International Research Journal of Gastroenterology and Hepatology

Understanding Drug-Induced Gastritis: from Molecular Mechanisms to Therapeutic Management

2026-04-09T06:53:42+00:00

Drug-induced gastritis (DIG) represents an underrecognized yet clinically important cause of gastric mucosal injury with significant morbidity and mortality. It arises from the widespread use of medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, bisphosphonates, iron supplements, selective serotonin reuptake inhibitors (SSRIs), antibiotics, and chemotherapeutic agents. These drugs disrupt gastric defense mechanisms through diverse pathways, including direct mucosal irritation, inhibition of prostaglandin synthesis, immune-mediated injury, and gut microbiota dysbiosis. Clinically, DIG may present with nonspecific symptoms like epigastric pain, nausea, and dyspepsia, but can progress to complications such as ulceration, bleeding, or perforation. Diagnosis relies on careful history-taking, supported by endoscopic evaluation, biopsy, and laboratory investigations. Management primarily involves withdrawal or substitution of the offending drug, along with acid suppression therapy using proton pump inhibitors, complemented by mucosal protective agents like misoprostol or sucralfate when appropriate. Preventive strategies, including co-prescription of PPIs, use of gastroprotective formulations, risk stratification in high-risk populations, and patient education, remain essential. Future perspectives emphasize personalized approaches through pharmacogenomics, gut microbiome modulation, and biomarker discovery for early detection. Overall, improved awareness and integration of preventive and precision medicine strategies are crucial to mitigate the global burden of drug-induced gastritis.

A Review on Lymphadenectomy Strategies in Early Gastric Cancer: Sentinel Node Navigation Surgery Versus Regional Lymphadenectomy

2026-04-16T12:40:54+00:00

Introduction: Conventional management of early gastric cancer (EGC) includes standard anatomical gastrectomy along with D1/D2 lymph node dissection. Despite achieving oncological excellence, this approach affects patients' quality of life. Few approaches have been developed to counter this. Most notable among these are - “Sentinel Node Navigation Surgery” (SNNS) and “Regional Lymphadenectomy” (RL).

Methods and Materials: PUBMED/EMBASE/SCOPUS databases were searched with keywords - “Early Gastric Cancer”, "Lymphadenectomy Strategy”, “Sentinel Node Navigation Surgery”, “Regional Lymphadenectomy”. Animal studies, studies containing amalgamated subsets of several gastrointestinal cancers, case reports, editorials, letters, conference abstracts without sufficient data, preprints and review articles were excluded. The review only included studies published in English. Studies with available full texts were included. This review included studies conducted in hospital-based or tertiary care settings where patients with EGC underwent surgical treatment with SNNS or RL.

Objectives: The primary objective of this review was to evaluate and compare two novel lymphadenectomy strategies for EGC - SNNS and RL. The review specifically focused on several key areas - oncological safety and efficacy, diagnostic performance, “Quality of Life” (QoL), addressing technical challenges and impact of clinical factors.

Results: The post hoc analysis of the SENORITA trial demonstrated superiority of SNNS over the RL approach in terms of diagnostic performance. With RL, the rate of the skip metastasis was 2.5%. Oncological safety of SNNS was found to be non-inferior to that of standard guidelines surgery. Its diagnostic accuracy was influenced by cohort demographics and certain tumor characteristics. Combination of Maruyama computer program (MCP) with SNNS yielded a 100% negative predictive value (NPV).

Conclusion: Both SNNS and RL represent novel strategies, yet their potential oncological efficacy and safety profiles show notable differences. While the fixed RL approach aims to simplify the logistical burden of lymphadenectomy, the inherent risk of skip metastasis and concerns regarding its diagnostic reliability suggest that current data may be insufficient to establish its oncological adequacy without further prospective validation. Similarly, despite the function-preserving benefits of SNNS, it possesses certain pitfalls, including variable accuracy across different patient populations and specific tumor characteristics, that necessitate more extensive investigation in future clinical studies.

Helicobacter pylori Infection in Nigeria: Epidemiology, Risk Factors, Diagnostic Challenges, and Public Health Implications

2026-04-28T05:36:56+00:00

Background: Helicobacter pylori infection remains a major global public health concern, with disproportionately high prevalence in developing countries such as Nigeria.

