Asian Journal of Medicine and Health

Revolutionizing Medical Education in Kenya: Insight from Clinical Officers Training

Gideon Gachihi Githuthi — 2026-09-14

This narrative review examines challenges and reform priorities in medical education in Kenya, with particular attention to Clinical Officer training and the BSc Clinical Medicine curriculum. It considers persistent gaps between theoretical instruction and practical preparation, including limitations in clinical exposure, critical thinking, innovation, curriculum flexibility, specialisation opportunities, and readiness for changing healthcare demands. The review also considers the relevance of competency-based curriculum principles to tertiary medical training and the extent to which these principles may support a closer connection between educational outcomes and clinical practice. Kuhnian paradigm shifts and Popper’s falsification principle are used as complementary philosophical perspectives for considering curriculum change, continuous evaluation, and evidence-responsive reform. The review discusses the need to balance local and cultural relevance with competencies required in wider healthcare environments. Proposed priorities include mapping the curriculum to relevant national and international competency expectations, strengthening structured clinical experience and interdisciplinary learning, improving feedback and assessment systems, supporting flexible and modular learning pathways, and using pilot projects and research to guide subsequent reforms. The review further emphasises stakeholder participation and periodic evaluation of graduate outcomes. Overall, reform of Clinical Officer education should be evidence-informed, context-sensitive, and implemented progressively, with careful evaluation of whether proposed changes improve practical competence, graduate preparedness, employability, and the responsiveness of medical training to Kenya’s evolving healthcare needs.

Artificial Intelligence-based Pets in Mental Health and Chronic Disease Care: A Critical Narrative Review of Evidence, Mechanisms and Implementation

Rosita Louis — 2026-09-19

Background: Artificial intelligence-based pets have been developed as alternatives to live-animal companionship in settings where allergies, infection control, animal welfare and care demands restrict access to animals. This critical narrative review evaluates evidence on their mental-health and chronic-disease applications, proposed mechanisms and implementation requirements.

Methods: Peer-reviewed studies and authoritative institutional sources were identified through structured searches of biomedical and multidisciplinary scholarly indexes and citation tracking. Randomised and non-randomised trials, systematic reviews, qualitative studies, experimental work and ethical analyses were appraised thematically.

Results: Evidence is most developed in dementia care, where robotic pets can improve short-term engagement and positive affect and may reduce agitation in some residents. Findings for depressive symptoms, cognition, quality of life and sleep remain inconsistent. Community studies suggest potential reductions in loneliness, although many are uncontrolled or rely on self-report or proxy assessment. Evidence in chronic pain, haemodialysis, cancer treatment, haematopoietic stem cell transplantation and persistent post-viral illness remains preliminary and is based mainly on small studies. Experimental findings indicate that interactivity contributes to engagement and some sensory outcomes, while simpler non-interactive comparators can produce overlapping affective effects.

Conclusion: Artificial intelligence-based pets should currently be considered facilitator-supported adjuncts rather than validated standalone treatments. Future research requires adequately powered, longer-term, mechanism-informed studies that address individual preference, cost, equity, privacy, governance and the durability of effects.

Normal Pressure Hydrocephalus: Lessons from Three Patients with Distinct Clinical Outcomes

Adekunle MUSTAPHA — 2026-09-28

Background: Normal pressure hydrocephalus (NPH) is a potentially reversible cause of gait disturbance, cognitive impairment, and urinary dysfunction in older adults. Early recognition and appropriate neurosurgical assessment may improve outcomes in patients who are suitable for intervention. However, clinical presentations may vary, and comorbid neurological and systemic conditions can complicate diagnosis and management. This case series describes three older male patients with clinical and radiological features suggestive of NPH who had distinct clinical trajectories and outcomes.

Methods: This is a retrospective descriptive case study of three patients managed through the Neurology Unit of Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria, between July and November 2025. Clinical records were reviewed for presenting features, neurological examination findings, neuroimaging findings, interventions, and documented outcomes.

Results: Case 1 was a 64-year-old man who presented with the classical triad of gait disturbance, cognitive impairment, and urinary incontinence. Brain MRI demonstrated ventriculomegaly with an Evans index of 0.41. A therapeutic cerebrospinal fluid (CSF) tap was planned but was not performed because the patient defaulted from follow-up. Case 2 was a 67-year-old man with the classical triad, expressive aphasia, and ventriculomegaly with an Evans index of 0.34. MRI also demonstrated the absence of the substantia nigra “swallow-tail” sign. A limited CSF tap yielded 10 mL of CSF because of the patient's restlessness, followed by ventriculoperitoneal shunt placement. His Glasgow Coma Scale score improved from 12/15 to 14/15 at discharge. Case 3 was a 76-year-old man who presented with an acute confusional state and urinary incontinence. Brain CT demonstrated ventriculomegaly with an Evans index of 0.40 alongside chronic cerebrovascular and small-vessel ischaemic changes. His acute presentation was considered multifactorial, with probable coexisting NPH. He received medical management and was subsequently transferred to another tertiary centre for neurosurgical evaluation.

