Tag: statistics

J Anaesthesiol Clin Pharmacol. 2025 Apr-Jun;41(2):286-291. doi: 10.4103/joacp.joacp_88_24. Epub 2025 Mar 24.

ABSTRACT

BACKGROUND AND AIMS: Postoperative hypotension is common in adults receiving epidural analgesia. Although risk factors have been reported in the literature, prognostic models have not been developed or validated. We aimed to develop and validate a multivariable, prognostic model for postoperative hypotension in patients receiving epidural analgesia.

MATERIAL AND METHODS: We retrieved retrospective cohort data of adults undergoing abdominal or thoracic surgery at five hospitals between 2014 and 2023 who received epidural analgesia for at least 24 hours after surgery. A systematic literature search helped define a priori candidate exposures. The primary outcome was postoperative hypotension during the first 72 hours after surgery. Multiple logistic regression was performed to evaluate a multivariable model. Exposures identified as statistically significant were used for logistic regression, linear discriminant analysis, and decision-tree model of random forest. Classification error was used to compare models, and variable importance was used for random forest analysis.

RESULTS: In total, 829 participants were included. The incidence of postoperative hypotension was 38.8%. Multivariable analysis identified the following independent prognostic factors: male sex, white race, body mass index, intraoperative hypotension, use of arterial line, bupivacaine concentration of 0.125% (vs. lower concentrations), and anesthesia duration. The error misclassification rate was 67% for multiple logistic regression, 27% for linear discriminant analysis, and 33.4% for random forest model.

CONCLUSION: Using retrospective cohort data, a prognostic model of hypotension produced the best performance results using linear discriminant analysis, with an error misclassification rate of 27%. Further studies are required to perform model optimization for future clinical use.

PMID:40248788 | PMC:PMC12002708 | DOI:10.4103/joacp.joacp_88_24

J Anaesthesiol Clin Pharmacol. 2025 Apr-Jun;41(2):219-225. doi: 10.4103/joacp.joacp_258_23. Epub 2025 Mar 22.

ABSTRACT

BACKGROUND AND AIMS: Postoperative pain is one of the most common problems after thoracic surgery. In this study, we aimed to investigate the analgesic effects of two different doses of intrathecal morphine (ITM) based on ideal body weight in patients who underwent video-assisted thoracoscopic surgery (VATS).

MATERIAL AND METHODS: Forty-six patients scheduled for elective lung resection were included in this study. Patients were allocated to receive 10 μg/kg (Group I) and 7 μg/kg (Group II) ITM according to the ideal body weight for postoperative analgesia. Intraoperative and postoperative hemodynamic variables, postoperative morphine consumption, pain scores (at rest and effort), side effects, and additional analgesic requirements were recorded.

RESULTS: Postoperative pain scores did not differ in the first 12 h between the groups, but were significantly lower in Group I compared with Group II at 18 and 24 hours (P = 0.024 and P = 0.017 at rest, and P = 0.025 and P = 0.002 at effort, respectively). Postoperative morphine consumption was statistically significantly lower in Group I at all time periods (P < 0.05). The incidence of side effects was similar for both groups (P > 0.05).

CONCLUSIONS: The use of 10 μg/kg ITM according to the ideal body weight provides more effective analgesia without increasing the side effects compared to 7 μg/kg ITM after VATS.

PMID:40248787 | PMC:PMC12002694 | DOI:10.4103/joacp.joacp_258_23

J Anaesthesiol Clin Pharmacol. 2025 Apr-Jun;41(2):265-269. doi: 10.4103/joacp.joacp_28_24. Epub 2024 Aug 16.

ABSTRACT

BACKGROUND AND AIMS: The use of intra-articular injection has been widely accepted as a therapy for pain due to osteoarthritis of the knee. We aimed to compare the efficacy of intra-articular injection of platelet-rich plasma (PRP) with a combination of bupivacaine and corticosteroid in osteoarthritis of the knee.

