Background: The job demands of some of the industries have been reported to be hazardous to the health and safety of workers. Workplace environmental hazards or occupational hazards are a globally major cause of disability and mortality among the working population. The present study was done to analyze the effect of exposure to metal dust on pulmonary function and respiratory symptoms. Materials and Methods: The study population selected as cases were 200 male mill workers working for at least 1-year duration (direct exposure) in the age group of 20–50 years, and controls were 200 age- and gender-matched male participants without any history of occupational or environmental exposure. A complete history was taken. Spirometry was done. Spirometric parameters studied were forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), ratio of FEV1 and FVC, and peak expiratory flow rate (PEFR). The spirometry data and baseline characteristics of the participants were compared using unpaired t-test. Results: The mean age of the participants of the study group and the control group was 42.3 years and 44.1 years, respectively. The majority of the study population belonged to the age group of 41–50 years. The mean FEV1 value among participants of the study group and control group was 2.69 and 2.13, respectively. The mean FVC value among participants of the study group and control group was 3.18 and 3.63, respectively. The mean FEV1/FVC value among participants of the study group and control group was 84.59% and 86.22%, respectively. The mean PEFR value among the study group and control group was 7.78 and 8.67, respectively. While analyzing statistically, mean lung functional tests were significantly lowered among the study group. About 69.5% of the participants of the study group thought it to be essential for making safety measures a necessity. Conclusion: The present study concluded that mean lung functional tests were significantly lowered among the study group. Despite the use of face mask, lung function abnormality was present in mill workers.

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Obesity and metabolic syndrome (MetS) are commonly observed in patients with epilepsy (PWE). Obesity and MetS are not only affecting the physical fitness and quality of life of these patients, rather antiepileptic drugs (AEDs) compliance and seizure control have also been affected. The objective of this review is to search the published literature regarding the prevalence of obesity and MetS in PWE and their relation to the response to AEDs. A comprehensive search using PubMed, Cochrane Databases, and Google Scholar was performed. A supplementary citation search was also conducted by analyzing the reference lists of identified sources. The initial search revealed 364 articles of potential relevance. The studies were analyzed in detail to obtain clinical information relevant to the objectives of the review. Many observational, case control studies, randomized control trials and few review articles were included for critical appraisal and review writing. Epilepsy is associated with MetS and obesity in all age groups. AEDs and lack of exercise are the chief causes while metabolic disturbances such as adiponectin, mitochondrial dysfunction, valproic acid (VPA)-associated insulin resistance, leptin deficiency, and endocrine dysfunction are also addressable factors. Although the risk of drug-resistant epilepsy (DRE) is also higher among obese PWE, the interaction between, MetS, and its components with DRE remain to be fully investigated. Further research is required to elucidate their interplay. Appropriate and careful selection of AEDs without compromising therapeutic efficacy supplemented by lifestyle counseling for exercise and diet should be practiced to avoid weight gain and potential DRE.

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Background: Periodontitis is the sixth most prevalent chronic disease. Literature suggests a relationship between diabetes and periodontitis and when coexist may aggravate each other deleterious consequences. Therefore, we aimed to assess the effects of periodontitis treatment on glycemic control. Materials and Methods: A systematic literature search was conducted in PubMed, Cochrane Library, and the first 100 articles in Google Scholar from January 2011 to October 2021. The terms periodontitis, periodontal treatment, diabetes mellitus, nonsurgical treatment, glycated hemoglobin (HbA1c) were used, with the Protean “AND” and “OR.” The titles, abstracts, and references of the included studies were screened. Any discrepancy was solved by an agreement between researchers. Out of 1059 studies retrieved, 320 stands after the removal of duplication, from them, 31 full texts were screened and only 11 studies were included in the final meta-analysis. Results: In the present meta-analysis, 11 studies (1469 patients included) were pooled, and the overall effect showed that periodontitis treatment improved the HbA1c, odd ratio, −0.024, 95% confidence interval, −0.42−.06, P value, 0.009, Chi-square, 52.99. However, substantial heterogeneity was observed, P value, < 0.001, I² for heterogeneity 81%. Conclusion: Periodontitis treatment improved the HbA1c among patients with diabetes and poor glycemic control. Screening of this common disease is important in diabetes holistic care.

