Journal of Global Medicine

End-of-life: assisted dying to active euthanasia – the Kessler Twins Continuum

2026-01-27T03:17:01+00:00

Disparities and inequalities in the clinical outcomes of colorectal cancer

2025-08-18T10:47:07+00:00

Economic Inequality and Cardiovascular disease in the United Kingdom: A new benchmark and a web dashboard

2025-07-07T12:23:23+00:00

This paper examines the disparities in heart disease prevalence among different income groups in the United Kingdom, highlighting significant inequalities that persist within the healthcare system. Utilising a specialised Gini index tailored for health inequality, we quantify the extent of these disparities, providing a robust statistical framework for understanding the relationship between socioeconomic status and heart disease outcomes. Our analysis reveals that lower-income groups experience a disproportionately higher burden of heart disease, underscoring the urgent need for targeted public health interventions. To enhance public awareness and accessibility of health equity data, we developed an interactive web dashboard that visualises the prevalence of heart disease across income brackets, allowing users to explore and comprehend the health inequities affecting their communities. This dashboard serves as a vital tool for policymakers, healthcare providers, and the general public, fostering informed discussions and driving efforts toward reducing health inequalities in the UK. Through this work, we aim to contribute to the ongoing dialogue around health equity and advocate for policies that address the root causes of health disparities.

Correlates of retention in HIV care among homosexual and heterosexual men: a comparative study

2026-01-12T06:37:00+00:00

Background: Globally, men who have sex with men (MSM) have a disproportionately high HIV burden compared with heterosexual men. In Nigeria, the HIV seroprevalence rate among MSM has steadily increased, threatening progress towards ending the epidemic.

Objective: This study, therefore, determined and compared the correlates of retention in HIV care among MSM and heterosexual men in Ibadan, Nigeria.

Method: A prospective study of 650 HIV-positive men was conducted. Respondent-driven sampling was used to select 160 HIV-positive MSM, while convenience sampling was used to select 490 HIV-positive heterosexual men from antiretroviral treatment (ART) clinics in Ibadan. All respondents were over 18 years old and ART-naïve. Data were collected using a semi-structured, interviewer-administered questionnaire and a clinical pro forma to track retention over 24 months. Descriptive analysis and a binomial regression model were performed at α = 0.05. Adjusted Risk Ratios (ARRs), defined as the ratio of outcome probabilities between groups after adjustment for confounders, were estimated from the regression model.

Result: The mean ages of heterosexual men and MSM were 43.1 ± 8.67 and 26.4 ± 5.82 years, respectively. Retention at 24 months was significantly higher among heterosexual men (87.6%) than MSM (68.1%) (P < 0.001). Heterosexual men were more likely to be retained if they had two or more wives (ARR): 1.19, 95% CI: 1.09–1.30), lived with a spouse (ARR): 1.23, 95% CI: 1.07–1.43), and had good knowledge of HIV (ARR: 1.16, 95% CI: 1.10–1.25). HIV-positive MSM who discussed HIV/AIDS with health workers/peer educators in the last 12 months ((ARR): 4.85, 95% CI: 4.17–5.63) and had a positive attitude to HIV (ARR): 6.14, 95% CI: 4.12–9.15) were more likely to be retained.

Conclusion: Having social relationships, good knowledge of HIV and a positive attitude to HIV influenced retention in care. HIV programmes need periodic outreach education to address HIV knowledge gaps deterring retention among heterosexual men, while integrating peer support and counselling is recommended to reduce internalised stigma and improve attitude among MSM.

Histological pattern of breast lesions in children and adolescents: a ten-year review

2025-08-11T09:08:21+00:00

Background: Breast lesions in children and adolescents exhibit varying patterns and diagnostic distributions. Understanding the relationship between age, specimen type, and histopathological diagnosis is essential for optimising clinical management and guiding diagnostic approaches. This study aims to examine the breast tissues collected in this age group, as well as the histological diagnoses and biological behaviours of the lesions.

Methods: This is a retrospective analysis of the histology of breast lesions and the distribution of diagnoses across two age groups (10–14 and 15–19 years). Chi-square and Fisher’s exact tests were used to assess statistical associations, with significance set at P < 0.05.

