Asian Journal of Medicine and Health

Understanding Depression: Clinical Perspectives on Risk Factors, Psychopathology, Symptoms, and Evidence Based Management

Alhaji Kolo Shettima — 2025-10-04

Depression is a profound burden far exceeding ordinary sadness. It manifests as a smothering blanket of despair, a hollowing out of pleasure (anhedonia), relentless exhaustion, and a worldview permanently shaded by pessimism. This condition devastates a person's capacity to function professionally, maintain relationships, or experience basic existence. Sleep becomes fractured, thinking processes either race uncontrollably or drag painfully slow, and overwhelming guilt imposes a crushing weight. At its most severe, depression fosters persistent thoughts of death, tragically reflected in the over 700,000 lives lost to suicide globally each year – positioning it as the fourth leading cause of death among young adults aged 15-29. Its reach is vast and pervasive: the World Health Organization estimates 280 million adults worldwide currently endure this illness, representing roughly 5% of the global adult population.

The sheer scale of depression's impact is staggering. It stands as the primary driver of disability across the planet, robbing individuals of more healthy years than conditions like heart disease or chronic pain. The economic devastation is equally shocking, with annual losses exceeding $1 trillion due to diminished productivity and healthcare expenses a deafening testament to its societal cost. Compounding the tragedy are stark inequalities: women experience depression at nearly double the rate of men, yet access to meaningful help remains critically low. Globally, only about half of those severely affected in high-income nations receive minimally adequate treatment. In lower-resource settings, that figure plunges to a devastating one in five, leaving millions to wage this battle in isolation.

Scientific understanding points overwhelmingly to chronic stress as the fundamental catalyst weaving through depression's complex origins. Life inevitably delivers blows grief, trauma, persistent adversity and our minds and bodies respond. Resilience allows most people to recover. However, when stressors are unrelenting or exceptionally severe, our innate biological coping mechanisms can fracture. The delicate regulation of stress hormones (like cortisol) becomes chaotic, neural pathways managing mood and resilience deteriorate, systemic inflammation persists, and the brain's fundamental adaptability weakens. Negative emotional responses – fear, anger, profound sorrow – cease to be transient reactions and instead solidify into an unyielding, suffocating state of being.

This stark reality makes the pursuit of deeper root causes not merely an academic exercise, but an urgent humanitarian imperative. Why do some individuals succumb to stress while others endure? What specific biological mechanisms fail? Unlocking these answers is critical. While existing treatments like therapy and medication are life-saving for some, they prove ineffective for far too many. A substantial number grapple with treatment-resistant depression, finding no solace in current options. The scale of human anguish is immense and unacceptable. We desperately require innovative, more effective, and widely accessible solutions, developed through a deeper understanding of the illness, to alleviate this burden for millions. Deciphering the intricate science of stress response and resilience is paramount – unlocking these secrets is a global necessity demanding immediate action.

Shoulder Endurance and Glenohumeral Internal Rotation Effects on Writing Speed in College Students: An Observational Study

Liya Zinab O K — 2025-10-10

Background and Objective: Handwriting proficiency requires coordinated fine motor control and optimal shoulder function. This study examined correlations between shoulder rotational endurance glenohumeral internal rotation, and handwriting speed among college students.

Methodology: An observational cross-sectional study recruited 100 college students aged 18-25 years following predetermined inclusion and exclusion criteria. Comprehensive demographic data were collected including age, anthropometric measurements, gender, and hand dominance. Handwriting speed was quantified using the standardized Word Per Minute (WPM) test, shoulder rotational endurance was assessed via the Shoulder Endurance Test (SET), and glenohumeral internal rotation was measured using universal goniometry techniques. Statistical analyses were performed Pearson correlation coefficients calculated to determine variable associations.

Results: The study included 100 participants (30 males, 70 females) with mean age 19.61 ± 1.79 years, and handwriting speed 25.96 ± 4.84 words per minute. Mean shoulder endurance was 60.65 ± 22.32 seconds, while dominant hand internal rotation averaged 62.77 ± 6.10 degrees. Statistically significant positive correlations were identified between handwriting speed and shoulder endurance (r = 0.248, p = 0.013) and between handwriting speed and dominant hand glenohumeral internal rotation (r = 0.366, p = 0.010).