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Context: Peritoneal adhesions unlike other immediately recognizable complications of the surgery may produce long-term consequences, which include infertility and intestinal obstruction. Aims: The study aimed to determine the prevalence, the determinants, and the outcomes of laparoscopic surgery associated with intraperitoneal adhesion findings. Settings and Design: This was a retrospective observational study. Materials and Methods: The study included all laparoscopic gynecological surgeries done between January 2017 and December 2021. Adhesion severity was graded, using the peritoneal adhesion index (PAI), by Coccolini et al. Statistical Analysis: The data were analyzed using the SPSS version 21.0. Binary logistic regression was used to assess the factors associated with adhesion finding during laparoscopy. Results: There were 158 laparoscopic surgeries with 26.6% prevalence of peritoneal adhesions. The prevalence of adhesions among women with previous surgery was 72.7%. Previous peritoneal surgery was a significant determinant of occurrence of adhesions (odds ratio = 8.291, 95% confidence interval [CI] = 4.464–15.397, P < 0.001), and such patients had significantly (P = 0.025, 95% CI = 0.408–5.704) more severe adhesions (PAI = 11.16 ± 3.94) than those without prior surgery (PAI = 8.10 ± 3.14). Abdominal myomectomy (PAI = 13.09 ± 2.95) was the most important primary surgical determinant of adhesion formation. There was no significant relationship between adhesion occurrence and conversion to laparotomy (P = 0.121) or mean duration of surgery (P = 0.962). Greater adhesion severity was, however, observed in individuals with operative blood loss <100 ml (PAI = 11.73 ± 3.56, P = 0.003) and those hospitalized for ≤2 days (PAI = 11.12 ± 3.81, P = 0.022). Conclusion: The prevalence of postoperative adhesions during laparoscopy in our center is comparable to what has been earlier reported. Abdominal myomectomy is associated with the greatest risk and severity of adhesions. Laparoscopy in patients with more severe adhesions resulted in less blood loss and shorter duration of hospitalization, suggesting an association of better outcomes with a cautious approach to adhesions.

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Fixed flexion deformity may accompany severe knee osteoarthritis in patients with long-standing pathology. This makes it difficult to achieve complete knee extension intraoperatively during total knee replacement surgery. Various options of treatment are available including preoperative serial knee extension and casting, intraoperative additional distal femoral resection to increase extension gap, and extensive soft tissue releases. We present this technique of on-table percutaneous medial hamstring tenotomy that we found helpful in achieving complete or near-complete knee extension intraoperatively, thereby minimizing the need for extensive bone resection and soft tissue dissection. An M is a 78-year-old man who presented with inability to walk for a 2-year duration due to pain and deformity of both knees. Complete clinical evaluation revealed the diagnosis of bilateral severe knee osteoarthritis with fixed flexion deformities. Ranges of knee motion were 90°–120° on the right and 80°–125° on the left. On-table percutaneous medial hamstring tenotomy + extension exercise under spinal anesthesia was carried out first and subsequently had posterior stabilized semi-constrained knee replacement. Knee extensions of 160° and 180° were achieved preoperatively after tenotomy and exercise and intraoperatively following distal cuts and soft tissue releases, respectively. This technique may be additive to various attempts at achieving adequate knee extension preoperatively for successful knee replacement. May be further evaluated to assess its effectiveness or otherwise to selected patients with severe flexion contractures undergoing primary total knee replacement.

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Context: After thirty years of ratifying the child rights convention and nineteen years of the Child Rights Act, implementing child rights instruments remains challenging in Nigeria. Healthcare providers are well positioned to change the current paradigm. Aim: To examine the knowledge, perception, and practice of child rights and the influence of demographics among Nigerian doctors and nurses. Materials and Methods: A descriptive, cross-sectional online survey was done using nonprobability sampling. Pretested multiple-choice questionnaire was disseminated across Nigeria's six geopolitical zones. Performance was measured on the frequency and ratio scales. Mean scores were compared with 50% and 75% thresholds. Results: A total of 821 practitioners were analyzed (doctors, 49.8%; nurses, 50.2%). Female-to-male ratio was 2:1 (doctors, 1.2:1; nurses, 3.6:1). Overall, knowledge score was 45.1%; both groups of health workers had similar scores. Most knowledgeable were holders of fellowship qualification (53.2%, P = 0.000) and pediatric practitioners (50.6%, P = 0.000). Perception score was 58.4% overall, and performances were also similar in both groups; females and southerners performed better (59.2%, P = 0.014 and 59.6%, P = 0.000, respectively). Practice score was 67.0% overall; nurses performed better (68.3% vs. 65.6%, P = 0.005) and postbasic nurses had the best score (70.9%, P = 0.000). Conclusions: Overall, our respondents' knowledge of child rights was poor. Their performances in perception and practice were good but not sufficient. Even though our findings may not apply to all health workers in Nigeria, we believe teaching child rights at various levels of medical and nursing education will be beneficial. Stakeholder engagements involving medical practitioners are crucial.

