Asian Journal of Medical Principles and Clinical Practice

Features of Early Osteoarthritis and Synovitis against the Background of Metabolic Syndrome: A Cross-Sectional Study

2026-06-23T11:48:09+00:00

Background: Early knee osteoarthritis may present with pain, stiffness, and functional limitation despite minimal radiographic changes. Metabolic syndrome may contribute to a more symptomatic and inflammatory disease pattern.

Objective: This cross-sectional study evaluated the clinical, functional, anthropometric, laboratory-inflammatory, and instrumental features of early knee osteoarthritis associated with metabolic syndrome, with particular attention to synovitis.

Methods: The study included 64 patients aged 35–60 years with early knee osteoarthritis. Thirty-eight patients had metabolic syndrome and 26 did not. Pain intensity was assessed using the visual analogue scale, and functional status and health-related quality of life were evaluated using WOMAC and KOOS indices. Body mass index, waist circumference, systemic inflammatory markers, cartilage oligomeric matrix protein, and knee-joint imaging findings were assessed.

Results: Patients with metabolic syndrome had higher pain intensity, worse WOMAC scores, lower KOOS values, and more frequent synovitis than patients without metabolic syndrome. They also had higher body mass index and waist circumference values, while arterial hypertension and diabetes mellitus were observed only in this group. Interleukin-6, cartilage oligomeric matrix protein, and C-reactive protein levels were significantly elevated in the metabolic syndrome group, indicating greater inflammatory activity and cartilage matrix turnover.

Conclusion: Early knee osteoarthritis associated with metabolic syndrome showed a metabolic-inflammatory pattern characterised by more pronounced symptoms, synovial involvement, and increased cartilage degradation markers. Comprehensive metabolic and inflammatory assessment may support early diagnosis and individualised management.

Point-of-Care Ultrasound in Paediatric Emergency Resuscitation: A Narrative Review

2026-06-01T11:29:17+00:00

Point-of-care ultrasound (POCUS) has progressively established itself as an indispensable diagnostic and procedural adjunct in paediatric emergency medicine, transforming the capacity of clinicians to assess and manage critically ill children at the bedside. Unlike its adoption in adult emergency medicine, the integration of POCUS into paediatric emergency resuscitation has followed a somewhat more uneven trajectory, shaped by anatomical peculiarities unique to the developing body, institutional variation in training provision, and a relative scarcity of large-scale paediatric-specific evidence. This critical narrative review synthesises the available evidence across the primary resuscitation domains of POCUS application in paediatric emergency care: cardiac arrest and rhythm assessment; haemodynamic evaluation and undifferentiated shock; airway management; pulmonary and thoracic imaging; focused cardiac ultrasound; procedural guidance including vascular access and lumbar puncture; and targeted abdominal diagnosis. A structured narrative review was conducted using PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, Embase, and the Cochrane Library, with literature searches covering the period from January 2001 to the present. The review critically appraises the diagnostic accuracy, procedural benefits, and clinical impact of POCUS across these domains, drawing on systematic reviews, meta-analyses, and landmark observational and interventional studies. It also examines current frameworks for training, credentialing, and quality assurance, alongside the significant barriers — particularly those related to operator dependency, training heterogeneity, and resource constraints — that continue to limit uniform implementation. The article identifies areas where evidence is emerging and highlights directions for future research, including simulation-based learning, artificial intelligence-assisted imaging, and the expanding role of POCUS in neonatal resuscitation and low-resource settings. The overall picture that emerges is of a technology with compelling and, in many domains, well-evidenced clinical utility, but one whose full potential in paediatric emergency resuscitation remains contingent on structured training systems, standardised protocols, and ongoing high-quality research.

Magnetic Resonance Imaging: Principles, Clinical Applications, and Problem Solving: A Critical Review

2026-06-08T10:14:46+00:00

Magnetic resonance imaging (MRI) has evolved over the past five decades from an experimental laboratory technique into one of the most versatile and clinically indispensable diagnostic imaging modalities in contemporary medicine. Grounded in the quantum mechanical phenomenon of nuclear magnetic resonance, MRI offers unparalleled soft-tissue contrast, multi-planar capability, and functional sensitivity without the use of ionising radiation. This critical review synthesises the current state of knowledge across the principal domains of MRI science and practice: physical principles including relaxation theory, pulse sequence design, and k-space reconstruction; hardware considerations spanning magnet technology, gradient systems, and radiofrequency coil arrays; and a broad landscape of clinical applications encompassing neuroimaging, cardiovascular assessment, oncological staging, musculoskeletal evaluation, and body imaging. A structured narrative review methodology was employed to identify, screen, and critically synthesise peer-reviewed literature on MRI principles, technologies, safety, and clinical applications published between January 2000 and March 2026 using databases including Web of Science, Scopus, PubMed, Google Scholar, IEEE Xplore, EMBASE, CINAHL, the Cochrane Library, and EUDAMED. Advanced techniques — including diffusion tensor imaging, functional MRI, arterial spin labelling, magnetic resonance spectroscopy, susceptibility-weighted imaging, and quantitative mapping — are examined alongside their translational significance. The review further addresses practical problem solving, with particular attention to artefact recognition and mitigation, radiofrequency and field inhomogeneity, and patient safety considerations relating to implanted devices, gadolinium-based contrast agents, and scanning during pregnancy. Emerging developments — comprising compressed sensing, artificial intelligence–driven reconstruction, ultra-high field MRI at 7 Tesla, portable low-field systems, and MR-guided therapy — are critically assessed in terms of their maturity, limitations, and realistic clinical prospects. The review identifies persistent challenges including acquisition speed, access inequity, artefact burden, and the translation gap between research innovation and routine clinical deployment, and concludes with a synthesis of strategic priorities for advancing MRI science and practice over the coming decade.