Conclusion: These cases illustrate the heterogeneous clinical presentation of suspected NPH and the diagnostic challenges posed by coexisting neurological and systemic conditions. The cases also highlight the importance of appropriate neuroimaging, clinical assessment, follow-up, and timely neurosurgical evaluation when NPH is suspected. Management should be individualised and undertaken within a multidisciplinary framework.

A Rare Cause of Progressive Spastic Motor Impairment in a Child: Vanishing White Matter Disease Due to Novel EIF2B1 Compound Heterozygosity—A Case Report with Physiotherapy Correlation

Riya Trivedi — 2026-09-04

Background: Leukoencephalopathy with vanishing white matter (VWM), also known as childhood ataxia with central nervous system hypomyelination, is a rare autosomal recessive leukodystrophy caused by pathogenic variants in EIF2B1–EIF2B5; EIF2B1-related disease is comparatively uncommon.

Case Presentation: An 11-year-old girl with essentially normal early development developed progressive loss of motor milestones and spasticity from approximately four years of age. Brain magnetic resonance imaging demonstrated near-symmetrical T2-weighted and FLAIR hyperintensity of the bilateral cerebral white matter with periventricular cystic change, additional involvement of deep grey matter, brainstem and cerebellar grey matter, and diffuse thinning of the corpus callosum. Whole mitochondrial genome sequencing was unremarkable. Clinical exome sequencing identified likely compound heterozygous EIF2B1 variants, c.439C>T (p.Arg147Ter) and c.824A>G (p.Tyr275Cys), supporting a diagnosis of EIF2B1-related VWM. At neuropaediatric physiotherapy assessment, lower-limb-predominant spasticity was evident, with Modified Ashworth Scale grades up to 3 at the knee flexors and ankle plantar flexors, brisk deep tendon reflexes, bilateral extensor plantar responses, bilateral knee flexion contracture, and marked limitation of standing and walking. Gross Motor Function Measure dimension scores were 100% for lying/rolling, 100% for sitting, 63.85% for crawling/kneeling, 19.14% for standing, and 0% for walking/running/jumping. Speech, cognition, and attention remained age-appropriate.

Conclusion: The case demonstrates the complementary diagnostic roles of neuroimaging and molecular testing and the value of structured physiotherapy outcome measures for rehabilitation planning in progressive VWM.

Assessing the Effectiveness of Social Health Authority Maternal Health Services on Maternal Health Care in Nyambene Sub-County Hospital, Kenya

Monica Gakii Maina — 2026-09-01

Background: The Social Health Authority (SHA) was established under the Social Health Insurance Act of 2023 to expand financial protection and improve access to healthcare services in Kenya, including maternal healthcare. However, evidence regarding its effectiveness at the health-facility level remains limited.

Objective: This study assessed the effectiveness of SHA-funded maternal health services at Nyambene Sub-County Hospital (NSCH) in Meru County by examining utilisation of antenatal, delivery and postnatal services, trends in maternal morbidity and mortality, and beneficiary satisfaction.

Methods: A descriptive cross-sectional survey was conducted among women aged 18–49 years who were registered with SHA and had utilised at least one maternal healthcare service at NSCH. Simple random sampling selected 197 participants; 176 completed the study (response rate 89.3%). Data were collected using a structured questionnaire and a checklist to extract morbidity and mortality information from the Digital Health Information System (DHIS). Data were analysed using SPSS, with descriptive statistics, chi-square tests, Cramer’s V and binary logistic regression.

Results: Overall, 91.5% of respondents attended at least one antenatal care (ANC) visit under SHA, although only 23.9% completed more than four visits and 44.9% initiated care in the first trimester. Additionally, 88.1% delivered at NSCH under SHA; 67.1% had normal vaginal deliveries while 23.9% underwent caesarean section. A 12-month review of 2,215 SHA-supported deliveries identified 371 maternal morbidity cases (167.5 per 1,000 deliveries). Anaemia was the leading morbidity (28.6%), followed by urinary tract infections (19.9%), haemorrhage (16.4%) and pre-eclampsia/eclampsia (11.3%). Seven maternal deaths yielded an institutional maternal mortality ratio of approximately 316 per 100,000 live births; postpartum haemorrhage accounted for 71.4% of deaths. Overall beneficiary satisfaction was 71.8%, with skilled birth attendance, confidentiality and affordability rated highly, while labour companionship, emergency waiting times, nursing staff adequacy and facility accessibility received lower ratings.

Conclusion: SHA has improved initial access to maternal healthcare but has not ensured complete continuity of care, comprehensive service availability, or adequate reductions in maternal morbidity and mortality. Strengthening early and complete ANC, diagnostic services, emergency obstetric readiness, anaemia prevention, staffing, timely emergency response and respectful, patient-centred maternity care is recommended.

Association of TCF7/L2 SNPs rs1790314 and rs12255372 Polymorphisms in Type 2 Diabetes Mellitus with Renal and Inflammatory Markers

Idoko Roseline — 2026-09-01

Background: Type 2 diabetes mellitus (T2DM) is a persistent metabolic disorder characterised by elevated blood glucose levels and influenced by both genetic and environmental factors.

