Journal of Advances in Medicine and Medical Research

Blood Pressure Control Following Fixed-dose Combination Antihypertensive Therapy in a Private Nigerian Cardiology Setting: A Retrospective Descriptive Study

Tue, 18 Aug 2026 00:00:00 +0000

Background: Hypertension is a leading modifiable risk factor for cardiovascular morbidity and mortality, with a disproportionate burden in low- and middle-income countries, including Nigeria. Questions remain regarding real-world prescribing patterns, blood pressure responses, and follow-up control rates among patients receiving combination antihypertensive therapy in Nigerian private clinical settings.

Aim: To evaluate antihypertensive prescribing patterns, blood pressure changes, control rates, and documented treatment-related adverse events among patients with hypertension managed at a private multispecialist hospital in Lagos, Nigeria.

Methods: A retrospective observational study was conducted among 563 adults with hypertension who had baseline and second-visit blood pressure measurements; 286 also had third-visit measurements. Demographic characteristics, comorbidities, treatment regimens, and blood pressure outcomes were analysed. Paired-samples t-tests were used to compare mean systolic and diastolic blood pressures across visits, while independent-samples t-tests and chi-square tests were used to compare patients who completed and did not complete follow-up. A p-value <0.05 was considered statistically significant.

Results: The cohort had a mean age of 60.23 ± 14.12 years and was predominantly male (57.73%). Significant reductions in systolic blood pressure were observed, with mean decreases of 21.09 mmHg and 28.53 mmHg at the second and third visits, respectively (p < 0.001). Among patients with available follow-up blood pressure measurements, mean systolic blood pressure decreased significantly from baseline to the second visit and from baseline to the third visit. Blood pressure control was achieved in 219/563 patients at the second visit and 172/286 patients at the third visit.

Conclusion: Antihypertensive therapy, particularly commonly used combination regimens, was associated with significant reductions in blood pressure and improved control rates across follow-up visits in this private Nigerian clinical setting. Prospective studies are needed to confirm the effectiveness, adherence benefits, and safety of fixed-dose combination therapy in broader Nigerian populations.

Factors Associated with High Blood Cholesterol among Indigenous Adults in Canada: A Cross-sectional Analysis of the 2022 Canadian Community Health Survey

Wed, 19 Aug 2026 00:00:00 +0000

Background: High blood cholesterol is a major modifiable risk factor for cardiovascular disease, but evidence on associated factors among Indigenous adults in Canada remains limited.

Objective: To identify demographic, socioeconomic, lifestyle, and clinical factors associated with high blood cholesterol among Indigenous adults in Canada.

Methods: A cross-sectional study was conducted using data from the 2022 Canadian Community Health Survey. The analysis included 1,632 Indigenous adults aged ≥18 years, representing 607,893 adults after survey weighting. Survey-weighted multivariable logistic regression with bootstrap replicate weights estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for self-reported high blood cholesterol.

Results: Older age, diabetes, hypertension, and province of residence were independently associated with high blood cholesterol. Compared with adults aged 18–34 years, higher odds were observed among those aged 50–64 years (aOR=5.16, 95% CI 1.88–14.16) and ≥65 years (aOR=5.80, 95% CI 2.05–16.42). Diabetes (aOR=7.06, 95% CI 2.77–17.99) and hypertension (aOR=2.36, 95% CI 1.18–4.70) were also associated with higher odds. Compared with Atlantic Canada, lower odds were observed in Quebec (aOR=0.25, 95% CI 0.07–0.98) and the Prairies (aOR=0.28, 95% CI 0.10–0.81). Sex, education, body mass index, smoking, and alcohol consumption were not significantly associated with the outcome.

Conclusions: Older age, diabetes, hypertension, and geographic region were associated with high blood cholesterol among Indigenous adults in Canada. These findings support integrated cardiovascular risk assessment and early identification of dyslipidaemia in Indigenous populations.

Effect of Dry Needling Combined with Scapular Stabilization Exercises Versus Scapular Stabilization Exercises Alone in Rotator Cuff-related Shoulder Pain: A Randomized Controlled Trial

Syed Rais Akhter Rizvi — Mon, 24 Aug 2026 00:00:00 +0000

Background: Rotator cuff-related shoulder pain (RCRSP) is associated with pain, disability, and restricted shoulder function. Scapular stabilisation exercises are commonly used in rehabilitation, while dry needling may provide adjunctive pain modulation. Whether dry needling adds benefit to a structured scapular stabilisation programme remains uncertain.