Clinical Impact of Rifaximin in Liver Cirrhosis: A Critical Review

2026-06-24T11:14:46+00:00

Liver cirrhosis represents a major contributor to global morbidity and mortality, characterised by progressive hepatic fibrosis, portal hypertension, and susceptibility to life-threatening complications including hepatic encephalopathy (HE), spontaneous bacterial peritonitis (SBP), and acute-on-chronic liver failure (ACLF). Rifaximin, a minimally absorbed, broad-spectrum oral antibiotic with gut-selective activity, has progressively emerged as a clinically significant agent in the management of cirrhosis and its sequelae. This critical review synthesises the current evidence base for rifaximin across the principal clinical domains of cirrhosis management, encompassing its well-established role in the secondary prophylaxis of overt HE, its eubiotic effects on the intestinal microbiome, its potential role in SBP prevention, and its emerging indications in portal haemodynamic stabilisation and systemic inflammation reduction. Evidence from landmark randomised controlled trials demonstrates that rifaximin substantially reduces HE recurrence and related hospitalisations, with a favourable long-term safety profile driven principally by its negligible systemic absorption. More tentative data support broader applications in SBP prevention and haemodynamic improvement, while the null result of the APACHE randomised controlled trial has tempered expectations regarding rifaximin as a universal disease-modifier in advanced decompensated cirrhosis. Key unresolved questions persist concerning optimal dosing strategies, combination approaches with lactulose and albumin, cost-effectiveness across diverse healthcare settings, and the long-term consequences of rifaximin on intestinal antimicrobial resistance profiles. This review critically appraises the available evidence across these domains and delineates priority areas for future investigation.

Influence of Gut Microbes on the Incretin System and Type 2 Diabetes Mellitus: A Critical Narrative Review

2026-07-09T12:06:37+00:00

Type 2 diabetes mellitus remains one of the principal drivers of global non-communicable disease burden, and impaired secretion or action of the incretin hormones glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide is now recognised as a core feature of its pathophysiology. Over the past two decades, the gut microbiota has emerged as an unexpected but influential regulator of this axis. Bacterial fermentation products such as short-chain fatty acids, microbially transformed bile acids, lipopolysaccharide, and amino acid derivatives interact with enteroendocrine L- and K-cells through dedicated receptors and signalling pathways, thereby shaping postprandial hormone output and downstream glycaemic control. This review synthesises mechanistic, observational, and interventional evidence describing how compositional and functional alterations of the intestinal microbiota influence incretin physiology and contribute to insulin resistance and hyperglycaemia. It traces the route from bacterial metabolite production, through G-protein-coupled receptor and nuclear receptor signalling, to enteroendocrine hormone release, and considers how individual taxa, dietary fibre, probiotics, faecal microbiota transplantation, bariatric surgery, and existing glucose-lowering drugs each intersect with this pathway. Particular attention is given to the bidirectional relationship between glucose-lowering agents and the microbiome, including emerging evidence that bacterial dipeptidyl peptidase-4 homologues may blunt incretin efficacy. The review closes by outlining priority research directions, drawing overall conclusions, and identifying the principal limitations of the current evidence base, with the aim of clarifying where microbiome-informed approaches might realistically refine the prevention and management of type 2 diabetes mellitus.

Adoptive Cellular Immunotherapy in Glioblastoma: Mechanistic Insights, Clinical Progress, and Future Directions of CAR-T and TIL Therapies

2026-07-13T06:34:02+00:00

Glioblastoma remains the most common and lethal primary malignant brain tumour in adults, and outcomes have changed little despite maximal surgical resection, radiotherapy and temozolomide chemotherapy. Adoptive cellular immunotherapy, principally chimeric antigen receptor T-cell (CAR-T) therapy and tumour-infiltrating lymphocyte (TIL) therapy, has emerged as a candidate strategy to overcome the profound treatment resistance of this tumour. This review synthesises mechanistic and clinical evidence on adoptive cellular therapy in glioblastoma, covering antigen selection, the immunosuppressive tumour microenvironment, delivery routes, toxicity profiles and combination strategies. CAR-T constructs directed against epidermal growth factor receptor variant III, interleukin-13 receptor alpha 2, human epidermal growth factor receptor 2, disialoganglioside GD2 and B7-H3 have progressed through early-phase trials, with locoregional intracranial or intraventricular delivery producing transient but reproducible radiographic responses. Antigen heterogeneity, an immunologically cold and metabolically hostile microenvironment, and limited T-cell persistence continue to constrain durable benefit. TIL therapy, although transformative in melanoma, remains comparatively underexplored in glioblastoma because of low native lymphocytic infiltration and difficulty in tumour-reactive lymphocyte expansion. Combination approaches pairing CAR-T with oncolytic virotherapy, checkpoint blockade or cytokine armouring show preclinical synergy and early clinical promise. Toxicities, including cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome, require structured grading and management, particularly given the confined intracranial space. This review concludes that adoptive cellular therapy for glioblastoma has moved from proof-of-concept toward early efficacy signals, but that antigen escape, microenvironmental suppression and neuroanatomical toxicity remain the principal barriers to be resolved before broader clinical adoption.

Management Strategies and Outcomes of Pediatric Renal Trauma: A Systematic Review and Meta-analysis

2026-05-26T13:37:41+00:00

Background: Pediatric renal trauma represents a large proportion of genitourinary injuries in children and is most often related to blunt abdominal trauma sustained in motor vehicle collisions, falls, sports injuries, and bicycle accidents. Imaging modalities, trauma care, and minimally invasive interventions have evolved, and the management strategies have changed from operative treatment to conservative approaches. Recent investigations have demonstrated the success of nonoperative management in the majority of hemodynamically stable pediatric patients, including some high-grade renal injuries.

Objective: To systematically review and meta-analyze published studies to assess current diagnostic approaches, management strategies, and clinical outcomes of pediatric renal trauma.

Methods: A systematic review meta-analysis was conducted according to PRISMA guidelines. Electronic databases including PubMed, Scopus, Web of Science, and Google Scholar were searched for studies published between 2013 and 2026. Studies were eligible if they included pediatric patients with renal trauma and reported management strategies, imaging findings, complications, or clinical outcomes. Pooled proportions and effect estimates were calculated using a random effects model. Heterogeneity was assessed with the I² statistic and Cochran’s Q test. Results The primary outcomes were renal preservation, success of nonoperative management, complications, and nephrectomy rates.

