International Journal of Medicine and Medical Sciences

International Journal of Medicine and Medical Sciences | Vol. 11, No. 9, September 2021 | pp. 65–72

DOI: 10.46882/2021/IJMMS/110065

Original Research Article

Assessment of Medication Adherence Barriers and Glycemic Outcomes among Elderly Type 2 Diabetes Patients

Chidi O. Okafor¹, Amina J. Hassan², Samuel K. Appiah¹*

¹Department of Medicine, College of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.

²Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Accra, Ghana.

Abstract:

Suboptimal medication adherence in elderly type 2 diabetes mellitus (T2DM) patients increases the risk of microvascular and macrovascular complications. This cross-sectional analytical study evaluated specific patient-centered barriers to medication adherence and their impact on glycemic outcomes in elderly patients. We enrolled 160 T2DM patients aged ≥ 65 years who were managed on oral antidiabetic agents for at least two years. Medication adherence was quantified using the 8-item Morisky Medication Adherence Scale (MMAS-8), and glycemic control was assessed via Glycated Hemoglobin (HbA1c), with values ≥ 7.5% defined as poor control in this demographic. The mean age of the participants was 71.4 ± 4.8 years, and 54.4% were female. Based on MMAS-8 scores, high adherence was found in only 28.1% of patients, moderate adherence in 41.3%, and low adherence in 30.6%. The overall prevalence of poor glycemic control was 62.5% (100/160), with a mean HbA1c of 8.2 ± 1.4% in the low adherence group. The most common self-reported barriers to adherence were polypharmacy ≥ 5 daily medications (68.5%), high out-of-pocket drug costs (58.0%), and forgetfulness or cognitive decline (42.5%). Multivariate logistic regression analysis showed that low adherence was strongly associated with a higher risk of poor glycemic control (OR = 3.6, 95% CI = 1.8–7.2, p < 0.001) and polypharmacy (OR = 2.4, p < 0.05). Poor medication adherence is common among elderly diabetic patients and is linked to polypharmacy and financial constraints. Targeted interventions, such as simplifying drug regimens and providing economic support, are essential to improve clinical outcomes.

Keywords: Type 2 Diabetes Mellitus, Elderly Patients, Medication Adherence, HbA1c, Polypharmacy, Financial Barriers

Manuscript Timeline: Received: May 20, 2021; Revised: June 28, 2021; Accepted: July 22, 2021; Published: September 16, 2021.

Citation: Okafor CO, Hassan AJ, Appiah SK. Assessment of Medication Adherence Barriers and Glycemic Outcomes among Elderly Type 2 Diabetes Patients. International Journal of Medicine and Medical Sciences, 2021, 11(9): 65–72. DOI: 10.46882/2021/IJMMS/110065

International Journal of Medicine and Medical Sciences | Vol. 11, No. 8, August 2021 | pp. 57–64

DOI: 10.46882/2021/IJMMS/110057

Original Research Article

Ameliorative Effects of Gongronema latifolium Crude Leaf Extract on Alloxan-Induced Pancreatic Beta-Cell Cytotoxicity and Oxidative Stress in Rats

Mustapha T. Gidado¹, Rose C. Obi², Elizabeth W. Wanjiku¹*

¹Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, University of Maiduguri, Maiduguri, Nigeria.

²Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya.

Abstract:

Oxidative stress-induced destruction of pancreatic beta-cells is a core mechanism in the pathogenesis of type 1 diabetes mellitus, making exogenous radical scavengers a major therapeutic target. This experimental animal study examined the protective and restorative potential of an ethanolic extract of Gongronema latifolium leaves (EEGL) against alloxan-induced pancreatic cytotoxicity and oxidative stress in Wistar rats. Male rats (n = 30) were divided equally into five groups: Normal Control, Diabetic Control (alloxan 140 mg/kg, single intraperitoneal injection), Glibenclamide standard control (5 mg/kg), and two diabetic groups treated orally with EEGL at 200 mg/kg and 400 mg/kg body weight daily for 28 days. Markers of oxidative stress, serum insulin concentrations, and pancreatic histopathological architecture were evaluated. Alloxan induction caused severe hyperglycemia and reduced serum insulin levels (from 18.4 ± 1.5 μIU/mL to 4.2 ± 0.6 μIU/mL, p < 0.01). It also induced oxidative stress, characterized by a significant increase in pancreatic malondialdehyde (MDA) and decreases in superoxide dismutase (SOD) and catalase activities (p < 0.01). Daily oral treatment with 400 mg/kg EEGL significantly lowered fasting blood glucose and increased serum insulin levels to 12.8 ± 1.1 μIU/mL (p < 0.01 vs. diabetic control). Furthermore, EEGL treatment reduced pancreatic MDA levels and restored antioxidant enzyme activities (p < 0.01). Histopathology confirmed these findings, showing a preservation of islet structure and a reduction in cellular degenerative changes. Gongronema latifolium leaves possess potent antioxidant properties that protect pancreatic beta-cells from oxidative damage and enhance insulin secretion.

