British Journal of Healthcare and Medical Research

Histoplasmosis in Patient with 23 Years Untreated HIV/AIDS

2025-12-23T06:54:08+00:00

Spatial Eigenvector Predictive Mapping Using a Second Order Eigenfunction Eigen-decomposition Autocorrelation Specification in a Regional Convolution Neural Network in a Geo-Intelligent Smartphone App to Identify Lead Contamination in Primary and Secondar

2025-12-08T18:58:43+00:00

Currently, there are no lead-contamination models to describe the locations of aggregation/non-aggregation sites (i.e., hot-and-cold spots) in Hillsborough County, Florida, USA. We generated a Global Moran's index (I) of spatial autocorrelation to identify hot-and-cold spots of lead contamination in Hillsborough County. The data used were based on lead sampling of water sources within the internal environments of elementary, middle, and high schools. A second-order eigenfunction eigen-decomposition algorithm embedded in a regional convolutional neural network (R-CNN) machine learning [ML] in a geo-spatial artificial intelligence [geo-AI] smartphone application yielded a model that identified Kingswood Elementary School as the most clustered geographic location with the highest lead contamination concentration levels. The spatial autocorrelation model also identified Essrig Elementary School as the least clustered geographic capture point. The Moran's I diagnostic summary plot revealed a final Z-score of 8.347 and a p-value of 0.000. Mapping hotspots of lead concentration using a second-order eigenfunction eigen-decomposition algorithm within an instantaneous R-CNN, ML, geo-AI, iOS pipeline can allow school administrative boards and policymakers to allocate resources to at-risk areas with lead contamination.

Budget Impact Analysis of Risk-Stratified Prostate Cancer Screening in the UK using National Audit Data

2026-01-03T09:14:21+00:00

Objective: This study performs a budget impact analysis of a hypothetical risk-stratified prostate cancer (PCa) detection programme in the UK. To contextualise this economic case, the profound ethnic and socioeconomic disparities in care are identified in the latest National Prostate Cancer Audit (NPCA) data. Methods: A budget impact analysis was conducted from a UK National Health Service (NHS) perspective over a one-year period. A cohort representing the 55,241 men diagnosed with PCa in England in 2023 was modelled, with baseline stage distribution (TNM) sourced from the NPCA 2024 Report(National Prostate Cancer Audit, 2025a). First-year, stage-specific mean treatment costs (2017/18 GBP) were derived from a published UK health economic study. We quantified the net budget impact of a hypothetical 10% stage-shift from Stages T2, T3, and T4 to Stage T1 (Wills et al., 2023). Results: The NPCA data revealed for men with high-risk disease, Black men were substantially less likely to receive curative radical treatment than White men (67.8% vs. 81.6% for ages 60-69) (National Prostate Cancer Audit, 2025a). Our model projected that a 10% stage shift had a net initial cost saving of £1.72 million for this annual cohort. The long-term economic benefit overshadows this short-term saving. The model averted 331 metastatic cases, each associated with an estimated one-year NHS cost of £63,284–£216,118 (see Appendix C). Conclusion: A risk-stratified PCa detection strategy in the UK offers a rare "dual dividend": it provides a direct mechanism to address profound health inequities while simultaneously being projected to be cost-saving to the NHS, both immediately and in the long term. These findings provide a robust economic and ethical mandate for the UK National Screening Committee to recommend the implementation of such a strategy.

The Blood Transfusion Outcomes and Analysis of Factors Associated with Blood Transfusion Reactions in Orthopaedic Trauma Patients Managed at Moi Teaching and Referral Hospital, Eldoret, Kenya

