Category: Statistics

Clin Ter. 2026 May-Jun;177(3):549-553. doi: 10.7417/CT.2026.2040.

ABSTRACT

BACKGROUND: The optimal management of patients with concurrent gallbladder and common bile duct (CBD) stones remains a topic of debate, especially in resource-limited settings. Single-stage laparoscopic cholecystectomy (LC) combined with endoscopic retrograde cholangiopancreatography (ERCP) under the same anesthesia has the potential to lower operative risks, reduce hospital stay, and cut healthcare costs.

METHODS: A retrospective review was conducted of 374 consecutive patients who underwent single-stage LC + ERCP between January 2018 and December 2024 at 115 People’s Hospital in Ho Chi Minh City, Vietnam. Demographic data, perioperative outcomes, operative time, complication rates, and postoperative recovery were analyzed.

RESULTS: The mean age was 60 ± 15 years; 59% were female. The mean total operative time was 123 ± 33 minutes, and the average postoperative hospital stay was 2 ± 1 days. Successful CBD stone clearance was achieved in 100% of patients, with 16% requiring temporary biliary stent placement. Postoperative complications occurred in 4% of patients, all mild pancreatitis, with no bile leakage, bleeding, or mortality. ERCP time >45 minutes, CBD diameter <10 mm, and previous ERCP were significantly associated with post-ERCP pancreatitis.

CONCLUSION: Single-stage LC + ERCP for concurrent gallbladder and CBD stones is safe, effective, and feasible in a tertiary Vietnamese hospital setting. The procedure achieved high success and low complication rates, with shortened hospital stay and minimal morbidity.

PMID:42047142 | DOI:10.7417/CT.2026.2040

Clin Ter. 2026 May-Jun;177(3):496-501. doi: 10.7417/CT.2026.2034.

ABSTRACT

BACKGROUND: Orthostatic hypotension (OH) represents a link between haemodynamic instability and psychosocial adversity in low-resource settings.

OBJECTIVES: To estimate the prevalence of OH among postpartum women in Ndola, Zambia, and examine associations with family scapegoating abuse (FSA) and symptoms of depression, anxiety, and stress.

METHODS: In a community-based cross-sectional study, postpartum women aged 20-30 years within one year of delivery (N = 666) underwent active-stand blood pressure testing. OH was defined as a ≥20 mmHg fall in systolic and/or ≥10 mmHg fall in diastolic pressure within 3 minutes of standing. FSA was measured using the FSA-25 and mental health symptoms using the DASS-21. Descriptive statistics, chi-square tests, logistic regression (including a stepwise sensitivity model), and structural equation modelling (SEM) evaluated direct, indirect, and moderated associations with OH.

RESULTS: OH was identified in 93 (13.9%) women. Any FSA was reported by 164 (24.6%) women, and moderate-to-severe scapegoating was present in 136 (20.4%). In SEM, depressive symptoms showed a positive direct association with OH, with indirect pathways involving anxiety and FSA, while stress related to OH primarily through FSA. In logistic regression, Stress_G(1) was associated with lower odds of OH (OR = 0.109, 95% CI: 0.042-0.280), whereas employment status was not independently associated with OH; interaction estimates with employment were unstable. In the stepwise model, Stress_G(1) was the only retained significant predictor of OH.

CONCLUSIONS: OH is a clinically relevant postpartum finding in this Zambian cohort and co-occurs with substantial family scapegoating and internalising symptoms. Integrating orthostatic blood pressure assessment with structured psychosocial screening may help identify women at heightened risk for dizziness, falls, and persistent mood and anxiety problems, supporting more holistic postpartum care in similar low-resource settings.

PMID:42047136 | DOI:10.7417/CT.2026.2034

Clin Ter. 2026 May-Jun;177(3):460-465. doi: 10.7417/CT.2026.2029.

ABSTRACT

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder associated with significant morbidity, mortality, and impaired quality of life (QOL). Insulin therapy is central to glycaemic control in advanced disease but poses psychosocial and practical challenges. This study evaluated QOL among insulin-treated T2DM patients in tertiary care hospitals.

METHODS: A cross-sectional study was conducted in the outpatient and inpatient departments of hospitals affiliated with Medical College in south Asian city. Total 272 patients aged >30 years with T2DM on insulin therapy for ≥3 months were included. Patients with type 1 diabetes or on oral therapy alone were excluded. Data on demographics, comorbidities, HbA1c, and complications were collected. QOL was assessed using the Quality-of-Life Instrument in Indian Diabetic Patients (QOLID), and barriers to insulin therapy were measured with the BITQ questionnaire. Statistical analysis was performed using SPSS v25, with p<0.05 considered significant.

