Cureus

Study design Retrospective cohort study. Objectives To correlate Hounsfield unit (HU) values, using elliptical regions of interest (ROI), that can be easily defined in routine clinical practice with magnetic resonance imaging (MRI) T2-hyperintense area fraction, as a surrogate for paraspinal muscle fat infiltration and to establish specific HU screening thresholds that may be applied with standard picture archiving and communication system (PACS). Methods We included 136 patients (71 men; 61.0 {+/-} 15.4 years) who underwent preoperative computed tomography (CT) and MRI within an 8-week period. Elliptical ROI HU values were measured at L2/3 and L4/5 for erector spinae, multifidus, and psoas major. MRI T2-hyperintense area fraction (Otsu thresholding) served as the fat infiltration reference. Linear mixed-effects (LME) models were used to assess the HU-T2 association and level-specific receiver operating characteristic (ROC) analyses (lower HU value side; n=136 per muscle-level) to identify thresholds for [≥]30% and [≥]50% infiltration criteria. Results Intraclass coefficients = 0.709 (HU) and 0.857 (T2 fraction); Goutallier weighted kappa = 0.579. In the overall LME, {beta} was -0.880 HU per 1% T2-fraction increase (95% confidence interval -0.935 to -0.825; marginal R2 =0.502); the association was steeper in multifidus ({beta} = -1.020) than in erector spinae ({beta} = -0.753). Psoas major (R = -0.226) was excluded from ROC analyses. Difference between L2/3 and L4/5 HU cutoffs was ~20 HU. The [≥]50% criterion revealed higher discrimination. Conclusions Elliptical ROI-based HU measurements may reliably screen paraspinal muscle fat infiltration in erector spinae and multifidus using standard PACS. Specific thresholds may allow practical preoperative evaluation without additional costs or radiation.

Introduction: Acute gastroenteritis (AGE) is a cause of childhood morbidity and may be associated with human adenovirus (HAdV) infection. This study aimed to investigate the occurrence of HAdV in fecal samples from children with AGE in Salvador, Bahia, Brazil, as well as to molecularly characterize the identified strains and evaluate their cytopathic effects in cell culture. Methods: A total of 131 samples were analyzed using the nested polymerase chain reaction (Nested-PCR) technique. Molecular characterization was performed through Sanger sequencing and phylogenetic analysis, while Vero cell cultures were used to investigate the occurrence of cytopathic effects. Results: Of the samples analyzed, 13 (9.9%) tested positive for HAdV, while 118 (90.1%) were negative. The highest detection frequency was observed in children aged three years or younger, particularly those under one year of age. Phylogenetic analysis identified variants related to HAdV-F41 and HAdV-B3, revealing genetic differences and distinct clustering patterns compared with reference sequences. In cell culture, cytopathic effects were observed four days after inoculation, although further analyses are required to confirm productive viral replication. Conclusion: These findings demonstrate the presence of HAdV in the samples studied and contribute to understanding its genetic diversity and circulation in Salvador, highlighting the importance of epidemiological surveillance and further studies on its role in the etiology of childhood AGE.

Introduction: Thyroid diseases are major health problems and among the most common endocrine disorders worldwide, including in Ethiopia. They are characterized by alterations in hormone secretion, enlargement of the thyroid gland, or both. Fine needle aspiration cytology is an important initial screening tool, and histopathologic examination is essential for the definitive diagnosis of thyroid disease. This study aimed to compare the diagnostic accuracy of fine needle aspiration cytology with histopathology in identifying thyroid diseases. Methods: A cross-sectional study was conducted at three health facilities in Hawassa City, Ethiopia, involving 304 patients who underwent both thyroid fine needle aspiration cytology and histopathologic examination of the same site between 30th October 2024 and 29th October 2025. FNAC results were classified using the Bethesda system, with histopathology as the gold standard. Data were entered into Kobo Toolbox, exported to SPSS version 27, and analyzed using cross-tabulation and chi-square ({chi}{superscript 2}) tests to determine diagnostic accuracy. Result: 304 patient records were included in the study. The fine needle aspiration cytology was determinate/diagnostic in 81.6% of cases. The study revealed the sensitivity and specificity of fine needle aspiration cytology to be 88.2% (CI 77.6-95.1%) and 94.4% (CI 90.6-97.1%), respectively. The false negative and false positive rates in this study were 2.4% and 4.4%, respectively. The positive predictive value was 80.3% (CI 68.7-89.3%), and the negative predictive value was 96.8% (CI 93.8-98.7%). The accuracy of fine needle aspiration cytology in differentiating benign from malignant thyroid lesions was 93.1%. Conclusion: FNAC demonstrated strong agreement with histopathology and remains a reliable, cost-effective first-line diagnostic tool for thyroid disease, particularly in resource-limited settings. Strengthening sample handling, ultrasound guidance, and adherence to Bethesda criteria may further improve diagnostic precision

