Category: Statistics

Postgrad Med J. 2024 Aug 31:qgae107. doi: 10.1093/postmj/qgae107. Online ahead of print.

ABSTRACT

PURPOSE: To systematically review the effect of vitamin D supplementation on diabetic foot ulcer (DFU) healing.

METHODS: The PubMed, Web of Science, Science direct, Ebsco host, CNKI, WanFang, VIP, and CBM databases were electronically searched to collect randomized controlled trials (RCTs) on the impact of vitamin D supplementation on DFUs from inception to 19 November 2022. Two researchers independently screened the literature, extracted the data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 software.

RESULTS: A total of seven studies involving 580 patients were included. The results of meta-analysis showed that compared with control group, the wound healing efficiency rate (RR = 1.42, 95%CI 1.03 to 1.95, P = 0.03) and wound reduction rate (MD = 13.11, 95%CI 4.65 to 21.56, P < 0.01) of the experimental group were higher; the change values of the wound area (MD = -3.29, 95%CI -4.89 to 1.70, P < 0.01) and 25 (OH) D (MD = 9.63, 95%CI 6.96 to 12.31, P < 0.01) were larger. Supplementation of vitamin D on DFU patients can improve glucose metabolism and insulin indexes: hemoglobin A1c (MD = -0.44, 95%CI -0.62 to -0.26, P < 0.01), fasting insulin (MD = -3.75, 95%CI -5.83 to -1.67, P < 0.01), HOMA – β (MD = -5.14, 95%CI -8.74 to -1.54, P < 0.01), and quantitative insulin sensitivity check index (MD = 0.02, 95%CI 0.01 to 0.02, P < 0.01). It can also improve inflammation and oxidative stress markers: high sensitivity C-reactive protein (MD = -0.83, 95%CI -1.06 to -0.59, P < 0.01), erythrocyte sedimentation rate (MD = -15.74, 95%CI -21.78 to -9.71, P<0.01), nitric oxide (MD = 1.81, 95%CI 0.07 to 3.55, P = 0.04), and malondialdehyde (MD = -0.43, 95%CI -0.61 to -0.24, P<0.01). There was no statistically significant difference in changes of fasting plasma glucose, homeostasis model of assessment-insulin resistance, total antioxidant capacity, glutathione, very low density lipoprotein cholesterol, low density lipoprotein cholesterol, and high density lipoprotein cholesterol (P>0.05).

CONCLUSION: The current evidence suggests that vitamin D supplementation can significantly promote DFU healing by lowering blood sugar and alleviating inflammation and oxidative stress. Key messages What is already known on this topic Diabetic foot ulcer (DFU) is a major complication of diabetes mellitus, with high morbidity, mortality and resource utilization. Vitamin D has the effect of lowering blood sugar, improving insulin sensitivity, and increasing anti-inflammatory response. Clinical research on vitamin D supplementation for the treatment of DFU is increasing, but due to the lack of combing and integration, the actual efficacy of vitamin D in patients is unclear. What this study adds This meta-analysis has shown that vitamin D supplementation can significantly promote DFU healing by lowering blood glucose and alleviating inflammation and oxidative stress. How this study might affect research, practice or policy This study preliminarily found the effectiveness of vitamin D supplementation on the healing of DFU, which can provide a reference for the treatment of DFU by medical staff.

PMID:39215492 | DOI:10.1093/postmj/qgae107

Ear Nose Throat J. 2024 Aug 30:1455613241272476. doi: 10.1177/01455613241272476. Online ahead of print.

