Category: Statistics

Tunis Med. 2025 Mar 5;103(3):363-368. doi: 10.62438/tunismed.v103i3.5381.

ABSTRACT

PURPOSE: To investigate factors associated with Pediatric Intensive Care Unit (PICU) admission in children with severe MIS-C.

METHODS: We conducted an observational cohort study between July 1, 2020, and May 31, 2021, in the only pediatric hospital in Tunisia.

RESULTS: A total of 45 children (33 males) with no recent history of COVID-19 infection were included. Mean age was 7±3.2 years. Sixteen patients (35%) required PICU admission. There was no significant difference in mean age of patients with and without PICU admission (7.5±2.7 vs. 6.76±3.46 years; p=0.4). The frequency of respiratory distress (p=0.001), shock (p=0.001), cardiac dysfunction (p=0.003), mean CRP (p=0.001), and median troponin (p=0.003) were significantly higher in patients with PICU admission than in those without. The independent predictive factor for PICU admission was cardiac dysfunction; adjusted Odds Ratio (aOR) = 12.8, 95% CI = (2.1-76.4), p=0.002.

CONCLUSION: The only independent risk factor for PICU admission in patients with MIS-C was cardiac dysfunction.

PMID:41712843 | DOI:10.62438/tunismed.v103i3.5381

Tunis Med. 2025 Mar 5;103(3):356-362. doi: 10.62438/tunismed.v103i3.5417.

ABSTRACT

BACKGROUND: Management of syncope in the emergency department (ED) is not yet well codified. Several scores have been developed to facilitate diagnosis and management. According to the European Society of Cardiology, an EGSYS (Evaluation of Guidelines in Syncope Study) score ≥3 predicts cardiac origin.

OBJECTIVE: Evaluate the performance of the EGSYS score in the diagnosis of cardiac syncope in ED.

METHODS: We conducted a prospective study (2011-2021). Inclusion of patients who consult for syncope with calculation of the EGSYS score. Diagnosis of cardiac syncope was based on the results of the cardiological investigation. Patients were divided into two groups: SC+ group with cardiac syncope and SC- group with another etiology.

RESULTS: Inclusion of 526 patients. Mean age =49± 20 years. Gender ratio=1.48. Two hundred and thirty-six patients (45%) had a cardiac syncope. Comparison between the two groups SC+ versus (vs. SC-) showed the following results: mean age (58 ±19 vs. 42 ±18 years), history of heart disease: 34 (14.5%) vs. 13 (4.5%), rhythm disorders 22(9.4%) vs. 4(1.4%), bradycardia: 40 (17%) vs. 17 (5.8%), atrioventricular block: 26 (11.1%) vs. 8 (2.7%), bundle branch block: 45 (19.1%) vs. 17 (5.8%), High risk criteria: 138 (58.7%) vs. 75 (25.8%). Diagnostic performance of the EGSYS score was satisfactory with AUC=0.769, CI95% [0.73 – 0.81], p 0.001. The threshold value was 3. Sensitivity, specificity, positive predictive value and negative predictive value were 79, 80, 76 and 83% respectively. Likelihood Ratio: Positive LR=4.04, negative LR=0.26.

CONCLUSION: The EGSYS score showed good performance in predicting the cardiac syncope.

PMID:41712842 | DOI:10.62438/tunismed.v103i3.5417

Tunis Med. 2025 Mar 5;103(3):379-382. doi: 10.62438/tunismed.v103i3.5452.

ABSTRACT

INTRODUCTION: Transfusion is the medical act of transferring blood or its constituents from one individual to another. The pre-transfusion bedside test is mandatory before any transfusion well codified in circular 32/15.

AIMS: To evaluate the theoretical and practical knowledge concerning the ultimate bedside test of medical and paramedical staff of the Adult clinical hematology department of the Aziza Othmana hospital (HAO).

