Category: Statistics

BMC Oral Health. 2026 Jul 20. doi: 10.1186/s12903-026-09362-8. Online ahead of print.

ABSTRACT

BACKGROUND: Augmented reality (AR) visualization projects preoperative virtual three-dimensional (3D) models onto real surgical sites and can provide intuitive intraoperative guidance. This in vitro proof-of-concept study evaluated the feasibility of markerless AR-guided endodontic microsurgery by comparing objective outcomes between AR guidance (ARG) and traditional freehand (FH) procedures on customized 3D-printed mandibular models.

METHODS: Customized 3D dental models with artificial periapical lesions (APLs) were generated from cone beam computed tomography (CBCT) images obtained from one patient. A total of 20 dental models (80 mandibular molars and 160 APLs) were included, with 10 models assigned to the ARG group and 10 to the FH group. Surgical planning was performed on virtual models reconstructed from CBCT images. All procedures were performed by one endodontist with more than 10 years of clinical experience after standardized training in both workflows. Surgical time was recorded during each procedure, and postoperative CBCT images were acquired to evaluate bone window marking errors, osteotomy errors, and root resection angle error.

RESULTS: The ARG group required less time than the FH group across all four molar positions. Median (IQR) surgical times ranged from 3.72 (2.99-5.75) to 5.25 (4.58-6.56) min in the ARG group and from 7.02 (6.60-7.66) to 9.13 (8.28-9.75) min in the FH group (all P < 0.05). The ARG group also yielded lower median (IQR) values for bone window marking, osteotomy, and root-resection angle errors. Several tooth-specific comparisons reached statistical significance (P < 0.05).

CONCLUSIONS: Within the limitations of an in vitro proof-of-concept study, markerless AR guidance was feasible and was associated with improved accuracy and time efficiency during simulated mandibular molar endodontic microsurgery. Further clinical studies are required before routine clinical application.

PMID:42477686 | DOI:10.1186/s12903-026-09362-8

BMC Musculoskelet Disord. 2026 Jul 20. doi: 10.1186/s12891-026-10189-1. Online ahead of print.

ABSTRACT

BACKGROUND: Open reduction and internal fixation (ORIF) using locking plates remains a widely used head-preserving treatment for displaced proximal humerus fractures in adults. While short-term outcomes are well documented, long-term functional performance, complication burden, and implant survivorship beyond 5-years remain poorly defined. This systematic review and meta-analysis aimed to synthesise long-term (≥ 5-years) functional outcomes, complication rates, and reoperation rates following locking plate ORIF for proximal humerus fractures.

METHODS: A protocol-registered (PROSPERO CRD420251156067) systematic review was conducted in accordance with PRISMA 2020 guidelines. PubMed, Scopus, and the Cochrane Library were searched for English-language randomized and non-randomized clinical studies reporting ≥ 5-year follow-up after ORIF with plate fixation for two-, three-, or four-part proximal humerus fractures in adults. Functional outcomes like Constant-Murley score (CMS), Disabilities of the Arm, Shoulder and Hand Score (DASH), University of California Los Angeles Shoulder Score (UCLA), and Oxford Shoulder Score (OSS), complications, and reoperation rates were extracted. Random-effects meta-analyses were performed, with heterogeneity assessed using the I² statistic. Risk of bias was evaluated using RoB 2 and ROBINS-I, and certainty of evidence was graded using GRADE.

RESULTS: Ten studies met the inclusion criteria, with follow-up ranging from 5 to nearly 15 years. Pooled analyses demonstrated no statistically significant long-term differences in CMS, DASH, or UCLA scores, although the OSS favored ORIF (MD 5.00; 95% CI 1.31-8.69). Long-term complications were common, particularly AVN (5-23%), screw penetration (9-15%), stiffness, and glenohumeral osteoarthritis (5-16%). Meta-analysis suggested reduced risks of complications (RR 0.06), overall reoperation/secondary surgery (RR 0.34; 95% CI 0.13-0.87), implant removal (RR 0.34; 95% CI 0.17-0.67), and revision surgery (RR 0.17; 95% CI 0.07-0.45); however, these estimates should be interpreted cautiously because heterogeneity was substantial to extreme across outcomes. Overall certainty of evidence was very low.