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Background: Preeclampsia poses a significant risk of maternal and neonatal morbidity and mortality. Magnesium sulfate superiority for seizure prophylaxis in severe preeclampsia has been proven globally. However, the search for the lowest effective dose is an area of continuing research. Aim: The aim of this study was to compare the effectiveness of loading dose with the Pritchard regimen of magnesium sulfate for seizure prophylaxis in severe preeclampsia. Materials and Methods: A total of 138 eligible women after 28-week gestation with severe preeclampsia were randomized to either receiving a single loading dose of MgSO₄ (study arm: n = 69) or Pritchard regimen of MgSO₄ (control: n = 69). The effectiveness was assessed by the development of seizure. The results obtained were analyzed using SPSS version 21. Categorical variables were analyzed using the Chi-square test and normally distributed continuous variables were analyzed with t-test and Fisher's exact test. P < 0.05 was considered statistical significance. Results: There were no significant differences between those who received only the loading dose when compared with those who had Pritchard regimen other than a single recorded convulsion among the control group (P = 0.316). Similarly, except for the duration of hospital stay which was significantly longer in the Pritchard group (P = 0.019), both the arms of the study shared similar maternal and fetal outcomes. Conclusion: This study suggests the effectiveness of just the loading dose of magnesium sulfate when compared with the standardized Pritchard regimen in the prevention of seizure among women with severe preeclampsia. The study also demonstrated safety and similarity in fetal-maternal outcome. The loading dose only had an added advantage of shorter duration of hospital stay.

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Background: This study aims to evaluate the use of haematological indices and coagulation profiles as possible low-cost predictors of disease severity and their associations with clinical outcomes in COVID-19-hospitalized patients in Nigeria. Materials and Methods: We carried out a hospital-based descriptive 3-month observational longitudinal study of 58 COVID-19-positive adult patients admitted at the Lagos University Teaching Hospital, Lagos, Nigeria. We used a structured questionnaire to obtain the participants' relevant sociodemographic and clinical data, including disease severity. Basic haematologic indices, their derivatives, and coagulation profile were obtained from patients' blood samples. Receiver Operating Characteristic (ROC) analysis was used to compare these laboratory-based values with disease severity. A P < 0.05 was considered statistically significant. Results: The mean age of the patients was 54.4 ± 14.8 years. More than half of the participants were males (55.2%, n = 32) and most had at least one comorbidity (79.3%, n = 46). Significantly higher absolute neutrophil count (ANC), neutrophil–lymphocyte ratio (NLR), systemic immune-inflammation index (SII), lower absolute lymphocyte count (ALC) and lymphocyte–monocyte ratio (LMR) were associated with severe disease (P < 0.05). Patients' hemoglobin concentration (P = 0.04), packed cell volume (P < 0.001), and mean cell hemoglobin concentration (P = 0.03) were also significantly associated with outcome. Receiver operating characteristic (ROC) analysis of disease severity was significant for the ANC, ALC, NLR, LMR, and SII. The coagulation profile did not show any significant associations with disease severity and outcomes in this study. Conclusion: Our findings identified haematological indices as possible low-cost predictors of disease severity in COVID-19 in Nigeria.

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Context: Tuberculosis (TB) treatment support is one of the recommended strategies to enhance treatment adherence and outcomes. Treatment supporters are at risk of contracting TB and adequate knowledge of TB and good preventive practices are required for their protection. Aims: This study aimed at assessing the knowledge and preventive practices of TB treatment supporters at Directly Observed Treatment Short-course (DOTS) centers in Lagos Mainland Local Government Area of Lagos state, Nigeria. Settings and Design: This cross-sectional study was conducted among 196 TB treatment supporters selected from five DOTS centers in Lagos. Methods: Data were obtained using an adapted pretested questionnaire. Statistical Analysis Used: Bivariate and multivariate analyses were performed to determine the factors associated with self-protection practices. A P < 0.05 was considered statistically significant. Results: The mean age of the participants was 37.3 ± 12.1 years. More than half of the respondents were females (59.2%) and immediate family members (61.3%). Overall, 22.5% had good knowledge of TB, while 53.0% had positive attitudes toward TB. Only 26.0% adequately protected themselves from infection. The caregiver's level of education (P = 0.001) and their relationship to the patient (P = 0.001) were significantly associated with good preventive practices in bivariate analysis. Not being related to the patient was a predictor of adequate TB prevention practices (adjusted odds ratio = 2.852; P = 0.006; 95% confidence interval = 1.360–5.984). Conclusions: This study revealed low levels of TB knowledge and fair preventive practices, especially among caregivers who are relatives. There is, therefore, a need to improve population literacy about TB and its prevention and a more focused orientation of relatives who volunteer as treatment supporters, through health education, with periodic monitoring during clinic visits, of how they prevent TB.