Aim: This study investigated the association of TCF7L2 SNPs rs1790314 and rs12255372 with renal and inflammatory markers in type 2 diabetes mellitus.

Methods: This cross-sectional study examined biochemical markers and the TCF7L2 SNPs rs12255372 and rs1790314 in 140 patients with T2DM attending the diabetic clinics of Rivers State University Teaching Hospital (RSUTH) and the University of Port Harcourt Teaching Hospital (UPTH), together with 40 non-diabetic controls. Biochemical parameters, including fasting blood glucose (FBG), HbA1c, C-peptide, insulin, HOMA-IR, cystatin C, estimated glomerular filtration rate (eGFR), creatinine, urea, and electrolytes, were measured using colourimetric and ELISA methods. The TCF7L2 variants were genotyped using BigDye Terminator sequencing. Data on these parameters and the TCF7L2 genotypes were analysed using GraphPad Prism, SPSS, and Excel. Descriptive statistics were presented as means ± SD, while inferential analyses included Student's t-test, Pearson's correlation, linear regression, and one-way ANOVA. Statistical significance was set at p < 0.05.

Results: The study found an increasing prevalence of T2DM in Port Harcourt in recent years, with rates of 23% in males and 21% in females, and a glycaemic control rate of 38.75%. The TCF7L2 genotype distribution showed that 32.5% had the CC genotype and 11.25% had the CT/TT genotypes at rs1790314, whereas 41.25% had the GG genotype and 3.75% had the GT/TT genotypes at rs12255372. Abnormalities such as hyponatraemia, low chloride levels, and hyperkalaemia were observed in patients with poorly controlled T2DM. Physical activity was associated with better cardiovascular health, as indicated by lower cardiac troponin I (cTnI) levels. Standard antidiabetic drugs, including metformin (Glucophage) and sulfonylureas (Amaryl), were associated with dyslipidaemia, particularly in males, characterised by reduced HDL-C and triglyceride levels and increased atherogenic ratios such as TC/TG. An association was also found between chloride levels and the T allele at rs1790314. BMI and WHR did not correlate with the CT/TT polymorphisms at rs1790314 or the GT/TT polymorphisms at rs12255372, although both were higher in individuals with T2DM carrying the TCF7L2 variants. The rs1790314 CT/TT mutation was associated with higher triglyceride, TC/TG, and TC/HDL ratios and lower HDL-C levels. Insulin resistance, indicated by increased C-peptide levels, was observed in rs1790314 CT/TT carriers, while renal abnormalities associated with rs12255372 GT/TT correlated with cystatin C. Overall, TCF7L2 variants were associated with dyslipidaemia, elevated cystatin C, and increased C-peptide levels. Patients with mutant T alleles in both variants had significantly higher HbA1c, WHR, BMI, lipid, atherogenic marker, and troponin I levels.

Conclusion: The findings suggest that increased insulin resistance and impaired cellular uptake occurred alongside significantly higher C-peptide levels in individuals with the CT/TT polymorphic variants of transcription factor 7-like 2 (TCF7L2) rs1790314. Furthermore, renal abnormalities were associated with the TCF7L2 rs12255372 GT/TT polymorphic variant, which was positively associated with cystatin C in participants with type 2 diabetes mellitus (T2DM) who expressed TCF7L2.

Effect of Palm Kernel Oil on Plasma Sodium, Potassium and Chloride in Wistar Rats Induced with Febrile Seizures

Ngozi Brisibe — 2026-09-01

Background: Fever plays an important role in causing disturbances in fluid and electrolyte balance. Hyponatraemia has been thought to enhance susceptibility to seizures associated with febrile illnesses in childhood. Severe hyponatraemia and a non-significant increase in potassium have been reported among children with convulsions attending a paediatric clinic. Electrolyte derangements are commonly encountered in daily clinical practice, and their diagnosis relies on laboratory findings. Complications of electrolyte derangements can range from simple dizziness to severe complications, such as brain damage, heart failure, and neurological manifestations including seizures that require emergency treatment.

Aim: This study evaluated whether palm kernel oil (PKO) alters plasma sodium, potassium, and chloride concentrations in Wistar rats with experimentally induced febrile seizures.

Material and Methods: Forty (40) Wistar rat pups were allocated into eight (8) groups of five (5) rats each. Group A was not induced and received normal saline (negative control). Group B was induced with seizures and received normal saline (positive control). Group C was induced with seizures and treated with the standard drug, diazepam (10 mg/kg), as described by Wang et al. (2018). Groups D, E, F, and G were induced with seizures and treated with 5, 10, 15, and 20 mg/kg of palm kernel oil, respectively. Group H was pre-treated with 5 mg/kg palm kernel oil for three days and then induced with a seizure on the fourth day. Data were analysed using GraphPad Prism version 8.02 (California, USA). Analysis of variance (ANOVA) and Tukey’s comparative analysis were used to compare group means. Results were expressed as mean ± standard deviation. Statistical significance was set at p < 0.05.

Results: The results for potassium, chloride, and sodium indicated no significant differences in the concentrations of these electrolytes in either the pre-treated or post-treated rats with induced seizures.