Results: The systematic review comprised 31 studies with 3482 pediatric patients with renal trauma; 18 studies were eligible for quantitative meta-analysis. Injury was most commonly due to blunt trauma (pooled proportion: 89.4%; 95% CI: 84.1–93.1; I2 = 58%). Low-grade renal injuries (AAST grades I-III) were the most common injury pattern. The pooled success rate of nonoperative management was 93.2% (95% confidence interval [CI]: 89.7–95.6; I2 = 42%). Renal preservation was achieved in 96.1% (95% CI: 93.4–97.8; I2 = 37%). Children with high-grade injuries who are hemodynamically stable and managed conservatively have favorable outcomes with significantly lower rates of nephrectomy than operative management (pooled OR: 0.28; 95% CI: 0.14–0.56; p < 0.001). The overall complication rates were low (11.6%; 95% CI: 8.2–16.1; I² = 49%) with urinoma, hematuria, and urinary extravasation being the most common complications reported. The use of minimally invasive procedures such as ureteral stenting and angioembolization increased in the management of complications with improved renal salvage rates.

Conclusion: The evidence available strongly promotes the use of conservative and minimally invasive management as the treatment of choice in most pediatric renal trauma cases, especially in hemodynamically stable patients. These strategies have been associated with high rates of renal preservation, low rates of complication, and significantly reduced rates of nephrectomy, thereby improving overall clinical outcomes.

Effectiveness of Strategies to Enhance Patients’ Compliance with Clinical Appointments: A Systematic Review

2026-06-23T13:39:30+00:00

Missed clinical appointments remain an important barrier to continuity of care, timely clinical review, and efficient use of health service resources. This systematic review examined strategies used to improve patients’ compliance with scheduled clinical appointments across global, African, and Nigerian healthcare settings. The review was guided by the PICO framework and included studies published in English between 2010 and 2026. Searches were conducted in PubMed/MEDLINE, Scopus, Web of Science, CINAHL, Google Scholar, African Journals Online, and relevant reference lists. Eligible studies included systematic reviews, randomised controlled trials, quasi-experimental studies, observational studies, and implementation studies that assessed interventions or determinants related to appointment attendance. Twenty-two studies were included in the qualitative synthesis. The evidence most consistently supported appointment reminder systems, particularly SMS/text reminders, telephone reminders, combined reminders, and reminder-plus interventions. SMS reminders were generally effective compared with no reminders and were often less costly than telephone calls. Evidence from Nigeria also showed benefit from SMS reminders in mental health follow-up, while local studies identified forgetfulness, transport cost, distance, financial constraints, and conflicting commitments as common reasons for missed appointments. Other useful strategies included patient navigation, case management, open-access scheduling, reduced appointment lead time, behavioural message framing, patient education, defaulter tracing, and transport-sensitive support. The review indicates that appointment compliance is best improved through proactive, patient-centred systems rather than passive appointment booking. In Nigeria and similar low-resource settings, low-cost reminders should be combined with updated appointment registers, targeted phone follow-up, flexible scheduling, patient education, and barrier assessment.

Effects of the Use of Information and Communication Technology on the Quality of Health Services in Public and Private Health Facilities: A Systematic Review

2026-06-30T12:55:51+00:00

Background: Information and Communication Technology is increasingly used in health facilities to support documentation, communication, clinical decision-making, telemedicine, patient engagement, surveillance and health information management. This systematic review examined evidence on its effects on health-service quality in public and private facilities, with attention to Nigerian, wider African, European and global settings.

Methods: A PRISMA-informed systematic review was conducted. Searches were undertaken in PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect and Google Scholar, with supplementary citation searching and relevant organisational sources. Eligible studies were English-language empirical studies published between January 2015 and May 2026 that examined digital health technologies in health-service settings and reported quality-related outcomes or implementation conditions linked to quality improvement. Because study designs, settings, technologies and outcomes varied, a narrative synthesis was undertaken.

Results: Thirty empirical studies were included. Information and Communication Technology was most consistently associated with improvements in documentation, patient satisfaction, provider communication, data quality, timeliness, specialist input, care coordination, protocol adherence, decision-making and selected primary-care quality indicators. Nigerian and wider African studies showed that benefits were influenced by infrastructure, power supply, internet connectivity, funding, training, organisational readiness, usability, technical support, data security and the policy environment. European and global studies provided stronger evidence for telemedicine, electronic health records, mobile health tools and workflow-related data quality, while showing mixed effects on mortality, readmission and complications.

Conclusion: Information and Communication Technology can enable better health-service quality, but its benefits depend on implementation quality, governance, interoperability, workforce capacity, infrastructure and continuous monitoring of patient-centred and clinical outcomes.

A Systematic Review on Genetic Polymorphisms Associated with Hypertension Risk

2026-07-06T11:11:03+00:00

Background: Hypertension is a major global public health burden with a significant heritable component. Despite extensive genomic research, evidence linking specific genetic polymorphisms to hypertension risk remains inconsistent, partly due to a lack of diversity in study populations and methodological heterogeneity.

Aim: This systematic review aimed to synthesise and critically appraise evidence of genetic polymorphisms associated with essential hypertension risk in adults, with a specific focus on population diversity and methodological quality.

Methods: The review followed PRISMA guidelines. A comprehensive search of five databases (PubMed, Embase, Scopus, Web of Science, Cochrane Library) was conducted. Observational studies (case-control, cohort) investigating specific polymorphisms in adults with essential hypertension were included. Two reviewers independently performed study selection, data extraction, and quality assessment using the Critical Appraisal Skills Programme (CASP) checklist. A narrative synthesis was conducted.

Results: Five studies (total n = 3,851 participants) were included. Quality assessment using the CASP tool revealed that most case-control studies were of moderate quality (rated as "Fair"), limited by factors such as modest sample sizes and hospital-based recruitment. Findings indicated that genetic risk is highly population-specific. For example, the ACE I/D polymorphism was significantly associated with hypertension in a North Indian population but showed no association in a Senegalese cohort. A high-quality ("Good") longitudinal Japanese cohort study demonstrated that polygenic accumulation of four SNPs predicted 12-year hypertension risk (OR up to 16.9). Novel associations were reported for GPR158 in a Han Chinese population and *PAI-1* in North Indian participants.

Conclusion: This review underscores the polygenic and population-specific architecture of hypertension. The current evidence base, marked by methodological limitations and ancestry-specific findings, is insufficient for the clinical application of individual polymorphism testing. Future research must prioritise large, diverse population-based cohorts, robust study designs, and investigations of gene-environment interactions to enable equitable progress in precision public health.

