Asian Pacific Journal of Health Sciences

A Case Report of Eccrine Porocarcinoma on the Scalp

2026-08-19T04:47:19+00:00

Eccrine porocarcinoma (EPC) is an exceptionally rare malignant adnexal neoplasm originating from the intraepidermal eccrine sweat duct, constituting < 0.01% of all cutaneous tumors. Its non-specific clinical presentation frequently results in misdiagnosis, and histopathological evaluation remains the diagnostic cornerstone. A 72-year-old female, who presented with a progressively enlarging, ulcerated mass on the left temporal region of the scalp. The lesion was surgically excised. Gross examination revealed a gray-brown nodular ulcerated mass with attached hair, measuring 3.5 × 2.5 × 2 cm, with solid gray-white areas and focal hemorrhage on the cut section. Microscopy demonstrated an intradermal malignant neoplasm maintaining continuity with the overlying epidermis, composed of nests, strands, and lobules of markedly pleomorphic poroid cells. The cells exhibited high nuclear-to-cytoplasmic ratios, hyperchromatic irregular nuclei, prominent nucleoli, focal clear cell change, nuclear grooving, increased mitotic activity (1–2/high-power field) including atypical mitoses, and a surrounding lymphoplasmacytic stromal infiltrate. These findings were diagnostic of EPC. Although the lower extremity is the most common site, EPC should be considered in the differential diagnosis of chronic ulcerated scalp lesions in the elderly. Complete surgical excision with tumor-free margins is essential to mitigate the risk of local recurrence and metastasis.

Comparative Diagnostic Accuracy of Ultrasonography and Magnetic Resonance Imaging in Placenta Accreta Spectrum

2026-08-19T04:53:30+00:00

Introduction: Placenta accreta spectrum (PAS) is a serious obstetric condition associated with significant maternal morbidity and mortality, particularly in resource-limited settings such as India. Early and accurate antenatal diagnosis is crucial for optimal management and significant reduction of obstetric complications. Aim: The aim of the study was to compare the diagnostic accuracy of ultrasonography (USG) and magnetic resonance imaging (MRI) in detecting PAS using histopathology as the gold standard. Materials and Methods: This prospective observational study included 30 pregnant women with suspected PAS. All patients underwent USG followed by MRI, and findings were correlated with histopathological examination results. Diagnostic performance parameters were calculated. Results: Out of 30 patients, PAS was confirmed in 26 cases. USG demonstrated a sensitivity of 73.08% and specificity of 25%, with an overall diagnostic accuracy of 66.67%. MRI showed higher sensitivity (92.31%) and specificity (75%), with superior diagnostic accuracy of 90%. MRI also showed better delineation of placental invasion, particularly in cases with posterior placenta and inconclusive USG findings. Conclusion: MRI demonstrates superior diagnostic performance compared to USG in the evaluation of PAS. While USG remains an effective first-line screening tool in resource limited setting such as India, MRI serves as a valuable adjunct in high-risk or equivocal cases, improving diagnostic confidence and aiding in preoperative planning.

Incidental Stromal Luteoma in a Post-menopausal Female: A Case Report

2026-08-19T05:01:41+00:00

Stromal luteomas are rare ovarian tumors occurring mostly in post-menopausal women. They are often associated with endocrine symptoms and signs of virilization. Post-menopausal bleeding related to hyperestrinism is observed frequently with fewer androgenic manifestations. We present a case report of a 68-year-old female who presented with post-menopausal bleeding. The presence of stromal luteoma of the ovary was diagnosed on histopathology.