Keywords: Gongronema latifolium, Alloxan, Pancreatic Beta-Cells, Oxidative Stress, Insulin Secretion, Histopathology

Manuscript Timeline: Received: April 15, 2021; Revised: May 24, 2021; Accepted: June 15, 2021; Published: August 14, 2021.

Citation: Gidado MT, Obi RC, Wanjiku EW. Ameliorative Effects of Gongronema latifolium Crude Leaf Extract on Alloxan-Induced Pancreatic Beta-Cell Cytotoxicity and Oxidative Stress in Rats. International Journal of Medicine and Medical Sciences, 2021, 11(8): 57–64. DOI: 10.46882/2021/IJMMS/110057

International Journal of Medicine and Medical Sciences | Vol. 11, No. 7, July 2021 | pp. 49–56

DOI: 10.46882/2021/IJMMS/110049

Original Research Article

Seroprevalence and Risk Factors of Hepatitis C Virus Infection among Patients Undergoing Chronic Hemodialysis

Patrick O. Diallo¹, Cynthia U. Nwachukwu², Jean-Pierre B. Diop¹*

¹Department of Nephrology, Faculty of Medicine, Université Cheikh Anta Diop, Dakar, Senegal.

²Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.

Abstract:

Patients undergoing long-term hemodialysis are highly vulnerable to nosocomial transmission of blood-borne pathogens due to frequent vascular access and shared treatment environments. This cross-sectional study investigated the seroprevalence and specific risk factors associated with Hepatitis C Virus (HCV) infection among patients undergoing chronic hemodialysis in regional renal units. Serum samples collected from 210 maintenance hemodialysis patients were screened for anti-HCV antibodies using a third-generation Enzyme-Linked Immunosorbent Assay (ELISA). Reactive samples were further validated using quantitative real-time polymerase chain reaction (RT-PCR) to detect HCV RNA. Clinical histories, dialysis vintage, and blood transfusion data were extracted from medical registries. The overall seroprevalence of anti-HCV antibodies was 14.3% (30/210), and HCV RNA positivity was confirmed in 73.3% (22/30) of the seroreactive patients, indicating active viremics. Multivariate logistic regression analysis demonstrated that a dialysis vintage > 24 months (OR = 3.8, 95% CI = 1.9–7.6, p < 0.01), receiving > 5 units of packed red blood cells (OR = 2.9, 95% CI = 1.4–5.9, p < 0.01), and a history of hemodialysis treatment across multiple healthcare centers (OR = 2.4, 95% CI = 1.1–5.2, p < 0.05) were independent risk factors for infection. HCV genotype analysis revealed a predominance of genotype 2 (63.6%) and genotype 1 (27.3%). The high seroprevalence of HCV in hemodialysis units underscores the urgent need for strict adherence to universal infection control precautions, dedicated dialysis machines for infected patients, regular biochemical screening, and expanded access to direct-acting antiviral treatments.

Keywords: Hepatitis C Virus, Hemodialysis, Seroprevalence, Dialysis Vintage, Nosocomial Transmission, HCV RNA

Manuscript Timeline: Received: March 12, 2021; Revised: April 22, 2021; Accepted: May 18, 2021; Published: July 12, 2021.

Citation: Diallo PO, Nwachukwu CU, Diop JPB. Seroprevalence and Risk Factors of Hepatitis C Virus Infection among Patients Undergoing Chronic Hemodialysis. International Journal of Medicine and Medical Sciences, 2021, 11(7): 49–56. DOI: 10.46882/2021/IJMMS/110049

International Journal of Medicine and Medical Sciences | Vol. 11, No. 6, June 2021 | pp. 41–48

DOI: 10.46882/2021/IJMMS/110041

Original Research Article

Diagnostic Performance of Serum Interleukin-6 versus Procalcitonin as Early Biomarkers for Severe Acute Cholangitis

Charles O. Igwe¹, Rachel L. Sanon², Anthony D. Boateng¹*

¹Department of Surgery, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Abuja, Nigeria.