Proprioceptive Deficits in Cervicogenic Headache: An Open-Source-Verified Systematic Review

2026-07-13T11:39:22+00:00

Background: Cervicogenic headache is a secondary headache disorder attributed to cervical spine or cervical soft-tissue dysfunction. Cervical proprioceptive impairment has been proposed as one mechanism linking neck pain, impaired head-neck orientation, dizziness, postural instability, and headache burden. However, the evidence base is small and uses heterogeneous measures such as cervical joint-position error, cervical kinaesthetic sense, gaze-direction recognition, sensory discrimination, and posturography.

Objective: To synthesize live-verified evidence published from 1 January 2000 to 30 March 2026 on proprioceptive and sensorimotor-control deficits in cervicogenic headache and on the effects of proprioceptive or sensorimotor rehabilitation.

Methods: A PRISMA 2020-informed systematic-review structure and SWiM-aligned narrative synthesis were used. The search was completed as an open-source verification search rather than a full subscription-database export. Open records were searched and verified through PubMed/MEDLINE-accessible records, Europe PMC, PubMed Central, publisher pages, DOI landing pages, ClinicalTrials.gov, institutional repositories, and open scholarly index pages. At least two independent reviewers were used for study screening, data extraction, and quality assessment. Eligibility required cervicogenic headache plus a proprioception, kinaesthetic, sensorimotor-control, balance, gaze-direction-recognition, sensory-discrimination, or postural-control outcome or intervention. Risk of bias was assessed with RoB 2 for randomized trials and ROBINS-I/JBI-style criteria for non-randomized and comparative studies. Meta-analysis was not performed because of clinical and methodological heterogeneity, incompatible outcome metrics, small samples, incomplete extractable numerical reporting, and possible overlap among related intervention cohorts.

Results: Nineteen open-source records were identified, one companion trial-register record was consolidated, 18 records were screened, 13 reports were assessed for eligibility, and 11 studies were included in narrative synthesis. The included evidence comprised five comparative or observational studies and six randomized or controlled intervention studies. Comparative evidence suggests that some people with cervicogenic headache, particularly those with dizziness or balance disturbance, demonstrate worse cervical proprioceptive or postural-control performance than asymptomatic controls and, in selected conditions, than migraine comparators. Intervention evidence suggests that gaze-direction-recognition training, cervical stabilization, cervical sensorimotor-control training, and laser-guided movement-control training may improve pain, disability, cervical range of motion, gaze-direction-recognition accuracy, pressure pain threshold, postural stability, headache frequency, or headache duration. Certainty was low to very low because samples were small, follow-up was short, intervention and measurement protocols varied, assessor blinding was inconsistent or incompletely reported, and several records lacked complete extractable datasets.

Conclusions: Open-source verified evidence suggests that proprioceptive and sensorimotor-control deficits may be clinically relevant in a subset of patients with cervicogenic headache and that targeted sensorimotor rehabilitation may improve selected symptoms and functional outcomes. The evidence is not strong enough to support proprioception testing as a stand-alone diagnostic discriminator or to claim universal treatment efficacy. Larger preregistered multicentre studies using ICHD-3 diagnosis, standardized proprioception protocols, blinded assessment, longer follow-up, adverse-event reporting, and open datasets are required.

Antibiogram of Salmonella among Internally Displaced Persons in Selected States of North-Central Nigeria

2026-05-25T12:52:41+00:00

Salmonella infections remain a major public health concern in developing regions, particularly among vulnerable populations such as Internally Displaced Persons (IDPs) in North-Central Nigeria. However, there is limited location-specific data on antimicrobial susceptibility patterns of Salmonella in IDP settings within this region. This study investigated the antimicrobial susceptibility patterns (antibiogram) of Salmonella isolates obtained from IDP camps in Benue, Nasarawa, and Plateau States. Standard microbiological techniques were employed, including the Kirby–Bauer disc diffusion method in accordance with Clinical and Laboratory Standards Institute (CLSI) guidelines. Additionally, Extended-Spectrum β-Lactamase (ESBL) production was detected using double-disc synergy and confirmatory tests. A total of 27 isolates from the three study locations demonstrated varying susceptibility patterns. Ciprofloxacin consistently showed the highest effectiveness, with sensitivity rates ranging from 87.5% to 90%, followed by ceftriaxone and norfloxacin. Conversely, high resistance was observed against commonly used antibiotics such as ampicillin (77.8–87.5%) and tetracycline (66.7–75%). Moderate resistance levels were also recorded for co-trimoxazole, gentamicin, and amoxicillin. Notably, 37.0% of the isolates were confirmed as ESBL producers, indicating the presence of advanced resistance mechanisms. The findings highlight a growing burden of multidrug-resistant Salmonella strains in IDP settings, driven by poor sanitation, overcrowding, and indiscriminate antibiotic use. This study underscores the importance of continuous surveillance and the use of evidence-based antibiograms to guide effective treatment strategies in resource-limited environments.

Roentgenographic Carpal Morphometry: Assessment of Sex- and Age-Related Variations in Normative Posteroanterior Wrist Radiographic Measurements among Adult Nigerians

2026-05-27T10:08:16+00:00

Background: In orthopedic surgery, accurate anthropometric measurements of the carpal bones is essential for the correction of post-traumatic deformities during corrective osteotomies. Likewise, accurate radiographic evaluation of carpal bone dimensions plays a critical role in the diagnostic assessment of carpal collapse syndromes observed in conditions such as Kienböck’s disease and rheumatoid arthritis. Despite the clinical relevance of these carpal parameters, limited normative radiographic data exist for the adult Nigerian population. This study, therefore, aimed to establish population-specific normative reference values for carpal bone dimensions based on posteroanterior wrist radiographs in adult Nigerians.

Methods: This retrospective observational study utilized 201 posteroanterior wrist radiographs archived in the Radiology Department of Delta State University Teaching Hospital, Oghara, Nigeria. Measurements of carpal height, lunate width, capitate length, and the scapholunate gap were obtained from the eight carpal bones using the Picture Archiving and Communication System (PACS). Data were analyzed using SPSS version 25. Sex-related differences were assessed using the independent-samples t-test, while age-group variations were evaluated with one-way ANOVA. Pearson’s correlation analysis was employed to determine associations among measured carpal parameters. A p-value ≤ 0.05 was considered statistically significant.

