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Med Princ Pract [journal]
- Orthognathic Surgery: Pretreatment Information and Patient Satisfaction. [JOURNAL ARTICLE]
- Med Princ Pract 2014 Apr 16.:218-224.
Objectives: This study sought to (1) analyze the demographic profile of patients who completed combined orthodontic and surgical treatments at the Kuwait Ministry of Health dental clinics, (2) evaluate the source, type, amount and timing of preoperative patient information, (3) determine posttreatment patient satisfaction and (4) examine whether patient satisfaction is associated with preoperative information. Subjects and Methods: Of the 145 patients who completed combined orthodontic and surgical treatments at least 6 months prior to the initiation of this study, 74 agreed to be interviewed by telephone by means of a structured survey including questions covering the study's objectives. Results: The mean age of participants was 21.1 years; 52 (70.3%) were female and 22 (29.7%) were male. Of these 74 patients, 70 (94%) did not regret their decision to undergo orthognathic surgery and 62 (83.8%) would repeat the same treatment if it was needed. The majority of the respondents reported that the importance of treatment compliance had been explained very well prior to surgery, but that information about the associated functional and social problems was lacking. The orthodontist was the most prominent source of information before treatment began. As the presurgical orthodontic treatment phase progressed, the roles of the surgeon and orthodontist became more evenly distributed. Conclusion: The patients who underwent orthognathic surgery were satisfied and generally well informed. However, information regarding surgical risks and functional discomforts was not adequate. Participants were more likely to be satisfied when they were provided with more information about discomfort and surgical risks. © 2014 S. Karger AG, Basel.
- Transthoracic Echocardiography and 6-Minute Walk Test in Kuwaiti Sickle Cell Disease Patients. [JOURNAL ARTICLE]
- Med Princ Pract 2014 Apr 17.:212-217.
Objective: The aim of this study was to investigate cardiac abnormalities in Kuwaiti sickle cell disease (SCD) patients using markers such as tricuspid regurgitant jet velocity (TRJV), pulmonary artery systolic pressure (PASP), and the 6-minute walk (6MW) test and correlate these findings with clinical, hematological, and biochemical parameters. Materials and Methods: Seventy-three patients with SCD and 70 matched controls were studied. The cardiac status was investigated using transthoracic echocardiography in 57 patients; the 6MW test was carried out in patients and controls. Complete blood counts and hemolytic parameters were assessed. Results: Reticulocytes, bilirubin, and lactate dehydrogenase were significantly higher (p < 0.0001) in patients, while hemoglobin (Hb) and haptoglobin were lower (p < 0.0001) than in controls. The mean fetal Hb among patients was 15.85 ± 8.7%. Of the 57 patients, 14 (24.5%) and 15 (26%) had mild tricuspid and mitral regurgitation, respectively. The mean ejection fraction, TRJV, and PASP were 63.9 ± 6.3%, 1.7 ± 0.5 m/s, and 23.0 ± 7.3 mm Hg, respectively. Three (5.2%) patients had mildly raised TRJV (2.6-2.97 m/s, normal range <2.5 m/s) while 8 (14%) had high PASP (mean 35.3 ± 5.1 mm Hg, normal range <30 mm Hg). Hb, hematocrit, and reticulocytes were different (p = 0.010, p = 0.006, and p = 0.011, respectively) between patients with normal and high PASP. All 3 patients who had a high TRJV had a high PASP, and 2 of these patients died during follow-up. The systolic and diastolic blood pressure, oxygen saturation before and after the 6MW test, and distance walked were lower (p = 0.006, p = 0.000, p = 0.002, p = 0.000, and p = 0.000, respectively) in patients compared to controls. Conclusion: Raised PASP was common in Kuwaiti SCD patients while raised TRJV was not. © 2014 S. Karger AG, Basel.
- Widespread Eosinophilic Pustular Folliculitis in a Nonimmunocompromised Patient. [JOURNAL ARTICLE]
- Med Princ Pract 2014 Apr 15.
Objective: We present a case of eosinophilic pustular folliculitis, a rare dermatosis which is often associated with HIV infection or internal malignancies. Clinical Presentation and Intervention: We report the case of a 66-year-old man with a medical history of hypertension. Histopathological examination showed a dense follicular inflammatory infiltrate with abundant eosinophils. The clinical response to indomethacin was excellent with no recurrence during the follow-up. Conclusion: The patient responded well to indomethacin treatment. © 2014 S. Karger AG, Basel.
- Influence of Recurrent Electroconvulsive Therapy on Cardiac Function. [JOURNAL ARTICLE]
- Med Princ Pract 2014 Apr 16.:225-228.