RESULTS: Of the 272 participants, 74% were aged >50 years and 61% were female. Neuropathy (18%) was the most common complication. Overall QOL score averaged 126.36 ± 21.69, with lowest scores in role limitation (19.40), physical endurance (19.25), and emotional health (15.58). Patients on combination therapy (insulin plus oral agents) reported better physical endurance and overall QOL compared to insulin-only users, though financial burden was greater. Complications and poor glycemic control (HbA1c) significantly worsened QOL across domains.

CONCLUSION: Insulin-treated T2DM patients experience moderate impairment in QOL, influenced by complications, poor glycaemic control, and financial and psychological burdens. A holistic, patient-centred approach incorporating medical, psychosocial, and economic support is essential to improve outcomes.

PMID:42047131 | DOI:10.7417/CT.2026.2029

Clin Ter. 2026 May-Jun;177(3):432-438. doi: 10.7417/CT.2026.2025.

ABSTRACT

BACKGROUND: Laparoscopic Nissen Fundoplication (NF) remains the gold standard anti-reflux procedure due to its well-established long-term efficacy and safety. However, the modified Nissen fundoplication (MNF) which incorporates additional sutures to fixate the esophagus to the right and left crus aims to enhance hiatal stabilization and potentially reduce GERD symptom recurrence.

AIM: This study aims to compare between conventional Laparoscopic Nissen Fundoplicalion and Modified Nissen Fundoplication regarding post-operative complications specially “Dysphagia, recurrence of GERD symptoms”.

PATIENTS AND METHODS: This study is a prospective randomized controlled trial. The study took place at Ain Shams University Hospitals. The study was conducted from January 2023 to January 2025, including one year for patient recruitment and one year for follow-up.

RESULTS: This study compared NF and MNF in terms of postoperative complications, revealing a statistically significant difference in the incidence of postoperative hiccups and left shoulder pain. While some prior studies found no significant differences between the two techniques, our results suggest that MNF can be performed safely by experienced surgeons without increased morbidity or complication rates.

CONCLUSION: The current study was constrained by its limited sample size and follow-up duration, which may affect the generalizability of findings. To further validate these results, future research should involve larger cohorts and extended follow-up periods to assess long-term recurrence rates and complications. Such data will help determine whether MNF offers superior outcomes over conventional NF, guiding clinical decision-making for optimal surgical management of GERD.

PMID:42047127 | DOI:10.7417/CT.2026.2025

Clin Ter. 2026 May-Jun;177(3):405-413. doi: 10.7417/CT.2026.2022.

ABSTRACT

OBJECTIVE: In chronic kidney disease, gut dysbiosis increases intestinal permeability, allowing toxins to enter the bloodstream and causing inflammation. This study aimed to assess the impact of probiotic supplementation on serum Zonulin levels, P-cresyl sulfate and highly sensitive C-reactive protein (hs-CRP) in hemodialysis patients.

MATERIALS AND METHODS: Forty hemodialysis patients were enrolled and divided into either a probiotic group or a control group (20 patients per group). The probiotic group received supplements for 3 months. Serum Zonulin, hs-CRP and P-cresyl sulfate were measured at baseline and after the 3-month intervention.

RESULTS: After 3 months of probiotic administration, the probiotic group showed a statistically significant decrease in serum Zonulin (p < 0.001), P-cresyl sulfate (p < 0.001) and hs-CRP (p = 0.037). Furthermore, a significant difference was observed between the two groups regarding post-intervention levels of Zonulin (p < 0.001), P-cresyl sulfate (p < 0.001), and hs-CRP (p < 0.001).

CONCLUSIONS: Probiotic administration in hemodialysis patients improved intestinal barrier integrity, reduced gut-derived toxin levels, and lowered systemic inflammation.

PMID:42047124 | DOI:10.7417/CT.2026.2022

Clin Ter. 2026 May-Jun;177(3):388-394. doi: 10.7417/CT.2026.2020.

ABSTRACT

BACKGROUND: Adrenaline is commonly added to local anesthetic solutions to reduce bleeding and prolong analgesia. However, its clinical impact during ultrasound-guided interfascial plane blocks in superficial soft tissue surgery remains insufficiently evaluated. This randomized controlled trial assessed the effect of adding adrenaline (1:200,000) to bupivacaine during ultrasound-guided lipoma plane block.