METHODS: It’s a single-center descriptive study, in the form of theoretical and practical test, during June 2024 among paramedical and medical staff working during this period at the adult clinical hematology department of (HAO).

RESULTS: We included 62 respondents, of whom 3,2% thought that the ultimate bed test replaced the compatibility test in the laboratory, 4,8% that it was obligatory before transfusion, 19,4% that it did not allow the detection of ABO incompatibility, 41,9% that it did not require the determination of the patient’s blood group and only one questioned that it did not require the identity of the patient against 61 questioned (98,4%) who checked it. Among those questioned, 69,4% knew that this test is the last key to transfusion safety, 80,6% knew that it is the responsibility of the doctor compared to 19,4% who were unaware of this. All those interviewed checked the concordance between the identity of the recipient and that mentioned on the grouping documents.

CONCLUSIONS: This study made it possible to show an average theoretical and good practical level of the staff of the adult clinical hematology department of the (HAO) and to target theoretical gaps during training.

PMID:41712839 | DOI:10.62438/tunismed.v103i3.5452

Tunis Med. 2025 Apr 5;103(4):499-505. doi: 10.62438/tunismed.v103i4.4993.

ABSTRACT

BACKGROUND: Therapeutic inertia is a major cause of uncontrolled hypertension. The aim of our work study is to describe the knowledge, attitudes, and practices of primary care physicians in the management of hypertension and to describe the factors of therapeutic inertia.

METHODS: This was a descriptive study among primary care physicians conducted through an online questionnaire created using Google Forms during the period from March 15 to May 15, 2022.

RESULTS: Our population included 232 physicians with an average age of 39 years. They mainly worked in the public sector (83%). Only 24% of the physicians knew the diagnostic thresholds for hypertension using all methods. Fifty percent knew the therapeutic objectives. Initiation with monotherapy was chosen by 49% of physicians. Angiotensin converting enzyme inhibitors and calcium channel blockers were chosen by 79.3% and 60.8% of physicians, respectively. The main reasons for therapeutic inertia were cost (78.4%), drug shortage (72.8%), non-adherence to therapy (61.2%), follow-up by another specialist (46.5%), fear of side effects of antihypertensive drugs (48.7%), patient’s age (40.5%), lack of organization of patient follow-up (36.6%), and the presence of other comorbidities (35%). Renal failure was the main comorbidity involved (78.4%).

CONCLUSIONS: Our study concludes that there was a lack of knowledge and application of the new recommendations for hypertension. It would be necessary to promote continuous training of primary care physicians, to insist on therapeutic education of patients, to reform the public health system in Tunisia to cover the provisions of hypertensive patients, and to introduce combination therapy.

PMID:41712830 | DOI:10.62438/tunismed.v103i4.4993

Water Environ Res. 2026 Feb;98(2):e70309. doi: 10.1002/wer.70309.

ABSTRACT

Incorporation of paddy husk biochar (PHBC 350) and Colocasia esculenta (C. esculenta) usage in vertical flow constructed wetlands (VFCWs) for treatment of synthetic wastewater mixed with rhodamine B (RhB) was the focus. To increase the removal efficiency of VFCW, pebbles (0.0125 m³), sand (0.005 m³), and PHBC 350 (0.0075 m³) were used. Setups of VFCWs, S (sand) and SB (sand + biochar [30% v/v]), were established. DO, pH, TS, TDS, TSS, EC, color, turbidity, dye concentration, and RhB removal percentage were evaluated. The measured values of DO, EC, pH, TS, TDS, and TSS in SB were 6.03 mg/L, 1.72 mS/cm, 6.14, 1080 ppm, 860 ppm, and 220 ppm, respectively, in 10 days. Moreover, SB gave a statistical level of RhB removal of 81.5%. All in all, incorporation of biochar into VFCWs created new knowledge to advance the removal performance for wastewater mixed with organic pollutants by understanding its mechanistic dynamics.