Background: Obstructive jaundice is a clinical condition caused by obstruction of the bile flow system and manifests as discolouration of the eyes and skin. The prevalence of malignant jaundice in nearby African nations is unacceptably high. Furthermore, there is local suspicion that gold mining activities are behind the high number of cancer patients in the northern region of Sudan. This study aims to identify the prevalence of malignancy among obstructive jaundice patients in the study area. Methods: We performed a hospital-based cross-sectional review of 60 consecutive patients diagnosed with obstructive jaundice at three major hospitals in Dongola between January and July 2024. Malignancy was defined by imaging and histopathology. Data were extracted from hospital records and supplemented by telephone interviews when records were incomplete. Descriptive statistics, bivariate tests, and multivariable logistic regression were used to compare malignant and benign cases; significance was set at p < 0.05. Analyses were performed using SPSS v27. Results: Malignancy accounted for 31/60 (51.7%) of obstructive jaundice cases. The most frequent malignant diagnoses were hepatocellular carcinoma (9/31, 29.0%) and carcinoma of the pancreatic head (8/31, 25.8%). Malignant cases more often reported weight loss, vague abdominal pain, dark urine, and pruritus, whereas right upper quadrant pain was more frequent in patients with benign disease. Mean serum bilirubin was significantly higher in malignant versus benign cases (11.2 mg/dL vs 5.0 mg/dL). In multivariable analysis (complete cases, events = 22), age and serum bilirubin remained independent predictors of malignancy (age aOR 1.47 per 10 years, 95% CI 1.07 - 2.01; bilirubin aOR 2.03 per 5 mg/dL, 95% CI 1.86 - 2.45). Metastasis showed a strong trend but did not reach significance. Gold mining exposure was significantly associated with malignancy in univariate analysis but lost significance when undergoing multivariable regression testing. Smoking and sex were not significant. Conclusion: In this hospital series from Dongola, over half of obstructive jaundice presentations were due to malignancy, with hepatocellular carcinoma and pancreatic head carcinoma being the most common. High bilirubin levels and older age were independent predictors of malignancy. Residence near gold mining areas was associated with malignancy in descriptive analyses but did not remain significant after adjustment; this finding is hypothesis-generating and requires environmental and epidemiologic follow-up.

Introduction Low back pain (LBP) is a common leading cause of functional disability in adults worldwide, presenting with Modic changes that are visible within the endplates of the vertebral body under magnetic resonance imaging (MRI). Modic changes (MC) are not just a coincidental imaging finding; they reflect underlying pathology that needs treatment focus. This study aimed to ascertain the prevalence and patterns of Modic changes in the lumbar spine among adult patients with a history of low back pain attending the Kilimanjaro Christian Medical Centre (KCMC) Orthopedic clinic. Methods A descriptive cross-sectional study was conducted at the KCMC orthopedic clinic from 2nd October 2024 to 30th May 2025. Data from adult patients with a history of low back pain who had undergone lumbar spine MRI were collected, cleaned, and analyzed in SPSS (version 25). Categorical variables were summarized by frequency and proportion, while continuous variables were summarized using the mean and standard deviation. Frequency tables, histograms, and pie charts were used for results presentation. Results Of the 283 patients enrolled in the study, the mean age was (57.2 {+/-}15.7) years, with the majority (145; 51.2%) being aged > 59 years. Most patients, 203 (71.7%), were females, while 176 (62.2%) were married, and 142 (50.2%) were overweight. The prevalence of MC on the lumbar spine among patients with a history of low back pain was 66.4% (n=188). Among patients with lumbar spine MC, the majority, 112 (59.6%), were aged over 59 years, and 125 (66.5%) had lumbar spine MC type II, which was the most predominant compared to other types of MC. Conclusion Modic changes on the lumbar spine are prevalent in adult patients with low back pain, particularly those over 59 years, with type II being the most common. Healthcare professionals and policymakers should recognize Modic changes as clinically relevant findings that require consideration in the management of patients with a history of low back pain rather than dismissing them as mere incidental or coincidental observations.