Association between Skeletal Muscle Mass and Blood Pressure among Healthy Young Adults: A Cross-Sectional Study

2026-08-19T05:10:41+00:00

Background: Skeletal muscle is the largest metabolically active tissue in the human body and plays an important role in cardiovascular and metabolic regulation. Although obesity is a well-established risk factor for hypertension, the relationship between skeletal muscle mass (SMM) and blood pressure in healthy young adults remains inadequately explored. Objectives: The objective of the study was to evaluate the association between SMM and blood pressure among healthy young adults. Materials and Methods: A cross-sectional observational study was conducted among 200 healthy medical students aged 18–25 years. SMM was measured using Bioelectrical Impedance Analysis. Blood pressure was recorded using a standardized automated sphygmomanometer following American Heart Association recommendations. Pearson’s correlation coefficient was used to assess the association between SMM and blood pressure parameters. Multiple linear regression analysis was performed to identify independent predictors of systolic and diastolic blood pressure (DBP) after adjusting for age, sex, height, and body mass index (BMI). A two-tailed P < 0.05 was considered statistically significant. Results: The mean SMM was 28.9 ± 5.8 kg. The mean systolic and DBP were 116.8 ± 10.4 mmHg and 74.2 ± 7.8 mmHg, respectively. SMM showed significant positive correlations with systolic blood pressure (SBP) (r = 0.32, P < 0.001), DBP (r = 0.28, P < 0.001), and mean arterial pressure (r = 0.30, P < 0.001), while no significant correlation was observed with pulse pressure (r = 0.09, P = 0.198). Multiple linear regression analysis demonstrated that SMM was an independent predictor of SBP (β = 0.23, P = 0.009) and DBP (β = 0.20, P = 0.014) after adjusting for age, sex, height, and BMI. Conclusion: SMM is significantly associated with systolic and DBP among healthy young adults. Assessment of SMM may complement conventional anthropometric measures in evaluating cardiovascular health and blood pressure.

Morphometric Evaluation of the Indian Goat Mandible for Biomechanical and Dental Implant Research

2026-08-19T06:56:32+00:00

Background: Biomechanical testing of maxillofacial fracture fixation hardware, as well as the placement of dental implants for practice, requires a suitable bone medium that may mimic human bone. Indian goat may be an appropriate candidate for the same due to its availability. However, clearly, a research gap exists in identifying a suitable region in the goat mandible for biomechanical and dental implants research. This study evaluated the morphometric characteristics of the Indian goat mandible and identified anatomically suitable sites for these experimental studies. Materials and Methods: A descriptive cadaveric cross-sectional study was performed on 30 adult Indian goat mandibles obtained from a slaughterhouse. Various horizontal and vertical morphometric parameters were recorded. Buccolingual thickness of the mandibular body was measured at the anterior, middle, and posterior dentate regions at the alveolar crest and 6 mm and 12 mm below the crest. Results: The mean mandibular length was 147.09 ± 4.74 mm, and the mean maximum mandibular height was 85.90 ± 23.55 mm. Buccolingual thickness progressively increased from the anterior to the posterior mandible. The posterior dentate region demonstrated the greatest bone width, measuring 8.19 mm at the alveolar crest, 12.12 mm at 6 mm, and 14.65 mm at 12 mm below the alveolar crest. Conclusion: Despite morphological differences from the human mandible, the goat mandible can be a suitable anatomical site for tribological studies. The posterior and middle dentate mandible appear most appropriate for biomechanical studies of fixation devices, practicing osteotomies, and implant placements.

Serum Uric Acid/Creatinine Ratio as a Potential Biomarker for Non-alcoholic Fatty Liver Disease in Type 2 Diabetes

