Chronic low back pain (LBP) is common and associated with lumbar disc herniation. The purpose of this study was to investigate if the grade of lumbar disc degeneration correlates with the degree of lumbar multifidus muscle (LMM) fatty atrophy. A retrospective analysis on 16 males and 19 females with chronic LBP and a mean age of 47.2 years. Using MRI, the grade of lumbar intervertebral discs degeneration was assessed according to the Pfirrmann classification at L4/L5 and L5/S1 levels. Fatty infiltration of the LMM was graded as normal, mild, moderate and severe. Adobe Photoshop CS6 was used for qualitative image analysis by measuring the Cross-sectional area (CSA) of the pure fat component of LMM. There was a low correlation (R = 0.37) and significant association (ANOVA, p = 0.001, 95% CI 2.07–8.14) between the grade of lumbar disc degeneration and the degree of LMM fatty atrophy. Mean value of intervertebral disc degeneration was 2.9 for the L4/L5 level and 3.2 for L5/S1 respectively. The percentage of fat infiltration of the LMM at both studied levels showed a mean value of 22.91+/− 13.19% for L4/L5 and a higher mean value of 26.37+/− 12.89% for L5/S1. There were higher fatty atrophy scores in women and more disc degeneration in men. The percentage of LMM atrophy is higher in the lower levels (L5/S1) and shows a low correlation with the grade of disc degeneration.

Occult hip fractures are often difficult to identify in busy trauma units. We aimed to present our institutions experience in the diagnosis and treatment of occult fractures around the hip and to help define a clinical and radiological management algorithm. We conducted a seven-year retrospective hospital medical record analysis. The electronic database was searched for ICD-10 CM codes S72.0 and S72.1 used for proximal femoral fractures upon patient discharge. We identified 34 (4.83 %) femoral neck fractures and 48 (4.42 %) trochanteric fractures labeled as occult. The majority of the cases were diagnosed by primary MRI scan (57.4 %) and 12 were diagnosed by emergency CT scan (14.6 %). For the remaining cases the final diagnosis was confirmed by 72 h CT scan in 9 patients (representing 39 % of the false negative cases) or by MRI in the rest of 14 patients. MRI was best at detecting incomplete pertrochanteric fracture patterns (13.45 % of total) and incomplete fractures of the greater trochanter (3.65 % of total) respectively. It also detected the majority of Garden I femoral neck fractures (20.7 % of total). CT scanning accurately detected 100 % of Garden 2 fractures (2.44 %) and 25 % (3.65 %) of the complete pertrochanteric fractures (false negative 25 %). Occult fractures should be suspected in all patients with traumatic onset of hip pain that is inconsistent with normal radiographic findings. MRI is the golden standard but not as readily available not as cheap and not quite as quick to perform as as a CT scan. The latter which in turn can provide falsely negative results in the first 24 h. Improved imaging protocols could expedite management and improve treatment.

Background/Objectives: Several studies have addressed the validity of ultrasound (US) for body composition assessment, but few have evaluated its reliability. This study aimed to determine the reliability of percent body fat (%BF) estimates using A-mode US in a heterogeneous sample. Subjects/Methods: A group of 144 healthy adults (81 men and 63 women), 30.4 (10.1) years (mean (SD)), BMI 24.6 (4.7) kg/m², completed 6 consecutive measurements of the subcutaneous fat layer thickness at 8 anatomical sites. The measurements were done, alternatively, by two testers, using a BodyMetrix™ instrument. To compute %BF, 4 formulas from the BodyView™ software were applied: 7-sites Jackson and Pollock, 3-sites Jackson and Pollock, 3-sites Pollock, and 1-point biceps. Results: The formula with the most anatomic sites provided the best reliability quantified by the following measures: intraclass correlation coefficient (ICC) = 0.979 for Tester 1 (T1) and 0.985 for T2, technical error of measurement (TEM) = 1.07% BF for T1 and 0.89% BF for T2, and minimal detectable change (MDC) = 2.95% BF for T1, and 2.47% BF for T2. The intertester bias was −0.5% BF, whereas the intertester ICC was 0.972. The intertester MDC was 3.43% BF for the entire sample, 3.24% BF for men, and 3.65% BF for women. Conclusions: A-mode US is highly reliable for %BF assessments, but it is more precise for men than for women. Examiner performance is a source of variability that needs to be mitigated to further improve the precision of this technique.

Clostridioides difficile (C. difficile) is a common cause of nosocomial diarrhea. The multi‑modal infection control strategies designed to contain the COVID‑19 pandemic have had an unintended positive effect on other hospital‑acquired infections. The aim of the present study was to analyze the impact of the COVID‑19 prevention measures on healthcare‑associated C. difficile infections in a large regional acute care center. Electronic databases were reviewed from the start of the pandemic (March) up to November 2020. Average values from the same months from 2019 and 2018 were used as controls. Using the ICD‑10 discharge coding, 65 C. difficile cases per 25,124 patients were identified in 2020 compared to 151/43,126 from the 2018 and 2019 averages (P=0.0484). The C. difficile cases were found to be decreased after the implementation of COVID‑19 infection control strategies compared to previous years, despite an increase in antibiotic use. Subset analysis during lockdown showed a clear decrease but the difference was not statistically significant. For the months of recovery after lockdown, the number of cases was comparable to previous years.

Aim: We aimed to translate and cross-culturally adapt the International Knee Documentation Committee—subjective knee form (IKDC) in Romanian.Method: The original (US) IKDC—subjective knee form was translated according to recommended guidelines. Validity was tested using Spearmans’s correlation coefficient between score sand test-retest reproducibility. Reliability and internal consistency were determined using Cronbach’s alpha coefficient and intraclass correlation coefficient (ICC).Results: A total of 106 data sets were available for processing. The average age was 52 years and the male to female ratio was 40:66. Fifty-five subjects repeated the form after an average of 4 days. There were no floor or ceiling effects (range 3.4–74.7). There was a strong correlation between the first and repeated administration of the IKDC—subjective knee form (r = 0.816,n = 50) and moderate compared to Tegner-Lysholm knee rating scale (r = 0.506,n = 102), KOOSJR (Knee disability and Osteoarthritis Outcome Score for Joint Replacement,r = − 0.622,n = 96), EuroqolEQ-5D-5L Index (r = 0.633,n = 100) and visual analogue scale VAS (r = 0.484,n = 99). Internal consistency was moderate with Cronbach’s alpha 0.611 (n = 102) and ICC 0.611 for average measures (95% CI 0.493–0.713).Conclusion: The Romanian translation of the IKDC—subjective knee form is a valid, consistent and reproducible outcome measure in patients with knee pain and dysfunction.