Asian Pacific Journal of Health Sciences

Efficacy and Tolerability of Nixoderm Cream in the Management of Atopic Dermatitis: An Open-Label, Comparator-Controlled Clinical Study

2026-09-22T06:09:53+00:00

Background: Topical formulations combining salicylic acid, benzoic acid, and precipitated sulfur have been reported to support the management of atopic dermatitis (AD) by aiding skin exfoliation, reducing microbial load, and easing inflammation. Aims: The aim of the study was to evaluate the efficacy and tolerability of Nixoderm Cream, applied twice daily, in subjects with AD, compared with a control arm. Materials and Methods: An open-label, parallel-group study was conducted at a single Centre following Ethics Committee approval. Forty two subjects diagnosed with AD per Hanifin–Rajka criteria were enrolled (Group A: Nixoderm Cream, n = 21; Group B: Control, n = 21) and assessed at day 0, 7, 15, and 30 using the Eczema area and severity index (EASI) and AD severity index (ADSI), alongside a structured patient-feedback questionnaire. Results: Group A showed statistically significant reductions in EASI and ADSI scores from baseline to day 30 in both full analysis set and per-protocol set analyses, while Group B showed slight improvement in EASI and ADSI. Between-group differences were statistically significant. No adverse events were reported in either arm. Patient-reported improvement in Group A rose to 88% by day 30. Conclusion: Nixoderm Cream demonstrated significant and well-tolerated improvement in AD severity over 30 days relative to control, supporting its potential role as a topical therapy for mild-to-moderate AD.

Efficacy and Tolerability of Nixoderm Tin in the Management of Atopic Dermatitis: An Open-Label, Comparator-Controlled Clinical Study

2026-09-22T12:08:11+00:00

Background: Topical formulations combining salicylic acid, benzoic acid, and precipitated sulfur have been reported to support the management of atopic dermatitis (AD)/eczema by aiding skin exfoliation, reducing microbial load, and easing inflammation. Aims: The aim of the study is to evaluate the efficacy and tolerability of Nixoderm Tin, applied twice daily, in subjects with AD, compared with a control arm. Materials and Methods: An open-label, parallel-group study was conducted at a single center following ethics committee approval. Forty subjects diagnosed with AD per Hanifin-Rajka criteria were enrolled (Group A: Nixoderm Tin, n = 20; Group B: Control, n = 20) and assessed at day 0, 7, 15, and 30 using the eczema area and severity index (EASI) and AD severity index (ADSI), alongside a structured patient-feedback questionnaire. Results: Group A showed statistically significant reductions in EASI and ADSI scores from baseline to day 30 in both full analysis set (FAS) and per-protocol set (PPS) analyses, while Group B showed slight improvement in EASI and ADSI. Between-group differences were statistically significant (EASI PPS day 30, P = 0.0003; ADSI FAS day 30, P < 0.0001). No adverse events were reported in either arm. Patient-reported improvement in Group A rose to 80% by day 30. Conclusion: Nixoderm Tin demonstrated significant and well-tolerated improvement in AD severity over 30 days relative to control, supporting its potential role as a topical therapy for mild-to-moderate AD.

A Rare Case of Pleomorphic Adenoma of the Nasal Cavity with Extensive Squamous Metaplasia: A Diagnostic Pitfall

2026-09-22T11:34:56+00:00

Pleomorphic adenoma (PA) is one of the most common benign tumor of the major salivary glands. Its occurrence in the nasal cavity, particularly arising from minor salivary glands of the nasal septum, is rare. Due to its unusual location and diverse histomorphology, it is often associated with diagnostic challenges. We report a case of a 56-year-old female presenting with unilateral nasal obstruction of 3 months duration on the right side of the nose. Radiological evaluation revealed a well-defined lesion in the right nasal cavity arising from the anterior nasal septum without evidence of bone destruction. Histopathological examination established the diagnosis of PA with extensive squamous metaplasia and keratin pearl formation, imparting a morphology that closely mimics keratinizing lesions of the nasal cavity. In conclusion, PAs in the nasal cavity are uncommon and often show higher epithelial cellularity with reduced stromal components compared to their major salivary gland counterparts, which may lead to misdiagnosis, particularly in limited biopsy specimens. Recognition of such histological variations is essential to avoid overdiagnosis and aggressive treatment.

