Chulalongkorn Medical Journal

Normal appendiceal diameter on computed tomography and its influencing factors in the pediatric population

2026-05-22T13:09:32+07:00

Background: Appendicitis is the most common indication for emergency abdominal surgery in children. Computed tomography (CT) plays a crucial role in evaluating pediatric patients with suspected appendicitis. However, the literature describing the normal appendiceal diameter in the pediatric Asian population remains limited.

Objectives: This study aimed to establish reference values for normal appendiceal diameter and to identify variables influencing its diameter in pediatric patients aged 18 years or younger who underwent abdominal CT.

Methods: The study was reviewed and approved by the Institutional Review Board. We conducted a retrospective study of 358 children (≤18 years of age) who underwent abdominal CT scans between January 1, 2018, and December 31, 2022, for indications unrelated to appendicitis. Demographic data, including calculated body mass index and body surface area (BSA), were recorded. Radiologic data on the appendices included the maximal outer diameter and single-wall thickness. The data were classified into five age-based strata, and the mean appendiceal diameters were calculated. Associations between appendiceal diameter and age, and between appendiceal diameter and BSA, were assessed using linear regression models.

Results: The mean appendiceal diameter was 5.0 ± 1.1 mm. Stratified analysis by age revealed the following mean appendiceal diameters: 4.2 mm (0–1 years), 4.4 mm (1–5 years), 4.9 mm (5–10 years), 5.5 mm (10–15 years), and 5.8 mm (15–18 years). Age and BSA demonstrated significant predictive variability for appendiceal diameter (P < 0.001), explaining 35.2% and 33.1% of the variance, respectively. The regression equations were: appendiceal diameter (mm) = 4.0 + 0.1 × age (years) and appendiceal diameter (mm) = 3.7 + 0.1 × BSA (m2).

Conclusion: A uniform diameter cutoff for appendiceal diameter should not be applied across the pediatric population because the appendix grows during childhood. This study demonstrated positive correlations between the appendiceal diameter and age and between the appendiceal diameter and BSA.

Global trends in school disaster preparedness research: bibliometric analysis of impacts on public health and safety

2026-05-25T13:06:12+07:00

Background: Disasters, caused by natural or artificial triggers, result in the daily disruption of human activities. The extent of their impact is affected by community vulnerability and resource capacity. Effective disaster management involves a cycle of mitigation, preparedness, response, and recovery. One such mitigation measure, which integrates education and capacity building, is to establish school disaster preparedness.

Objective: The aim of this research was to perform a bibliometric analysis of Scopus publications relating to school disaster preparedness.

Methods: A bibliometric analysis of publications indexed in Scopus from 1965 to 2024. Data were processed and visualized using VOSviewer to explore trends in annual outputs, contributing countries and institutions, citation performance, and co-occurring keywords.

Results: This bibliometric analysis identified 868 publications on school disaster preparedness, with a notable increase occurring following the COVID-19 pandemic. The most active countries in this field were the United States, Indonesia, and Japan. Prominent research themes included disaster training, earthquake preparedness, and community awareness, reflecting the interdisciplinary nature of school disaster preparedness. Of the 2197 institutions that contributed a document, the International Journal of Disaster Risk Reduction published the most articles. Keywords such as “disaster preparedness,” “emergency preparedness,” and “education” highlight the central role of schools in promoting proactive disaster management.

Conclusion: Our results show that there is growing research interest in school disaster preparedness, which emphasizes the importance of educational programs, community engagement, and cross-disciplinary collaboration. The incorporation of health and public safety considerations into school preparedness initiatives can reduce disaster-related risks and improve the safety and wellbeing of vulnerable populations.

Effectiveness and implementation of the SHIELD integrated multi-level model to reduce adolescent depression and internet addiction: A cluster randomized waitlist-controlled trial in Wang Chin district, Phrae province

2026-06-04T13:44:29+07:00

Background: Adolescent depression and internet addiction are substantial comorbid mental health challenges in rural Thailand, where access to evidence-based interventions remains limited. Traditional single-modality approaches often fail to address the complex interplay among individual, family, and systemic factors that contribute to these conditions.

