Seminars in Orthodontics

Ganeiber T., Bugaighis I.

Background Dental aesthetics and attractive, harmonious smiles contribute significantly to patients' decisions regarding treatment preference. Aims This article investigates the existence and suitability of golden proportion, golden percentage, and recurring aesthetic dental (RED) proportion in Libyan dental students with natural dentition. Methods This prospective cross-sectional observational study comprised 73 Libyan dental students who met the inclusion criteria (34.2% males and 65.8% females with a mean age of 25 ± 3.0 years). A photograph of the six anterior maxillary teeth was taken for each participant, and the apparent width of each was extracted digitally. Subsequently, the golden proportion, golden ratio, and the RED ratio were computed and compared with their corresponding standard notions. Descriptive and inferential analyses were performed at p < 0.05. Results There were no significant sex differences for all variables. Therefore, the data was pooled together for further analysis. The Libyan golden proportion differed significantly from their corresponding standard values at p < 0.05. A similar significant discrepancy was observed in the golden percentage except for the maxillary left lateral incisors (p = 0.206). Furthermore, the mean values of the RED proportion were not constant, and the mean ratio increased moving distally, which did not align with the standard RED proportions. Conclusion The proposed golden proportions, golden percentage, and RED rations were not pertinent to our cohort of Libyan dental students. Anterior tooth proportions vary among populations according to their ethnicity and geographic background. Therefore, proportions should be utilized based on the same population and ethnicity.

Oakley R., Ambarek M.S., Elhwuegi A.

Soyoye D.O., Adetunji T., Olowookere S.A., Ajayi A.A., Ilori T., Apampa T.O., Adejuyigbe O.T., Akinola B.J.

Background Diabetes mellitus is a noncommunicable chronic disease that is becoming prevalent among the youthful population. Aim This study assessed diabetic awareness, knowledge, attitude, and practices among undergraduates of a Nigerian university. Methods Descriptive cross-sectional study was conducted among 310 consenting undergraduates that completed a self-administered questionnaire on diabetes and diabetic self-care. Data collected were analyzed using descriptive and inferential statistics. Results The undergraduate age ranged from 16 to 30 years with the majority less than 20 years (55.5%), females 53.8%, Yoruba (87.4%), and second-year students (34.2%). Although a majority (85%) was aware of diabetes mellitus, 53% had poor knowledge, 70% had a negative attitude, and 60% had poor practices toward diabetes mellitus and diabetic self-care. Significant predictor of poor knowledge was being female (adjusted odds ratio 4.56; 95% confidence interval 2.79–7.45; p = 0.0001). Conclusion Despite high diabetes awareness, the knowledge, attitude, and practices were poor among undergraduates. There should be continuous education program on diabetes and diabetic self-care among the students.

Famurewa B.A., Jimoh T.A., Ugwu E.I., Oginni F.O.

Background Ambulatory surgical procedures are integral aspects of oral and maxillofacial surgical (OMS) practice. Objective The aim of this study is to report the scope of ambulatory OMS procedures in a Nigerian suburban teaching hospital. Method A retrospective review of ambulatory OMS procedures performed at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, between March 2021 and February 2022 was conducted. Sociodemographic data, diagnoses, procedures, type of anesthesia, and immediate postoperative complications were retrieved from patients' records. Data were analyzed using the Statistical Package of Social Sciences (SPSS) version 22. Results Two hundred and fifty-two ambulatory OMS procedures were performed during the 12-month study period. This accounted for 80.3% (252/314) of elective surgeries. The patients' mean (standard deviation [SD]) age was 32.2 (10.4) years, while a slight male preponderance (51.6%) was recorded. Third molar surgery was the commonest (48.0%) procedure undertaken in ambulatory setting. Most (90.9%) of them were performed under local anesthesia. Satisfactory postoperative pain control was achieved with the use of oral nonsteroidal anti-inflammatory analgesics in most patients (81.7%). However, owing to a failed ambulatory session, there was an eventual admission rate of 0.4% (1/252). Conclusion Ambulatory surgical procedures constitute the majority of the OMS elective cases, with third molar surgery being the commonest procedure. Judicious prescription and administration of oral analgesics were effective in managing postoperative pain in our day case OMS patients. We recommend a prospective study to determine an intermediate/long-term outcome of care in ambulatory settings.