Conclusion: Palm kernel oil administered before and after seizure induction did not significantly change sodium, potassium, or chloride concentrations in rats receiving 5 mg/kg PKO as pre-treatment and 5–20 mg/kg in the post-treatment groups. The maintenance of these electrolyte concentrations may be related to the antioxidant and anti-inflammatory properties of PKO through damage-associated signalling when given prophylactically, possibly by modulating cellular resilience or baseline inflammatory priming.

Crystalloid Coloading Versus Preloading for Prevention of Hypotension After Spinal Anaesthesia in a Mixed Adult Surgical Population: A Prospective Quasi-Randomised Comparative Study

Bolanle Adeola Oladele — 2026-09-04

Background: Hypotension is a frequent complication of spinal anaesthesia. Crystalloid preloading and coloading are commonly used fluid strategies, but evidence from mixed surgical populations in sub-Saharan Africa is limited.

Methods: This prospective quasi-randomised comparative study was conducted at Bowen University Teaching Hospital, Ogbomoso, Nigeria, from June to August 2025. Ninety-two adults aged 18 to 60 years with American Society of Anesthesiologists physical status I or II were assigned by odd or even surgical-list order to receive 500 mL of 0.9% saline either before spinal anaesthesia (preloading, n = 46) or immediately after intrathecal injection (coloading, n = 46). The primary outcome was any episode of post-spinal hypotension within 60 minutes, defined as absolute systolic blood pressure below 90 mmHg. Unadjusted risk ratios and absolute risk differences were calculated from the reported aggregate counts.

Results: Post-spinal hypotension occurred in 15 of 46 patients (32.6%) in the coloading group and 25 of 46 patients (54.3%) in the preloading group. The unadjusted risk ratio was 0.60 (95% confidence interval 0.37 to 0.98), and the absolute risk difference was -21.7 percentage points (95% confidence interval -39.6 to -1.5). Rescue ephedrine was administered to 14 patients (30.4%) after coloading and 25 patients (54.3%) after preloading, corresponding to an unadjusted risk ratio of 0.56 (95% confidence interval 0.34 to 0.93). The reported systolic blood pressure series was broadly similar between groups at most time points, but patient-level repeated-measures analysis was not available.

Conclusion: In this single-centre quasi-randomised study, crystalloid coloading was associated with fewer observed episodes of post-spinal hypotension and less rescue ephedrine use than preloading. Predictable allocation, baseline heterogeneity, limited sample size and absence of adjusted and repeated-measures analyses restrict causal interpretation.

Perceived Barriers to Immunization and Effective Strategies for Improving Uptake among Parents and Caregivers in Yobe State, Nigeria

Dauda Bukar Dauda — 2026-09-04

Introduction: Immunisation as a public health intervention has proven to be one of the most effective methods of controlling and eliminating life-threatening infectious diseases that cause morbidity and mortality among infants and children. Despite its availability and effectiveness, many children remain unvaccinated and vulnerable to infectious diseases because of vaccine hesitancy and other barriers in many low-income countries. Thus, this study investigates barriers to immunisation among parents and caregivers and effective strategies for improving uptake and coverage in Yobe State, Nigeria.

Method: A qualitative study comprising Focus Group Discussions (FGDs) and Key Informant Interviews (KIIs) was conducted with mothers, fathers, caregivers, religious and traditional leaders, health workers, Ward Development Committee members, and community influencers in six selected wards across three Local Government Areas in Yobe State, Nigeria. Participants were purposively selected to capture different perspectives on barriers to immunisation and to identify effective strategies for improving uptake and coverage in the study areas.

Results: Barriers to immunisation identified in the study included fear of side effects, family opposition, transport and accessibility challenges, religious and cultural beliefs, long queues and waiting times, and health workers’ attitudes towards parents and caregivers. Community awareness and education, the involvement of traditional and religious leaders, immunisation defaulter tracking, the organisation of immunisation outreach services, and the provision of cash and non-cash incentives were the strategies found to be effective in improving coverage in the communities.

Conclusion: Findings from the study show the need for government commitment to providing and upgrading health facilities in the communities. Collaboration among stakeholders, policymakers, and community leaders is also needed to educate parents and caregivers and raise awareness of the importance and benefits of immunisation.

Design, Development, and Characterization of Luliconazole-loaded Bilosomal Gel for Enhanced Cutaneous Delivery

