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Purpose: Traditional direct ophthalmoscopy (TDO) is the oldest method of fundus examination; however, it has fallen out of use due to its technical difficulty and limitations to clinical utility, amidst the advent of potentially better options. A spectrum of new technologies may help in addressing the shortcomings of TDO: simulation mannequins with non-tracked TDO, simulation models with tracked TDO, and smartphone ophthalmoscopy (SFO). Methodology: A systematic search of PubMed, Embase, and Cochrane databases for all studies evaluating usage of simulation mannequins/models and SFO in ophthalmology education was performed, from inception till April 2023 with no language restriction. We ensured that we included all possible relevant articles by performing backward reference searching of included articles and published review articles. Results: We reviewed studies on non-tracked TDO (n = 5), tracked TDO (n = 3) and SFO (n = 12). Non-tracked TDO and SFO were superior in training competency relative to control (TDO on real eyes). Intriguingly, tracked TDO was non superior to controls. SFO appears to enhance the learning effectiveness of ophthalmoscopy, due to real-time projection of the retina view, permitting instantaneous and targeted feedback. Learners reported improved ergonomics, including a wider field of view and more comfortable viewing distance. Retention of images and recordings permitted the audit of learning and paves the way for storage of such images in patients' electronic medical record and rapid dissemination for specialist referral. Conclusions: Smartphone ophthalmoscopy (SFO) permits integration of both the practice and learning of ophthalmoscopy, and the auditing of both. These advantages over traditional methods (with simulation or otherwise) may lead to a paradigm shift in undergraduate ophthalmology education. However, the nascency of SFO necessitates preservation of traditional techniques to tide through this period of transition. [ABSTRACT FROM AUTHOR]

Endometriosis is a complex gynecologic disorder characterized primarily by symptoms of pelvic pain, infertility, and altered quality of life. National and international guidelines highlight the diagnostic difficulties and lack of conclusive diagnostic tools for endometriosis. Furthermore, guidelines are becoming questionable at an increasingly rapid rate as new diagnostic techniques emerge. This work aims to provide a knowledge synthesis of the relevance of various diagnostic tools and to assess areas of improvement of conventional algorithms. MEDLINE and Cochrane Library databases were searched from January 2021 to December 2023 using relevant key words. Articles evaluating the diagnostic relevance and performance of various tools were included and independently reviewed by the authors for eligibility. Included studies were assessed using the GRADE and QUADAS‐2 tools. Of the 4204 retrieved articles, 26 were included. While anamnesis and clinical examination do contribute to diagnostic accuracy, their level of evidence and impact on the diagnostic process remains limited. Although imaging techniques are recommended to investigate endometriosis, ultrasonography remains highly operator dependent. Magnetic resonance imaging appears to exhibit higher sensitivities than ultrasound. However, concerns persist with regards to the terminology, anatomical definition of lesions, and accuracies of both ultrasound and magnetic resonance imaging. Recently, several biological markers have been studied and cumulative evidence supports the contribution of noncoding RNAs to the diagnosis of endometriosis. Marginal improvements have been suggested for anamnesis, clinical examination, and imaging examinations. Conversely, some biomarkers, including the saliva microRNA signature for endometriosis, have emerged as diagnostic tools which inspire reflection on the revision of conventional diagnostic algorithms. Synopsis: Endometriosis diagnosis remains complex. In addition to anamnesis, clinical examination, and imaging techniques, biomarkers offer encouraging perspectives supporting their inclusion in diagnostic algorithms for endometriosis. [ABSTRACT FROM AUTHOR]

To evaluate the ability of blood-biomarkers, clinical examination, electrophysiology, or neuroimaging, assessed within 14 days from return of circulation to predict good neurological outcome in children following out- or in-hospital cardiac arrest. Medline, EMBASE and Cochrane Trials databases were searched (2010–2023). Sensitivity and false positive rates (FPR) for good neurological outcome (defined as either 'no, mild, moderate disability or minimal change from baseline') in paediatric survivors were calculated for each predictor. Risk of bias was assessed using the QUIPS tool. Thirty-five studies (2974 children) were included. The presence of any of the following had a FPR < 30% for predicting good neurological outcome with moderate (50–75%) or high (>75%) sensitivity: bilateral reactive pupillary light response within 12 h; motor component ≥ 4 on the Glasgow Coma Scale score at 6 h; bilateral somatosensory evoked potentials at 24–72 h; sleep spindles, and continuous cortical activity on electroencephalography within 24 h; or a normal brain MRI at 4-6d. Early (≤12 h) normal lactate levels (<2mmol/L) or normal s100b, NSE or MBP levels predicted good neurological outcome with FPR rate < 30% and low (<50%) sensitivity. All studies had moderate to high risk of bias with timing of measurement, definition of test, use of multi-modal tests, or outcome assessment heterogeneity. Clinical examination, electrophysiology, neuroimaging or blood-biomarkers as individual tests can predict good neurological outcome after cardiac arrest in children. However, evidence is often low quality and studies are heterogeneous. Use of a standardised, multimodal, prognostic algorithm should be studied and is likely of added value over single modality testing. [ABSTRACT FROM AUTHOR]