Algheryani A., Younis S.M., Duma A.M.

Agenesis of the psoas minor muscle is very common as it can be absent in approximately 56% of the population. Moreover, previous three case reports described hypoplasia of the psoas muscle. However, our case had complete agenesis of the three iliopsoas muscle components on the right side. A 26-year-old woman presented with right-side weak hip flexion that had persisted for 2 years. Magnetic resonance imaging revealed complete agenesis of the right iliopsoas muscle, and no spine pathology was detected. Radiologists should put agenesis of the iliopsoas muscle into consideration in patients presented with weak hip flexion especially when no spine pathology is detected. Follow-up is advised to study the long-term effects of iliopsoas muscle agenesis. To the best of our knowledge, we believe that this is the first report in the general literature.

Alarifi S.H., Gebril M.M.

Background Color vision deficiency (CVD) is a common disorder caused by damage to retinal photoreceptors and cones. The disorder makes a person less able to perceive color variations. Aims The objective of the study was to assess the prevalence of CVD among the school children in Benghazi, Libya. Methods This cross-sectional study was performed in the Department of Ophthalmology, Benghazi University, Benghazi, Libya, during the period from December 2023 to March 2024. The study included 1,022 students aged 6 to 18 years to assess the prevalence of CVD. Visual acuity assessment was performed in a place with good daylight illumination using the standard Snellen Tumbling E chart at a distance of 6 m. Color vision evaluation was performed in the schools using Ishihara color plates (24 plate–edition). The quantitative variables were presented as mean ± standard deviation, and the qualitative variables were presented as frequencies and percentages. The Student's t-test was used for comparing means, whereas the chi-square test was applied for comparing the frequencies. A p-value of < 0.05 was considered statistically significant. Results CVD was present in 15 cases (1.5%). There were 13 males (2.6%) and 2 females (0.38%) with a statistically significant difference regarding gender. Among the 13 males with CVD, 7 students (53.8%) had deuteranomaly, 2 students (15.4%) had deuteranopia, 1 student (7.7%) had protanomaly, and 3 students (23.1%) had color blindness. The two females with CVD both had deuteranomaly. Conclusion Early detection of CVD is vital to making informed decisions about a student's future career. With early detection, parents and teachers can adjust their educational strategies to ensure the best learning outcomes for the student.

Abduelkarem A.R.

Since the 1960s, the world has witnessed a significant development in the role of clinical pharmacists, as the pharmacy profession has shifted toward improving drug treatment, promoting health, and preventing diseases. Clinical pharmacists are in high demand around the world and are now recognized as indispensable members of health care teams. Key competencies required in a clinical pharmacist include patient care, medical knowledge, collaboration with health care teams, professionalism, delivery of exceptional care, and ensuring the safe use of medications. Modern competency-based pharmacy education focuses on specific outcomes that graduates are expected to achieve, in alignment with professional standards. This curriculum prepares students to excel in changing and evolving health care delivery, ultimately leading to improved patient outcomes and more efficient health care delivery. Therefore, the future of clinical pharmacy looks bright as pharmacists play vital roles in patient care using advanced technology and personalized medicine. Collaboration with other health care professionals is also key to improving outcomes. Therefore, pharmacy education must be changed by focusing on clinical skills, combined professional training, and career development. Challenges such as regulations, differences in practices, and lack of recognition must be addressed through collaboration between health stakeholders, educators, and policy makers. This review article aims to explore the evolving role of clinical pharmacists in the health care system, highlighting their key competencies, the impact of competency-based education, and future prospects for the clinical pharmacy profession in the context of advancing technology and personalized medicine.

Elmsalaty O.R., Bukhatwa S.A.

