Category: Statistics

Indian J Orthop. 2025 Jun 27;59(9):1563-1574. doi: 10.1007/s43465-025-01440-3. eCollection 2025 Sep.

ABSTRACT

BACKGROUND: Ankle arthrodesis is still the gold standard for painful, dislocated ankles with insufficient response to conservative treatment. This study presents a new arthroscopic solution to treat varus ankles over 25 degrees.

METHODS: Sixty-four patients with varus ankle deformities (35 males, 29 females, 33 right ankles, 31 left ankles) underwent arthroscopic fusion between February 2019 and February 2022. Patients were categorized into Group A (34 patients, varus > 25 degrees) and Group B (30 patients, varus < 25 degrees). The conditions included post-traumatic osteoarthritis (50%), primary osteoarthritis (20.3%), rheumatoid arthritis (17.2%), talar osteonecrosis (7.8%), and talar dome osteochondral defects (4.7%). Outcome measures included ankle joint mobility, radiographic assessment, VAS score, Mazur score, range of motion, stiffness, swelling, union rate, and patient satisfaction at 6, 12, and 24 months postoperative. Statistics analyses were performed using Fisher’s Exact test and Mann-Whitney test.

RESULTS: All procedures were performed successfully and follow-up was 24.08 months on average. VAS and Mazur scores improved significantly in both groups. Group A had a better final outcome than Group B (14.47 weeks for union).

CONCLUSION: The proposed arthroscopic fusion technique can effectively improve the alignment of the tibiotalar joint in varus ankle deformities greater than 25° through medial deltoid release, with promising clinical and functional outcomes.

PMID:41054762 | PMC:PMC12496405 | DOI:10.1007/s43465-025-01440-3

Indian J Orthop. 2025 May 13;59(9):1537-1545. doi: 10.1007/s43465-025-01406-5. eCollection 2025 Sep.

ABSTRACT

OBJECTIVE: To explore the manifestations of extradural fat in patients with Redundant nerve roots (RNRs) via lumbar MRI.

METHODS: A total of 492 patients with RNRs were enrolled and divided into two groups: Group A (n = 459) with known potential causes of RNRs, such as lumbar spondylolisthesis, scoliosis, disc herniation, and ligamentum flavum hypertrophy; Group B (n = 33) without the aforementioned causes; and control Group C (n = 33) with age- and sex-matched RNRs-negative patients. MRI was used to assess the morphology of extradural fat and the appearance of the cauda equina and to measure the subcutaneous fat thickness in the lumbar-sacral region (LSFTT). Statistical analysis was performed via t tests, chi-square tests, and Wilcoxon signed-rank tests, with p < 0.05 considered statistically significant.

RESULTS: In Group A, there was no statistically significant difference in the LSFTT among the different grades of extradural fat. In Group B, the incidence rates of Grade 2 and Grade 3 extradural fat were 66.7% and 24.2%, respectively, which were significantly greater than the 27.3% and 0% reported in Group C, with a statistically significant difference between Groups B and C (p < 0.001). The correlation coefficient between increased extradural fat and RNRs was 0.669 (p < 0.001). There were no statistically significant differences in the morphology or relative length of the RNRs among the different grades of extradural fat in Group B.

CONCLUSION: MRI is an important tool for assessing extradural fat and RNRs, providing crucial information for clinical decision-making and improving patients’ prognoses. Increased extradural fat may contribute to the development of RNRs and should be a concern for clinicians.

PMID:41054757 | PMC:PMC12496402 | DOI:10.1007/s43465-025-01406-5

Indian J Orthop. 2025 Jun 11;59(9):1413-1419. doi: 10.1007/s43465-025-01430-5. eCollection 2025 Sep.

ABSTRACT

INTRODUCTION: On-the-go (OTG) reference is defined as the reference that clinicians make on the go in a narrow time frame during patient care, which tends to play a significant role in decision-making. The common sources of these references over the years, have been changing from hard copies of textbooks and journals to online platforms. With the introduction of artificial intelligence (AI) based large language model (LLM) platforms, they are now being relied upon for these OTG references to provide clinicians with the necessary facts to make good clinical decisions by analyzing the maximum available resources. This study aims to compare the answers given by various LLM platforms with the answers obtained by clinicians using conventional referencing and also grade the relevance of the answers provided by these platforms.

