Category: Statistics

Cureus. 2026 Jun 24;18(6):e111410. doi: 10.7759/cureus.111410. eCollection 2026 Jun.

ABSTRACT

Background and objective Congenital hyperinsulinemic hypoglycemia (CHH) is the leading cause of persistent hypoglycemia in neonates and infants. In high-resource settings, diagnosis and management depend on rapid genetic testing and advanced imaging to differentiate focal from diffuse disease. However, in low-resource settings, limited diagnostic capacity and lack of access to medications often necessitate early surgical intervention. This study aimed to evaluate the clinical features, surgical intervention, and outcomes in infants undergoing pancreatectomy for congenital hyperinsulinism at Al Ribat University Hospital, Sudan. Methods A retrospective descriptive study was conducted, involving all pediatric patients who underwent pancreatectomy for CHH from January 2019 to December 2024. Data were extracted from operative logs and medical records, including demographics, diagnostic investigations, medical therapy, surgical procedures, postoperative complications, histopathology, and one-year outcomes. Descriptive statistics and appropriate inferential statistical tests were used for the analysis. Results Thirty-two patients were included, of whom 19 (59.4%) were female. The majority were diagnosed during the first week of life (n = 19, 59.4%). Diazoxide was administered to 30 (93.75%) patients, with only eight (26.7%) showing a therapeutic response. Restricted access to genetic testing (n = 8, 25%) and imaging (n = 6, 18.8%) resulted in the predominance of near-total pancreatectomy (n = 31, 96.9%). Intraoperative complications were minimal, with bleeding occurring in two cases (6.25%) and vascular injury in one case (3.1%). Early postoperative hypoglycemia was noted in 13 patients (40.6%), whereas hyperglycemia was noted in one patient (3.1%). Surgical complications included wound infection in seven patients (21.9%) and intestinal obstruction in one patient (3.1%). Histopathology confirmed CHH in all cases, with diffuse disease in 27 patients (84.4%). During a one-year follow-up period, three patients (9.4%) died, including two (6.3%) due to recurrent hypoglycemia. Conclusions Near-total pancreatectomy remains a practical and life-saving option for infants with medically unresponsive CHH in low-resource settings where diagnostic and pharmacologic limitations restrict individualized care. Despite limited access to preoperative localization and the predominance of diffuse disease, surgical outcomes were acceptable, with low intraoperative morbidity and manageable rates of postoperative complications. Persistent postoperative hypoglycemia and late mortality highlight the need for structured endocrine follow-up and improved access to medical therapy. Strengthening diagnostic capacity, ensuring medication availability, and establishing coordinated multidisciplinary care pathways are essential to improving long-term outcomes for children with CHH in resource-limited environments.

PMID:42500796 | PMC:PMC13397328 | DOI:10.7759/cureus.111410

Cureus. 2026 Jun 24;18(6):e111405. doi: 10.7759/cureus.111405. eCollection 2026 Jun.

ABSTRACT

Background Maternal health literacy is a key factor in helping women acquire, understand, and utilize health information during pregnancy. Poor health literacy may impede effective decision-making and impact maternal and newborn health. The objective of this study was to assess maternal health literacy and its association with pregnancy outcomes among postnatal women in Lahore, Pakistan. Methodology This analytical cross-sectional study was conducted among 374 postnatal women at the University of Lahore, Pakistan, between January 1, 2025, and June 30, 2025. The Maternal Health Literacy and Pregnancy Outcome Questionnaire recorded data, socio-demographic data, and obstetric data. IBM SPSS Statistics software, version 26.0 (IBM Corp., Armonk, NY), was used for statistical analyses. Data did not satisfy the assumption of normality, so nonparametric tests were used to explore associations among the study variables. Results Women with live births demonstrated significantly higher maternal health literacy scores than those reporting neonatal deaths (Mann-Whitney U = 214.5, p < 0.001). Pregnancy outcomes were significantly associated with educational status, household income, parity, neonatal birth weight, neonatal intensive care unit (NICU) admission, APGAR score, and maternal comorbidities (all p < 0.05). Conclusions Maternal health literacy was positively associated with favorable pregnancy outcomes. Further prospective studies are required to determine whether interventions aimed at improving maternal health literacy can improve maternal and neonatal outcomes.

PMID:42500794 | PMC:PMC13397089 | DOI:10.7759/cureus.111405

Cureus. 2026 Jun 24;18(6):e111404. doi: 10.7759/cureus.111404. eCollection 2026 Jun.