Introduction: Acute gastroenteritis (AGE) is a global public health problem and a major cause of mortality in low- and lower-middle-income countries. Human bocavirus (HBoV) is among the viral agents associated with this condition. Therefore, investigating the presence of HBoV in cases of AGE in Salvador, Bahia, as well as its prevalence and circulating strains, is important. Objective: To investigate the occurrence of HBoV infection during an AGE outbreak in Salvador. Methods: A total of 178 samples were analyzed for HBoV using nested polymerase chain reaction (nested PCR), and the amplification products were visualized by agarose gel electrophoresis. HBoV was detected in 5.7% of the samples analyzed. Conclusion: This study contributes to the understanding of HBoV epidemiology as a secondary agent associated with acute gastroenteritis during a norovirus outbreak in Salvador. Continued investigation and identification of the etiological agents involved in outbreaks are essential for evaluating the causes of AGE. These findings also highlight the need for broader diagnostic approaches and the importance of phylogenetic analysis for monitoring and controlling viral infections.

Objective: Hyperthyroidism and hypothyroidism related to iodine deficiency are major public health concerns in Afghanistan. This study aimed to assess the frequency of thyroid dysfunction among male patients referred for thyroid testing and its association with age, and to examine monthly trends in thyroid dysfunction at Asia Med Laboratory in Herat, Afghanistan, from July 2021 to January 2022. Methods: A retrospective analysis was conducted on 250 male patients aged 0-69 years. We measured Serum TSH, total T4, and total T3 levels, and thyroid status was classified using age specific reference ranges. In addition, the frequency of thyroid dysfunction was analyzed across age groups with monthly trends of thyroid state. Results: Overall, the euthyroid state consisted of 69.2% of participants, 24.8% with overt hypothyroidism, 3.2% with overt hyperthyroidism, and 2.8% with subclinical hyperthyroidism. Thyroid status differed significantly by age (p = 0.0135), with hypothyroidism increasing in older age groups and reaching its highest proportion among men aged 60-69 years (55.6%). Euthyroidism predominated in patients aged 10-39 years, while hyperthyroidism across age groups remained relatively infrequent. After September 2021, a threefold increase was observed in the total number of male patients referred for thyroid testing. During this period, the proportion of hyperthyroidism increased slightly, whereas hypothyroidism cases declined. Conclusion: In conclusion, hypothyroidism was more frequent with older age. The rise in absolute case numbers after September 2021 likely reflects increased patient referrals, underscoring the need for ongoing monitoring of thyroid function. The study may assist in the early management of thyroid disorders and in reducing their complications.

Background: Lung cancer is leading cause of cancer related death globally. It is second most prevalent cancer among women worldwide and ranks third among females in Nepal. Contributing factors are smoking, tobacco use, air pollution, and delayed diagnosis. Image-guided fine needle aspiration cytology (FNAC) is rapid diagnostic technique for evaluating lung lesions. It is minimally invasive procedure with less complications. This study examine histocytologic makeup of lung lesions and link the results. Materials and Methods: This cross-sectional observational study included 65 patients irrespective of age and sex presenting with lung masses at Chitwan Medical College and Teaching Hospital from April 2023 to September 2024. After clinical and radiologic evaluation, all cases underwent image-guided FNAC and biopsy. Only specimens with unequivocal malignant features were classified positive. Histopathology served as diagnostic reference standard. Results: FNAC diagnosed 90.8% as malignant and 9.2% as benign. Biopsy confirmed malignancy in 92.3% of cases. FNAC demonstrated a sensitivity of 98.33%, specificity of 100%, positive predictive value(PPV) of 100%, and negative predictive value (NPV) of 83.33%. Concordance between FNAC and histopathological subtyping was 98.46%. Adenocarcinoma was most common subtype, followed by Squamous cell carcinoma(SCC) and small cell carcinoma. Smoking was most common contributing factor associated with malignancy. Conclusion and implications: Image-guided FNAC is an excellent diagnostic accuracy tool which possess higher level of concordance with biopsy in evaluating lung masses. It should be considered as frontline diagnostic tool, especially in resource limited settings. Keywords: FNAC, Lung cancer, Biopsy, SCC, Adenocarcinoma, Small cell carcinoma, Nepal

