Asian Journal of Research in Medical and Pharmaceutical Sciences

Haloperidol as a Novel Augmentation Strategy in Treatment-Resistant Depression: A Clinical Practice Perspective with Case Series

2026-09-24T10:50:54+00:00

Treatment-resistant depression (TRD) remains a major clinical challenge when adequate antidepressant trials fail to achieve remission. This clinical practice perspective examines low-dose haloperidol as a potential augmentation strategy in carefully selected, treatment-refractory affective presentations. The manuscript combines an integrative theoretical review of dopaminergic dysregulation with an observational case series of three inpatients with severe treatment-refractory depression, including bipolar and unipolar presentations. Clinical outcomes were evaluated through psychiatric assessment and symptom-severity measures, with attention to depressive symptoms, suicidal ideation, anxiety, psychomotor activity, sleep, and neurological adverse effects. Following the introduction of low-dose haloperidol alongside existing treatment, all three patients showed clinically meaningful short-term improvement, including resolution or reduction of suicidal ideation, mood stabilisation, reduced anxiety, improved sleep, and greater psychomotor or social engagement. At three-month follow-up, two patients remained clinically stable on the augmented regimen, while one patient required haloperidol dose reduction because of mild parkinsonian symptoms, which subsequently resolved. Interpretation is limited by the small uncontrolled sample, concomitant medications, inpatient therapeutic milieu, selection bias, and brief follow-up. The findings therefore do not establish efficacy or causality. Rather, they support a preliminary clinical-neurobiological hypothesis that warrants systematic evaluation in controlled studies with rigorous neurological monitoring and longer-term safety assessment in future research.

From Diagnosis by Accumulation to Diagnosis by Layers: Cognitive Psychiatry and Iatrogenic Risk in an Adolescent with Autism Spectrum Disorder: A Case Report and Narrative Review

2026-11-02T05:48:14+00:00

Background: Adolescents with autism spectrum disorder (ASD) may show overlapping behavioural descriptions arising from neurodevelopmental features, psychiatric syndromes, environmental stressors and medication effects.

Objective: To illustrate a layered psychiatric formulation using the clinical course of an adolescent with ASD, self-harm, restrictive eating, atypical experiences and prolonged psychopharmacological exposure.

Methods: Clinical material supplied by the treating team was synthesised as a case report, with a complementary structured narrative review of literature on diagnostic overlap, pharmacotherapy, puberty, safety and feeding. The main PubMed/MEDLINE search covered January 2023 to September 2026, with a subsequent targeted update; evidence selection was purposive rather than systematic.

Case Presentation: A 16-year-old adolescent experienced school and adaptive difficulties, sensory sensitivities, food restriction with occasional self-induced vomiting, self-injury and suicidal ideation. Clinical records described sequential exposure to several psychotropic agents. A reduction in lithium dose from 450 to 300 mg/day during the September 2026 admission was followed by improvement in reported hygiene, food variety and family interaction, but later by distress and an urge to self-harm. Co-occurring psychotherapy, environmental changes and uncertain clinical measurements prevent causal attribution.

Discussion: The proposed eight-layer framework considers constitutional traits, temperament, neurodevelopment and cognition, psychodynamics, relationships and environment, superimposed syndromes, somatic factors and treatment effects. The concept is heuristic, not a validated diagnostic instrument. Feeding symptoms warrant assessment of sensory selectivity, body-image concerns, compensatory behaviours and nutritional consequences. Evidence associating adverse childhood experiences with neuroimaging measures in autistic samples is relevant context but does not substitute for individual assessment.

Conclusion: Longitudinal, risk-sensitive formulation may help identify competing explanations and measurable intervention targets. The clinical sequence does not establish that medication, family circumstances or any single intervention caused the observed outcomes.

Self-harm, Personified Inner States and Identity-related Distress in a Young Patient with Autistic Features: An Analytic Case Report

2026-11-05T13:26:02+00:00

Background: Self-injury and suicidal thinking can co-occur with autistic characteristics, affective symptoms and difficulties identifying emotional states, but these phenomena require individual assessment rather than a unitary causal explanation.

Case Presentation: A young female patient receiving inpatient psychiatric care in Goiânia, Brazil, during September 2026 described recurrent distress following ambiguous interpersonal exchanges, rumination, impaired self-care, suicidal ideation and self-injury associated with tension relief, self-punishment and identity-related expression. She developed 11 illustrated inner characters, categorised as traumatic, protective or destructive, and described their intentions as protective despite their potentially harmful consequences. A history suggesting autistic characteristics, relational adversity and psychotropic medication exposure was reported; formal diagnostic substantiation, event-level documentation and treatment outcomes were not available for independent assessment.