Deepak Prashar — 2026-09-04

Luliconazole (LZ) is a broad-spectrum antifungal agent whose topical performance is limited by poor aqueous solubility and restricted skin penetration. This study aimed to develop and characterise LZ-loaded bilosomes incorporated into a topical gel to enhance cutaneous delivery. Eight bilosomal formulations were prepared by thin-film hydration using soy phosphatidylcholine, cholesterol and Span 80, followed by incorporation of the optimised bilosomal suspension into a Carbopol/HPMC gel. The formulations were assessed for particle size, polydispersity, zeta potential, entrapment efficiency, morphology, in vitro drug release, skin permeation, antifungal activity and stability. BLS-6 showed a particle size of 187.45 ± 5.12 nm, a PDI of 0.289 ± 0.042 and an entrapment efficiency of 86.34 ± 3.21%. The vesicles showed spherical, well-defined morphology without noticeable aggregation or visible drug crystals. At 24 h, BLS-6 released 71.23 ± 3.45% of the encapsulated drug, compared with 94.12 ± 2.89% from the free drug. Skin permeation flux was 45.23 ± 2.89 μg/cm²/h versus 18.67 ± 1.45 μg/cm²/h for the control gel. The bilosomal gel showed MIC values of 2.5, 3.1 and 2.8 μg/mL against Candida albicans, Aspergillus niger and Trichophyton mentagrophytes, respectively. After 8 weeks, drug retention was 91.34 ± 2.45% at 25°C/60% RH and 85.67 ± 3.12% at 40°C/75% RH. These findings support further evaluation of the LZ-loaded bilosomal gel as a controlled topical delivery system.

Assessment of Air Quality Index in Port Harcourt Metropolis, Rivers State

Okongko Aniefiok Dickson — 2026-09-07

Background: The Air Quality Index (AQI) is a measure of the level of air pollution. Its assessment is important in urban and industrial regions, where rapid development increases emissions from vehicles, factories and other sources, leading to detrimental environmental and health outcomes. This study assessed the AQI in selected areas of Port Harcourt Metropolis, Rivers State.

Methods: The research employed a cross-sectional design. An air-quality monitoring device was used to measure the AQI in selected areas of Port Harcourt Metropolis over one year. All ethical procedures were followed. Approval for the study was obtained from the University of Port Harcourt Research Ethics Committee (UPH/CEREMAD/REC/MM91/067). Data were analysed using the Statistical Package for the Social Sciences (SPSS), version 25. Descriptive statistics, including frequencies and percentages, were calculated, and inferential statistics were performed using the chi-square test. A p-value of ≤ 0.05 was considered statistically significant.

Results: The study recorded variation in air-quality parameters across the six locations. Statistically significant differences were observed in PM₁.₀, PM₂.₅ and PM₁₀ concentrations across the study areas, with p-values of 0.003, 0.003 and 0.002, respectively. Unhealthy carbon monoxide levels were reported in Elekahia and Rumukurushi, and relative humidity was above the stated acceptable limit in these locations. Ambient temperature and noise levels were reported as moderate and within the acceptable limit.

Conclusion: Unhealthy levels of particulate matter, carbon monoxide and relative humidity were observed in different parts of Port Harcourt Metropolis. These findings indicate the need for localised air-quality management strategies and prompt action by policymakers and urban planners to mitigate pollution sources and protect public health in Port Harcourt Metropolis and its environs.

Assessment of Tuberculosis Preventive Therapy (TPT) Uptake among Healthcare Workers at Meru Teaching and Referral Hospital, Kenya: Barriers and Recommendations

Lilian Kinya Kinyua — 2026-09-10

Background: Healthcare workers (HCWs) in high-burden tuberculosis (TB) settings face elevated occupational risk of latent TB infection (LTBI). Although Tuberculosis Preventive Therapy (TPT) reduces progression risk by 60–90%, uptake among Kenyan HCWs remains suboptimal.

Aim: To assess TPT uptake, adherence, knowledge, and factors influencing uptake among HCWs at Meru Teaching and Referral Hospital (MeTRH), Kenya.

Methods: A descriptive cross-sectional survey was conducted among 214 HCWs selected by simple random sampling from a target population of 560 (response rate 94.3%). Data were collected using a structured self-administered questionnaire aligned with World Health Organization TPT guidelines. Descriptive statistics, Pearson’s chi-square tests, Spearman’s correlations, and binary logistic regression (unadjusted and adjusted) were performed. The level of statistical significance was set at p < 0.05.

Results: Only 39.3% (84/214) of respondents had ever initiated TPT despite 78.5% reporting occupational TB exposure. Among initiates, 66.7% completed the full course; side effects (35.7%), work-related time constraints (21.4%), and financial limitations (17.9%) were the main reasons for non-completion. Formal training was reported by 44.9% and was significantly associated with uptake (χ² = 16.25, p < .001). Self-rated knowledge was also associated with uptake (χ² = 13.34, p = .010). After adjustment, formal training remained the strongest independent predictor (adjusted OR 2.71, 95% CI 1.47–4.99, p = .001). Gender, age, and stigma were not statistically significant.

Conclusions: TPT uptake and completion among HCWs at MeTRH, Kenya, remain inadequate and are constrained primarily by modifiable programme-related factors, especially gaps in structured training, rather than demographic characteristics. Mandatory recurrent training, strengthened pre-initiation counselling, proactive follow-up, workplace-based dispensing, and expanded access to shorter regimens are recommended.

Prevalence and Feto-maternal Outcomes of Preeclampsia/Eclampsia at Two Tertiary Health Care Facilities in Niger Delta Region of Nigeria

Aimiehinor Edward Akhator — 2026-09-14

Background: Preeclampsia/eclampsia remains an important cause of maternal and perinatal morbidity and mortality, particularly where access to timely maternity care is limited.