Objective Influenza-like illness (ILI) is characterized by the sudden onset of systemic and respiratory symptoms such as fever, fatigue and myalgia, requiring prompt management. Anas barbariae 200K, a homeopathic medicinal product, is traditionally used to relieve flu-like symptoms. This study aimed to evaluate its efficacy in alleviating ILI symptoms within 72 hours. Secondary outcomes assessed symptoms relief, adverse effects, functional outcomes, compliance, and participant and investigator satisfaction. Methods This prospective, randomized, double-blind, placebo-controlled multicenter superiority trial with two parallel groups was conducted in primary care in India in 2021. Children (6-12 years) and adults (18-65 years) with ILI symptoms for less than 24 hours were randomized to receive either Anas barbariae 200K (Oscillococcinum(R)) or placebo. Treatment was given three times daily for three days. The primary endpoint was the proportion of participants with alleviation of ILI symptoms within 72 hours following the initiation of treatment. Results A total of 707 participants received Anas barbariae 200K (n = 352) or placebo (n = 355). Within 72 hours, the Anas barbariae 200K group showed significantly greater symptom relief than the placebo group (74% vs. 44.5%; p < 0.0001). Secondary endpoints also favored Anas barbariae 200K group, including faster symptom alleviation (46.7 vs. 67.3 hours; p < 0.0001) and shorter median time, estimated by KM analysis, to return to daily activities (4.0 vs. 6.0 days; p < 0.0001). No serious adverse events were reported. Conclusion Anas barbariae 200K significantly alleviated ILI symptoms within 72 hours, with improvements that were both statistically and clinically significant. Significant benefits were also observed across secondary outcomes, with no safety signal identified. This study showed that Anas barbariae 200K could be an effective and well-tolerated treatment for ILI symptoms. Trial registration Clinical Trials Registry of India, CTRI: 2021/02/031250, registered on February 12, 2021. Keywords Influenza-like illness, Oscillococcinum(R), Respiratory tract infections, Randomized controlled trial, Homeopathy, Respiratory and systemic symptoms, Treatment outcome.

Purpose: Posterior pharyngeal wall (PPW) thickening is a common structural manifestation of treatment-related internal lymphedema in patients with head and neck cancer and can be evaluated using lateral videofluoroscopic images acquired during modified barium swallow (MBS) studies. However, no standardized method currently exists for quantitative measurement. Methods: This two-phase methodological study first conducted a scoping review to characterize existing approaches to PPW thickness measurement and identify the principal factors contributing to variation in PPW thickness measurement. Eight studies were identified with variation observed across these measurement factors. An empirical reliability study was then performed using 107 MBS studies from 93 Head and Neck Cancer patients. Two independent raters annotated 10 anatomical landmarks on pre-swallow and post-swallow resting frames, and a computer-assisted algorithm quantitatively generated seven candidate PPW thickness measurements based on different vertebral reference points and measurement directions. Reliability was assessed intraclass correlation coefficients (ICCs). Results: Inter-rater reliability was highest for the measurement originating from the midpoint of C3 and extending perpendicular to the anterior C3 surface (ICC, 0.78; 95% CI, 0.72-0.83). Among the normalization references, C2-C4 vertebral length demonstrated greater reliability than C3 vertebral length, with an ICC of 0.88 (95% CI, 0.85-0.91). No significant differences were observed between pre-swallow and post-swallow PPW thickness measurements across the evaluated approaches. Conclusions: These findings provide a methodological foundation for more standardized and reliable quantification of PPW thickness, with potential to expand the role of MBS from the functional evaluation of swallowing to include quantitative characterization of pharyngeal structural abnormalities.

Background Automated colonoscope navigation requires a way to determine where the lumen continues. One possible approach is to estimate the distance from the endoscope tip to the surrounding wall. However, adding a range sensor to a conventional colonoscope is technically difficult, and depth estimation from monocular endoscopic images remains challenging. We considered a simpler possibility. Because the light source of an endoscope is located close to the camera, distant regions of the lumen tend to appear darker than nearby walls. Aim To determine whether lumen direction can be estimated from image brightness alone in a patient-derived virtual colon, and to compare this estimate with one obtained from true wall distances. Methods A virtual colon was reconstructed from the author's CT colonography data (0.5 mm isotropic resolution). Endoluminal images were rendered at 342 positions along 1368 mm of the colonic centreline. At each position, the image was divided into 24 x 24 directional cells. Lumen direction was estimated from the darkness-weighted centroid of the largest connected component among the darkest 10% of cells. For comparison, the true distance from the virtual endoscope to the wall was obtained by ray casting, and a distance-based direction was calculated using the same method. Two illumination models were tested: a directional light without distance attenuation and a point source at the endoscope tip with distance attenuation. Results With point-source illumination, the brightness-based direction closely matched the distance-based direction, with a median angular difference of 2.5 degrees. Differences greater than 30 degrees occurred in 2.3% of frames. Within each frame, brightness and true wall distance were negatively correlated in all 342 frames (median Spearman rho = -0.770). Using the direction toward the centreline point 40 mm ahead as a fixed geometric reference, the median angular error was 6.6 degrees for the brightness-based estimator and 6.5 degrees for the distance-based estimator. The median frame-by-frame difference in error was -0.09 degrees. In contrast, the brightness cue failed under directional illumination without distance attenuation (median difference from the distance-based direction, 43.1 degrees). Conclusion In this patient-derived virtual colon, image brightness provided nearly the same lumen-direction information as exact wall distance when a point-source illumination model with distance attenuation was used. Exact metric distance was therefore not necessary for this specific navigation task. These findings suggest a simple, learning-free approach to semi-autonomous colonoscope steering based on image brightness and deterministic calculation.