Discussion: A provisional functional formulation links perceived interpersonal threat, poorly differentiated affect, rumination, disturbances of identity continuity and behavioural relief. The characters could facilitate symbolic communication and emotional differentiation, but this interpretation cannot be distinguished definitively from artistic expression, intrusive cognitions, dissociation or psychosis without fuller phenomenological evidence.

Conclusion: The descriptive value of this case lies in the coexistence of multiple attributed functions of self-injury and a structured system of personified internal experiences. Proposed mechanisms remain untested, and no conclusion about a confirmed autism diagnosis or the causal role of the characters is warranted.

Utilization, Correlates and Predictors of Contraceptive Use among Married Women in Amassoma, Bayelsa State, Nigeria

2026-09-28T13:06:48+00:00

Background: Nigeria's national modern contraceptive prevalence rate among married women remains low, at roughly 12% to 20%, with wide sub-national variation, and a recurring explanation is that awareness of contraceptives does not reliably translate into use. This study determined the prevalence and pattern of contraceptive use among married women in Amassoma, Bayelsa State, Nigeria, and tested whether knowledge of contraceptives and socio-demographic factors (age, education, occupation and parity) are associated with, and independently predictive of, use.

Methods: A descriptive cross-sectional study was conducted in 2024 among 400 married women using a structured, interviewer-administered questionnaire (100% response rate). Prevalence and pattern of use were summarised as frequencies and percentages. Five bivariate hypotheses linking knowledge, age, education, occupation and parity to contraceptive use were tested using the Chi-square test of association, and a multivariable binary logistic regression model, adjusted for age, education, parity and knowledge, was fitted to identify independent correlates of use. Significance was set at p<0.05, and key distributions are presented as pie and bar charts.

Results: Of the 400 respondents, 281 (70.3%) were current contraceptive users. Among users, implants were by far the most commonly used method (65.1%), followed by pills (11.0%), withdrawal (7.5%), calendar/rhythm method (5.0%), condoms (4.3%), lactational amenorrhoea method (3.9%) and injections (3.2%). More than one-third of users (37.7%) had used their current method for about five years, while 28.1% had started within the past year. Contraceptive use was significantly associated with knowledge of contraceptives (X²=52.261, p<0.001), age (X²=25.145, p<0.001), education (X²=15.575, p=0.004), occupation (X²=15.993, p=0.007) and parity (X²=15.828, p=0.003) at the bivariate level. In the adjusted logistic regression model, knowledge of contraceptives remained a strong, independent predictor of use (adjusted odds ratio [aOR]=6.53, 95% CI: 3.39-12.60, p<0.001), and women aged 31-36 years had significantly higher odds of use than the youngest reference group (aOR=3.14, 95% CI: 1.16-8.47, p=0.024). Education, occupation and parity did not retain independent significance after adjustment.

Conclusion: Contraceptive utilisation among married women in Amassoma is considerably higher than national and several sub-national averages, driven substantially by a strong preference for implants. All five hypothesised correlates were supported at the bivariate level, but knowledge of contraceptives emerged as the dominant, independent driver of use even after accounting for socio-demographic factors, indicating that closing the knowledge gap is likely to be the single most impactful lever for improving contraceptive uptake in this community.

Distribution of Sorbic Acid Tube Precipitation and Leukocyte Adherence Inhibition Results in Two Clinically Selected Patient Cohorts: A Retrospective Descriptive Study

2026-10-09T07:45:48+00:00

Background: Hypersensitivity has been reported in association with sorbic acid and sorbate salts in susceptible individuals.

Objective: This retrospective descriptive analysis characterised the distribution of Tube Titration of Precipitins (TTP) and Leukocyte Adherence Inhibition Test (LAIT) responses to sorbic acid among patients with allergic multimorbidity and polysensitisation.

Methods: Two clinically selected outpatient cohorts (100 patients each) were identified from electronic medical records. Humoral immunoreactivity was assessed by TTP with sorbic acid solution in one cohort, while the other underwent an ex vivo sorbic acid challenge monitored by LAIT to examine cellular immunoreactivity. The cohorts were independent and lacked healthy controls, disease controls, and an independent diagnostic reference standard.

Results: All TTP observations were positive. The mean titre was 1:220, the median was 1:128, the mode was 1:128 and occurred 30 times, and the standard deviation was 1:167. LAI values extended from 0% to 98%; the mean was 29.4%, the median 25%, the standard deviation 28.6%, and the mode 0%, which occurred 29 times.