Results: Fibroadenoma was the most prevalent diagnosis, accounting for 76.8% of cases of excised lumps. The two trucut biopsies showed a malignant (B5b) and an atypical (B3) lesion. Fibrocystic change increased with age, peaking at 12.4% in the 15–19 years category. Malignant and atypical breast lesions were rare but present across different age groups. The proportion of fibroadenomas was higher in the older age group, at 77.2%, compared to 68%.

Conclusion: This study highlights fibroadenoma as the predominant breast lesion among adolescents and young adults. Malignant lesions were seen in this age group, albeit rarely, justifying the need to histologically examine all breast lesions, even in the very young. The significance of increasing age underscores the need for age-specific diagnostic approaches and the selection of appropriate specimens for accurate histopathological evaluation. Early detection and monitoring of atypical and malignant lesions remain crucial for optimal clinical management.

Bladder injuries at caesarean section: risk factors and management

2025-12-10T05:04:25+00:00

Iatrogenic injury to the urinary bladder may occur during caesarean section (CS) due to the close anatomic proximity of the two organs. Risk factors predisposing to bladder injuries during caesarean deliveries include dense adhesions, CS in advanced/prolonged labour, failed instrumental deliveries, uterine rupture, and attempts to control bleeding following repeat CS. An awareness of the risk factors and mechanisms of injury should help the obstetrician prevent bladder injuries. Early recognition of injury and intraoperative repair during the primary surgery most often result in less morbidity for the patient and a more successful outcome.

Disparities in prostate cancer epidemiology: a comparative analysis of West Africa and Europe

2025-08-01T06:10:15+00:00

Prostate cancer remains a leading cause of morbidity and mortality worldwide, disproportionately affecting black men. This review examines the differences in prostate cancer incidence and mortality rates between West Africa and Europe. While prostate cancer is more prevalent in Europe, primarily attributed to widespread screening programmes, West Africa faces significant challenges, including underdeveloped cancer registration systems, low public awareness, and limited access to screening. These factors lead to underreporting of incidence rates, yet higher mortality rates. In addition, this narrative review explores the role of environmental and lifestyle factors, including high levels of chronic stress and exposure to pollutants, as additional risk factors for prostate cancer in West Africa compared to European countries. As the global incidence of prostate cancer is projected to increase, implementing region-specific interventions and targeting modifiable lifestyle factors will be vital in alleviating the burden in West Africa. Addressing these disparities is essential for improving early detection, enhancing survival outcomes, and promoting more equitable prostate cancer care.

The oocyte paradox; a compelling cause for continued ART surveillance in a developing country

2025-08-01T06:10:18+00:00

The introduction of assisted reproductive technology (ART) has revolutionised the management of infertile couples. ART is available in many developing countries, but only to those who can afford the service. This inequity in access has resulted in an unmet need amongst those who are economically vulnerable. Late presentation is common in developing countries due to the enormous cost of ART, resulting in a disproportionately larger cohort of older women seeking ART. Oocyte donation is in high demand in many developing countries, but there is often a lack of regulations and enforcement capabilities. This may inadvertently subject the oocyte to the law of supply and demand with consequent exploitation. Altruistic gamete donation has gradually been superseded by compensated donation, paving the way for commercialisation in contrast to the concept of ‘a true gift’. The value of the human oocyte becomes a function of its designation either for research or treatment during ART.

In many developing countries where research in human reproduction is minimal and altruistic donation extremely low, the oocyte paradoxically attains a commercial status and is available to the highest bidder. There is a compelling need to strengthen regulatory agencies in developing countries to discourage the commodification of gametes. An important strategy involves the development of policies and guidelines for donor compensation rather than the current practice of discretion. Gamete sharing will reduce the pressure on ART recipients and, if properly implemented, will minimise desperation and discourage exploitation. In developing countries, Oocyte banking should be explored to allow equitable distribution of scarce gametes.