Objectives: This study aimed to evaluate the effectiveness and implementation outcomes of the SHIELD (Screening & surveillance, Health literacy enhancement, Internet wellness program, Empowering families, Linkage to care, Data-driven monitoring) integrated multi-level intervention for reducing depression and internet addiction among at-risk adolescents in rural Thailand.

Methods: A cluster-randomized waitlist-controlled trial was conducted across eight secondary schools in the Wang Chin district, Phrae province, between October 2024 and June 2025. The schools were randomized to immediate intervention (n = 4) or waitlist (n = 4) control groups. Participants included 240 at-risk students aged 12–18 years with Patient Health Questionnaire-9 (PHQ-9) ≥ 5 and Internet Addiction Test (IAT) ≥ 40. The 12-week SHIELD intervention integrated digital screening, psychoeducation, family therapy, internet wellness training, care coordination, and real-time monitoring, which was delivered by trained registered nurses, school counselors, and clinical psychologists. Primary outcomes included depression severity (PHQ- 9) and internet addiction levels (IAT). The secondary outcomes included mental health literacy, family functioning, quality of life, and implementation metrics using the RE-AIM framework. The observed intracluster correlation coefficient was 0.048. Data were analyzed using intention-to-treat mixed-effects models accounting for clustering, with economic evaluation performed from a societal perspective.

Results: At 6-month follow-up, the intervention group demonstrated significantly greater improvements in PHQ-9 scores (mean difference: −3.1, 95% CI: −4.0 to −2.2,P < 0.001, Cohen’s d = 0.68) and IAT scores (mean difference: −11.2, 95% CI: −14.8 to −7.6,P < 0.001, d = 0.67) compared to controls. Moreover, the clinical response rates (≥ 50% PHQ-9 reduction) were 64.8% vs. 25.5% (OR = 5.4, 95% CI: 3.2–9.2, NNT = 3) and the remission rates (PHQ-9 < 5) were 35.2% vs. 11.8% (OR = 4.1, 95% CI: 2.1–8.0, NNT = 5) differed between the intervention and control groups, respectively. Subgroup analyses demonstrated consistent intervention benefits across sex and age groups, with greater effects observed among students with moderate-to-severe baseline depression (d = 0.81) than mild depression (d = 0.54). Furthermore, the secondary outcomes revealed significant improvements in mental health literacy (d = 0.78), family functioning (d = 0.52), and quality of life (d = 0.40). The implementation outcomes demonstrated high fidelity (88.4%), excellent adoption (100.0% school participation), and favorable cost-effectiveness (ICER = 12,830 THB per depression-free year, below the WHO threshold of 34,400 THB).

Conclusion: The SHIELD integrated multi-level intervention exhibited substantial and sustained effectiveness in reducing adolescent depression and internet addiction with excellent implementation outcomes and favorable cost-effectiveness. Despite real-world implementation challenges, including initial barriers to parental engagement and technology access in rural settings, high fidelity was maintained throughout the trial. These findings support the potential for scaling evidence-based, culturally adapted interventions within Thailand’s educational and mental health systems to address the growing adolescent mental health needs in resourceconstrained settings.

Effects of maternal vitamin D supplementation during pregnancy and lactation on immune development in offspring: A systematic review

2026-06-09T14:54:45+07:00

Background: Vitamin D, a fat-soluble prohormone, is essential for skeletal health and plays a key role in immune regulation. Deficiency is common among pregnant and lactating women, raising concerns that fetal and neonatal vitamin D status depends largely on maternal stores. Insufficiency during these periods has been associated with adverse birth outcomes and immune-mediated disorders.

Objective: To examine the effects of maternal vitamin D supplementation during pregnancy and/or lactation on offspring immune development.