Conclusion: These clinically selected cohorts showed wide distributions of humoral and cellular immunoreactivity to sorbic acid. The data do not determine sensitivity, specificity, diagnostic utility, or immune endotypes. Accordingly, the findings are descriptive and hypothesis-generating and require prospective confirmation using appropriate controls and an independent diagnostic reference standard.

Prospective Evaluation of a Structured Management Protocol for Adhesive Small Bowel Obstruction: Gastrografin and Initial Severity Stratification

2026-10-15T08:02:55+00:00

Background: Adhesive small bowel obstruction (ASBO) is a frequent surgical emergency, and identifying patients who require early operative intervention remains challenging.

Aim: This study evaluated outcomes under a structured management protocol incorporating initial severity stratification and selective Gastrografin use.

Methods: A prospective, single-centre observational study included 32 patients aged ≥14 years with imaging-confirmed ASBO managed between January 2022 and December 2024. Patients underwent clinical, laboratory and radiological assessment, followed by nasogastric decompression and fluid resuscitation. Gastrografin was administered selectively to patients without severity criteria who did not improve with initial management.

Results: Medical treatment alone resolved obstruction in 5 of 32 patients (15.6%). Seven patients underwent a Gastrografin challenge, of whom four (57.1%) avoided surgery. Overall, nine patients (28.1%) were managed conservatively, while 23 (71.9%) underwent laparotomy. Bowel resection was performed in eight of 23 operated patients (34.8%). All eight resections occurred among the 15 patients with a positive initial severity profile; none occurred among the 17 patients without such criteria (Fisher's exact test, p<0.001). Complications were recorded in five of 30 evaluable patients (16.7%). Median hospital stay was 4.5 days after conservative management and 6.5 days after surgery (p=0.053).

Conclusion: The structured protocol permitted non-operative resolution in a subset of patients. Initial severity criteria were associated with bowel resection, although the small sample and non-random allocation limit interpretation.

Neuropathological Changes Induced by Microplastics Associated with Sachet Water in Wistar Rats: Implications for Human Neurological Health

2026-10-16T13:24:47+00:00

Background: The widespread consumption of sachet water in Nigeria has raised concerns about microplastic contamination and associated health risks, particularly after environmental exposure during storage. Although microplastics have been associated with oxidative stress and neurotoxicity, limited data exist on the neurological effects of ingestion through drinking water.

Aim: This study investigated the neurotoxic effects of microplastic-contaminated sachet water in Wistar rats.

Study Design: A controlled in vivo experimental study involving twenty male Wistar rats randomly assigned to five groups.

Place and Duration of Study: The study was conducted in Enugu State, Nigeria. Experimental exposure lasted 30 days following a two-week acclimatisation period.

Methodology: Two sachet water brands (AX and NM) were categorised into sunlight-exposed and unexposed groups. Twenty male Wistar rats were randomly assigned to five groups and orally exposed to the water samples for 30 days. Physicochemical analysis and Fourier transform infrared (FTIR) spectroscopy were performed. Brain tissues were analysed for neurotransmitters, oxidative stress markers, and histopathological changes. Data were analysed using one-way ANOVA (p < 0.05).

Results: FTIR analysis revealed spectral features potentially associated with polymeric materials in the investigated water samples, including the control. Significant overall differences were observed in glutamate, glutamate decarboxylase activity, dopamine, gamma-aminobutyric acid, norepinephrine, reduced glutathione, glutathione peroxidase, malondialdehyde, and catalase. The sunlight-exposed NM group exhibited the highest mean glutamate and dopamine concentrations and the lowest mean reduced glutathione and catalase values. Histopathological examination revealed alterations including gliosis and mononuclear cell infiltration in exposed groups.

Conclusions: Chronic consumption of sunlight-exposed sachet water was associated with oxidative stress, neurochemical imbalance, and structural brain changes in Wistar rats, highlighting potential neurological risks and the need for improved packaging, storage, and regulation.

Comparative Assessment of Phostoxin-Induced Biochemical and Histopathological Renal Toxicity in Male and Female Wistar Rats

2026-10-17T11:39:02+00:00

Background: Phostoxin, an aluminium phosphide–based pesticide, is widely used as a fumigant but poses significant health risks due to its potential to cause oxidative and organ toxicity.

Aim: This study conducted a comparative assessment of phostoxin-induced biochemical and histopathological renal toxicity in male and female Wistar rats.

Methods: Thirty-six Wistar rats were assigned to three groups (n = 12 per group). Treatment groups were exposed to phostoxin for 30 and 60 days, while control rats were maintained under normal air conditions. Serum levels of sodium (Na⁺), potassium (K⁺), chloride (Cl⁻), bicarbonate (HCO₃⁻), urea, and creatinine were analysed using standard biochemical methods. Renal tissues were processed for histopathological evaluation using haematoxylin and eosin staining.