Objective: The study aims to compare dry needling combined with scapular stabilisation exercises with scapular stabilisation exercises alone in individuals with RCRSP.

Methods: Thirty-six individuals were screened, and 32 eligible participants were randomised equally to two groups and completed the study. The experimental group received dry needling plus scapular stabilisation exercises, whereas the control group received the same exercise programme alone. Treatment was delivered three times weekly for four weeks. Pain, shoulder disability, and active shoulder range of motion were assessed at baseline and post-intervention using the Numeric Pain Rating Scale (NPRS), Shoulder Pain and Disability Index (SPADI), and goniometry.

Results: NPRS decreased from 7.50 ± 1.63 to 2.94 ± 1.06 in the experimental group and from 7.50 ± 1.63 to 5.00 ± 1.26 in the control group. Mean reductions were 4.56 and 2.50 points, respectively, with a significant time × group interaction (F(1,30) = 73.30, p < 0.001). Both groups also improved in SPADI and all measured range-of-motion outcomes, with larger numerical changes in the experimental group. Internal rotation differed at baseline, warranting cautious interpretation.

Conclusion: Both interventions improved clinical outcomes, while adding dry needling produced a greater short-term reduction in pain.

Biochemical and in-silico Insights into the Cardioprotective Potential of Agaricus bisporus through NF-κB and Keap1/Nrf2 Pathway Modulation

M. O. Enemali, A. A. Oladejo, C. B. Okeke — Thu, 27 Aug 2026 00:00:00 +0000

Background: Myocardial infarction is associated with oxidative stress, cellular injury and dysregulation of inflammatory signalling. Agaricus bisporus contains diverse bioactive constituents with reported antioxidant and pharmacological activities, but its cardioprotective effects and possible molecular mechanisms remain incompletely characterised.

Aim: This study investigated the cardioprotective activity of A. bisporus fractions in isoproterenol-induced myocardial infarction using in vivo and in silico approaches.

Methods: Fresh A. bisporus was sequentially extracted to obtain n-hexane, ethyl acetate, ethanol and aqueous fractions. Wistar rats were pretreated orally with each fraction at 100, 200 or 400 mg/kg for 14 days before myocardial injury was induced with isoproterenol (150 mg/kg, intraperitoneally) on two consecutive days. Lisinopril-treated, isoproterenol-induced and normal groups served as controls. Serum catalase (CAT), superoxide dismutase (SOD) and lactate dehydrogenase (LDH) activities were determined. Molecular docking was subsequently performed using AutoDock Vina to evaluate the interactions of selected A. bisporus phytoconstituents with NF-κB and Keap1.

Results: Isoproterenol administration markedly reduced SOD activity and increased LDH activity relative to the normal control, indicating oxidative imbalance and myocardial cellular injury, while CAT activity showed comparatively modest changes. Treatment with A. bisporus fractions produced variable, fraction- and dose-dependent effects. The 400 mg/kg ethanol fraction produced the most pronounced increase in SOD activity (104.12 × 10⁻⁶ U/mL), whereas the 400 mg/kg ethyl acetate fraction produced the lowest LDH activity (225.54 U/L). Molecular docking revealed favourable interactions of several investigated phytoconstituents with the target proteins. Rutin exhibited the strongest predicted binding affinity towards NF-κB (−7.4 kcal/mol) and Keap1 (−9.6 kcal/mol), while myricetin and quercetin also demonstrated strong predicted interactions with Keap1 (−9.5 kcal/mol each).

Conclusion: Agaricus bisporus fractions demonstrated promising cardioprotective potential against isoproterenol-induced myocardial injury, particularly through modulation of antioxidant defence and reduction of cellular injury. The docking findings further suggest that phytoconstituents such as rutin, myricetin, quercetin, catechin and epigallocatechin may contribute to these effects through interactions with NF-κB and Keap1. Further experimental studies are required to validate these predicted molecular mechanisms and identify the specific bioactive constituents responsible for the cardioprotective activity.

An Unusual Presentation of a Cutaneous Horn on the Volar Surface of a Finger: A Case Report of a Young Nigerian Adult

Fri, 21 Aug 2026 00:00:00 +0000

Aim: To describe an uncommon cutaneous horn on the volar surface of a finger in a young Nigerian adult and highlight the unusual age and anatomical site.