Histomorphological Analysis and Clinicopathological Correlation of Tumors and Cysts of Skin and its Appendages – A Retrospective Study at a Tertiary Care Center in Hyderabad

2026-09-22T12:31:54+00:00

Background: Skin tumors and cysts are a heterogenous group of lesions that have varied presentations. It is difficult to diagnose them as benign or malignant lesions as their clinical manifestations tend to overlap. Therefore, histopathological examination serves as the gold standard for diagnosis and proper patient management. Objectives: Histomorphological spectrum of skin tumors and cutaneous cysts and their correlation with clinicopathological diagnoses was evaluated in a tertiary care hospital. Materials and Methods: A retrospective observational study conducted in the department of pathology at CMR institute of medical sciences and hospital, Hyderabad over a period of two and a half years (January 2023 to June 2025). A total of 130 excised skin tumors and cutaneous cysts that were subjected to histopathological examination were included in this study. Inflammation and infection related cases were excluded from the study. The clinical details of the patient were obtained from the pathology requisition forms. Formalin fixed, Paraffin-embedded samples were examined microscopically after hematoxylin and eosin staining. Data analysis was done in Microsoft excel software and Statistical Package for the Social Sciences version 25.0 (IBM Corp., Armonk, NY, USA). Results were presented in frequencies, percentage, mean, and standard deviation. Results: Among the 130 patients studied, 72 (55.4%) were male and 58 (44.6%) were female with a mean age of 37.5 ± 18.4 years (range 1–82 years). Most cases were in the 21–40 year age group (53.1%) and posterior chest region was the most common site involved (23.1%). Epidermoid cysts were the commonest lesions (47.7%), followed by infected epidermoid cysts (13.8%) and papillomas (11.5%). Malignant tumors constituted 7.7% of the total cases studied, with the most common being squamous cell carcinoma. Clinicopathological concordance was seen in 70% of cases while 30% of the cases showed clinicopathological discordance which mainly occurred due to misdiagnosis of epidermoid cysts as sebaceous cysts clinically. Conclusion: Epidermoid cysts were the commonest cutaneous lesions seen among young adults with a slight male predominance. High clinicopathological discordance in this study emphasizes the need for routine histopathological examination to make a precise diagnosis.

Clinical and Echocardiographic Correlation of the Mitral L-Wave: An Observational Study

2026-09-23T04:17:55+00:00

Background: The mitral L-wave is a mid-diastolic transmitral Doppler flow signal that is often underrecognized in routine echocardiography despite its diagnostic and prognostic importance. This observational study evaluated the clinical and echocardiographic correlates of the mitral L-wave among patients attending a tertiary care general medicine department. Methods: Fifty-three patients with an echocardiographically confirmed mitral L-wave were studied over 6 months (April 2024–September 2024) at the Department of General Medicine, L.N. Medical College and J.K. Hospital, Bhopal. Clinical presentation, comorbidity profile, and the response of the L-wave to the Valsalva maneuver were recorded and analyzed descriptively. Results: A mitral L-wave was frequently observed in patients with coronary artery disease and chronic kidney disease (50.9% each), and hypertension and type 2 diabetes mellitus (49.1% each), consistent with elevated left ventricular filling pressures. Dyspnea on exertion (62.2%) was the most common presenting symptom, and females constituted a slightly higher proportion (52.8%) of the cohort. Eight patients (15.1%) showed a preload-dependent change in L-wave amplitude during the Valsalva maneuver. Conclusion: The mitral L-wave is a reproducible, load-sensitive Doppler finding associated with diastolic burden that may assist in the early detection and management of heart failure with preserved ejection fraction.

Prevalence, Clinicobiochemical, and Immunological Profile of Human Immunodeficiency Virus and Human Immunodeficiency Virus–Hepatitis B Virus Coinfected Patients in a Tertiary Care Hospital in South India

2026-09-23T04:23:48+00:00

Background: Human immunodeficiency virus (HIV) and hepatitis B virus (HBV) share common transmission routes, and coinfection is known to worsen immunological recovery in both conditions; Indian data on the clinicobiochemical profile of HIV–HBV coinfection remain limited. Methods: This cross-sectional observational study, conducted at the anti-retroviral therapy (ART) center, Government General Hospital, Vijayawada, over 6 months, aimed to determine the prevalence of HIV–HBV coinfection, compare demographic, clinical, biochemical, and immunological profiles between HIV-monoinfected and HIV–HBV coinfected patients, and assess the association between CD4 T-cell counts and opportunistic infections. Of 1,802 HIV-positive individuals screened for hepatitis B surface antigen, 101 were coinfected (cases), and 100 HIV-monoinfected patients served as controls; data were analyzed using the Statistical Package for the Social Sciences v25. Results: The prevalence of HIV–HBV coinfection was 5.6%. Coinfection was more frequent among males (66.3%) and rural residents (73.3%, P < 0.05), with heterosexual transmission predominating (82.2%). Coinfected patients had significantly lower mean CD4 counts (214 ± 86 vs. 328 ± 112 cells/μL; P < 0.001), more advanced centers for disease control and prevention Stage C disease (50.5% vs. 35.0%), and higher rates of elevated alanine aminotransferase (63.4% vs. 26.0%) and aspartate aminotransferase (74.3% vs. 31.0%; both P < 0.001). Opportunistic infections, particularly chronic diarrhea (43.6%) and pulmonary tuberculosis (21.8%), were more common in coinfected patients. Conclusion: HIV–HBV coinfection significantly worsens immunosuppression, accelerates hepatic injury, and increases the burden of systemic opportunistic infections. Routine HBV screening in all HIV patients, early initiation of dual-active ART, and targeted rural health interventions are warranted.

