Journal of Advances in Medicine and Medical Research

Diversity in Storage Abnormalities on Vascular Cell Adhesion Molecules (VCAM-1), Intercellular Adhesion Molecule-1 (ICAM-1), and P-selectin (SELP) in CPDA-1-Whole Blood Containing Specific ABO Antigens

Augustine Okereke Abani — 2026-09-15

Background: Blood storage is associated with progressive biochemical and cellular changes that may alter the concentrations of soluble adhesion molecules. Vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), and P-selectin (SELP) are important mediators of inflammation and endothelial function, but data on their stability in CPDA-1-stored whole blood remain scarce in the local setting.

Aim: This study assessed storage-related changes in vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), and P-selectin across ABO blood groups.

All donors were screened and confirmed negative for human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and syphilis before blood collection. Whole blood was collected into Citrate Phosphate Dextrose Adenine-1 (CPDA-1) blood bags and stored under standard blood bank conditions. Serum concentrations of VCAM-1, ICAM-1, and P-selectin were determined on Days 1, 8, 15 and 22 of storage using an enzyme-linked immunosorbent assay (ELISA).

Results: Serum concentrations of VCAM-1, P-selectin, and ICAM-1 declined progressively during storage. Significant reductions were observed from Day 1 through Day 22 for all three adhesion molecules (p < 0.001). Across the ABO blood groups, VCAM-1 and ICAM-1 concentrations were highest in blood group A and lowest in blood group O, whereas P-selectin concentrations were highest in blood group AB and lowest in blood group O. Correlation analysis demonstrated a weak, non-significant positive relationship between VCAM-1 and P-selectin (r = 0.294, p = 0.208), whereas VCAM-1 showed a strong and statistically significant positive correlation with ICAM-1 (r = 0.888, p = 0.001).

Conclusion: These results suggest that prolonged storage of whole blood reduces key adhesion molecules, potentially affecting the functional and haemostatic properties of stored blood and possibly influencing its clinical efficacy and inflammatory response upon transfusion.

Antimicrobial Susceptibility of Urinary Tract Pathogens in a Resource-Limited Southern Nigerian Setting: Data to Inform Local Stewardship Frameworks

Sandra Chinonyerem Ogbusi — 2026-09-22

Background: Urinary tract infections (UTIs) contribute substantially to infectious disease morbidity, while locally derived antimicrobial resistance data remain limited in many semi-urban Nigerian settings. This study assessed uropathogen prevalence and antimicrobial susceptibility at Igbinedion University Teaching Hospital, Okada, Nigeria, to support local stewardship and empirical treatment decisions.

Methods: A retrospective review of archived microbiology records from March 2022 to January 2025 included urine samples submitted for culture and susceptibility testing. Culture positivity, organism distribution, gender distribution, and resistance patterns were analysed. Antimicrobial susceptibility testing used the Kirby–Bauer disk diffusion method with CLSI 2021 breakpoints.

Results: Of 571 urine samples, 442 (77.4%) showed significant microbial growth. Female patients contributed 439 samples (76.9%). Staphylococcus aureus was the most frequently isolated organism (222; 50.2%), followed by Escherichia coli (160; 36.2%). The predominance of S. aureus requires cautious interpretation because contamination, referral-centre case mix, and local identification practices may have contributed. Resistance was highest to erythromycin (96.6%) and nitrofurantoin (88.4%), whereas ciprofloxacin showed comparatively higher susceptibility.

Conclusion: The findings indicate a high burden of bacteriuria and antimicrobial resistance in this hospital population. Routine urine culture, locally generated antibiograms, and structured antimicrobial stewardship are warranted. Erythromycin and nitrofurantoin appear unreliable for empirical treatment at this facility, while fluoroquinolone use should remain cautious and culture guided.