Background Helicobacter pylori is a highly prevalent chronic infection that induces persistent gastric inflammation and has been increasingly implicated in alterations of lipid metabolism. Several studies suggest an association between H. pylori infection and dyslipidemia, potentially contributing to atherosclerosis and cardiovascular disease; however, findings remain inconsistent and causal relationships are debated. Objective The objective of the study is to determine the association between Helicobacter pylori infection and dyslipidemia. Materials and methods This study is a cross-sectional study conducted at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal, a tertiary care referral center. It involved a retrospective analysis of records collected at General Health Checkup (GHC) clinic by a physician. Data collection was done retrospectively from pre-existing medical records. The study population included patients with documented H. pylori serological status and available lipid profile results during the study period. Information on demographic characteristics, clinical presentation, medication use, lifestyle factors and known comorbidities was collected using a pretested, standardized questionnaire adapted from literature. Standardized methods were used for anthropometric measurements. Body mass index (BMI) was calculated as weight (kg) divided by height squared (m2). Results This study included a total of 242 participants and categorized them into three groups based on Helicobacter pylori serology - seronegative, equivocal, and seropositive. In the study, BMI and body weight showed significant positive correlations with LDL (r = 0.208, p = 0.008) and total cholesterol (r = 0.187, p = 0.017). Body weight was positively correlated with total cholesterol (r = 0.204, p = 0.009). No significant correlations were observed between fasting blood glucose and lipid parameters, suggesting that H. pylori infection may be associated with increased body weight, though not with overt hyperglycemia. The current study's findings showed that there was no statistically significant difference in the mean Fasting Blood Sugar (FBS) levels of those with and without H. pylori infection. (FBG: 5.37 {+/-} 1.20 mmol/L in seronegative participants, 5.29 {+/-} 0.93 mmol/L in equivocal participants, and 5.56 {+/-} 0.92 mmol/L in seropositive participants (p = 0.347)). Among other risk factors, a significant association was found between male sex and H. pylori infection (H. pylori-seropositive men (49.1%) compared to seronegative males (26.5%), p = 0.004). Smoking status did not substantially differ among patients who tested positive for H. Pylori, and alcohol consumption showed a weak correlation (P=0.064). Conclusion The findings of the study suggest that H. pylori seropositivity is significantly associated with higher body weight and dyslipidemia, particularly elevated TC and LDL cholesterol levels, highlighting the importance of lipid screening and weight reduction in H. pylori-positive patients.

Background: Sternal dimensions show population-specific sexual dimorphism and may support forensic identification when more informative skeletal elements are unavailable. Computed tomography (CT) permits non-destructive, reproducible three-dimensional assessment of the sternum. Objective: To quantify sex- and age-associated differences in CT-derived sternal measurements among adults from Western Uttar Pradesh, India. Methods: This prospective cross-sectional study included 250 adults aged 20-80 years (155 males and 95 females) referred for chest CT at a tertiary hospital in Moradabad. Images were acquired using a Philips Ingenuity Core 128-slice scanner with 1-mm sections and 0.5-mm reconstruction increments. Manubrium width (MW), manubrium length (ML), sternal body length (B), corpus sterni widths at the first and third sternebrae (CSWS1 and CSWS3), sternal index (SI), combined length (CL), and sternal area (SA) were evaluated. Independent-samples t tests, one-way analysis of variance with Tukey post hoc testing, and Pearson correlations were used. Results: Mean age was 48.1 years. Males had greater MW (57.3 vs 49.9 mm), ML (45.3 vs 40.4 mm), B (90.2 vs 75.7 mm), CSWS1 (26.1 vs 23.0 mm), CSWS3 (31.6 vs 27.9 mm), CL (135.5 vs 116.1 mm), and SA (5258.3 vs 3880.5 mm; all p < 0.001). SI was greater in females (53.8 vs 50.8; p = 0.009). Across age groups, only MW (p = 0.001) and SA (p = 0.002) differed significantly. Strong correlations were observed for B with CL (r = 0.902), CL with SA (r = 0.895), B with SA (r = 0.869), and MW with SA (r = 0.847; all p < 0.001). Conclusion: CT-derived sternal morphometry demonstrates marked sexual dimorphism in this Western Uttar Pradesh sample, particularly for SA, CL, B, and MW. These reference values provide a basis for population-specific forensic models; however, predictive accuracy cannot be inferred without classifier development and validation.