Study of Clinico-Radiological Examination and Histopathological Examination in Management of Breast Lump

2026-09-23T04:30:05+00:00

Background: Breast lumps are among the most common presenting complaints in surgical outpatient departments, encompassing a wide spectrum from benign fibrocystic disease to invasive malignancy. Accurate early differentiation is critical to prevent diagnostic delays, reduce unnecessary surgery, and optimize patient outcomes. The triple assessment – comprising clinical breast examination (CBE), radiological imaging (ultrasonography [USG]/mammography), and fine needle aspiration cytology (FNAC) – is the internationally recommended standard for evaluating breast lumps. However, institution-specific data validating its performance in the Indian clinical context remain sparse. Materials and Methods: This prospective observational study enrolled 50 patients with palpable breast lumps at SGT Medical College, Gurugram, between 2024 and 2026. All patients underwent structured CBE, radiological assessment (USG ± mammography) classified by the Breast Imaging Reporting and Data System (BI-RADS), and FNAC classified by the C1–C5 cytology grading system. Histopathological examination (HPE) served as the reference standard. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and Cohen’s kappa (κ) were computed. Results: Of 50 patients (mean age 38.6 ± 9.4 years), 32 (64%) had benign and 18 (36%) had malignant lesions on HPE. Key malignancy-associated clinical features included puckering/dimpling (66.7% vs. 9.4%; P < 0.001), peau d’orange (50.0% vs. 3.1%; P < 0.001), and axillary lymphadenopathy (72.2% vs. 9.4%; P < 0.001). All BI-RADS 5 lesions (100%) were histologically malignant. FNAC: Sensitivity 94.4%, specificity 90.6%, accuracy 92.0%. Kappa values: Clinical κ = 0.71, radiology κ = 0.79, FNAC κ = 0.84, triple assessment κ = 0.88. Conclusion: Integrated triple assessment achieves near-perfect concordance with histopathology (κ = 0.88) and represents the optimal diagnostic strategy for breast lumps. FNAC is the most accurate single modality. Multicentric studies with larger cohorts are warranted.

The APACHE 3 Prognostic System Risk Prediction of Hospital Mortality in Critically Ill Hospitalized Adults in Medical Intensive Care Unit on Mechanical Ventilation in Tertiary Care Center

2026-09-24T11:28:22+00:00

Background: Critically ill patients requiring mechanical ventilation have substantial morbidity and mortality, necessitating reliable tools for severity assessment and outcome prediction. The Acute Physiology and Chronic Health Evaluation III (APACHE III) scoring system incorporates physiological variables, age, and chronic health conditions to estimate hospital mortality. Materials and Methods: A prospective observational study was conducted among 120 patients requiring mechanical ventilation in the 10-bedded intensive care unit (ICU) of New Civil Hospital, Surat, from May 2018 to October 2019. Demographic characteristics, indications for ventilation, ventilator-related parameters, comorbidities, clinical findings, and laboratory investigations were recorded. The worst physiological parameters during the first 24 h of ICU admission were used to calculate the APACHE III score. Predicted mortality was calculated using the APACHE III mortality equations and compared with observed hospital mortality. Results: The majority of patients were aged 18–30 years (48.3%), and 77% were male. Neurological conditions were the most frequent broad indication for mechanical ventilation (67%), with organophosphorus (OP) poisoning being the most common individual diagnosis (50%). Most patients required ventilation for 1–7 days (60%). Overall, 48 patients (40%) died, whereas the mean predicted mortality was 32% and the mean APACHE III score was 62. Higher APACHE III scores were significantly associated with increased mortality (χ2 = 72.018, P < 0.001). A significant association was also observed between mortality and comorbidities (P < 0.001) and PaO2 levels (P < 0.001). Among patients with OP poisoning, APACHE III score was strongly associated with mortality (χ2 = 21.071, P < 0.001). Conclusion: APACHE III demonstrated good prognostic utility and effectively stratified mortality risk among mechanically ventilated ICU patients. Higher scores were strongly associated with increased observed mortality, supporting its use for outcome prediction in critically ill patients.