MATERIAL AND METHODS: Fifty patients (aged more than 50 years) with pain pattern consistent with osteoarthritis of the knee who did not respond to conservative treatment were included in the study. They were randomly divided into two groups of 25 each: group I (n = 25) patients were administered fluoroscope-guided intra-articular knee injection of bupivacaine and steroid, and group II (n = 25) patients were administered intra-articular knee injection of PRP. In group I, patients were administered 9 ml of drug solution comprising 8 ml of 0.5% bupivacaine and 1 ml of triamcinolone (40 mg). In group II, patients were administered 6 ml of PRP. Pain, patient satisfaction, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were assessed at different time intervals before and after the procedure for up to 12 months.

RESULTS: Pain score and WOMAC were both clinically and statistically better at 2 weeks and 1 month after injection in group I (P < 0.05). But results were better clinically in group II compared to group I at 2, 3, 6, and 12 months after the procedure. More than 50% of patients in both groups had excellent satisfaction.

CONCLUSIONS: Both techniques were effective in providing good analgesia. Pain relief and improvement in disability were clinically higher with PRP for longer duration.

PMID:40248785 | PMC:PMC12002684 | DOI:10.4103/joacp.joacp_28_24

J Anaesthesiol Clin Pharmacol. 2025 Apr-Jun;41(2):280-285. doi: 10.4103/joacp.joacp_40_24. Epub 2024 Dec 16.

ABSTRACT

BACKGROUND AND AIMS: Chronic perineal pain (CPP) is the anorectal and perineal pain without underlying organic disease. The prevalence of CPP is 6-18%. The etiology for CPP may be idiopathic, benign, or malignant. We compared radiofrequency thermocoagulation of ganglion Impar with block using a combination of local anaesthetic and steroid for management of chronic perineal pain, with respect to pain relief, patients’ self-reported belief about the efficacy of treatment, and side effects or complications, if any.

MATERIAL AND METHODS: Forty patients attending the Pain Management Centre of either sex in the age group of 20-70 years with history, physical examination, and pain patterns consistent with chronic perineal pain, who had been investigated to rule out malignancy and failed to respond to 6 weeks of conservative treatment with a combination of analgesics, anti-inflammatory drugs, neuromodulators, and physiotherapy, were enrolled in the study. The patients were randomly divided into two groups of 20 each using a computer-generated randomization number table. Group-I (n = 20): Patients were administered ganglion Impar block using a drug mixture comprising of 8 ml of 0.25% bupivacaine plus 80 mg of triamcinolone acetate under fluoroscopic guidance. Group II (n = 20): Patients received conventional radiofrequency thermocoagulation of ganglion Impar at 80 degree Celsius for 90 seconds under fluoroscopic guidance. Outcome assessment was done after minimally invasive pain and spine intervention (MIPSI) with evaluation of pain using the Numeric Rating Scale (0-10), patients’ self-reported belief about the efficacy of treatment using Patient Global Impression of Change (PGI-C), and side effects or complications, if any.

RESULTS: The majority of the patients in our study were in the age group of 40-50 years, and 80% of the patients were females and weighed 60-70 kg. The majority of the patients in our study had history of trauma, which led to coccygodynia. There was statistically and clinically significant improvement in pain score after ganglion Impar block in both the groups at all time intervals during the study period (P < 0.05). Patients’ self-reported belief about efficacy as per PGI-C was clinically and statistically better in group II as compared to group I at all time intervals throughout the study period (P < 0.005). Four patients in group I required second ganglion Impar block during the 12 months study period. The most common side effect was temporary pain on injection.

CONCLUSIONS: Both the techniques of MIPSI, that is, fluoroscope-guided ganglion Impar block using corticosteroid and local anaesthetic and radiofrequency thermocoagulation, are effective and provide good pain relief to the symptomatic patients. With respect to improvement in pain relief and patients’ self-reported belief about the efficacy of treatment and side effects or complications, fluoroscope-guided ganglion Impar radiofrequency thermocoagulation is better as compared to fluoroscope-guided ganglion Impar block using corticosteroids and local anesthetics.

PMID:40248784 | PMC:PMC12002680 | DOI:10.4103/joacp.joacp_40_24

Mov Ecol. 2025 Apr 17;13(1):27. doi: 10.1186/s40462-025-00549-2.