METHODS: In this prospective randomized controlled study, 40 adult patients undergoing elective superficial lipoma excision were randomly assigned to two groups (20 patients each). Group A received 0.25% bupivacaine with adrenaline (1:200,000), and Group B received 0.25% bupivacaine alone. Primary outcomes were intraoperative blood loss, operative time, and postoperative pain scores at 2, 6, and 24 hours. Secondary outcomes included need for rescue analgesia, supplemental anesthesia, ease of dissection, capsule integrity, and postoperative complications. Statistical significance was defined as p < 0.05.

RESULTS: Baseline characteristics were comparable between groups. Intraoperative blood loss was significantly lower in Group A (6.2 ± 1.5 mL) compared with Group B (12.7 ± 2.8 mL; p < 0.001). Operative time was shorter in the adrenaline group (12.4 ± 3.1 min vs. 17.8 ± 3.9 min; p = 0.002). Postoperative pain scores were significantly lower in Group A at 2 hours (p = 0.004), 6 hours (p = 0.006), and 24 hours (p = 0.009). Rescue analgesia was required less frequently in Group A (15% vs. 40%; p = 0.038). Ease of dissection and capsule integrity preservation were significantly improved with adrenaline. Minor hematoma occurred less frequently in Group A (5% vs. 20%; p = 0.041). No serious adverse events were observed.

CONCLUSIONS: The addition of adrenaline (1:200,000) to bupivacaine in ultrasound-guided lipoma plane block significantly reduces intraoperative blood loss, shortens operative time, and improves postoperative analgesia. Adrenaline appears to be a safe and effective adjunct in superficial lipoma excision.

PMID:42047122 | DOI:10.7417/CT.2026.2020

Afr J Reprod Health. 2026 Apr 28;30(8):53-65. doi: 10.29063/ajrh2026/v30i8.6.

ABSTRACT

Using a qualitative interpretive descriptive-analytical approach, this study analysed harmonised secondary data from the World Bank World Development Indicators covering six countries between 2000 and 2024. Longitudinal trend assessment and crosscountry comparisons were employed to examine urban population, modern contraceptive prevalence, and total fertility rates. The findings indicate sustained urban expansion across all countries, accompanied by gradual increases in contraceptive uptake and fertility decline. However, these patterns remain uneven across national contexts. Ghana and Sierra Leone combine relatively high urbanisation with stronger improvements in contraceptive prevalence and faster fertility decline. In contrast, Nigeria and Guinea maintain comparatively high fertility levels despite substantial urban growth and weaker contraceptive uptake. The Gambia and Liberia display intermediate trajectories characterised by moderate urbanisation, rising contraceptive use, and gradual fertility reduction. The results indicate that urbanisation alone does not generate uniform reproductive outcomes; rather, fertility transitions are mediated by contraceptive access and the effectiveness of urban health service. The study recommends integrating family planning into urban development strategies and strengthening reproductive health service delivery in rapidly expanding urban and peri-urban settlements to reduce persistent reproductive health inequalities.

PMID:42047119 | DOI:10.29063/ajrh2026/v30i8.6

J Med Econ. 2026 Dec;29(1):1230-1245. doi: 10.1080/13696998.2026.2652780. Epub 2026 Apr 28.

ABSTRACT

BACKGROUND: The costs associated with advanced Parkinson’s disease (aPD) extend beyond direct medical expenditure. As symptoms become more severe, professional and informal personal care costs are likely to exceed those incurred for medical and pharmacological treatment. The objective of this analysis is to explore the impact of treatment with subcutaneous foslevodopa/foscarbidopa (LDp/CDp) on the societal cost impact in the UK, France, Germany, Spain, and Canada.

METHODS: A model was developed to aggregate expected costs incurred by a cohort with aPD over a 5-year time frame. Resource use for direct medical, non-medical, and informal care are estimated from a real world data source (Adelphi), mapped to the severity of disease as estimated by the extent of OFF-time experienced by patients. Indirect societal costs are estimated from published literature. Unit costs for each of the included countries are then applied to these resource use estimates. Symptom progression of individuals within the cohort are derived from a previously developed Markov model, which captures the differential effect on OFF-time of LDp/CDp versus best medical treatment (BMT).

RESULTS: Overall costs for aDP patients were shown to rise over the 5-year time horizon, as symptom progression occurred. The use of LDp/CDp incurred greater drug costs than BMT, but, by delaying exacerbation of OFF-time, this additional cost was more than offset by other savings – principally attributable to professional and informal care. Aggregated results showed a net cumulative saving of €96,273 per patient over the 5 year time horizon. Results for the five individual countries evaluated ranged from €50,297 to €135,208 per patient saving.