METHODS: Three commonly used AI-based LLM chat platforms: ChatGPT Version 4(GPT 4), Microsoft Bing chat and Google Bard were selected for the study. 250 OTG clinical queries were collated from orthopaedic practitioners along with their answers and references used. The queries were given to the LLMs and their answers were compared and graded with the human answers for relevance and level of evidence (LOE) of the reference cited to support their answers.

RESULTS: We did not find any significant difference between the AI-LLM models tested regarding the relevance of generated answers to the clinical queries raised (p = 0.110). ChatGPT answers were significantly better to queries that necessitated numerical answers (p = 0.006) while Bard (p = 0.503) and Bing (p = 0.545) did not differ in their performance based on query types. We noted a statistically significant difference concerning the LOE of answers obtained (p < 0.001). Upon ranking the three LLMs with the LOE of human references, human references ranked the best followed by Bing, ChatGPT, and Bard.

CONCLUSION: Of the three compared tools, Bing Chat used relatively better LOE in answering OTG questions. All three compared AI-LLM tools show promising results concerning OTG referencing. We propose that customization to the medical domain and regulatory policies are needed before their recommended use.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43465-025-01430-5.

PMID:41054750 | PMC:PMC12496309 | DOI:10.1007/s43465-025-01430-5

Indian J Orthop. 2025 May 13;59(9):1440-1446. doi: 10.1007/s43465-025-01386-6. eCollection 2025 Sep.

ABSTRACT

AIM: To identify the frequency of developmental dysplasia of the hip (DDH) in infants subjected to traditional swaddling for awareness purpose and early intervention, in addition to detect the accuracy of clinical and radiological techniques in the diagnosis of cases.

METHODS: This prospective observational study was conducted by a multidisciplinary team at Azadi Teaching Hospital and Maternity Hospital in Duhok City from October 2022 to October 2024. This study included a total of 110 newborns whose parents continued to practice traditional swaddling despite receiving immediate postnatal warnings against its use. however, newborns who were not exposed to this method of swaddling were excluded. Clinical and radiological assessments were conducted at birth till 6 months of age. Statistical analyses were performed using SPSS version 27 to evaluate the relationship between traditional swaddling and DDH.

RESULTS: Among the 110 neonates, 6.4% were diagnosed with DDH by the age of six months. Significant associations were found with female sex, breech presentation, first-born status, and a positive family history. Left-sided hip involvement was predominant. Early ultrasound by about 8 weeks detected dysplasia in 10% of patients, with 54% progressing to DDH. By six months, X-rays imaging confirmed a 6.4% prevalence of DDH.

CONCLUSION: Traditional swaddling practices were linked with an increased risk of DDH, particularly in infants with other risk factors. Ultrasound within the first 3 months and follow-up X-ray at 6 months are reliable diagnostic tools for identifying DDH. Early screening and safe swaddling education are critical for DDH prevention.

PMID:41054749 | PMC:PMC12496375 | DOI:10.1007/s43465-025-01386-6

Indian J Orthop. 2025 Jun 28;59(9):1455-1461. doi: 10.1007/s43465-025-01452-z. eCollection 2025 Sep.

ABSTRACT

BACKGROUND: Tourniquets are used in knee arthroplasty surgeries for a bloodless field and effective bone-cement integration. However, their use is associated with known complications and of late surgeons have proposed limiting their use. The present randomized study was carried out to analyze the effectiveness of limited tourniquet usage in knee arthroplasty.

METHODOLOGY: 60 patients were randomized into two groups, full tourniquet time (FTT) group and the limited tourniquet time (LTT) group. Demographic parameters, preoperative haemoglobin and haematocrit, operative time, duration of tourniquet use, and measured blood losses were recorded. Drain outputs, post-operative Hb, hematocrit, transfusion requirements, total blood loss by day 5 were recorded and calculated. Hidden blood loss was calculated based on the above-derived data.