Factors Contributing to Pneumococcal Vaccination Hesitancy among Caregivers of Children with Sickle Cell Anaemia in a Resource-limited Setting: Implications for Vaccine Coverage

Ayuba Zakar — 2026-09-22

Background: Children with sickle cell anaemia (SCA) are at increased risk of invasive pneumococcal disease, making pneumococcal vaccination an important preventive measure. However, vaccine hesitancy may reduce uptake, particularly in resource-limited settings where access to vaccines and reliable information may be constrained.

Aim: This study examined factors contributing to pneumococcal vaccination hesitancy among caregivers of children with SCA and their implications for vaccine coverage.

Study Design: The work was a hospital-based cross-sectional study conducted among caregivers of children with SCA.

Place and Duration of Study: The study was conducted at the sickle cell clinic of the Yobe State Specialist Hospital, Potiskum, from April to June 2026.

Methodology: Data were collected using a structured, interviewer-administered questionnaire addressing sociodemographic characteristics, vaccination status, and reported reasons for hesitancy. Descriptive statistics were used to summarise the reported barriers.

Results: Of the 126 participating caregivers, 108 (85.7%) vaccinated their children, while 18 (14.3%) did not or were unsure of their vaccination status. The most frequently reported reasons for hesitancy were fear of side effects and vaccine unavailability (27.8% each), followed by lack of trust (16.7%), lack of awareness (11.1%), and high cost (11.1%). The majority (83.3%) of the hesitant caregivers indicated that encouragement from healthcare workers would motivate them to vaccinate their children.

Conclusion: Pneumococcal vaccine hesitancy is influenced by both caregiver-related concerns and health-system barriers. Strengthening vaccine counselling services, addressing safety concerns, and ensuring that vaccines are available, affordable, and accessible may enhance pneumococcal conjugate vaccine (PCV) uptake among children with SCA.

Association between Ultra-processed Food Consumption and History of Colorectal Cancer among U.S. Adults: A Cross-sectional Analysis of National Health and Nutrition Examination Survey (2017– March 2020)

Genevieve O. Onwughalu — 2026-09-23

Background: Ultra-processed foods constitute a substantial proportion of dietary intake among U.S. adults and have been associated with several chronic diseases. Evidence regarding their relationship with colorectal cancer remains limited and inconsistent, particularly in nationally representative populations.

Objective: To examine the association between ultra-processed food consumption and a history of colorectal cancer among U.S. adults.

Methods: This cross-sectional study used NHANES 2017–March 2020 pre-pandemic data. Foods reported during the Day 1 24-hour dietary recall were classified according to the NOVA system. Ultra-processed food intake was expressed as a percentage of total daily energy intake and categorised into quartiles. A history of colorectal cancer was identified using the Medical Conditions Questionnaire. Survey-weighted logistic regression was performed with adjustment for age, sex, race and ethnicity, educational attainment, body mass index, diabetes, hypertension, smoking status, and physical activity.

Results: The analytic sample included 7,372 adults, of whom 58 reported a history of colorectal cancer, representing approximately 232,402,091 U.S. adults. The weighted prevalence of colorectal cancer ranged from 0.43% to 0.89% across quartiles of ultra-processed food intake. Compared with the lowest quartile, the adjusted odds ratios were 1.66 (95% CI, 0.45–6.20) for the second quartile, 0.96 (95% CI, 0.31–3.03) for the third quartile, and 1.34 (95% CI, 0.47–3.85) for the highest quartile. None of these estimates was statistically significant, and the confidence intervals were wide.

Conclusions: This cross-sectional analysis did not identify a statistically significant association between ultra-processed food intake and a history of colorectal cancer. However, the small number of colorectal cancer cases, wide confidence intervals, use of a single dietary recall, and inability to establish temporality limit the interpretation of the findings. The results should not be considered evidence that an association is absent. Larger prospective studies using repeated dietary assessments and validated incident colorectal cancer outcomes are needed.

Post-treatment Dermal Thickness after Repeated Autologous Albumin Platelet-rich Fibrin Versus Hyaluronic Acid at the Nasolabial Fold: An Age-adjusted Ultrasound Comparative Study

Nina Hassani — 2026-09-24

Background: Nasolabial-fold correction can be achieved with hyaluronic acid (HA) fillers or autologous platelet-rich fibrin-based materials, but post-treatment tissue thickness may reflect different structural effects.