Results: Phostoxin exposure caused a significant (p < 0.05) elevation in serum sodium and chloride levels and a corresponding decline in potassium levels compared with controls. Bicarbonate levels decreased slightly but not significantly. Urea and creatinine concentrations increased markedly (p < 0.05) after prolonged exposure, indicating impaired renal function. Histopathological analysis revealed mild haemorrhage, glomerular infiltration, and vacuolar degeneration after 30 days, whereas 60-day exposure resulted in glomerular distortion, tubular necrosis, and extensive vacuolation.

Conclusion: These findings indicate that chronic inhalation of Phostoxin induces significant biochemical and histological alterations in the kidneys of both male and female rats, reflecting dose- and duration-dependent nephrotoxicity.

Comparative Effects of Atracurium and Rocuronium on Perioperative Blood Glucose in Non-Diabetic Patients Undergoing Appendectomy under General Anesthesia

2026-10-17T11:46:32+00:00

Aims: To compare perioperative capillary blood glucose levels between non-diabetic patients receiving atracurium or rocuronium during general anaesthesia for appendectomy.

Study Design: A prospective, randomised, two-group clinical study.

Place and Duration of Study: The study was conducted in Najaf, Iraq, from October 2025 to January 2026.

Methodology: Thirty non-diabetic patients undergoing appendectomy under general anaesthesia were allocated into two equal groups. Group A received atracurium (0.5 mg/kg; n = 15), while Group B received rocuronium (0.6 mg/kg; n = 15). Capillary blood glucose was measured at three time points: 10 minutes before induction, 10–15 minutes after induction, and 10 minutes after surgery. Data were analysed using GraphPad Prism 9.0. A two-way repeated-measures ANOVA with Geisser–Greenhouse correction was performed, followed by Šídák’s multiple comparisons test. Results were expressed as mean ± standard error of the mean (SEM), with statistical significance set at P < 0.05.

Results: Preoperative blood glucose concentrations were comparable between the atracurium and rocuronium groups (92.40 vs 90.27 mg/dL; adjusted P = 0.3109). Intraoperative glucose concentrations were higher in the atracurium group (115.00 vs 105.47 mg/dL; adjusted P < 0.0001). This difference persisted postoperatively (113.33 vs 107.60 mg/dL; adjusted P < 0.0001). Repeated-measures ANOVA demonstrated a significant interaction between treatment group and measurement time (P < 0.0001).

Conclusion: Intraoperative and postoperative blood glucose concentrations were significantly higher in the atracurium group than in the rocuronium group. Repeated-measures analysis demonstrated a significant interaction between neuromuscular blocking agent and measurement time. However, the small sample size and potential clinical confounding factors limit causal interpretation. Further controlled studies are required to confirm these findings and determine their clinical significance.

Design-dependent Drug Content and In-vitro Permeation of Naltrexone Hydrochloride from Dissolving Microneedle Patches

2026-10-24T07:42:35+00:00

Aims: To develop sodium carboxymethylcellulose (CMC)-based dissolving microneedle patches for naltrexone hydrochloride (NTX) and to evaluate the influence of polymer characteristics and drug localisation on formulation performance.

Study Design: An experimental formulation study comparing two dissolving microneedle designs differing in NTX localisation and conventional matrix patches.

Place and Duration of Study: Department of Technology of Drug Forms with Biopharmaceutics, Faculty of Pharmacy, Medical University – Sofia, Sofia, Bulgaria, between 06.2024 and 09.2026.

Methodology: Microneedle patches were prepared using micromoulding using two CMC grades at 5% and 10%. NTX was incorporated either into the microneedle-forming layer (Design A) or into the backing layer (Design B). Conventional matrix patches (Design C) served as controls. Morphology, drug content, and 24-h in vitro permeation across a synthetic membrane were evaluated.

Results: Drug localisation markedly affected formulation performance. Design A provided rapid fractional permeation but low drug content (6.66–23.83% of the theoretical value), whereas Design B achieved near-theoretical drug content (99.67–100.83%) with more gradual permeation. CMC 7MF-5/B combined 99.67% drug content with 80.32% permeation over 24 h. Conventional matrix patches showed substantially lower 24-h permeation (19.78–28.08%). Lower CMC molecular weight and concentration also provided more favourable microneedle morphology.