Aims: This study presents a narrative review of the epidemiology, transmission dynamics, risk factors, diagnostic approaches, and public health implications of Helicobacter pylori infection in Nigeria.

Study Design: This study is a narrative review with elements of systematic literature search.

Place and Duration of Study: The study was conducted as a desk-based literature review using electronic databases, with the review process carried out between 2010 and 2025.

Methodology: A narrative review with a structured literature search was performed using PubMed and Google Scholar, where relevant studies were screened and analyzed based on predefined inclusion criteria.

Results: Findings indicate that the prevalence of Helicobacter pylori infection in Nigeria varies widely, ranging from 5.5% among university students to as high as 96% among symptomatic patients, with an overall national estimate between 30% and 87.7%. Higher prevalence rates were consistently reported in Northern Nigeria compared to Southern regions. Infection is commonly acquired during childhood and is strongly associated with low socioeconomic status, poor sanitation, overcrowding, unsafe drinking water, alcohol consumption, and smoking. Diagnostic practices rely on both invasive and non-invasive methods; however, access to reliable diagnostic tools such as urea breath tests and molecular techniques remains limited in many settings. Additionally, increasing antimicrobial resistance, particularly to commonly used antibiotics, poses a significant challenge to effective treatment.

Conclusion: Helicobacter pylori infection remains highly endemic in Nigeria, with marked regional and demographic disparities. Strengthening healthcare infrastructure, improving sanitation, promoting health education, and implementing antimicrobial stewardship programmes are essential strategies for reducing infection burden and preventing long-term complications.

Prevalence and Possible Risk Factors of Helicobacter Pylori Infection among Adults in Aba, Nigeria

2026-01-01T11:05:33+00:00

Background: Helicobacter pylori (H. pylori) infection is a major public health concern and is strongly associated with various gastrointestinal (GI) disorders, including gastritis, peptic ulcer disease, and gastric cancer.

Aim: This study aimed to determine the prevalence of H. pylori infection among adults in Aba, Nigeria.

Study Design: Cross sectional study design.

Methodology: A total of 140 subjects aged 20-75 years (mean age: 43.4 ± 15.7 years) were analyzed and screened using rapid serological methods. Participants were categorized based on age, gender, occupation, and the presence or absence of GI symptoms. Blood samples were tested for H. pylori antibodies to determine infection status. The prevalence of H. pylori was assessed and compared across different demographic and occupational groups.

Results: The overall prevalence of H. pylori infection was 51.4%. Age-specific distribution showed the highest prevalence in individuals aged 38-43 years (75.0%), while the lowest was in the 20-25 age group (27.3%). Males had a slightly higher prevalence (53.3%) than females (50.0%). Occupation-based analysis revealed the highest prevalence among drivers (58.3%) and traders (54.2%), while students had the lowest prevalence (45.5%). Among subjects with GI symptoms, H. pylori were most prevalent in those experiencing gastric pain (57.1%) and diarrhea (53.3%), while asymptomatic individuals had a prevalence of 40.0%.

Conclusion: The findings suggest that H. pylori infection is significantly associated with GI disorders, with higher prevalence among symptomatic individuals, middle-aged adults, and high-risk occupational groups. Given the asymptomatic carriage of the bacterium in a substantial proportion of individuals, routine screening, early treatment, and preventive measures such as improved hygiene and safe food handling are essential for reducing H. pylori-related complications.

Mapping Obesity in the United States: Statewise Demographic Trends and Implications

2026-01-15T12:34:26+00:00

Background: Obesity is a major public health challenge associated with numerous chronic conditions, including diabetes, polycystic ovarian syndrome(PCOS), hypertension, stroke, gastroesophageal reflux disease( GERD), metabolic dysfunction-associated steatotic liver disease (MASLD), cancer, and depression. The prevalence in the United States continues to rise and varies significantly across racial, geographic, and demographic groups. This study analyzes obesity trends from 2011 to 2023, focusing on regional and population-level differences to better understand the distribution and inferred clinical implications of obesity, using a multi-level, population-based framework to identify obesity determinants and guide targeted, evidence-based lifestyle interventions

Methods: Data were obtained from the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2023. Obesity prevalence was stratified by race/ethnicity and geographic region (South, Midwest, West, Northeast). Descriptive statistics and graphical illustrations were used to identify trends. Findings were contextualized with peer-reviewed literature addressing the associations between obesity, medical conditions, and sociodemographic variables.