Hand-foot Anthropometric Correlates of Stature among Undergraduate Medical Students: A Cross-sectional Study

2026-09-29T11:21:46+00:00

Background: Stature is an important anthropometric characteristic with applications in biological anthropology, clinical assessment, and forensic identification. When complete skeletal remains or an intact body are unavailable, measurements of peripheral body parts such as the hand and foot may provide useful information for estimating stature. However, anthropometric relationships are population-specific and may vary according to sex, age, geographical background, and body proportions. This study evaluated the relationship between hand and foot anthropometric parameters and stature among undergraduate medical students and explored sex-specific prediction models. Materials and Methods: A cross-sectional observational study was designed among 240 undergraduate medical students aged 18–24 years. Stature, bilateral hand length, hand breadth, foot length, and foot breadth were measured using standardized anthropometric procedures. Pearson correlation analysis was performed to determine associations between anthropometric variables and stature. Independent-samples t-tests were used to compare measurements between male and female participants. Multiple linear regression models were developed to evaluate the predictive contribution of hand and foot measurements. Model performance was assessed using R2, adjusted R2 and standard error of estimate (SEE). Results: In this study, 120 males and 120 females were included. Mean stature was 170.64 ± 5.89 cm among males and 158.80 ± 5.93 cm among females. All measured hand and foot parameters demonstrated positive correlations with stature. Right foot length showed the strongest overall correlation with stature (r = 0.909), followed by left foot length (r = 0.908) and right hand length (r = 0.894). A combined model incorporating right hand length and right foot length explained 88.4% of the variance in stature in the overall simulated sample (adjusted R2 = 0.883; SEE = 2.73 cm). Conclusion: This study demonstrates that hand and foot anthropometric dimensions are positively associated with stature and that combined hand-foot measurements may provide better prediction than individual parameters. Population-specific and sex-specific regression equations may be useful in anthropometric and forensic applications.

Clinical Spectrum and Surgical Management of Hand Glomus Tumors: A Case Series of Five Histopathologically Confirmed Cases

2026-09-28T10:58:59+00:00

Background: Glomus tumors are rare benign neoplasms arising from the glomus body and most commonly occur in the subungual region of the digits. Despite their small size, they characteristically cause severe localized pain, point tenderness, and cold hypersensitivity, often resulting in delayed diagnosis. This case series describes the clinical presentation, anatomical distribution, diagnostic evaluation, surgical management, and outcomes of five histopathologically confirmed glomus tumors of the hand. Case Series: We retrospectively reviewed five consecutive patients with histopathologically confirmed glomus tumors who underwent surgical excision at a tertiary care center. The patients included three women and two men, aged 34–49 years. Three tumors were subungual, involving the right thumb, left thumb, and right little finger; one involved the fingertip pulp of the right ring finger; and one was located on the dorsum of the right hand. Patients presented with chronic localized pain, with cold hypersensitivity and point tenderness documented in the clinically typical lesions. Imaging was performed selectively for lesion localization. Complete surgical excision was achieved in all cases through an approach tailored to the anatomical location, including transungual, direct pulp, and dorsal approaches. Histopathological examination confirmed glomus tumor in all five cases. During follow-up, all patients reported complete resolution of pain, with no documented recurrence or significant post-operative nail deformity. Conclusion: Glomus tumors should be considered in patients presenting with persistent, localized digital pain, particularly when associated with point tenderness and cold hypersensitivity. Although the subungual region is the most common site, lesions may occur in atypical locations such as the fingertip pulp and dorsum of the hand. Careful clinical assessment, appropriate imaging when indicated, complete surgical excision, and histopathological confirmation are essential for accurate diagnosis and effective treatment. Early recognition may reduce diagnostic delay and facilitate excellent symptomatic outcomes.