ABSTRACT

Purpose: To perform a meta-analysis of clinical trials comparing percutaneous microwave ablation (PMWA) guided by ultrasound with conventional thyroidectomy for the management of papillary thyroid microcarcinoma (PTMC), analyzing feasibility, safety, and long-term efficacy, and to provide clinical guidance for the treatment selection of PTMC. Methods: Embase, PubMed, Cochrane Library, Web of Science, CNKI, VIP Database, and Wanfang Database were systematically searched to identify clinical studies of PMWA or thyroidectomy for PTMC up to December 2023. The relevant data from the articles were extracted, and the data analysis was performed using RevMan 5.4 software. Results: A total of 442 articles were identified and subsequently screened based on the inclusion and exclusion criteria, 9 clinical studies involving a total of 1577 patients were included, with 788 patients in the PMWA group and 789 patients in the surgery group. Following data extraction and statistical analysis, in comparison to the surgery group, the PMWA group had shorter operation time [mean differences (MD) = -36.36; 95% CI -55.66 to -17.06; P = .0002], shorter hospital stay (MD = -3.93; 95% CI -5.55 to -2.30; P < .00001), less intraoperative bleeding (MD = -21.25; 95% CI -27.36 to -15.15; P < .00001), and lower hospital costs (MD = -1.00; 95% CI -1.33 to -0.66; P < .00001), all with statistical significance. The comparison of postoperative complications revealed a lower incidence of complications in the PMWA group compared to the surgery group [relative risk (RR) = 0.29; 95% CI 0.21 to 0.40; P < .00001], with statistical significance. Thyroid-related hormone analysis showed that the free triiodothyronine (MD = 0.61; 95% CI 0.33 to 0.90; P < .00001) and free thyroxine (MD = 1.81; 95% CI 0.94 to 2.68; P < .0001) levels in the PMWA group were higher than those in the traditional surgery group, while the levels of thyroid-stimulating hormone were lower than those in the traditional surgery group (MD = -7.63; 95% CI -10.25 to -5.01; P < .00001), with statistically significant differences, indicating that PMWA had a smaller impact on thyroid function. In 2 studies, there were no statistically significant disparities in postoperative recurrence or lymph node metastasis (LNM) between the 2 cohorts (RR = 0.70; 95% CI 0.33 to 1.50; P = .36). There were no statistically significant differences in physiological health score between different groups and different time points before and after treatment (P > .05); However, the mental component score and the total score of the Medical Outcomes Study (MOS) item short-form health survey were significantly elevated in the ablation group compared to the excision group post-treatment (P < .05). Conclusion: For patients with low-risk PTMC with definitive diagnosis and precise risk stratification, PMWA can be selected. PMWA treatment for patients with PTMC is comparable to conventional surgical treatment and has the advantages of minimal trauma, rapid recovery, no scarring, and fewer complications, which are superior to open surgery to a certain extent. For patients with ambiguous preoperative diagnosis and uncertainty regarding LNM status, surgical intervention is the optimal choice.

PMID:39215491 | DOI:10.1177/01455613241272476

Ear Nose Throat J. 2024 Aug 30:1455613241271680. doi: 10.1177/01455613241271680. Online ahead of print.

ABSTRACT

Objective: To investigate the relationship between environmental and meteorological factors and the incidence of epistaxis in different age groups in Yangzhou, as well as to provide a reference and theoretical basis for epistaxis prevention and treatment. Methods: The patients with epistaxis who were treated in Northern Jiangsu People’s Hospital of Jiangsu Province from January 2016 to December 2020 were reviewed, and the relationship between the local environmental meteorological factors at the time of onset and the incidence of epistaxis in different age groups was analyzed, and the potential environmental meteorological risk factors of epistaxis in each age group were determined by Stepwise logistic regression. Results: From 2016 to 2020, there were 24,407 cases of epistaxis, mostly males and children. The effects of O₃ concentration, average humidity, average temperature, NO₂ concentration, sunshine duration, average wind speed, CO concentration, and temperature difference on the study population were statistically significant (P < .05). Analysis by age group showed that there were differences in environmental and meteorological factors related to epistaxis in different age groups. Conclusions: In Yangzhou, epistaxis is more prevalent among males and children. The environmental meteorological factors are related to the incidence of epistaxis in Yangzhou, among which the average humidity and temperature difference are negatively correlated with the incidence of epistaxis. In contrast O₃ concentration, average temperature, NO₂ concentration, sunshine duration, average wind speed, and CO concentration are positively correlated with epistaxis occurrence. However, the impact of these environmental and meteorological factors varies in different age groups.

PMID:39215480 | DOI:10.1177/01455613241271680

Ear Nose Throat J. 2024 Aug 30:1455613241272455. doi: 10.1177/01455613241272455. Online ahead of print.

ABSTRACT

Objectives: The role of uric acid in pathogenesis of benign paroxysmal positional vertigo (BPPV) is not fully understood. It is aimed to assess the serum uric acid levels in BPPV patients compared to healthy controls. Study design: Systematic review and meta-analysis. Methods: Web of science, PubMed, Scopus, Google Scholar, Embase, Medline, and Cochrane library were systematically searched. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Problem/Population, Intervention, Comparison, and Outcome (PICO) guidelines were used. Results: In total, 20 studies including 3967 participants met the inclusion criteria. Ten studies (50%) reported higher uric acid (UA) levels in BPPV patients, 4 studies (20%) indicated lower UA levels in BPPV patients, while 6 studies (30%) found no significant difference in UA levels between BPPV patients and healthy controls. The overall mean serum levels of UA (SMD: 0.265, [-0.163 to 0.693]) were higher in BPPV patients than control group. However, this difference was not statistically significant (P-value: .225). Conclusion: There is no significant difference in serum level of UA between BPPV patients and healthy controls. It means that serum level of UA (whether low or high) is not likely the underlying factor of development of BPPV.

