Category: Statistics

Cureus. 2025 Mar 21;17(3):e80967. doi: 10.7759/cureus.80967. eCollection 2025 Mar.

ABSTRACT

Objective Patients undergoing below-knee amputation may experience considerable postoperative mortality risk, particularly in the presence of comorbid conditions. The aim of this study was to present a newly developed risk index and scoring system to predict one-year mortality, morbidity, and functional independence in patients undergoing below-knee amputation. Materials and methods One-year postoperative follow-up data were obtained retrospectively from 30 patients who underwent below-knee amputation at our clinic. A novel scoring system was developed using variables including age, preoperative systemic diseases, diabetic foot infection, previous extremity surgery, postoperative mobilization time, and early complications. Survival analysis was performed, and functional independence was assessed using the Katz Activities of Daily Living Scale (Katz scores). The relationship between patients’ survival status and Katz scores with the developed risk index was statistically evaluated. Results The average age of the patients was 71.7 years. Survival analysis indicated that higher scores on the newly developed index were significantly associated with increased mortality and morbidity (p<0.05). There was also a strong negative correlation between patients’ scores and Katz scores (r=-0.757; p<0.001), indicating that patients with higher risk scores experienced poorer functional outcomes. Conclusions This retrospective study introduced a novel scoring system that reliably predicts functional independence in patients following below-knee amputation. However, its accuracy in predicting mortality and morbidity remains limited. Further refinement and validation in larger patient populations are required to enhance predictive accuracy and clinical applicability.

PMID:40260362 | PMC:PMC12010033 | DOI:10.7759/cureus.80967

Cureus. 2025 Mar 21;17(3):e80974. doi: 10.7759/cureus.80974. eCollection 2025 Mar.

ABSTRACT

Introduction Diabetes mellitus is a metabolic disorder characterized by abnormally high sugar levels in the blood for prolonged periods of time. The world’s largest number of diabetics resides in India, making it the world’s diabetic capital, with a diabetic foot ulcer (DFU) incidence of around 8-17%. Due to the polymicrobial and multidrug resistant (MDR) nature of DFUs, antimicrobial susceptibility testing is of high importance to help treat patients effectively and prevent the development of MDR bacteria. The ability to form biofilms is a significant additive to virulence of an organism that causes an able strain to be resistant to more antibiotics as compared to a free-living strain, thereby further delaying the healing of DFUs. Materials and methods This study included 74 samples collected from patients with DFUs, out of which 69 (93.24%) yielded growth on culture. Gram staining was done for the direct microscopy, isolation, and determination of organism, and the detection of biofilm formers using Congo Red Agar plates. Data were tabulated and statistically analyzed. Results Out of 74 samples collected, 69 (93.24%) yielded growth on culturing, with 5 (6.76%) cultures coming back negative. On Gram staining, 42 (56.8%) samples showed Gram-positive cocci and 53 (71.6%) showed Gram-negative bacilli. On isolating organisms from the samples, 16 (21.7%) samples had Pseudomonas aeruginosa, followed by Klebsiella pneumoniae at 13 (17.6%) and Proteus mirabilis and Escherichia coli at 11 each (14.9%), indicating a Gram-negative bacteria predominance. Of the Gram-positive bacteria isolated, Staphylococcus aureus stands at two (2.7%) and Streptococcus pyogenes at one (1.4%). The prevailing monomicrobiality could be attributed to antibiotic administration prior to sample collection. On antibiotic sensitivity of organisms tested against each antibiotic, more than 75% of tested samples were resistant to ampicillin, cefuroxime, and erythromycin, and around 70% and more of tested samples were sensitive to ertapenem, meropenem, amikacin, gentamicin, benzylpenicillin, vancomycin, and clindamycin. Out of the 69 positive cultures, 29 (42.03%) yielded biofilm formers. Pseudomonas aeruginosa was the predominant biofilm former with 10 (34.48%) of 29 of total biofilm-forming isolates, followed by E. coli and K. pneumoniae with five each (17.24%) and Proteus mirabilis with three samples (10.34%). Regarding strains forming biofilms according to bacterium species, S. aureus was predominant, with 100% (two out of two samples) of isolates forming biofilms. Staphylococcus aureus was followed by Pseudomonas aeruginosa with 62.5% (10 out of 16 samples), Acinetobacter baumannii (two out of four samples) and Enterobacter cloacae (one out of two samples) with 50% each, E. coli with 45.45% (5 out of 11 samples), and K. pneumoniae with 38.46% (5 out of 13 samples) of isolates forming biofilms. It should be noted that only two S. aureus, four A. baumannii, and two Enterobacter cloacae samples were isolated in comparison to a larger number of Gram-negative bacteria. This study has found that 100% of multidrug-resistant organisms (MDROs) are biofilm formers. Conclusion The ability to form biofilms adds immensely to the virulence and antibiotic resistance. Detection of biofilm formers is non-invasive and convenient to measure and would help provide insight into antibiotics to be administered to the patient, thereby reducing development of MDROs and reducing healing time.