Conclusion: Enhanced shoulder muscle endurance and improved internal rotation mobility are associated with increased writing speeds. These findings have implications for academic performance optimization and rehabilitation strategies targeting handwriting difficulties.

Association of Age and Residual/ Recurrence in First Year after Treatment of Oral Cavity Squamous Cell Carcinoma

Tatsanachat Jittreetat — 2025-10-11

Background: Patients diagnosed with oral cavity squamous cell carcinoma (OCSCC) face a significant risk of recurrence with early treatment. Early recurrence detection potentially improves patient outcomes. Controversy exists over whether younger patients could be prioritized to be primarily treated for better outcomes. This study aims to determine the association between age and one-year recurrence of OCSCC, and factors related to the early recurrence were explored.

Methods: A retrospective case-control study was designed to compare the year recurrence of OCSCC patients based on data between 1 April 2012 and 1 April 2022, from the head and neck cancer referral center registry, Rajavithi Hospital. Cases were defined as patients with one-year recurrence, and controls were matched and defined as those who did not have recurrence after one year of treatment. The associations between age and other factors and recurrence in the first year after treatment were assessed. Multivariable analysis was used to calculate odds ratios and 95% confidence intervals to estimate the risk of each factor on recurrence.

Results: Overall, 68 cases and 152 controls were collected. The mean±SD of participants' ages was 56.52±12.97 years and 58.16±12.90 years for the case and control group, respectively, and over 60% of both groups were male. Results indicated that age was not significantly different between the groups. Factors associated with recurrence in one year after treatment of OCSCC were those having positive nodal metastasis for the treatment N-stage (Adjusted OR 2.24 [95% CI 1.04-4.83]; p=0.040) and non-treatment completion (Adjusted OR 4.02 [95% CI 1.24-13.03]; p=0.020).

Conclusion: Age is not an associated factor of early recurrence of OCSCC and should not be used for prioritizing the early treatment. The nodal metastasis and treatment completion should be considered for increasing survival rates and better outcomes.

Competency Gaps and Training Needs of State Human Resources for Health (HRH) Managers in Nigeria: A Rapid Capacity Assessment for Health Workforce Management Strengthening

Rogers Kanee — 2025-10-11

Background: The shortage of skilled healthcare workers remains a significant challenge contributing to poor health outcomes in Nigeria. One major factor in health workforce development is competent human resources for health managers who plan and effectively manage the health workforce. The study assessed the competency gaps and training needs of human resources for health (HRH) managers at the state levels in Nigeria.

Methods: The study was conducted in Nigeria among state-based HRH managers and focal persons using a rapid assessment design. Semi-structured questionnaires were administered to 36+1 purposively selected state HRH focal persons. Statistical Package for the Social Sciences (SPSS) version 27 was used for the data analysis. Descriptive statistics, including frequencies and percentages, were used to summarize the characteristics of the study participants. To assess associations between variables, inferential analysis was performed using the univariate Chi-square test. All analyses were carried out at a 95% confidence level, with statistical significance set at a p-value of less than 0.05. Findings from the study were validated by the 36 states and the Federal Capital of Nigeria Department of Health Planning, Research & Statistics (DHPRS) directors and focal persons through a virtual validation meeting.

Results: Responses were received from 32 of the 36+1 states (86.5% response rate). Subsequent analyses were based solely on the data provided by the 32 states. The study included 32 participants from the health structure across 36 states in Nigeria. 17 (53.1%) of the participants were male, while 15 (46.9%) were female. The study revealed a 12.5% high and 87.5% low competency among the states’ human resources for health-focal persons in HRH's leadership, governance, and communication strategy; 9.4% had high competency and 81.3% had low competence in HRH analytics. The study also revealed a deficit in competency levels for HRH planning among most participants, with 90.6% having low competency and 9.4% having high competency. In HRH resource mobilization, 12.5% showed high competence, and 87.5% showed low competence. There was no association between the socio-demographics and the different competency variables.

Conclusion: The study identified critical gaps and challenges in competency levels among HRH managers. To bridge the competency gaps in HRH development, more systematic, standardized, targeted interventions such as developing an eLearning system for HRH manager for continuous learning are required to improve the capacity of HRH management and development in Nigeria.