Methods: This study followed PRISMA guidelines and was registered with PROSPERO (No. CRD420251117397). Experimental studies published in English between August 2015 and 2025 were eligible. Reviews, in vitro examinations, without full text or prenatal vitamin D exposure, and did not assess immunerelated offspring outcomes, or included offspring, were excluded. PubMed, ScienceDirect, and EBSCOhost were searched, most recently on August 10, 2025. Risk of bias was assessed with the SYRCLE tool, and findings were synthesized narratively. This study was funded by the KNB Scholarship, Ministry of Higher Education, Science, and Technology, the Republic of Indonesia (https://knb.kemdiktisaintek.go.id/).

Results: Finally, four studies were included, and evidence was limited to a small number of heterogeneous rodent studies. Maternal vitamin D supplementation enhanced T helper (Th) 1 responses and regulatory T-cell function; suppressed Th2 and Th17 subsets; reduced interleukin (IL)-6, IL-17, and IL-23; and elevated IL-10 and transforming growth factor-beta expression. It also elevated vitamin D receptor and forkhead box P3 levels and interferon-gamma promoter methylation, suggesting epigenetic reprogramming.

Conclusion: Maternal vitamin D may influence early-life immune programming and improve offspring immune resilience. Human studies with standardized protocols and long-term follow-up are needed.

The role of the NLRP3 inflammasome in preeclampsia and implantation failure: A molecular review

2026-06-08T14:51:02+07:00

The NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome is a critical molecular sensor for danger signals within the innate immune system. While its role in general inflammatory disorders is welldocumented, its specific contribution to reproductive failures remains a critical knowledge gap in maternalfetal medicine. Preeclampsia and implantation failure represent significant clinical challenges characterized by maladaptive sterile inflammation. This review synthesizes the molecular architecture of NLRP3 and its dual role in health and disease. We specifically examine how NLRP3 dysregulation disrupts the delicate immunological balance at the maternal-fetal interface. By analyzing the mechanisms of hyper-activation and failure within the uterine microenvironment, we highlight potential therapeutic strategies, such as small-molecule inhibitors, to improve obstetric outcomes.

Skip-segment Hirschsprung’s disease: Report of a rare case and literature review

2026-05-22T15:43:48+07:00

We present an unusual case of skip-segment Hirschsprung’s disease, initially diagnosed with total colonic aganglionosis. A term newborn male presented with distal intestinal obstruction and underwent exploratory laparotomy at 3 days old after an ultrasound-guided contrast enema. Intra-operative frozen sections of full-thickness biopsies from each part of the colon and terminal ileum revealed no ganglion cells. Therefore, we performed a double-ended ileostomy. Although all final pathology reports confirmed the absence of ganglion cells, which were similar to those in the frozen sections, we were concerned about the problematic bowel because preoperative imaging (at 30 months of age) showed a dilated transverse colon. Therefore, we repeated the contrast enema, and the procedure showed a transition zone at the splenic flexure. An intra-operative frozen section of the normal caliber ascending colon was positive for ganglia in both layers, and then a pull-through operation with a protective ileostomy was performed. The final pathology report showed no ganglion cells in the rectum and transverse colon, whereas normal ganglion cells were observed in the sigmoid area. To date, approximately 30 cases of skip-segment Hirschsprung’s disease have been reported; therefore, this phenomenon is rare but important. All patients who do not present with a typical picture of Hirschsprung’s disease should be carefully evaluated, as the spectrum of this disease can alter the resected bowel length.

Pituitary apoplexy in a 19-year-old woman: An uncommon age and gender presentation

2026-06-12T14:21:38+07:00

Pituitary apoplexy is a rare clinical syndrome that is caused by acute hemorrhage or infarction of the pituitary gland. It is most frequently reported in men during the 5thand 6thdecades of life and is rarely encountered in young women. In this report, we describe a 19-year-old woman who presented with acute visual disturbance accompanied by occasional mild headaches. Ophthalmologic examination revealed bitemporal hemianopia, and head magnetic resonance imaging demonstrated an intrasellar mass with suprasellar extension, intratumoral hemorrhage, and optic chiasm compression, consistent with a pituitary macroadenoma with apoplexy. The patient also had a history of secondary amenorrhea, thereby suggesting possible endocrine dysfunction. This case highlights the importance of considering pituitary apoplexy in young patients with acute visual disturbances.