CONCLUSION: LDp/CDp has been shown to significantly improve OFF-time burden in patients with aPD, compared with BMT. Once the costs of professional and informal care are taken into account, the additional acquisition costs of LDp/CDp are more than offset, yielding a net societal saving.

PMID:42047110 | DOI:10.1080/13696998.2026.2652780

Mol Biol Evol. 2026 Apr 28:msag107. doi: 10.1093/molbev/msag107. Online ahead of print.

ABSTRACT

Genomic prediction leverages all available markers, irrespective of their statistical significance in genome-wide association studies (GWAS). Recent advancements in marker density, sample sizes, and sophisticated statistical GWAS methods have demonstrated that integrating GWAS results can potentially boost the accuracy of genomic predictions. The Genomic Association and Prediction Tool (GAPIT) has recently begun incorporating GWAS findings into its prediction framework, streamlining this approach, referred to as GWAS-Assisted Genomic Best Linear Unbiased Prediction (GAGBLUP). A sufficient simulation study revealed that the benefits of GAGBLUP depend on the GWAS model used. Multiple-locus models, such as Bayesian-information and Linkage-disequilibrium Iteratively Nested Keyway (BLINK), outperformed single-locus models, like the mixed linear model. Specifically, when BLINK GWAS results in a real trait were incorporated into genomic Best Linear Unbiased Prediction (GBLUP), prediction accuracy improved by over 20% compared to GBLUP alone. This approach integrates the trait-specific insights from GWAS with the polygenic modeling capacity of GBLUP, resulting in more stable prediction across varying genetic backgrounds. This broader applicability enhances the utility of genomic selection in breeding programs, enabling its deployment across a wider range of crops and trait architectures.

PMID:42047095 | DOI:10.1093/molbev/msag107

J Prosthodont. 2026 Apr 28. doi: 10.1111/jopr.70152. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this in vitro study was to investigate the effect of print orientation and printing technology on the accuracy of static computer-aided implant surgery (s-CAIS).

MATERIALS AND METHODS: A cone beam computed tomography (CBCT) scan and a partially edentulous mandibular intraoral scan (IOS) of an unidentified patient missing the mandibular right first molar were used for this study. Fifty-two resin models were printed from the obtained IOS. Digital implant planning software CoDiagnostiX was used to virtually plan the implant based on a prosthetically driven approach. A tooth-supported surgical guide was designed, and the resultant STL files were then used to manufacture 52 different guides. Two different printing technologies were employed: stereolithography (SLA) and digital light processing (DLP). The groups were further subdivided according to print orientation into 0° and 45° orientations, with 13 guides per group (n = 13). Fifty-two fully guided implants were placed in their respective models. Scan bodies were placed on each implant, and an intraoral implant scan was obtained. Post-placement STL files were then imported into the CoDiagnostiX treatment evaluation tool to assess the accuracy of the placed implants compared to the planned ones. Three different parameters were assessed: implant angular deviation, deviation at the entry point, and deviation at the apex. Two-way analysis of variance (ANOVA) and post hoc Tukey pairwise comparison tests were used to compare the means, with a significance level set at p < 0.05 (α = 0.05) using the R programming language.

RESULTS: No statistically significant difference was observed in mean angular deviation among the groups (p > 0.05). At the entry point, the 45° SLA group demonstrated the lowest mean deviation (0.86 ± 0.13 mm), which was significantly lower than 0° SLA (1.35 ± 0.22 mm), 0° DLP (1.23 ± 0.20 mm), and 45° DLP (1.11 ± 0.29 mm) (p < 0.05). No significant differences were observed between 0° DLP and 0° SLA or between 0° DLP and 45° DLP. At the apical level, the 45° SLA group exhibited the lowest mean deviation (1.16 ± 0.23 mm) and differed significantly from both 0° SLA (1.45 ± 0.25 mm) and 0° DLP (1.49 ± 0.32 mm) (p < 0.05), whereas no significant differences were found between 45° SLA and 45° DLP.

CONCLUSION: Overall, print orientation (0° vs. 45°) and printing technology (SLA vs. DLP) did not significantly affect angular deviation. For the SLA group, printing at a 45° orientation significantly reduced the offset at both the entry point and the apex compared to the 0° orientation, with results favoring the 45° orientation. In contrast, print orientation did not significantly influence accuracy in the DLP group.

PMID:42047093 | DOI:10.1111/jopr.70152