Conclusion: Drug localisation within the microneedle patch was a key determinant of NTX content and permeation behaviour. Incorporation of NTX into the backing layer resulted in near-theoretical drug content while maintaining substantial 24-h permeation. CMC 7MF-5/B provided the most favourable overall performance among the investigated formulations.

The Relationship between Sleep Quality and Body Composition among Male Novice Sri Lankan Bodybuilders Aged 18–21 Years in the Kandy District

2026-10-30T12:50:12+00:00

Introduction: Sleep is relevant to recovery and physical performance but evidence on its association with changes in body composition among novice bodybuilders in Sri Lanka is limited. Poor sleep quality has reached epidemic levels, especially among young adults, adversely affecting metabolic, cognitive, and physical health.

Aims: To assess the association between sleep quality and changes in body composition among male novice bodybuilders aged 18–21 years in Kandy District, Sri Lanka.

Study Design: A quantitative observational cohort study.

Study Setting and Duration: Selected training centres in Kandy District, Sri Lanka; data collection took place over eight weeks of standardised training.

Methodology: A standardised resistance-training regimen was completed by 50 novice bodybuilders aged 18–21 years. Sleep quality was assessed at baseline using the Pittsburgh Sleep Quality Index (PSQI). Body weight and body-composition estimates were measured at baseline and week 8 using bioelectrical impedance analysis (BIA) and the skinfold caliper method.

Results: PSQI scores were moderately correlated with both baseline body-fat percentage (r =.45, P =.001) and change in body-fat percentage (r =.38, P =.006), with participants with poorer sleep showing smaller reductions over time and higher baseline body fat. PSQI scores were moderately negatively correlated with changes in lean body mass (r = −.41, P =.003) and skeletal muscle mass (r = −.54, P <.001). Participants with good sleep quality gained more BIA-estimated skeletal muscle mass (1.07 ± 0.48 kg) than those who slept poorly (0.61 ± 0.48 kg; P =.007). Sleep quality accounted for 29.2% of the variation in skeletal muscle mass change. These findings supported the rejection of the null hypotheses: poorer sleep quality was associated with higher body fat and smaller gains in lean mass.

Conclusion: In this sample, poorer baseline self-reported sleep quality was associated with less favourable body-composition changes over eight weeks. Larger studies using objective sleep measures, clearly specified body-composition methods, and adjustment for relevant confounders are needed.

Evaluation of the Histological Effects of Prednisolone Administration on the Pancreas of Male Wistar Rats

2026-11-05T13:18:59+00:00

Background: Prednisolone is a synthetic glucocorticoid widely used to manage inflammatory and autoimmune conditions. However, its effects on pancreatic tissue morphology require further investigation.

Aim: This study evaluated the histological effects of different doses of prednisolone on the pancreas of male Wistar rats.

Methods: Twenty adult male Wistar rats weighing 185–195 g were randomly assigned to four groups of five animals each. Group 1 served as the control, while Groups 2, 3 and 4 received prednisolone orally at doses of 30, 20 and 10 mg/kg body weight, respectively, once daily for 21 days. At the end of treatment, pancreatic tissues were collected, processed and examined using haematoxylin-and-eosin-stained sections.

Results: The control group exhibited well-defined islets of Langerhans and preserved acinar architecture. The 30 mg/kg group showed more prominent islet profiles, whereas the 20 mg/kg group exhibited less pronounced islet prominence. Pancreatic architecture appeared relatively preserved in the 10 mg/kg group. These observations indicated descriptive differences in pancreatic morphology among the experimental groups. However, quantitative morphometric measurements and corresponding statistical results were not reported.

Conclusion: Prednisolone administration was associated with differences in pancreatic histological appearance under the experimental conditions. Nevertheless, the findings do not establish statistically significant dose-dependent changes, confirmed endocrine-cell hyperplasia or functional pancreatic impairment. Further quantitative and functional investigations are required to determine their biological significance.

Radical Treatment of Verneuil's Disease: Interest of Split-Thickness Skin Grafting and Perforating Fasciocutaneous Flaps

2026-11-10T13:43:54+00:00

Background: Advanced Verneuil's disease (hidradenitis suppurativa) may require radical excision, leaving substantial axillary or perineal defects for which an appropriate method of coverage must be selected

Aims: To compare reconstructive coverage using split-thickness skin grafts with that using local flaps (including arm fasciocutaneous and perineal keystone flaps) after radical surgery for advanced Verneuil's disease (hidradenitis suppurativa) in the axillary and perineal regions.

Place and duration of Study: Department of Plastic, Reconstructive, and Burn Surgery at the Mohamed V Military Instruction Hospital in Rabat, Morocco; with patients treated between 2019 and 2021.