RESULTS: The demographic and the pre-operative variables of the two groups were similar. On intra-group analysis, all the parameters were statistically significant except the VAS scores. On comparison between the two groups the tourniquet time, day 1 Hb in the FTT group and pain experienced by the FTT group on day 5 was significantly higher whereas the operative time LTT group was significantly higher. There was no significant difference in the rest of the parameters.

CONCLUSION: Tourniquet usage is associated with known complications. There is no significant advantage in blood loss while using tourniquet throughout the surgery. However, limiting the tourniquet use is associated with significantly lower pain scores on 5th post-op day. Hence, it is recommended that the use should be reduced to mitigate the complications of tourniquet usage.

PMID:41054748 | PMC:PMC12496396 | DOI:10.1007/s43465-025-01452-z

Indian J Orthop. 2025 Jun 29;59(9):1462-1468. doi: 10.1007/s43465-025-01464-9. eCollection 2025 Sep.

ABSTRACT

INTRODUCTION: Conventionally, radiographs have been used to assess the severity of knee osteoarthritis (OA), but they fail to measure soft tissue changes responsible for generating symptoms. In recent literature, there is discordance between clinical symptoms and X-ray findings in knee OA. Therefore, we used MRI in our study to assess the correlation between patient-reported outcome measures as assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and MRI findings as assessed by the Whole-Organ Magnetic Resonance Imaging Score (WORMS) score in knee OA. The study was done after approval from The Institutional Human Ethics Committee.

METHODS: The sample size was calculated as 34. Eight women and 26 men who fulfilled the inclusion and exclusion criteria were included in the study. The knee with a higher Kellgren and Lawrence (KL) grade underwent MRI. The WOMAC score was used to assess pain, morning stiffness and physical function and the MRI findings were evaluated using the WORMS score. Spearman’s rank correlation coefficient was used for correlation analysis.

RESULTS: The mean age was 53.5 ± 8.08 years, BMI 29.35 ± 4.51 kg/m², disease duration 2.57 ± 1.91 years, VAS score 5.08 ± 1.50, total WOMAC score 41.50 ± 10.80, and total WORMS score 64.78 ± 26.49. Statistical analysis revealed a positive correlation between WOMAC score and WORMS score (Spearman’s rho value-0.645, p-value- < 0.05, Confidence Interval- 95%), and between WORMS score and KL grade (Spearman’s rho value-0.637, p-value- < 0.05, Confidence Interval- 95%). There was no correlation between the WOMAC score and KL grade, highlighting the limitation of radiographs in reflecting symptom severity.

CONCLUSION: Conventional radiography is a good screening tool for knee osteoarthritis but cannot detect structural changes causing symptoms, leading to symptom-radiograph discordance. MRI better identifies these changes, as our study shows, and is useful when symptoms and radiographs misalign or conservative treatment fails. Future research should identify WORMS subgroups that better correlate with symptoms for improved diagnosis and management.

PMID:41054741 | PMC:PMC12496301 | DOI:10.1007/s43465-025-01464-9

F S Rep. 2025 Jun 28;6(3):299-308. doi: 10.1016/j.xfre.2025.06.009. eCollection 2025 Sep.

ABSTRACT

OBJECTIVE: To investigate clinical characteristics and in vitro fertilization (IVF) outcomes in patients after radical abdominal trachelectomy (RAT) for early-stage cervical cancer.

DESIGN: A retrospective cohort study of patients who underwent IVF after RAT between January 2009 and December 2022, with comparison to age-matched controls.

SUBJECTS: Forty-one patients who underwent RAT for early-stage cervical cancer and subsequently sought IVF, compared with 82 age-matched controls.

EXPOSURE: Radical abdominal trachelectomy as a fertility-sparing surgery for early-stage cervical cancer, followed by IVF.

MAIN OUTCOME MEASURES: Embryological outcomes, clinical pregnancy rates, live birth rates, and factors influencing IVF success, including age at first oocyte retrieval, ovarian response parameters, number of oocytes retrieved, presence of cervical stenosis, and endometrial thickness at embryo transfer (ET) were compared between the RAT and control groups.