Objective: To investigate the effects of recurrent electroconvulsive therapy (ECT) on cardiac function as assessed by echocardiography. Subjects and Methods: Twenty-three patients (11 males and 12 females) with different psychiatric disorders who were apparently free of any cardiovascular disorders and underwent ECT were enrolled in the study. Echocardiographic findings including diastolic mitral inflow and tissue Doppler features were recorded at baseline and at the end of the 7th and last ECT in all patients. Results: The mean age of the patients was 37.95 ± 13.28 years (range 19-71). There was no significant difference in mitral E wave velocities and tissue Doppler E' velocities between the baseline and after the 1st ECT (p = 0.161 and p = 0.083, respectively). The results were similar after the last ECT session (p = 0.463 and p = 0.310, respectively). However, there was a significant increase in transmitral A wave velocity after the 1st and 7th ECT session compared to the values at baseline (p = 0.008 and p = 0.017, respectively). Conclusion: The mitral diastolic inflow A wave velocity increased 20 min after ECT, and this increase persisted after recurrent ECT sessions. This finding could be considered as an indicator of acutely increased sympathetic tone. © 2014 S. Karger AG, Basel.
- Degrees of Kidney Disease in Nigerian Adults with Sickle-Cell Disease. [JOURNAL ARTICLE]
- Med Princ Pract 2014 Apr 16.:271-274.
Objective: To study degrees of chronic kidney disease (CKD) using creatinine clearance in adult Nigerian patients with sickle-cell disease (SCD). Methods: One hundred SCD patients, made up of 79 HbSS (homozygous haemoglobin S) patients and 21 HbSC (heterozygous haemoglobins S and C) patients, were investigated prospectively, along with 50 normal controls. Their sociodemographic data, weight and drug history were documented. Each participant underwent dipstick urinalysis, and creatinine clearance was calculated following a 24-hour urine collection and serum creatinine measurement. They were categorized into stages of CKD based on the creatinine clearance. Results: Of the 79 HbSS patients, 14 (18%), 28 (35%), 33 (42%) and 4 (5%) had stage 1, 2, 3 and 4 CKD, respectively. In the HbSC group, 3 (14%), 9 (43%) and 9 (43%) patients had stage 1, 2 and 3 CKD, respectively. Proteinuria was noted in 16 (20%) HbSS patients but not in any of the HbSC patients. Of the subjects aged ≤24 years (n = 49), 9 (18%), 18 (37%), 21 (43%) and 1 (2%) had stage 1, 2, 3 and 4 CKD, respectively. Of those aged >24 years (n = 51), 8 (16%), 19 (37%), 21 (41%) and 3 (6%) had stage 1, 2, 3 and 4 CKD, respectively. None of the subjects had stage 5 CKD. Conclusion: In this study, the adult subjects with SCD had various degrees of CKD. Adequate follow-up and active intervention are advocated to delay the onset of end-stage nephropathy. © 2014 S. Karger AG, Basel.
- The CHA2DS2-VASc Score as a Predictor of Left Atrial Thrombus in Patients with Non-Valvular Atrial Fibrillation. [JOURNAL ARTICLE]
- Med Princ Pract 2014 Apr 16.:234-238.
Objective: To investigate whether or not the CHA2DS2-VASc score predicts left atrial (LA) thrombus detected on pre-cardioversion transoesophageal echocardiography (TEE). Materials and Methods: The medical records of patients who had undergone TEE were reviewed to assess the presence of LA thrombus prior to direct-current cardioversion for atrial fibrillation (AF). The CHA2DS2-VASc score was calculated for each patient. Clinical TEE reports were reviewed for the presence of LA thrombus. Patients with a valve prosthesis or rheumatic mitral valve disease were excluded from this study. Results: A total of 309 patients were identified. The mean age was 70.1 ± 9.8 years and 151 (49%) patients were males and 158 (51%) were females. LA thrombus was seen in 32 (10.3%) of the 309 patients. Fifty (16.2%) patients had a low CHA2DS2-VASc score (0-1), 230 (74.4%) had an intermediate score (2-4) and 29 (9.4%) had a high score (5-9). The incidence of LA thrombus in the low, intermediate and high CHA2DS2-VASc score groups was 0, 4.4 and 68.7%, respectively. The LA thrombus risk increased with increasing CHA2DS2-VASc scores. On multivariate logistic analysis, the CHA2DS2-VASc score (OR 3.26, 95% CI 2.3-4.65; p = 0.001) and age (OR 0.93, 95% CI 0.88-0.98; p = 0.004) were independent risk factors for LA thrombus in patients with non-valvular AF. Conclusion: A high CHA2DS2-VASc score was independently associated with the presence of LA thrombus in patients with non-valvular AF. © 2014 S. Karger AG, Basel.
- Evaluation of the Comparative Efficacy and Safety of Artemether-Lumefantrine, Artesunate-Amodiaquine and Artesunate-Amodiaquine-Chlorpheniramine (Artemoclo™) for the Treatment of Acute Uncomplicated Malaria in Nigerian Children. [JOURNAL ARTICLE]
- Med Princ Pract 2014 Apr 8.