Methodology: A retrospective, single-centre review of five male patients presenting with axillary and perineal hidradenitis, with unilateral (two cases) or bilateral (three cases) involvement. All patients underwent radical surgical excision of the entire inflammatory and fistulous plaque, extended to the entire hair-bearing area under general anesthesia. Reconstruction was performed using either a secondary split-thickness skin graft harvested from the thigh (three cases) or single-stage coverage using flaps (two cases), specifically a fasciocutaneous flap from the inner aspect of the arm for axillary defects and a keystone fasciocutaneous flap for perineal defects.

Results: The mean skin graft take rate was 90% at the first dressing change (third postoperative day), with an overall average take rate of 80%. Full graft lysis occurred in one patient, who was subsequently managed via secondary intention healing. The mean time to complete healing was 32 days for the split-thickness skin graft group, compared to 10 to 15 days for the local flaps group. The flap group demonstrated a 60% reduction in hospital stay, alongside decreased convalescence, lower postoperative functional disability, and a greater improvement in quality of life compared to the graft group. No disease recurrence was reported in either group during the follow-up period.

Conclusion: Local flaps provide high-quality skin morphologically close to the recipient region, without the risk of retraction or take failure seen with split-thickness skin grafts. Flaps achieve rapid, high-quality healing in a single surgical procedure, effectively reducing hospital stay, minimising patient discomfort, lowering donor-site morbidity, and reducing overall management costs for advanced Verneuil's disease.

Drug Utilization Pattern for Pain Management among Postoperative Patients of Orthopaedic and Surgery Departments in a Tertiary Care Hospital: A Prospective Observational Study

2026-11-12T13:06:42+00:00

Aims: To evaluate analgesic utilisation patterns among postoperative patients in the Orthopaedic and Surgery departments of a tertiary care hospital; to compare opioid and non-opioid prescribing; to assess routes of administration and brand versus generic prescribing; and to compare the effectiveness of monotherapy and combination therapy.

Study Design: A Prospective observational study.

Place and Duration of Study: Departments of Orthopaedics and Surgery, Basaveshwara Medical College & Hospital, Chitradurga, Karnataka, India, over six months, from April 2025 to September 2025.

Methodology: Postoperative inpatients receiving analgesics were enrolled (n = 150). Demographic details, type of surgery, and analgesic drugs (class, dose, route, frequency, duration and brand/generic name) were recorded from case sheets and medication charts using a self-designed data collection form. Data were analysed using descriptive statistics and SPSS version 27. Pain reduction scores of monotherapy and combination therapy were compared using the Mann–Whitney U test.

Results: Of the 150 patients, 60% were male and 40% were female, with the largest group aged 31–45 years. Open reduction and internal fixation (13.16%) and appendectomy (12.50%) were the most common surgeries. Of 388 analgesic prescriptions analysed, non-opioids (57.11%) were most frequent, followed by opioids (17.57%) and adjuvants (13.95%). Paracetamol and diclofenac were the most prescribed non-opioids; tramadol was the predominant opioid. Intravenous administration (68.56%) was preferred over oral (31.44%). Brand-name prescribing (76.03%) exceeded generic prescribing (23.97%). Combination therapy achieved significantly greater pain reduction (mean score 3.59 ± 0.94) than monotherapy (2.87 ± 0.88; p < 0.001).

Conclusion: Combination therapy was associated with greater pain relief than monotherapy, supporting multimodal analgesia. Non-opioid analgesics formed the backbone of pain management, with tramadol the preferred opioid. However, the high prevalence of brand-name prescribing indicates a need to encourage generic prescribing for cost-effectiveness. Rational prescribing and multimodal strategies can improve patient outcomes and ensure safer postoperative pain management.

Prevalence and Associated Factors of Left Ventricular Systolic Dysfunction among Children Living with HIV in Sokoto, Nigeria: A Comparative Cross-Sectional Study

2026-11-12T13:09:44+00:00

Aim: To determine the prevalence of left ventricular (LV) systolic dysfunction and its relationship with age and disease stage among children living with HIV at a tertiary health facility in Sokoto, Nigeria.

Study Design: This was a cross-sectional, descriptive and comparative study.

Place and Duration of Study: The antiretroviral therapy and paediatric outpatient clinics of Usmanu Danfodiyo University Teaching Hospital, Sokoto, north-western Nigeria, between June and October 2021.

Methodology: Ninety eligible children living with HIV, aged 18 months to 15 years, and an equal number of age- and gender-matched uninfected peers were recruited using systematic random sampling. M-mode echocardiographic parameters, ejection fraction (EF) and fractional shortening (FS), were used to assess left ventricular (LV) systolic function.