From the journals: important excerpts from other leading

2025-11-27T12:11:06+00:00

Hidden struggles in cancer treatment: A brief taste of loss

2025-12-18T04:37:05+00:00

This reflective article examines a brief personal experience of taste loss to illuminate the often-overlooked challenges encountered by individuals undergoing cancer treatment. Employing both personal narrative and patient case studies, this discussion highlights the limitations inherent in toxicity grading systems, underscores discrepancies between clinical perspectives and patient experiences, and emphasises the importance of shared decision-making processes. The piece contends that extended survival is valuable only when accompanied by dignity, enjoyment, and a sense of personal meaning.

The hypothesis of Early Home Oxygen Therapy (EHOT) in sickle cell crisis

2025-12-18T04:40:47+00:00

The article by Omoigui (1) presents a thought-provoking perspective on the management of sickle cell crisis, focusing on the potential of a simple, yet overlooked, intervention: concentrated oxygen therapy during the "golden half hour." This commentary offers a constructive evaluation of the article's central thesis and its potential implications.

The central hypothesis is that when triggers induce haemoglobin polymerisation, resulting in sickling and increased rigidity of erythrocytes, the sickle cells formed can be reversed with early administration of concentrated oxygen. This time-dependent use of oxygen prevents reversible sickle cells (RSC) from progressing to irreversible sickle cells (ISC), thereby preventing the end-organ sequelae of sickle cell crises.

While the proposal is promising, a comprehensive appraisal must address several critical limitations. These points are essential for guiding future research and clinical application. There is limited patient data, as the hypothesis has been tested only on a small sample size of seven patients over a 20-year period. This is insufficient data to establish a causal relationship or justify a significant change in clinical guidelines. The safety of home oxygen use needs to be addressed, as does the role of oxygen therapy in exacerbating ischaemia-reperfusion injury.

Omoigui's article (1) is potentially an essential contribution to the field of sickle cell disease management. It serves as a vital call to re-evaluate our foundational assumptions about crisis management and prevention, and it should stimulate a new wave of studies dedicated to validating this promising approach. The priority is to test the hypothesis in a large sample of patients with measurable objective markers, both before and after the initiation of early home oxygen therapy.

Sequential intussusception in a set of female twins

2025-11-19T07:30:28+00:00

Introduction: Intussusception is the leading cause of intestinal obstruction in children in sub-Saharan Africa. Familial occurrences of intussusception have been reported. Simultaneous or concurrent twin intussusception is rarely reported, particularly in Africa.

Case presentation: We report a case of intussusception in 5-month-old dizygotic female twins occurring 18 days apart in Southern Nigeria. The younger twin presented at our facility with symptoms including vomiting, the passage of red currant jelly stool, and abdominal distension for 4 days. She subsequently experienced a seizure and underwent a right hemicolectomy for a perforated gangrenous ileocolic intussusception. Eighteen days later, the old twin presented with vomiting and the passage of red currant jelly stool for 1 day. She successfully underwent an ultrasound-guided hydrostatic reduction of her ileocolic intussusception.

Conclusion: The exact cause of sequential twin intussusception is not entirely understood; however, it appears to be multifactorial. It seems that twins with similar systemic inflammatory responses, combined with congenital anatomical and genetic predispositions, are more likely to develop intussusception when simultaneously exposed to the same trigger.

A panoramic view of the life of Al-Rhazes, the polymath pioneer of psychopharmacology and psychiatry

2025-12-10T05:04:55+00:00

This work examines the life and contributions of Abū Bakr Muhammad ibn Zakariyyā al-Rāzī (865–925 AD), also known as Rhazes, a renowned Persian polymath and physician. Being famous as the father of psychiatry, psychology and pharmacology, Rhazes made significant advancements in medicine, philosophy, ethics and alchemy. His works, including influential treatises and translations of Greek medical texts, laid the groundwork for modern medical practices. As a physician and medical director in Baghdad, his humanitarian efforts were particularly aimed at aiding the poor. This biography examines Rhazes’s achievements, highlighting his interdisciplinary impact on various medical fields and natural sciences. By studying and marvelling at his contributions, we gain valuable insights into the historical evolution of medical knowledge and the foundational concepts that continue to influence contemporary medical practices.