²Department of Gastroenterology, Faculty of Health Sciences, Université de Ouagadougou, Ouagadougou, Burkina Faso.

Abstract:

Acute cholangitis is a life-threatening biliary infection that requires rapid risk stratification to prevent systemic septic shock. This prospective diagnostic study evaluated and compared the performance of serum Interleukin-6 (IL-6) and procalcitonin (PCT) as early biochemical indicators for severe acute cholangitis. We evaluated 115 adult patients admitted with confirmed acute cholangitis within 24 hours of symptom onset. Patients were classified into mild/moderate (n = 75) or severe (n = 40) groups according to the Tokyo Guidelines (TG13/TG18) grading criteria. Serum IL-6 and PCT concentrations were measured via enzyme-linked immunosorbent assay (ELISA) at admission, and diagnostic utilities were assessed using Receiver Operating Characteristic (ROC) curves. Serum IL-6 at a cutoff value of 120 pg/mL demonstrated a sensitivity of 90.0%, specificity of 84.0%, positive predictive value (PPV) of 75.0%, and negative predictive value (NPV) of 94.0% for identifying severe cases. In comparison, serum PCT at a cutoff value of 3.5 ng/mL showed a sensitivity of 80.0%, specificity of 78.7%, PPV of 66.7%, and NPV of 88.1%. The Area Under the Curve (AUC) was significantly larger for IL-6 (AUC = 0.91, 95% CI = 0.85–0.97) than for PCT (AUC = 0.82, 95% CI = 0.73–0.91, p < 0.05). Combining both inflammatory biomarkers significantly enhanced the overall diagnostic sensitivity to 95.0% and the NPV to 96.7%. Serum IL-6 offers superior early diagnostic accuracy and sensitivity compared to procalcitonin in predicting severity in acute cholangitis, serving as an effective clinical tool to guide urgent biliary decompression interventions.

Keywords: Acute Cholangitis, Interleukin-6, Procalcitonin, Biomarkers, Diagnostic Accuracy, Biliary Sepsis

Manuscript Timeline: Received: February 18, 2021; Revised: March 25, 2021; Accepted: April 20, 2021; Published: June 15, 2021.

Citation: Igwe CO, Sanon RL, Boateng AD. Diagnostic Performance of Serum Interleukin-6 versus Procalcitonin as Early Biomarkers for Severe Acute Cholangitis. International Journal of Medicine and Medical Sciences, 2021, 11(6): 41–48. DOI: 10.46882/2021/IJMMS/110041

International Journal of Medicine and Medical Sciences | Vol. 11, No. 5, May 2021 | pp. 33–40

DOI: 10.46882/2021/IJMMS/110033

Original Research Article

Antimicrobial Resistance Trends and Molecular Mechanisms of Extended-Spectrum Beta-Lactamase (ESBL) Production in Pediatric Diarrheagenic Escherichia coli

Elizabeth A. Cole¹, Moses Z. Tarawallie², Victoria N. Okoye¹*

¹Department of Medical Microbiology, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.

²Department of Paediatrics, Connaught Hospital, Freetown, Sierra Leone.

Abstract:

The emergence of Extended-Spectrum Beta-Lactamase (ESBL)-producing enteric bacteria in pediatric populations complicates clinical management and limits oral antibiotic options. This prospective cross-sectional study evaluated the prevalence, susceptibility trends, and molecular genotypes of ESBL-producing Escherichia coli isolated from stool samples of children under five years old presenting with acute diarrhea. Stool specimens from 300 children were cultured on selective media, and E. coli isolates were identified using standard biochemical profiles. Phenotypic confirmation of ESBL production was performed using the double-disk synergy test, and underlying genotypes (blaCTX-M, blaTEM, and blaSHV genes) were screened via multiplex PCR. The overall isolation rate of diarrheagenic E. coli was 38.0% (114/300). Among these isolates, the prevalence of phenotypically confirmed ESBL producers was 24.6% (28/114). Antibiogram screening showed high co-resistance rates among ESBL strains to trimethoprim-sulfamethoxazole (92.8%), ciprofloxacin (64.3%), and gentamicin (57.1%); however, all strains remained completely susceptible to amikacin and meropenem (100%). Molecular analysis revealed that the blaCTX-M gene was the most common genotype (78.6%), followed by blaTEM (53.6%) and blaSHV (17.8%), with multiple resistance genes detected in 35.7% of the isolates. Risk factor analysis indicated that previous over-the-counter antibiotic use (OR = 3.8, 95% CI = 1.9–7.6, p < 0.01) was strongly associated with ESBL-producing infections. ESBL-producing E. coli represents a significant cause of pediatric diarrhea, showing high resistance to common oral drugs. This highlights the need for stronger oversight of over-the-counter antibiotic sales and routine laboratory testing for pediatric gastrointestinal infections.

