Dental Health Knowledge Attitude and Practice Among University of Calabar Students.

Introduction Oral health has been linked to aspects of individual knowledge, attitude, and practices. In Nigeria, the increased prevalence of poor oral hygiene has been attributed behavioral factors. Behavioral aspects that include the increased intake of sugary foods and beverages, and lack of proper oral hygiene have been touted as the main causes of poor oral hygiene among university students. The knowledge of oral health is vital owing to its contribution to better oral health; however, unless students develop good oral habits and attitudes and subsequently put them into practice, very little will be realized with regard improvement in oral health and hygiene. Objective This research aimed to explore the knowledge, attitude, and practice of dental care among the University of Calabar students. Method This study was a descriptive cross-sectional study conducted between 2016 and 2017. A standardized questionnaire was used to collect data from 430 student participants in a university using a multi-stage random technique. An inferential statistical approach was adopted to test the relationships represented in the tables. Data were analyzed using the statistical package for social sciences, version 20.0. Result The study included 430 participants, 239 (55.6%) females and 191 (44.4%) males. The survey revealed that 94% of the 404 respondents agreed that poor dental care can cause dental diseases, while only 6% disagreed. Regarding excessive drinking of water, 91% of the respondents agreed that it cannot cause dental disease, 4.2% agreed it could, and 4.8% did not know. Furthermore, 60.2% of the 430 respondents acknowledged that genetic inheritance could cause dental disease, while 21.4% disagreed, and 18.4% did not know. Finally, 74.9% of the respondents knew that trauma to the teeth could cause dental disease, while only 9.3% thought that trauma could not cause illness to the teeth. Regarding attitude to dental care, 232 (54%) respondents agreed that visiting the dentist was necessary, while 164 (38.1%) strongly agreed. Only eight (1.9%) strongly disagreed, while five (1.2%) disagreed that visiting the dentist was necessary. Moreover, 82% of the respondents agreed that bad breath was associated with poor dental care, with 195 (45.3%) respondents strongly agreeing and 158 (36.7%) agreeing. However, 37 (8.6%) disagreed, and 16 (3.7%) strongly disagreed, while 24 (5.6%) were indifferent. As regards practice, most respondents used the up-down technique when brushing their teeth (62.8%), while 17.4% brushed left-right and 19.8% used both methods. Moreover, 67.4% of the respondents brushed twice daily, 26.5% brushed once daily, and only 6.1% brushed after every meal. About half of the students spent one to three minutes brushing their teeth (50.5%), while the other half spent more time. Over half of the students replaced their toothbrushes every three months (57.7%), with the most common reason for replacement being the fraying of bristles. However, the use of dental floss was found to be low. Conclusion The utilization of dental care facilities was low among most University of Calabar students, who did not see the need for dental clinic visits unless they had dental needs. The lack of dental visits was attributed to perceived high dental costs and a lack of time. Targeted interventions and educational programs that address these barriers could promote better oral hygiene practices among the students.

The Role of Biomarkers in the Diagnosis and Prognosis of Different Stages of Melanoma.

Melanoma is a skin cancer arising from melanocytes, the cells responsible for synthesizing melanin pigment, which gives the skin its color. Early diagnosis and treatment of melanoma increase survival rates. Clinical examination and biopsy are the primary tools used to diagnose melanoma. However, distinguishing between pre-malignant melanocytic lesions and early invasive melanoma histopathologically remains challenging. Therefore, additional modalities such as a detailed clinical history, imaging, genetic testing, and biomarkers have been applied to diagnose melanoma. This review discusses the current trends in biomarker advancements over the last 10 years to assist in the early detection and diagnosis of melanoma. Biomarkers such as melanoma-associated antigens (MAAs), S100B, microRNAs (miRNAs), and circulating tumor cells (CTCs) have the potential to aid in the detection, diagnosis, and prognosis of melanoma. However, the application of biomarkers in the diagnosis of melanoma is still evolving.