Objective: To determine the prevalence, patient characteristics, and pregnancy outcomes of preeclampsia/eclampsia managed at two tertiary health-care facilities in the Niger Delta region of Nigeria.

Methods: This retrospective study reviewed cases managed between January, 1 2020 and December 31 2025. Maternal demographic and obstetric characteristics, mode of delivery, maternal complications, and foetal outcomes were analysed. Results: Among 8,685 deliveries, 1,148 cases of preeclampsia/eclampsia were identified, giving a prevalence of 13.21%. Preeclampsia accounted for 967 cases (11.13%) and eclampsia for 181 (2.08%). Nulliparous women constituted 56.9% of cases, 35.5% were aged 25–29 years, and 63.2% were unbooked. Caesarean section was the predominant mode of delivery (75.6%). Eighteen maternal deaths occurred, corresponding to a case-fatality rate of 1.57%. Perinatal outcomes included 176 cases of birth asphyxia, 113 stillbirths, and 75 early neonatal deaths; the reported perinatal mortality rate was 16.2%.

Conclusion: Preeclampsia/eclampsia had a high prevalence in the two tertiary facilities and was associated with substantial maternal and perinatal morbidity and mortality. The poorer outcomes among unbooked women support efforts to promote early antenatal booking, timely referral, and prompt use of appropriate maternity services.

Prevalence of ESBL and Antibiotic Resistance Profile of Escherichia coli from Diabetic Wound Infections in a Nigerian Tertiary Hospital

Charity Nneka John-Emaimo — 2026-09-16

Background: Diabetes-related foot wounds are frequently complicated by bacterial infection, and antimicrobial resistance can restrict therapeutic options. This study determined the prevalence of phenotypic extended-spectrum beta-lactamase (ESBL) production and described the antibiotic resistance profile of Escherichia coli recovered from diabetic foot wound samples at a tertiary hospital in Abakaliki, Nigeria.

Methods: One hundred wound swab specimens were processed using conventional microbiological methods. Escherichia coli isolates were identified by biochemical testing with VITEK® 2 COMPACT confirmation. Antibiotic susceptibility testing was performed by Kirby-Bauer disk diffusion using the disk contents recorded in the study protocol, and ESBL production was assessed by a double-disk synergy method. Principal proportions were summarised using 95% Wilson confidence intervals, and ward-level proportions were compared using two-sided Fisher's exact tests. Because disk diffusion is not recommended for colistin under CLSI M100-Ed32, the colistin row is retained as an original screening classification but is not used for clinical susceptibility inference.

Results: Escherichia coli was recovered from 46/100 samples (46.0%; 95% CI, 36.6-55.7). Recovery was 37.5% in A&E and 53.8% in GOPD (P = .113). ESBL production was detected in 34/46 isolates (73.9%; 95% CI, 59.7-84.4), including 16/18 A&E isolates (88.9%) and 18/28 GOPD isolates (64.3%); this ward difference was not statistically significant (P = .090). Under the recorded study protocol, all 34 ESBL-producing isolates were classified as resistant to amoxicillin-clavulanic acid, the four tested cephalosporins, three carbapenems, nalidixic acid, trimethoprim-sulfamethoxazole, and tetracycline, whereas all were classified as susceptible to gentamicin. Aztreonam resistance was 88.2%; ciprofloxacin susceptibility was 88.2%; and ofloxacin susceptibility was 61.8%. The MARI recalculated from all 16 recorded categorical results was 0.836 overall, 0.852 for A&E, and 0.823 for GOPD; these values are interpreted descriptively because of the susceptibility-testing limitations noted above.

Conclusion: The study identified a high proportion of phenotypic ESBL-producing Escherichia coli and a broad recorded resistance pattern among isolates from diabetic foot wounds. The extreme carbapenem-resistance pattern warrants confirmation using fully standardised susceptibility procedures and, where feasible, molecular characterisation. The findings support local antimicrobial-resistance surveillance, laboratory quality assurance, and antimicrobial stewardship, but they should not be used alone to select clinical therapy.

Correlation between Diabetic Retinopathy and the Stage of Peripheral Arterial Disease among Patients with Diabetes Mellitus: A Cross-Sectional Study

Shoaeb Imtiaz Alam — 2026-09-19

Background: Diabetes mellitus is associated with both microvascular and macrovascular complications. Diabetic retinopathy (DR) reflects systemic microvascular injury, whereas peripheral arterial disease (PAD) represents a major macrovascular complication. Whether the severity of DR is associated with the clinical severity of lower-extremity PAD is clinically relevant, particularly in resource-limited settings.

Objective: To assess the association between the severity of diabetic retinopathy and the clinical stage of lower-extremity peripheral arterial disease among patients with diabetes mellitus.

Methods: A hospital-based cross-sectional observational study was conducted in the Department of Vascular Surgery in collaboration with the Department of Ophthalmology at Dhaka Medical College Hospital, Bangladesh, from January 2023 to June 2026. A total of 120 patients aged ≥40 years with type 2 diabetes mellitus and clinically established lower-extremity PAD were included. PAD severity was classified according to the Rutherford classification (stages 2–6), while diabetic retinopathy was graded as no DR, mild non-proliferative DR (NPDR), moderate NPDR, severe NPDR, or proliferative DR (PDR). Clinical and laboratory variables, including duration of diabetes, HbA1c, and serum creatinine, were also assessed. Associations between ordinal variables were evaluated using Spearman's rank correlation coefficient.

