International Journal of Medicine and Medical Sciences

International Journal of Medicine and Medical Sciences | Vol. 16, No. 7, July 2026 | pp. 49–56

DOI: 10.46882/2026/IJMMS/160049

Original Research Article

Transmitted Drug Resistance Patterns and Molecular Surveillance among Antiretroviral-Naive Adults with Acute HIV-1 Infection

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

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

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

Abstract:

The transmission of drug-resistant HIV-1 strains threatens the long-term clinical efficacy of standard first-line antiretroviral therapy (ART) regimens. This prospective molecular surveillance study evaluated the prevalence of transmitted drug resistance (TDR) and characterized specific mutations among treatment-naive adult patients diagnosed with acute HIV-1 infection. Blood samples from 220 newly diagnosed, baseline ART-naive participants were collected. Viral RNA was extracted, and the pol gene (protease and partial reverse transcriptase regions) was amplified via nested PCR and sequenced using Sanger sequencing methods. Major drug resistance mutations were identified according to the World Health Organization (WHO) surveillance definitions. The overall prevalence of TDR in this cohort was found to be 11.8% (26/220). Resistance mutations directed against non-nucleoside reverse transcriptase inhibitors (NNRTIs) predominated, accounting for 7.3% of the total cohort, with the K103N (42.3%) and V106M (26.9%) substitutions being the most frequent. Nucleoside reverse transcriptase inhibitor (NRTI) mutations (M184V and T215Y) were detected in 3.2% of the participants, while protease inhibitor (PI) resistance remained low at 1.4%. Molecular genotypic routing showed a high prevalence of the CRF02_AG recombinant form (68.5%). Multivariate logistic regression modeling demonstrated that an age under 25 years (OR = 3.2, 95% CI = 1.5–6.8, p < 0.01) was an independent clinical risk factor for harboring a resistant variant. The TDR prevalence has crossed the intermediate threshold in this urban environment, driven by NNRTI-resistant clones. Baseline genotype tracking is recommended to preserve therapeutic outcomes.

Keywords: HIV-1, Transmitted Drug Resistance, Reverse Transcriptase, Genotype Surveillance, CRF02_AG, Molecular Mutations

Manuscript Timeline: Received: April 14, 2026; Revised: May 22, 2026; Accepted: June 10, 2026; Published: July 14, 2026.

Citation: Diallo PO, Nwachukwu CU, Diop JPB. Transmitted Drug Resistance Patterns and Molecular Surveillance among Antiretroviral-Naive Adults with Acute HIV-1 Infection. International Journal of Medicine and Medical Sciences, 2026, 16(7): 49–56. DOI: 10.46882/2026/IJMMS/160049

International Journal of Medicine and Medical Sciences | Vol. 16, No. 6, June 2026 | pp. 57–64

DOI: 10.46882/2026/IJMMS/160051

Original Research Article

Evaluation of Regional Cerebral Oxygen Saturation using Near-Infrared Spectroscopy versus Mean Arterial Pressure for Predicting Postoperative Cognitive Dysfunction in Elderly Patients

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

¹Department of Anesthesiology and Intensive Care, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Abuja, Nigeria.

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

Abstract:

Postoperative cognitive dysfunction (POCD) is a frequent and serious complication in elderly patients undergoing major surgery, but relying on standard systemic hemodynamic parameters like mean arterial pressure (MAP) often fails to detect localized cerebral hypoperfusion. This prospective observational study evaluated the utility of continuous regional cerebral oxygen saturation (rScO₂) monitoring via Near-Infrared Spectroscopy (NIRS) compared to intraoperative MAP tracking for predicting early POCD. We evaluated 130 elderly patients (aged ≥ 65 years) undergoing major elective orthopedic or abdominal surgeries under general anesthesia. Intraoperative rScO₂ and MAP variations were recorded, and cognitive function was assessed preoperatively and on postoperative day 7 using a standardized neuropsychological test battery. Severe intraoperative cerebral desaturation was defined as a decrease in rScO₂ > 20% from baseline lasting for ≥ 15 minutes. A total of 24 patients developed confirmed early POCD (18.5%). In the POCD cohort, the mean intraoperative rScO₂ dropped significantly below baseline values during the maintenance phase, whereas mean intraoperative MAP remained within 20% of baseline targets for 83.3% of these patients, showing no predictive correlation. Receiver Operating Characteristic (ROC) analysis showed that a maximum intraoperative rScO₂ drop > 22% predicted day 7 POCD with a sensitivity of 87.5%, a specificity of 83.0%, and an Area Under the Curve (AUC) of 0.89 (95% CI = 0.82–0.95). Relying on systemic MAP alone is insufficient to protect the aging brain. Real-time NIRS monitoring offers an effective tool for detecting clinical cerebral desaturation events and guiding targeted anesthetic management to mitigate POCD risks.