RESULTS: The RAT group had similar anti-mullerian hormone levels and embryological outcomes compared with controls. In the RAT group, clinical pregnancy and live birth rates were 68.3% (28/41) and 58.5% (24/41) per patient and 20.8% (37/178) and 15.7% (28/178) per ET, respectively. These rates were comparable to those in the control group, which were 62.2% (51/82) and 50.0% (41/82) per patient and 25.4% (80/314) and 16.6% (52/314) per ET, respectively. In the RAT group, live birth outcomes were associated with younger age at first oocyte retrieval, higher number of oocytes retrieved, fewer cases of cervical stenosis, and greater endometrial thickness at ET. An endometrial thickness of 9.2 mm was identified as the optimal statistical boundary for predicting both clinical pregnancy and live birth.

CONCLUSION: The live birth rate in the RAT group was comparable to that in the age-matched control group, indicating that RAT does not negatively impact assisted reproductive technologies outcomes. Age at first oocyte retrieval, number of oocytes retrieved, presence of cervical stenosis, and endometrial thickness at ET may influence IVF outcomes after RAT.

PMID:41054736 | PMC:PMC12496419 | DOI:10.1016/j.xfre.2025.06.009

F S Rep. 2025 Jul 1;6(3):328-334. doi: 10.1016/j.xfre.2025.06.011. eCollection 2025 Sep.

ABSTRACT

OBJECTIVE: To compare the outcomes of oocyte cryopreservation in transgender patients with and without prior testosterone use.

DESIGN: Retrospective cohort study.

SUBJECTS: Transmasculine/non-binary patients assigned female at birth who were referred for fertility preservation from January 2012 to March 2024 at a multicenter health maintenance organization.

EXPOSURE: Gender-affirming hormone therapy with testosterone.

MAIN OUTCOME MEASURES: The primary outcome measure was the number of mature oocytes collected. Secondary outcomes included the total number of oocytes, percentage of mature to total oocytes, total dose of gonadotropins used, baseline antimüllerian hormone, baseline antral follicle count, and baseline endometrial thickness.

RESULTS: Data from 50 transgender oocyte cryopreservation cycles were analyzed in the time period studied. A total of 34 subjects (68%) had no exposure to testosterone, whereas prior testosterone use was reported in 16 subjects (32%). The mean duration of testosterone was 4.1 ± 2.6 years. Testosterone was discontinued 3 weeks to 3 months before cycle start. There were no significant differences in baseline demographics, such as age and body mass index, between the two patient groups. The total number of oocytes retrieved was statistically the same between transgender patients with prior testosterone use (17.3 ± 10.1) and those without (21.3 ± 10.1). Additionally, there were no differences in the number of mature oocytes (12.0 ± 7.5 vs. 16.1 ± 9.1) or ratio of mature/total oocytes between the two groups (72.3% ± 18.3% vs. 70.9% ± 22.4%). Secondary outcomes such as baseline antral follicle count, baseline antimüllerian hormone, total dose of gonadotropins used, and baseline endometrial thickness demonstrated no significant difference between the two study groups.

CONCLUSION: Our study suggests that prior testosterone use does not appear to impact oocyte cryopreservation outcomes in transgender patients. As a growing number of transgender patients seek fertility care, there is a need for evidence-based research that can guide clinical practice and empower this population to realize their aspirations for parenthood.

PMID:41054727 | PMC:PMC12496435 | DOI:10.1016/j.xfre.2025.06.011

F S Rep. 2025 May 9;6(3):270-279. doi: 10.1016/j.xfre.2025.05.002. eCollection 2025 Sep.

ABSTRACT

OBJECTIVE: To examine the utility of semen parameters and sperm mitochondrial DNA copy number (mtDNAcn) to predict couples’ time to pregnancy (TTP).