Results: The mean age of the participants was 59.8 ± 9.6 years, and 94 (78.3%) were male. Diabetic retinopathy was present in 77 (64.2%) patients, including 22 (18.3%) with mild NPDR, 26 (21.7%) with moderate NPDR, 15 (12.5%) with severe NPDR, and 14 (11.7%) with PDR. Rutherford stages 2, 3, 4, 5, and 6 were present in 19 (15.8%), 27 (22.5%), 24 (20.0%), 33 (27.5%), and 17 (14.2%) patients, respectively. The distribution of diabetic retinopathy severity differed significantly across Rutherford stages (Pearson χ²=37.70, df=16, p=0.002). Vision-threatening diabetic retinopathy, defined as severe NPDR or PDR, was present in 29 (24.2%) patients. It was more frequent among patients with chronic limb-threatening ischaemia (Rutherford stages 4–6) than among those with intermittent claudication (Rutherford stages 2–3), occurring in 27/74 (36.5%) and 2/46 (4.3%) patients, respectively. Diabetic retinopathy severity also showed positive correlations with Rutherford stage (ρ=0.49, p<0.001), duration of diabetes (ρ=0.54, p<0.001), HbA1c (ρ=0.48, p<0.001), and serum creatinine (ρ=0.39, p=0.002).

Conclusion: Greater severity of diabetic retinopathy was significantly associated with more advanced clinical stages of lower-extremity peripheral arterial disease. The strong ordinal association between retinopathy severity and Rutherford stage suggests that diabetic retinopathy may serve as a clinically relevant marker of systemic vascular disease burden. Larger prospective studies are warranted to determine the temporal relationship and clinical utility of this association.

Association between Vitamin D Deficiency and Lower Respiratory Tract Infections among Sudanese Patients, Sudan

Abdulrahman Abdullahi Ishag — 2026-09-22

Background: Lower respiratory tract infections represent a significant cause of hospital admissions, patient morbidity, and mortality worldwide. Vitamin D plays a crucial regulatory role in immune function, and inadequate levels have been associated with increased vulnerability to respiratory pathogens and more severe clinical courses.

Objective: This study aimed to evaluate the relationship between vitamin D deficiency and lower respiratory tract infections in patients admitted to Atbara Teaching Hospital during 2026.

Methods: A hospital-based observational analytical study was conducted over six months (February to July 2026) at Atbara Teaching Hospital in Sudan. The study enrolled 50 adult patients admitted with lower respiratory tract infections. Data were collected using a structured questionnaire and case record form. Serum 25-hydroxyvitamin D levels were measured, and vitamin D status was categorised as deficient, insufficient, or sufficient. Disease severity was evaluated using the CURB-65 scoring system. Statistical analysis was performed using SPSS, with statistical significance defined as p < 0.05.

Results: The mean serum 25-hydroxyvitamin D level was 20.60 ± 15.69 ng/mL, ranging from 2.00 to 55.00 ng/mL. Vitamin D deficiency was identified in 23 patients (46.0%), insufficiency in 12 (24.0%), and sufficient levels in 15 (30.0%). Cough was reported by all participants (100.0%), followed by fever (76.0%) and sputum production (72.0%). Hypertension was the most common comorbidity (36.0%), followed by diabetes mellitus (32.0%). Vitamin D status demonstrated significant associations with CURB-65 score (p = 0.012), length of hospital stay (p = 0.021), and the presence of comorbidities (p = 0.007). Although ICU admission, sepsis, septic shock, acute respiratory distress syndrome, and mortality were not significantly associated with vitamin D status, these adverse outcomes occurred more frequently among vitamin D-deficient patients.

Conclusion: Vitamin D deficiency was highly prevalent among patients with lower respiratory tract infections and demonstrated significant associations with increased disease severity, prolonged hospitalisation, and comorbid conditions. Assessment of vitamin D status should be considered in admitted patients, particularly those presenting with severe illness or chronic comorbidities.

Clinical Factors Associated with Hypercoagulable and Prothrombotic Abnormalities in Patients with Acute Ischemic Stroke: A Prospective Observational Study

Waliul Haque — 2026-09-23

Background: Hypercoagulable and prothrombotic states may contribute to acute ischaemic stroke, particularly in younger patients and those with recurrent or otherwise unexplained thrombotic events.

Aim: This study evaluated the frequency of selected hypercoagulable and prothrombotic laboratory abnormalities and identified clinical factors associated with their presence among patients with acute ischaemic stroke.

Methods: This prospective observational study was conducted in the Department of Neurology, Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh, from January 2022 to December 2025. A total of 100 consecutive adults with imaging-confirmed acute ischaemic stroke were enrolled. The primary outcome was the presence of at least one predefined hypercoagulable or prothrombotic laboratory abnormality. Associations between clinical characteristics and the primary outcome were evaluated using univariable and multivariable logistic regression.

