Asian Journal of Medical Principles and Clinical Practice

Point-of-Care Ultrasound in Paediatric Emergency Resuscitation: A Narrative Review

2026-06-01T11:29:17+00:00

Point-of-care ultrasound (POCUS) has progressively established itself as an indispensable diagnostic and procedural adjunct in paediatric emergency medicine, transforming the capacity of clinicians to assess and manage critically ill children at the bedside. Unlike its adoption in adult emergency medicine, the integration of POCUS into paediatric emergency resuscitation has followed a somewhat more uneven trajectory, shaped by anatomical peculiarities unique to the developing body, institutional variation in training provision, and a relative scarcity of large-scale paediatric-specific evidence. This critical narrative review synthesises the available evidence across the primary resuscitation domains of POCUS application in paediatric emergency care: cardiac arrest and rhythm assessment; haemodynamic evaluation and undifferentiated shock; airway management; pulmonary and thoracic imaging; focused cardiac ultrasound; procedural guidance including vascular access and lumbar puncture; and targeted abdominal diagnosis. A structured narrative review was conducted using PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, Embase, and the Cochrane Library, with literature searches covering the period from January 2001 to the present. The review critically appraises the diagnostic accuracy, procedural benefits, and clinical impact of POCUS across these domains, drawing on systematic reviews, meta-analyses, and landmark observational and interventional studies. It also examines current frameworks for training, credentialing, and quality assurance, alongside the significant barriers — particularly those related to operator dependency, training heterogeneity, and resource constraints — that continue to limit uniform implementation. The article identifies areas where evidence is emerging and highlights directions for future research, including simulation-based learning, artificial intelligence-assisted imaging, and the expanding role of POCUS in neonatal resuscitation and low-resource settings. The overall picture that emerges is of a technology with compelling and, in many domains, well-evidenced clinical utility, but one whose full potential in paediatric emergency resuscitation remains contingent on structured training systems, standardised protocols, and ongoing high-quality research.

Magnetic Resonance Imaging: Principles, Clinical Applications, and Problem Solving: A Critical Review

2026-06-08T10:14:46+00:00

Magnetic resonance imaging (MRI) has evolved over the past five decades from an experimental laboratory technique into one of the most versatile and clinically indispensable diagnostic imaging modalities in contemporary medicine. Grounded in the quantum mechanical phenomenon of nuclear magnetic resonance, MRI offers unparalleled soft-tissue contrast, multi-planar capability, and functional sensitivity without the use of ionising radiation. This critical review synthesises the current state of knowledge across the principal domains of MRI science and practice: physical principles including relaxation theory, pulse sequence design, and k-space reconstruction; hardware considerations spanning magnet technology, gradient systems, and radiofrequency coil arrays; and a broad landscape of clinical applications encompassing neuroimaging, cardiovascular assessment, oncological staging, musculoskeletal evaluation, and body imaging. A structured narrative review methodology was employed to identify, screen, and critically synthesise peer-reviewed literature on MRI principles, technologies, safety, and clinical applications published between January 2000 and March 2026 using databases including Web of Science, Scopus, PubMed, Google Scholar, IEEE Xplore, EMBASE, CINAHL, the Cochrane Library, and EUDAMED. Advanced techniques — including diffusion tensor imaging, functional MRI, arterial spin labelling, magnetic resonance spectroscopy, susceptibility-weighted imaging, and quantitative mapping — are examined alongside their translational significance. The review further addresses practical problem solving, with particular attention to artefact recognition and mitigation, radiofrequency and field inhomogeneity, and patient safety considerations relating to implanted devices, gadolinium-based contrast agents, and scanning during pregnancy. Emerging developments — comprising compressed sensing, artificial intelligence–driven reconstruction, ultra-high field MRI at 7 Tesla, portable low-field systems, and MR-guided therapy — are critically assessed in terms of their maturity, limitations, and realistic clinical prospects. The review identifies persistent challenges including acquisition speed, access inequity, artefact burden, and the translation gap between research innovation and routine clinical deployment, and concludes with a synthesis of strategic priorities for advancing MRI science and practice over the coming decade.

Management Strategies and Outcomes of Pediatric Renal Trauma: A Systematic Review and Meta-analysis

2026-05-26T13:37:41+00:00

Background: Pediatric renal trauma represents a large proportion of genitourinary injuries in children and is most often related to blunt abdominal trauma sustained in motor vehicle collisions, falls, sports injuries, and bicycle accidents. Imaging modalities, trauma care, and minimally invasive interventions have evolved, and the management strategies have changed from operative treatment to conservative approaches. Recent investigations have demonstrated the success of nonoperative management in the majority of hemodynamically stable pediatric patients, including some high-grade renal injuries.