Lipid Profile in Type 2 Diabetes Mellitus: A Cross-Sectional Case–Control Study

2026-10-01T05:25:09+00:00

Background: Dyslipidemia is a common metabolic abnormality in type 2 diabetes mellitus (T2DM) and contributes to an increased risk of cardiovascular complications. Alterations in lipid metabolism may become more pronounced with prolonged duration and poor glycemic control. Objectives: The aim of this study was to compare the serum lipid profile of patients with T2DM and healthy controls and to assess the association of lipid parameters with the duration and severity of diabetes. Materials and Methods: A cross-sectional case–control study was conducted at MNR Medical College and Hospital, Sangareddy, from December 2017 to November 2019. Fifty patients with T2DM and 50 age- and sex-matched healthy controls were included. Patients with conditions affecting lipid metabolism, including hypothyroidism, were excluded. Fasting serum total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and very-low-density lipoprotein cholesterol (VLDL-C) were assessed. Glycemic status was evaluated using glycated hemoglobin (HbA1c). Lipid abnormalities were interpreted according to NCEP ATP III criteria. Results: The mean age was 58.46 ± 7.73 years in the diabetic group and 58.40 ± 9.08 years in controls. Mean TC, LDL-C, and VLDL-C were significantly higher in diabetics than controls: TC, 203.76 ± 52.84 versus 166.06 ± 39.06 mg/dL (P < 0.00001); LDL-C, 135.78 ± 47.90 versus 94.98 ± 35.51 mg/dL (P = 0.00002); and VLDL-C, 33.68 ± 9.65 versus 28.64 ± 8.63 mg/dL (P = 0.0203). TG and HDL-C differences were not statistically significant in the case–control comparison. With increasing duration of diabetes, TG increased and HDL-C decreased significantly (P < 0.001). Increasing HbA1c severity was associated with higher TG, TC, LDL-C, and VLDL-C and lower HDL-C. Conclusion: T2DM is associated with significant alterations in lipid metabolism, particularly increased TC, LDL-C, and VLDL-C. Longer duration and poorer glycemic control were associated with worsening lipid abnormalities. Regular lipid assessment and optimal glycemic control may help reduce cardiovascular and vascular complications in patients with T2DM.

Comparative Analysis of Peripapillary Retinal Nerve Fiber Layer and Macular Parameters Using Spectral-Domain Optical Coherence Tomography in Primary Open-Angle Glaucoma and Normal Eyes: A Cross-Sectional Observational Study

2026-10-01T05:33:08+00:00

Purpose: The purpose of the study is to compare peripapillary retinal nerve fiber layer (RNFL) thickness and macular parameters measured by spectral-domain optical coherence tomography (SD-OCT) between normal subjects and patients with primary open-angle glaucoma (POAG) and to correlate RNFL thickness with age, spherical equivalent, central corneal thickness (CCT), disc area, and rim area. Materials and Methods: This is a cross-sectional study of 109 eyes (55 normal, 54 POAG). All subjects underwent perimetry, pachymetry, and Cirrus SD-OCT (fast RNFL and macular cube protocols). Groups were compared using the unpaired t-test/Mann–Whitney U test; correlations were assessed using Pearson’s coefficient. Results: Mean RNFL thickness was lower in POAG than in normal eyes (68.13 ± 10.9 vs. 96.64 ± 8.3 μm; P < 0.001), as were all four quadrants (P < 0.001 each). Average macular thickness, central macular thickness, and average macular volume were all significantly reduced in POAG (P ≤ 0.011). RNFL thickness correlated negatively with age (r = −0.86/−0.84) and positively with spherical equivalent (r = 0.76/0.74) in both groups (P < 0.001), with no significant CCT correlation. Conclusion: SD-OCT-derived macular volume, macular thickness, and peripapillary RNFL thickness are all significantly reduced in POAG, and macular parameters track RNFL loss closely enough to serve as a useful adjunct to disc and RNFL assessment.

Environmental Modulation in Larval Development of the mosquito, Culex quinquefasciatus Say: Effects of Temperature and Organic Pollution

2026-10-01T05:37:03+00:00

Introduction: Culex quinquefasciatus is the principal vector of lymphatic filariasis and an important vector of Japanese encephalitis in urban India. Aim:This study investigated the individual and combined effects of ambient temperature and organic pollution on the larval development, survival, and adult emergence of C. quinquefasciatus in Agra, Uttar Pradesh. Materials and Methods: Larvae of were collected every monthduring January, 2025 to December, 2025 from four representative breeding site categories and reared under controlled laboratory temperatures (20°C, 25°C, 30°C, and 35°C). Results: Water quality analysis revealed significant seasonal variation in biological oxygen demand (BOD), dissolved oxygen (DO), and nutrient loads. Developmental time was shortest at 30°C (7.2 ± 0.6 days) and longest at 20°C (18.4 ± 1.1 days), whereas survival peaked at 25°C (89%). Organic pollution, measured by BOD and ammonium concentration, showed a significant positive correlation with larval density (r = 0.84, P < 0.01) but an inverse relationship with dissolved oxygen. Sites with BOD > 10 mg/L supported 2.8-fold higher larval densities than clean water habitats. Conclusion: These findings demonstrate that the interaction between thermal regime and organic enrichment strongly modulates vector productivity in Agra, underscoring the need for sanitation-integrated vector management.