PMID:40260359 | PMC:PMC12010084 | DOI:10.7759/cureus.80974

Cureus. 2025 Mar 21;17(3):e80976. doi: 10.7759/cureus.80976. eCollection 2025 Mar.

ABSTRACT

Background Plain language summaries (PLSs) make scientific research accessible to a broad non-expert audience. However, crafting effective PLS can be challenging, particularly for non-native English-speaking researchers. Large language model (LLM) chatbots have the potential to assist in generating summaries, but their effectiveness compared to human-generated PLS remains underexplored. Methods This cross-sectional study compared 30 human-written PLS with LLM chatbot (viz., ChatGPT (OpenAI, San Francisco, CA), Claude (Anthropic, San Francisco, CA), Copilot (Microsoft Corp., Washington, DC), Gemini (Google, Mountain View, CA), Meta AI (Meta, Menlo Park, CA), and Perplexity (Perplexity AI, Inc., San Francisco, CA)) generated PLS. The readability of the PLS was checked by the Flesch reading (FR) ease score, and understandability was checked by the Flesch-Kincaid (FK) grade level. Three authors rated the text on seven-item predefined criteria, and their average score was used to compare the quality of the PLS. Results In comparison to human-written PLS, chatbots could generate PLS with lower FK grade levels (p-value < 0.0001) and except Copilot, all others had higher FR ease scores. The overall score of human-written PLS was 8.89±0.26. Although there was statistically significant variance among the scores (F = 7.16, p-value = 0.0012), in the post-hoc test, there was no difference between human-generated and individual chatbots-generated PLS (ChatGPT 8.8±0.34, Claude 8.89±0.33, Copilot 8.69±0.4, Gemini 8.56±0.56, Meta AI 8.98±0.23, and Perplexity 8.8±0.3). Conclusion LLM chatbots can generate PLS with better readability and a person with a lower grade of education can understand it. The PLS are of similar quality to those written by human authors. Hence, authors can generate PLS from LLM chatbots and it is particularly beneficial for researchers in developing countries. While LLM chatbots improve readability, they may introduce minor inaccuracies also. Hence, PLS generated by LLM should always checked for accuracy and relevancy.

PMID:40260353 | PMC:PMC12010112 | DOI:10.7759/cureus.80976

Int J Health Plann Manage. 2025 Apr 21. doi: 10.1002/hpm.3939. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to illustrate the state of stroke care and rehabilitation in the Philippines through the perspectives of local government officials, policymakers, and organisational leaders. It sought to identify challenges, opportunities, and recommendations for improving stroke policies and services across different administrative levels.

METHODS: Mixed-methods approach involving a structured survey of 131 local government officials and in-depth interviews with eight key stakeholders. Survey participants included Department of Health (DoH) officials, local chief executives, policymakers, Local Government Unit (LGU) employees, and representatives from non-government agencies. Interviewees comprised leads and managers from the DoH and representatives from organisations including the Philippine Academy of Rehabilitation Medicine (PARM), Physicians for Peace Philippines, and the Philippine Council for Health Research and Development (PCHRD). Quantitative survey data were analysed using descriptive statistics and qualitative interview data were thematically analysed, then the two types of data were triangulated and organised by theme.

RESULTS: Findings revealed significant gaps in funding, healthcare infrastructure, and policy implementation. Challenges included inadequate facilities, lack of qualified staff, financial barriers, and regional disparities in service provision. Survey and interview participants emphasised the need for increased government support, comprehensive policies, and community-based rehabilitation (CBR) programmes. Improving stroke survivors’ quality of life was ranked as the most critical aspect of rehabilitation programmes.