Aims: To determine whether repeated autologous albumin platelet-rich fibrin treatment is associated with a stronger sonographic dermal-thickness signal than repeated hyaluronic acid treatment at the nasolabial fold after accounting for age.

Study Design: Retrospective cross-sectional comparative study.

Place and Duration of Study: Cardiomed Jura, Courrendlin, Switzerland. The albumin platelet-rich fibrin cohort received three sessions over approximately one year; ultrasound was performed three months after the third session. The hyaluronic acid cohort had received at least three treatments during the preceding three years, with imaging at least three months after the latest treatment.

Methodology: Twenty women were included (10 per group). High-frequency ultrasound assessed post-treatment dermal thickness. Exact Mann-Whitney testing, within-group Spearman correlations, and an exploratory age-adjusted linear model were used.

Results: Mean age was 57.1 ± 8.0 years for hyaluronic acid and 52.1 ± 7.0 years for albumin platelet-rich fibrin (P = .22). Mean dermal thickness was 1.34 ± 0.09 versus 2.29 ± 0.21 mm, respectively (difference, 0.95 mm; U = 0; P < .001). Thickness decreased with age in both cohorts. After adjustment, albumin platelet-rich fibrin remained associated with 0.86 mm greater thickness (95% CI, 0.77-0.95; P < .001).

Conclusion: Repeated albumin platelet-rich fibrin was associated with a marked age-independent post-treatment dermal-thickness signal compared with repeated hyaluronic acid. This objective signal is compatible with dermal remodelling; however, the absence of pretreatment ultrasound precludes proof of treatment-induced regeneration or neocollagenesis.

Diagnostic Agreement between Manual Liquid-Based Cytology and Histopathology among HIV-Positive Women at Machakos Level 5 Hospital, Kenya

Onesmus Muia Mutuku — 2026-09-24

Aims: This study assessed the diagnostic agreement between manual liquid-based cervical cytology (MLBC) and histopathology among HIV-positive women attending Machakos Level 5 Hospital, Kenya.

Study Design: A prospective comparative cross-sectional study.

Place and Duration of Study: The study was conducted at the Comprehensive Care Centre, Machakos Level 5 Hospital, Machakos County, Kenya, between July and December 2020.

Methodology: The study included 400 HIV-positive women attending the Comprehensive Care Centre. Cervical specimens were collected and processed using the manual liquid-based cytology technique. Cytological examination was performed by the principal investigator, while all abnormal smears were reviewed by a pathologist. Participants with cytological findings of high-grade squamous intraepithelial lesions or worse were referred for biopsy and histopathological examination. Cohen's kappa statistic was used to assess the level of agreement between manual liquid-based cervical cytology and histopathological findings.

Results: Of the 400 women evaluated, 385 had satisfactory cytological specimens, while 15 (3.8%) were unsatisfactory. Cervical cytological abnormalities were detected in 30 (7.8%) women. Ten women with high-grade cytological abnormalities or worse were referred for biopsy and histopathological examination. Histopathology revealed CIN 2 in 4 (40%) women, CIN 3 in 3 (30%), squamous cell carcinoma in 2 (20%), and chronic cervicitis in 1 (10%). The agreement between manual liquid-based cervical cytology and histopathology was moderate (Cohen’s κ = 0.574; 95% CI: 0.41–0.60; p = 0.11), with a contingency coefficient of 0.689.

Conclusion: Manual liquid-based cervical cytology demonstrated moderate diagnostic agreement with histopathology among HIV-positive women. The technique may provide a practical and potentially useful cervical cancer screening approach in resource-limited settings where automated liquid-based cytology is less accessible.

Evaluating the Clinical Use of Cefoperazone/ Sulbactam and Post-discharge Antibiotics Practices in Infectious Diseases Patients

Maitreyi Joshi — 2026-09-26

Background: Rational use of broad-spectrum antimicrobials and appropriate post-discharge de-escalation are important components of antimicrobial stewardship.