2026-08-19T07:04:14+00:00

Background: One of the predominant diseases among patients suffering from Type 2 diabetes mellitus (T2DM) is non-alcoholic fatty liver disease (NAFLD). Finding reliable biomarkers for predicting NAFLD severity is required for early intervention and prevention of further diseases such as fibrosis, hepatocellular cancer, and liver failure among these patients. The objective of our study was to find out that among T2DM patients can serum uric acid/creatinine ratio (SUA/CR ratio) predict NAFLD severity. Materials and Methods: The sample size of this cross-sectional study was 108 T2DM patients (56 males, 52 females). The participants are further divided into two groups NAFLD Grade 1 and NAFLD grade 2(Confirmed by Ultrasonography). We assessed biochemical parameters such as SUA, Creatinine, SUA/CR ratio (calculated), plasma fasting glucose (FBS), total cholesterol (TC), low density lipoprotein (LDL) cholesterol, high density cholesterol (HDL-C), glycated hemoglobin (HbA1c), Triglyceride (TG), alanine aminotransferase (ALT), and aspartate aminotransferase (AST). SUA/Cr ratio was calculated. Statistical analyses (t-tests, analysis of variance) were performed to identify predictors of NAFLD severity. Results: Grade 1NAFLD patients showed a decreased SUA/CR ratio than Grade 2 NAFLD patients with T2DM. Grade 2 NAFLD group was presented with increased SUA/CR, TGs, TC, and LDL levels and elevated ALT than Grade 1 NAFLD patients, indicating injury to the liver (P = 0.001). FBS, HbA1c, HDL-C cholesterol, and AST are not positively associated with SUA/CR ratio in Grade 1 and Grade 2 NAFLD groups. Conclusion: SUA/CR ratio is a simple and cost-effective marker linked with the severity of NAFLD, dyslipidemia, and elevated ALT among patients suffering with T2DM. SUA/CR might predict the risk of NAFLD and the severity of NAFLD among the T2DM population. In the future, large longitudinal studies should validate these findings.

From Meconium Staining to Respiratory Support: Clinical Spectrum and Early Neonatal Outcomes across Two Referral Centers

2026-08-19T07:09:47+00:00

Background: Meconium-stained amniotic fluid (MSAF) is associated with neonatal respiratory morbidity, including meconium aspiration syndrome (MAS). Objective: The objective of this study was to evaluate the clinical characteristics, spectrum of respiratory support required, and short-term outcomes among neonates born through MSAF in two referral centers. Materials and Methods: This prospective two-center cohort study included 72 neonates born through MSAF. Maternal, obstetric, and neonatal characteristics were recorded. Neonates were assessed for respiratory distress, MAS, need for oxygen, continuous positive airway pressure (CPAP), mechanical ventilation, complications, and in-hospital outcome. Results: MAS developed in 19/72 neonates (26.4%), while respiratory distress occurred in 26/72 (36.1%). Neonates with MAS had significantly lower Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) scores at 1 min (5.40 vs. 7.40) and 5 min (7.50 vs. 8.50; both P = 0.001). Among neonates with respiratory distress, 26.9% settled within 2 h, 30.8% received oxygen by hood, 26.9% required CPAP, and 15.4% required mechanical ventilation. Pneumothorax occurred in 4.2%, while persistent pulmonary hypertension, septicemia, hypoxic-ischemic encephalopathy, and shock each occurred in 2.8%. Two of 19 neonates with MAS died. Conclusion: MAS was common among MSAF-exposed neonates and was associated with lower APGAR scores and substantial respiratory morbidity.

Comparison of Ultrasound-Guided and Landmark-Guided Central Venous Catheterization Success Rate and Complications

2026-08-19T07:14:24+00:00

Background: Central venous catheterization (CVC) is widely used in perioperative and critical care practice but may be associated with multiple attempts and mechanical complications. Ultrasound guidance may improve procedural success and safety compared with the conventional anatomical landmark technique. Objectives: The purpose of this study was to compare ultrasound-guided (USG) and landmark-guided (LMG) internal jugular CVC in terms of first-attempt success, overall success, number of attempts, procedural time, and mechanical complications. Materials and Methods: Patients were allocated equally to an USG group (n = 70) and a LMG group (n = 70). The primary outcome was first-attempt catheterization success. Secondary outcomes included overall success within three attempts, number of puncture attempts, access time, total catheterization time, and procedure-related mechanical complications. Statistical significance was set at P < 0.05. Results: First-attempt success was significantly higher in the USG group than in the LMG group (91.4% vs. 71.4%; P = 0.002). Overall success within three attempts was 98.6% and 91.4%, respectively. Patients in the USG group required fewer puncture attempts (1.11 ± 0.40 vs. 1.43 ± 0.73; P = 0.002). Conclusion: USG internal jugular CVC provides higher first-attempt success, requires fewer attempts, shortens procedural time, and reduces overall mechanical complications compared with the anatomical landmark technique.