Background Endothelial cell density and morphology vary across ethnic groups. Aim This article investigates the corneal endothelial cell density and morphology in healthy Libyan eyes. Methods A 3-month cross-sectional observational study was conducted at Benghazi Teaching Eye Hospital, involving 198 eyes of 100 healthy Libyan participants. The noncontact Topcon specular microscope (SP-1P model) was used to assess the following parameters: the mean central corneal thickness (CCT), the mean cell density (MCD), the mean coefficient of variation (CV%), and the mean percentage of the hexagonal cell (Hex [%]). The variables were analyzed in relation to age and gender using the Statistical Package for the Social Sciences (SPSS version 25.0) Results The mean age of participants in this study was 47.4 ± 13.8 years (range 21–75 years). The mean CCT was 516.45 ± 43.04 μm, the MCD was 2664.30 ± 371.26 cells/mm2, the mean CV% was 32.3% ± 3.7, and the mean Hex (%) was 52.8% ± 9.6. There was no statistical difference in the age, CCT, and MCD across genders. Whereas CV (%) and Hex (%) showed significant gender differences (p < 0.01 for both). There was a significant negative weak correlation between CCT (r = –0.10) and age, as well as a significant negative moderate correlation between MCD and Hex (%) with age (r = –0.36 and r = –0.31, respectively). CV% exhibited a significant, moderately positive association with age (r = 0.35). The higher endothelial cell loss rate of 8.4% was in the third decade of life whereas other age groups ranged between 1.1 and 2.7%. Conclusion The normative data for the endothelium of Libyan eyes are reported, which can be used as a baseline for future studies.

Elmatri H.H., Gheryani N.A., Saad R.H., Amer A.H.

Background Thyroid lesions are a worldwide common clinical problem. Majority of thyroid nodules are benign whereas less than 5% are malignant. Fine-needle aspiration cytology (FNAC) is a commonly used method in the diagnosis of thyroid lesions with some limitations. Aim The objective was to assess the precision of FNAC in identifying thyroid lesions. Methods A retrospective analysis was conducted on 62 patients with thyroid lesions who underwent preoperative FNAC followed by surgical resection. Data collection took place from January 2017 to December 2022 and included demographic information such as age, gender, and chief complaint. Cytological and histopathologic diagnoses were obtained from pathology reports. The correlation between histopathological diagnosis and preoperative FNAC results was assessed for each patient in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy. The data were presented as frequencies and percentages. Results The diagnosis by FNAC was correlated with histopathology. The analysis showed that FNAC had a sensitivity of 94%, specificity of 91%, PPV of 80%, and NPV of 97%. However, the overall accuracy in this study was determined to be 92%. Conclusion As a tool for the preoperative diagnosis of thyroid lesions, FNAC was proved in our laboratory to be sensitive and specific with a high accuracy rate.

Oakley R.E., Altawaty A., Al-Areibi A., Saad M.

Elmansoury A.M., El-Naas N.A., Elkawafi M., Kushan A., Arfan S.

Background Online courses that utilize problem-based learning (PBL) are widely recognized as an effective educational method that blends self-directed learning with collaborative problem-solving. Aim The aim of this study was to evaluate the satisfaction of students from the Faculty of Basic Medical Sciences (BMS) at Libyan International Medical University (LIMU) with an online PBL course during the coronavirus disease 2019 (COVID-19) pandemic in 2020. Method This is a cross-sectional study performed during the COVID-19 pandemic in 2020, involving a total of 293 students from four different classes of Faculty of BMS. Each online PBL session ran for 2 hours and was arranged independently for each year group. Students had access to a seven-closed-question questionnaire for a few hours after the end of the session. The questions were of three different categories. The first category was related to the online organization of the session, tutor control, and instructions provided in the applied Modular Object-Oriented Dynamic Learning Environment (Moodle). The second category involves questions related to online communication problems, the facility of the Google Hangouts application used, and the time allocated for the session. The third category was the cooperation of the PBL group. The student was asked to answer agree or disagree for each question. If the student did not choose one of the answers, his response was recorded as (no response). The scores of (agree), (disagree), or (no response) for each student were transferred to a Microsoft Office (2021) Excel file and were displayed as frequency and percentages. A two-way analysis of variance without replication was performed to analyze the differences in student responses across various groups using Excel statistics. The proportion test was utilized to determine whether the proportion of positive responses (agree) in any group significantly differed from a specified level of 0.75 (75%). The acceptable proportion of no response was set at 0.2 (20%). The significant level was set at p-value less than 0.05. Results For the first category, the highest level of student satisfaction (79.9%) was associated with Moodle instructions, followed by tutor control (79.5%), and online organization (72%). However, students in the third year of medicine demonstrated significantly lower satisfaction with online organizations compared with other groups (62.3%, p < 0.05). For the second category, all groups, except first-year medicine students, reported significantly low satisfaction with online access (58% p < 0.05). All groups expressed satisfaction with the time allotted for the session (74%) and the online Google Hangouts application used (71%), except for third-year medicine students, who exhibited a notable level of dissatisfaction with the use of online Google Hangouts application (7%, p < 0.05). Lastly, the third category focused on group cooperation and reflected an overall student satisfaction rate of 80%. Conclusion BMS students responded positively regarding their first online PBL session during the COVID-19 pandemic. The study displayed that the availability of online communication, the clarity of instructions, good session organization, and control are important factors that will determine the effectiveness of online PBL.

