Medical Science: Updates and Prospects Vol. 11

Scrub Typhus Mimicking Acute Abdomen with Concurrent Myocarditis and Acute Kidney Injury: A Case Report

Vyas Kumar Rathaur — 2026-07-01

Background: Scrub typhus is a multisystem infection that may mimic surgical and infectious conditions, delaying recognition and treatment. Severe complications include acute respiratory distress syndrome, myocarditis, acute kidney injury, hepatic dysfunction, meningoencephalitis and rhabdomyolysis, particularly during the second week of untreated illness.

Case Presentation: We report a 14-year-old girl who presented with one week of abdominal pain, vomiting and loose stools, with marked epigastric and right hypochondrial guarding. Initial assessment considered common surgical causes; however, investigations demonstrated leucocytosis with thrombocytopenia, hyperbilirubinaemia, transaminitis, renal impairment and elevated D-dimer. Imaging showed gall bladder wall thickening, enlarged lymph nodes, caecal thickening and bilateral pulmonary opacities. Scrub typhus was suspected because of fever, thrombocytopenia and splenomegaly and was confirmed by positive immunoglobulin M serology.

Discussion: During admission, the patient developed shock requiring dopamine and noradrenaline, followed by progressive respiratory failure requiring invasive ventilation. Echocardiography showed left ventricular dysfunction with an ejection fraction of 40%. She also developed worsening acute kidney injury, metabolic acidosis, hyperkalaemia and disseminated intravascular coagulation requiring blood products. Despite antimicrobial escalation and intensive organ support, she developed sudden ventricular tachycardia and died after 24 hours of invasive ventilation.

Conclusion: This case highlights the need to consider scrub typhus in endemic settings when acute abdomen is accompanied by thrombocytopenia and early organ dysfunction.

Normal and Varied Anatomy of Spinal Accessory Nerve and its Clinical Implications

Rajani Singh — 2026-07-01

There are twelve cranial nerves, and the spinal accessory nerve is the XI cranial nerve, innervating the sternocleidomastoid and trapezius muscles. The nerve under study arises from a nucleus in the spinal cord and emerges as a variable number of twigs attached to the spinal cord; later, it fuses with the cranial root, which originates in the medulla. It enters the cranial cavity through the foramen magnum and exits through the jugular foramen. Outside the cranial cavity, this nerve passes superficial to the jugular vein. In the posterior triangle, it makes several connections and terminates in the trapezius muscle. The inclusion of this nerve among the cranial nerves is controversial, as it is often subject to non-union with the cranial twig. Moreover, the nerve under consideration varies anatomically, and lack of awareness of this variation may place neurosurgeons in difficulty when planning the diagnosis and management of medical conditions related to this nerve. In this chapter, the normal and varied anatomy of this nerve is highlighted, and its associated implications are discussed to help clinicians treat related medical conditions with minimal risk. The aim of the study is to underscore the importance of the spinal accessory nerve, and this information will be useful for neurosurgeons, anatomists, otolaryngologists and clinicians involved in head and neck interventions in related areas with fewer complications.

The literature was scrutinised using different online databases, such as ResearchGate, SciELO, MEDLINE, PubMed, PubMed Central and Google Scholar. The results of the literature search were interpreted, analysed and discussed.

The literature survey revealed that the SpA travelled superficial to the internal jugular vein in most cases (about eighty-seven percent), whereas in the remaining eleven percent of specimens, the spinal accessory nerve was detected deep to the internal jugular vein. Some authors and investigators observed this nerve passing superficial to the internal jugular vein in 51.4% of individuals. The aforementioned studies emphasised that clinicians should be cautious while performing surgery in the region of the jugular foramen.