Objective: To systematically review and meta-analyze published studies to assess current diagnostic approaches, management strategies, and clinical outcomes of pediatric renal trauma.

Methods: A systematic review meta-analysis was conducted according to PRISMA guidelines. Electronic databases including PubMed, Scopus, Web of Science, and Google Scholar were searched for studies published between 2013 and 2026. Studies were eligible if they included pediatric patients with renal trauma and reported management strategies, imaging findings, complications, or clinical outcomes. Pooled proportions and effect estimates were calculated using a random effects model. Heterogeneity was assessed with the I² statistic and Cochran’s Q test. Results The primary outcomes were renal preservation, success of nonoperative management, complications, and nephrectomy rates.

Results: The systematic review comprised 31 studies with 3482 pediatric patients with renal trauma; 18 studies were eligible for quantitative meta-analysis. Injury was most commonly due to blunt trauma (pooled proportion: 89.4%; 95% CI: 84.1–93.1; I2 = 58%). Low-grade renal injuries (AAST grades I-III) were the most common injury pattern. The pooled success rate of nonoperative management was 93.2% (95% confidence interval [CI]: 89.7–95.6; I2 = 42%). Renal preservation was achieved in 96.1% (95% CI: 93.4–97.8; I2 = 37%). Children with high-grade injuries who are hemodynamically stable and managed conservatively have favorable outcomes with significantly lower rates of nephrectomy than operative management (pooled OR: 0.28; 95% CI: 0.14–0.56; p < 0.001). The overall complication rates were low (11.6%; 95% CI: 8.2–16.1; I² = 49%) with urinoma, hematuria, and urinary extravasation being the most common complications reported. The use of minimally invasive procedures such as ureteral stenting and angioembolization increased in the management of complications with improved renal salvage rates.

Conclusion: The evidence available strongly promotes the use of conservative and minimally invasive management as the treatment of choice in most pediatric renal trauma cases, especially in hemodynamically stable patients. These strategies have been associated with high rates of renal preservation, low rates of complication, and significantly reduced rates of nephrectomy, thereby improving overall clinical outcomes.

Antibiogram of Salmonella among Internally Displaced Persons in Selected States of North-Central Nigeria

2026-05-25T12:52:41+00:00

Salmonella infections remain a major public health concern in developing regions, particularly among vulnerable populations such as Internally Displaced Persons (IDPs) in North-Central Nigeria. However, there is limited location-specific data on antimicrobial susceptibility patterns of Salmonella in IDP settings within this region. This study investigated the antimicrobial susceptibility patterns (antibiogram) of Salmonella isolates obtained from IDP camps in Benue, Nasarawa, and Plateau States. Standard microbiological techniques were employed, including the Kirby–Bauer disc diffusion method in accordance with Clinical and Laboratory Standards Institute (CLSI) guidelines. Additionally, Extended-Spectrum β-Lactamase (ESBL) production was detected using double-disc synergy and confirmatory tests. A total of 27 isolates from the three study locations demonstrated varying susceptibility patterns. Ciprofloxacin consistently showed the highest effectiveness, with sensitivity rates ranging from 87.5% to 90%, followed by ceftriaxone and norfloxacin. Conversely, high resistance was observed against commonly used antibiotics such as ampicillin (77.8–87.5%) and tetracycline (66.7–75%). Moderate resistance levels were also recorded for co-trimoxazole, gentamicin, and amoxicillin. Notably, 37.0% of the isolates were confirmed as ESBL producers, indicating the presence of advanced resistance mechanisms. The findings highlight a growing burden of multidrug-resistant Salmonella strains in IDP settings, driven by poor sanitation, overcrowding, and indiscriminate antibiotic use. This study underscores the importance of continuous surveillance and the use of evidence-based antibiograms to guide effective treatment strategies in resource-limited environments.

Roentgenographic Carpal Morphometry: Assessment of Sex- and Age-Related Variations in Normative Posteroanterior Wrist Radiographic Measurements among Adult Nigerians

2026-05-27T10:08:16+00:00

Background: In orthopedic surgery, accurate anthropometric measurements of the carpal bones is essential for the correction of post-traumatic deformities during corrective osteotomies. Likewise, accurate radiographic evaluation of carpal bone dimensions plays a critical role in the diagnostic assessment of carpal collapse syndromes observed in conditions such as Kienböck’s disease and rheumatoid arthritis. Despite the clinical relevance of these carpal parameters, limited normative radiographic data exist for the adult Nigerian population. This study, therefore, aimed to establish population-specific normative reference values for carpal bone dimensions based on posteroanterior wrist radiographs in adult Nigerians.