PMID:39215477 | DOI:10.1177/01455613241272455

Clin Trials. 2024 Aug 30:17407745241272012. doi: 10.1177/17407745241272012. Online ahead of print.

NO ABSTRACT

PMID:39215469 | DOI:10.1177/17407745241272012

Clin Pediatr (Phila). 2024 Aug 30:99228241273343. doi: 10.1177/00099228241273343. Online ahead of print.

ABSTRACT

COVID-19 highlighted the importance of schools for child health, as emerging data suggest that pandemic-related school closures may have led to worsening child health and exacerbated health disparities. This study examines school-aged children’s well-being, and characterizes changes in school-related needs, from 2021 to 2022. This is a secondary analysis of a longitudinal cohort study, where a nationally representative sample of parents of school-aged children were surveyed in June 2021 and 2022. The percentage of children with deficits in total difficulties, hyperactivity, and prosocial behavior decreased at follow-up, while a high percentage of children continued to experience peer problems. At least one school-related need remained for most parents. Highest priority needs were academic enrichment, socialization, physical activity, tutoring, and coping with stress. Academic support and social-emotional well-being remained major parental concerns, with social development showing significant deficit. Improvements in child well-being were experienced unequally across demographic groups.

PMID:39215459 | DOI:10.1177/00099228241273343

Vet Med Sci. 2024 Sep;10(5):e70008. doi: 10.1002/vms3.70008.

ABSTRACT

BACKGROUND: Hydatidosis, caused by the larval stage of the tapeworm Echinococcus granulosus, affect cattle by forming hydatid cyst in thier lungs, livers and pose great financial loss in animal production and country’s economy by both direct and indirect effect. Despite its great economic and health importance, there is an absence of current information on cystic echinococcosis in cattle slaughtered at Wolaita Sodo municipality abattoir in Ethiopia.

OBJECTIVES: Current investigation determines the prevalence, organ distribution and fertility of hydatid cysts in cattle slaughtered at the Wolaita Sodo municipality abattoir in Ethiopia.

METHODS: A cross-sectional study was conducted from February, 2023, to October, 2023, at Wolaita Sodo municipality abattoir in southern Ethiopia, through regular meat examinations and cyst characterisation to determine the prevalence, organ distribution and fertility of hydatid cysts.

RESULTS: The overall prevalence of hydatidosis recorede in current study was 17.9% (69/384) and has shown a statistically significant association (p < 0.05) with the body condition of cattle. However, there was no statistically significant association (p > 0.05) between the prevalence of hydatidosis and other risk factors such as sex, breed, production system and origin of animals. This study showed that the lungs and liver were the most affected organs in cattle, followed by the spleen and kidneys. On cyst characterisation, the majority of hydatid cysts were found sterile (55.4%) followed by fertile (38.8%) and calcified (8.7%) cysts. Out of 125 fertile hydatid cysts tested for survival, 18.8% (58/321) were viable and 20% (67/321) were nonviable.

CONCLUSION: The finding of this study shows that cystic echinococcus was important health threat of the cattle and widespread in the internal organs of affected cattle causing significant economic loss by condemning edible organs that are not suitable for human consumption. Therefore, urgent and integreted preventive action is needed to disrupt the life cycle of cystic echinococcosis to tackle subsequent financial loss and risk of zoonosis to humans in the study area.

PMID:39215458 | DOI:10.1002/vms3.70008

Ophthalmic Plast Reconstr Surg. 2024 Aug 28. doi: 10.1097/IOP.0000000000002768. Online ahead of print.

ABSTRACT

PURPOSE: The primary objective was to document change in postoperative marginal reflex distance-1 (MRD1) after Müller muscle conjunctival resection surgery. The secondary objective was to identify predictors of change in postoperative MRD1.