Results: Obesity prevalence was highest in the South and Midwest, with women exhibiting slightly higher median values than men. The regression model shows a strong relationship between year and obesity rate (R = 0.956, R² = 0.914), meaning 91.4% of the changes in obesity rates can be explained by the year. The model fits well (Adjusted R² = 0.906, Standard Error ≈ 0.70), and the obesity rate is increasing by about 0.561% per year in the South among Non-Hispanic Black adults (p = 0.060), the overall model is still statistically significant, and the coefficients have strong significance (p < 0.0001). Overall, this model suggests a clear upward trend and can be used to forecast future obesity rates if the pattern continues. Adjusted R² (0.906) accounts for the number of predictors in the model, and it's slightly lower than R², suggesting the model is robust and doesn't overfit the data, with Standard Error of the Estimate = 0.70048 that represents the average distance that the observed values fall from the regression line indicating better predictive accuracy(p < 0.0001,95% CI 0f 0.447 to 0.675).

Conclusion: The continuing rise of obesity prevalence, particularly in minority populations such as African Americans, has critical implications for GI health. The study indicates that generally, obesity is concentrated in Non-Hispanic Black and Hawaiian/Pacific Islander populations. Obesity is generally more prevalent in southern and midwestern regions. Screening, prevention, and management strategies for GI disorders should be redefined to integrate obesity reduction interventions, including pharmacologic therapies, dietary counseling, and lifestyle modifications. Providers serving high-risk communities must adopt these approaches to improve outcomes and reduce obesity-related GI morbidity.

Bacterial and Protozoan Etiology of Acute Diarrhea among under-five Children in Nasarawa West, Nigeria

2026-01-21T13:15:52+00:00

Background: Diarrheal diseases continue to constitute challenges to public health globally, with children under five years in underdeveloped and developing countries being the most affected.

Aim: The current study aimed to determine the pathogenic bacterial and protozoan agents associated with acute diarrhea among children under five years, alongside possible factors that contribute to the continuous predisposition of diarrheal diseases in the study area.

Methodology: The study was a hospital-based cross-sectional study conducted from July 2024 to August 2025, which utilised 420 diarrheic stool samples of children aged 0-5 years. Demographics and clinical information about the children were obtained using a questionnaire. Diarrheic stools were analysed using standard microbiological methods. The Chi-square test, Fisher’s exact test, and Cochran-Armitage test were used to test independence and trends. Statistical significance was defined as P < 0.05, and 95% confidence intervals were reported where applicable. Descriptive statistics, such as percentages, were used to summarise the collected data.

Results: Overall, 211(50.2%) of the samples were positive for bacterial and protozoan pathogens, with presumptive diarrheagenic Escherichia coli (DEC) being the predominant enteric bacteria isolated (27.4%). Enteric protozoa were detected in (18.9%) of cases, with Entamoeba histolytica (12.9%) and Giardia lamblia (4.3%) being the most prevalent. Furthermore, 13.6% of the cases were co-infection specifically with presumptive diarrheagenic Escherichia coli (DEC) and Entamoeba histolytica. The highest enteric pathogen infection rates were in the 25-36-month age group (86.1%) (P < 0.05). A greater number of males were infected (60.9%) compared to females (34.1%) (P < 0.05). Furthermore, fever, vomiting, diarrhea episodes, sources of drinking water, and sanitary practices were associated with the rate of infection (P < 0.05).

Conclusion: The findings indicate the endemicity of pathogenic enteric bacteria and protozoa in the study area. The cases of co-infection suggest that the children are exposed to multiple sources of contamination. Although this study was a hospital-based design, the high correlation between open defecation and infection (74.6%) suggests that community-led total sanitation (CLTS) programs should be prioritised over general health education in Nasarawa West.