CONCLUSIONS: The study highlights the critical need for more equitable and accessible stroke care and rehabilitation in the Philippines. This can be facilitated by sustained government support, inter-agency collaboration, community engagement, and the implementation of holistic, evidence-based, and cost-effective CBR initiatives.

PMID:40259445 | DOI:10.1002/hpm.3939

Int J Cancer. 2025 Apr 21. doi: 10.1002/ijc.35451. Online ahead of print.

ABSTRACT

Lynch-like syndrome (LLS) presents very similar clinicopathological characteristics to Lynch syndrome (LS) but the mechanism for cancer predisposition remains unknown. The present study aims to investigate the causal mechanism of LLS by a comprehensive genetic and epigenetic approach. Thirty-two LLS and 34 LS patients with colorectal cancer (CRC) fitting the Amsterdam and Bethesda criteria were included, along with 29 CRC sporadic patients, and analyzed for the presence of pathogenic variants in 94 genes associated with hereditary tumors. The cohorts were also characterized for the methylation profile and examined through a sample group analysis and a Stochastic Epigenetic Mutations (SEMs) analysis in comparison with 29 age-matched healthy controls. The multigene panel analysis revealed the presence of pathogenic variants in non-mismatch repair (MMR) genes and three variants classified as pathogenic/likely pathogenic possibly predisposing to LLS. The epigenetic analysis showed epivariations targeting genes associated with LS or DNA repair, most of them associated with the Fanconi Anemia pathway, which could explain the susceptibility to cancer. Our results highlight the need for using extended genetic and epigenetic analyses to understand the causal mechanism of LLS.

PMID:40259440 | DOI:10.1002/ijc.35451

Alzheimers Res Ther. 2025 Apr 21;17(1):86. doi: 10.1186/s13195-025-01738-2.

ABSTRACT

BACKGROUND AND OBJECTIVES: The association between obesity and young-onset dementia (YOD, defined as dementia diagnosed before age 65) is established, but the specific impact of abdominal obesity in women remains unclear. Abdominal obesity, driven by excess visceral fat, may increase dementia risk through metabolic and vascular pathways. We investigated the association between abdominal obesity and YOD risk in women using a large nationwide cohort.

METHODS: We analyzed 964,536 Korean women aged 40-60 years who underwent national health checkups in 2009. General obesity was defined by body mass index (BMI), and abdominal obesity was categorized by waist circumference (WC) into < 75 cm, 76-84 cm, 85-94 cm, and ≥ 95 cm. YOD was identified using ICD-10 codes and dementia medication prescriptions. Hazard ratios (HRs) for YOD were estimated using multivariable Cox proportional hazard models adjusted for lifestyle and clinical factors.

RESULTS: Over a median follow-up of 8.2 years, YOD incidence increased progressively with higher WC. Women with WC ≥ 95 cm had a 55% increased risk of YOD (HR 1.55; 95% CI 1.34-1.79) compared to those with WC < 75 cm. The association was particularly strong for vascular dementia (VD), with HR 1.83 (95% CI 1.30-2.57). By contrast, BMI showed a U-shaped relationship, with the lowest YOD risk observed in women with normal BMI (18.5-22.9 kg/m²), and significantly elevated risks in both underweight (BMI < 18.5 kg/m²; HR 1.39, 95% CI 1.13-1.71) and morbidly obese women (BMI ≥ 30 kg/m²; HR 1.26, 95% CI 1.10-1.45).

DISCUSSION: Abdominal obesity is a significant, independent risk factor for YOD in women, particularly for VD. These findings underscore the importance of addressing abdominal obesity in middle-aged women to reduce dementia risk.

PMID:40259430 | DOI:10.1186/s13195-025-01738-2

J Health Popul Nutr. 2025 Apr 21;44(1):130. doi: 10.1186/s41043-025-00870-x.

ABSTRACT

BACKGROUND: Tuberculosis (TB) is known to be a disease associated with underprivileged social conditions such as poverty, malnutrition, and overcrowding. Homeless individuals are at a higher risk of contracting TB due to factors such as substance misuse, alcohol disorder, smoking, and malnutrition. Recognizing this risk, the World Health Organization recommends TB screening in these vulnerable populations. As a result, this study aims to evaluate the prevalence of TB and its associated factors among people who experience homelessness living in Wolaita Zone Towns.