Abdala M.A., Masoud S.M., Geilani N.A.

Background Glaucoma is a prevalent cause of visual impairment, and early detection is critical to prevent progressive vision loss. Optical coherence tomography angiography (OCT-A) enables visualization of retinal and optic nerve microvasculature and holds promise for early glaucoma detection. Aims This study aims to assess microvasculature density alterations in glaucoma using OCT-A. Methods An observational cross-sectional case–control study was conducted at Benghazi Eye Hospital in Libya from December 2022 to August 2023. It included 160 eyes of 126 patients diagnosed with primary open-angle glaucoma and 120 eyes of 96 control subjects. OCT-A was performed using the Swept-Source OCT DRI Triton. Vessel density measurements were obtained from OCT-A images using new built-in software within the device. The data presented as mean ± standard deviation and percentages were analyzed using SPSS. The statistical significance of the differences between different groups was determined using independent t-tests, and the level of significance was set at p-value less than 0.05. Results OCT-A demonstrated significantly reduced microvasculature density in glaucoma eyes across all optic nerve sectors including the inferior (29.0%), superior (25.2%), central (23.5%), nasal (9.9%), and temporal sectors (9.3%; p < 0.02). Moreover, glaucoma patients exhibited a significant reduction in vessel density in the superior macula (17% reduction), the temporal (15.7%,), nasal (12.9%), and inferior sectors (12.6%) (p < 0.002). No statistical difference was seen with vessel density of the central sector (0.49%, p >0.05). Conclusion OCT-A demonstrated significant reductions in microvasculature density in glaucoma patients compared with healthy controls. These findings support the association between glaucoma and vascular changes. Additionally, the TOPCON Swept-Source OCT DRI Triton new software shows promise as a valuable tool for early detection and monitoring of glaucoma-related vascular changes.

Garoushi I.H., Bayou K.M., Eldfeir R., Bengdara A., Abushiha M., Ali N.B.

Background A pregnant woman with dental issues may not see a dentist unless her gynecologist advices her to do so. Thus, gynecologists need to be aware of the impact of dental health on pregnancy and what pregnant women need to do to improve their dental health. Aim The aim of this study is to evaluate gynecologists' awareness, understanding, and practice regarding the impacts of dental therapy during pregnancy and the influence of dental disease on pregnancy outcomes. Methods All the data in this cross-sectional study were acquired from gynecologists in public and private hospitals in Benghazi, Libya, over a period of 6 months during 2022. A modified structured questionnaire developed by Paneer et al consisting of 20 closed-ended questions related to oral care of pregnant patients was given to the participating gynecologists. Data obtained were presented as frequencies and percentages using the SPSS statistical package. Results Sixty gynecologists, with ages ranging from 35 to 65 years, completed the questionnaire. The majority (81%) recognized that pregnancy increases the risk of gingival inflammation, but only 60% attributed this to hormonal changes. While 45% were aware of the impact of periodontal inflammation on pregnancy outcomes, only 38.3% knew about its association with preterm birth and low birth weight. Most participants (83%) considered dental referral important, and 81.7% believed oral cavity examination should be a part of maternal health, yet only 36% actually performed it. Ninety percent of the participants reported that they advise pregnant women on oral hygiene and routine checkups. Regarding safety, only 46.7% believed radiographs to be safe during pregnancy, and 51.7% considered local anesthesia with vasoconstriction safe. However, 95% agreed that the second and third trimesters are the safest period for dental treatment. Conclusion The results of the current study show that gynecologists are fairly knowledgeable about the link between dental health and pregnancy. There is, however, unquestionably some miscomprehension about offering dental care to expectant mothers. Pregnant women and the medical community need access to more information, and misconceptions about suitable dental procedures during pregnancy must be addressed to improve oral health care.