Effect of Smartphone Use-induced Mental Stress on Cardiovascular Autonomic Parameters in Medical Students: A Cross-sectional Analytical Study

2026-10-03T15:55:49+00:00

Background: Smartphones have become an essential component of medical education and social communication. However, prolonged and problematic smartphone use has been associated with psychological stress, sleep disturbance, and other adverse behavioral outcomes. Psychological stress can influence autonomic cardiovascular regulation, which can be assessed non-invasively using heart rate variability (HRV). Aim: The aim of the study was to evaluate the association between smartphone use, perceived psychological stress, and cardiovascular autonomic parameters among medical students. Materials and Methods: A cross-sectional analytical study was designed among undergraduate medical students aged 18–25 years. Daily smartphone exposure was assessed using objectively recorded smartphone screen time. Perceived psychological stress was assessed using the 10-item perceived stress scale (PSS-10). Cardiovascular autonomic function was evaluated using short-term electrocardiographic HRV analysis, including standard deviation of normal-to-normal intervals (SDNN), root mean square of successive differences (RMSSD), percentage of successive NN intervals, low-frequency (LF) power, high-frequency (HF) power, and LF/HF ratio. Resting heart rate and blood pressure were also recorded. Participants were categorized according to daily smartphone-use duration. Correlations and multivariable regression analyses were planned to assess the independent association between smartphone exposure, perceived stress, and HRV. Results: In this study, we included 200 medical students; mean smartphone use was 5.7 ± 2.1 h/day, and mean PSS-10 score was 20.8 ± 6.2. Students with >6 h/day of smartphone use demonstrated higher mean PSS scores and lower RMSSD and SDNN compared with students using smartphones <4 h/day. Mean RMSSD was 28.4 ± 9.7 ms in the high-use group compared with 35.8 ± 11.2 ms in the low-use group. The mean LF/HF ratio was 2.31 ± 0.91 and 1.74 ± 0.72, respectively. Smartphone-use duration showed a positive correlation with PSS score and an inverse correlation with RMSSD. PSS score was independently associated with RMSSD after adjustment for age, sex, body mass index, sleep duration, caffeine intake, and physical activity. Conclusion: Higher smartphone exposure may be associated with increased perceived psychological stress and altered cardiovascular autonomic modulation among medical students. However, due to the cross-sectional design, these associations should not be interpreted as evidence of causality. Prospective and interventional studies are required to determine whether reducing problematic smartphone use improves psychological stress and autonomic cardiovascular function.

From Discussion to Demonstration: Read–Teach–Validate–Demonstrate an Innovative Peer-Assisted Learning Model for Teaching Pediatric Central Nervous System Examination to Undergraduate Medical Students

2026-10-03T16:11:28+00:00

Background: Competency-based medical education requires undergraduate learners to participate actively in clinical learning and progressively develop the knowledge, communication, and examination skills needed for safe patient care. Neurological examination in children is particularly challenging because it requires integration of structured examination steps with developmental considerations and interpretation of clinical findings. Traditional demonstration-based sessions may not provide sufficient opportunity for every learner to practice, explain, and receive immediate feedback. The Read–Teach–Validate–Demonstrate (RTVD) model was designed to combine self-directed preparation, peer-assisted teaching, faculty validation, and bedside demonstration within a single structured clinical learning encounter. Objectives: The objectives of the study are to evaluate the effect and feasibility of the RTVD teaching model on knowledge acquisition and self-reported confidence among undergraduate medical students learning components of the pediatric central nervous system (CNS) examination. Materials and Methods: An educational intervention was conducted during undergraduate pediatrics clinical postings. The source teaching plan divided the CNS examination into component areas and used small-group learning, a brief self-directed reading period, peer teaching, faculty validation, and bedside demonstration. The accompanying Excel dataset contained 30 3rd-year MBBS students distributed equally across three analyzed topic groups – cranial nerve examination, motor system, and reflexes. Knowledge was assessed using 20-item pre- and post-intervention scores, while confidence was recorded on a five-point scale before and after the session. Descriptive statistics and paired comparisons were performed. Mean change, 95% confidence interval (CI), paired t-test, Wilcoxon signed-rank test, and within-student effect size were calculated. Results: Mean knowledge scores increased from 9.37 ± 1.40 before the intervention to 15.40 ± 1.04 after the intervention, representing a mean absolute gain of 6.03 marks (95% CI 5.39–6.67; P < 0.001). The paired-samples t-test showed a highly significant improvement (t = 19.31, df = 29, P < 0.001), and the Wilcoxon signed-rank test confirmed the same direction of change (P < 0.001). The standardized within-student effect size was large (dz = 3.52). Mean percentage improvement relative to baseline score was 67.9%, while mean normalized gain was approximately 0.56. Confidence increased from 2.40 ± 0.50 to 4.40 ± 0.50 on the five-point scale, a mean increase of 2.00 points (P < 0.001). Similar knowledge gains were observed across the three analyzed topic groups, with no significant difference in gain between topics (one-way analysis of variance, P = 0.958). Conclusion: In this cohort, the RTVD model was associated with substantial improvement in short-term knowledge and self-reported confidence in selected components of pediatric CNS examination. Its educational value appears to arise from the deliberate sequence of preparation, explanation, correction, and clinical demonstration, which increases learner participation while retaining faculty oversight. RTVD is simple, low-cost, and potentially adaptable to other clinical examination skills. Larger controlled studies with objective bedside performance assessment, retention testing, and longer follow-up are required before definitive conclusions about its comparative effectiveness can be made.