How sickle cell crisis stymied modern medicine for 100 years, whilst a solution was hidden in plain sight: A hypothesis

2025-08-11T09:08:23+00:00

Reversible sickle cells (RSCs) can become irreversible sickle cells (ISCs) after repeated episodes of sickling. The RSCs can revert to their original flexible discoid shape when reoxygenated; however, repeated sickling can damage the cell membrane, making it impossible for the cells to return to their standard shape and resulting in ISCs. Home oxygen therapy during the critical first half-hour after the onset of a crisis restores RSCs. It prevents them from progressing to a critical mass of ISCs, where the sickle cell crisis becomes established and intractable. Developing a medication to prevent and stop a sickle cell crisis within the golden half hour has been very difficult. The efficacy of oxygen therapy in preventing and aborting a crisis in the golden half hour is very promising. When you stop the crisis, you prevent severe pain, emergency care, hospitalisation and multi-organ damage. It would reduce the complications, disability and mortality rates linked to this chronic condition.

After the Cass Report, what now for puberty blockers?

2025-08-05T06:29:22+00:00

Dear Editor,

Your editorial on the Cass report [1] was encouraging for its boldness in tackling a sensitive and crucial clinical topic. The opening paragraph is apt in decrying the systemic weaknesses that led clinicians to abandon the basic tenets of evidence-based medical practice. In this instance, evidence-based medicine was abandoned in favour of socially desirable clinical outcomes. Perhaps a further study of clinicians’ decisions should be undertaken to fully understand how such a contentious practice became ‘routine clinical practice’ despite the weak evidence base.

The issue of comorbidity associated with gender incongruence and dysmorphism also raises important issues of diagnostic fidelity and the nosological value of these diagnostic categories. The foregoing further highlights the physician’s role in objectively interpreting subjective phenomena and enhancing the repeatability of diagnostic determinations.

My own experience, as a frontline clinician, is that many patients with gender identity disorder have, on detailed exploration of their longitudinal personal history, distinct adult emotional dysfunction, manifesting as abnormal personality traits, related to, or even arising from, adverse early experiences and attachment difficulties. These markers of psychological dysfunction often appear to predate the overt manifestation of the recognised symptoms of gender dysphoria and should be carefully considered in differential diagnosis.

Acute emergencies among youths in the National Youth Service Corps Orientation Camp: a case for optimization of oxygen services and emergency care at the camp clinic

2025-08-11T09:08:20+00:00

Dear Editor,

The National Youth Service Corps (NYSC) is a mandatory 1-year service program for all Nigerians under the age of 30 who have completed full-time undergraduate studies. One of its key components is the orientation course, a 3-week training held at designated camps across all states and the Federal Capital Territory (FCT), Abuja [1]. While the camp serves as a platform for youth development and national integration, it also presents health challenges, with campers exposed to various illnesses and injuries [2], some of which may require prompt medical intervention.

Hypoxemia, low blood oxygen level, is a life-threatening condition that may result in death if not promptly managed [3, 4]. At the orientation camp, corps members engage in strenuous activities such as paramilitary drills, endurance treks, and sports, often under extreme weather conditions. These activities not only predispose them but can also precipitate various medical emergencies such as acute exacerbation of bronchial asthma, head injury, syncopal attacks, and hypertensive crisis. All these conditions may be associated with hypoxemia, which requires medical oxygen. Without adequate emergency services, preparedness, and oxygen services, healthcare personnel can do little in the camp, which leads to moral distress among healthcare workers [5].

Though NYSC has mandated medical screening for all prospective corps members, the intensive and strenuous activities at the orientation camp can precipitate medical emergencies in apparently healthy individuals. Past reports of corps members’ deaths during the orientation camp [6, 7] underscore the need for oxygen service optimization, particularly those in remote settings where external supports may be delayed during acute emergencies. All 36 camps must have adequate medical oxygen equipment, basic emergency medications, and consumables.