PMID:41711082 | DOI:10.1002/wer.70309

J Burn Care Res. 2026 Feb 19:irag029. doi: 10.1093/jbcr/irag029. Online ahead of print.

ABSTRACT

Microstomia, or small oral aperture, often results from facial burns. This condition appears as scars form within the oral tissue and at the oral commissures, narrowing the oral opening, and leading to mobility, speech, respiratory difficulties, emotional distress, and social interaction challenges. This study examines the presence of reported burn microstomia and its related clinical factors. Pediatric and adult data from a multicenter longitudinal database from 2003-2005 were analyzed to determine the frequency of microstomia at discharge. Summary statistics were used to describe clinical characteristics, demographics, and burn location in pediatric and adult burn survivors. Clinical and burn characteristics were then tested to determine if there was an association with the development of microstomia. Data revealed 4.7% (n = 10) of adult burn survivors (n=214) and 11% (n =10) of pediatric burn survivors (n=91) presented with microstomia at hospital discharge. Those with microstomia had significantly larger TBSA burns, higher rate of inhalation injury, more days on ventilation, and higher rate of adjacent contractures. No differences were found when considering age, sex, race, ethnicity, etiology of burn, or discharge location. Burn size and length of time requiring ventilation were predictive of microstomia. Knowledge of these risk factors suggests therapists should focus on early microstomia prevention, even during times of ventilation, especially in those with larger burn injuries. The high incidence of adjacent contractures demonstrates the impact of cutaneokinematic skin recruitment and suggests areas beyond the perioral should be considered when developing a treatment and prevention program for microstomia following a burn injury.

PMID:41711076 | DOI:10.1093/jbcr/irag029

Biomol Biomed. 2026 Feb 18. doi: 10.17305/bb.2026.13704. Online ahead of print.

ABSTRACT

Bisphenol A (BPA), a synthetic compound widely used in plastic manufacturing, has been shown to cause testicular damage and disrupt spermatogenesis. This study aimed to investigate the potential protective effects of astaxanthin (AST) against BPA-induced testicular injury. Four experimental groups of Wistar Albino rats were established (n=8 per group): Control, Sham, BPA, and BPA+AST. At the conclusion of the study, serum samples were analyzed for total antioxidant capacity (TAC), total oxidant status (TOS), oxidative stress index (OSI) [OSI=TOS/TAC], and CRP. Histopathological evaluations included measurements of tubule diameter, Johnsen scoring, and Masson’s trichrome staining. The expression levels of anti-B-cell lymphoma 2 (Bcl-2) and anti-Bcl-2-associated X protein (Bax) were assessed using immunofluorescence (IF) staining and RT-qPCR in testicular tissues. Additionally, tissue collagen (COL1A1, COL3A1) expressions were quantified via RT-qPCR. Results indicated significant increases in TOS, OSI, and CRP levels in the BPA group (p<0.001, p<0.001, and p=0.042, respectively), while TAC levels remained unchanged (p=0.119). AST administration did not significantly alter these biochemical parameters. Histopathological analysis revealed decreased Johnsen scores and tubule diameters in the BPA group; however, these metrics improved in the BPA+AST group. IF analysis confirmed that AST restored the pro-apoptotic Bax/Bcl-2 imbalance induced by BPA (p<0.001), although RT-qPCR results indicated that AST normalized only Bax expression (p<0.001) while Bcl-2 levels remained unchanged (p=0.487). Moreover, COL1A1 and COL3A1 were significantly upregulated in the BPA group (p<0.001 for both), and Masson’s trichrome staining corroborated the presence of fibrosis in this group. AST treatment mitigated these fibrotic changes, as evidenced by reductions in gene expression (p=0.001 for COL1A1 and p=0.005 for COL3A1) and improvements in Masson’s trichrome staining. In conclusion, this study suggests that AST may confer a protective effect against BPA-induced testicular damage by reducing apoptosis and fibrosis; however, changes in oxidative stress markers did not achieve statistical significance. Furthermore, AST may enhance spermatogenesis.