Predictors of Failed Induction of Labor in Term Pregnancies: A Prospective Observational Study

2026-10-03T16:21:07+00:00

Background: Induction of labor (IOL) is a commonly performed obstetric intervention when continuation of pregnancy poses greater maternal or fetal risk than delivery. However, induction does not always result in successful vaginal delivery, and failed induction may contribute to increased operative delivery. Identification of factors associated with failed induction can facilitate appropriate counseling and individualized management. Objective: The objective of the study was to identify predictors of failed IOL among women with term pregnancies and evaluate their association with maternal and neonatal outcomes. Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology at a tertiary care teaching hospital. Sixty women with singleton term pregnancies (37+0–41+6 weeks) undergoing IOL were consecutively enrolled after informed consent. Maternal characteristics, parity, body mass index (BMI), gestational age, indication for induction, estimated fetal weight and pre-induction Bishop score were recorded. Details of induction methods and intrapartum outcomes were documented prospectively. The primary outcome was failed IOL, defined according to the study protocol as failure to achieve successful labor and vaginal delivery despite adequate cervical ripening and an adequate trial of induction. Associations between potential predictors and induction outcome were assessed using appropriate statistical tests, with P < 0.05 considered statistically significant. Results: Successful induction occurred in 48 (80.0%) women, while 12 (20.0%) experienced failed induction. Failure was more frequent among primigravidas than multigravidas (29.4% vs. 7.7%) and increased with maternal BMI, from 8.0% in women with BMI <25 kg/m2–45.5% in those with BMI ≥30 kg/m2. Women with gestational age >40 weeks and estimated fetal weight >3.5 kg also had higher failure proportions. Bishop score showed the strongest association with outcome (P < 0.001); failure occurred in 50.0% of women with Bishop score ≤3 compared with none among women with score ≥8. Conclusion: An unfavorable Bishop score was the strongest factor associated with failed induction. Primiparity, higher BMI, advanced gestation and higher estimated fetal weight also showed an association with induction failure. Comprehensive pre-induction assessment may improve counseling and clinical decision-making.

Hepatitis B Vaccination Coverage and Factors Associated with Incomplete Vaccination among Healthcare Workers

2026-10-03T16:27:40+00:00

Background: Hepatitis B virus infection remains an important occupational health concern among healthcare workers (HCWs) due to their potential exposure to infected blood, body fluids, and contaminated sharps. Vaccination is an effective strategy for preventing occupational hepatitis B infection. However, incomplete vaccination may leave HCWs inadequately protected. This study assessed hepatitis B vaccination coverage and factors associated with incomplete vaccination among HCWs in a tertiary care hospital. Methods: A hospital-based cross-sectional study was conducted among 300 HCWs. Data were collected using a pretested structured questionnaire covering sociodemographic characteristics, occupational exposure, hepatitis B vaccination status, number of vaccine doses received, knowledge regarding hepatitis B vaccination, and reasons for incomplete or non-vaccination. Complete vaccination was defined as receipt of three doses of hepatitis B vaccine. Data were analyzed using descriptive statistics, Chi-square test and Fisher’s exact test, as appropriate. P < 0.05 was considered statistically significant. Results: Of the 300 HCWs, 264 (88.0%) had received at least one dose of hepatitis B vaccine, while 226 (75.3%) had completed the three-dose schedule. Overall, 74 (24.7%) participants had incomplete or no vaccination. Good knowledge regarding hepatitis B vaccination was observed among 174 (58.0%) participants. Incomplete vaccination was significantly associated with younger age (P = 0.041), professional category (P < 0.001), shorter duration of service (P = 0.002), and knowledge level (P < 0.001). The most common reasons for incomplete or non-vaccination were forgetting subsequent doses (29.7%), lack of time due to work commitments (24.3%), and inadequate awareness regarding the requirement for all three doses (16.2%). Conclusion: Although hepatitis B vaccination uptake was relatively high, completion of the recommended vaccination schedule remained suboptimal. Institutional vaccination programs, timely reminders, proper documentation, and targeted educational interventions may help improve completion of hepatitis B vaccination among HCWs.