Geodemographic Disparities in Obesity Prevalence across U.S. States: A Population-based Multi-level Analysis to Guide Primary Care Interventions

2026-01-22T13:06:38+00:00

Background: Obesity is a chronic condition described as excessive fat accumulation, which has the potential to severely impact one’s health. It develops through a combination of several factors such as genetics, metabolic conditions, diet, physical activity and much more. The rates of obesity have increased over the decades and continue to rise, with non-Hispanic Blacks having the highest rates, and Asian populations continuously maintaining the lowest rates. Numerous gastrointestinal, mental and cardiovascular conditions are associated with obesity, such as GERD, metabolic dysfunction-associated steatotic liver disease (MASLD), Barrett’s esophagus, pancreatitis, several cancers, acute coronary syndrome, kidney failure and more. Obesity is not evenly distributed across the United States. This is due to many factors such as race, ethnicity, socioeconomic status, education level, financial knowledge, and access to better food options and healthcare. This study brings attention to the trend of obesity rates by region, income, gender, and ethnicity.

Methods: Data were obtained from the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2023. Obesity prevalence was stratified by race/ethnicity and geographic region (South, Midwest, West, Northeast). Descriptive statistics and graphical illustrations were used to identify trends. Findings were contextualized with peer-reviewed literature addressing the associations and prevalence of obesity and sociodemographic variables with relation to primary care interventions.

Results: The study found that obesity has a high prevalence in the South and Midwest areas, with females having slightly higher median and mean values compared to men (female obesity rate distribution mean=30.842, median=30.600, whereas male obesity rate has a mean=30.625, median=30.700). The graphical illustration shows that non-Hispanic Black and Hawaiian/Pacific Islanders individuals generally have the highest rates of obesity, with regional/state-wise distribution. Non-Hispanic blacks(Odd ratio at 95%CI of 1.65 (1.58–1.72) in the South with high prevalence of obesity.

Overall, obesity rates increased steadily for each income group. Within populations that earned less than $15,000 per year, the obesity rate was consistently higher across almost all the years except for 2022.In the Midwest, obesity rates also fluctuated, rising above 40% from 2019-2021 and again in 2023. While the obesity rate rose slightly in Asian individuals between 2011 and 2023 up to almost 25%, they still had consistently lower rates of obesity than every other race/ethnicity. Hawaiian/Pacific Islander, Hispanic, Non-Hispanic Black, and American Indian/Alaska Native groups consistently had higher obesity rates, almost always above 30%. The obesity rate in Non-Hispanic White, Other, and those identifying as 2 or more races fluctuated between 30-35%. In 2023, there was a sharp increase to 40% observed for Hawaiian/Pacific Islanders in 2023.

Conclusion: Populations in the South and Midwest consistently had higher obesity rates, as did those who had a lower socioeconomic status. In terms of race, the Asian population tended to have the lowest rates of obesity, whereas non-Hispanic Black populations and Hawaiian/Pacific Islander populations tended to have higher rates of obesity. Among Non-Hispanic Black populations, the South exhibits particularly elevated and rising rates, consistent with broader patterns of inequity in access to resources. In regard to gender, females and males have similar average obesity rates, 30.843 and 30.625, respectively. This study highlights certain areas in which social determinants of health, such as income, race, gender, and geographic location, impact health trends. The obesity rate in United States is high and is increasing yearly, and thus interventions that take these factors into consideration need to be further studied and implemented in a region-specific manner to have a positive impact on the health of the nation.

Effect of Carica Papaya (Paw-Paw) Leaf Extract on the Histology of the Pancreas in the Tramadol-Induced Male Wistar Rats