Presentation of Case: A 29-year-old man presented with a solitary lesion over the volar aspect of the proximal interphalangeal joint of the right ring finger that had been present for 2 years. He reported no preceding trauma or surgery and no pain, itching, or bleeding. Examination showed a firm, horny lesion approximately 1 cm in length with a broad base and no basal erythema. The lesion was excised along the digital crease with a 3 mm margin, extending to just above the flexor tendon sheath. Histopathology demonstrated protuberant hyperkeratosis without appreciable parakeratosis, with mild papillomatosis, focal hypergranulosis, acanthosis, and mild perivascular lymphocytic infiltrates in the superficial dermis.

Discussion: Cutaneous horns are more commonly reported in older individuals and at sun-exposed sites, whereas this lesion occurred at a relatively photoprotected volar digital site in a young adult of African descent. As the horn represents a morphological presentation rather than the underlying pathology, assessment of the lesion base remains important.

Conclusion: Cutaneous horns may occur at unusual anatomical sites and in younger patients. Further documentation may help clarify their clinical spectrum in African populations.

Postauricular Dermoid Cyst in a Young Nigerian Man: A Case Report

Oluwawalehinmi Samson Oni, Dele Eradebamwen Imasogie — Sat, 22 Aug 2026 00:00:00 +0000

Aim: To describe an uncommon postauricular dermoid cyst in a young Nigerian man and document its clinical, radiological, operative, and histopathological features.

Presentation of Case: A 29-year-old man presented with a slow-growing right postauricular mass that had been noticed at birth. He reported no additional symptoms and no history of traumatic or inflammatory events, but the lesion had contributed to low self-esteem. Examination showed a soft 37 mm x 23 mm x 17 mm mass that obliterated the postauricular sulcus and was not attached to the overlying skin. Magnetic resonance imaging confirmed that the lesion was confined to the subcutaneous tissue. The swelling was completely excised under local anaesthesia, revealing a well-encapsulated mass in contact with the pericranium of the temporal bone. Histopathological examination showed a cyst lined by stratified squamous epithelium with pilosebaceous units and adipose tissue, and keratinous debris within the lumen, confirming a dermoid cyst. No recurrence was observed 2 months after surgery.

Discussion: Postauricular dermoid cysts are rare congenital lesions and may resemble other benign postauricular masses clinically. Imaging may assist in defining lesion extent when appropriate, whereas complete excision provides treatment and tissue for definitive histopathological classification.

Conclusion: Histopathological confirmation remains important for distinguishing a dermoid cyst from clinically similar postauricular lesions and for establishing the final diagnosis.

Artificial Intelligence in Primary Care for Disease Surveillance, Early Diagnosis, Preventive Care and Population Health Outcomes: A Critical Narrative Review

Wed, 12 Aug 2026 00:00:00 +0000

Primary care generates the longitudinal, population-wide records on which much contemporary health intelligence depends, and it is the setting in which most disease is first suspected and most preventive activity is delivered. Artificial intelligence has accordingly been proposed as a means of strengthening disease surveillance, accelerating early diagnosis, extending preventive care and improving population health outcomes. This critical narrative review examines whether the accumulated evidence supports those expectations, and where it does not. Peer-reviewed literature was identified through Europe PMC, which indexes MEDLINE and PubMed Central records, and through Crossref metadata records, supplemented by citation-informed retrieval and by targeted searching of an intergovernmental publication repository. Evidence was appraised for design adequacy, validation status, setting representativeness and the nature of the outcomes measured. The synthesis identifies a consistent and analytically important asymmetry across the four domains. Diagnostic performance evidence is comparatively mature for image-based and physiological-signal tasks, several of which have been evaluated prospectively or in randomised designs conducted wholly or partly in primary care. Surveillance and preventive applications remain dominated by retrospective model development, with external validation uncommon and prospective impact evaluation rare. Population health outcomes are almost never measured directly; the literature substitutes discrimination statistics, detection yield and process indicators, and the causal chain linking improved prediction to improved population health remains largely untested. Recurrent methodological weaknesses, including case-control sampling, optimistic internal validation, incomplete reporting of population characteristics and the use of convenient proxy outcomes, plausibly explain part of the gap between reported accuracy and demonstrated benefit. Evidence on differential performance across population subgroups is sparse relative to the strength of equity claims made for these technologies. Progress will depend less on further gains in discrimination than on pragmatic evaluation in representative primary care populations, on prespecified patient-relevant and population-level endpoints, and on governance that treats deployed models as interventions requiring continued surveillance rather than as fixed devices.