METHODS: A multicenter prospective cohort study was performed on patients consecutively recruited for Müller muscle conjunctival resection. MRD1 was measured immediately after Müller muscle conjunctival resection, at the 1-week postoperative visit, and the ≥3-month postoperative visit. MRD1 at the immediate and 1-week time points were compared with MRD1 ≥3 months using descriptive statistics. Predictors of change in MRD1 were analyzed using multivariate regression analysis.

RESULTS: A total of 150 patients (226 eyelids) were included. Regarding the immediate to ≥3-month interval, 53.8% of eyelids remained clinically similar (rise or fall ≤0.5 mm), 19.8% rose ≥1 mm, and 26.4% fell ≥1 mm. Regarding the 1-week to ≥3-month interval, 76.5% remained clinically similar, 17.3% rose ≥1 mm, and 6.2% fell ≥1 mm. No variable predicted change in MRD1 over either interval with both clinical and statistical significance.

CONCLUSIONS: Immediate postoperative MRD1 is likely to reflect the late result in only 54% of cases. However, 1-week postoperative MRD1 is similar to the late result in 77% of cases and is highly unlikely (6%) to fall by the final visit. No variable significantly impacts change in postoperative MRD1.

PMID:39197179 | DOI:10.1097/IOP.0000000000002768

Ophthalmic Plast Reconstr Surg. 2024 Aug 28. doi: 10.1097/IOP.0000000000002770. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study is to investigate the association between cannabis usage and thyroid eye disease (TED) in patients with autoimmune hyperthyroidism. While the association between cigarette smoking and TED is well established, the effect of cannabis on TED is unclear.

METHODS: This cohort study examined data from TriNetX, an electronic health record platform, for patients with autoimmune hyperthyroidism between December 1, 2003, and December 1, 2023. Primary outcomes were TED presentation (exophthalmos, eyelid retraction, eyelid edema, orbital edema, strabismus, and optic neuropathy) and treatment (teprotumumab, methylprednisolone, tarsorrhaphy, and orbital decompression) in cannabis users, nicotine users, and control patients. Propensity matching was performed to control for characteristics such as age, sex, race, prior thyroidectomy, and/or radio ablation. Relative risk between cohorts was calculated for each outcome in 6-month, 1-year, and 2-year intervals following diagnosis of autoimmune hyperthyroidism.

RESULTS: Of 36,186 patients with autoimmune hyperthyroidism, 783 were cannabis users, 17,310 were nicotine users, and 18,093 were control patients without cannabis or nicotine usage. Compared with control patients, cannabis users were more likely to be younger, male, and Black/African American and have anxiety or depression. After propensity matching, cannabis users were 1.9 times more likely to develop exophthalmos (p = 0.03) and 1.6 times more likely to develop any TED presentation (p = 0.049) in the 1-year interval although these differences did not remain statistically significant in the 2-year interval.

CONCLUSIONS: Cannabis users had a significantly increased risk for TED outcomes in the 1-year interval. Further research is needed to inform TED management.

PMID:39197177 | DOI:10.1097/IOP.0000000000002770

Inflamm Bowel Dis. 2024 Aug 28:izae201. doi: 10.1093/ibd/izae201. Online ahead of print.

ABSTRACT

BACKGROUND: Previous research suggests patients living with inflammatory bowel disease (IBD) understand IBD remission differently than healthcare professionals, which could influence patient expectations and clinical outcomes. We investigated 3 questions to better understand this: (1) How do patients currently understand remission; (2) Do patients currently face any barriers to communicating with their healthcare professional about remission; and (3) Can existing educational material be improved to help patients feel more prepared to discuss remission and treatment goals with their healthcare professional?

METHODS: We sent a web-based survey to adult patients with IBD in the United States. This survey included an educational experiment where patients were randomly assigned to 1 of 3 improved versions of existing educational material.

RESULTS: In total, 1495 patients with IBD completed the survey. The majority of patients (67%) agreed that remission is possible in IBD, but there was significant diversity in how they defined it with the most common being “my symptoms are reduced” (22%) and “I am no longer experiencing any symptoms” (14%). Patients reported being able to communicate openly with their healthcare professionals. Exposure to improved educational material did not have a statistically significant effect on patients’ feelings of preparedness for discussing different aspects of their care with their healthcare professionals.

CONCLUSIONS: Our study confirms that patients tend to define remission in terms of resolving symptoms. We found little evidence of barriers preventing patients from discussing remission with their healthcare professionals. This suggests that educational material could be used to resolve this discrepancy in understanding.

PMID:39197162 | DOI:10.1093/ibd/izae201