Background. Guidelines recommend surgery for moderate and severe cervical spondylotic myelopathy (CSM) but support either surgery or nonoperative care for mild disease. How patients weigh the adverse events associated with each pathway is not well characterized. Methods. We conducted a three-arm randomized vignette experiment among United States adults aged 40 years and older recruited through an online research panel. All participants read an identical description of mild CSM and were randomized to one of three scenarios: surgery that improved symptoms, surgery that halted progression without improvement, or nonoperative management with symptom progression. Participants in the surgical scenarios rated 12 possible complications and those in the nonoperative scenario rated 8 progression outcomes. For each item, participants rated how strongly it would influence their decision (0-10) and whether they would still choose the same treatment. Items for which participants would no longer choose the same treatment were termed dominant decision factors. Results. Of 276 respondents, 263 (95.2%) were analyzed. Dominant factor rates ranged from 13.5% to 87.8% across complications. Complications described as persisting at one year produced substantially higher rates than the same complications described as resolving by three months. Adverse events more frequently constituted dominant factors when surgery was framed as offering less benefit, although differences between scenarios were not statistically significant. In the nonoperative scenario, worsening bladder control (56.6%) and neck pain interfering with sleep (53.0%) were the strongest influences, exceeding needing a cane to walk (32.1%). Conclusions. Treatment decisions for mild CSM are driven primarily by the expected permanence of adverse events and their anticipated impact on daily quality of life, rather than by conventional neurological metrics or surgical benefit framing.

Background: Early defibrillation is a key factor of survival following out of hospital cardiac arrest (OHCA). In the United Kingdom, initial anterior lateral (AL) defibrillator pad placement is standard practice. However, anterior posterior (AP) pad positioning has been proposed as a method of improving current flow through the myocardium particularly in cases of refractory ventricular fibrillation (VF). Concerns remain regarding potential delays to defibrillation associated with alternative pad placement strategies and the practical application of AP positioning. Objective: We conducted two consecutive simulation studies to explore whether there is a difference in the time taken to apply defibrillator pads, and placement accuracy, between AP and AL positions during simulated OHCA. Methods: This research study comprised of two simulation studies. First, we evaluated pad placement accuracy before and after written instruction showing optimal pad placement (RESTART SIM accuracy). Second, we undertook a randomised crossover examining time to pad placement, timing to successful pad application was recorded for each attempt (RESTART SIM speed). Results: RESTART SIM (accuracy) out of 14 participants 50% correctly placed AL pads and 14% correctly placed AP pads initially. Following provision of guidance this increased to 93% for AL but remained at 14% for AP placement. 9 participants completed RESTART SIM (speed). Mean AP pad placement time was 14.2 seconds and standard deviation of 2.64, compared with 10.6 seconds for AL placement and a standard deviation of 4.24. AP first strategy mean placement time was 15.3 seconds and mean AL placement time was 11.5 seconds. In AL first mean AP placement time was 12.8 seconds and mean AL placement time was 9.6 seconds. Conclusion: AP pad placement whilst slower than AL placement the time difference of 4 seconds is unlikely to be clinically significant. However, without guidance, both AL and AP placements were often inaccurate. After a guidance picture AL placement was increased but AP remained poorly placed.