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Background: Thyroid gland diseases are a common health problem worldwide. Increase of thyroid gland hormones can cause numerous conditions that range from mild cases to life-threatening diseases. Hyperthyroidism is not a common risk factor for venous thrombosis (VT), many studies found a relation between hyperthyroidism and thromboembolism. Objectives: We sought to detect any changes in thyroid-stimulating hormone (TSH), and free T4 value associated with the occurrence of Deep vein thrombosis (DVT), pulmonary embolism (PE), and cerebral VT. Methodology: An observational retrospective review of outpatients' records in King Abdulaziz Medical City in Riyadh from January 2018 to March 2020 includes all patients with hyperthyroidism, patients who are bedridden, recent surgeries, and those on oral contraceptives pills or on anticoagulants were excluded from the study. All symptomatic VT cases are objectively confirmed. Results: Three hundred patients were recognized, of whom most were female (80%), whereas (20%) were male, mean age in identified patients was (42.3 ± 14.5 years; range, 18–80 years). Of all patients, 3 (1%) patients had DVTs, equally 3 (1%) patients had PE, and 2 (0.7%) patients had cerebral embolism. TSH level has a significant association with the overall risk of DVT, PE, and cerebral embolism. In the FT₄ level, there was a significant association with the risk of DVT and PE but not with cerebral embolism. Conclusions: The literature indicates a significantly associated between the development of VT and hyperthyroidism. Furthermore, the data support that hyperthyroidism is considered an additional risk factor for VT.

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Background: Oral health-related quality of life (OHRQoL) is used for evaluating needs of people, their health problems, their level of satisfaction, and various effects of any intervention which have been provided for recording of various nonclinical aspects of oral health. Aim: The objective of the study was to compare OHRQoL and its association with periodontal health among adult population. Materials and Methods: This prospective and cross-sectional study was conducted on 300 respondents who were diagnosed with periodontitis. 14-item containing Oral Health Impact Profile 14 (OHIP-14) questionnaire was used for study analysis. A single observer made clinical examinations. Mann–Whitney “U” and Kruskal–Wallis statistical tests were used for comparing the OHIP-14 scores. Statistically significance was set at P < 0.05. Results: Majority of study participants were of female gender (62.0%). A significant association was observed between loss of attachment and OHIP14 scores (P = 0.003). Conclusion: Poor periodontal health may affect the OHRQoL.

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She was born at 28 weeks of gestation and weighed 800g. Following delivery, her mother suffered wound dehiscence and was re-admitted for a prolonged period. For the care of the little baby, the father had preferred a public health facility where the cost is less prohibitive. Incidentally, Nigerian resident doctors were 23 days into a nationwide industrial action at the time; health workers were on strike during the two previous births. With no one available to help out with household chores, the father alone combined the care of two children and the logistics of two hospitals. Having to pay hospital bills out of pocket, the financial burden became unbearable, and the baby's siblings soon dropped out of school. Though the prolonged stay in the hospitals eventually ended on a happy note, it came at a huge social and economic cost that may linger for some time.

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A 37-year-old Nigerian woman presented with an itchy and occasionally painful scar that appeared after the healing of an acne lesion over the left parotid region, 13 years ago. She noticed a progressive increase; however, there was no history of facial weakness. Examination revealed a keloid lesion overlying a firm nontender mass. Ultrasound scan and fine-needle aspiration cytology indicated a benign tumor of the left parotid. Superficial parotidectomy was performed, and the histology revealed a keloid overlying a pleomorphic adenoma. This is an unusual presentation of keloid which developed over a pleomorphic adenoma. Hence, we report the above case for its rarity.