ABSTRACT

Background Ovarian neoplasms represent a heterogeneous category of tumors with different histogenesis, clinical behavior, and prognosis, thus presenting a major challenge in gynecological oncology. The most popular biomarker in ovarian cancer is serum cancer antigen 125 (CA-125). Hence, the purpose of our study is to assess the diagnostic accuracy of serum CA-125 to differentiate between benign and malignant ovarian tumors using clinicopathological correlation in a tertiary care institution. Methods This is an observational study, retrospective in nature, carried out in the Department of Pathology at Rajendra Institute of Medical Sciences (RIMS), Ranchi, over 18 months. A total of 76 histopathologically confirmed ovarian tumor cases with available clinical, radiological, and serum CA-125 data were included. Preoperative serum CA-125 levels were measured using a cutoff value of 35 U/mL. Tumors were categorized as benign, borderline, or malignant based on histopathological criteria. Statistical analysis was performed using SPSS (IBM SPSS Statistics for Windows, IBM Corp., Version 27, Armonk, NY). Results Out of 76 ovarian tumors, 55 (72.4%) were benign, two (2.6%) were borderline, and 19 (25.0%) were malignant. Epithelial tumors (46, 60.5%) were the most common histological type. Serous cystadenoma (16, 21.1%) was the most frequent subtype. Elevated CA-125 levels were observed in all malignant tumors (19, 100%), while most benign tumors (49, 89.1%) showed normal levels. Serum CA-125 demonstrated sensitivity of 100%, specificity of 87.7%, positive predictive value of 73.1%, negative predictive value of 100%, and overall diagnostic accuracy of 90.7%. Conclusion The present study indicates that ovarian tumors are mainly benign, and most histological subtypes are epithelial tumors. Serum CA-125 demonstrated an excellent sensitivity in the detection of malignant tumors of the ovary, with all the malignant tumors portraying high levels of CA-125. These results show that CA-125 is a useful biomarker for identifying malignant ovarian tumors. However, its interpretation should be made in conjunction with clinical, radiological, and histopathological findings.

PMID:42500789 | PMC:PMC13399596 | DOI:10.7759/cureus.111404

Cureus. 2026 Jun 24;18(6):e111431. doi: 10.7759/cureus.111431. eCollection 2026 Jun.

ABSTRACT

BACKGROUND: Iron deficiency anemia (IDA) has been increasingly associated with Helicobacter pylori (H. pylori) infection, especially in developing countries.

OBJECTIVE: This study aimed to evaluate the association between H. pylori infection and IDA severity and to compare hematological parameters between H. pylori-positive and -negative adult patients attending a tertiary care hospital.

METHODOLOGY: This was a cross-sectional analytical study conducted at Lady Reading Hospital, Peshawar, from January 2025 to December 2025. Consecutive non-probability sampling was used to recruit a total of 236 adult patients with IDA. Stool antigen testing was used to diagnose infection with H. pylori. Hematological parameters, such as hemoglobin, serum ferritin, serum iron, total iron-binding capacity (TIBC), and mean corpuscular volume (MCV), were determined. Data were analyzed using IBM SPSS Statistics, version 26, while the chi-square test and independent t-test were used to determine the association of the data.

RESULTS: H. pylori infection was positive in 136 (57.63%) patients and negative in 100 (42.37%). A significant association was observed between infection and moderate-to-severe anemia (p < 0.001, odds ratio (OR) = 2.58). Hemoglobin levels were significantly lower in infected patients (9.31 ± 1.42 vs. 10.72 ± 1.39 g/dL, p < 0.001). Similarly, serum ferritin (11.02 ± 5.10 vs. 19.48 ± 6.25 ng/mL, p < 0.001), serum iron (40.65 ± 11.02 vs. 59.37 ± 12.10 µg/dL, p < 0.001), TIBC (415.28 ± 39.21 vs. 354.62 ± 40.85 µg/dL, p < 0.001), and MCV (70.84 ± 6.72 vs. 78.91 ± 6.88 fL, p < 0.001) also showed statistically significant differences between groups.

CONCLUSION: IDA severity and hematologic parameters are significantly associated with H. pylori infection in adult patients.

PMID:42500788 | PMC:PMC13398527 | DOI:10.7759/cureus.111431

Cureus. 2026 Jun 24;18(6):e111443. doi: 10.7759/cureus.111443. eCollection 2026 Jun.