2026-01-01T09:19:25+00:00

Background: Blood transfusion is required in the management of life threatening orthopaedic trauma hemorrhage. However, it is necessary to categorize the patients on the need for blood transfusion as well as adhering to the blood transfusion guidelines in order to avoid risks and hence ameliorate challenges and have good outcomes. Objective: To establish the blood transfusion outcomes and analyze the factors associated with blood transfusion reactions in the orthopaedic trauma patients managed at Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. Methods: A hospital based descriptive cross-sectional study of 132 transfused orthopedic trauma patients was carried out between March, 2019 and January, 2020 at MTRH, after approval by relevant authorities. The patients were recruited by consecutive sampling method. Data on blood transfusion outcomes, as well as on factors associated with blood transfusion reactions (Sociodemographic, trauma and laboratory characteristics) was collected using interviewer administered structured questionnaire. Analysis of the aforementioned factors using the Fisher’s Exact Test was done and p value < 0.05 was considered statistically significant. Results: A total of 15 out of 132 patients (11.4%) had minor blood transfusion reactions. No mortality was recorded. Majority (6) were young (age group 21- 30 years old), followed by age group 41- 50 years old (5). Male (10) dominated over female (ratio- 2:1). Majority (13) were victims of RTA, 8 had long bones fractures, and debridement done in 8 patients. Majority (12) had Haemoglobin level of 7.1- 10.0 g%, and blood groups A⁺ and O⁺ (5 each). The findings on analysis of association of blood transfusion reactions and the stated factors were all not statistically significant (p>0.05). Conclusion: The incidence of blood transfusion reactions was low (11.4%). Majority of patients were young with male dominance. Majority of patients were victims of RTA, with long bones fractures who were done debridement. Most were of moderate low haemoglobin level and of blood groups A and O positive. Recommendations: High index of suspicion is necessary for diagnosis of blood transfusion reactions and cautions to eradicate these reactions be put in place. Further study on healthcare providers’ knowledge on blood transfusion, and the pattern of reactions noted in this study need be encouraged.

Relationship between Dietary Diversity and Central Obesity in Adults Aged 18–65 Years: A Cross-Sectional Study in Chongqing, China

2025-12-31T04:31:36+00:00

Aim: Dietary diversity is considered a key component of a healthy diet, as it ensures the intake of a wide range of nutrients, which help maintain normal metabolic functions. This study aims to explore the relationship between dietary diversity and the prevalence of central obesity in adults aged 18–65 years, as well as the associated factors in the adults aged 18–65 years. Methods: A cross-sectional study was conducted in a health center that included adults aged 18–65 years. Dietary intake information was obtained using the food frequency questionnaire, and physical examination data were obtained from their health examination reports. The dietary diversity score is calculated by adding up the scores for the types of foods consumed. Logistic regression was used to analyze the association between dietary diversity score and central obesity, with adjustment for confounding factors and stratified analysis. Results: Among 833 individuals, central obesity was 144 (17.29%). In the fully adjusted model, total dietary diversity score (OR=0.89, 95% CI: 0.80~0.98) and plant-based dietary diversity score (OR = 0.87, 95% CI: 0.76~0.99) was associated with a reduced risk of central obesity. The higher the DDS, the lower the risk of central obesity. Additionally, stratified analysis revealed that dietary diversity scores among different genders and ages were associated with the risk of central obesity. Conclusions: The results of this study indicate that dietary diversity is a protective factor for central obesity, and adopting a diversified diet may reduce the risk of central obesity in the.

Sharpening the Critique of Vaccination Mandates: A Review Essay

2025-12-26T12:35:15+00:00

Metronidazole Research: Historical Developments and Future Directions

2025-12-24T08:02:57+00:00

Metronidazole is widely used around the world to treat anaerobic, parasitic, and bacterial infections. Yet, despite its significance, a comprehensive review that weaves together its historical Breakthroughs and charts a course for future research is still missing. This study used bibliometric analysis to comprehensively examine the global landscape of Metronidazole research, based on publications from the Scopus database between 1960 and 2024. Data were analyzed using R software, VOS viewer, and Cite Space to explore qualitative and quantitative trends. Results: The first article published in 1960, the number of scientific publications has increased, especially after 1985. 6,172 publications were identified with 160,000 citations, showing a steady annual growth rate of 6.26%, reflecting a vibrant and steadily growing field. Notably, publication rates soared after 2024. WANG was the most prolific author, while China and the United States led in productivity, with 13% international collaboration. The Journal of Antimicrobial Chemotherapy is the leading journal in terms of publication venue. Network analysis spotlighted Metronidazole, tetracycline, and vancomycin as central antibiotics. Highly cited studies focused on Clostridium difficile infection, Helicobacter pylori eradication, and bacterial vaginosis. Over time, research themes have shifted from traditional pharmacology and microbiology to innovative areas such as nanotechnology, biosensing, computational modeling, and green chemistry. The research on Metronidazole shifting into four promising directions for future exploration: harnessing artificial intelligence to predict resistance, leveraging computational tools to uncover new applications, embracing green chemistry to minimize environmental impact, and advancing precision medicine through genetic biomarkers.