Spectrum of Electrolyte Abnormalities and their Association with Mortality and Intensive Care Unit Outcomes in Critically Ill Patients: A Prospective Observational Study

2026-08-19T14:20:22+00:00

Introduction: Electrolyte disturbances are common in critically ill patients and may adversely affect cardiac conduction, neuromuscular function, and acid–base balance. These abnormalities may reflect disease severity and are associated with poor intensive care unit (ICU) outcome and increased mortality. This study aimed to determine the spectrum of electrolyte imbalances among critically ill patients and assess their association with mortality. Methodology: After obtaining approval from the Institutional Ethics Committee, a hospital-based, prospective study was carried out in the Department of Respiratory Medicine, Gouri Devi Institute of Medical Sciences and Hospital over a period of 3 months, including 123 adult ICU patients. Serum sodium and potassium levels obtained within the first 24 h were measured by the ion-selective electrode method, and clinical outcomes were recorded using a structured case record form. Results: A total of 123 critically ill patients were included. Hyponatremia was the most common electrolyte abnormality (29.3%), followed by hypokalemia (12.2%), hypernatremia (10.6%), and hyperkalemia (9.8%). Overall ICU mortality was 33.3% (41/123) and was higher among patients with electrolyte abnormalities than those with normal electrolyte levels, with the highest mortality observed in hypernatremia (46.2%) and hypokalemia (53.3%). Conclusion: Electrolyte imbalances are common in critically ill ICU patients, and routine monitoring and appropriate management of electrolyte abnormalities are important.

Diverse Presentations of Appendicitis: A Clinical Perspective

2026-08-25T12:32:53+00:00

Background: Acute appendicitis is among the most frequent surgical emergencies encountered worldwide and remains a predominantly clinical diagnosis supported by laboratory and imaging findings. Although the classical presentation of migratory right iliac fossa pain with anorexia, nausea, and localized tenderness is well recognized, a considerable proportion of patients present atypically. Variations in appendicular position, extremes of age, and underlying neoplastic disease of the appendix may all alter the clinical picture and delay definitive management. Case Series: We report three patients managed at a tertiary care teaching hospital who illustrate the breadth of this spectrum. The first, a 51-year-old male with a short history of right lower quadrant pain, was found on ultrasonography to have an appendicular mucocele; histopathology after laparoscopic appendectomy revealed a low-grade appendiceal mucinous neoplasm, and he underwent completion right hemicolectomy. The second, a 13-year-old girl, presented with generalized peritonitis secondary to a perforated appendix with an appendicolith and required emergency exploratory laparotomy with appendectomy. The third, a 54-year-old male, presented with lower abdominal pain radiating to the back accompanied by loose stools, mimicking a colonic or urological cause, and was managed by emergency open appendectomy. Conclusion: These cases demonstrate that appendicitis may present as uncomplicated inflammation, as established perforation with peritonitis, or as an incidentally detected neoplastic lesion. A structured approach combining careful history, clinical examination, appropriate imaging, and mandatory histopathological examination of every appendectomy specimen is essential to avoid missed diagnoses and to guide further management.

Cardiovascular Profile of Patients with Chronic Kidney Disease: A Cross-Sectional Study

