This study aimed to systematically review evidence on the magnetic resonance imaging (MRI) findings—particularly postoperative ones—that correlate with the clinical outcomes to assess the adequacy of decompression surgery for degenerative lumbar spinal stenosis (LSS). Few studies have evaluated postoperative MRI findings and their correlation with clinical outcomes following decompression surgery for degenerative LSS. A comprehensive literature search was performed employing search engines. We analyzed postoperative MRI findings to identify those that correlated with clinical outcomes. Our study included 12 articles. Available literature indicated that certain postoperative MRI findings correlated with clinical outcomes and thus reflect the adequacy of decompression surgery. These findings included postoperative dural sac cross-sectional area (DSCA) expansion, amelioration in the grade of stenosis, reversion of nerve root sedimentation sign (SedSign), and absence of redundant nerve roots (RNRs). Postoperative MRI indicators—such as DSCA expansion, improved stenosis grade, SedSign reversal, and absence of RNRs—correlate with clinical improvement and should be actively assessed to evaluate the adequacy of decompression surgery in LSS.

Introduction: The COVID -19 pandemic significantly impacted the mental health and wellbeing of healthcare workers worldwide. This study examined the prevalence and predictors of self -reported mental health problems, specifically depression, anxiety, stress, and burnout among government healthcare professionals in Brunei Darussalam during the second and subsequent waves of the pandemic. Materials and Methods : A cross -sectional online survey was distributed to all government healthcare workers employed by the Ministry of Health in Brunei Darussalam. The survey collected sociodemographic information and applied two validated tools: the Depression Anxiety Stress Scale 21 -item version (DASS -21) to assess the depression, anxiety, and stress, and the Oldenburg Burnout Inventory (OLBI) to measure burnout. Results : Of 1,759 invited healthcare workers, 704 responded (response rate 40.0%). The prevalence of common mental health problems and burnout were 32.4% and 71.7%, respectively. Older age was protective against common mental health problems. Performing clinical duties outside one's training scope, and direct involvement in managing COVID -19 patients were significant predictors of common mental health problems. Expatriate staff had significantly lower odds of burnout compared to Bruneian nationals. Shift work and additional administrative duties independently predicted burnout. A history of mental health problems and difficulty accessing mental health support were strongly associated with both outcomes. Conclusions : This study identified a substantial burden of depression, anxiety, stress, and burnout among government healthcare professionals in Brunei Darussalam, with distinct vulnerable subgroups. These findings highlight the need for targeted mental health interventions, improved access to support services, and systemic workplace strategies to safeguard the wellbeing of the healthcare workforce. The Brunei International Medical Journal (BIMJ) is a peer -reviewed official publication of the Ministry of Health and Universiti Brunei Darussalam, under the auspices of the Clinical Research Unit, Ministry of Health, Brunei Darussalam. The BIMJ publishes articles ranging from original research papers, review articl es, medical practice papers, special reports, audits, case reports, images of interest, education and technical/innovation papers, editorials, commentaries, and letters to the Editor. Topics of interest include all subjects related to clinical practice and research in all branches of medicine, both basic and clinical, including topics related to allied health care fields. The BIMJ welcome s manuscripts from contributors but usually solicits review articles and special reports. Proposals for review papers can be sent directly to the Managing Editor. Please refer to the contact inf ormation of the Editorial Office. DISCLAIMER: All articles published, including editorials and letters, represent the opinions of the contributors and do not reflect the o fficial views or policies of the Clinical Research Unit, the Ministry of Health, or the institutions with which the contributors are affiliated, unless clearly stated. The appearance of advertisements does not constitute an endorsement by the Clinical Research Unit or the Ministry of Health, Brunei Darussalam. Furthermore, the publisher cannot accept responsibility for the c orrectness or accuracy of the advertisers' text, claims, or any bimjonline@gmail.com www.bimjonline.com Author Details: 1 Psychiatry Services, Ministry of Health, Brunei Darussalam 2 Dorset Healthcare University NHS Foundation Trust, United Kingdom 3 Community Psychology Division, Ministry of Health, Brunei Darussalam 4 PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam 5 Department of Forensic Psychiatry, NHS Forth Valley, United Kingdom 6 Primary Health Care, Ministry of Health, Brunei Darussalam 25 Mikhail SOLIMAN1,2*, Fauziyyah MANAP3, Nur Syahirah CHUA3, Rina RAHMAD3, Hjh Rozailah RAHMAN3, Hanif ABDUL RAHMAN4, Najib NAIBI6, Kartini TUDIN1, Hilda HO1,5