Aliyu F.O., Orimogunje T., Bello S.I., Abdulbaki M., Jamiu M.O., Ogaji I.J.

Background Patients with diabetes mellitus have an increased risk of developing dyslipidemia, predisposing them to macro- and microvascular consequences such as coronary heart disease. Aim The aim of this study was to assess the prevalence of dyslipidemia, drug therapy problems (DTPs), and medication adherence in type 2 diabetes mellitus (T2DM) patients in a tertiary hospital in North Central Nigeria. Method This study was a cross-sectional convenient sampling of eligible patients conducted in the General Outpatient Department of General Hospital, Ilorin, from March to May 2022. A validated questionnaire was administered to obtain all relevant information on sociodemographic information, and blood samples were collected in a medium plain heparinized tube and sent to the laboratory where fasting blood sugar, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) values were calculated as appropriate. Morisky's Medication Adherence Scale 8 (MMAS-8) was used to capture patient's adherence level, and DTP was assessed using the Pharmaceutical Care Network Europe (PCNE) Criteria version 7. Ethical approval was obtained from the Ministry of Health, Ilorin. Statistical Package for Social Sciences was used to analyze the data collected for descriptive and inferential statistics. Results The mean age of the respondents was 60 ± 0.7 years. Of the 60 respondents, 25 (41.67%) were males and 35 (58.33%) were females. All the respondents had dyslipidemia, 30% respondents were identified with a DTP of nonadherence, 16.7% needed additional drug/monitoring, dosage was too low in 11.7%, and 11.6% could not afford their medication due to high cost. In all, 45 (75%) respondents had poor sugar control and 33 (55%) had poor blood pressure control. Using MMAS-8, the majority (41, [68.30%]) of the respondents were found to have poor adherence to their diabetic medications. Conclusion High prevalence of dyslipidemia, poor medication adherence, and DTPs were found in the T2DM patients in this study.

Aliyu F.O., Olatunde O.O., Abdulbaki M., Bello S.I., Olajide Q.

Background Hypertension is one of the major causes of related maternal deaths worldwide and it is one of the most common medical disorders encountered during pregnancy. Aim This study aimed at assessing the demographic and medical characteristics of hypertensive pregnant women in two secondary healthcare facilities, in Ilorin, Nigeria Method This was a cross-sectional study among 104 pregnant women with hypertension attending the outpatient department of General Hospital and Civil Service Clinic, Ilorin between March and May 2021. A validated self-administered questionnaire was used to obtain information on sociodemographics. Data on the medical characteristics of the respondents and their medications were extracted from the respondent's medical files. Ethical approval was obtained from the Ministry of Health and General Hospital, Ilorin. For statistical analysis for categorical measurements, the frequencies and percentages were computed. Results Seventy-five percent of the correspondents were below 36 years old, 97% were married, 79% had tertiary education, and 74% were above 24 weeks of gestation. About 68% of the correspondents had blood pressure more than or equal to 140/90 and 10% had blood pressure more than 160 mm Hg systolic or more than 100 mm Hg diastolic. About 78.8% of the correspondents had a family history of hypertension, 13.5% had a family history of diabetes mellitus, and 22.1% had a family history of obesity. About 27.9% had pre-existing hypertension, 61.5% developed hypertension before the end of 20 weeks of gestation, and 10.6% developed hypertension after 20 weeks of gestation. About 24% had their antihypertensive medication changed during pregnancy, 38.5% were treated with methyldopa, 31.7% with nifedipine, and 27% with nifedipine and methyldopa. Majority (83.6%) of the respondents were not adherent to their medications. Conclusion Two-third of the patients had poor blood pressure control irrespective of the fact that all were under drug therapy. Family history and large body mass index are the main risk factors for the development of hypertension during pregnancy. Noncompliance may play a significant role in no drug response.