2026-08-25T12:38:45+00:00

Background: Chronic kidney disease (CKD) carries a high risk of cardiovascular disease, the leading cause of mortality in these patients. Early detection improves risk stratification and clinical outcomes. Objectives: This study aimed to assess the cardiovascular profile, electrocardiography (ECG), echocardiographic, and carotid Doppler findings in CKD patients, evaluate associated risk factors, and determine the association between CKD stages and cardiovascular abnormalities. Materials and Methods: A hospital-based cross-sectional study of 320 CKD patients was conducted at ESIC Medical College and Hospital and Super Specialty Hospital, Hyderabad, from October 2024 to March 2026. Participants diagnosed with CKD using the Kidney Disease: Improving Global Outcomes 2012 guidelines were enrolled via consecutive sampling. Clinical evaluation, laboratory tests, ECG, 2D echocardiography, and carotid Doppler ultrasound were performed. Data analysis utilized IBM Statistical Package for the Social Sciences version 23, with P < 0.05 considered statistically significant. Results: The mean age was 55.4 ± 20.2 years, with 52.5% males. Stage 3 CKD was most prevalent (47.2%). ECG abnormalities occurred in 63.7% of patients, whereas echocardiographic and carotid Doppler abnormalities were present in 73.8% each. Left ventricular hypertrophy, reduced ejection fraction, carotid plaques, and carotid stenosis predominated. Significant associations were found between advanced CKD stages and ECG abnormalities (P < 0.001), echocardiographic abnormalities (P = 0.001), and carotid Doppler abnormalities (P = 0.016). Conclusion: Cardiovascular abnormalities are highly prevalent in CKD patients and increase significantly with advancing disease stages. Routine screening via ECG, echocardiography, and carotid Doppler enables early detection, precise risk stratification, and timely interventions to mitigate severe complications.

Fibrous Dysplasia Involving Mandible and Maxilla: A Case Report

2026-08-26T01:04:02+00:00

Fibrous dysplasia (FD) is a benign fibro-osseous lesion in which normal bone is replaced by fibrous connective tissue and irregular trabeculae of immature bone. This report presents a case of an 18-year-old male with an extensive hard bony swelling involving the left mandibular and maxillary regions, resulting in marked facial asymmetry. The swelling extended from the parasymphysis region of the mandible to the neck of the condyle posteriorly and superiorly involved the maxillary zygomatic region. Surgical management was performed using an extraoral approach for the mandible and an intraoral vestibular approach for the maxilla, with bone contouring and saucerization. Post-operative healing was uneventful, and the patient showed significant improvement in facial symmetry. This case highlights the importance of early diagnosis and conservative surgical management in craniofacial FD to achieve favorable esthetic and functional outcomes.

Impact of Consanguineous Marriage on Hearing Loss and Subsequent Speech and Language Delay in Under-Five Children: A Focused Case–Control Analysis

2026-08-26T16:08:32+00:00

Background: Parental consanguinity remains prevalent in South India due to socio-cultural practices. Although its association with congenital anomalies is established, its quantitative relationship with childhood hearing impairment and subsequent speech and language delay (SLD) requires regional evaluation. Objectives: The objective of the study was to quantify the association between parental consanguinity, hearing loss, and developmental speech/language delay among children under 5 years. Materials and Methods: A hospital-based case–control study was conducted in the Pediatric outpatient department in collaboration with ENT at Aarupadai Veedu Medical College and Hospital, Puducherry. Forty age- and gender-matched children were enrolled: 20 with parental consanguinity (Cases) and 20 without (Controls). Language development was assessed using the Language Evaluation Scale Trivandrum for children aged 1–3 years and the Trivandrum Developmental Screening Chart for those aged 3–5 years. Objective hearing assessment included Otoacoustic Emissions and Brainstem Auditory Evoked Responses. Results: SLD was identified in 14 (70.0%) Cases compared with 4 (20.0%) Controls (odds ratio [OR] 9.33, 95% confidence interval [CI]: 2.11–41.22; P = 0.0016). Hearing impairment was detected in 10 (50.0%) Cases versus 2 (10.0%) Controls (OR 9.00, 95% CI: 1.54–52.48; P = 0.0064). Expressive language delay was the predominant phenotype. Conclusion: Parental consanguinity was strongly associated with childhood hearing impairment and speech/language delay. These findings support integrating neonatal hearing screening and early language surveillance into primary healthcare, particularly in populations with prevalent consanguineous marriage practices.