ABSTRACT

Understanding species-habitat associations is fundamental to ecological sciences and for species conservation. Consequently, various statistical approaches have been designed to infer species-habitat associations. Due to their conceptual and mathematical differences, these methods can yield contrasting results. In this paper, we describe and compare commonly used statistical models that relate animal movement data to environmental data. Specifically, we examined selection functions which include resource selection function (RSF) and step-selection function (SSF), as well as hidden Markov models (HMMs) and related methods such as state-space models. We demonstrate differences in assumptions while highlighting advantages and limitations of each method. Additionally, we provide guidance on selecting the most appropriate statistical method based on the scale of the data and intended inference. To illustrate the varying ecological insights derived from each statistical model, we apply them to the movement track of a single ringed seal (Pusa hispida) in a case study. Through our case study, we demonstrate that each model yields varying ecological insights. For example, while the selection coefficient values from RSFs appear to show a stronger positive relationship with prey diversity than those of the SSFs, when we accounted for the autocorrelation in the data none of these relationships with prey diversity were statistically significant. Furthermore, the HMM reveals variable associations with prey diversity across different behaviors, for example, a positive relationship between prey diversity and a slow-movement behaviour. Notably, the three models identified different “important” areas. This case study highlights the critical significance of selecting the appropriate model as an essential step in the process of identifying species-habitat relationships and specific areas of importance. Our comprehensive review provides the foundational information required for making informed decisions when choosing the most suitable statistical methods to address specific questions, such as identifying expansive corridors or protected zones, understanding movement patterns, or studying behaviours. In addition, this study informs researchers with the necessary tools to apply these methods effectively.

PMID:40247418 | DOI:10.1186/s40462-025-00549-2

Ital J Pediatr. 2025 Apr 17;51(1):126. doi: 10.1186/s13052-025-01965-1.

ABSTRACT

BACKGROUND: This study aimed to evaluate the effects of community-acquired pneumonia (CAP) on cardiac function in children and compare the effectiveness of tissue Doppler imaging (TDI) and two-dimensional speckle tracking echocardiography (2D-STE) with conventional echocardiography in the early detection of biventricular cardiac dysfunction in children with CAP.

METHODS: The study included 50 hospitalized children diagnosed with CAP and 50 matched healthy controls. All patients underwent cardiac evaluation including conventional echocardiography, TDI, and 2D-STE.

RESULTS: Fifty children with CAP with a mean age of 5.02 ± 2.46 years participated in the study. Thirty-two were male (64.0%). LV systolic function (S) and RV diastolic function (E’/A’) were significantly lower in the diseased group compared to the control group (p < 0.001). The myocardial performance index (MPI) of both ventricles was significantly higher in the diseased group compared to the control group (p < 0.001). In patients with CAP, the mean value of two-dimensional longitudinal strain (2D LS) was significantly lower than that of the control group (p < 0.001). No statistically significant differences in echocardiographic parameters were observed when comparing complicated and non-complicated CAP subgroups.

CONCLUSION: TDI and 2D-STE demonstrated the ability to detect early biventricular dysfunction in pediatric patients diagnosed with CAP.

PMID:40247416 | DOI:10.1186/s13052-025-01965-1

Mov Ecol. 2025 Apr 17;13(1):28. doi: 10.1186/s40462-025-00557-2.

ABSTRACT

BACKGROUND: Current research on livestock movement ecology focuses on quantifying the factors that trigger alterations in movement behavior and understanding hidden mechanisms. Modern tracking technologies and robust statistical analysis models deliver new opportunities for investigating how individual animals cope with the joint effect of biotic and abiotic factors at different time scales.

METHODS: We applied multivariate Hidden Markov Models (HMMs) to characterize the fine-scale movement behavior (30-second intervals) of GPS-tracked domestic Zhongwei goats (Capra aegagrus hircus) for 124 days and analyzed the combined influence of biotic and abiotic factors and specific time of day on their seasonal movement behavioral transition in a predator-free, semi-arid mountain grassland in China.