Structural musculoskeletal pain, defined as pain associated with musculoskeletal conditions of the spine and peripheral joints, afflicts persons widely, independent of demographic, and continues to contribute substantially to disability on a global scale. Osteopathic manipulative treatment (OMT) is a non-invasive therapy performed by osteopathic physicians, encompassing a wide variety of techniques meant to heal the dysfunctions manifesting structural musculoskeletal pain. However, the efficacy of OMT in relieving pain symptomatology remains subject to debate. This meta-analysis examines the effect OMT serves to manage structural musculoskeletal pain, measured on a Visual Analog Scale. Three randomized control studies (RCTs) were included, with a total of 231 participants, 117 of which received OMT as part of pain management treatment, the other 114 receiving other treatment modalities. Using the random effects model, the mean difference between OMT and non-OMT treated groups was -1.80 (-7.31; 3.78). Although this mean difference favors OMT with regard to greater reduction in pain, the finding is not statistically significant. Heterogeneity was found to be extraordinarily high (I2 = 96%) and statistically significant (p = <0.0001), albeit attributed to one of the papers, deemed an outlier. With its removal, heterogeneity was still moderate (I2 = 54.4%). Given these findings, the efficacy of OMT in reducing structural musculoskeletal pain cannot be proven. A significant limitation of this study was a low sample size, consisting of 3 RCTs, reducing statistical power. In addition, there was high heterogeneity between studies. More high-quality RCTs with larger sample sizes, standardized methods, and an examination of a broader set of structural musculoskeletal conditions are necessitated to better evaluate the contribution of OMT in pain reduction. Key Words: Pain Management, Osteopathic Manipulative Medicine, Osteopathic Manipulative Treatment, Structural Pain, Orthopaedics, Knee Arthritis, Shoulder Pain, Cervical Spondylosis

Background: Cervical cancer (CC), mostly associated with high-risk human papillomaviruses (hrHPV) infection, is the most common cancer that disproportionately affects women in developing countries, including Ethiopia. Early detection of CC and initiation of treatment are key to positive health outcomes. Identifying factors associated with delayed CC diagnosis is essential for effective prevention and control efforts. This study assessed the stage at diagnosis and examined associated clinical and sociodemographic factors. Methods: An institution-based cross-sectional study was conducted among 284 women newly diagnosed with CC who attended Tibebe Ghion Specialized Hospital (TGSH) between 1st January 2021 and 31st December 2022. A structured questionnaire was used to collect data on the participants' demographic, reproductive, and gynaecologic history, and clinical profiles. The CC stage at diagnosis was categorised as early (stage I-IIA) or late (stage IIB-IV). Logistic regression models (unadjusted and adjusted) were used to examine associations of sociodemographic or clinical factors with stage at CC diagnosis. Results: The mean age ({+/-}standard deviation) at presentation was 53.2 {+/-} 11.3 years, with an age range of 18 - 80 years. Most of the patients (73.6%) were from rural areas, and three-fifths (58.1%) had no medical insurance. Among participants, 74.6% (95% CI: 69.4, 79.6%) had late-stage CC. The odds of late-stage CC diagnosis were higher for women from rural areas (AOR: 2.21; 95% CI:1.18, 4.12; p<0.013), and those with anaemia (defined as <12 mg/dl haemoglobin) (AOR: 3.42; 95% CI: 1.88, 6.23; p<0.001). On the other hand, the odds of late-stage CC diagnosis were lower in HIV positive women (AOR:0.41; 95%CI:0.19, 0.88; p<0.021). Conclusion: The proportion of late-stage diagnosis among CC patients was high. Residential area, anaemia status, and HIV serostatus were factors associated with stage at CC diagnosis. These findings can inform screening efforts of CC and call for expanding of the screening services to the rural setting in order to reduce the burden of late-stage CC diagnosis.

Objective: The ocular surface is an integral unit of the visual system. Its smooth and wet surface which is maintained by the tear film, is the most important refractive interface of the visual system. This study compared ocular surface alterations among glaucoma subjects living with and without diabetes mellitus in a Owerri, Imo State, Nigeria Methods: Subjects diagnosed of glaucoma living with and without diabetes mellitus were included in the study. Ocular surface assessment included the Ocular Surface Disease Index (OSDI) questionnaire, and tear break-up time (TBUT). Descriptive statistics, independent samples t-test and Chi-square test were used to examine the data at 0.05 level of significance. Results: Considerable shorter tear break-up time (11.3 +/- 9.0s) was seen among glaucoma subjects living with diabetes mellitus than those living without diabetes mellitus (16.0 +/- 10.6s; p = 0.003), demonstrating the higher tear film instability. This was similarly reflected by the mean OSDI score, which was considerably higher in glaucoma patients living with diabetes mellitus (40.0 +/- 23.4) compared with those without diabetes mellitus (28.1 +/- 21.8; p = 0.001) showing a larger ocular surface symptom load. However, although the frequency of severe OSDI symptoms was greater in glaucoma subjects living with diabetes mellitus, the relationship between diabetes status and OSDI severity categories was not statistically significant ({chi} 2 = 7.584, p = 0.055). Conclusion: Diabetes mellitus significantly impacts the health of the ocular surface in glaucoma subjects. The combination of glaucoma and diabetes may result in more rapid tear film instability, increased ocular pain, and decreased quality of life and adherence to long-term glaucoma medication. Keywords: Glaucoma, Diabetes Mellitus, Tear Break Up Time, Ocular Surface Disease Index, Ocular surface symptoms