CONCLUSION: Locking plate ORIF for proximal humerus fractures provides acceptable but highly variable long-term functional outcomes, with a considerable burden of late complications and secondary procedures. These findings highlight the importance of careful patient selection, meticulous surgical technique, and long-term follow-up. High-quality prospective studies with standardized outcome reporting are needed to better define the durability of ORIF in this challenging injury.

PMID:42477681 | DOI:10.1186/s12891-026-10189-1

BMC Med Educ. 2026 Jul 20. doi: 10.1186/s12909-026-09967-1. Online ahead of print.

ABSTRACT

BACKGROUND: Medical Student Syndrome (MSS) is a well-recognized phenomenon characterized by transient health anxiety and misinterpretation of benign bodily sensations as symptoms of serious illness. However, it remains underexplored in Yemen, particularly among medical students exposed to clinical training stressors. This study aimed to estimate the prevalence of MSS-like symptoms among medical students at Thamar University, Yemen, identify associated factors, and assess perceived severity and functional impact.

METHODS: A cross-sectional study was conducted among 193 medical students at Thamar University, Yemen. MSS-like symptoms were defined as a self-reported experience consistent with MSS, supported by at least four of five supporting features such as transient and recurrent symptoms with reported normal test results, and short symptom duration. Descriptive statistics were used to summarize participant characteristics and the prevalence of MSS-like symptoms. Bivariable associations were assessed using the chi-square test, and multivariable logistic regression was performed to identify associated factors. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported, with statistical significance set at p < 0.05.

RESULTS: The prevalence of MSS-like symptoms based solely on self-reported experience was 71.0% (137/193), while 37.3% (72/193) met the operational definition. Among participants with MSS-like symptoms, 35 (48.6%) reported moderate perceived severity and 54 (75%) reported moderate perceived functional impact on daily activities and academic performance. In multivariable analysis, MSS-like symptoms were associated with being in the fifth academic year (AOR = 2.58, 95% CI: 1.14-5.82, p = 0.022) and having a chronic disease (AOR = 4.68, 95% CI: 2.17-10.09, p < 0.001).

CONCLUSIONS: More than one-third of medical students at Thamar University met the operational MSS like symptoms. These findings suggest that MSS-like symptoms may be associated with academic exposure and individual health context. Integrating mental health support and stress management strategies into medical training may help reduce health-related anxiety and improve student well-being.

PMID:42477675 | DOI:10.1186/s12909-026-09967-1

BMC Public Health. 2026 Jul 20. doi: 10.1186/s12889-026-28621-5. Online ahead of print.

ABSTRACT

INTRODUCTION: Oral lesions are frequent complications of Human Immunodeficiency Virus (HIV) infection, particularly among individuals with advanced immunosuppression. These lesions reduce quality of life and increase vulnerability to secondary infections. This study assessed knowledge, risk factors, and healthcare-seeking behavior related to oral lesions among HIV enrollees in Osun State, Nigeria.

METHODOLOGY: A descriptive cross-sectional study was conducted among 180 HIV-positive adults with clinically confirmed oral lesions attending selected Antiretroviral Therapy (ART) clinics in Osun State, Nigeria. Participants were recruited from three selected ART clinics using complete enumeration. Data were collected using a structured interviewer-administered questionnaire and analysed using SPSS version 20. Descriptive statistics and appropriate bivariate tests were used, with statistical significance set at p < 0.05.

RESULTS: Participants were mostly male (51.7%) and Yoruba (74.4%). Only 56.1% had good knowledge of oral lesions. Common risk factors included poor oral hygiene (56.1%), alcohol use (31.7%), and ART non-adherence. Healthcare-seeking within two weeks of symptoms was low (26.7%). Religion, education, and occupation were significantly associated with care-seeking. Poor oral hygiene and low CD4 counts were significant predictors of oral lesions.

CONCLUSION: Knowledge and prompt care-seeking for oral lesions remain inadequate among HIV enrollees. Integrating oral health education, routine screening, and dental care into HIV treatment services is essential to improve outcomes in this population.