Methods: This retrospective observational study utilized 201 posteroanterior wrist radiographs archived in the Radiology Department of Delta State University Teaching Hospital, Oghara, Nigeria. Measurements of carpal height, lunate width, capitate length, and the scapholunate gap were obtained from the eight carpal bones using the Picture Archiving and Communication System (PACS). Data were analyzed using SPSS version 25. Sex-related differences were assessed using the independent-samples t-test, while age-group variations were evaluated with one-way ANOVA. Pearson’s correlation analysis was employed to determine associations among measured carpal parameters. A p-value ≤ 0.05 was considered statistically significant.

Results: Obtained mean values for carpal height (3.215 cm), capitate length (2.153 cm), lunate width (14.032 mm), and scapholunate gap (0.202 cm), reflected a pronounced range of sex variation with males exhibiting significantly larger mean values. Age-specific analysis of mean values across the five age groups showed minimal variation in carpal bone dimensions, with carpal height ranging from 3.19 to 3.24 cm, capitate length from 2.144 to 2.157 cm, lunate width from 14.003 to 14.143 mm, and the scapholunate gap from 0.195 to 0.207 cm. Corresponding p-values for all inter-group comparisons exceeded 0.05 in all parameters, indicating no statistically significant differences attributable to age.

Conclusion: This study reveals marked sexual dimorphism alongside a high degree of age-independent consistency in adult carpal morphometric parameters. These outcomes hold important implications for forensic identification, anthropometric investigations, orthopedic decision-making, and radiologic assessment. Moreover, the findings enrich the existing repository of population-specific skeletal data in Delta State, building on prior regional anatomical research and enhancing the accuracy of clinical and forensic interpretations.

Awareness and Determinants of Excessive Screen-time among Secondary School Students in Osisioma-Ngwa LGA, Abia State, Nigeria

2026-06-04T09:46:57+00:00

Background: Excessive screen-time has emerged as a significant public health concern among adolescents due to its association with adverse physical, mental, and social health outcomes. Despite increasing access to digital devices among Nigerian youths, evidence on awareness of screen-time-related health consequences and its influence on usage behaviour remains limited, particularly in secondary school settings.

Objective: This study assessed the level of awareness of the health consequences of excessive screen-time, patterns of screen use, and factors influencing screen-time among secondary school students in Osisioma-Ngwa Local Government Area, Abia State, Nigeria.

Methods: A cross-sectional descriptive survey was conducted among 276 students selected through stratified proportional random sampling from one public and one private secondary school. Data were collected using a structured self-administered questionnaire covering socio-demographic characteristics, screen-time patterns, awareness of health consequences, information sources, and barriers to screen-time reduction. Data were analysed using descriptive statistics, chi-square tests, and binary logistic regression at a significance level of p < 0.05.

Results: Smartphone ownership was high (87.2%), and 54.4% of respondents reported high screen-time, with 25.8% spending more than five hours daily on non-academic activities. Social media was the predominant purpose of screen use (41.1%). Most students were aware of the physical (71.7%) and mental/social (67.8%) health consequences of excessive screen-time, while 42.4% demonstrated good overall awareness. Commonly recognised consequences included eye strain (76.8%), poor concentration (75.4%), reduced face-to-face interaction (70.6%), and anxiety or stress (68.4%). Internet/social media (63.1%) and teachers (50.9%) were the primary sources of information. Entertainment (55.2%), social connectivity (48.5%), and peer influence (43.7%) were the major barriers to reducing screen-time. A significant association was observed between awareness level and screen-time duration (χ² = 7.622, p = 0.022); however, awareness was not an independent predictor of lower screen-time in logistic regression analysis (AOR = 0.90, 95% CI: 0.28–2.93, p = 0.867). Female students were significantly less likely to engage in high screen-time than males (AOR = 0.45, 95% CI: 0.26–0.78, p = 0.004).

Conclusion: Excessive screen-time is prevalent among secondary school students despite relatively high awareness of its health consequences. Awareness alone is insufficient to drive behavioural change. Comprehensive interventions emphasising digital wellness skills, parental involvement, self-regulation, and attractive offline recreational alternatives are required to promote healthier screen-use behaviours among adolescents.