Objectives: The study aims to evaluate the clinical use of Cefoperazone/Sulbactam in hospitalised patients with infectious diseases and to examine post-discharge antibiotic prescribing practices by assessing the appropriateness of therapy, duration of treatment, clinical outcomes, and compliance with antimicrobial stewardship guidelines.

Materials and Methods: A prospective observational study was conducted in the inpatient department of a tertiary care hospital in Pune, India, over six months. Data from 130 patients were collected using a validated patient profile form and included demographics, diagnoses, comorbidities, laboratory findings, microbiological results, treatment patterns, clinical outcomes at discharge, and discharge medications. Descriptive statistics were used.

Results: The study examined Cefoperazone/Sulbactam use in 130 inpatients over a six-month period at a tertiary care hospital. The mean age of the cohort was 55.77 years (approximately 56 years), and the sex distribution was approximately equal (53% male and 47% female). Urine culture and sensitivity testing was performed in 53 patients (40.77%), and 17 isolates were identified; the most frequent Gram-negative organisms were Escherichia coli (7.69%), Pseudomonas aeruginosa (1.54%), and Klebsiella pneumoniae (1.54%). Compliance with treatment guidelines was high, with 81.16% of male and 83.61% of female patients adhering to recommended practices. The study also identified a substantial switch from intravenous to oral therapy at discharge.

Conclusion: The findings indicate that Cefoperazone/Sulbactam was used with high guideline compliance in this inpatient cohort, particularly for infections involving Gram-negative organisms. The study emphasises the importance of adherence to recommended treatment guidelines, appropriate microbiological testing, and responsible antimicrobial stewardship. It also underscores the need for continuous surveillance and rational antibiotic use to support appropriate clinical practice and limit the development of antimicrobial resistance.

Early Cardiometabolic Responses to Pharmacological Therapy in Patients with Metabolic Syndrome in Rural Southern Nigeria: A Prospective Observational Study

Harmony Uchenna Ibezim — 2026-09-26

Background: Metabolic syndrome is a major public health concern because the clustering of cardiometabolic risk factors, particularly hypertension and impaired glucose metabolism, substantially increases the risk of cardiovascular disease and type 2 diabetes.

Aim: This study evaluated early clinical and biochemical responses to pharmacological therapy among patients with metabolic syndrome receiving routine care at a tertiary hospital serving rural communities in Southern Nigeria.

Methods: Seventy-five patients diagnosed with metabolic syndrome using the Joint Interim Statement criteria were enrolled in this prospective observational study. Baseline fasting blood glucose and blood pressure were measured before pharmacological therapy was started, and follow-up measurements were recorded after four weeks of treatment. Antihypertensive and hypoglycaemic medications were prescribed according to routine clinical practice and physician discretion.

Results: Systolic and diastolic blood pressure fell significantly after treatment (p < 0.001), and fasting blood glucose also declined significantly over the four-week follow-up period (p < 0.001). A proportion of patients achieved good control of blood pressure and glycaemia during follow-up. Outcomes varied across individual drug regimens, but differences between regimens were not consistently statistically significant, and the small subgroup sizes limit comparisons between regimens.

Conclusion: These findings indicate that pharmacological treatment was associated with measurable short-term improvements in cardiometabolic parameters among patients with metabolic syndrome in this resource-limited setting. Because the study had no control group and treatment was physician-directed, the results describe associations rather than the causal efficacy of specific drugs.

Comparative Assessment of p53 Tumour Suppressor and Ki-67 Proliferative Markers in Prostatic Adenocarcinoma: A Prospective Immunohistochemical Study from Makurdi, North-Central Nigeria

Christian A. Agbo — 2026-09-23

Background: Prostate cancer is the most common malignancy among Nigerian men, with the majority presenting late with high-grade disease.

Objectives: This study aimed to evaluate the utility of p53 and Ki-67 biomarkers in Nigerian men with prostate cancer by determining their expression frequencies and correlations with Gleason scores.

