke Nigerian Journal of Clinical Practice 2019 22(11):1509-1515 Background: Blood is the most donated tissue in medical practice and a veritable tool in many life-saving situations if used appropriately and judiciously. Despite the increased demand for blood, the supply of safe blood has been inadequate. Objective: The aim of this study is to determine the perception and attitude toward voluntary non-remunerated blood donation among medical students in Abakaliki. Subjects and Methods: This was a cross-sectional study carried out at Federal Teaching Hospital, Abakaliki, between October 2017 and March 2018. Stratified and simple random sampling technique was used to recruit participants from among medical students using pretested, semi-structured, self-administered questionnaire. Data were analyzed using SPSS software version 20. Results: A total of 158 medical students who participated in the study were made up of 90 (57%) males and 68 (43%) females. The most prevalent age group was 20–25 years. Most of the participants, 151 (95.6%), were single. The proportion of the participants who had good knowledge about voluntary blood donation was 72.8%, while the attitudes of the respondents were positive to most aspects of blood donation considered. However, participants were found to have poor practice of voluntary blood donation as only 56 of 158 (35.4%) had ever donated blood. Conclusion: The majority of the participants have good knowledge and positive attitude toward voluntary non-remunerated blood donation. However, their practice of voluntary blood donation was poor. Sustained awareness creation and enlightenment is relevant to influence the masses to have better knowledge and positive attitudes toward voluntary non-remunerated blood donation with improved blood donation practices.

Assessment of a free maternal and child health program and the prospects for program re-activation and scale-up using a new health fund in Nigeria O Onwujekwe, F Obi, H Ichoku, N Ezumah, C Okeke, U Ezenwaka, B Uzochukwu, H Wang Nigerian Journal of Clinical Practice 2019 22(11):1516-1529 Background: A Free Maternal and Child Health program (FMCHP) was implemented in 12 states in Nigeria by the National Health Insurance Scheme (NHIS), between 2009 and 2015, using funds from the debt relief gains. It was called the Millennium Development Goals (MDGs) NHIS-MDG FMCHP. The program ended with the termination of the MDG in 2015. With the creation of the Basic Health Care Provision Fund (BHCPF) in Nigeria, this study sought to examine the past implementation experiences of the NHIS-MCH project with a view to identifying the enabling and constraining factors to program implementation, and the opportunities for adaptation and program scale-up in Nigeria using the BHCPF. Methods: The study was undertaken in the Federal Capital Territory, Abuja, and involved review of relevant documents and in-depth interviews with 21 key informants. The program was assessed in themes from the conceptual framework. Interviews were transcribed and analyzed using thematic analysis. Results: The program enrolled about 1.5 million pregnant women and children during the period of implementation in the country. The respondents perceived the program as pro-poor, efficient, and effective, and led to marked improvement in the functionality of the facilities, availability of services and reduced out-of-pocket expenditure, which led to increased demand and utilization of MCH services. There was inadequate stakeholder consultation, alleged corrupt practices, challenges with registration, issues with counterpart funding and public financing management issues identified. Most respondents supported the idea of using the new fund (BHCPF) to revitalize/scale-up the Free MCH program. Conclusion: This study highlights the key lessons and implementation challenges identified by the respondents. The NHIS-MDG FMCHP had positive impact on the target population though it was not sustained following the conclusion of the MDG program. The findings will inform policy decisions about the appropriateness of sustaining the program and the feasibility of extending healthcare coverage using the proposed BHCPF. The new fund (BHCPF) can be used to reactivate and scale-up the Free MCH program, but the current level of funding will not assure universal health coverage for the target beneficiaries as realized from the costing aspect of this study.

Post-orthodontic cephalometric variations in bimaxillary protrusion cases managed by premolar extraction – A retrospective study ND Alqahtani, R Alshammari, K Almoammar, N Almosa, A Almahdy, SF Albarakati Nigerian Journal of Clinical Practice 2019 22(11):1530-1538 Background: Bimaxillary protrusion is a common dentofacial condition associated with proclination of maxillary and mandibular incisors in relation to the dental and cranial bases resulting in soft tissue procumbency. The present retrospective study aimed to investigate dental and soft tissue profile changes using cephalometric analysis to evaluate bimaxillary protrusion patients after extraction of the first four premolars and subsequent retraction of the anterior teeth. Materials and Methods: Pre-treatment and post-treatment cephalometric radiographs of 46 Saudi patients (16 males and 30 females), 18-30 years of age with bimaxillary protrusion, were selected based on inclusion criteria. Dental and soft tissue landmarks were traced using the Dolphin® imaging software and statistically analyzed with SPSS® 21 software. Results: The upper and lower incisors retroclined by a mean value of 9.6° and 9.65°, respectively, and an average distance of 4.1 mm. The level of maxillary incisor exposure was reduced by approximately 1.1 mm after treatment. A mean increase of 6.6° in the nasolabial angle was also observed. Multiple regression analysis showed that retraction of both upper and lower incisors by 1 mm would result in a 0.44 mm retraction of the upper and lower lips. Conclusion: A statistically significant increase in the nasolabial angle and upper lip length was found in relation to upper and lower incisor retraction and retroclination. A significant reduction was also evident in the post treatment upper incisor exposure, facial convexity angle and mentolabial sulcus depth.