ABSTRACT

Background Assessment of facial dimensions provides valuable insights into craniofacial characteristics and population-based morphological diversity. The facial index (FI), calculated from the relationship between facial height and facial width, is commonly used to evaluate facial proportions and classify facial phenotypes. Therefore, the present study aimed to assess the FI and determine the distribution of facial phenotypes among undergraduate medical students at the Institute of Medical Sciences, Banaras Hindu University (IMS-BHU), Uttar Pradesh, India. Materials and methods A cross-sectional study was performed among undergraduate medical students in the Department of Anatomy at IMS-BHU, Varanasi, India. A total of 200 undergraduate medical students (104 (52.0%) males and 96 (48.0%) females) were included. Morphological facial height (nasion-gnathion distance) and bizygomatic breadth (zygion-zygion distance) were measured using a standard spreading calliper. The FI was calculated. Participants were classified into facial phenotypes according to Bannister’s classification. Data processing and statistical evaluation were carried out using GraphPad Prism. Comparisons of quantitative variables were conducted using the independent-samples t-test, whereas associations between categorical variables were assessed using the chi-square test. A p-value below 0.05 was considered indicative of statistical significance. Results The mean morphological facial height, bizygomatic breadth, and FI among males were 121.64 ± 6.47 mm, 138.38 ± 6.87 mm, and 88.15 ± 6.88, respectively. The corresponding values among females were 113.63 ± 4.61 mm, 132.77 ± 5.29 mm, and 85.74 ± 5.26, respectively. Male participants demonstrated significantly greater morphological facial height (p < 0.001), bizygomatic breadth (p < 0.001), and FI (p = 0.006) compared to females. The mesoprosopic phenotype was the predominant facial phenotype, observed in 69 (34.5%) participants, followed by the euriprosopic phenotype in 57 (28.5%), leptoprosopic phenotype in 30 (15.0%), and both hypereuriprosopic and hyperleptoprosopic phenotypes in 22 (11.0%) participants each. The pattern of facial phenotype distribution was comparable between sexes and did not demonstrate a statistically significant association with sex (χ² = 6.07, df = 4, p = 0.194). Conclusion Significant sexual dimorphism was observed in facial anthropometric measurements and the FI among undergraduate medical students at IMS-BHU, Uttar Pradesh, with the mesoprosopic phenotype being predominant in both sexes. The study provides valuable regional reference data for craniofacial assessment in clinical, forensic, and anthropological settings.

PMID:42500786 | PMC:PMC13399996 | DOI:10.7759/cureus.111443

Cureus. 2026 Jun 24;18(6):e111415. doi: 10.7759/cureus.111415. eCollection 2026 Jun.

ABSTRACT

Introduction Intracerebral hemorrhage (ICH) is frequently associated with impaired consciousness due to disruption of cortical, subcortical, and brainstem arousal networks. Reduced consciousness limits participation in rehabilitation and highlights the need for safe early interventions to facilitate responsiveness. Conventional multisensory stimulation provides visual, auditory, tactile, and olfactory input to support arousal. Graded vestibular stimulation may offer additional benefit through head movements, positional changes, and visual-vestibular activities; however, its role in patients with ICH remains insufficiently explored. This study aimed to evaluate the effectiveness of adding graded vestibular stimulation exercises to conventional multisensory stimulation for improving the level of consciousness (LOC) in patients with ICH. Methods This randomized controlled parallel-group trial was conducted in the neuro-ICU of Krishna Vishwa Vidyapeeth (Deemed to be University), Karad. Thirty-six patients with ICH were randomly allocated to an experimental group or a control group (n = 18 each). Both groups received conventional multisensory stimulation. The experimental group additionally received a graded vestibular stimulation exercise protocol, modified according to the patient’s LOC, including head and head-trunk movements, head-end inclination and declination positioning, rocking-based vestibular stimulation, wheelchair mobilization, gaze stabilization, eye movement exercises, and optokinetic visual stimulation. Interventions were administered once daily for 14 consecutive days; total treatment exposure was greater in the experimental group because vestibular exercises were provided as an add-on intervention. LOC was assessed by a blinded assessor using the Glasgow Coma Scale (GCS) and Full Outline of UnResponsiveness (FOUR) score at baseline (Day 1), Day 7, and Day 14. Statistical significance was set at p < 0.05. Results Both groups demonstrated significant improvement in level-of-consciousness scores from baseline to Day 14 (p < 0.001). Baseline GCS and FOUR scores did not differ significantly between groups. On Day 7, the experimental group demonstrated significantly higher GCS scores than the control group (9.2 ± 1.3 vs. 8.1 ± 1.2; p = 0.018) and significantly higher FOUR scores (11.0 ± 1.6 vs. 9.6 ± 1.5; p = 0.013). On Day 14, GCS scores remained significantly higher in the experimental group (11.3 ± 1.4 vs. 10.1 ± 1.3; p = 0.010), as did FOUR scores (13.4 ± 1.7 vs. 11.8 ± 1.6; p = 0.005). From Day 1 to Day 14, mean GCS and FOUR scores increased by 4.5 and 5.2 points, respectively, in the experimental group, compared with 3.4 and 3.7 points in the control group. Conclusions The addition of graded vestibular stimulation exercises to conventional multisensory stimulation was associated with significantly higher GCS and FOUR scores at Day 7 and Day 14 than conventional multisensory stimulation alone in patients with ICH. As total treatment exposure was greater in the experimental group, the findings reflect the effect of the add-on intervention rather than the isolated effect of vestibular stimulation alone.