Patients and Methods: This was a prospective cross-sectional study conducted at Benue State University Teaching Hospital, Makurdi, Nigeria. Forty-seven patients with histologically confirmed prostate adenocarcinoma were recruited over one year. Clinical data, including age and serum PSA, were documented. Gleason scores were assigned using the 2019 ISUP modified system. Immunohistochemistry for p53 and Ki-67 was performed using the streptavidin-biotin immunoperoxidase method on 4µm sections. Positivity was assessed by a single pathologist. Chi-square tests and Spearman's correlation analyses were performed using SPSS version 26.

Results: The age range was 37-84 years, with a mean of 67.3 ±10.2 years. All 47 tumours (100%) were acinar adenocarcinomas. Gleason Grade Group 4 (Gleason score 8) was the most common, occurring in 20 cases (42.6%). Poorly differentiated tumours accounted for 32 cases (68.1%). p53 was positive in 11 cases (23.4%) and negative in 36 (76.6%). The p53-positive cases comprised 7 (14.9% of the cohort) poorly differentiated, 3 (6.4%) moderately differentiated, and 1 (2.1%) well-differentiated tumour. There was no significant association with Gleason grade (p=0.103). Ki-67 was positive in 35 cases (74.5%) and negative in 12 (25.5%). Ki-67 positivity increased with grade, and the association was significant (p=0.001). Both markers correlated with PSA: p53 showed a moderate correlation (rho=+0.496, p=0.005), whereas Ki-67 showed a strong correlation (rho=+0.876, p=0.001).

Conclusion: In this Nigerian cohort, Ki-67 showed a stronger association with aggressive disease indices than p53. While p53 was expressed in a minority of cases and was not significantly associated with grade, Ki-67 correlated with both higher Gleason grade and higher PSA.

Importance of Recognising Signs and Symptoms of Pre-eclampsia for Nursing Care in Primary Health Care: A Narrative Review

Irene Gomes Ferreira De Oliveira — 2026-09-18

Objective: To synthesise current evidence on the recognition of signs and symptoms of pre-eclampsia and to examine how this recognition supports safe nursing care in primary health care.

Methods: A narrative review with a structured literature search was undertaken. PubMed/MEDLINE, SciELO and relevant peer-reviewed journal platforms were searched for publications from 2020 to 2025 using combinations of terms related to pre-eclampsia, eclampsia, nursing, primary health care, antenatal care, signs, symptoms, knowledge and education. Peer-reviewed clinical guidelines, reviews, observational studies and educational interventions directly relevant to the review question were prioritised.

Results: Pre-eclampsia is a multisystem disorder diagnosed after 20 weeks of gestation by new-onset hypertension with proteinuria and/or maternal organ or uteroplacental dysfunction. Symptoms such as persistent severe headache, visual disturbance, epigastric or right upper quadrant pain and dyspnoea warrant urgent assessment, while oedema and rapid weight gain are nonspecific. Evidence indicates that nurses are central to accurate blood-pressure assessment, risk identification, symptom enquiry, health education, continuity of antenatal care and timely escalation or referral. Studies also identify clinically important gaps in nurses' knowledge and show that structured education can improve professional knowledge and pregnant women's awareness.

Conclusion: Early recognition of pre-eclampsia depends on systematic clinical assessment rather than symptoms alone. In primary health care, nursing practice should combine accurate surveillance, evidence-based education, risk-directed prevention and prompt referral when warning features are identified. Educational materials may support this work, but their content and effectiveness require formal validation before they are treated as validated interventions.