Results: The mean age of the participants was 56.8 ± 11.4 years, and 62 (62.0%) were female. Hypertension was present in 69 (69.0%) patients, diabetes mellitus in 52 (52.0%), dyslipidaemia in 45 (45.0%), and current smoking in 37 (37.0%). Overall, 39 (39.0%) patients had at least one predefined hypercoagulable or prothrombotic laboratory abnormality. Antiphospholipid antibody abnormalities were identified in 18 (18.0%) patients and hyperhomocysteinaemia in 12 (12.0%). Patients with laboratory abnormalities were younger than those without abnormalities (53.7 ± 9.8 vs. 58.8 ± 11.2 years; p = 0.019), were more frequently female (74.4% vs. 54.1%; p = 0.041), and more frequently had previous venous thromboembolism (17.9% vs. 3.3%; p = 0.009). Severe neurological impairment, defined as NIHSS ≥15, was also more frequent among patients with abnormalities (41.0% vs. 19.7%; p = 0.019). In multivariable analysis, age <60 years (adjusted OR [aOR] 2.84, 95% CI 1.19–6.78; p = 0.022), female sex (aOR 2.18, 95% CI 1.01–4.72; p = 0.047), previous venous thromboembolism (aOR 3.91, 95% CI 1.29–11.82; p = 0.016), and NIHSS ≥15 (aOR 2.86, 95% CI 1.14–7.19; p = 0.024) were independently associated with the presence of a hypercoagulable or prothrombotic laboratory abnormality.

Conclusion: Younger age, female sex, previous venous thromboembolism, and greater stroke severity were independently associated with these laboratory findings. These results support a clinically targeted rather than universal approach to thrombophilia evaluation in selected patients with ischaemic stroke. Because several thrombophilia assays may be affected by acute illness and anticoagulant therapy, abnormal findings obtained during the acute phase should be interpreted cautiously and confirmed after the acute event when clinically appropriate.

Association of Sleep Duration and Sleep Quality with Work Productivity among Bus Drivers

Siti Wisnaini Safitri — 2026-09-28

Aims: Work productivity reflects a worker's ability to perform tasks optimally; inadequate sleep duration and poor sleep quality can lead to reduced concentration, mood changes, fatigue, and health issues that lower work productivity. This study aimed to assess the association of sleep duration and sleep quality with work productivity among bus drivers.

Study Design: An analytical observational study with a quantitative cross-sectional design was conducted to evaluate the association of sleep duration and sleep quality with work productivity.

Place and Duration of Study: This study was conducted at a bus pool in Jakarta between 10 October and 28 November 2025.

Methodology: A total of 100 participants aged 20–60 years participated in this study and were selected using consecutive non-random sampling. Sociodemographic data were collected using a structured questionnaire. Sleep quality was assessed using the Pittsburgh Sleep Quality Index, and work productivity was measured using the Stanford Presenteeism Scale. Data were analysed using the chi-square test, with a p-value < 0.05 considered statistically significant.

Results: Most participants were middle-aged (40–60 years; 54%), male (92%), had a high school education (87%), worked the morning-evening shift (65%), and had long service (67%). Poor sleep duration, poor sleep quality, and poor work productivity were observed in 50%, 22%, and 19% of participants, respectively. Significant associations were found between sleep duration and work productivity ( < 0.001) and between sleep quality and work productivity ( < 0.001).

Conclusion: This study found associations of sleep duration and sleep quality with work productivity. Achieving sufficient sleep duration and good sleep quality, combined with improved shift scheduling, appropriate rest periods, and regular health check-ups, may help support work productivity.

Psychological Distress and Quality of Life Among Epilepsy Patients in Mazabuka District, Zambia

Faith Mukupa Mbewe — 2026-10-01

Background: Epilepsy is accompanied by substantial psychosocial and mental health burdens that may affect quality of life, particularly in low-resource settings. This study assessed psychological distress, anxiety, depression, and quality of life among patients with epilepsy in Mazabuka District, Zambia, and explored experiences contributing to these outcomes.

Methods: A parallel-convergent mixed-methods design combined quantitative surveys of 60 adult patients with qualitative interviews involving 30 participants and perspectives from 10 key informants. Psychological distress, anxiety, depression, and quality of life were assessed using the K10, GAD-7, PHQ-9, and QOLIE-31, respectively. Quantitative data were summarised descriptively and examined using prespecified inferential tests, while qualitative data were analysed thematically.

Results: Mean K10, GAD-7, and PHQ-9 scores were 27.3, 10.4, and 14, respectively. Moderately severe depression was reported by 30.0% of patients, severe anxiety by 16.7%, and moderate quality of life by 53.3%. Seizure frequency was significantly associated with psychological distress, while longer epilepsy duration was associated with higher depression scores and unemployment with lower quality of life. Qualitative findings identified seizure unpredictability, stigma, financial strain, and reduced independence as important sources of distress, alongside coping through peer support, family involvement, mindfulness, and counselling.

Conclusion: Psychological distress, anxiety, and depression were common, while quality of life remained moderate for many participants. The findings support integrated epilepsy care that includes routine mental health screening and psychosocial support.