Epidemiology and Outcomes of Treatments of Oesophageal Cancers in East Africa: A Review

R. Wismayer — 2026-07-01

Oesophageal squamous cell carcinoma (ESCC) represents a major source of cancer-related morbidity and mortality in Eastern Africa. The vast majority of regional patients present with advanced-stage disease at diagnosis. Current palliative strategies in the region include chemotherapy, radiation therapy (with or without concurrent chemotherapy), and self-expandable metallic oesophageal stents. However, the comparative effectiveness of these modalities within a low-resource framework has yet to be evaluated. This narrative literature review highlights the increasing burden of oesophageal carcinoma and the risk factors responsible for the histological differences observed in this part of the world. The benefits associated with different treatments in East Africa are also outlined. Oesophageal cancer (OC) varies geographically; over 80% of global cases and deaths occur in developing countries. The oesophageal cancer burden in four urban Eastern African registries (2004–2008) was evaluated to characterise this high-incidence region. The cohorts included: Blantyre, Malawi (351 males [59%], ASR 47.2; 239 females [41%], ASR 30.3); Harare, Zimbabwe (213 males [61%], ASR 33.4; 134 females [39%], ASR 25.3); Kampala, Uganda (196 males [59%], ASR 36.7; 137 females [41%], ASR 24.8); and Nairobi, Kenya (323 males [57%], ASR 22.6; 239 females [43%], ASR 21.6). Median age at diagnosis ranged from 50 years (Blantyre) to 65 years (Harare). Male incidence significantly exceeded female incidence at all sites except Nairobi. Squamous cell carcinoma predominated universally. Because these regional ASRs substantially exceed global averages, further research into local environmental, dietary, and lifestyle risk factors is critical. This review will also help clinicians in resource-limited settings define optimal management strategies for oesophageal squamous cell carcinoma in East Africa.

Current Concepts in Chyluria: Pathophysiology, Diagnosis and Contemporary Management

Ashutosh Kumar Tiwari — 2026-07-01

Chyluria is an uncommon but clinically significant disorder characterised by the passage of chyle into the urine secondary to abnormal lymphatic-urinary communication. Traditionally associated with lymphatic filariasis in endemic tropical regions, particularly South and Southeast Asia, the spectrum of chyluria has broadened considerably with increasing recognition of non-parasitic causes such as malignancy, trauma, tuberculosis, congenital lymphatic malformations, and iatrogenic lymphatic injury. Although many patients present with intermittent passage of milky urine, severe disease may result in haematochyluria, recurrent clot retention, malnutrition, immunosuppression, and debilitating metabolic derangements. Over recent decades, substantial advances have been made in understanding lymphatic pathophysiology, diagnostic imaging, endourological intervention, and minimally invasive surgical management. Conservative therapy remains the cornerstone for mild disease; however, renal pelvic instillation sclerotherapy has emerged as the principal minimally invasive therapeutic modality for persistent disease. In refractory cases, pyelolymphatic disconnection continues to represent the definitive surgical intervention, with laparoscopic and robotic approaches increasingly replacing traditional open surgery. Emerging strategies, including lymphatic embolisation and lymphaticovenous microsurgical reconstruction, are expanding therapeutic possibilities in selected patients.

This chapter provides a comprehensive review of the epidemiology, aetiopathogenesis, clinical presentation, diagnostic evaluation, and contemporary management of chyluria. Particular emphasis is placed on the comparative analysis of sclerosant agents, technical considerations during intervention, evolving minimally invasive surgical approaches, and long-term outcomes. Current evidence gaps, controversies, and future directions are also discussed.

Biomechanical Regulation of Tumor Progression and Therapeutic Resistance: A Comprehensive Review of Mechanotransduction Pathways and Clinical Implications