2026-02-04T11:48:41+00:00

Tramadol, a synthetic opioid analgesic, is frequently misused for non-medical purposes, resulting in several adverse effects, including pancreatic toxicity. The pancreas, due to its dual exocrine and endocrine functions, is highly vulnerable to drug-induced oxidative stress and inflammation. Carica papaya leaves contain phytochemicals with antioxidant and anti-inflammatory properties that may help protect organs from such damage. This study assessed the protective effects of Carica papaya leaf extract on the pancreatic histology in tramadol-induced Wistar rats. Fifteen (15) Wistar rats (mixed gender, weighing 150-200g) were randomly divided into five groups (n=3). Group A served as the control and received distilled water. Group B received tramadol (50 mg/kg) for 14 days only. Group C received tramadol (50 mg/kg) for 14 days, followed by Vitamin C (500 mg/kg). Groups D and E received tramadol (50 mg/kg) for 14 days, followed by Carica papaya leaf extract at doses of 200 mg/kg and 400 mg/kg, respectively. The plant material was shade-dried, extracted with aqueous methods, and subjected to preliminary phytochemical screening. Acute toxicity (LD50) was determined using Lorke's method. At the end of the experiment, the pancreas was harvested for histological analysis. Phytochemical screening revealed the presence of flavonoids, alkaloids, tannins, saponins, phenols, and glycosides. The LD50 of the extract was above 5000 mg/kg, indicating it is practically non-toxic. Histological analysis showed that tramadol caused notable acinar cell degeneration, necrosis, and inflammatory infiltration. Treatment with Carica papaya leaf extract, particularly at 400 mg/kg, improved pancreatic histoarchitecture, with reduced inflammation and restoration of acinar and islet cell integrity. Carica papaya leaf extract demonstrated a significant protective potential against tramadol-induced pancreatic damage in Wistar rats. These protective effects are likely due to its rich phytochemical composition and antioxidant properties. The findings support its potential as a safe, affordable, and accessible natural prophylaxis for drug-induced pancreatic toxicity.

Cross-sectional Study of the Seroprevalence and Risk Factors of Hepatitis C Virus Infection among Adults Attending Primary Health Care in Plateau State, North-central Nigeria

2026-03-02T12:36:52+00:00

Background: Hepatitis C virus (HCV) infection is a significant public health challenge in Nigeria, contributing heavily to chronic liver disease, including cirrhosis and hepatocellular carcinoma. While recent data is emerging, national estimates indicate a varied, often underreported burden, particularly in localized, subnational, and high-risk populations.

Methods: A descriptive cross-sectional study was conducted to investigate the prevalence and risk factors of Hepatitis C Virus (HCV) among 461 adults at nine primary healthcare centers in Plateau State, Nigeria, from December 2023 to September 2024. Using interviewer-administered questionnaires and third-generation ELISA for anti-HCV antibodies, polymerase chain reaction for confirmation and analyzed associations with potential risk factors with Chi-square and Fisher’s exact test with p<0.05 considered statistically significant.

Results: The overall data revealed high (10.6%) burden Hepatitis C virus (HCV) infection among participants with several key socioeconomic and behavioral drivers that significantly linked to higher infection rates (p<0.05). This finding aligns with broader regional data in Nigeria, where some areas, particularly in the North Central region, exhibit double-digit prevalence rates significantly higher than the national average of ~1%.

Conclusion: The high HCV prevalence in Plateau state signals a major public health crisis. To meet WHO 2030 elimination targets, the state must urgently implement community-specific screening, intensive risk-reduction education, and more robust referral pathways within the primary healthcare system.

Prevalence, Awareness and Socio-demographic Determinants of Hepatitis B Infection among Antenatal Women in Southeast Nigeria: A Cross-sectional Study

2026-03-25T07:56:10+00:00

Background: Hepatitis B virus (HBV) infection remains a significant global health problem, particularly in sub-Saharan Africa, where it contributes substantially to maternal and neonatal morbidity. There is an increased risk of vertical transmission and other adverse events from HBV infection during pregnancy. This study assessed the prevalence, awareness, and sociodemographic factors associated with HBV infection among pregnant women attending antenatal clinic in Onitsha, Nigeria.

Methods: A cross-sectional descriptive study was conducted among 125 pregnant women receiving antenatal care at St. Charles Borromeo Specialist Hospital, Onitsha. Sociodemographic data and information on HBV awareness were collected using structured questionnaires. Venous blood samples were analyzed for hepatitis B surface antigen (HBsAg) using ELISA. Data were analyzed using Chi-square test, with statistical significance set at p < 0.05.