Trends of Cardiovascular Interventions Stratified by Body Mass Index: An Analysis of the 2016-2020 Nationwide Inpatient Sample Population.

Background There is a scarcity of studies delineating the trends of cardiovascular interventions in the hospitalized population stratified by body mass index (BMI). Our study aimed to study the burden of cardiovascular interventions and outcomes by BMI. Methods We retrospectively analyzed the Nationwide Inpatient Sample (NIS) database between January 2016 and December 2020. We identified the population of interest using the International Classification of Diseases, Tenth Revision (ICD-10) code. We studied the BMI in five categories: "healthy weight" (HW; BMI < 19.9-24.9 kg/m2), "overweight" (OV; BMI = 25-29.9 kg/m2), "obesity class one" (OB1; BMI = 30-34.9 kg/m2), "obesity class two" (OB2; BMI = 35-39.9 kg/m2), and "obesity class three" (OB3; BMI > 40 kg/m2). Results There were 5,654,905 hospitalizations with an ICD-10 code related to BMI within this study period. The HW group had 1,103,659 (19.5%) hospitalizations, the OV group had 462,464 (8.2%), the OB1 group had 1,095,325 (19.4%), the OB2 group had 1,036,682 (18.3%), and the OB3 group had 1,956,775 (34.6%) hospitalizations. The mean age of the population with obesity was as follows: OB1 = 61 years (SD = 16); OB2 = 58 years (SD = 15.9); and OB3 = 55 years (SD = 15.5). The mean ages of the HW and OV groups were 68 years (SD = 16.6) and 65 years (SD = 16.1), respectively. In the HW group, there were 948 (8.1%) hospital admissions for aortic valve replacement (AVR), 54 (11%) for aortic valve repair (AVRr), 737 (15.9%) for mitral valve replacement (MVRr), 12 (17.1%) for mitral valve repair (MVR), 79 (2.2%) for left atrial appendage (LAA) closure, and 3390 (5.2%) for percutaneous coronary intervention (PCI). The OV group had 1049 (8.9%) hospital admissions for AVRs, 42 (9%) for AVRr, 461 (10%) for MVRr, four (5.7%) for MVR, 307 (8.6%) for LAA closure, and 5703 (8.8%) for PCIs. The OB1 group had 3326 (28.4%) hospital admissions for AVR, 125 (26.9%) for AVRr, 1229 (26.7%) for MVRr, 23 (32.9%) for MVR, 1173 (32.9%) for LAA, and 20,255 (31.3%) for PCI, while the OB2 group had 2725 (23.3%) hospital admissions for AVR, 105 (22.6%) for AVRr, 898 (19.4%) for MVRr, 11 (15.7%) for MVR, 933 (26.2%) for LAA, and 16,773 (25.9%) for PCI. Lastly, the OB3 group had 3626 (31%) hospital admissions for AVR, 139 (29.9%) for AVRr, 1285 (27.8%) for MVRr, 20 (28.6%) for MVR, 1063 (29.9%) for LAA, and 18,589 (28.7%) for PCI. Conclusion Our study supports the evidence of increased cardiovascular interventions with increasing BMI. Albeit, an inconsistent presentation across the spectrum of cardiovascular diseases and outcomes, for example, equal or better outcomes in obese cohorts compared to the healthy weight population undergoing PCI. However, the increasing cardiovascular intervention burden in the youngest studied population suggests a rise in the cardiovascular disease burden among the young and partially explains their better outcomes. Steps to include weight management for these patients are paramount.

Berberine for Adjunct/Alternative Treatment of Dyslipidemia: A Literature Review.

Berberine (BBR) is an ancient plant popular in China and is used to treat dyslipidemia, among other cardiovascular and metabolic-related diseases. BBR has historically been regarded as having multiple benefits, with a few clinical trials indicating this fact. We searched PubMed, Embase, and Google Scholar with the following keywords: Berberidaceae, berberine, Berberis spp., dyslipidemia, atherosclerosis, and inflammation. We synthesized the information within the literature to provide an updated review of BBR, its potential, and its applicability in real-world medicine in the future. This review sought to evaluate the literature and advancement in BBR's efficacy regarding dyslipidemia, inflammation, and atherosclerosis.