Cannabis and Cannabinoids in Cancer Treatment: A Critical Narrative Review of Supportive Care, Antitumour Evidence, Safety and Translational Gaps

Blessing Gerald Ibokette — 2026-09-23

Cannabis and cannabinoid-based products are increasingly used by people with cancer, yet the term “cancer treatment” encompasses two fundamentally different questions: whether cannabinoids can relieve cancer- or treatment-related symptoms, and whether they can modify tumour biology sufficiently to function as anticancer therapy. This critical narrative review evaluates these questions separately and then integrates them through an evidence hierarchy spanning pharmacology, preclinical oncology, randomised supportive-care trials, early cancer-directed studies, observational cohorts, drug-interaction research and contemporary clinical guidance. Literature published from 1 January 1990 to 19 July 2026 was identified through multidisciplinary scholarly searches, supplemented by citation tracking, trial-registry checks and DOI verification. The most clinically credible role is supportive rather than tumour-directed. Cannabinoid medicines can provide benefit for refractory chemotherapy-induced nausea and vomiting when added to contemporary antiemetic care, although much historical evidence predates current prophylaxis. By contrast, randomised evidence does not establish a clinically important benefit for opioid-refractory cancer pain, a dependable opioid-sparing effect, or meaningful reversal of cancer cachexia. Recent placebo-controlled data also fail to show improvement in overall symptom burden with balanced tetrahydrocannabinol–cannabidiol oil, despite limited secondary pain signals accompanied by greater psychomimetic toxicity. Preclinical studies demonstrate context-dependent effects on apoptosis, autophagy, proliferation, angiogenesis, invasion and immune signalling, but effective experimental concentrations, heterogeneous formulations, model limitations and predominantly high risk of bias constrain translation. Human anticancer evidence remains restricted to small glioblastoma studies and non-randomised observations, insufficient to establish efficacy. Immune-checkpoint inhibitor interactions remain unresolved, with conflicting observational signals. The evidence therefore supports a sharply differentiated interpretation: selected cannabinoid medicines may be useful as adjuncts for particular symptoms, whereas cannabis or cannabinoids should not replace established anticancer therapy outside clinical trials. Progress depends on pharmaceutical-grade formulations, exposure-confirmed dosing, mechanism-informed tumour selection, modern supportive-care comparators and adequately powered trials with clinically meaningful endpoints.

Phenylketonuria from Classical Phenotypes to Base Editing and Targeted Small Molecules: A Critical Narrative Review of Mechanistic Advance and Translational Uncertainty

Stefan Bittmann — 2026-09-29

Phenylalanine hydroxylase deficiency, historically described as phenylketonuria, occupies an unusual position in medicine. It was the first inherited metabolic disorder for which dietary intervention prevented intellectual disability, the first to be detected through population newborn screening, and it is now among the first for which in vivo genome correction has reached advanced preclinical validation. This review examines whether the conceptual architecture inherited from that history, above all the classification of patients into discrete phenotypic categories defined by pre-treatment blood phenylalanine concentration, remains adequate for a therapeutic landscape organised around residual enzyme function, variant-specific pharmacology and allele-specific correction. Literature was identified through structured searching of biomedical and multidisciplinary scholarly sources, supplemented by backward and forward citation tracking and by targeted searches for corrections and post-publication correspondence, with critical appraisal focused on design adequacy, endpoint validity and the distance between mechanistic demonstration and demonstrated clinical benefit. Four findings structure the synthesis. First, phenotypic classification predicts population-level severity but performs inconsistently at the level of the individual patient, and its predictive limits are inherited by every therapy selected on its basis. Second, the residual morbidity of early and continuously treated disease is real but modest in average magnitude, heterogeneous in expression and inconsistently attributable to phenylalanine exposure rather than to the restrictive diet itself. Third, pharmacological options have expanded substantially, and a recent head-to-head trial provides the first randomised comparison between cofactor-based agents, yet the evidence base remains dominated by biochemical surrogates over short horizons. Fourth, adenine base editing has achieved durable normalisation of blood phenylalanine in variant-humanised mouse models and improvement in brain biochemistry and motor phenotype, but no corrective editing approach has published peer-reviewed clinical outcomes, and the variant heterogeneity of the disorder poses a scalability problem that current allele-specific strategies do not resolve. The field's principal unresolved question is no longer whether phenylalanine can be lowered, but which outcomes justify which risks, in whom, and at what age.