Pre-operative Ultrasound Assessment of Gastric Contents in Diabetic and Non-diabetic Patients Undergoing Elective Surgery: A Cross-sectional Analytical Study

2026-08-26T16:12:37+00:00

Background: Pulmonary aspiration remains a potentially catastrophic perioperative complication. Although current fasting guidelines reduce aspiration risk in most patients, delayed gastric emptying is frequently encountered in patients with diabetes mellitus because of autonomic neuropathy and diabetic gastroparesis. Consequently, standard fasting periods may not reliably ensure an empty stomach in diabetic patients. Point-of-care gastric ultrasonography has emerged as a rapid, non-invasive bedside tool for qualitative and quantitative assessment of gastric contents and may facilitate individualized anesthetic planning. Objectives: The objective of the study was to compare pre-operative gastric antral cross-sectional area (CSA), estimated gastric volume, qualitative gastric contents, and aspiration risk between diabetic and non-diabetic patients undergoing elective surgery using bedside gastric ultrasonography. Materials and Methods: A hospital-based cross-sectional analytical study was conducted in 100 adult patients scheduled for elective surgery. Fifty diabetic patients (Group D) and 15 non-diabetic patients (Group ND) who complied with standard fasting guidelines underwent pre-operative gastric ultrasonography using a 3–5 MHz curvilinear probe. Gastric antral CSA was measured in both the supine and right lateral decubitus (RLD) positions. Estimated gastric volume was calculated using the validated Perlas formula. Gastric contents were graded qualitatively according to the Perlas grading system, and aspiration risk was categorized accordingly. Statistical analysis was performed using Student’s t-test and Chi-square test, with P < 0.05 considered statistically significant. Results: Diabetic patients demonstrated significantly larger gastric antral CSA in both the supine (5.88 ± 0.53 cm2 vs. 3.25 ± 0.34 cm2; P < 0.001) and RLD positions (7.32 ± 0.87 cm2 vs. 3.78 ± 0.42 cm2; P < 0.001). Estimated gastric volume was significantly greater in diabetic patients than non-diabetic patients (58.69 ± 17.63 mL vs. 25.28 ± 16.85 mL; P < 0.001). Grade 2 stomachs were identified exclusively among diabetic patients (12%), whereas none of the non-diabetic patients demonstrated high-risk gastric contents. High aspiration risk was observed in 12% of diabetic patients compared with 0% of non-diabetic patients (P = 0.012). Conclusion: Despite adherence to standard fasting guidelines, diabetic patients exhibited significantly greater residual gastric volume and a higher prevalence of high-risk gastric contents than non-diabetic patients. Bedside gastric ultrasonography provides a valuable individualized assessment of gastric contents and may improve perioperative risk stratification and anesthetic decision-making in diabetic patients.

Acute Mesenteric Ischemia and Ischemic Bowel Complications in Patients with COVID-19: A Six-Case Series

2026-08-27T04:25:35+00:00

Background: Coronavirus disease 2019 (COVID-19) is associated with systemic inflammation, endothelial dysfunction, and thromboembolic complications. Acute mesenteric ischemia is an uncommon but life-threatening abdominal manifestation that may rapidly progress to bowel infarction, gangrene, or perforation. Materials and Methods: We describe six reverse transcription-polymerase chain reaction-confirmed COVID-19 patients who developed acute mesenteric ischemia or related ischemic bowel complications during the first pandemic wave between March and October 2020. Clinical presentation, laboratory findings, chest and abdominal computed tomography (CT) findings, operative details, histopathology, anticoagulation, and short-term outcomes were reviewed. Results: The patients included three men and three women aged 50–73 years. All had acute abdominal symptoms and were subjected to emergency laparotomy and bowel resection. Three patients had superior mesenteric artery thrombosis, one of whom had splenic artery thrombosis and another had portal venous gas. One patient developed sigmoid-colon ischemia with suspected partial inferior mesenteric artery thrombosis, one had probable non-occlusive mesenteric ischemia, and one developed ischemic ileal perforation without major-vessel thrombosis. Four patients had pneumatosis intestinalis or coli. All six cases had transmural ischemic necrosis with fibrin thrombi in intraluminal or submucosal vessels on histopathological examination. Five patients received unfractionated heparin, and one patient with probable non-occlusive mesenteric ischemia did not receive anticoagulation. The early postoperative mortality rate was 66.7% (4 patients). At 3-month follow-up, the two survivors were asymptomatic. Conclusion: Intestinal ischemia associated with COVID-19 can be caused by large-vessel arterial thrombosis, non-occlusive ischemia, or microvascular thrombosis and can manifest as bowel gangrene or perforation. In patients with COVID-19, persistent or severe abdominal symptoms should be evaluated promptly with contrast-enhanced CT and early surgical evaluation. Even with emergency intervention, mortality is high after the development of transmural bowel necrosis.