PMID:42500765 | PMC:PMC13397862 | DOI:10.7759/cureus.111415

Cureus. 2026 Jun 23;18(6):e111394. doi: 10.7759/cureus.111394. eCollection 2026 Jun.

ABSTRACT

Introduction Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder in children, marked by inattention, hyperactivity, impulsivity, and impaired motor coordination. While pharmacological and behavioral interventions remain the primary management strategies, growing evidence highlights the influence of motor-based interventions on cognitive and attentional functions. Physiotherapy approaches incorporating bimanual and whole-body movements may enhance sensory integration, bilateral coordination, and executive control. However, limited research exists on structured play-based bimanual training combined with lower-limb activities in children with ADHD. Method An experimental pre-post interventional study was conducted at the Department of Pediatric Physiotherapy, Krishna College of Physiotherapy, Krishna Vishwa Vidyapeeth (KVV), Karad, and Chaitanya Bal Rugnalaya, Karad. Eighteen children aged 6-12 years with mild to moderate ADHD were recruited through convenience sampling. Participants underwent a 12-week play-based bimanual training program with lower-limb activities using hopscotch mats, sensory boards, balance trainers, Swiss balls, and sorting tasks. Motor proficiency and behavioral outcomes were assessed pre- and post-intervention using the Bruininks-Oseretsky Test of Motor Proficiency-2, Second Edition (BOT-2) (Short Form) and Conners’ Parent Rating Scale-Revised (CPRS-R). Result Results showed statistically significant improvement in motor coordination, attention, and concentration following the 12-week intervention. BOT-2 scores improved significantly from 32.17 ± 3.35 to 41.11 ± 3.08, while CPRS-R scores reduced from 160.61 ± 25.39 to 105.56 ± 14.42, indicating decreased ADHD symptom severity and enhanced behavioral performance. Conclusion Bimanual training with lower-limb assistance is an effective, engaging physiotherapy intervention for children with ADHD. It simultaneously addresses motor coordination deficits and cognitive-behavioral deficits, making it a valuable adjunct to existing ADHD management strategies. Future large-scale randomized controlled trials are recommended to further establish its clinical efficacy.

PMID:42500756 | PMC:PMC13399577 | DOI:10.7759/cureus.111394

Cureus. 2026 Jun 24;18(6):e111407. doi: 10.7759/cureus.111407. eCollection 2026 Jun.

ABSTRACT

Glucose balance is essential for life and health. It’s regulated by organs that absorb glucose after eating and by the liver that produces glucose during fasting. This study aimed to investigate the acute effect of Nutrilite® All Plant Protein (APP), administered as a preload in 250 mL spiced buttermilk, on glycemic response to a standardized 75 g oral glucose load in individuals with compromised blood glucose levels. The impact of APP, a plant-based dietary protein formulation, was assessed using a non-randomized, fixed-sequence, controlled crossover design to evaluate its potential as a nutritional intervention to improve glycemic response. Fourteen participants were enrolled in the study. Efficacy analyses were conducted in the complete paired efficacy population, defined as participants with usable paired glucose measurements at both intervention visits and all predefined time points (n = 10). Blood glucose spikes were better regulated with APP preload at almost all time points compared to the reference product (glucose). In this acute oral glucose tolerance test (OGTT)-based setting, participants maintained glucose values within the normoglycemic range for a longer duration after the APP preload condition than after the glucose-only reference condition. In the complete paired efficacy population (n = 10), the average incremental area under the curve (iAUC) for the reference product was 3049.5 ± 1290.45. In contrast, the average iAUC for APP combined with the reference product was 700.5 ± 688.74, representing a 78% reduction. This decrease in iAUC was statistically significant (p < 0.005). The significant reduction in iAUC suggests that APP may blunt acute glycemic excursions after a 75 g oral glucose challenge. These findings should not be directly extrapolated to mixed-meal settings without additional vehicle-controlled and meal-based studies. Furthermore, the findings should be interpreted as an acute reshaping of the OGTT glucose response curve rather than as evidence of uniformly improved glycemic control throughout the full 120-minute period.