Changing Spectrum of Dermatophytes and their Association with Clinical Patterns in a Tertiary Care Centre

2026-10-06T04:06:33+00:00

Background: Dermatophytosis is a common superficial fungal infection with considerable variation in its clinical presentation and etiological profile. Recent studies from India have reported changes in the distribution of dermatophyte species, particularly an increasing contribution of the Trichophyton mentagrophytes complex and emergence of Trichophyton indotineae. The present study evaluated the contemporary dermatophyte spectrum and its relationship with clinical patterns in a tertiary care setting. Methods: A prospective observational study was conducted among 280 patients with clinically suspected dermatophytosis attending a tertiary care center. Demographic and clinical characteristics, including age, sex, duration of disease, recurrence, previous antifungal treatment, anatomical site and clinical pattern, were recorded. Skin scrapings, nail clippings or hair samples were collected as appropriate. Direct microscopy using 10% potassium hydroxide preparation and fungal culture were performed, followed by identification of dermatophyte species using standard mycological methods. The distribution of species across clinical patterns and anatomical sites was analyzed. Associations were assessed using the Chi-square test, with P < 0.05 considered statistically significant. Results: The majority of patients were aged 21–30 years (32.5%), and males constituted 58.6% of the study population. Tinea corporis was the commonest clinical pattern (29.3%), followed by tinea cruris (19.6%) and combined tinea corporis with cruris (16.8%). The T. mentagrophytes complex was the predominant dermatophyte (37.1%), followed by Trichophyton rubrum (25.4%) and T. indotineae (15.0%). Dermatophyte distribution differed significantly across clinical patterns (χ2 = 25.84, P = 0.016). Conclusion: The study demonstrates a changing dermatophyte spectrum characterized by predominance of the T. mentagrophytes complex, continued representation of T. rubrum and notable occurrence of T. indotineae. The significant variation of species across clinical patterns supports the importance of clinicomycological correlation and continued local surveillance of dermatophytosis.

Sudden Sensorineural Hearing Loss: Clinical Profile and Hearing Outcomes Following an Office-Based Treatment Protocol – A Retrospective Study

2026-10-06T16:13:03+00:00

Background: Sudden sensorineural hearing loss (SSNHL) is an otological emergency in which early recognition, audiological confirmation, and timely treatment are considered important for hearing recovery. Management in routine office-based practice may require a systematic approach incorporating early audiological assessment, identification of potentially contributory factors, and corticosteroid-based treatment. Objective: The aim of the study was to describe the clinical characteristics, evaluation, management, and short-term hearing outcomes of patients with SSNHL managed using a systematic office-based treatment protocol. Methods: This retrospective observational study included patients presenting with SSNHL to an office-based ENT practice between June 2019 and January 2023. Demographic characteristics, presenting symptoms, potential etiological or contributory factors, comorbidities, audiological findings, investigations, and treatment were reviewed. Pure-tone audiometry was performed before treatment and during follow-up. The primary outcome was change in pure-tone hearing threshold following treatment. Results: Thirty patients were included, comprising 18 males and 12 females. Tinnitus was present in 40% of patients and giddiness in 15%. The majority of cases were classified as idiopathic, with idiopathic SSNHL associated with comorbidities accounting for an additional proportion. Comorbid conditions included hypertension, Type 2 diabetes mellitus, dyslipidemia, thyroid disorders and cardiac disease. The mean pretreatment pure-tone hearing threshold was 60.50 ± 20.74 dB HL, which decreased to 21.67 ± 8.77 dB HL following treatment. The difference between pretreatment and post-treatment thresholds was statistically significant (P < 0.001). Conclusion: In this retrospective cohort from an office-based ENT practice, a systematic approach incorporating early audiological assessment and corticosteroid-based management was associated with significant short-term improvement in hearing thresholds. These findings support the importance of prompt evaluation and structured management of SSNHL. Larger prospective studies with standardized treatment protocols, longer follow-up, and appropriate comparator groups are required to determine the independent contribution of individual treatment components to hearing recovery.