Comparative Evaluation of Clinical Scoring Systems and Development of a Combined Predictor Score for Acute Appendicitis

2026-08-28T08:11:04+00:00

Background: Acute appendicitis remains a common surgical emergency in which variable clinical presentations can result in diagnostic uncertainty and negative appendectomy. Clinical scoring systems provide structured assessment, but their performance may vary between populations. This study compared six established scoring systems and evaluated a newly formulated combined predictor score in a secondary-care hospital population. Materials and Methods: This cross-sectional observational study included 100 patients older than 12 years presenting with suspected acute appendicitis and scheduled for appendectomy at Victoria Hospital attached to BMC-RI Bengaluru between July 2025 and July 2026. Clinical, laboratory, operative and histopathological data were collected. Alvarado, Modified Alvarado Scoring System, Teicher, Fenyo, Ohmann and RIPASA scores were calculated for each patient. Candidate predictors were assessed using sensitivity, specificity, risk ratio, Yates-corrected Chi-square and P-values. A16-item combined predictor score was formulated by assigning one point to each significant predictor. Diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and receiver operating characteristic (ROC) area under the curve (AUC). Results: Sixty-seven patients had acute appendicitis and 33 had a normal appendix. RIPASA and Teicher had the highest sensitivity (97.56% each); Fenyo had the highest specificity (97.78%) and PPV (98.04%); Ohmann had the highest diagnostic accuracy among the established scores (93.70%). The new combined predictor score achieved 95.12% sensitivity, 95.56% specificity, 97.50% PPV, 91.49% NPV, and 95.28% diagnostic accuracy at a cutoff of 10, with ROC AUC 0.99. Serum bilirubin was not significantly associated with appendicular perforation (Yates-corrected c²=0.01788; P = 0.893659). Conclusion: Diagnostic performance varied substantially across scoring systems. In this study population, the new combined predictor score demonstrated the highest overall diagnostic accuracy and a high ROC AUC. Its simple dichotomous structure may be useful in secondary-care settings, although prospective validation in larger and more diverse populations is required before routine clinical adoption.

Poor Sleep Quality and Associated Factors among Healthcare Workers in a Tertiary Care Hospital in North Kerala: A Cross-sectional Study