Results: A total of 180 children (90 HIV-infected and 90 uninfected) were recruited into the study, with a 100% response rate.

The prevalence of LV systolic dysfunction among HIV-infected participants was 32.2%, compared with 3.3% among their uninfected peers (P < 0.01). The associations of LV systolic dysfunction with age and disease stage (clinical and immunological) among HIV-infected participants (ART-exposed and ART-naïve) were not statistically significant.

Conclusion: The prevalence of LV systolic dysfunction was relatively high among children living with HIV attending UDUTH, supporting the inclusion of echocardiography in their routine care.

Hyperbaric Oxygen Therapy in Non-Healing Wounds: A Critical Narrative Review of Mechanisms, Clinical Applications and Outcomes

2026-09-21T14:03:27+00:00

Non-healing wounds impose a substantial and rising clinical and economic burden, and hyperbaric oxygen therapy remains one of the most contested adjuncts in their management. Half a century of mechanistic work has established that intermittent hyperoxia raises dissolved plasma oxygen far above the physiological range, generates a controlled oxidative stress, activates hypoxia-inducible factor signalling, mobilises vasculogenic progenitor cells and augments oxidative bacterial killing. Translation of that biology into reproducible clinical benefit has, however, been inconsistent. This critical narrative review examines why mechanistic plausibility and clinical performance have diverged, and defines the conditions under which the therapy can be defended. Peer-reviewed literature was identified through structured searching of biomedical databases and open scholarly indexes, supplemented by backward and forward citation tracking, publisher records and retraction notices, with bibliographic details and digital object identifiers verified individually. The synthesis is organised around mechanisms, the randomised and observational evidence in diabetes-related foot ulceration, the evidence position in late radiation tissue injury, venous leg ulceration, necrotising soft tissue infection, compromised flaps and rare refractory wounds, and the determinants of patient selection, dose, safety and cost. Randomised trials in diabetes-related foot ulceration diverge sharply, and this divergence tracks systematically with baseline perfusion, ulcer severity, comparator design and per-protocol treatment exposure rather than with chance alone. Aggregated syntheses reproduce these differences and have additionally been contaminated by several retracted meta-analyses, an underappreciated threat to the integrity of the pooled estimates now entering guidelines. The evidence is strongest for ischaemic, severe-grade ulceration in patients with measurable oxygen responsiveness and weakest for well-perfused, non-ischaemic wounds. Prospective, physiologically stratified randomised trials with adequate treatment exposure and standardised endpoints are the principal unmet requirement. Until such trials are reported, hyperbaric oxygen therapy is best regarded as a selectively indicated adjunct rather than a general treatment for wounds that fail to heal.

Exercise Echocardiography in the Diagnostic Work-up of Unexplained Dyspnoea: A Critical Narrative Review of Physiological Targets, Diagnostic Performance and Unresolved Controversies

2026-10-23T07:09:54+00:00

Background: Chronic exertional dyspnoea frequently remains unexplained after clinical assessment, natriuretic peptide measurement and resting echocardiography. Many underlying cardiovascular abnormalities, particularly heart failure with preserved ejection fraction and exercise pulmonary hypertension, become apparent only during physiological stress. Exercise echocardiography is non-invasive, widely available and free of ionising radiation, but its diagnostic role outside ischaemia testing remains contested.

Purpose and Scope: This critical narrative review evaluates the evidence supporting exercise echocardiography in adults with chronic exertional dyspnoea that remains unexplained after first-line evaluation. It examines test conduct and feasibility, the diastolic stress test, pulmonary vascular and right ventricular responses, ischaemic, valvular and dynamic obstructive causes, and multiparametric approaches incorporating lung ultrasound, cardiopulmonary exercise testing and artificial intelligence.

Methods: Literature was identified through structured searches of bibliographic databases and scholarly indexes, supplemented by citation tracking and professional-society guidance. Evidence was appraised with attention to patient spectrum, reference standards, feasibility reporting and outcome relevance, and synthesised thematically.

Principal Findings: Invasive studies consistently show that exercise unmasks haemodynamic abnormalities that resting tests miss. Exercise-derived echocardiographic abnormalities, including elevated filling-pressure surrogates, exercise pulmonary hypertension and exercise-induced pulmonary congestion, carry consistent prognostic information. The diagnostic accuracy of individual markers, especially the ratio of early mitral inflow to early diastolic annular velocity, is considerably less secure: validation studies conflict, largely because of differences in patient spectrum, reference standards and measurement timing. Tricuspid regurgitation signals are frequently unobtainable at peak exercise, and the incremental value of stress testing over probability scores appears modest in several invasive validation cohorts. Left atrial mechanics, systolic reserve, cardiac output-indexed pulmonary pressures and lung ultrasound show promise but require external validation.