Sharmy Saimon Mano — 2026-07-01

Cancer progression is influenced not only by genetic and biochemical changes but also by mechanical interactions within the tumour microenvironment (TME). This review summarises how extracellular matrix stiffness, shear stress, compression, interstitial fluid pressure and tissue tension regulate tumour initiation, epithelial-mesenchymal transition, circulating tumour cell survival, cancer stem cell maintenance and therapeutic resistance. Progressive tumour growth leads to severe complications, including local tissue invasion, disruption of organ function, angiogenesis, immune evasion and metastatic spread to distant organs. These complications substantially increase disease burden, reduce treatment efficacy and contribute to cancer-related morbidity and mortality. Mechanobiology examines how factors such as extracellular matrix (ECM) stiffness, shear stress, compression and tissue tension regulate tumour growth, metastasis and therapeutic resistance. Mechanical forces activate mechanotransduction pathways involving integrins, focal adhesion kinase (FAK), phosphatidylinositol 3-kinase/protein kinase B (PI3K/AKT), mitogen-activated protein kinase (MAPK), and Yes-associated protein (YAP) and transcriptional coactivator with PDZ-binding motif (TAZ) signalling, thereby promoting epithelial-mesenchymal transition (EMT), cancer stemness, invasion and survival. Mechanical abnormalities also impair drug delivery and contribute to resistance to chemotherapy, radiotherapy and immunotherapy. Advanced models, including three-dimensional (3D) cultures, organoids, microfluidics and atomic force microscopy, have improved understanding of cancer mechanobiology and therapeutic targeting.

Advancing Medical Research in Saudi Arabia in Alignment with Vision 2030: Barriers, Progress and Future Directions

Abdulhameed G. Albeshr — 2026-07-01

Background: Medical research is fundamental to evidence-based healthcare and plays a critical role in improving clinical practice, professional development, and health-system performance. Despite substantial investment in healthcare and academic infrastructure, research productivity among healthcare professionals in Saudi Arabia remains variable, with several reported challenges limiting effective research engagement.

Objective: To systematically review and synthesise existing evidence on attitudes, knowledge, research participation, and barriers to conducting and publishing medical research among healthcare professionals in Saudi Arabia.

Methods: A narrative review was conducted using PubMed, Embase, Google Scholar, and the Saudi Digital Library. English-language studies published up to September 2023 that examined research engagement, productivity, attitudes, or barriers among Saudi healthcare professionals or trainees were included. Eligible studies were screened, and relevant data were extracted and narratively synthesised due to methodological heterogeneity.

Results: Most included studies reported positive attitudes toward medical research, with more than 66% of participants acknowledging its importance for professional growth and evidence-based practice. However, actual research participation and publication output were considerably lower, frequently reported in fewer than 30% of respondents. Lack of protected research time and heavy clinical workload were the most common barriers, affecting approximately half to three-quarters of healthcare professionals. Additional obstacles included inadequate training in research methodology and biostatistics, limited mentorship, insufficient institutional support, and complex ethical approval processes. Institutions with structured research training, protected time, and incentive-based promotion policies demonstrated higher research productivity.

Conclusion: Although awareness and positive attitudes toward medical research are widespread among healthcare professionals in Saudi Arabia, significant individual and institutional barriers continue to limit research output. Addressing these challenges through structured education, protected research time, streamlined governance, and incentive-based academic systems is essential to strengthen research capacity and align with Saudi Vision 2030 healthcare objectives.

Decoronation as a Ridge-Preserving Strategy for Ankylosed Permanent Teeth: An Overview of Scientific Reports in Dentistry through the Years

Carlos Roberto Emerenciano Bueno — 2026-07-01

Decoronation is a conservative surgical technique in which the crown of an ankylosed permanent tooth is removed below the level of the cementoenamel junction whilst the root is retained in situ within the alveolar socket. First described in 1984, the procedure was developed as a biologically rational response to the clinical challenge posed by replacement resorption and dentoalveolar ankylosis in growing patients. In the decades following its introduction, decoronation attracted considerable clinical interest, and a growing body of scientific literature has examined its outcomes with increasing rigour. This critical narrative review synthesises the scientific literature on decoronation published between 2000 and 2025, supplemented by the foundational 1984 report, to provide a comprehensive account of the procedure's historical development, biological underpinnings, surgical technique, clinical evidence, evolving indications, post-operative management, and long-term prosthetic sequelae. The literature search was conducted during the period from January 2000 to April 2025. Evidence from systematic reviews, retrospective cohort studies, case series, and case reports consistently demonstrates that decoronation preserves both the buccolingual width and the vertical height of the alveolar ridge in growing individuals, enabling future implant-based rehabilitation under significantly more favourable anatomical conditions than those achievable after conventional extraction. Recent advances, including flapless approaches and expanded application to non-traumatic conditions such as external cervical resorption, have widened the clinical scope of the procedure. The cumulative evidence supports decoronation as the preferred intervention for ankylosed permanent incisors in children and adolescents when performed at the appropriate developmental stage, although the evidence base remains largely observational and heterogeneous in design. Future research should prioritise prospective comparative studies, standardised outcome measures, and refined criteria for timing.