Results: The overall prevalence of HBV infection was 1.6% (2/125). Positive cases were identified among women aged 30–39 years, all of whom were married and had tertiary education. Infection occurred only in the third trimester and among women with higher parity. However, no statistically significant association was found between HBV infection and sociodemographic or obstetric variables (p > 0.05). Although 65.6% of participants had knowledge of HBV, awareness of vertical transmission (40.8%), preventive measures (33.6%), and treatment options (28%) was low.

Conclusion: HBV prevalence in this study was 1.6%, supporting the need for routine HBV screening in pregnant women. However, awareness remains limited (including vertical transmission, prevention, and treatment). Therefore, the findings highlight the importance of continued routine HBV screening and improved awareness among pregnant women.

In vivo and Computational Evaluation of Brassica oleracea Mitigation on Lead Acetate-Mediated Pancreatic Damage on Adult Male Wistar Rats: A Molecular Docking, ADMET and Drug Likeness Studies

2026-04-20T12:22:32+00:00

Lead acetate exposure induces oxidative stress and pancreatic damage, representing a critical public health concern. Brassica oleracea is recognized for its antioxidant and protective bioactivities, but its efficacy against lead-induced pancreatic toxicity requires further evaluation. This study investigates the in vivo protective effects of Brassica oleracea on pancreatic damage in adult male Wistar rats and explores the molecular docking, ADMET, and drug-likeness profiles of its key bioactive compounds against relevant pancreatic protein targets. The in vivo study demonstrates that Brassica oleracea extract has significant ameliorative effects against lead acetate-induced pancreatic toxicity in Wistar rats. The moderate dose of Brassica oleracea extract (Group D) provided the most substantial improvements in both biochemical markers and histological features, suggesting that this dosage offers an optimal balance between antioxidant activity and pancreatic recovery. Molecular docking revealed strong binding affinities ranging from -5.1 to -11.7 kcal/mol, with rutin exhibiting the highest affinity at -11.7 kcal/mol against multiple pancreatic enzymes, while neoxanthin and apigenin showed affinities up to -8.9 and -7.8 kcal/mol, respectively. ADMET analysis indicated favorable absorption and metabolism profiles for apigenin, with lower toxicity risks compared to neoxanthin and rutin. Drug-likeness evaluations favored apigenin, which complied with Lipinski’s and other key rules. These findings suggest that Brassica oleracea exerts protective effects against lead acetate-mediated pancreatic injury, with its bioactive compounds, particularly rutin and apigenin, exhibiting strong molecular interactions and promising pharmacological profiles. Further studies are warranted to develop these compounds as potential therapeutic agents.

Effect of Ocimum gratissimum and Vernonia amygdalina Leaf Extracts on Carbon Tetrachloride-induced Gastro-intestinal Toxicity in Rats

2026-05-14T13:30:00+00:00

Introduction: Globally, the occurrence of gastrointestinal diseases appears to have increased rapidly and currently accounts for the upsurge in disease burden and household expenditures on healthcare. For example, a 25.82 percent increase in the occurrence of gastric ulcers was reported between 1990 and 2019 and was projected to go higher in the years ahead.

Aim: To determine the effect of the extracts of Ocimum gratissimum (OG) and Vernonia amygdalina (VA) on induced gastrointestinal toxicity in male rats

Methods: A total of twenty-five (25) adult Wistar rats were used for the study and randomly divided into five groups of five rats each. Group I served as the normal control, Group 2 received CCl₄ only, Group 3 received CCl₄ followed by OG extract, Group 4 received CCl₄ followed by VA extract, while Group 5 received CCl₄ followed by a combined extract of OG and VA. The plant extracts were administered orally at a dosage of 208 mg/kg for OG and 52 mg/kg for VA for the treatment period of two weeks.

Results: On mucus weight, Group 5 (OG + VA) combined treatment resulted in a weight of 41.00 $\pm$ 1.73 which is higher than the positive control. This indicated that VA exhibited the strongest restorative effect on mucus weight (P < 0.05). on pH of the stomach, Treatment groups (Group 3, 4 and 5) showed significantly higher pH values (3.04 $\pm$ 0.30, 3.04 $\pm$ 0.25, 3.07 $\pm$ 0.25) comparable to the negative control group 1 (3.00 $\pm$ 0.48) at P < 0.05. Also, pepsin activity was highest in the positive control group 2 (23.50 $\pm$ 0.18) P < 0.05 indicating increased proteolytic activity that could worsen gastric damage. All treatment groups showed significantly lower pepsin activity, similar to the negative control group 1 (20.24 $\pm$ 0.12) at P < 0.05.