While corps members are covered under the National Health Insurance [8], the cost of oxygen therapy is not included in the scheme as of April 2025. Considering the high cost of oxygen therapy to patients [9], this service must be optimized in all camp clinics. Implementation of the national strategic document on medical oxygen in Nigeria [10] should be extended to the NYSC clinics. A safe, reliable, and effective oxygen system is needed in all the camp clinics. This includes adequate pulse oximeters, oxygen concentrators (±flow splitters), backup oxygen cylinders (either as bedside access or through a manifold system), trained and motivated staff, and effective supply chains. Biomedical technicians should also be deployed to camp clinics alongside other medical personnel. In addition to informing planning and resource allocation, there is a need for empirical research to assess oxygen needs, access gaps, and camp clinic readiness to provide optimal oxygen services.

In conclusion, optimizing oxygen services in all the NYSC orientation camps is essential and requires attention from all stakeholders. The high incidence of acute medical emergencies in these settings highlights the necessity for readily accessible oxygen therapy.

The importance of recognising dying: audit and subsequent service developments to improve earlier recognition of the dying patient

2026-01-22T03:44:08+00:00

Early recognition of the dying patient leads to better end-of-life care for patients and their relatives. In 2019, the National Audit for Care at the End of Life (NACEL) identified several areas for improvement in a large NHS acute trust, including delays in recognition of the dying patient. The audit showed that in this trust, 22% of dying patients were only recognised to be dying in the last 8 hours of life compared to 17% nationally. This has significant consequences on the quality of end-of-life care.

This article examines the challenges associated with recognising when a patient is approaching the end of life and highlights the significance of timely identification. In response to the findings of the 2019 NACEL audit, the Trust introduced several service developments, including the expansion of palliative care services, enhanced staff training with an emphasis on early recognition of dying, and improved processes for referring patients to palliative care. We have used descriptive statistical analysis, which is appropriate for an audit-based evaluation.

A subsequent reaudit conducted in 2022 demonstrated significant improvement; the proportion of patients for whom dying was recognised less than eight hours before death decreased from 22% to 10.4%. Additionally, in 94% of cases, it was acknowledged that the patient may be dying, an increase from 85% in 2019. This article will summarise the key findings from NACEL, discuss their implications, and outline the interventions implemented that contributed to these improvements.

Improving placenta accreta spectrum diagnosis: impact of structured imaging protocols and multidisciplinary review in a tertiary service evaluation and re-audit

2025-12-18T05:30:58+00:00

Objective: The study aims to assess the impact of targeted diagnostic and organisational interventions on placenta accreta spectrum (PAS) screening performance in a tertiary referral centre.

Design: Retrospective comparative audit.

Setting: Liverpool Women’s Hospital, UK.

Methods: PAS screening outcomes from two periods (2017–2020 vs. 2022–2024) were compared. Interventions included standardised ultrasound reporting using the ISUOG proforma, dedicated placental imaging protocols, regional multidisciplinary team (MDT) review, enhanced sonographer training, and selective magnetic resonance imaging (MRI) in indeterminate cases. Screening sensitivity, specificity, predictive values, and diagnostic accuracy were calculated. Ultrasound features associated with true and false positive diagnoses were analysed, and the role of serial scans was assessed.

Results: A total of 60 and 146 patients were screened in the first and second audit periods, respectively. Sensitivity improved from 60.0 to 92.3%, with a modest decrease in specificity from 100.0 to 94.0%. High-yield sonographic signs included bladder line disruption and bladder bulge (positive predictive value [PPV] 100%). Subplacental hypervascularity and lacunae had lower specificity (PPV 53–56%). Serial scanning improved sensitivity (from 69.2 to 92.3%) and accuracy (from 90.4 to 93.8%). False positives were more common with high- or low-lying placentas compared to placenta previa.

Conclusions: Structured imaging protocols, serial scan review, and regional MDT collaboration significantly enhanced PAS detection, supporting safer delivery planning and improved maternal–neonatal outcomes. Future priorities include expanding specialist capacity, formalising care coordination, and implementing real-time data collection to sustain diagnostic gains and progress toward Level 3 PAS surgical centre capability.

An Improbable Psychiatrist, by Rebecca Lawrence (2024)

2025-01-08T09:16:23+00:00