Shaikh Zayed Hospital

e17082 Background: Prostate cancer (PC) is one of the leading causes of death among men in the United States and represents a major public health burden. Tobacco use contributes to PC through carcinogen-induced DNA damage, chronic inflammation, and oxidative stress, particularly among men aged ≥55 years bearing the highest mortality burden. Existing literature is only focused on the mortality due to PC but the major contributing factor such as tobacco addiction needs to be addressed; therefore, this study aims to analyze the national mortality trends due to PC and tobacco use. Methods: National mortality trends involving prostate cancer (C61) and tobacco use (F17, T65.2) were examined using data from the Centers for Disease Control and Prevention WONDER database. Age-adjusted mortality rates (AAMR) per 1 million of adults aged ≥55 years, and temporal changes were quantified using Joinpoint regression to evaluate Average Annual Percentage Change (AAPC) and 95% confidence interval (CI). Results: Between 1999 and 2024, 65,035 deaths were attributed to prostate cancer with concurrent tobacco use, with a sustained overall increase in mortality (AAPC: 10.1; 95% CI: 4.8–15.8). Rising trends were observed across racial groups, including Non-Hispanic (NH) Black/African American (AAPC: 11.7; 95% CI: 8.1–15.3) and NH White populations (AAPC: 12.0; 95% CI: 10.0–14.1). Mortality increased across all census regions, with the steepest incline in the Northeast (AAPC: 13.9; 95% CI: 11.1–16.7), followed by the South (AAPC: 12.0; 95% CI: 8.9–15.2), Midwest (AAPC: 11.1; 95% CI: 9.2–13.0), and West (AAPC: 9.3; 95% CI: 7.6–11.0). Urban–rural differences were evident, with mortality increasing in both metropolitan (AAPC: 13.8; 95% CI: 11.3–16.4) and non-metropolitan areas (AAPC: 14.6; 95% CI: 11.6–17.6). Age-specific analysis demonstrated the most profound increase in mortality among older individuals aged 75–85+ years bearing the burden of 42,178 deaths with a persistent increase (AAPC: 12.2; 95% CI: 10.3–14.2) followed by the individuals aged 55–74 years with 22,857 deaths (AAPC: 9.1; 95% CI: 4.2–14.3). Conclusions: Mortality involving PC and tobacco use has increased substantially over the past two decades, with consistently increasing trends across geo-demographic variables. Older adults (75-85+ years) experience both a higher prevalence of tobacco use and an increased risk of PC, contributing to elevated mortality, underscoring the need for effective population-level tobacco control interventions according to the WHO Framework Convention on Tobacco Control. There is also a need to integrate the tobacco addiction management into targeted prevention strategies including tobacco cessation services, age-specific screening initiatives, and advancements in diagnostic and treatment modalities to mitigate the risk of PC associated mortality.

OBJECTIVE:To measure the morphology of the pelvic floor muscle and levator ani hiatus (LAH) using 3D MRI segmentation in females with (SUI) and to assess correlations with age, body mass index (BMI), and parity. METHODS:This study includes 80 patients with SUI who underwent 3.0 T pelvic MRI. Patients were grouped based on age, BMI, and parity. Manual segmentation and 3D modeling of the pelvic floor muscle and LAH were performed to get volumetric and dimensional measurements. Statistical analysis included Kruskal-Wallis, Mann-Witney, and post hoc testing to evaluate group variations. RESULTS:The cohort included patients from 20 to 90 years old (mean 53.9 ± 11.7), with a mean BMI of 25.3 ± 3.4 and a mean parity of 1.85 ± 1.03. Significant variations in LAM surface (H(2) = 6.650, p = 0.036), flatness (H(2) = 6.471, p = 0.039), median intensity (H(2) = 8.218, p = 0.016), and curvature mean (H(2) = 7.382, p = 0.025) among age groups. The greatest LAM surface rankings were found in the 50-65 age range, whereas the highest LAM flatness ranks were found in those over 65 years old. BMI demonstrated a limited association, with overweight/obese participants exhibiting 11.3% larger LAM surface area compared to normal/underweight individuals (p = 0.044, r = 0.225). No significant associations were found between parity and any pelvic floor morphometric parameters (all p > 0.05). CONCLUSION:This study identifies age-dependent morphological changes in levator ani muscle architecture as the primary determinant of pelvic floor structural adaptation in women with stress urinary incontinence. These quantitative shape-based parameters offer novel diagnostic and therapeutic insights, advancing precision medicine approaches in urogynecological assessment and management.

BACKGROUND:Fibromyalgia syndrome (FMS) is a chronic disorder characterized by widespread musculoskeletal pain, often accompanied by fatigue, sleep disturbance, and cognitive impairment. Neuropathic pain is an important but underrecognized component of FMS, which significantly worsens disease burden. Micronutrient deficiencies, particularly serum vitamin B12 and ferritin, are suggested to influence pain perception and neuronal function, yet their role in FMS remains unclear, especially in Pakistan. OBJECTIVES:To determine the association of serum vitamin B12 and ferritin levels with neuropathic pain and disease severity in patients with fibromyalgia. STUDY DESIGN AND SETTING:A cross-sectional analytical study conducted at the Department of Medicine, Shaikh Zayed Hospital, Lahore, Pakistan, from January to June 2025. METHODOLOGY:A total of 241 patients fulfilling the American College of Rheumatology (ACR 2016) criteria for FMS were enrolled. Demographic data, Fibromyalgia Impact Questionnaire-Revised (FIQR) scores, and Douleur Neuropathique en 4 Questions (DN4) scores were recorded. Serum vitamin B12 and ferritin levels were measured. Independent sample t-test and chi-square test were applied for comparisons, and multivariable logistic regression was performed to identify predictors of neuropathic pain, with p < 0.05 considered significant. RESULTS:Mean age of participants was 46.0 ± 15.6 years, with female predominance (77.6%). Neuropathic pain was present in 58.5% of cases. Patients with neuropathic pain had significantly higher FIQR (52.7 ± 9.5 vs. 41.0 ± 8.9, p < 0.001) and DN4 scores (5.8 ± 1.4 vs. 2.8 ± 1.0, p < 0.001). Serum vitamin B12 and ferritin levels were lower in neuropathic patients (p = 0.001 and p = 0.005, respectively). Multivariable regression identified FIQR score as the strongest predictor of neuropathic pain (OR = 1.159, 95% CI: 1.112-1.208, p < 0.001). CONCLUSION:Neuropathic pain is highly prevalent in FMS and is strongly associated with disease severity. Although vitamin B12 and ferritin showed lower levels in affected patients, only disease severity independently predicted neuropathic pain. Larger longitudinal studies are warranted to clarify causal pathways and therapeutic implications.