RESULTS: We classified the behaviors of goats into two states: foraging (low step length, varied turning angle) and travelling (long step lengths, small turning angles). The terrain slopes had the most impact on their movement behavioral transition in the full year, spring, autumn, and winter. However, in the summer with hotter temperatures, the specific time of day explains their movement behavior most. Forage resources indicated by the Normalized Difference Vegetation Index (NDVI), and terrain ruggedness measured by the Vector Ruggedness Measure (VRM), had less impact on their behavior transitions compared to terrain slope and specific time of day. Elevation and solar radiation could not explain their movement behavior in different seasons, nor could NDVI in winter or VRM in spring and autumn. Across different seasons, the probability of foraging behavior increased with the later times of day, steeper terrain slopes, and higher NDVI, while it decreased with increasing VRM. The impact of NDVI on the probability of foraging behavior was largest during the early onset of vegetation growth in spring, and lowest in winter coinciding with a lower availability of food resources. The movement speed was lower, and the daily foraging percentage was higher in spring and winter due to lower food resources and shorter daylight hours. In contrast, movement speed was higher, and the daily foraging percentage was lower in summer and autumn with more food resources and longer daylight hours. The percentage of time allocated to foraging increases hourly from 9:00 am to 8:00 pm across various seasons.

CONCLUSIONS: HMMs were found to be useful for disentangling the movement behavior of goats. Our approach provides new insights into the seasonal and daily behavioral strategies of goats. Results demonstrate that in the mountain region, terrain slopes and specific times of the day more effectively trigger domestic goat behavioral transition from one state to the next compared with biotic factors, represented herein by NDVI, across different seasons. The early onset of vegetation growth and a shorter period of available high-quality forage in spring, significantly influenced goat behavioral transitions. Overall, these results are important for designing appropriate grazing management strategies that satisfy the ecological and socioeconomic demands of semi-arid grassland ecosystems.

PMID:40247393 | DOI:10.1186/s40462-025-00557-2

Ital J Pediatr. 2025 Apr 17;51(1):121. doi: 10.1186/s13052-025-01956-2.

ABSTRACT

BACKGROUND: Helicobacter pylori (H. pylori) causes chronic infection in more than half of the population worldwide. Accumulating body of evidence indicates the possible role of H. Pylori infection in extra-intestinal health problems, including epilepsy. This study aims to investigate the efficacy of treating H. pylori infection on seizure frequency among children with drug-resistant idiopathic generalized epilepsy (IGE).

METHODS: A parallel, two-arm, open-label, randomized controlled trial was conducted on 126 children with drug-resistant IGE and positive H. pylori stool antigen test who were randomly assigned to study and comparison groups in 1.2:1 ratio. Only the study group received H. pylori eradication therapy (esomeprazole, amoxicillin, and clarithromycin) for two weeks. The primary outcome was seizure improvement (≥ 50% seizure frequency reduction compared with baseline) after 2.5 months. Secondary outcomes were occurrence of status epilepticus, escalation of antiseizure medication (ASMs), and adverse effects. Outcomes between the two groups were compared using Chi-square/Fisher exact tests on an intention-to-treat principle. Logistic regression analysis was performed to investigate possible effects of baseline variables on primary outcome.

RESULTS: Seizure improvement occurred in 23 (33%) children in the study group compared with seven (12%) children in the comparison group (Risk ratio [RR] 2.7, 95% confidence interval [CI]: 1.3-5.9; p 0.006). The study group had lower occurrence of status epilepticus (2.9% vs. 14%; RR 0.21, 95%CI: 0.05-0.93; p 0.042) and lesser need for ASMs escalation (4.4% vs. 19.3%; RR 0.23, 95%CI: 0.07-0.77; p 0.010). Adverse effects were more frequent among subjects in the study group, including nausea (15.9% vs. 10.5%) vomiting (8.7% vs. 3.5%), diarrhea (11.6% vs. 5.3%), and skin rash (4.4% vs. 1.8%), but the differences were not statistically significant (p > 0.05). None of baseline participants’ variables was significantly associated with the primary outcome.

CONCLUSION: Treating H. pylori infection may improve seizure control in children with drug-resistant IGE, but further studies are warranted to confirm our findings and explore mechanisms behind seizure improvement following H. pylori eradication therapy.

TRIAL REGISTRATION: Registered on www.

CLINICALTRIALS: gov (identifier: NCT05297695) on 17 March 2022. https://clinicaltrials.gov/study/NCT05297695 .

PMID:40247384 | DOI:10.1186/s13052-025-01956-2

Eur J Med Res. 2025 Apr 17;30(1):305. doi: 10.1186/s40001-025-02563-x.