PMID:41711065 | DOI:10.17305/bb.2026.13704

Stat Med. 2026 Feb;45(3-5):e70388. doi: 10.1002/sim.70388.

NO ABSTRACT

PMID:41711013 | DOI:10.1002/sim.70388

Pharm Stat. 2026 Mar-Apr;25(2):e70079. doi: 10.1002/pst.70079.

ABSTRACT

The advancement of precision medicine hinges on accurately tailored diagnostic strategies yet estimating reliable confidence intervals (CIs) for the maximal partial Youden Index under verification bias presents considerable challenges, especially within critical false positive rate (FPR) ranges (e.g., (0, 0.1), (0.05, 0.2)) vital for specific clinical applications. While previous work established the partial Youden Index framework, and methods like full imputation (FI), mean score imputation (MSI), inverse probability weighting (IPW), and semiparametric efficient (SPE) address verification bias, robustly integrating these for the partial index across demanding FPRs has needed further development. This paper significantly advances this area by adapting and applying these four bias-correction techniques to estimate the partial Youden Index and its confidence interval (CIs) under verification bias. We systematically evaluate their performance with the proposed (bootstrap-based, MOVER) CI construction approaches. Extensive simulations demonstrate distinct method-specific patterns across verification proportions and FPR ranges, revealing the complexities in achieving reliable estimates. Bootstrap-based CIs exhibit greater robustness to model misspecification, a common clinical uncertainty, while analytical CIs often face undercoverage issues. A cardiovascular disease biomarker analysis corroborates these findings, showing Blood Pressure’s superior discriminatory capability compared to Pulse Rate. Operating under the Missing at Random (MAR) assumption, these results offer crucial, updated guidance for CI estimation in diagnostic studies with incomplete verification, providing significant value where precise evaluation in specific FPR regions is paramount and complete verification is unfeasible. Our findings enhance the statistical foundation for diagnostic test evaluation, extending beyond previous work by comprehensively addressing the partial Youden Index with these updated verification bias correction and CI formula applications.

PMID:41710981 | DOI:10.1002/pst.70079

Tumori. 2026 Feb 19:3008916251410090. doi: 10.1177/03008916251410090. Online ahead of print.

ABSTRACT

OBJECTIVE: Many studies have highlighted that elevated body mass index (BMI) not only correlates with an elevated likelihood of developing breast cancer (BC) but may also influence patients’ responsiveness to therapeutic regimens and long-term survival outcomes. The impact of BMI on therapeutic response to neoadjuvant chemotherapy (NAC) in patients with BC remains inconclusive. This study seeks to evaluate the effect of BMI on treatment response in the BC population undergoing NAC via a meta-analysis, thereby providing evidence-based support for clinical decision-making.

METHODS: PubMed, Embase, Web of Science, and the Cochrane Library were thoroughly searched until July 29, 2024. Eligible studies were selected as per predefined eligibility criteria. Data extraction and quality assessment were executed via the Newcastle-Ottawa Scale (NOS). Statistical analyses were enabled by R 4.4.1 and Stata 17.

RESULTS: Fifteen studies encompassing 15,235 patients were incorporated. The meta-analysis revealed that in contrast to patients with a normal or low BMI, those who were overweight or obese had a significantly reduced pathlological complete response (pCR) rate (OR: 0.79, p = 0.040). The underweight cohort demonstrated a higher pCR rate in comparison to those with normal BMI (OR: 1.56, p=0.015). Moreover, overweight and obese cohorts displayed a lower pCR rate in contrast to those having normal BMI (OR: 0.83, p < 0.0001).

CONCLUSION: This study indicates that overweight and obese patients tend to exhibit a reduced pCR, highlighting the need for standardized BMI definitions. Future well-designed prospective studies are necessitated to validate these observations.

PMID:41710980 | DOI:10.1177/03008916251410090