Prevalence of Placental Malaria Relative to Placental Cytokines and Birth Anthropometry Among Sub-Sahara Black African Women in their First or Second Pregnancy

2025-12-19T18:44:46+00:00

Introduction: Pregnancy is a complex condition during which pathological complications such as iron deficiency anemia, infections, under- or over-nutrition and excessive production of cytokines may occur to jeopardize the well-being of the fetus. Objective: The objective of this study was to evaluate the interactions between placental or peripheral malaria (PlacMal or PerMal), Tumor Necrosis Factor-α (TNF-α), Interferon-γ (IFN-γ), Iron deficiency anemia (IDA), Platelets (Plt) and immature granulocytes (IG) in the placenta and neonatal birthweight, birth length and birth head circumference among study subjects in their 1^st or 2^nd pregnancy in Nigeria. Materials and Method: This was part of a prospective and exploratory study carried out among women in their 1^st and 2^nd pregnancy at Ikorodu General Hospital and its annex, Ita-Elewa Primary Health Care Center at Ikorodu, Lagos, Nigeria. Complete data from 78 women in their 1^st or 2^nd pregnancy who were assessed for TNF-α and IFN-γ, and whose socio-demographic characteristics, ante-natal history, birth anthropometry, placental hemogram and malaria parasitemia were recorded and analyzed. Data analysis was conducted using NCSS and STATA softwares. Results: Study participants in their 2^nd pregnancy were significantly older (t-test=4.51, P-value=0.00004) and heavier (t-test=2.44, P-value=0.02) than those in their 1^st pregnancy. While the means of TNF-α<20 pg/ml in subjects with (9.4±1.5) and without (20.3±24.1) PlacMal were notably different (t-test=3.74, P-value=0.0004), the means in subjects with (20.3±14.8) and without PerMal (19.8±25.4) were insignificant. At normal TNF of <20 pg/ml, mean birth length of neonates from 1^st pregnancy (50.6±1.8 cm) was notable higher (t-test=2.98, P-value=0.005) than that those 2^nd pregnancy (47.8±5.1 cm). Overall birthweight was significantly higher (3.2±0.5) when Hgb was ≥9.5 and TNF-α was <20 pg/ml than when Hgb was ≥9.5 and TNF-α was ≥20 pg/ml. Overall birth length (52.0±0.0) was notably longer (t-test=3.79, P-value=0.004) when IG was >0.456 and Hgb was <9.5 compared to when IG >0.456 and Hgb was ≥9.5. The mean platelets count (x10⁹/L) of subjects with (27.7±14.2) and without (79.6±89.4) PlacMal were significantly different (t-test=3.94, P-value=0.002) but those of subjects with (69.2±50.5) and without (79.6±95.3) PerMal were not. Multivariate regression analysis indicates a positive, statistically significant relationship between birthweight and age group (coeff. = 0.22, SE=0.06, t-test = 3.78, P-value = 0.003). Conclusion: Placental TNF-α, IFN-γ, Platelet count, and IG may have a distinct or combined role to play the the development of gestation process and neonatal anthropometry. More studies are needed to support and substantiate these findings.

Single-shot Spinal Versus Epidural Analgesia During Early Labor: A Prospective Randomized Trial

2026-01-02T09:19:44+00:00

Background: Effective pain relief during labor is essential for maternal comfort and favorable obstetric outcomes. Epidural analgesia (EA) is considered the gold standard ; however, single-shot spinal analgesia (SA) using low-dose local anesthetic represents a faster and simpler alternative, particularly in low-resource settings. Evidence for its use in early labor remains limited. Objective: To compare the efficacy, onset, duration, safety, and maternal-neonatal outcomes of single-shot spinal analgesia versus epidural analgesia initiated at 4 cm cervical dilatation. Methods: In this prospective, randomized, open-label, single-center study, 100 ASA I–II parturients in active labor (4 cm cervical dilatation) were allocated into two groups (n = 50 each). The SA group received an intrathecal injection of 5 mg isobaric bupivacaine combined with 5 μg sufentanil. The EA group received epidural administration of 20 mg bupivacaine with 5 μg sufentanil via catheter. Pain was assessed using the visual analog scale (VAS) at regular intervals. Onset and duration of analgesia, sensory level, motor block, labor duration, need for reinjection, maternal satisfaction, adverse events, oxytocin use, mode of delivery, and neonatal Apgar scores were recorded. Results: Spinal analgesia provided a significantly faster onset of pain relief (1.84 ± 1.09 vs. 8.25 ± 1.88 min, p < 0.001) and quicker achievement of maximal sensory block. Labor duration was significantly shorter in SA for both primiparous and multiparous women (84.06 ± 12.11 vs. 94.78 ± 14.06 min, p < 0.0001). Analgesic efficacy (VAS scores) and maternal satisfaction were comparable between the two groups (96% vs. 90%, p = 0.42). Reinjection was required only in the EA group (16%, p = 0.01). Adverse maternal and neonatal outcomes, were similar between groups. Conclusion: Single-shot spinal analgesia using low-dose bupivacaine provides rapid, effective, and sustained labor analgesia with a safety profile comparable to epidural analgesia. It may represent a valuable, practical alternative in busy obstetric units or resource-limited settings.