HIV infection significantly elevated the odds of cardiovascular diseases, including myocardial fibrosis. We aimed to determine the difference of late gadolinium enhancement (LGE), extracellular volume (ECV), T1, and T2 using cardiac magnetic resonance imaging (CMR) in patients living with HIV (PLWH) and healthy controls. The databases Scopus, Web of Science, Embase, and PubMed were searched systematically using relevant keywords. STATA version 17 was used for meta-analysis using random effect and fixed effect models for heterogeneous and non-heterogeneous analyses. An overall number of 13 studies were included in the current analysis involving 1425 PLWH and 766 healthy controls. PLWH showed significantly higher LGE (OR: 5.47, 95% CI: 1.90-15.64, p<0.001) and ECV (mean difference: 1.46, 95% CI: 0.21-2.71, p=0.02) compared to controls. However, differences in Left Ventricular Ejection Fraction (LVEF) were not significant (mean difference: -1.41, 95% CI: -2.81- -0.01, p=0.05). There were no meaningful disparities in pro B-type natriuretic peptide (BNP) values (mean difference: 8.67, 95% CI: 0.04-17.29, p=0.05) or T2 values (mean difference: 0.91 ms, 95% CI: -1.04-2.86, p=0.36), but T1 values were significantly higher in PLWH (mean difference: 13.78 ms, 95% CI: 9.16-18.40, p<0.001). In meta regression, LGE was correlated with nadir CD4 (z=-3.41, p-value<0.001). In addition, ECV was correlated with white race (Z=-3.97, p-value<0.001), Hepatitis C (Z=-2.08, p-value=0.037), and smoking (Z=2.05, p-value=0.041). HIV is related to a significantly elevated rate of myocardial fibrosis, and factors such as lower nadir CD4, white race, hepatitis C, and smoking were correlated with hepatitis C. Keywords: Myocardial fibrosis, HIV, AIDS, Cardiovascular diseases, Heart failure

Objectives To evaluate discrepancies between radiologists and referring physicians in the interpretation of diagnostic probabilities conveyed by common Japanese expressions used in radiology reports. Materials and Methods Fifteen expressions commonly used to convey diagnostic probabilities in radiology reports were selected by five attending radiologists. An anonymous online survey was distributed to 26 radiologists and 33 referring physicians at a single institution. Participants assigned a diagnostic probability (from 0% to 100% in 10% increments) to each expression. Differences in median probabilities between radiologists and referring physicians were analyzed using the Mann-Whitney U test. Variability in interpretation was assessed using interquartile range (IQR), with IQR [&ge;] 30% defined as substantial variability. Results All radiologists (26/26) and 97% of referring physicians (32/33) completed the survey. Seven of the 15 expressions showed statistically significant differences in interpretation between radiologists and referring physicians: "c/w" (80% vs. 60%; p = 0.031), the Japanese equivalents of "present" (100% vs. 100%; p = 0.024), "suspect of" (80% vs. 70%; p = 0.007), "possibly" (50% vs. 70%; p < 0.001), "unlikely" (10% vs. 10%; p = 0.022), "cannot be ruled out" (25% vs. 40%; p < 0.001), and "not inconsistent with" (80% vs. 90%; p = 0.008). Substantial variability in interpretation (IQR [&ge;] 30%) was observed for four expressions: "cannot be ruled out" (IQR, 10%-40%), "s/o" (IQR, 60%-90%), "c/w" (IQR, 50%-90%), and "not inconsistent with" (IQR, 70%-100%). Conclusion This study revealed that nearly half of the Japanese expressions commonly used to convey diagnostic probabilities were interpreted differently by radiologists and referring physicians. These discrepancies highlight the need for a standardized lexicon to improve clarity and consistency in radiology reporting.