Results: Obtained mean values for carpal height (3.215 cm), capitate length (2.153 cm), lunate width (14.032 mm), and scapholunate gap (0.202 cm), reflected a pronounced range of sex variation with males exhibiting significantly larger mean values. Age-specific analysis of mean values across the five age groups showed minimal variation in carpal bone dimensions, with carpal height ranging from 3.19 to 3.24 cm, capitate length from 2.144 to 2.157 cm, lunate width from 14.003 to 14.143 mm, and the scapholunate gap from 0.195 to 0.207 cm. Corresponding p-values for all inter-group comparisons exceeded 0.05 in all parameters, indicating no statistically significant differences attributable to age.

Conclusion: This study reveals marked sexual dimorphism alongside a high degree of age-independent consistency in adult carpal morphometric parameters. These outcomes hold important implications for forensic identification, anthropometric investigations, orthopedic decision-making, and radiologic assessment. Moreover, the findings enrich the existing repository of population-specific skeletal data in Delta State, building on prior regional anatomical research and enhancing the accuracy of clinical and forensic interpretations.

Awareness and Determinants of Excessive Screen-time among Secondary School Students in Osisioma-Ngwa LGA, Abia State, Nigeria

2026-06-04T09:46:57+00:00

Background: Excessive screen-time has emerged as a significant public health concern among adolescents due to its association with adverse physical, mental, and social health outcomes. Despite increasing access to digital devices among Nigerian youths, evidence on awareness of screen-time-related health consequences and its influence on usage behaviour remains limited, particularly in secondary school settings.

Objective: This study assessed the level of awareness of the health consequences of excessive screen-time, patterns of screen use, and factors influencing screen-time among secondary school students in Osisioma-Ngwa Local Government Area, Abia State, Nigeria.

Methods: A cross-sectional descriptive survey was conducted among 276 students selected through stratified proportional random sampling from one public and one private secondary school. Data were collected using a structured self-administered questionnaire covering socio-demographic characteristics, screen-time patterns, awareness of health consequences, information sources, and barriers to screen-time reduction. Data were analysed using descriptive statistics, chi-square tests, and binary logistic regression at a significance level of p < 0.05.

Results: Smartphone ownership was high (87.2%), and 54.4% of respondents reported high screen-time, with 25.8% spending more than five hours daily on non-academic activities. Social media was the predominant purpose of screen use (41.1%). Most students were aware of the physical (71.7%) and mental/social (67.8%) health consequences of excessive screen-time, while 42.4% demonstrated good overall awareness. Commonly recognised consequences included eye strain (76.8%), poor concentration (75.4%), reduced face-to-face interaction (70.6%), and anxiety or stress (68.4%). Internet/social media (63.1%) and teachers (50.9%) were the primary sources of information. Entertainment (55.2%), social connectivity (48.5%), and peer influence (43.7%) were the major barriers to reducing screen-time. A significant association was observed between awareness level and screen-time duration (χ² = 7.622, p = 0.022); however, awareness was not an independent predictor of lower screen-time in logistic regression analysis (AOR = 0.90, 95% CI: 0.28–2.93, p = 0.867). Female students were significantly less likely to engage in high screen-time than males (AOR = 0.45, 95% CI: 0.26–0.78, p = 0.004).

Conclusion: Excessive screen-time is prevalent among secondary school students despite relatively high awareness of its health consequences. Awareness alone is insufficient to drive behavioural change. Comprehensive interventions emphasising digital wellness skills, parental involvement, self-regulation, and attractive offline recreational alternatives are required to promote healthier screen-use behaviours among adolescents.

Mental Health of Healthcare Workers during Crises: Insights from Systems Engineering

2026-06-05T13:43:05+00:00

Background: Healthcare workers (HCWs) experience substantial occupational stress and psychological strain during crises, which can compromise both their well-being and the quality of patient care. This study examined the mental health of healthcare workers during crises, guided by a Systems Engineering Initiative for Patient Safety (SEIPS) framework. The study addressed five research questions and one null hypothesis tested at 0.05 level of significance.

Methods: A mixed-methods research design informed by human factors engineering principles was employed. The study was conducted in selected public and private healthcare facilities in Anambra State, Nigeria, including tertiary hospitals, general hospitals, private/mission hospitals, and Primary Health Centres. A multistage sampling procedure yielded a sample of 100 healthcare workers, including physicians, nurses, allied health professionals, and administrators. Data were collected using a structured questionnaire, semi-structured interviews, and focus group discussions. The questionnaire measured work-related stressors, psychological well-being, mental health support utilisation, and organisational support, with reliability coefficients ranging from 0.76 to 0.86. Quantitative data were analysed using descriptive statistics and multiple regression analysis, while qualitative data were analysed using thematic analysis guided by the SEIPS framework.

Results: The findings revealed that healthcare workers experienced significant work-related stressors during crises, including increased workload, staff shortages, fear of infection, and rapidly changing procedures. Moderate levels of emotional exhaustion and anxiety were observed among participants. Mental health support services were poorly utilised. Multiple regression analysis indicated that work-related stressors, mental health support utilisation, and organisational/system-level support significantly predicted psychological well-being, with organisational support emerging as the strongest predictor.

Conclusion: The study highlights that healthcare workers’ psychological well-being during crises is shaped by complex interactions among task demands, organisational structures, environmental risks, and individual coping factors within healthcare work systems. The findings emphasise the need for systems-based interventions, including supportive leadership, workload management, and accessible mental health services, to strengthen healthcare workforce resilience during future crises.

The ‘Digital Phantom Limb’ Phenomenon and Bedside Clinical Competency among Nursing Students at Kaduna State College of Nursing Sciences, Kafanchan Campus: A Descriptive Study

2026-06-06T12:29:03+00:00

Background: The pervasive integration of smartphones into nursing education has given rise to a phenomenon termed the “digital phantom limb”—a psychological and tactile dependence on the device characterised by phantom vibrations, compulsive checking urges, and separation anxiety. While nomophobia and smartphone addiction are widely documented, no prior study has examined this specific construct as a form of smartphone-dependent learning or its empirical relationship with multidimensional bedside clinical competence.