Cure vs. Care: Case in Korea

2026-01-01T02:37:27+00:00

Medical sciences increase the life expectancy to the point that centenarian population is projected to quadruple over the next 30 years. Highlighting medical advancements and corresponding technological achievements is undeniably crucial for optimizing therapies and treatments; however, this focus significantly puts aside the critical goal of alleviating suffering in dying patients (Lionis et al., 2025), especially those in the end-of-life (EOL) stage. End-of-life is an emotional issue for everyone involved (patients, family, caregivers and religious community, etc.) which requires not only medical interventions, more importantly it (EOL) requires emotional support by and from every stakeholder in relieving pain and emotional stress emanated from isolation from family and friends, neglected by society and abandoned by government.

Reward Deficiency Syndrome (RDS): A Common Neurogenetic Trait/State of All Addictions: Is this the new DSM?

2025-12-25T09:06:26+00:00

Steven Hyman, former director of the NIMH (2012), noted that neuroscience studies of psychiatric disorders often rely on definitions from the Diagnostic and Statistical Manual of Mental Disorders (DSM), which treats conditions as distinct entities. However, boundaries between disorders are less strict than DSM categories suggest. To address this, Hyman’s group introduced the Research Domain Criteria (RDoC) project, which defines five brain-based domains impaired across psychiatric conditions. Similarly, Blum (1995) proposed Reward Deficiency Syndrome (RDS) as a unifying framework for substance and non-substance addictive behaviors. Currently, over 1,650 PubMed studies link to “reward deficiency,” and 281 specifically to RDS. Recent GWAS and pharmacogenomic (PGX) studies in 88.8 million subjects support dopamine dysregulation as the accurate phenotype of RDS. The Genetic Addiction Risk Severity (GARS®) test has been developed as a predictor of RDS and preaddiction. Psychiatric disorders identified in the DSM-5 share many genetic polymorphisms, often tied to dopaminergic signaling. We propose a biphasic prevention and treatment model for addictions (alcohol, nicotine, glucose, etc.). Acute harm reduction should target postsynaptic Nucleus Accumbens (NAc) dopamine receptors (D1–D5), while long-term therapy should promote dopamine activation/release at the NAc. Failure to balance these may lead to mood instability, aberrant behavior, or suicidal ideation. Individuals with serotonergic/dopaminergic receptor deficits or high COMT activity may self-medicate with substances and behaviors that release dopamine. Evidence suggests that upregulating D2 receptors in genetically vulnerable individuals could mitigate addictive risk. While in vivo D2 agonists downregulate receptors, in vitro studies show constant stimulation can promote receptor proliferation. Gene therapy inducing DRD2 overexpression reduces alcohol and cocaine craving in rodents. Natural dopaminergic repletion therapy may provide a safe, long-term strategy to restore dopaminergic function, improve recovery, and enhance quality of life in RDS-related behaviors. WC 286

Antiplatelet Therapy after Coronary Artery Bypass Grafting: Current Status and Future Perspectives

2025-12-28T12:28:07+00:00

Antiplatelet therapy is a critical component in managing patients undergoing coronary artery bypass grafting (CABG) to prevent graft occlusion and reduce thrombotic events. Current treatment options primarily include monotherapy with aspirin, dual antiplatelet therapy (DAPT), combining aspirin with a P2Y12 inhibitor, and, in some cases, triple therapy incorporating an anticoagulant. Recent advancements have focused on optimizing treatment regimens to balance the efficacy of antithrombotic protection with the associated risks of bleeding. Personalized treatment approaches, driven by patient-specific factors and genetic profiling, are increasingly recognized as essential for improving patient outcomes. Ongoing research aims to identify biomarkers that can predict patient responses to antiplatelet therapy, enabling more precise and effective treatment strategies. Additionally, novel therapeutic targets and new antiplatelet agents are being investigated to enhance the safety and efficacy of treatment. The results of these studies will shape the future of antiplatelet therapy and contribute to better clinical practices. The integration of genetic and pharmacogenomic data is anticipated to play a significant role in the personalization of antiplatelet therapy, ultimately leading to improved patient care in the context of CABG. This review article provides a comprehensive analysis of the current status and future perspectives of antiplatelet therapy in CABG.

