Tag: statistics

Ital J Pediatr. 2025 May 19;51(1):145. doi: 10.1186/s13052-025-01995-9.

ABSTRACT

BACKGROUND: To investigate the clinical characteristics, surgical strategy, and surgical outcomes in children with purulent meningitis with hydrocephalus (PMH) under 3 years old.

METHODS: This retrospective controlled study included 46 pediatric patients who underwent the Conventional external ventricular drain (C-EVD) or modified external ventricular drainage (M-EVD) for PMH treatment at Hebei Province of Children’s Hospital from January 2018 to December 2023. Conventional external ventricular drain placement is standard of care in the management of purulent meningitis with hydrocephalus. The indwelling time of conventional external ventricular drainage is relatively short, 7-10 days. Long-term external drainage devices may lead to retrograde infection. This study has modified the external ventricular drain procedure. Clinical outcomes, cerebrospinal fluid (CSF) test results, complications, and outcomes were compared between the modified external ventricular drainage (n = 21) group and conventional external ventricular drain (n = 25) group.

RESULTS: The two groups were similar regarding age, sex, weight and other general conditions (P > 0.05). There were significant differences in the values of white blood cells (WBC), glucose (GLU) and protein (PR) in cerebrospinal fluid between the two groups when the drainage tube was removed, which was statistically significant. The median days of removing the drainage tube in the conventional external ventricular drain group and the modified external ventricular drainage group were 9 days and 19 days, respectively. The median days of CSF returning to normal were 19 days and 13 days (P < 0.05). A total of 13 children in the modified external ventricular drainage group underwent ventriculo-peritoneal shunt surgery, while 17 children in the conventional external ventricular drain group were treated with entriculo-peritoneal shunt surgery (P = 0.665).

CONCLUSION: The modified external ventricular drainage has more obvious advantages compared to conventional external ventricular drain. The modified significantly prolonged the catheterization time, which can more effectively treat purulent meningitis with hydrocephalus in pediatric patients.

PMID:40390131 | DOI:10.1186/s13052-025-01995-9

Ital J Pediatr. 2025 May 19;51(1):144. doi: 10.1186/s13052-025-01997-7.

ABSTRACT

BACKGROUND: A major cause of deaths among children under five is neonatal mortality, a worldwide problem. However, the problem in sub-Saharan Africa is not well documented. Understanding the prevalence of neonatal death and its related causes is crucial for creating efforts and policies that could help address the problem. This study set out to determine the prevalence of neonatal death and its determinants in sub-Saharan Africa.

METHODS: Using secondary data analysis of demographic and health surveys conducted between 2014 and 2024 in sub-Saharan Africa. Total weighted samples of 133,448 live births in all during the period in 31 Sub- Saharan Africa. The determinants of neonatal mortality were identified using a multilevel mixed-effects logistic regression model. A multilevel binary logistic regression was fitted to identify the significant determinants of neonatal mortality. The Intra-class Correlation Coefficient, Median Odds Ratio, Proportional Change in Variance was used for assessing the clustering effect, and deviance for model comparison. Variables with a p-value < 0.2 in the Bivariable analysis were considered in the multivariable analysis. In the multivariable multilevel binary logistic regression analysis, Adjusted Odds Ratio with 95% CI was reported to declare statistically significant determinants of neonatal mortality.

RESULTS: The neonatal mortality in sub-Saharan Africa was 32 per 1000 live births (95% CI: 30, 34). maternal occupation (AOR = 1.26, 95% CI: 1.16, 1.37), home delivery (AOR = 1.29; 95% CI: 1.21, 1.39), caesarean section (AOR = 1.58; 95%CI: 1.36, 1.83), twin births(AOR = 2.48, 95% CI: 2.05, 2.54), birth order of 2-4 (AOR = 1.30, 95% CI: 1.18, 1.44), birth order of ≥ 5 (AOR = 1.43, 95% CI: 1.31, 1.59) and smaller size than average (AOR = 1.49, 95% CI: 1.36, 1.63)were significantly associated with higher odds of neonatal mortality.

CONCLUSION: According to this study, in sub-Saharan Africa neonatal mortality rate was high. The following factors should be taken into account while developing policies and measures to reduce newborn mortality in sub-Saharan Africa: the mother’s education, wealth index, occupation, place of delivery, mode of delivery, twin birth, neonatal sex, birth order, and size at birth.

PMID:40390123 | DOI:10.1186/s13052-025-01997-7

J Orthop Surg Res. 2025 May 19;20(1):483. doi: 10.1186/s13018-025-05862-5.

ABSTRACT

BACKGROUND: Appropriate treatment of chondral lesions in the hip greatly improves symptoms and reduces the need for early joint replacement in these patients. Whilst the outcomes of Autologous Chondrocyte Transplantation (ACT) and Autologous Matrix Induced Chondrogenesis (AMIC) in the knee have been thoroughly researched, data on these treatments in the hip is comparatively limited.

AIM: To evaluate the outcomes of ACT and AMIC in the hip.

METHODS: Following PRISMA guidelines, a literature search was performed using free text and MeSH terms relating to ACT, AMIC, and variations of these terms across 6 databases. This resulted in 506 abstracts, which were screened down to 12 papers which met the eligibility criteria. Weighted means and pooled estimates using a random effects model were used to assess the success of both procedures.