PMID:42477674 | DOI:10.1186/s12889-026-28621-5

BMC Oral Health. 2026 Jul 20. doi: 10.1186/s12903-026-09183-9. Online ahead of print.

ABSTRACT

BACKGROUND: Additive manufacturing has expanded the clinical application of resin-based materials for definitive fixed dental prostheses (FDPs). This study aimed to evaluate the effect of different printing orientations on marginal and internal misfit, overall discrepancy, and fracture load of three-unit FDPs fabricated from a reinforced resin-based material (VarseoSmile TriniQ).

METHODS: Forty-eight three-unit FDPs were fabricated and divided into four groups (n = 12): a lithium disilicate control group (IPS, IPS e.max CAD) and three experimental groups of a permanent composite resin (VST, VarseoSmile TriniQ) printed at 0°, 45°, and 90° build orientations (VST-0, VST-45, and VST-90). Marginal and internal misfit values were evaluated using micro-computed tomography (micro-CT) before and after chewing simulation. Dynamic aging was followed by fracture load testing using a single-load-to-failure protocol. Failure modes were classified under stereomicroscopic examination. Data were analyzed using nonparametric statistical methods. Intergroup comparisons were performed using the Kruskal-Wallis test with Dunn’s post hoc analysis, while pre- and post-aging comparisons were assessed using the Wilcoxon signed-rank test. Correlations between misfit parameters and fracture load were evaluated using Spearman’s rank correlation analysis (α = 0.05).

RESULTS: Printing orientation significantly affected the marginal and internal misfit of TriniQ restorations. The 45° build orientation demonstrated the most consistent fit values both before and after the chewing simulation. Chewing simulation resulted in statistically significant increases in marginal, internal misfit as well as overall discrepancy values across all groups (p < 0.05). No statistically significant differences in fracture load were observed among the groups (p = 0.094). However, the IPS control group exhibited the highest Weibull modulus (m = 8.41). Spearman’s rank correlation analysis revealed no statistically significant correlations between fracture load and overall discrepancy in any group (p > 0.05). IPS restorations predominantly exhibited catastrophic brittle fractures, whereas TriniQ restorations mainly exhibited connector-related and deformation type failure patterns.

CONCLUSIONS: Build orientation influenced the adaptation accuracy of additively manufactured three unit FDPs, whereas no statistically significant differences in fracture load were observed among the groups. Minor variations in overall discrepancy did not appear to influence fracture load under static loading conditions. All tested groups exhibited fracture resistance values exceeding reported physiological masticatory forces. IPS e.max CAD restorations demonstrated higher structural reliability and more consistent, yet comparatively brittle, fracture behavior.

PMID:42477658 | DOI:10.1186/s12903-026-09183-9

BMC Nephrol. 2026 Jul 20. doi: 10.1186/s12882-026-05211-6. Online ahead of print.

ABSTRACT

BACKGROUND: Kidney biopsy is the gold standard for diagnosing kidney disease, yet its use during pregnancy remains controversial due to concerns about procedure related complications and limited contemporary evidence. This study evaluates long term kidney outcomes with biopsy timing in pregnant and postpartum females.

METHODS: We conducted a retrospective cohort study spanning over 22-years including females aged ≥ 18 years who underwent native kidney biopsy during pregnancy or within three months postpartum. Demographic, clinical, histopathological, maternal, fetal, and long-term kidney outcomes were abstracted from electronic health records. Kaplan-Meier analysis evaluated kidney survival, defined as time to dialysis initiation and statistical significance was set at p-value < 0.05.

RESULTS: In our cohort, 29 females met inclusion criteria: 13 biopsied during pregnancy and 16 postpartum. Long term kidney survival did not differ significantly between groups (log rank p = 0.3). Complication rates were comparable between groups; low, limited to small, and self-limiting hematomas. Lupus nephritis was the most frequent diagnosis in both groups.