Impact of Long-Term Steroid Use on the Disposition of Patients Undergoing Transcatheter Aortic Valve Replacement: A Retrospective Nationwide Sample Analysis.

Background Chronic steroid use is debilitating to health, but, in some cases, it is necessary. We examined the effect of chronic steroid use on the discharge disposition of people undergoing transcatheter aortic valve replacement (TAVR). Methods We queried the National Inpatient Sample Database (NIS) from 2016 to 2019. We identified patients with current chronic steroid use with the International Classification of Diseases for the Tenth (ICD-10) code Z7952. Furthermore, we used the ICD-10 procedure codes for TAVR 02RF3. Outcomes were the length of hospitalization (LOS), Charlson Comorbidity Index (CCI), disposition, in-hospital mortality, and total hospital charges (THC).  Results Between 2016 and 2019, we identified 44,200 TAVR hospitalizations, and 382,497 were on current long-term steroid therapy. Of these, 934 had current chronic steroid use and underwent TAVR (STEROID) with a mean age of 78 (SD=8.4). About 50% were female, 89% were Whites, 3.7% were Blacks, 4.2% were Hispanics, and 1.3% were Asians. Disposition was 'home,' 'home with home health' (HWHH), 'skilled nursing home' (SNF), 'short-term inpatient therapy' (SIT), 'discharged against medical advice' (AMA), and 'died.'  A total of 602 (65.5%) were discharged home, 206 ( 22%) were discharged to HWHH, 109 (11.7%) to SNF, and 12 (1.28%) died. In the SIT and AMA groups, there were only three and two patients, respectively, p=0.23. The group that underwent TAVR and was not on chronic steroid therapy (NOSTEROID) had a mean age of 79 (SD=8.5), with 28731 (66.4%) being discharged home, 8399 (19.4%) to HWHH, 5319 (12.3%) to SNF, and 617 (1.43%) died p=0.17.  Comparing the STEROID vs. NONSTEROID group, according to the CCI, the STEROID group scored higher than the NOSTEROID group; 3.5 (SD=2) vs. 3 (SD=2) p=0.0001, while for LOS, it was 3.7 days (SD=4.3) vs. 4.1 days (SD=5.3), p=0.28, and the THC was $203,213 (SD=$110,476) vs. $215,858 (SD=$138,540), p=0.15. Conclusion The comorbidity burden of individuals on long-term steroids undergoing TAVR was slightly higher than those not on steroids undergoing TAVR. Despite this, there was no statistically significant difference in their hospital outcomes following TAVR with respect to dispositions.

The Evolution of Hypertension Guidelines Over the Last 20+ Years: A Comprehensive Review.

Hypertension is the most common modifiable risk factor for cardiovascular and cerebrovascular diseases. In the last two decades, the guidelines have evolved tremendously from areas with no recommendations for screening or treatment to targeted recommendations for some at-risk groups. We sought to go through the literature that provided guidelines for the management of hypertension at any point in time over the last 22 years from 2000 to 2022. We searched four databases: PubMed, Embase, Google Scholar, and Cochrane, using specified search terms. The keywords used were "hypertension" and "guidelines." We combined them using the Boolean operators (AND, OR) and searched for articles. A total of 2461 publications were initially identified; 348 publications were excluded after screening for full-text availability. The full-text articles were further filtered based on title and abstract screening. Following this, a total of 1443 articles were excluded. The remaining 670 full-text articles were assessed for eligibility. Of the 670 full-text articles, 480 were excluded based on exclusion criteria, and following the full-text article screening, 190 articles met the final inclusion criteria. Most of these guideline evolutions concerned establishing and adjusting thresholds for the subgroups of the elderly population and patients with diabetic kidney disease, chronic kidney disease, and stroke. Furthermore, the medications of choice are now guided by the stage of disease, presence or absence of comorbidities, and other relevant information, as opposed to ethnicity, which was previously a heavy yardstick for medication choice.