Introduction: Although breast pain as a sole symptom is very rarely associated with cancer, national guidelines recommend that all women with a complaint of breast pain have to be referred for ultrasound evaluation. This study sought to investigate the necessity of this practice., Methods: A retrospective study was conducted in consecutive women aged between 17 and 39 years, at average risk of breast cancer who presented at a major tertiary breast clinic with clinically significant breast pain (unilateral, unifocal, and noncyclic) in 2017-2023. Data on background, physical examination, imaging, and pathology were collected from the electronic medical records and analyzed by outcome., Results: The cohort included 814 women. Among the 574 women (70%) with a normal physical breast examination, ultrasound revealed normal findings or BI-RADS 1-2 lesions in 499 (87%), BI-RADS 3 lesions in 59 (10%), and BI-RADS 4 lesions in 16 (3%). Biopsies, performed in 30 BI-RADS 3 lesions and all BI-RADS 4 lesions, were benign. Half of the 337 patients with available follow-up data continued to attend the breast clinic (mean 3.5 ± 2.2 years). Among the 240 women (30%) with a palpable abnormality on breast examination, ultrasound revealed normal or benign BI-RADS 2 findings in 112 (47%), BI-RADS 3 lesions in 69 (29%), and BI-RADS 4-5 lesions in 59 (25%). Biopsies performed in BI-RADS 3 lesions (12%) were all benign. Biopsies, performed in all BI-RADS 4-5 lesions, yielded malignant pathology in 16 lesions (7%) (including IDC, DCIS, or angiosarcoma). The overall breast cancer risk was 2%. Ultrasound sensitivity was 94%, specificity 85%, and negative predictive value 99%. The negative predictive value for dedicated physical examination without imaging was 100%. The biopsy-proven positive predictive value was 0 in patients with a normal breast examination compared to 18% in patients with a palpable finding on breast examination ( p = 0.0017)., Conclusion: A subset of women <40 years old with average breast cancer risk and breast pain, who would normally be referred for imaging, can be triaged by a dedicated physical examination. Limiting ultrasound evaluation to those with palpable findings will spare patients and the healthcare system unnecessary radiology and biopsy studies., Competing Interests: The authors have no conflicts of interest to declare., (© 2025 S. Karger AG, Basel.)

Introduction: Free flaps on the lower limb could make the difference between salvage and amputation. Regional tissue oximetry (rSO₂) measured by near-infrared light is a tool that is not yet widely described or recognized, as most published studies focus on its use in breast flap monitoring. However, in the context of lower limb reconstruction, it offers an objective and real-time evaluation of flap tissue perfusion, enabling faster responses for salvage compared to traditional clinical monitoring., Material and Methods: We conducted a retrospective study comparing lower limb free flap monitoring using two techniques. Group A (June 2016-January 2020) used local real-time rSO 2 monitoring with the INVOS-TM 5100C Somatic Oximeter (Medtronic Inc., Minneapolis, MN); each patient had two sensors, one over the flap, another (control) over a nearby non-flap area. Group B (February 2013-May 2016) relied on traditional clinical examination., Results: A total of 148 free flaps were included (74 in each group). There was a small, non-significant difference in overall flap survival (Group A: 94.6% vs. Group B: 90.5%, p = 0.344). The flap salvage rate, when reoperated within the first 72 h, was higher but not significantly so (66% vs. 43%, p = 0.483) and significantly faster (121 vs. 181 min, p = < 0.001) in Group A. According to our study, INVOS demonstrated 100% sensitivity and negative predictive value (NPV), with 90% specificity., Conclusions: Regional tissue oximetry monitoring of lower limb free flaps is a real-time, objective, non-invasive, and reliable method for early detection of complications. This study allows us to affirm that the revisions of the flaps are statistically significantly faster. It also provides valuable information about anastomotic failure, clearly differentiating between arterial and venous issues, as well as identifying local or systemic issues., (© 2025 Wiley Periodicals LLC.)

Background: There is very little information available about the health status of young stallions from the German Warmblood population that will, once licensed, shape the future of equestrian sport and horse breeding., Objectives: To evaluate the prevalence of clinical findings at licensing examinations of candidate stallions and the influences of season of birth, age at licensing, year of licensing, and the evaluator on the distribution of recorded findings., Study Design: Retrospective observational study., Methods: Clinical records of 1655 candidate stallions presented for licensing in 2018-2020 were reviewed. Data were provided by all German Warmblood horse-breeding associations and their official veterinarians. Storage and processing of the records was performed using the German equine health database. Generalised linear models were used to determine the influences of fixed effects (season of birth, age at licensing, year of licensing, evaluator) on main clinical findings. The significance level was set at p < 0.05., Results: No remarks were documented on the clinical examination protocol in 777 of the 1655 horses (47.0%). Furthermore, 51.9% of those stallions with remarks had only one finding documented. The main abnormalities recorded were skin lesions, enlargements on the limbs, and testicular findings. The distributions of several clinical findings differed significantly between the evaluators., Main Limitations: Homogenous study population and retrospective data., Conclusions: The clinical part of the licensing examination of German Warmblood candidate stallions presented in 2018-2020 rarely revealed abnormalities. The majority of the clinical findings which were recorded are considered to be of minor clinical relevance, implying an overall favourable clinical health status of the presented stallions., (© 2025 The Author(s). Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.)

Cutaneous T-cell lymphomas (CTCL) are a heterogeneous group of extranodal non-Hodgkin's lymphomas characterised by a cutaneous infiltration of malignant monoclonal T lymphocytes. While this broad spectrum of disease with its varied etiopathogenesis, clinical features and management options are well characterised, an approach from a dermatologist's perspective is lacking in the literature. We strive to elucidate the approach from a clinician's point of view, especially in respect of clinical examination, investigations, staging and management options that are available in the realm of the dermatologists. This review article is the first part out of the two, covering the etiopathogenesis, clinical features and evaluation.