Introduction: The COVID -19 pandemic significantly impacted the mental health and wellbeing of healthcare workers worldwide. This study examined the prevalence and predictors of self -reported mental health problems, specifically depression, anxiety, stress, and burnout among government healthcare professionals in Brunei Darussalam during the second and subsequent waves of the pandemic. Materials and Methods : A cross -sectional online survey was distributed to all government healthcare workers employed by the Ministry of Health in Brunei Darussalam. The survey collected sociodemographic information and applied two validated tools: the Depression Anxiety Stress Scale 21 -item version (DASS -21) to assess the depression, anxiety, and stress, and the Oldenburg Burnout Inventory (OLBI) to measure burnout. Results : Of 1,759 invited healthcare workers, 704 responded (response rate 40.0%). The prevalence of common mental health problems and burnout were 32.4% and 71.7%, respectively. Older age was protective against common mental health problems. Performing clinical duties outside one's training scope, and direct involvement in managing COVID -19 patients were significant predictors of common mental health problems. Expatriate staff had significantly lower odds of burnout compared to Bruneian nationals. Shift work and additional administrative duties independently predicted burnout. A history of mental health problems and difficulty accessing mental health support were strongly associated with both outcomes. Conclusions : This study identified a substantial burden of depression, anxiety, stress, and burnout among government healthcare professionals in Brunei Darussalam, with distinct vulnerable subgroups. These findings highlight the need for targeted mental health interventions, improved access to support services, and systemic workplace strategies to safeguard the wellbeing of the healthcare workforce. The Brunei International Medical Journal (BIMJ) is a peer -reviewed official publication of the Ministry of Health and Universiti Brunei Darussalam, under the auspices of the Clinical Research Unit, Ministry of Health, Brunei Darussalam. The BIMJ publishes articles ranging from original research papers, review articl es, medical practice papers, special reports, audits, case reports, images of interest, education and technical/innovation papers, editorials, commentaries, and letters to the Editor. Topics of interest include all subjects related to clinical practice and research in all branches of medicine, both basic and clinical, including topics related to allied health care fields. The BIMJ welcome s manuscripts from contributors but usually solicits review articles and special reports. Proposals for review papers can be sent directly to the Managing Editor. Please refer to the contact inf ormation of the Editorial Office. DISCLAIMER: All articles published, including editorials and letters, represent the opinions of the contributors and do not reflect the o fficial views or policies of the Clinical Research Unit, the Ministry of Health, or the institutions with which the contributors are affiliated, unless clearly stated. The appearance of advertisements does not constitute an endorsement by the Clinical Research Unit or the Ministry of Health, Brunei Darussalam. Furthermore, the publisher cannot accept responsibility for the c orrectness or accuracy of the advertisers' text, claims, or any bimjonline@gmail.com www.bimjonline.com Author Details: 1 Psychiatry Services, Ministry of Health, Brunei Darussalam 2 Dorset Healthcare University NHS Foundation Trust, United Kingdom 3 Community Psychology Division, Ministry of Health, Brunei Darussalam 4 PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam 5 Department of Forensic Psychiatry, NHS Forth Valley, United Kingdom 6 Primary Health Care, Ministry of Health, Brunei Darussalam 25 Mikhail SOLIMAN1,2*, Fauziyyah MANAP3, Nur Syahirah CHUA3, Rina RAHMAD3, Hjh Rozailah RAHMAN3, Hanif ABDUL RAHMAN4, Najib NAIBI6, Kartini TUDIN1, Hilda HO1,5

Objective: To prove 5-time sit-to-stand (5-STS) and 30-second sit-to-stand (30sSTS) tests in assessing cardiorespiratory fitness in chronic heart failure (HF) patients with systolic dysfunction. Alternative tests, such as 5-STS and 30sSTS, may be used to assess cardiorespiratory fitness in patients with HF but have not been thoroughly evaluated. Thus, this study aimed to prove 5-STS and 30sSTS tests in assessing cardiorespiratory fitness in chronic HF patients with systolic dysfunction. Methods: A cross-sectional study was done, evaluating chronic HF patients with systolic dysfunction that have received optimal guideline directed medical treatment for at least 3 months. All patients underwent the same intervention on the same day, starting with an initial 5-STS test, followed by a 30sSTS, and a 6-minute walk test (6MWT). Results: A total of 34 patients were enrolled in this study. The median left ventricular ejection fraction was 44% (interquartile range=34%–48%). Mean values of 5-STS, 30sSTS, and 6MWT were 13.90±4.72, 13.29±3.38, and 463.65±87.04, respectively. 5-STS showed moderate correlation with 6MWT (r=-0.436, p=0.01). However, the 30sSTS revealed strong correlation with 6MWT (r=0.629, p<0.001). Conclusion The 30sSTS test had strong correlation with 6MWT. It could be used to illustrate cardiorespiratory fitness in chronic HF patients with systolic dysfunction.