A Meta-Analysis of Randomized Controlled Trials on the Effectiveness of Exercise Intervention in Preventing Sports Injuries.

Athletes risk injury every day during practice sessions and actual games, with the majority of the affected population being young males. The Centers for Disease Control and Prevention 2011-2014 report on sport and recreation-related injuries in the United States has consistently shown the average annual estimate of the millions of dollars spent on sport and recreation injuries. These injuries translate to a significant financial implication for the athlete, the team, the health system, and the public health. We composed a review protocol. We enumerated our inclusion and exclusion criteria, injury definition, and search strategy. We searched PubMed and SPORTDiscus. Then we used Forrest plots for the meta-analysis of the relevant selected studies. We used various keywords in our search strategy. These included "injury," "sports," "exercise," "prevention," "techniques," and every possible combination of them. Search results showed 2516 hits with our keywords, and we included 20 of those results. Twenty trials, including 19712 individuals with 2855 injuries, were analyzed. Eccentric Training relative risk (RR) of 0.54 (95% CI 0.395 to 0.739 with X2 of p < 0.05) showed that the risk of the injury was decreased by 54% in the intervention group compared to the control group. In the neuromuscular training group, a RR of 0.682 (95% CI 0.621 to 0.749 with X2 of p < 0.001) showed that the risk of the injury was decreased by 68.2% in its intervention group subgroup compared to its control group. Also, the "11" International Federation of Association Football (FIFA) program had a RR of 0.771, indicating that there was a 77.1% decrease in injury by this set of exercises (95% CI 0.728 to 0.816 with X2 of p < 0.05), and this "11" FIFA program also had the most preventative effects. Warm-up had a RR of 0.843 (95% CI 0.749 to 0.949 with X2 of p < 0.05) and showed small prevention. Strength Training RR of 0.97 (95% CI 0.57 to 1.63 with X2 of p > 0.05) had no preventive effect. Our analysis showed that different exercises have preventive roles in sports injuries. The warm-up FIFA, neuromuscular training, and eccentric training reduced the risk of injury in the intervention group compared to the control group by a high percentage. At the same time, neuromuscular warm-up and FIFA 11 dynamic warm-up also decreased the relative risk of injury in the intervention group. These effects varied among exercise type, injury type, and sport.

A Review of Four Practice Guidelines of Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD) is a term that encompasses conditions characterized by chronic inflammation of the gastrointestinal tract (GIT). It includes Crohn's disease and ulcerative colitis. Major scientific organizations interested in gastrointestinal systems or GIT-focused organizations worldwide release guidelines for diagnosing, classifying, managing, and treating IBD. However, there are subtle differences among each of these guidelines. This review evaluates four evidence-based guidelines in the management of IBD and seeks to highlight the differences and similarities between them. The main differences in the evaluated guidelines were in diagnosis and treatment recommendations. The diagnosing recommendations were comparable amongst the four guidelines; however, some were more specific about limiting the number of interventions necessary to confirm a diagnosis. Regarding treatment options, each guideline had clear suggestions about what was considered ideal. Although the treatment options were identical, the main differences existed in the recommended diets and initial therapy in patients with moderate disease. Clinical practice guidelines (CPGs) recommend evidence-based practice from opinion leaders in clinical decision-making. Rather than dictating a one-size-fits-all approach in IBD management, reviewing various guidelines can enhance the cross-pollination of ideas amongst clinicians to improve decision-making. Clearly describing and appraising evidence-based reasoning for scientific recommendations remain driving factors for quality patient care. The effectiveness of CPGs in improving health and the complexities of their formation requires constant review to maximize constructive criticisms and explore possible improvements.