Knowledge, Awareness, and Preventive Practices Regarding Radiation-Induced Caries among Dental Students and Practitioners: A Cross-Sectional Survey

Sarita Gill — 2026-07-01

Background: Radiation-induced caries is a long-term oral complication of head and neck radiotherapy, mainly associated with salivary gland dysfunction, xerostomia, and changes in the oral environment. This study assessed knowledge, awareness, and preventive practices regarding radiation-induced caries among dental students and practitioners.

Materials and Methods: A cross-sectional, questionnaire-based survey was conducted among undergraduate dental students, postgraduate dental students, and general dental practitioners. A 22-item electronic questionnaire structured around Knowledge–Awareness–Practice (KAP) domains was distributed. Twenty-one evaluative items were scored to generate a composite KAP score ranging from 0 to 21, while one behavioural practice item was analysed descriptively. Descriptive statistics were calculated. Differences among professional groups were examined using the Kruskal–Wallis test, and correlations among KAP domains were assessed using Spearman's rank correlation coefficient.

Results: Of 100 responses received, 97 complete responses were included in subgroup analysis. Mean composite KAP scores were 12.53 ± 5.23 for undergraduate students, 12.63 ± 3.35 for postgraduate students, and 13.69 ± 3.16 for general dental practitioners. No statistically significant difference in composite KAP scores was observed among the groups (H = 1.44, p = 0.487). Among undergraduate students, strong positive correlations were observed between Knowledge and Prevention (rs = 0.820) and between Awareness and Prevention (rs = 0.735). Overall, 47.9% (46/96) of participants reported always performing pre-radiotherapy dental caries risk assessment. Respondents most frequently recognised xerostomia and topical fluoride therapy as important factors in prevention.

Conclusion: Dental students and practitioners demonstrated generally satisfactory knowledge and awareness of radiation-induced caries, but inconsistencies remained in the routine application of preventive practices and in selected aspects of clinical management.

Perspectives of Paediatric Healthcare Workers on Nigerian Babywearing Method (Babybacking): A Survey Among Paediatric Healthcare Professionals in Lokoja, Kogi State, Nigeria

Tunmise T. Oladipe — 2026-07-01

Background: Babybacking is a common Nigerian babywearing practice in which an infant is carried on a caregiver’s back using a cloth wrapper and, in some cases, an additional support sash. However, locally relevant safety recommendations on materials, positioning, duration and caregiver suitability remain limited. This study assessed the perspectives and recommendations of paediatric healthcare workers in Lokoja, Kogi State, Nigeria, regarding babybacking practices.

Methods: A descriptive cross-sectional survey was conducted among 37 paediatric healthcare workers from the Federal University Teaching Hospital, Lokoja, and Kogi State Specialist Hospital, Lokoja. Data were collected using a self-administered structured questionnaire covering socio-demographic characteristics, perspectives on babybacking and proposed safety rules. Responses were summarised using frequencies and percentages.

Results: The respondents included pediatric doctors (45.9%) and paediatric nurses (54.1%); 54.1% were aged 20–39 years, and all worked in government hospitals. All respondents (100%) regarded suitable material selection as essential for babybacking, while 67.6% considered an additional support sash necessary. Most respondents recommended limiting babybacking to 4 hours per day (75.7%) and 1–2 hours per interval (73.0%). Physical caregiver characteristics were considered relevant by 89.2%, and 86.5% supported babybacking training for intending mothers. The highest-ranked proposed safety rule was the use of suitable material.

Conclusion: Paediatric healthcare workers in Lokoja offered varied but safety-oriented recommendations on babybacking. Further context-specific guidance is needed to support safer babybacking practice.