Asian Journal of Medicine and Health

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, Nikita Patel, Adyata Dave, Kosha Shah — Fri, 04 Sep 2026 00:00:00 +0000

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, Mary Amatu, Zachary Muriuki — Tue, 01 Sep 2026 00:00:00 +0000

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, Brown Holy, Onwuli Donatus, Nwachuku Edna Ogechi — Tue, 01 Sep 2026 00:00:00 +0000

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, Ibioku Elekima, Holy Brown, Edna O. Nwachuku — Tue, 01 Sep 2026 00:00:00 +0000

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

Fri, 04 Sep 2026 00:00:00 +0000

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, Kabiru M. Yakasai, Muhammad Abdullahi Sabo — Fri, 04 Sep 2026 00:00:00 +0000

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

Fri, 04 Sep 2026 00:00:00 +0000

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, Cole Osagie Kenneth, Best Ordinioha — Mon, 07 Sep 2026 00:00:00 +0000

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, Jane Rutto, Elias Kinoti, Fredrick Otieno — Thu, 10 Sep 2026 00:00:00 +0000

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.