Keywords: Diarrheagenic Escherichia coli, Pediatric Diarrhea, Extended-Spectrum Beta-Lactamase, blaCTX-M gene, Drug Resistance, Antimicrobial Stewardship

Manuscript Timeline: Received: January 10, 2021; Revised: February 20, 2021; Accepted: March 15, 2021; Published: May 12, 2021.

Citation: Cole EA, Tarawallie MZ, Okoye VN. Antimicrobial Resistance Trends and Molecular Mechanisms of Extended-Spectrum Beta-Lactamase (ESBL) Production in Pediatric Diarrheagenic Escherichia coli. International Journal of Medicine and Medical Sciences, 2021, 11(5): 33–40. DOI: 10.46882/2021/IJMMS/110033

International Journal of Medicine and Medical Sciences | Vol. 11, No. 4, April 2021 | pp. 25–32

DOI: 10.46882/2021/IJMMS/110025

Original Research Article

Pulmonary Function Impairment and Respiratory Symptoms among Commercial Stone Quarry Workers

Festus M. Tetteh¹, Kingsley C. Amadi², Arthur J. Bond¹*

¹Department of Physiology, School of Biomedical Sciences, University of Ghana, Accra, Ghana.

²Department of Medicine, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria.

Abstract:

Chronic exposure to respirable crystalline silica dust during stone crushing causes progressive airway inflammation and parenchymal damage. This cross-sectional analytical study evaluated the prevalence of occupational respiratory symptoms and chronic lung function alterations among commercial stone quarry workers. We matched 140 male quarry workers exposed to stone dust for at least 3 years with 140 unexposed healthy male control subjects based on age, height, and body mass index. Respiratory profiles were evaluated using the Medical Research Council questionnaire, and lung parameters were captured via computerized spirometry. Quarry workers exhibited a significantly higher prevalence of chronic dry cough (42.1% vs. 11.4%, p < 0.01), chest tightness (32.9% vs. 7.1%, p < 0.01), and exertional dyspnea (35.7% vs. 8.6%, p < 0.01) than the control cohort. Spirometric evaluations revealed significant reductions in Forced Vital Capacity (FVC) (3.12 ± 0.38 L vs. 3.91 ± 0.41 L, p < 0.01) and Forced Expiratory Volume in 1 second (FEV1) (2.28 ± 0.32 L vs. 3.24 ± 0.36 L, p < 0.01) in the exposed group. The FEV1/FVC ratio was also significantly reduced in quarry workers (73.07 ± 4.8% vs. 82.86 ± 3.5%, p < 0.05), indicating a mixed pattern of ventilatory restriction and obstruction. Regression analysis showed that exposure duration > 5 years was strongly correlated with a larger reduction in FVC (r = -0.62, p < 0.01). Occupational exposure to stone dust induces severe respiratory symptoms and impairs lung function. Mandatory use of appropriate personal respirators, industrial wet-drilling engineering modifications, and regular medical screening are necessary to safeguard worker health.

Keywords: Silica Dust, Stone Quarry, Spirometry, Forced Vital Capacity, Occupational Health, Lung Impairment

Manuscript Timeline: Received: December 02, 2020; Revised: January 14, 2021; Accepted: February 05, 2021; Published: April 15, 2021.

Citation: Tetteh FM, Amadi KC, Bond AJ. Pulmonary Function Impairment and Respiratory Symptoms among Commercial Stone Quarry Workers. International Journal of Medicine and Medical Sciences, 2021, 11(4): 25–32. DOI: 10.46882/2021/IJMMS/110025