2026-08-28T08:20:56+00:00

Background and Objectives: Sleep is a vital determinant of physical and mental well-being, particularly among healthcare workers who are exposed to demanding work schedules, shift duties, and occupational stress. Poor sleep quality adversely affects health, job performance, and patient safety. The present study aimed to estimate the prevalence of poor sleep quality and identify its associated factors among healthcare workers in a tertiary care hospital in Wayanad, Kerala. Methodology: A hospital-based cross-sectional study was conducted among 204 healthcare workers employed at a tertiary care teaching hospital in Wayanad, Kerala. Participants were selected using stratified random sampling. Data were collected using a structured questionnaire comprising sociodemographic details, occupational characteristics, lifestyle factors, and the Pittsburgh Sleep Quality Index (PSQI). A global PSQI score >5 was considered indicative of poor sleep quality. Data were analysed using appropriate jamovi 2.3.28.0. Associations between sleep quality and independent variables were assessed using the Chi-square test and multivariable logistic regression. A P < 0.05 was considered statistically significant. Results: A total of 204 healthcare workers were included in the study, with females constituting 57.4% of the participants. The prevalence of poor sleep quality was 48.5%. Poor sleep quality was significantly associated with smartphone use after 9 PM, working more than 10 h/day, hypertension, and high caffeine consumption (P < 0.05). On multivariable logistic regression, smartphone use after 9 PM (adjusted odds ratio [AOR] 2.31, 95% confidence interval [CI] 1.29–4.12) and hypertension (AOR 1.94, 95% CI 1.05–3.60) remained independent predictors of poor sleep quality. Conclusion: Poor sleep quality affected a substantial proportion of healthcare workers, underscoring its importance as an occupational health issue. Alcohol consumption emerged as the only significant correlate of poor sleep quality, suggesting that behavioral factors may have a greater influence than demographic or workplace characteristics in this setting. Incorporating sleep health assessment into occupational health programs and promoting healthy lifestyle practices may improve healthcare workers’ well-being and work performance.

Antimicrobial Resistance Pattern and Clinical Spectrum of Blood Culture-Proven Typhoid Fever in Children

2026-08-28T09:33:23+00:00

Background: Enteric fever remains a major cause of morbidity in children in endemic, resource-limited settings, and emerging antimicrobial resistance (AMR) threatens effective treatment. This study describes the clinical spectrum and AMR pattern of blood culture-proven typhoid fever in children at a tertiary care center. Materials and Methods: This retrospective observational study included culture-positive typhoid cases admitted to the pediatrics department of a tertiary care center from January 2023 to 2025. Demographic, clinical, and laboratory data were obtained from hospital records, and case definitions and treatment protocols followed the Indian Academy of Pediatrics protocol. Statistical analysis was performed using the Statistical Package for the Social Sciences version 20. Results: Of 64 blood culture-proven cases, 90.6% were due to Salmonella. Typhi and 9.4% to S. Paratyphi, with equal sex distribution and 40% of cases in children under 5 years. Fever was the most common presentation (95%), followed by vomiting (56%), abdominal pain (46%), diarrhea (19%), cough (17%), convulsions (6.5%), and respiratory distress (3.5%). The Widal test was positive in 35.4% of cases. Complications occurred in 17.1% of children, most commonly hepatitis (6.4%) and shock (4.6%). Resistance was observed too floxacin (25.4%), ampicillin (4.7%), co-trimoxazole (3.17%), ceftriaxone (3.17%), and azithromycin (1.8%); multidrug-resistant strains were seen in 3.1% and extensively drug-resistant strains in 1.56% of cases. Conclusion: Typhoid fever continues to cause significant morbidity in children, with high ofloxacin resistance but a notable decline in resistance to first-line drugs, raising the possibility of their future reuse. Continued antimicrobial surveillance is warranted to guide empirical treatment and detect emerging resistant strains.

Suzetrigine: A First-in-Class NaV1.8 Inhibitor – Mechanism and Clinical Trial Evidence for Acute Pain

2026-08-28T09:39:50+00:00

Pain management remains challenging due to opioid limitations and adverse effects. Suzetrigine is a novel, selective NaV1.8 sodium channel inhibitor developed as a non-opioid alternative for moderate-to-severe acute pain. This narrative review summarizes evidence on its mechanism of action, pharmacokinetics, clinical efficacy, safety profile, and regulatory status. Literature through March 2026 was reviewed from PubMed, Scopus, Google Scholar, and ClinicalTrials.gov. Clinical studies demonstrate Suzetrigine provides significant analgesic efficacy in acute post-operative pain with favorable tolerability. Common adverse effects – nausea, headache, constipation, and pruritus – were generally mild-to-moderate. However, benefit in chronic neuropathic pain appears limited. Suzetrigine received U.S. Food and Drug Administration approval in 2025 as the first oral selective NaV1.8 inhibitor for acute pain management, representing an important advancement in non-opioid analgesic therapy and a potential strategy to reduce opioid dependence.