Unresolved Questions: Consensus is lacking on the reference standard, age- and sex-specific normal responses, optimal protocols and the effect of test-guided management on patient outcomes.

Implications and Conclusion: Exercise echocardiography is best regarded as a question-driven, multiparametric physiological test integrated with pre-test probability and, where available, gas-exchange measurement, rather than as a single-parameter rule-in or rule-out tool. Prospective multicentre studies with invasive reference standards and outcome-oriented diagnostic trials are needed before stronger recommendations can be justified.

Fatty Pancreas Disease: An Updated Review of Risk Factors, Diagnosis, Clinical Associations and Management

2026-10-27T07:12:23+00:00

Fat accumulation within the pancreas is increasingly detected during abdominal imaging, but whether an imaging phenotype constitutes a clinically actionable disease remains uncertain. This critical narrative review evaluates the determinants, biological interpretation, diagnostic assessment, clinical associations and management of fatty pancreas disease, integrating contemporary epidemiological, imaging, pathological, mechanistic and longitudinal evidence. The literature was critically selected from accessible scholarly sources, with emphasis on studies published from 2007 to 13 August 2026 and earlier foundational work when necessary. The synthesis distinguishes physiological intrapancreatic lipid from excessive, potentially harmful deposition and contrasts two influential 2026 international consensus frameworks. Age, visceral adiposity, metabolic dysfunction and selected genetic or pancreatic factors are recurrent correlates, but substantial heterogeneity in body composition and fat compartmentalisation limits any single causal model. Quantitative magnetic resonance imaging, particularly proton density fat fraction techniques, provides the most defensible non-invasive assessment; nevertheless, sampling methods, thresholds and clinically relevant severity categories remain inadequately validated. Cohort studies associate greater pancreatic fat with incident diabetes, pancreatitis and pancreatic cancer, although residual confounding, reverse causality and inconsistent endpoint ascertainment complicate causal interpretation. Histopathology and experimental work support several biologically plausible pathways, but do not establish that removing pancreatic fat alone prevents pancreatic disease. Weight loss and metabolic treatment can reduce pancreatic fat, yet benefits specific to pancreatic fat reduction have not been isolated from broader improvements in metabolic health. No pharmacological or procedural treatment is established solely for asymptomatic fatty pancreas, and incidental imaging findings do not independently justify pancreatic cancer surveillance. The review proposes a phenotype-aware clinical approach centred on established risk-factor management, diagnostic restraint and appropriately designed prospective trials. The immediate priorities are harmonised imaging acquisition, validation against meaningful clinical outcomes and intervention studies capable of distinguishing a causal target from a correlated metabolic marker.

Antenatal Education and Pregnancy Outcomes: Mechanisms, Clinical Evidence and Implementation

2026-10-27T12:04:14+00:00

Antenatal education is widely integrated into maternity services, yet its contribution to pregnancy outcomes is frequently inferred from interventions that combine information with clinical surveillance, psychological counselling or social support. This critical narrative review evaluates whether, how and under what conditions antenatal education influences psychological, obstetric, behavioural and early postnatal outcomes. Peer-reviewed randomised trials, observational studies, evidence syntheses and authoritative maternal-health guidance published between 2005 and 19 August 2026 were considered, with attention to intervention definition, comparator integrity, causal attribution and applicability across health systems. Evidence is most consistent for improvement in childbirth-related knowledge, selected dimensions of confidence and, particularly in targeted interventions, fear of childbirth. Effects on mode of birth are more conditional: some pooled analyses indicate fewer planned caesarean births and more vaginal births, whereas effects on unplanned caesarean birth, epidural use and neonatal outcomes are uncertain or inconsistent. Group antenatal care can strengthen health literacy and preparation for complications, but such service packages cannot establish an education-only effect. Antenatal breastfeeding education alone has not consistently improved sustained breastfeeding, and apparent benefits of blended perinatal programmes often include postnatal support. Digital approaches expand potential reach while introducing access, privacy and engagement inequalities. Across themes, outcome measurement, intervention heterogeneity, incomplete reporting, self-selection and repeated reporting from single trials constrain inference. Antenatal education should therefore be understood as a potentially valuable, context-dependent component of quality maternity care rather than an independent determinant of all pregnancy outcomes. Future evaluations need well-specified components, active comparators, prespecified patient-valued outcomes, longer follow-up and explicit assessment of equity and implementation fidelity.