Objective: To evaluate the comparative efficacy and safety of artemether-lumefantrine (AL), artesunate-amodiaquine (ASAQ) and artesunate-amodiaquine-chlorpheniramine (AQC) for the treatment of acute uncomplicated malaria among Southwest Nigerian children. Subjects and Methods: One hundred and sixty children aged 6 months to 14 years with acute uncomplicated malaria were randomized to AL (n = 53), ASAQ (n = 53), or AQC (n = 54). Enrollees were seen daily on days 0-3 and then on days 7, 14, 21, 28 and 42 for clinical and parasitological evaluations. Paired samples of genomic DNA at enrolment and at the time of recurrent parasitaemia were genotyped using nested PCR to distinguish between reinfection and recrudescence. Detailed haematological and biochemical evaluations were carried out in a subset of enrollees on days 0, 7 and 28 as part of a safety evaluation. Results: Of the 160 children, 144 (90%) completed the study. The mean fever clearance times and parasite clearance times for AL, ASAQ and AQC were comparable (p = 0.94 and p = 0.122, respectively). On day 14, the adequate clinical and parasitological response (ACPR) for AL and AQC was 100% and for ASAQ it was 90% (p = 0.39). The PCR-uncorrected results on days 28 and 42 and the ACPR-corrected results on day 42 were similar for all drugs (p = 0.62 and p = 0.56, respectively). AQC resulted in the best parasite clearance and haematological recovery on day 2 (p = 0.022 and p = 0.018, respectively). Biochemical parameters were not adversely affected by the three artemisinin-based combination therapies (ACTs) and these were well tolerated. Conclusion: The three ACTs were efficacious and safe, but AQC resulted in a better haematological recovery on day 2 and higher cure rates throughout the study period. © 2014 S. Karger AG, Basel.
- Reply. The role of mean platelet volume in infective endocarditis. [Comment, Letter]
- Med Princ Pract 2014; 23(2):189-90.
- Entangled Titanium Fibre Balls Combined with Nano Strontium Hydroxyapatite in Repairing Bone Defects. [JOURNAL ARTICLE]
- Med Princ Pract 2014 Mar 28.
Objective: To investigate the effect of entangled titanium fibre balls (ETFBs) combined with nano strontium hydroxyapatite (nano-Sr-HAP) on the repair of bone defects in vivo. Materials and Methods: Twenty-four 6-month-old, specific pathogen-free, male Sprague-Dawley rats were used. Drill defects were created in bilateral femoral condyles. ETFBs combined with nano-Sr-HAP were selected randomly from 72 samples and implanted into the femoral bone defects of left legs, which served as the experimental group, while ETFBs without nano-Sr-HAP were implanted into right legs for comparison. The bone defects on both sides were X-rayed. The anteroposterior positions and histological procedures and evaluations of each sample were performed at 1, 2, 4 and 8 weeks post-surgery. Results: Histological results showed that the ETBs allowed new bone to grow within their structure. Additionally, an increase in new bone was seen on the nano-Sr-HAP side compared to the control side. The results of histomorphometric analysis confirmed that the new bone formation on the left side gradually increased with time. There was a statistical increase in new bone at 2, 4 and 8 weeks, and the differences between the two sides were statistically significant at weeks 4 and 8 (p < 0.05 for all comparisons). Conclusion: The results showed that ETFBs possess a unique 3-dimensional interconnective porous structure and have excellent biocompatibility, cell affinity and osteoconductivity, which makes them useful as scaffold materials for repairing bone defects. On the other hand, nano-Sr-HAP improved the bone defect-repairing capacity of the ETFBs, which showed osteoinductive properties. © 2014 S. Karger AG, Basel.
- Priapism in Homozygous Sickle Cell Patients: Important Clinical and Laboratory Associations. [JOURNAL ARTICLE]
- Med Princ Pract 2014 Mar 28.
Objective: To evaluate the relationship between the occurrence of priapism and important steady-state clinical and laboratory parameters in homozygous sickle cell disease (SCD). Subjects and Methods: Steady-state clinical and laboratory data were obtained from the medical records of 126 male patients seen in the clinic over a 7-year period. Estimated prevalence rates, correlation coefficients and independent t tests were calculated to assess the relationship between priapism and several important clinical and laboratory indices. Patient data on age, haemoglobin concentrations, the frequency of crises per annum, leucocyte counts, platelet counts, serum bilirubin and aspartate transaminase were evaluated. Results: The prevalence of priapism was determined to be 21.4%, and 22.2% of those affected had erectile dysfunction. There was a significant positive correlation between priapism and older age (p = 0.049) and lower leucocyte counts (p = 0.008). There was no significant relationship with other clinical or laboratory indices. Conclusion: About 1 in 4 of all homozygous older SCD patients had priapism, and an approximately similar ratio developed erectile dysfunction; they also had lower steady-state leucocyte counts. Other clinical and laboratory indicators of disease severity in SCD did not positively correlate with the occurrence of priapism, and this may imply an alternative pathogenetic mechanism. © 2014 S. Karger AG, Basel.