Keywords: Postoperative Cognitive Dysfunction, Near-Infrared Spectroscopy, Cerebral Desaturation, Mean Arterial Pressure, Elderly Patients, Neuropsychological Testing

Manuscript Timeline: Received: March 20, 2026; Revised: April 28, 2026; Accepted: May 20, 2026; Published: June 25, 2026.

Citation: Igwe CO, Sanon RL, Boateng AD. Evaluation of Regional Cerebral Oxygen Saturation using Near-Infrared Spectroscopy versus Mean Arterial Pressure for Predicting Postoperative Cognitive Dysfunction in Elderly Patients. International Journal of Medicine and Medical Sciences, 2026, 16(6): 57–64. DOI: 10.46882/2026/IJMMS/160051

International Journal of Medicine and Medical Sciences | Vol. 16, No. 5, May 2026 | pp. 33–40

DOI: 10.46882/2026/IJMMS/160033

Original Research Article

Diagnostic Accuracy of Urinary Interleukin-18 versus Serum Creatinine for Early Identification of Sepsis-Associated Acute Kidney Injury

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

¹Department of Anesthesiology and Intensive Care, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Abuja, Nigeria.

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

Abstract:

Sepsis-associated acute kidney injury (SA-AKI) significantly drives mortality in intensive care settings, but traditional serum creatinine changes lag behind renal structural harm. This prospective cohort study evaluated the diagnostic accuracy of urinary Interleukin-18 (uIL-18) for early identification of AKI among critically ill septic patients. We evaluated 130 adult patients admitted to the intensive care unit (ICU) meeting the Sepsis-3 diagnostic criteria with normal baseline renal function. Urinary IL-18 concentrations were quantified via enzyme-linked immunosorbent assay (ELISA) at admission, 6, 12, and 24 hours, while serum creatinine was monitored daily for 7 days. AKI was graded according to the KDIGO classification criteria. Thirty patients developed confirmed SA-AKI (23.1%) within 48 hours of admission. In the AKI group, uIL-18 levels rose significantly from a baseline of 42.4 ± 6.8 pg/mL to 186.5 ± 24.2 pg/mL at 6 hours post-admission (p < 0.01), long before significant serum creatinine modifications were observable. Receiver Operating Characteristic (ROC) analysis showed that 6-hour uIL-18 at a cutoff value of 140 pg/mL had a sensitivity of 90.0%, a specificity of 85.0%, and an Area Under the Curve (AUC) of 0.92 (95% CI = 0.85–0.97). In contrast, 24-hour serum creatinine achieved an AUC of only 0.65. Urinary IL-18 serves as a highly sensitive and precise early diagnostic biomarker for inflammatory tubular cell injury during sepsis, permitting early clinical risk stratification and fluid balancing optimization before functional filtration failure becomes established.

Keywords: Sepsis, Acute Kidney Injury, Interleukin-18, Biomarkers, Intensive Care Unit, Diagnostic Accuracy

Manuscript Timeline: Received: February 14, 2026; Revised: March 22, 2026; Accepted: April 11, 2026; Published: May 15, 2026.