Objective: This study aimed to (1) quantify the prevalence and intensity of the digital phantom limb phenomenon, (2) determine the level of bedside clinical competency, and (3) examine the direction and strength of the relationship between the two among nursing students at Kaduna State College of Nursing Sciences, Kafancan Campus, Nigeria.

Methods: A descriptive correlational design was employed. A total of 162 ND I and ND II nursing students were recruited via proportionate stratified random sampling from a population of 283. Smartphone-dependent learning was measured using the Smartphone Addiction Scale–Short Version (SAS-SV; Kwon et al., 2013). Bedside clinical competency was assessed via self‑report using the adapted Clinical Competency Questionnaire (CCQ‑N), which evaluates physical assessment, procedural accuracy, clinical decision‑making, and documentation.

Results: The digital phantom limb phenomenon was highly prevalent, with 61.8% of students scoring above the gender-specific SAS-SV threshold. The mean SAS-SV score was 32.42 (SD = 9.84). Overall clinical competency was moderate (M = 128.73, SD = 24.56), with the lowest ratings in advanced clinical decision-making (59.2% of maximum). A statistically significant, moderate negative correlation was found between the digital phantom limb score and total clinical competency (r = -0.47, p < 0.001). Regression analysis revealed that smartphone-dependent learning independently accounted for 22.1% of the variance in bedside clinical competency (R² = 0.221, β = -0.47, p < 0.001).

Conclusion: The digital phantom limb phenomenon is endemic among nursing students and is inversely associated with self‑reported clinical competence, particularly in the domain of clinical decision‑making. These findings, based on self‑reported competency, provide robust evidence for integrating digital wellness interventions into nursing curricula to safeguard patient safety and enhance bedside care. Future research should incorporate objective competency assessments-including Objective Structured Clinical Examinations (OSCEs), preceptor evaluations, and direct clinical observation-to validate the observed associations and establish the magnitude of the relationship with actual patient care performance.

Annona muricata Ethanolic Leaf Extract Attenuates Dexamethasone Induced Oxidative Stress, Dyslipidemia and Hepatotoxicity in Rats through Upregulation of Endogenous Antioxidant Enzymes and Lipid Profile Normalization

2026-06-12T12:14:22+00:00

Background: The therapeutic use of dexamethasone is often associated with adverse effects such as oxidative stress, dyslipidemia, and hepatotoxicity, primarily due to the generation of reactive oxygen species and disruption of metabolic homeostasis. Natural plant‑based antioxidants have gained attention for their potential to mitigate these complications.

Aim: This study aimed to evaluate the protective effects of ethanolic leaf extract of Annona muricata against dexamethasone‑induced oxidative stress, lipid abnormalities, and liver dysfunction in Wistar rats.

Methodology: Thirty adult male Wistar rats were randomly divided into five groups (n = 6). Group I served as the normal control (normal saline). Group II received dexamethasone (1 mg/kg, i.p.) to induce oxidative and metabolic disturbances. Groups III, IV and V were co‑treated with dexamethasone (1 mg/kg, i.p.) plus graded doses (100, 200, and 400 mg/kg, orally) of Annona muricata ethanolic leaf extract, respectively. Treatments were administered for 14 consecutive days. Biochemical analyses were conducted to assess oxidative stress markers (malondialdehyde, nitric oxide, reduced glutathione), antioxidant enzymes (superoxide dismutase, catalase, glutathione peroxidase), lipid profile (total cholesterol, triglycerides, low‑density lipoprotein), and liver function enzymes (alanine aminotransferase, aspartate aminotransferase).

Results: Dexamethasone administration significantly increased oxidative stress markers, lipid profile indices, and liver enzyme levels, while significantly reducing antioxidant enzyme activities (p < 0.05). Treatment with Annona muricata extract significantly and dose‑dependently reversed these effects by reducing malondialdehyde and nitric oxide levels, enhancing antioxidant enzyme activities, improving lipid profile parameters, and restoring liver enzyme levels toward normal.

Conclusion: The ethanolic leaf extract of Annona muricata exhibits potent antioxidant, hypolipidemic, and hepatoprotective effects against dexamethasone‑induced toxicity, likely mediated through enhancement of endogenous antioxidant defense systems and normalization of lipid metabolism. These findings support its potential as a natural therapeutic agent for managing glucocorticoid‑induced metabolic and hepatic disorders.

The Importance of the Two-way Referral System in Healthcare Delivery: A Survey of Oju Local Government Area, Benue State, Nigeria

2026-06-22T06:00:04+00:00

The two-way referral system is a bidirectional mechanism that enables patients to move between levels of healthcare according to clinical need and return to the originating provider with relevant feedback for continued management. This study examined the importance of the two-way referral system in healthcare delivery in Oju Local Government Area of Benue State, Nigeria. A descriptive survey design was adopted. Six health facilities were randomly selected from the study area, and 20 respondents were drawn from each facility, giving a total sample of 120 health workers. Data were collected with structured questionnaires based on four research questions and analysed using frequency tables, simple percentages and pie charts. The findings showed strong agreement among respondents regarding the value of the two-way referral system. Specifically, 110 respondents (91.7%) agreed that it enhances continuity of care, 114 respondents (95.0%) agreed that it facilitates good patient outcomes, 115 respondents (95.8%) agreed that it promotes proper feedback between facilities, and 112 respondents (93.3%) agreed that it reduces patient mortality rates. These findings indicate that health workers in Oju LGA perceive the two-way referral system as an important component of coordinated healthcare delivery, particularly in a rural context where primary healthcare workers often serve as the first point of patient contact. The study concludes that effective implementation of bidirectional referral processes can support continuity, communication and timely access to appropriate care. It recommends prompt referral of cases beyond primary-level competence, consistent feedback from receiving facilities, and institutionalised referral protocols for emergency and high-risk cases.