Objective: To prove 5-time sit-to-stand (5-STS) and 30-second sit-to-stand (30sSTS) tests in assessing cardiorespiratory fitness in chronic heart failure (HF) patients with systolic dysfunction. Alternative tests, such as 5-STS and 30sSTS, may be used to assess cardiorespiratory fitness in patients with HF but have not been thoroughly evaluated. Thus, this study aimed to prove 5-STS and 30sSTS tests in assessing cardiorespiratory fitness in chronic HF patients with systolic dysfunction. Methods: A cross-sectional study was done, evaluating chronic HF patients with systolic dysfunction that have received optimal guideline directed medical treatment for at least 3 months. All patients underwent the same intervention on the same day, starting with an initial 5-STS test, followed by a 30sSTS, and a 6-minute walk test (6MWT). Results: A total of 34 patients were enrolled in this study. The median left ventricular ejection fraction was 44% (interquartile range=34%–48%). Mean values of 5-STS, 30sSTS, and 6MWT were 13.90±4.72, 13.29±3.38, and 463.65±87.04, respectively. 5-STS showed moderate correlation with 6MWT (r=-0.436, p=0.01). However, the 30sSTS revealed strong correlation with 6MWT (r=0.629, p<0.001). Conclusion The 30sSTS test had strong correlation with 6MWT. It could be used to illustrate cardiorespiratory fitness in chronic HF patients with systolic dysfunction.

Objective: To prove 5-time sit-to-stand (5-STS) and 30-second sit-to-stand (30sSTS) tests in assessing cardiorespiratory fitness in chronic heart failure (HF) patients with systolic dysfunction. Alternative tests, such as 5-STS and 30sSTS, may be used to assess cardiorespiratory fitness in patients with HF but have not been thoroughly evaluated. Thus, this study aimed to prove 5-STS and 30sSTS tests in assessing cardiorespiratory fitness in chronic HF patients with systolic dysfunction. Methods: A cross-sectional study was done, evaluating chronic HF patients with systolic dysfunction that have received optimal guideline directed medical treatment for at least 3 months. All patients underwent the same intervention on the same day, starting with an initial 5-STS test, followed by a 30sSTS, and a 6-minute walk test (6MWT). Results: A total of 34 patients were enrolled in this study. The median left ventricular ejection fraction was 44% (interquartile range=34%–48%). Mean values of 5-STS, 30sSTS, and 6MWT were 13.90±4.72, 13.29±3.38, and 463.65±87.04, respectively. 5-STS showed moderate correlation with 6MWT (r=-0.436, p=0.01). However, the 30sSTS revealed strong correlation with 6MWT (r=0.629, p<0.001). Conclusion The 30sSTS test had strong correlation with 6MWT. It could be used to illustrate cardiorespiratory fitness in chronic HF patients with systolic dysfunction.

Pedicle screws are commonly used for vertebral instrumentation, and a postoperative computed tomography (CT) scan is used to evaluate their position within the pedicle. Medial pedicle screw breaching occurs in 20%–40% of cases. This study investigated the correlation between radiographically evident medial breaching and the incidence of nerve injury, shedding light on the clinical implications. A literature search was conducted on biomedical databases regarding neurologic deficits associated with medially breached pedicle screws with pre-defined inclusion and exclusion criteria. The methodology of the included studies was analyzed, and a systematic review and meta-analysis were performed to investigate the correlation between medial breach on axial CT and clinical neurologic deficits. Our study included thirteen articles. Medial breaches <2 mm caused no neurologic deficit. Medial breaches of 2–4 mm increased the risk of neurologic deficit by 83%, with a risk ratio of 0.17. Breaches exceeding 4 mm increased the risk by 90%, with a risk ratio of 0.1, and were associated with radiculopathy or muscle weakness in 25%–100% of cases. Medial pedicle screw breaches <2 mm are safe, carrying no risk of neurologic injury. Breaches exceeding ≥2 mm significantly increase this risk. For patients experiencing new neurologic deficit (sensory or motor) after pedicle screw instrumentation, particularly in lumbar vertebrae, a postoperative axial CT scan is recommended to identify breaches exceeding 2 mm as the potential cause of neurologic deficit.