Extending the Andersen Behavioral Model: Service Innovation, Treatment Adherence, and Patient Satisfaction in Malaria Care in Papua, Indonesia

Reynold Rizal Ubra — 2025-10-19

Aims: This study aims to examine the direct and indirect effects of treatment adherence on patient satisfaction, incorporating service innovation into Andersen Behavioral Model of Health Service Use.

Methodology: A cross-sectional survey of 220 respondents was conducted at the Wania Health Center, Mimika District, Papua. Data were analyzed using SmartPLS 4 with reliability, validity, and structural relationships tested through bootstrapping (5,000 resamples).

Results: The results showed that predisposing and reinforcing factors of treatment adherence significantly improved patient satisfaction, while enabling factors had no effect. Service innovation, including streamlined malaria service, home visits, and digital monitoring, partially mediated adherence–satisfaction relationship. The model explained 77.6% of the variance in satisfaction.

Conclusion: Service innovation enhances satisfaction both directly and indirectly, extending Andersen Behavioral Model and offering actionable insights for policymakers. The results underscore the need for patient-centered innovation to strengthen malaria elimination strategies in resource-limited settings.

Assessing Neonatal Health: The Role of Blood Gas Analysis in Predicting Neonatal Outcomes

Vijayakumar P.G. — 2025-10-04

Introduction: Blood gas analysis is a commonly used diagnostic tool to evaluate the partial pressures of gases in blood and acid -base balance. ABG remains the gold standard. Neonatal mortality rate was 20 per 1,000 live births in 2020, Traditionally clinical indicators such as the Apgar score were used to assess neonatal well-being; however, these are subjective and influenced by many factors. Cord blood gas analysis offers an objective, quantifiable measure of perinatal hypoxia and acidosis

Aim: This study reviews the significance and clinical applications of cord blood gas analysis

Materials and Method: A prospective observational study between May 2022 and July 2023, at Dr. Mehta’s Multispecialty Hospital Pvt. Ltd., Chetpet Campus, Chennai, Tamil Nadu, India. The study included 150 consecutive deliveries

Results & Discussion: Mean/SD pH was 7.25/0.83, Mean BE -5.80/2.82, Mean /SD PaO2 22.29 /6.43, mmHg, Mean/SD PaCO2 50.55/12.58 mmHg, Mean/SD Bicarb 22.47/2.45mmol/l, Arterial pH and BE are significant predictors of Neonatal morbidity with BE being more sensetive. Cord blood gas analysis helps identify whether complications during labor and delivery deprived the neonate of oxygen Though Apgar score remains useful for immediate newborn evaluation its subjective In contrast, cord blood gas analysis provides an objective assessment of neonatal status

Conclusion: Arterial pH and BE are significant predictors of neonatal morbidity, Modern blood gas analyzers are indispensable in obstetric and neonatal practice, guiding immediate clinical decision-making and improving neonatal outcomes.

Hypomagnesemia in Type 2 Diabetes Mellitus: Correlation with Glycemic Control and Microvascular Complications

Vishnu M S — 2025-10-06

Background: Low magnesium levels contribute to defective tyrosine-kinase activity, post-receptor impairment of insulin action, and aggravated insulin resistance in patients with Type 2 Diabetes Mellitus (T2DM). Hypomagnesemia has also been linked to the development of microvascular and macrovascular complications such as neuropathy, retinopathy, and cardiovascular disease.

Methods: This study included patients with a history of T2DM who attended the clinic and fulfilled eligibility criteria. Patients were diagnosed according to ADA/WHO guidelines and had regular hospital follow-up for at least one year. A detailed clinical history was obtained, including duration of diabetes, treatment type, and symptoms such as blurring of vision, tingling, numbness, burning sensation, frothing of urine, and pedal oedema. Past history of coronary artery disease and cerebrovascular accidents was also recorded. Clinical examination included general assessment, body mass index (BMI), waist circumference, pulse rate, and blood pressure measurement.

Results: The study highlighted the association between hypomagnesemia and T2DM, with low magnesium levels linked to poor glycemic control and increased risk of complications. Hypomagnesemia is seen in 31.5 patients and was significantly associated with longer duration of diabetes (>10 Hypomagnesemia years: 45.2%). Poor long-term glycemic control (HbA1c >8%) was significantly associated with hypomagnesemia (37.9% vs 22.6%, p=0.02), whereas short-term control (FBS >130) showed only a trend (p=0.06).