Roadmap for Recognition of Coronary Surgery as a Subspecialty

2025-12-28T15:56:46+00:00

Coronary artery bypass grafting (CABG) remains a cornerstone of cardiovascular surgery, yet coronary surgery has not been formally recognized as a distinct subspecialty despite its increasing technical complexity and impact on patient outcomes. As the risk profile of CABG patients continues to evolve—often characterized by advanced age, severe comorbidities, and prior interventions—off-pump coronary artery bypass grafting (OPCAB) has emerged as a preferred strategy for reducing surgical morbidity and improving recovery. Specialized expertise in coronary revascularization, including OPCAB and total arterial grafting techniques, has been shown to optimize long-term survival, reinforcing the need for dedicated training pathways. In addition to traditional approaches, minimally invasive techniques such as robotic-assisted CABG and hybrid revascularization strategies are increasingly recognized for their ability to reduce surgical trauma, enhance graft patency, and accelerate postoperative recovery. Despite these advancements, current cardiac surgical training lacks structured subspecialization in coronary surgery, limiting the widespread adoption and refinement of these techniques. The absence of formalized coronary surgery training contributes to variability in surgical expertise, influencing patient outcomes across institutions. This review outlines the imperative need for recognizing coronary surgery as a subspecialty, addressing key challenges such as institutional resistance, variability in case volume, and limited research on the long-term benefits of specialized coronary surgeons. It further proposes a structured framework for achieving recognition, including dedicated fellowship programs, standardized curricula emphasizing OPCAB and arterial grafting, accreditation mechanisms, and evidence-based guidelines. The integration of advanced imaging technologies and artificial intelligence-driven surgical planning also presents opportunities to enhance precision in coronary revascularization. Future research should focus on demonstrating the improved patient outcomes associated with specialized coronary surgeons, evaluating the cost-effectiveness of coronary surgery subspecialization, and refining minimally invasive CABG techniques through real-world evidence. Recognizing coronary surgery as an independent subspecialty could lead to enhanced surgical expertise, optimized revascularization strategies, and broader adoption of innovative techniques—ultimately improving long-term results for patients undergoing CABG.

SWOT Analysis of Off-pump Coronary Artery Bypass Grafting

2025-12-27T20:14:30+00:00

Off‑pump coronary artery bypass grafting (OPCAB) has undergone significant evolution since its introduction as an alternative to conventional on‑pump CABG. By avoiding cardiopulmonary bypass (CPB) and minimizing aortic manipulation, OPCAB aims to reduce perioperative morbidity, neurological complications, and systemic inflammatory responses. Despite these theoretical advantages, its adoption has varied widely across institutions due to concerns regarding graft patency, completeness of revascularization, and operator dependency. This state‑of‑the‑art review provides a comprehensive SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis of OPCAB, integrating evidence from randomized trials, meta‑analyses, and large observational studies. The strengths of OPCAB include reduced stroke risk, lower perioperative morbidity in high‑risk populations, decreased bleeding and transfusion requirements, and compatibility with anaortic total arterial revascularization. Weaknesses include technical complexity, variability in surgeon experience, concerns regarding long‑term graft patency, and inconsistent evidence from randomized trials. Emerging opportunities include the expansion of anaortic no‑touch techniques, integration with minimally invasive and robotic platforms, advances in intraoperative imaging, and the potential for subspecialty training to standardize outcomes. Threats include declining surgeon experience, competition from percutaneous coronary intervention and hybrid revascularization strategies, persistent skepticism regarding patency and completeness of revascularization, and economic or technological barriers to widespread adoption. Through a structured SWOT framework, this review synthesizes contemporary evidence to clarify OPCAB’s current role and future trajectory in coronary surgery. The analysis highlights the importance of surgeon expertise, institutional commitment, and technological integration in optimizing outcomes. OPCAB remains a valuable strategy for selected patients, particularly those at elevated risk for neurological complications or adverse effects of CPB.