Citation: Igwe CO, Sanon RL, Boateng AD. Diagnostic Accuracy of Urinary Interleukin-18 versus Serum Creatinine for Early Identification of Sepsis-Associated Acute Kidney Injury. International Journal of Medicine and Medical Sciences, 2026, 16(5): 33–40. DOI: 10.46882/2026/IJMMS/160033

International Journal of Medicine and Medical Sciences | Vol. 16, No. 6, April 2026 | pp. 41–48

DOI: 10.46882/2026/IJMMS/160041

Original Research Article

Efficacy of Low-Dose Ketamine Infusions versus Standard Opioid Analgesia for Postoperative Pain Management in Major Abdominal Surgery

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

¹Department of Anesthesiology and Intensive Care, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Abuja, Nigeria.

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

Abstract:

Postoperative pain management following major open abdominal procedures frequently relies on high-dose opioid regimens, which are associated with adverse outcomes such as respiratory depression, ileus, and prolonged recovery times. This randomized, open-label, comparative clinical trial evaluated the therapeutic efficacy, safety, and opioid-sparing capacity of low-dose intraoperative and postoperative ketamine infusions compared to standard patient-controlled opioid analgesia. A total of 140 adult patients scheduled for major elective open laparotomies were randomly assigned to receive either an intravenous ketamine bolus (0.25 mg/kg) followed by continuous infusion (0.125 mg/kg/h) until 24 hours post-surgery (n = 70) or standard intravenous morphine patient-controlled analgesia (n = 70). The primary outcomes were total cumulative morphine consumption at 24 and 48 hours, and visual analog scale (VAS) pain scores. Patients in the ketamine cohort demonstrated a highly significant 38.5% reduction in total morphine consumption at 24 hours (mean = 24.5 ± 4.2 mg) compared to the control group (mean = 39.8 ± 6.4 mg, p < 0.001). Mean VAS pain scores at rest and during coughing were significantly lower in the ketamine arm across the first 12 hours post-surgery (p < 0.01). Furthermore, the incidence of postoperative opioid-induced nausea and vomiting was significantly lower in the ketamine group (8.6% vs. 24.3%, p < 0.05), and the mean time to first flatus was shortened by 8.2 hours (p < 0.01). Low-dose perioperative ketamine infusions provide effective analgesia and demonstrate a significant opioid-sparing effect, leading to fewer opioid-related side effects and promoting faster gastrointestinal recovery after major abdominal surgery.

Keywords: Ketamine Infusion, Postoperative Pain, Opioid Analgesia, Opioid-Sparing Effect, Major Laparotomy, Gastrointestinal Recovery

Manuscript Timeline: Received: March 10, 2026; Revised: April 19, 2026; Accepted: April 12, 2026; Published: April 15, 2026.

Citation: Igwe CO, Sanon RL, Boateng AD. Efficacy of Low-Dose Ketamine Infusions versus Standard Opioid Analgesia for Postoperative Pain Management in Major Abdominal Surgery. International Journal of Medicine and Medical Sciences, 2026, 16(6): 41–48. DOI: 10.46882/2026/IJMMS/160041

International Journal of Medicine and Medical Sciences | Vol. 16, No. 4, April 2026 | pp. 25–32

DOI: 10.46882/2026/IJMMS/160025

Original Research Article

Bacterial Pathogens and Antimicrobial Susceptibility Mapping among Adult Patients with Acute Suppurative Peritonitis

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 Surgery, Connaught Hospital, Freetown, Sierra Leone.

Abstract:

Acute suppurative peritonitis resulting from hollow viscus perforation is a critical emergency, with treatment increasingly complicated by the emergence of multidrug-resistant enteric pathogens. This prospective cross-sectional study identified the predominant bacterial pathogens and mapped their antimicrobial susceptibility profiles among adult patients undergoing emergency laparotomy for secondary peritonitis. Peritoneal fluid samples collected intraoperatively from 120 patients were cultured. Bacterial confirmation was achieved using standard automated methods, and susceptibility profiles were assessed using the disk diffusion technique. Significant bacterial growth was confirmed in 88.3% (106/120) of the specimens, displaying a polymicrobial infection rate of 34.0%. Escherichia coli was the most common isolate (42.5%), followed by Klebsiella pneumoniae (22.6%), Pseudomonas aeruginosa (15.1%), and Bacteroides fragilis (11.3%). Antibiogram mapping revealed high resistance rates among Gram-negative isolates to amoxicillin-clavulanic acid (84.9%) and ceftriaxone (72.6%). Conversely, excellent susceptibility rates were observed for amikacin (92.5%) and imipenem (95.3%). Extended-Spectrum Beta-Lactamase (ESBL) production was confirmed in 29.4% of the E. coli strains. Logistic regression showed that a history of empirical over-the-counter antibiotic use prior to hospital presentation was strongly associated with an ESBL-producing strain (OR = 3.2, 95% CI = 1.5–6.8, p < 0.01). Bacterial pathogens causing secondary peritonitis exhibit high resistance to common cephalosporins, emphasizing the necessity of guiding postoperative therapeutic choices by fluid culture results rather than blind empirical protocols to avoid systemic septic complications.

Keywords: Acute Peritonitis, Escherichia coli, Antimicrobial Resistance, Ceftriaxone Resistance, Emergency Laparotomy, Peritoneal Fluid

Manuscript Timeline: Received: January 10, 2026; Revised: February 18, 2026; Accepted: March 12, 2026; Published: April 15, 2026.

Citation: Cole EA, Tarawallie MZ, Okoye VN. Bacterial Pathogens and Antimicrobial Susceptibility Mapping among Adult Patients with Acute Suppurative Peritonitis. International Journal of Medicine and Medical Sciences, 2026, 16(4): 25–32. DOI: 10.46882/2026/IJMMS/160025

International Journal of Medicine and Medical Sciences | Vol. 16, No. 3, March 2026 | pp. 17–24

DOI: 10.46882/2026/IJMMS/160017

Original Research Article

Evaluation of Lung Function Indices and Respiratory Symptoms among Commercial Pesticide Agricultural Spraymen

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 occupational inhalation of organophosphate and carbamate chemical pesticides causes progressive airway hyper-responsiveness and localized parenchymal inflammation. This cross-sectional analytical study evaluated the prevalence of respiratory symptoms and alterations in lung function indices among commercial agricultural spraymen. We matched 140 male spraymen exposed to pesticide mist for at least 3 seasons with 140 unexposed healthy male agricultural workers based on age, height, and body mass index. Symptom profiles were captured using a standardized respiratory questionnaire, and pulmonary function metrics were measured via computerized spirometry. Spraymen demonstrated a significantly higher prevalence of chronic dry cough (42.9% vs. 11.4%, p < 0.01), morning chest tightness (32.9% vs. 7.1%, p < 0.01), and exertional dyspnea (35.7% vs. 8.6%, p < 0.01) compared to the unexposed control group. Spirometric evaluation showed significant reductions in Forced Vital Capacity (FVC) (3.14 ± 0.38 L vs. 3.92 ± 0.42 L, p < 0.01) and Forced Expiratory Volume in 1 second (FEV1) (2.26 ± 0.32 L vs. 3.24 ± 0.28 L, p < 0.01) in the exposed cohort. The FEV1/FVC ratio was also significantly lower in pesticide spraymen (71.97 ± 4.8% vs. 82.65 ± 3.1%, p < 0.05), indicating a mixed pattern of ventilatory obstruction and restriction. Occupational exposure to pesticide mist impairs pulmonary indices and increases respiratory symptoms, emphasizing the need for targeted safety training, regular medical surveillance, and the mandatory use of appropriate chemical cartridge respirators.

Keywords: Pesticide Exposure, Occupational Health, Spirometry, Forced Vital Capacity, Airway Hyper-responsiveness, Respiratory Symptoms

Manuscript Timeline: Received: December 02, 2025; Revised: January 14, 2026; Accepted: February 08, 2026; Published: March 13, 2026.

Citation: Tetteh FM, Amadi KC, Bond AJ. Evaluation of Lung Function Indices and Respiratory Symptoms among Commercial Pesticide Agricultural Spraymen. International Journal of Medicine and Medical Sciences, 2026, 16(3): 17–24. DOI: 10.46882/2026/IJMMS/160017