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Background: This study aimed at evaluating the clinico-etiological profile of altered mental status (AMS) among elderly patients and making recommendations regarding management based on etiologies, thereby improving both morbidity and mortality outcomes. Materials and Methods: This retrospective observational study was conducted in a teaching cum tertiary care hospital. Two years data (from July 2017 to June 2019) were extracted from the medical records section, and 172 eligible participants were analyzed using descriptive statistics for clinical outcomes, demographic profiles, and various etiological factors. Results: A total of 1784 elderly inpatients (age >60 years) were screened from the records, and 172 eligible elderly AMS patients were found eligible for the study. The male elderly population consisted of 110 (63.95%), and the female elderly was 62 (36.04%). The mean age of the study population was 67.82 years. The etiological factors of AMS in the study population were neurological – 47.09% (n = 81), infection – 30.23% (n = 52), metabolic/endocrine – 16.27% (n = 28), pulmonary – 2.32% (n = 4), fall – 1.74% (n = 3), toxic cause – 1.16% (n = 2), and psychiatric illness – 1.16% (n = 2). The total mortality rate was 9.30% (n = 16). Conclusion: The main etiological factors of AMS in the elderly population were predominantly of neurological, septic, and metabolic causes. These factors were preventable and treatable by training physicians, staff (as most of the physicians in the developing countries are not trained in managing this fragile group of population with multiple comorbidities), and by decentralizing geriatrics health-care setups.

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Introduction: COVID-19 infection has a myriad of presentation. Rural India and other developing nations are relatively resource poor, not having access to modern specialized investigations. In this study, we tried to evaluate only biochemical parameters in predicting the severity of the infection. The aim of this study was to find a cost-effective means to predict the clinical course at the time of admission and thereby to reduce mortality and, if possible, morbidity by timely intervention. Materials and Methods: All COVID-19-positive cases admitted at our hospital from March 21 to December 31, 2020, were recruited in this study. The same acted as sham control at recovery. Results: We observed a significant difference in biochemical parameters at the time of admission and discharge, between mild/moderate disease and severe disease. We found slightly deranged liver function tests at admission, which becomes normal at the time of discharge. Urea, C-reactive protein (CRP), procalcitonin, lactate dehydrogenase, and ferritin concentrations in severe/critical patients were significantly higher than that in the mild/moderate group. Receiver operating characteristic curves were plotted to predict the severity on the basis of biochemical parameters independently, of the patients based on these values. Conclusion: We proposed cutoff values of certain biochemical parameters, which will help in judging the severity of the infection at admission. We developed a predictive model with a significant predictive capability for CRP and ferritin values, using normal available biochemical parameters, routinely done in resource-poor centers. Clinicians working in resource-poor situations will be benefitted by having an idea of the severity of the disease. Timely intervention will reduce mortality and severe morbidity.

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Introduction: Gender differences exist in the demographic, clinical characteristic and outcome of patients with cardiac and vascular surgery (CVS) associated acute kidney injury (AKI). Materials and Methods: This retrospective study had a total of 88 participants for which socio-demographic, clinical and laboratory (serum electrolyte, full blood count, urine analysis and urine volume, creatinine, and glomerular filtration rate) data of participants were taken preoperative and postoperative days 1, 7, and 30. Results: A total of 88 (66 males and 22 females) participants were studied. Diseases of the heart valves were more common in females than males. The mean age of the participants was 65.9 ± 6.9 years, with males 65.1 ± 7.6 years and females 68.3 ± 8.4 years, P = 0.02. Before surgery, a significantly greater proportion of females had kidney dysfunction compared to males, P = 0.003. Valvular surgery and coronary bypass were the most common surgeries. The proportion of emergency surgeries and admissions <7 days were significantly higher in females than males, P = 0.04 and P = 0.02, respectively. Full recovering from AKI was significantly higher in males as partial recovery and death were significantly lower in them, P = 0.02. Of the 35 (39.8%) who had dialysis, 85.7% recovered fully, 5.7% became dialysis, and dependent while 8.6% died. The predictors of nonrecovery from CVS-AKI were female gender, elderly, preoperative kidney dysfunction and AKI stage 3. Conclusion: Males with AKI were younger than the females. Valvular surgeries were most common. Background kidney dysfunction and advance age were risk factors for AKI. Postoperative, AKI was commoner in males who were more likely to recover full kidney function. Optimizing patient preparation could reduce the incidence of CVS-AKI.

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