Prevalence of Text Neck Syndrome and Its Impact on Workplace Productivity and Activities of Daily Living among the Digital Workforce: A Cross-sectional Study

2026-06-22T09:18:46+00:00

Background: The increasing reliance on smartphones, laptops and desktop computers has increased prolonged screen exposure and sustained forward head posture among digital device users. Text Neck Syndrome (TNS) is commonly associated with neck pain, stiffness, muscular strain and functional limitation; however, its combined influence on workplace productivity and activities of daily living among the digital workforce remains insufficiently documented.

Aim: This study aimed to determine the prevalence of TNS and evaluate its impact on workplace productivity and activities of daily living among digital device users.

Methods: A cross-sectional observational study was conducted among 300 participants aged 18-45 years who used digital devices for at least 4 hours daily. The sample included students, IT professionals, office workers and other digital workers. Data were collected using a structured self-administered questionnaire and standardised assessment tools, including the Neck Disability Index, Visual Analogue Scale, Work Productivity and Activity Impairment Scale and Activities of Daily Living Scale. Descriptive and inferential statistical analyses were performed.

Results: Participants were predominantly aged 18-25 years (40.0%), followed by 26-35 years (36.7%) and 36-45 years (23.3%). Male participants constituted 56.7% of the sample. Students formed the largest occupational group (40.0%), followed by IT professionals (30.0%), office workers (20.0%) and other digital workers (10.0%). Neck pain was reported by 240 participants (80.0%), and forward head posture was present in 225 participants (75.0%). Participants with prolonged screen exposure and poor ergonomic practices showed greater pain severity, higher neck disability, reduced concentration, decreased work efficiency and greater difficulty in daily activities.

Conclusion: TNS was common among the digital workforce and was associated with impaired workplace productivity and activities of daily living. Ergonomic education, posture correction, regular breaks and preventive physiotherapy strategies may help reduce its functional burden.

Therapeutic Effect of Ethanolic Extract of Zingiber officinale (Ginger Rhizomes) on Selected Biochemical Parameters and Some Electrolytes in Male Wistar Rats

2026-06-27T11:14:09+00:00

This study evaluated the effect of ethanolic extract of Zingiber officinale (ginger rhizomes) on selected biochemical parameters and electrolytes in male Wistar rats. Twenty healthy adult male Wistar rats weighing about 150 g were randomly assigned to four groups of five rats each. Group 1 served as the control and received standard feed and distilled water. Groups 2, 3 and 4 received ethanolic extract of Zingiber officinale orally at low, medium and high doses, corresponding to 50 mg/kg, 100 mg/kg and 200 mg/kg, respectively, alongside normal feed. The animals were maintained under a 12 h light/dark cycle and sacrificed on day 29, after which blood samples were collected for serum analysis. Total cholesterol, triglycerides, HDL-C, LDL-C, VLDL-C, AST, ALT, ALP and selected electrolytes were evaluated. The 200 mg/kg ginger-treated group showed significant reductions in total cholesterol, triglycerides and VLDL-C compared with the control group. HDL-C was significantly reduced in the 100 mg/kg and 200 mg/kg groups, while LDL-C increased significantly at 100 mg/kg and decreased at 200 mg/kg compared with the 100 mg/kg group. AST was significantly reduced only at 200 mg/kg, while ALT was significantly reduced at 50 mg/kg and 200 mg/kg. ALP increased significantly at 50 mg/kg and 200 mg/kg. Sodium, potassium and bicarbonate were not significantly altered, whereas calcium decreased significantly at 200 mg/kg.

Bridging the Knowledge - practice Gap in Emergency Care at the Primary Healthcare Level: Evidence from Ahafo Ano North Municipality, Ghana

2026-07-04T10:15:07+00:00

Emergency care at the primary healthcare level is essential for the timely assessment, stabilisation, and referral of patients with acute illnesses and injuries, particularly in rural settings where access to higher-level facilities may be delayed. This study examined emergency care knowledge, confidence, training exposure, and perceived system barriers among nursing professionals in Ahafo Ano North Municipality, Ghana. A descriptive cross-sectional design was used to collect quantitative data from 224 nurses working in primary healthcare facilities, including health centres and Community-Based Health Planning and Services compounds. Participants were selected through convenience sampling from a municipal nursing population of 246. Data were collected using a structured questionnaire and analysed using IBM SPSS Statistics version 27 and R version 4.3.1. Descriptive statistics and inferential analyses were used to summarise participant characteristics and explore associations among emergency care knowledge, confidence, training exposure, and related factors. The mean age of participants was 31.53 years, indicating a predominantly young nursing workforce. Participants reported moderate-to-high emergency care knowledge, with a mean score of 3.44 and a standard deviation of 0.49. Confidence in managing emergency cases was moderate, with a mean score of 2.86 and a standard deviation of 0.66. Male participants reported significantly higher knowledge scores than female participants, while confidence levels did not differ significantly by gender. Commonly encountered emergencies included trauma-related accidents, obstetric emergencies, paediatric emergencies, and cardiac emergencies. Reported barriers included staff shortages, inadequate emergency equipment, limited training, delayed access to specialist care, communication challenges, and limited management support. The findings suggest that improving emergency care at the primary healthcare level requires structured training, regular drills, adequate staffing, essential equipment, strengthened referral systems, and supportive supervision.

Rituximab Infusion-Related Reactions in Routine Clinical Practice: A Retrospective Pharmacovigilance Study from Iraq

2026-07-07T06:34:55+00:00

Background: Rituximab (RTX) is widely used for autoimmune and haematological diseases, but infusion-related adverse drug reactions (ADRs) remain a clinically important safety concern in routine care.
Aim: This retrospective pharmacovigilance study described rituximab-associated adverse drug reactions reported at Marjan Teaching Hospital, Iraq, over a six-month period.

Methods: Data were collected from routine pharmacovigilance reports and medical records for patients with suspected rituximab-associated adverse drug reactions from January to 10^th June 2026. Extracted variables included demographic characteristics, underlying diagnosis, clinical manifestations, seriousness, management, outcomes, and causality assessment. Causality was assessed using the World Health Organization–Uppsala Monitoring Centre (WHO-UMC) system, and descriptive statistics were performed using GraphPad Prism version 10.0.