METHOD: A cross-sectional study was conducted on 352 homeless individuals with presumed TB from May 1 to July 30, 2023. Data was collected using pre-tested structured questionnaires. The symptom was assessed using WHO guidelines. Sputum samples were screened for TB using GeneXpert MTB/RIF assay technique and those found to be positive were confirmed via the Lowenstein-Jensen(LJ) culture method by comparing equal numbers of positives and negatives. The data was analyzed using statistical software packages (SPSS) version 26. Logistic regression analysis was used to identify factors associated with TB and a P-value of less than 0.05 at a 95% confidence interval was considered statistically significant.

RESULTS: The prevalence of bacteriological confirmed TB among homeless individuals was 7.7% [95% CI: 4.8- 10.5] and rifampicin-resistant TB (RR-TB) was not detected. Multivariate logistic regression analysis revealed that smoking cigarettes[AOR = 7.673, 95% CI: 1.622,36.303], smoking benzene[AOR = 8.348, 95% CI: 2.061,33.813], chewing tobacco [AOR = 4.138, 95% CI: 1.249,13.709], duration of being homeless[AOR = 6.749, 95% CI: 1.914, 23.797], taking any medication currently [AOR = 4.686, 95% CI:1.216,18.064], BMI [AOR = 5.328, 95% CI: 1.663,17.070] and having HIV infection [AOR = 5.234, 95% CI: 1.558, 17.585] were significantly associated with the prevalence of PTB in people who experience homelessnesss.

CONCLUSIONS: This study indicates a higher prevalence of pulmonary TB (PTB) in homeless individuals compared to the general population. It is strongly recommended to implement targeted TB preventive and control measures and actively monitor for the diseases within those vulnerable population.

PMID:40259425 | DOI:10.1186/s41043-025-00870-x

Eur J Med Res. 2025 Apr 22;30(1):315. doi: 10.1186/s40001-025-02579-3.

ABSTRACT

BACKGROUND AND OBJECTIVE: The timing of enteral nutrition initiation in critically ill patients in the intensive care unit (ICU) plays a crucial role in clinical outcomes. This study aimed to evaluate the impact of early (within 48 h of ICU admission) versus delayed enteral feeding on 28-day mortality, ventilator dependency, and ICU length of stay.

METHODS: A retrospective cohort study was conducted involving 295 patients across four ICUs in two Tehran hospitals, admitted between 2017 and 2018. Participants were grouped into early (n = 161) and delayed (n = 134) enteral feeding categories. Baseline characteristics were analyzed using the Mann-Whitney and Chi-Square tests. Mortality was assessed using Kaplan-Meier survival analysis and Cox proportional hazards models, while logistic and linear regression models were applied to examine associations with ventilator dependency and ICU length of stay, respectively.

RESULTS: Early enteral feeding (EEF) was significantly associated with reduced 28-day mortality (25.5% vs. 50.0%, p < 0.001), lower incidence of mechanical ventilation (66.5% vs. 80.6%, p = 0.007), and a shorter ICU stay (13.07 ± 16.44 days vs. 16.23 ± 13.57 days, p < 0.001). Kaplan-Meier analysis revealed a higher survival probability at 28 days in the early feeding group (log-rank test, p < 0.001). However, after adjusting for potential confounders (age, gender, BMI, baseline APACHEII, baseline SOFA score, number of comorbid, primary diagnosis and admission category), the relationships between delayed feeding and mortality (HR: 1.49, 95% CI 0.98, 2.26, p = 0.062), ventilator dependency (OR: 1.28, 95% CI 0.59, 2.70, p = 0.558), and ICU length of stay (LOS) (β: 1.96, 95% CI – 1.52, 5.45, p = 0.268) were not statistically significant. Subgroup analyses revealed that delayed enteral feeding was significantly associated with higher mortality risk in surgical patients (adjusted HR: 1.85, 95% CI 1.02, 3.35, p = 0.043) and prolonged ICU stay (β: 3.75, 95% CI 0.27, 7.23, p = 0.035), whereas no significant associations were observed in medical patients.