PMID:42500755 | PMC:PMC13397331 | DOI:10.7759/cureus.111407

Cureus. 2026 Jun 23;18(6):e111399. doi: 10.7759/cureus.111399. eCollection 2026 Jun.

ABSTRACT

BACKGROUND: The role of whole brain radiotherapy (WBRT) in non-small cell lung cancer (NSCLC) brain metastases is increasingly debated in the era of immunotherapy, with much research suggesting that its use provides little benefit for this cohort of patients.

METHODS: A retrospective cohort study included patients diagnosed with NSCLC and brain metastases (2017-2020, n=147). Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression were performed, and a two-tailed p-value of <0.05 was considered statistically significant.

RESULTS: Median survival was 9.7 months, with average survival being 15.9 months from the time of diagnosis. Patients who received immunotherapy lived for 31.5 months, while those who did not lived for 14.7 months. Patients who received WBRT + immunotherapy lived an average of 19.5 months, and those who received WBRT lived an average of 10.2 months. Immunotherapy (hazard ratio (HR) 0.48, p<0.001) and stereotactic radiotherapy (SRS) (HR 0.62, p<0.001) were independently associated with improved survival. WBRT alone was associated with poorer outcomes.

CONCLUSION: WBRT alone provides limited benefit; immunotherapy and SRS improve survival and should be prioritized in future clinical practice.

PMID:42500752 | PMC:PMC13396687 | DOI:10.7759/cureus.111399

Cureus. 2026 Jun 24;18(6):e111422. doi: 10.7759/cureus.111422. eCollection 2026 Jun.

ABSTRACT

BACKGROUND: Maintaining the availability of blood components remains a major challenge for transfusion services and healthcare institutions. Blood shortages can disrupt clinical care, complicate prioritization decisions, and place substantial operational pressure on transfusion services. Limited attention has been given to the perspectives of transfusion service personnel directly involved in shortage management, particularly within tertiary healthcare settings in Riyadh, Saudi Arabia.

METHODS: A cross-sectional questionnaire-based study was conducted using a structured survey designed to assess respondent and institutional characteristics, perception of blood component shortage, practices implemented during shortage, barriers affecting shortage management, and perceived strategies to improve blood component availability. A total of 94 responses were collected from transfusion service personnel working in healthcare institutions in Riyadh. Of these, 64 respondents who were directly involved in shortage management were included in the principal analytical sample. Data were analyzed using IBM SPSS Statistics for Windows, Version 26.0 (IBM Corp., Armonk, New York, United States). Descriptive statistics were used to summarize demographic, institutional, and item-level response patterns. Composite domain scores were calculated, and reliability was assessed using Cronbach’s alpha. Subgroup analyses were conducted according to age, years of experience, academic qualification, and role in shortage management.

RESULTS: Blood component shortage was perceived as a meaningful and recurrent operational challenge. The mean composite scores were 3.68±0.90 for shortage perception, 4.03±0.52 for practices during shortage, 3.69±1.06 for barriers and constraints, and 4.44±0.73 for improvement strategies. The most strongly endorsed shortage-related experiences were the need for regular coordination with clinical departments and hospital leadership and the prioritization of patients or procedures during shortage periods. The most frequently reported practices included intensification of donor recruitment, close monitoring of blood inventory, and recall of repeat donors. Major perceived barriers included limited donor availability, high workload, insufficient staffing, high transfusion demand, and limited decision-making authority. Respondents showed the strongest agreement regarding improvement strategies, particularly increasing public awareness of blood donation, implementation of patient blood management programs, and establishment of a national blood service system. Postgraduate-qualified respondents demonstrated significantly higher shortage perception and stronger recognition of selected barriers.

CONCLUSIONS: Blood component shortage in tertiary healthcare settings in Riyadh is perceived not merely as a donor supply issue but as a broader system-level challenge shaped by operational demands, workforce capacity, governance limitations, and institutional coordination requirements. These findings support the need for integrated interventions combining donor awareness, patient blood management, workforce strengthening, and system-level coordination to improve the resilience and sustainability of blood component availability.

PMID:42500751 | PMC:PMC13399943 | DOI:10.7759/cureus.111422