Results: Among 312 rituximab infusions, 56 patients experienced documented adverse drug reactions, yielding an incidence of 17.9% (95% CI: 13.8–22.5%). Most patients were female (96.4%), and the mean age was 42.8 years. Rheumatoid arthritis was the most common underlying diagnosis (64.3%), followed by systemic lupus erythematosus (25.0%). Shortness of breath, itching, and cough were the most frequently reported manifestations, while 50.0% of reactions were classified as serious. Most reactions were considered probable/likely by WHO-UMC assessment. All patients recovered, and rituximab was resumed at a slower infusion rate in 85.7% of cases.

Conclusion: The findings support careful infusion monitoring, prompt recognition of symptoms, and structured pharmacovigilance reporting to improve patient safety during rituximab therapy.

Nurses Knowledge and Perception on Patient Acuity Tool and Their Relationship with Self-assessed Patient Outcomes in Houston, Texas, United States of America

2026-07-08T07:14:19+00:00

This study assessed registered nurses’ knowledge and perceptions of the Patient Acuity Tool (PAT) and examined their relationship with self-assessed patient outcomes in acute care settings in Houston, Texas, United States. A quantitative descriptive-comparative-correlational design was used. The study included 415 registered nurses from four acute care hospitals selected through convenience sampling. Data were collected using a structured questionnaire covering demographic and professional characteristics, PAT knowledge, perceptions of tool use, and self-assessed patient outcomes. The instrument demonstrated acceptable content validity (Aiken’s V = 0.77) and excellent internal consistency (Cronbach’s alpha = 0.940). Data were analysed using frequency, percentage, mean, standard deviation, independent-samples t-test, one-way analysis of variance, and Pearson product-moment correlation, with statistical significance set at p < 0.05. The findings showed limited overall knowledge of PAT use, with an overall knowledge score of 46.1%. Nurses were more accurate in identifying acuity in clear safety-related scenarios than in complex postoperative or specialised clinical situations. Respondents reported a neutral perception of PAT (overall mean = 3.31), while self-assessed patient outcomes were rated favourably (overall mean = 3.41). Significant differences were found according to years of nursing experience, perception of tool use, and self-assessed patient outcomes. Perception of PAT was positively associated with self-assessed patient outcomes, whereas knowledge showed weak negative correlations with perceptions and self-assessed outcomes. The findings indicate the need for targeted training, mentorship, and organisational support to improve consistent and effective use of acuity-based staffing tools.

Lifestyle and Reproductive Risk Factors Associated with Cervical Dysplasia among Women in Rivers State, Nigeria

2026-07-10T11:05:49+00:00

Background: Cervical dysplasia remains an important preventable precursor of cervical cancer, particularly in low- and middle-income settings where screening uptake, early detection, and follow-up care remain uneven. Lifestyle behaviours and reproductive exposures may contribute to cervical abnormalities by influencing infection exposure, immune response, health-seeking behaviour, and persistence of cervical risk conditions.

Objective: This study examined lifestyle and reproductive risk factors associated with cervical dysplasia among women attending selected clinics at the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria.

Methods: A descriptive cross-sectional survey design was adopted. The study population comprised women aged 20–60 years attending selected clinics at the University of Port Harcourt Teaching Hospital. A sample of 384 women was selected using a simple random sampling technique. Data were collected using a structured questionnaire and cervical screening procedures, including Visual Inspection with Acetic Acid and Pap smear cytology. The instrument was validated by experts, while reliability was determined through the test–retest method, which yielded a coefficient of 0.79. Data were analysed using SPSS version 27. Frequencies, percentages, chi-square tests, and binary logistic regression were applied at the 0.05 level of significance.

Results: The findings showed that the type of sexually transmitted infection (p < .001), HIV status (p < .001), smoking status (p = .013), and family history of cervical cancer (p = .022) were significantly associated with cervical dysplasia, whereas occupation (p = .603) and alcohol consumption (p = .553) were not significantly associated with the condition. In the adjusted lifestyle model, smoking status (p = .049) and type of sexually transmitted infection (p = .012) significantly predicted cervical dysplasia. Among reproductive factors, parity (p = .010), age at first childbirth (p = .034), age at first intercourse (p < .001), and number of sexual partners (p = .003) were significantly associated with cervical dysplasia. In the adjusted reproductive model, only age at first intercourse remained a significant predictor (p = .015).

Conclusion: Cervical dysplasia among women in Rivers State was associated with selected lifestyle and reproductive risk factors, particularly sexually transmitted infection type, HIV status, smoking exposure, family history of cervical cancer, parity, age at first childbirth, age at first intercourse, and number of sexual partners. Cervical screening services should incorporate risk assessment, counselling on modifiable exposures, strengthened sexually transmitted infection management, and follow-up care for women with identified risk factors.

Effect of Sociodemographic Factors on Uptake of Intermittent Preventive Treatment for Malaria at Antenatal Clinics at Primary Health Centers in Orlu Zone, Nigeria

2026-07-18T12:42:42+00:00

Background: Intermittent preventive treatment in pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) reduces malaria-related risks, but completion of the recommended dosing schedule remains suboptimal.

Aim: This study assessed the influence of sociodemographic factors on IPTp-SP uptake among women attending antenatal clinics at primary health centres in Orlu Zone, Imo State, Nigeria.

Methods: A facility-based, cross-sectional descriptive study was conducted among 400 pregnant women attending 33 primary health centres. Eligible participants were selected purposively and followed across antenatal visits. Data were collected using a semi-structured, interviewer-administered questionnaire and summarised using frequencies, percentages, tables, and charts. Associations were assessed using the chi-square test at a 5% significance level.

Results: Of the 400 participants, 280 (70.0%) received at least one dose of IPTp-SP, whereas 120 (30.0%) received none. Overall, 114 (28.50%) received one dose, 99 (24.75%) received two doses, and only 67 (16.75%) received three or more doses. Among recipients, the largest proportions were aged 30–39 years (41.79%), had completed senior secondary education (37.50%), had parity of 2–4 (39.64%), attended antenatal care at least four times (41.07%), had husbands with senior secondary education (38.21%), and belonged to husband wealth-index class 3 (45.00%). Husband’s apathy was the most frequently reported reason for non-uptake (61.67%).

Conclusion: Although initiation of IPTp-SP was relatively common, optimal-dose completion was low. Improving regular antenatal attendance, health education, drug availability, directly observed administration, and constructive male-partner engagement may strengthen uptake.