Mental Health of Healthcare Workers during Crises: Insights from Systems Engineering

2026-06-05T13:43:05+00:00

Background: Healthcare workers (HCWs) experience substantial occupational stress and psychological strain during crises, which can compromise both their well-being and the quality of patient care. This study examined the mental health of healthcare workers during crises, guided by a Systems Engineering Initiative for Patient Safety (SEIPS) framework. The study addressed five research questions and one null hypothesis tested at 0.05 level of significance.

Methods: A mixed-methods research design informed by human factors engineering principles was employed. The study was conducted in selected public and private healthcare facilities in Anambra State, Nigeria, including tertiary hospitals, general hospitals, private/mission hospitals, and Primary Health Centres. A multistage sampling procedure yielded a sample of 100 healthcare workers, including physicians, nurses, allied health professionals, and administrators. Data were collected using a structured questionnaire, semi-structured interviews, and focus group discussions. The questionnaire measured work-related stressors, psychological well-being, mental health support utilisation, and organisational support, with reliability coefficients ranging from 0.76 to 0.86. Quantitative data were analysed using descriptive statistics and multiple regression analysis, while qualitative data were analysed using thematic analysis guided by the SEIPS framework.

Results: The findings revealed that healthcare workers experienced significant work-related stressors during crises, including increased workload, staff shortages, fear of infection, and rapidly changing procedures. Moderate levels of emotional exhaustion and anxiety were observed among participants. Mental health support services were poorly utilised. Multiple regression analysis indicated that work-related stressors, mental health support utilisation, and organisational/system-level support significantly predicted psychological well-being, with organisational support emerging as the strongest predictor.

Conclusion: The study highlights that healthcare workers’ psychological well-being during crises is shaped by complex interactions among task demands, organisational structures, environmental risks, and individual coping factors within healthcare work systems. The findings emphasise the need for systems-based interventions, including supportive leadership, workload management, and accessible mental health services, to strengthen healthcare workforce resilience during future crises.

The ‘Digital Phantom Limb’ Phenomenon and Bedside Clinical Competency among Nursing Students at Kaduna State College of Nursing Sciences, Kafanchan Campus: A Descriptive Study

2026-06-06T12:29:03+00:00

Background: The pervasive integration of smartphones into nursing education has given rise to a phenomenon termed the “digital phantom limb”—a psychological and tactile dependence on the device characterised by phantom vibrations, compulsive checking urges, and separation anxiety. While nomophobia and smartphone addiction are widely documented, no prior study has examined this specific construct as a form of smartphone-dependent learning or its empirical relationship with multidimensional bedside clinical competence.

Objective: This study aimed to (1) quantify the prevalence and intensity of the digital phantom limb phenomenon, (2) determine the level of bedside clinical competency, and (3) examine the direction and strength of the relationship between the two among nursing students at Kaduna State College of Nursing Sciences, Kafancan Campus, Nigeria.

Methods: A descriptive correlational design was employed. A total of 162 ND I and ND II nursing students were recruited via proportionate stratified random sampling from a population of 283. Smartphone-dependent learning was measured using the Smartphone Addiction Scale–Short Version (SAS-SV; Kwon et al., 2013). Bedside clinical competency was assessed via self‑report using the adapted Clinical Competency Questionnaire (CCQ‑N), which evaluates physical assessment, procedural accuracy, clinical decision‑making, and documentation.

Results: The digital phantom limb phenomenon was highly prevalent, with 61.8% of students scoring above the gender-specific SAS-SV threshold. The mean SAS-SV score was 32.42 (SD = 9.84). Overall clinical competency was moderate (M = 128.73, SD = 24.56), with the lowest ratings in advanced clinical decision-making (59.2% of maximum). A statistically significant, moderate negative correlation was found between the digital phantom limb score and total clinical competency (r = -0.47, p < 0.001). Regression analysis revealed that smartphone-dependent learning independently accounted for 22.1% of the variance in bedside clinical competency (R² = 0.221, β = -0.47, p < 0.001).

Conclusion: The digital phantom limb phenomenon is endemic among nursing students and is inversely associated with self‑reported clinical competence, particularly in the domain of clinical decision‑making. These findings, based on self‑reported competency, provide robust evidence for integrating digital wellness interventions into nursing curricula to safeguard patient safety and enhance bedside care. Future research should incorporate objective competency assessments-including Objective Structured Clinical Examinations (OSCEs), preceptor evaluations, and direct clinical observation-to validate the observed associations and establish the magnitude of the relationship with actual patient care performance.