Conclusion: oral administration of OG and VA leaf extracts at a dose of 208 mg/kg and 52 mg/kg respectively exhibited protective effects against CCl₄-induced gastrointestinal toxicity in rats, with the combined extract showing enhanced efficacy. These findings suggest the potential therapeutic role of these medicinal plants in managing gastrointestinal toxicity.

Outcome of a Nurse-led Diabetes Education Program on Coping Strategies and Health-related Quality of Life among Adults with Type 2 Diabetes Mellitus in Kaduna State, Nigeria: A Single-group Pre-post Study

2026-06-01T12:56:35+00:00

Background: Type 2 diabetes mellitus (T2DM) poses a significant public health challenge in Nigeria, exacerbated by the psychosocial burden of the disease. While nurse-led education is a promising intervention, evidence regarding its impact on coping strategies and health-related quality of life (HRQoL) in Nigerian adults remains limited.

Method: A quasi-experimental pre-post study was conducted with 332 adults with T2DM across three secondary healthcare facilities in Kaduna State. Participants received a six-week structured nurse-led diabetes education program covering self-management and coping skills. Outcomes were assessed using the Brief COPE inventory and WHOQOL-BREF instrument. Data were analyzed using paired t-tests and multiple linear regression. Post-intervention, significant improvements were observed in diabetes knowledge, total coping strategies, and HRQoL (p < 0.001 for all).

Result: Post-intervention, higher scores were observed for diabetes knowledge, total coping strategies, and HRQoL (p < 0.001 for all). While adaptive coping scores were higher, maladaptive coping scores were also higher post-program. Cross-sectional analysis indicated that post-intervention coping scores were significantly associated with post-intervention HRQoL (β = 0.184, p < 0.001), whereas knowledge scores were not. Tertiary education was also associated with better HRQoL.

Conclusion: Participants demonstrated higher knowledge, coping, and HRQoL scores following the nurse-led education program. The finding that coping skills, rather than knowledge alone, were associated with HRQoL suggests that educational interventions should prioritize psychological coping development. These hypothesis-generating findings support the need for controlled trials to evaluate structured, coping-focused nurse-led education in low-resource settings.

Midodrine Therapy in Cirrhosis with Refractory Ascites: Impact on Survival and Paracentesis Frequency Compared with Large-volume Paracentesis

2026-04-23T13:05:55+00:00

Background: Refractory ascites is a major complication of cirrhosis with a 1-year survival rate of less than 50%. Large-volume paracentesis (LVP) is the standard treatment but does not improve survival and carries risks of circulatory dysfunction. Midodrine, an oral alpha-adrenergic agonist, with or without octreotide, has been studied as a potential alternative or adjunct therapy.

Methods: A systematic review was conducted using Ovid Medline, CINAHL, and Scopus. After screening, eight studies met inclusion criteria that evaluated midodrine, alone or in combination, in patients with cirrhosis and refractory ascites.

Results: Midodrine consistently improved systemic hemodynamics and renal function. Evidence for its role in reducing paracentesis-induced circulatory dysfunction and decreasing paracentesis frequency was mixed. Combination therapy with propranolol reduced first variceal bleeding and improved ascites control, while midodrine with octreotide was not superior to albumin. A pediatric study suggested renal protection but no improvement in ascites outcomes.

Discussion: Discussion: Midodrine appears to provide circulatory and renal benefits and may be useful as an adjunct therapy. However, current evidence does not support its use as a replacement for albumin or as a treatment that reliably improves survival or reduces paracentesis frequency. The strength of evidence is limited by small sample sizes, heterogeneity in study design and interventions, and reliance on several pilot trials. Additionally, many studies had short follow-up periods and were underpowered to detect meaningful differences in survival outcomes.