CONCLUSION: Initiating enteral feeding within 48 h of ICU admission is associated with improved clinical outcomes, although these benefits may be influenced by individual patient factors and disease severity. Future studies should focus on tailoring enteral feeding strategies to optimize outcomes across varied ICU populations.

PMID:40259420 | DOI:10.1186/s40001-025-02579-3

BMC Nutr. 2025 Apr 21;11(1):82. doi: 10.1186/s40795-025-01068-4.

ABSTRACT

BACKGROUND: Communities afflicted by armed conflict are characterized by pervasive malnutrition and widespread hunger. For nearly two years, there has been an unbroken conflict in Tigray. However, little is understood about the coping mechanisms people used in reaction to a lack of food and cash. This study evaluated the coping mechanisms used by urban residents of Mekelle City in Tigray, Northern Ethiopia.

METHODOLOGY: A community-based cross-sectional survey was conducted among 315 randomly selected households in Mekelle City. Data were collected from May to June 2022 using a pre-tested structured questionnaire and entered, cleaned, coded, and analyzed using Stata version 14. We used descriptive statistics to describe the mean, frequency distribution, and percentages. The t-test was used to analyze the consumption-based coping strategy index.

RESULTS: The current analysis indicates that 272 households, or 87%, experienced food shortages. To cope with this situation, 101 households (32.6%) reduced the size of their meals. Additionally, 85 households (27.3%) opted to lower the quality of their meals or substituted less preferred dishes. Furthermore, approximately 72 households (23.2%) skipped meals as a strategy to manage food scarcity. The mean reduced coping strategy index (rCSI) for households that skipped meals is 181.84 (SD: 112.5), whereas it is 38.6 for those that did not skip meals (p < 0.01). For households that reduced the food content, the mean rCSI is 152.4, compared to 51.12 for those who did not reduce food content (p < 0.01).

CONCLUSION: The study revealed that the communities affected by the war faced a tough struggle due to the food crisis. The study highlights the food crisis in war-affected communities, highlighting coping mechanisms like reducing meal quantity and quality and eating less desirable foods. Thus, targeted food ration distributions and blanket supplemental feeding programs should be in place through humanitarian agents to reduce acute malnutrition and mortality, and enable recovery.

PMID:40259413 | DOI:10.1186/s40795-025-01068-4

Orphanet J Rare Dis. 2025 Apr 21;20(1):191. doi: 10.1186/s13023-025-03680-w.

ABSTRACT

BACKGROUND: This study aims to investigate the clinical characteristics, imaging features, treatment, and prognostic factors of jaw Langerhans cell histiocytosis (JLCH), providing valuable insights for its clinical diagnosis and management.

METHOD: This study retrospectively analyzed the clinical and follow-up data of JLCH patients treated between January 2010 and January 2024. Data collected included gender, age, symptoms, imaging findings, treatment strategies, and outcomes. Univariate and multivariate Cox regression analyses were performed using SAS software to identify factors affecting treatment outcomes, with P ≤ 0.05 considered statistically significant.

RESULTS: A total of 68 patients (50 males, 18 females; median age 13.5 years) were included. Forty percent of patients were under 10 years old, and 71% had mandibular involvement. Disease classification included 49 cases of single-system unifocal (SS-s) disease, 10 cases of single-system multifocal (SS-m) disease, and 9 cases of multi-system (MS) disease. Common symptoms included jaw or tooth pain (28 cases), facial swelling (22), gingival ulceration (10), and loose teeth (9). Imaging revealed periodontal disease-like (7), cyst-like (17), and osteomyelitis-like (44) lesions. Univariate and multivariate Cox regression analyses identified that female patients had a lower risk of progression (P = 0.014, HR 0.071), while SS-m (P = 0.019, HR 4.992) and MS patients (P = 0.030, HR 4.182) exhibited higher progression risks compared to SS-s patients. Cyst-like (P = 0.001, HR 0.054) and osteomyelitis-like lesions (P < 0.001, HR 0.023) were associated with lower progression risks compared to alveolar lesions.

CONCLUSION: JLCH can affect individuals of all ages, though it is more common in children. Factors such as gender, lesion multiplicity, and lesion type (alveolar) are significant in predicting disease progression. Complete surgical resection combined with radiotherapy offers the highest likelihood of cure for SS-type JLCH.

PMID:40259405 | DOI:10.1186/s13023-025-03680-w