Asian Journal of Medical Principles and Clinical Practice

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Clinical Impact of Rifaximin in Liver Cirrhosis: A Critical Review

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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