ABSTRACT

BACKGROUND: While previous studies have indicated comparable outcomes for redo surgical valve replacement (SVR) and primary SVR, there is limited information regarding the long-term follow-up of these patients. Providing prognostic data on redo SVR is crucial for enhancing decision-making and medical care, as well as for identifying low-risk subsets of patients eligible for redo SVR. This study aimed to evaluate the short- and mid-term outcomes of patients who underwent their first and second redo SVR of a previously replaced valve.

METHODS: We included 118 consecutive patients with a history of first or second redo SVR. The participants had a mean age of 57.5 ± 14.4 years, with 71 (60%) being female. The median follow-up period was 69 months. Clinical, intraoperative, and laboratory data were analyzed to assess all-cause mortality, major adverse events (MAE), and a composite of prosthetic valve thrombosis, embolic events, and major hemorrhage (TEH), along with their predictors. Bayesian model averaging was used for statistical analysis.

RESULTS: The 30-day mortality rate was 11 patients (9.3%). Chronic kidney disease was identified as an independent predictor of 30-day mortality. The overall survival rates at one and five years were 86% (95% CI 80% to 93%) and 76% (95% CI 68% to 85%), respectively. Dyslipidemia, a history of major bleeding, chronic kidney disease, stroke, and transvalvular leakage in biological prostheses were all associated with all-cause mortality as independent predictors. The TEH-free survival rates at one and five years were 91% (95% CI 86% to 97%) and 79% (95% CI 71% to 88%), respectively. Diabetes, sex, a history of percutaneous coronary intervention, and baseline functional capacity were identified as independent predictors for the occurrence of TEH. The MAE-free survival rates at one and five years were 82% (95% CI 73% to 92%) and 61% (95% CI 49% to 75%), respectively. Hypertension and baseline functional class were independent predictors of MAE occurrence. The type and anatomical position of the valve were not predictors of mortality, THE, and MAE.

CONCLUSIONS: Our study demonstrated acceptable short- and mid-term outcomes for redo SVR, especially in patients without significant risk factors. Several potential predictors of adverse outcomes were identified.

PMID:40247382 | DOI:10.1186/s40001-025-02563-x

J Orthop Surg Res. 2025 Apr 17;20(1):385. doi: 10.1186/s13018-025-05769-1.

ABSTRACT

PURPOSE: To evaluate the functional outcomes of arthroscopic onlay dynamic anterior stabilization (DAS) using the long head of the biceps (LHB) tendon for treatment of anterior glenohumeral instability (AGI) with limited to subcritical glenoid bone loss (GBL).

METHODS: Twenty-five patients underwent arthroscopic DAS using LHB tendon between March 2022 and October 2022 for treatment of anterior glenohumeral instability (AGI) with limited to subcritical glenoid bone loss (GBL) were included in a prospective study with a minimum follow-up period of 2 years. The shoulder functional outcomes were assessed using the Rowe and the Quick Disabilities of Arm, Shoulder and Hand (Quick DASH) scores both preoperative and at 2 years follow-up. Magnetic resonance imaging (MRI) was done 6 months after surgery to evaluate LHB tendon healing to the anterior glenoid.

RESULTS: The study included 25 patients complaining of recurrent AGI. Twenty-one patients were males and four patients were females. The mean age of the patients at surgery was 22.75 ± 3.24 years. The mean duration between the first shoulder dislocation episode and surgery was 5.5 ± 2.13 months. The right shoulder was injured in 15 patients while the left shoulder was involved in 10 patients. The mean follow-up period was 24.25 ± 0.82 months. DAS using the long head of the biceps tendon resulted in a statistically significant improvement of the mean Rowe and the Quick DASH scores between preoperative and 2 years postoperative. Recurrent dislocation was reported in two (8%) patients during the follow-up period.

CONCLUSION: Arthroscopic onlay dynamic anterior stabilization using the long head of the biceps tendon is a safe and effective method for the treatment of recurrent anterior shoulder instability with GBL up to 25%.

LEVEL OF EVIDENCE: Level IV, case series study.

PMID:40247377 | DOI:10.1186/s13018-025-05769-1