DESIGN: This study assessed the predictive power of sperm mtDNAcn and 34 semen parameters. Two composite semen quality indices (SQIs) were developed; an unweighted ranked-sperm quality index (ranked-SQI) derived from only semen parameters and a weighted sperm quality index generated using machine learning via elastic net (ElNet-SQI). Discrete-time proportional hazard models, logistic regression, and receiver operating characteristic (ROC) analyses were used to evaluate the predictive ability of achieving pregnancy at 3, 6, and 12 months, and the overall TTP.

SUBJECTS: The participants included 281 men from the Longitudinal Investigation of Fertility and the Environment study, a large preconception general population cohort designed to explore factors affecting conception.

EXPOSURE: Sperm mtDNAcn, 34 semen parameters, unweighted ranked-SQI, and a machine learning-based weighted SQI were evaluated for the ability to predict pregnancy.

MAIN OUTCOMES MEASURES: The main outcome measures were the overall time taken to achieve pregnancy and the likelihood of achieving pregnancy within 3, 6, or 12 months of trying to conceive.

RESULTS: For individual semen measures, sperm mtDNAcn was most predictive of pregnancy at 12 menstrual cycles in ROC analyses (area under the curve [AUC], 0.68; 95% confidence interval [CI], 0.58-0.78). Among multiparameter biomarkers, ElNet-SQI (comprised of 8 semen parameters and mtDNAcn), demonstrated the highest AUC, 0.73; 95% CI, 0.61-0.84) for pregnancy status at 12 cycles. Furthermore, ElNet-SQI was the most strongly associated with TTP than any other individual or combinations of semen parameters (fecundability odds ratio [FOR], 1.30; 95% CI, 1.14-1.45; P=6.0∗10^-5).

CONCLUSION: Sperm mtDNAcn is associated with multiple conventional and detailed semen parameters. Moreover, a composite machine learning ElNet-SQI that included mtDNAcn and several semen parameters had the highest predictive ability of pregnancy. These results indicate that sperm mtDNAcn can serve as a biomarker of overall sperm fitness and likelihood of reproductive success.

PMID:41054723 | PMC:PMC12496432 | DOI:10.1016/j.xfre.2025.05.002

Reprod Health. 2025 Oct 6;22(1):184. doi: 10.1186/s12978-025-02070-6.

ABSTRACT

BACKGROUND: This study explores the awareness and predictors of knowledge regarding sexually transmitted diseases among early adolescents (ages 11-15) in the Koforidua Municipality.

METHODS: The study was designed as convergent parallel mixed-methods research hinged on an analytical cross-sectional and descriptive phenomenological design. In all, 373 adolescents were surveyed, obtaining varied insights across different demographic groups, with an additional 10 interviews conducted for qualitative analysis. Quantitative data were analyzed using descriptive statistics and multilevel logistic regression, while the qualitative data were thematically analyzed.

RESULTS: Two-thirds (67.3%) of early adolescents reported awareness of STDs. 134(53.4%) out of the 251 early adolescents who were aware of STDs opted to test for them. HIV (M = 1.33, SD = 0.699), and Gonorrhea (M = 1.55, SD = 0.827) were the most commonly recognized infections but misconceptions about Syphilis (M = 1.94, SD = 0.929), Chlamydia (M = 2.49, SD = 0.778), Genital wart (M = 2.35, SD = 0.854) and Hepatitis (M = 2.36, SD = 0.755) as types of STDs were dominant. Early adolescents in Junior High School -JHS1 (AOR 0.307 (95.0% CI 0.111-0.847 p = 0.023), JHS 2 (AOR 0.201 (95.0% CI 0.070-0.579 p = 0.003), JHS 3 (AOR 0.134 (95.0% CI 0.043-0.414 p = 0.00) were less likely to know STDs compared to those in primary six. Early adolescents who had never dated (AOR 0.705 (95.0% CI 0.423-1.173 p = 0.014) were also less likely to know about STDs compared to those who had ever dated.

CONCLUSION: The findings highlight the need for the Ghana Education Service to integrate comprehensive sexual health education into primary and junior high school curricula to improve STD knowledge among early adolescents.

PMID:41053753 | DOI:10.1186/s12978-025-02070-6