Pedicle screws are commonly used for vertebral instrumentation, and a postoperative computed tomography (CT) scan is used to evaluate their position within the pedicle. Medial pedicle screw breaching occurs in 20%–40% of cases. This study investigated the correlation between radiographically evident medial breaching and the incidence of nerve injury, shedding light on the clinical implications. A literature search was conducted on biomedical databases regarding neurologic deficits associated with medially breached pedicle screws with pre-defined inclusion and exclusion criteria. The methodology of the included studies was analyzed, and a systematic review and meta-analysis were performed to investigate the correlation between medial breach on axial CT and clinical neurologic deficits. Our study included thirteen articles. Medial breaches <2 mm caused no neurologic deficit. Medial breaches of 2–4 mm increased the risk of neurologic deficit by 83%, with a risk ratio of 0.17. Breaches exceeding 4 mm increased the risk by 90%, with a risk ratio of 0.1, and were associated with radiculopathy or muscle weakness in 25%–100% of cases. Medial pedicle screw breaches <2 mm are safe, carrying no risk of neurologic injury. Breaches exceeding ≥2 mm significantly increase this risk. For patients experiencing new neurologic deficit (sensory or motor) after pedicle screw instrumentation, particularly in lumbar vertebrae, a postoperative axial CT scan is recommended to identify breaches exceeding 2 mm as the potential cause of neurologic deficit.

Pedicle screws are commonly used for vertebral instrumentation, and a postoperative computed tomography (CT) scan is used to evaluate their position within the pedicle. Medial pedicle screw breaching occurs in 20%–40% of cases. This study investigated the correlation between radiographically evident medial breaching and the incidence of nerve injury, shedding light on the clinical implications. A literature search was conducted on biomedical databases regarding neurologic deficits associated with medially breached pedicle screws with pre-defined inclusion and exclusion criteria. The methodology of the included studies was analyzed, and a systematic review and meta-analysis were performed to investigate the correlation between medial breach on axial CT and clinical neurologic deficits. Our study included thirteen articles. Medial breaches <2 mm caused no neurologic deficit. Medial breaches of 2–4 mm increased the risk of neurologic deficit by 83%, with a risk ratio of 0.17. Breaches exceeding 4 mm increased the risk by 90%, with a risk ratio of 0.1, and were associated with radiculopathy or muscle weakness in 25%–100% of cases. Medial pedicle screw breaches <2 mm are safe, carrying no risk of neurologic injury. Breaches exceeding ≥2 mm significantly increase this risk. For patients experiencing new neurologic deficit (sensory or motor) after pedicle screw instrumentation, particularly in lumbar vertebrae, a postoperative axial CT scan is recommended to identify breaches exceeding 2 mm as the potential cause of neurologic deficit.

Purpose: This systematic review aims to assess and summarize the clinical values of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameter changes as early biomarkers of tumor responses following radiation therapy (RT) in patients with spinal metastases. Materials and Methods: A systematic search was conducted on five electronic databases: PubMed, Scopus, Science Direct, Cochrane, and Embase. Studies were included if they mentioned DCE-MRI parameter changes before and after RT in patients with spinal metastases with a correlation to tumor responses based on clinical and imaging criteria. The Quality Assessment of Diagnostic Accuracy Studies 2 was used to assess study quality. Results: This systematic review included seven studies involving 107 patients. All seven studies evaluated the transfer constant (Ktrans), six studies evaluated the plasma volume fraction (Vp), three studies evaluated the extravascular extracellular space volume fraction, and two studies evaluated the rate constant. There were variations in the type of primary cancer, RT techniques used, post-treatment scan time, and median follow-up time. Despite the variations, however, the collected evidence generally suggested that significant differences could be detected in DCE-MRI parameters between before and after RT, which might reflect treatment success or failures in long-term follow-up. Responders showed higher reduction and lower values of Ktrans and Vp after RT. DCE-MRI parameters showed changes and detectable recurrences significantly earlier (up to 6 months) than conventional MRI with favorable diagnostic values. Conclusion The results of this systematic review suggested that DCE-MRI parameter changes in patients with spinal metastases could be a promising tool for treatment-response assessment following RT. Lower values and higher reduction of Ktrans and Vp after treatment demonstrated good prediction of local control. Compared to conventional MRI, DCE-MRI showed more rapid changes and earlier prediction of treatment failure.