DISCUSSION: Although long term dialysis rates were comparable between the two groups, the postpartum cohort had a shorter duration of follow up. Biopsies performed during pregnancy and postpartum were safe in this cohort and yielded clinically meaningful information that frequently altered acute management. Nephrotic range proteinuria and an eGFR below 60 mL/min/1.73 m² were key predictors of progression to ESKD.

CONCLUSION: In our study, no statistically significant difference in long-term kidney survival was observed by biopsy timing during pregnancy vs. postpartum, even though pregnancy group had much longer follow-up than the postpartum group.

PMID:42477653 | DOI:10.1186/s12882-026-05211-6

BMC Pediatr. 2026 Jul 20. doi: 10.1186/s12887-026-07230-6. Online ahead of print.

ABSTRACT

BACKGROUND: To compare the effectiveness and safety of different phototherapy strategies in preterm infants using a network meta-analysis of randomized controlled trials, and to explore whether treatment and population-level characteristics modify the rate of bilirubin decline.

METHODS: We performed a systematic review and frequentist random-effects network meta-analysis of randomized controlled trials enrolling preterm infants (< 37 weeks’ gestation). Phototherapy interventions were grouped based on light source and delivery configuration. Prespecified network meta-regression analyses were conducted to explore potential effect modification by irradiance intensity, delivery configuration, gestational age, birth weight, and baseline bilirubin. The primary outcome was rate of total serum bilirubin decline within 24 h of treatment initiation. This network meta-analysis was prospectively registered in PROSPERO (CRD420261307223).

RESULTS: Twenty randomized trials were included. Double surface phototherapy led to increased TSB reduction (mean difference 0.17 mg/dl/h, 95% CI 0.11-0.22). Higher irradiance strategies demonstrated greater point estimates, although most pairwise comparisons did not reach statistical significance. Meta-regression did not identify statistically significant effect modification, but effect directions were consistent.

CONCLUSIONS: In preterm infants, phototherapy efficacy appears to be more closely related to irradiance intensity and exposed body surface area than to device category alone.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42477649 | DOI:10.1186/s12887-026-07230-6

BMC Cancer. 2026 Jul 20. doi: 10.1186/s12885-026-16554-6. Online ahead of print.

ABSTRACT

BACKGROUND: Gastrointestinal tract (GIT) cancers are a leading cause of cancer-related death worldwide. Chemotherapy, a cornerstone of treatment, often causes toxicities that can compromise clinical outcomes. However, evidence on the prevalence and risk factors of chemotherapy-induced toxicity among GIT cancer patients in Ethiopia remains limited. Therefore, this study aimed to assess the prevalence and associated factors of chemotherapy-induced toxicity among GIT cancer patients at two Tertiary Care Hospitals in Addis Ababa, Ethiopia.

METHODS: A hospital-based prospective observational study was conducted among patients enrolled prior to chemotherapy initiation and followed biweekly until treatment completion. Adverse drug reactions (ADRs) were collected from patient interviews and medical records, and assessed using the Naranjo algorithm, Hartwig-Siegel scale, and National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) version 5. Data were analyzed using descriptive statistics and logistic regression in SPSS version 26, with P < 0.05 considered statistically significant.

RESULTS: The mean (± SD) age of patients was 51.59 (± 11.18) years. A total of 1499 ADRs were reported, of which 47.4% (n = 710) were hematological toxicities. Based on the Naranjo scale, 54.8% of the ADRs were classified as probable, while the Hartwig-Siegel scale severity score classified 53.7% as mild ADRs. According to NCI-CTCAE v5.0 grading score, 37.1% of the ADRs were graded ≥ 3. Poor pathological grade (AOR: 4.410, 95% CI: 1.823-10.666, p = 0.001), low baseline hemoglobin (AOR: 4.456, 95% CI: 2.021-9.824, p = 0.001) and low absolute neutrophil counts (AOR: 2.237, 95% CI: 1.061-4.717, p = 0.034) were significantly associated with severe ADRs. Granulocyte colony-stimulating factor (G-CSF) use was independently associated with lower odds of high-grade ADRs (AOR = 0.508, 95% CI: 0.260-0.995, p = 0.048).