Epidemiology, Pathophysiology and Clinical Presentation of Pandemics Over the Last Three Decades: A Critical Narrative Review of the Evidence Base for Prevention, Control and Management

Albert Opoku, Asafo, T. A. Adjei, Raymond Ahenkorah, Yvonne Arhin Sarpong — Wed, 19 Aug 2026 00:00:00 +0000

Pandemics and pandemic-scale emergencies of the past three decades have produced an unusually large and heterogeneous body of evidence, yet the epidemiological, mechanistic and clinical literatures have largely developed in parallel and have rarely been appraised together. This review examines that literature critically, taking as its material the human immunodeficiency virus pandemic, the 2003 severe acute respiratory syndrome epidemic, the 2009 influenza A(H1N1) pandemic, Middle East respiratory syndrome, the West African and Congolese Ebola virus disease epidemics, the Zika virus epidemic, the ongoing seventh cholera pandemic, coronavirus disease 2019, the multi-country mpox emergencies, and the panzootic spread of highly pathogenic avian influenza A(H5N1). Literature was identified through searches of three openly accessible bibliographic resources and selected institutional sources, with all bibliographic records verified against registry metadata. The synthesis identifies four persistent problems. First, the operational category of a pandemic remains unstable, which affects the timing of declarations, the comparability of burden estimates and the allocation of resources. Second, the principal epidemiological quantities used to guide policy, including reproduction numbers, case fatality ratios and excess mortality, are estimated by methods whose assumptions are frequently unstated and whose disagreements are substantial enough to alter conclusions. Third, mechanistic accounts of severe disease have converged on a small number of shared processes, in particular innate immune dysregulation, endothelial injury and immunothrombosis, but the inferential basis for these accounts rests heavily on cross-sectional and post-mortem material from severely ill patients in high-income settings. Fourth, evidence on countermeasures is markedly stratified, with randomised evidence for vaccines and several therapeutics but predominantly observational and model-based evidence for non-pharmaceutical interventions. Confidence is strongest for the age gradient of severity, for the efficacy of several vaccine platforms and for the existence of a substantial post-acute symptom burden, and weakest for the comparative effectiveness of individual non-pharmaceutical interventions and for the mechanistic basis of post-acute syndromes. Research priorities that follow from these findings concern standardised burden estimation, prospective mechanistic cohorts recruited across the severity spectrum, and pre-agreed trial infrastructure capable of producing interpretable results during the acute phase of an emergency.

Gut Microbiota and Paediatric Endocrine-metabolic Disease: A Critical Appraisal of the Evidence in Childhood Obesity, Type 1 Diabetes, Steatotic Liver Disease and Growth Disorders

Thu, 27 Aug 2026 00:00:00 +0000

The intestinal microbial community assembles during the same developmental window in which adiposity, islet autoimmunity, hepatic lipid handling and linear growth are established, and this temporal coincidence has encouraged the view that microbial variation is a modifiable determinant of paediatric endocrine-metabolic disease. Evidence supporting that view is unevenly distributed across disorders and rests on designs of very different inferential strength. This critical narrative review evaluates the state of knowledge across four domains that are usually reviewed separately: childhood obesity and adiposity, type 1 diabetes and islet autoimmunity, paediatric metabolic dysfunction-associated steatotic liver disease, and disorders of linear growth including undernutrition-associated growth faltering. Literature was identified through structured searching of biomedical and multidisciplinary scholarly indexes, supplemented by citation tracking and by a regional index, and appraised for design adequacy, confounder control, analytical robustness and replication rather than for citation count. The synthesis indicates that mechanistic and gnotobiotic work provides reasonably strong support for microbial contributions to energy harvest, mucosal immune calibration, gut barrier function, bile acid signalling and somatotropic axis activity, whereas human paediatric evidence is dominated by cross-sectional case-control comparisons with modest samples, inconsistent taxonomic findings and limited adjustment for diet, adiposity, medication and geography. The strongest causal human evidence is found where interventions were designed against a defined microbial target, most notably microbiota-directed complementary feeding in undernutrition; the weakest is in obesity, where taxonomic signatures replicate poorly and intervention effects on adiposity are small and short-lived. Consistent shortcomings include reliance on faecal amplicon profiling as a proxy for a functionally heterogeneous ecosystem, scarce longitudinal sampling through puberty, and near-absence of hard clinical endpoints. Priorities include strain-resolved longitudinal cohorts spanning pubertal transition, target-engagement trials with prespecified microbial mediators, and deliberate representation of populations in which growth faltering and obesity coexist.