Conclusion: Monitoring serum magnesium levels in T2DM patients is clinically important. Correction of hypomagnesemia through dietary supplementation or pharmacological replacement can improve insulin sensitivity, glycemic control, and endothelial function. Routine screening for magnesium deficiency, particularly in females and patients with long-standing diabetes, may help reduce complication risk and support timely interventions.

Cardiopulmonary Resuscitation Induced Consciousness in Asystolic Cardiac Arrest: A Case Report from Vinmec Smart City Hospital, Vietnam

Nguyen Cong Hoa — 2025-10-11

Background: Cardiopulmonary resuscitation–induced consciousness (CPRIC) refers to the presence of awareness, motor activity, or purposeful movements during ongoing chest compressions in the absence of return of spontaneous circulation (ROSC). Its reported incidence ranges from 0.3–0.9% of cardiac arrests, and it is typically observed in shockable rhythms such as ventricular fibrillation. Occurrence in asystole is exceedingly rare and poses challenges for both recognition and management.

Case Report: We describe a 62-year-old woman with a history of benign vertigo but no cardiovascular risk factors who suddenly collapsed at home. She was resuscitated at a local health post with 1 mg adrenaline and chest compressions before being transferred by emergency medical services (EMS) to Vinmec Smart City International Hospital. On arrival, she remained in asystole after approximately 20 minutes of no-flow/low-flow time. High-quality advanced life support was initiated and continued for 60 minutes. Despite persistent asystole on ECG, the patient exhibited repeated upper limb movements during chest compressions, raising suspicion for CPRIC. No eye opening or verbal response occurred. More than 10 doses of adrenaline were administered, with transient EtCO₂ elevations up to 25 mmHg and oxygen saturations between 98–100%. Bedside ultrasound and point-of-care laboratory tests revealed no reversible cause of arrest. Although extracorporeal cardiopulmonary resuscitation (ECPR) was considered, it was not initiated given the asystolic rhythm, prolonged arrest, and family decision. Resuscitation was ultimately terminated without ROSC.

Conclusion: This case highlights CPRIC in asystolic cardiac arrest, an uncommon presentation that may mislead resuscitation teams. Awareness of CPRIC is crucial to prevent inappropriate termination of compressions and to guide decisions regarding sedation or ECPR in selected patients. This report contributes to the limited literature on CPRIC in non-shockable rhythms.

The Evolving Role of the Emergency Department in Mass Casualty Incident (MCI) Response: A Review of Triage, Surge Capacity, and Decontamination Strategies

Fahad Mohammmed Aldossari — 2025-10-10

Mass Casualty Incidents (MCIs) represent a critical stress test for any healthcare system, positioning the hospital Emergency Department (ED) as the fulcrum of the medical response. This review article provides an exhaustive analysis of the evolving role of the ED in MCI management, synthesizing the current body of literature across three core operational domains: triage, surge capacity, and decontamination. The article traces the evolution of ED preparedness, shaped by seminal events such as the 9/11 terrorist attacks, Hurricane Katrina, and the COVID-19 pandemic, which have collectively driven a paradigm shift from isolated, reactive planning to proactive, integrated, and community-wide response frameworks. In triage, the review examines the fundamental ethical transition from individual-focused care to a utilitarian model aimed at achieving the greatest good for the greatest number. It critically compares foundational field triage systems, including Simple Triage and Rapid Treatment (START) and the nationally proposed Sort, Assess, Lifesaving Interventions, Treat/Transport (SALT) system, while also addressing the complexities of secondary triage in the ED and the unique challenges posed by special patient populations. The concept of surge capacity is deconstructed through the '4 S' framework—Staff, Stuff, Structure, and Systems—providing a comprehensive overview of innovative strategies for managing personnel, critical resources, physical space, and command and control. Finally, the article details the principles and operationalization of hospital-based decontamination, reviewing evidence for different methods and protocols for chemical, biological, and radiological threats. Principal findings indicate that these three domains are deeply interdependent, where failure in one can cascade and cripple the others. Key research gaps are identified, particularly in the validation of triage tools, sustainable models for responder mental health, and evidence-based protocols for non-ambulatory patient decontamination. The review concludes that a modern, resilient ED must be adaptable, technologically integrated, and deeply embedded within a regional healthcare coalition, committed to continuous training, simulation, and innovation to meet the challenges of an uncertain future.