CONCLUSION: Chemotherapy-induced toxicities were highly prevalent among GIT cancer patients, with a substantial proportion experiencing severe toxicities. Poor pathological grade, low baseline hemoglobin, and low absolute neutrophil count were significantly associated with high-grade toxicities, while G-CSF use was protective. These findings highlight the need for improved toxicity management and personalized treatment strategies in Ethiopian oncology practice.

PMID:42477648 | DOI:10.1186/s12885-026-16554-6

BMC Public Health. 2026 Jul 21. doi: 10.1186/s12889-026-28553-0. Online ahead of print.

ABSTRACT

INTRODUCTION: Academic achievement anxiety is a common psychosocial stressor among university students and may be associated with menstrual health outcomes. However, limited research has examined the relationships between academic achievement anxiety, perceived stress, menstrual pain, and menstrual hygiene behaviors simultaneously in female university populations.

MATERIALS AND METHODS: This cross-sectional study included 307 female university students in Turkiye (mean age = 20.59 ± 2.02 years). Participants completed online self-report measures assessing academic achievement anxiety, perceived stress, menstrual pain severity and menstrual hygiene behaviors. Descriptive statistics, Pearson correlations and regression analyses were conducted to examine associations among the variables.

RESULTS: Academic achievement anxiety was positively associated with perceived stress and menstrual pain and negatively associated with genital hygiene behaviors. Multiple linear regression analyses showed that these associations remained significant after controlling for relevant covariates, including age, income level, menstrual regularity, and faculty. Academic achievement anxiety emerged as a significant predictor of perceived stress(β = 0.315, p < 0.001), menstrual pain (β = 0.211, p < 0.001), and genital hygiene behaviors (β = -0.126, p = 0.026).

CONCLUSION: Academic achievement anxiety was associated with higher perceived stress, increased menstrual pain and slightly less optimal menstrual hygiene practices among female university students. However, these associations were modest, suggesting that academic-related stress may represent one of several factors related to menstrual health outcomes. Addressing academic-related stress within a broader context that includes psychological and structural factors may support student wellbeing. Future research should further explore these relationships using more comprehensive designs.

PMID:42477642 | DOI:10.1186/s12889-026-28553-0

BMC Ophthalmol. 2026 Jul 20. doi: 10.1186/s12886-026-05147-3. Online ahead of print.

ABSTRACT

BACKGROUND: Traumatic optic neuropathy (TON) is a potentially blinding complication of craniofacial trauma with an uncertain prognosis and no established standard of care. Evidence on outcomes and prognostic factors remains limited, particularly in Southeast Asian populations.

METHODS: A retrospective observational study was conducted at a tertiary referral centre in Malaysia between September 2020 and August 2025. Patients diagnosed with TON were identified through medical record review. Visual acuity (VA) was categorised according to the World Health Organization (WHO) visual impairment classification. Visual outcomes at one-year follow-up were analysed using the Wilcoxon signed-rank test, and factors associated with visual improvement were evaluated using Fisher’s exact test.

RESULTS: Fifty-eight patients were identified, of whom 54 had complete data for visual outcome analysis. The median age was 23.5 years, and most patients were male (82.8%). Road traffic accidents were the predominant aetiology, accounting for 86.2% of TON cases. TON occurred across all traumatic brain injury severities, with comparable distribution in mild and severe cases. At presentation, 53.8% had severe visual impairment, including 13.8% with no perception of light. There was a statistically significant overall improvement in visual acuity at one-year follow-up compared with baseline (p = 0.003). However, subgroup analysis showed no significant association between treatment modality and visual improvement. Visual improvement was also not significantly associated with age, baseline severity, timing of corticosteroid initiation, or the presence of orbital or skull fractures and intracranial haemorrhage (all p > 0.05).

CONCLUSION: Visual outcomes in TON are variable and unpredictable, highlighting the importance of early neuro-ophthalmic assessment, close visual monitoring, and appropriate counselling regarding the guarded visual prognosis. Due to the relatively small sample size of this cohort, these findings may not be generalisable to broader populations.

PMID:42477640 | DOI:10.1186/s12886-026-05147-3