RESULTS: 628 hips were identified within 12 papers. Weighted mean age 35.8 years (18-55 years), weighted mean lesion size 3.3 cm² (2.2-5.1 cm²)., weighted mean follow-up 46.9 months (6-96 months). Improvement in mHHS was measured for both interventions, with a mean improvement of 31.1 points following ACT and 35.8 following AMIC. The pooled success rate for AMIC (99.6% [95% CI, 99.0-100.0%]) was higher than that for ACT (98.3% [95% CI, 96.4-100.0%]). All PROs assessed showed statistically significant postoperative improvements.

CONCLUSION: Both techniques produced significant improvements from baseline. Due to the treatment characteristics, we suggest AMIC is a preferable treatment to ACT. Further research is required to assess the limitations of these procedures concerning chondral lesion size and duration of symptom improvement.

PMID:40390088 | DOI:10.1186/s13018-025-05862-5

BMC Med Genomics. 2025 May 19;18(1):90. doi: 10.1186/s12920-025-02155-y.

ABSTRACT

BACKGROUND: Chromosome 17p13.3 is a region of genomic instability associated with different neurodevelopmental diseases. The malformation spectrum of 17p13.3 microdeletions ranges from an isolated lissencephaly sequence to Miller-Dieker syndrome, while 17p13.3 microduplications result in autism, learning disabilities, microcephaly and other brain malformations. This study aims to provide a more comprehensive delineation of the clinical and genetic characteristics associated with 17p13.3 alterations.

METHODS: We retrospectively analyzed the next-generation sequencing (NGS) data of more than 40 thousand patients from January 2016 to December 2021 and identified 38 pediatric patients with copy-number variations (CNVs) or single-nucleotide variations (SNVs) in 17p13.3 region. Published patients with CNVs in the 17p13.3 region were also collected and we performed a Chi-square test to compare the phenotype spectrum of microdeletions and microduplications.

RESULTS: Among the 27 CNV patients, 20 patients with microdeletions and 7 patients with microduplications were found. PAFAH1B1 was the most frequently deleted gene and CRK was the most frequently duplicated gene. Affected genes in 11 SNV patients included PAFAH1B1 and PRPF8. Developmental delay was the most common abnormality detected in the 38 patients (29/38, 76.3%). Of note, Case 10 presented omphalocele and Case 23 presented scoliosis, webbed neck and bone cyst, all of which were unusual variant phenotypes in this region. The Chi-square test revealed that epilepsy, lissencephaly and short stature were statistically significant with microdeletions, while behavioral abnormalities and hand and foot abnormalities were significant with microduplications (p < 0.01).

CONCLUSIONS: While PAFAH1B1, YWHAE and CRK are associated with major phenotypes of 17p13.3, RTN4RL1 may be involved in white matter changes and HIC1 might contribute to the occurrence of omphalocele. This study provided a comprehensive understanding of genetic information and phenotype spectrum of the 17p13.3 region.

PMID:40390087 | DOI:10.1186/s12920-025-02155-y

World J Emerg Surg. 2025 May 19;20(1):41. doi: 10.1186/s13017-025-00617-3.

ABSTRACT

INTRODUCTION: Acute gastric volvulus (AGV), is an uncommon complication of large paraesophageal hernias (PEH), resulting in closed-loop obstruction that may lead to incarceration and strangulation. The aim of this study was to summarize the evidence on clinical characteristics, surgical treatment, postoperative complications (POC), recurrence, and 30-day mortality (30DM), in patients undergoing surgery for AGV secondary to PEH.

METHODS: A systematic review including studies on AGV secondary to PEH was conducted. Searches were performed in WoS, Embase, Medline, Scopus, BIREME-BV and SciELO. Primary outcomes included POC, 30DM and recurrence. Secondary outcomes comprised publication date, study origin and design, number of patients, volvulus type, hospital stay length, treatments; and methodological quality (MQ) of studies assessed using MInCir-T and MInCir-Pr₂ scales. Descriptive statistics, weighted averages (WA), least squares logistic regression for comparisons, and meta-analysis of POC prevalence and HM were applied.

RESULTS: Of 1049 studies 171 met selection criteria, encompassing 15,178 patients. The WA age of patients was 75.3 ± 13.9 years, with 51.3% female. Most studies originated from USA (31.6%), with 52.6% published in the last decade. The WA of hospital stay was 7.9 ± 5.3 days. Among patients, 32.0% experienced POC, 7.6% required reinterventions and HM was 5.7%. MQ scores averaged 8.9 ± 2.3 (MInCir-T) and 13.4 ± 5.4 (MInCir-Pr₂). When comparing 1990-2014 and 2015-2024 periods, there were significant differences in age, reinterventions, readmissions and recurrence rates.

CONCLUSIONS: Despite surgical and resuscitative advancements, AGV prognosis remains poor, with high POC rates, prolonged hospitalization and significant 30DM. These findings emphasize the importance of early diagnosis and timely intervention for acute PEH to improve surgical outcomes.

PMID:40390075 | DOI:10.1186/s13017-025-00617-3

Radiat Oncol. 2025 May 19;20(1):79. doi: 10.1186/s13014-025-02662-3.

ABSTRACT

BACKGROUND: Primary small cell carcinoma of the esophagus (SCCE) is an aggressive carcinoma with a rare incidence. Most patients were diagnosed with stage III-IV and have a poor prognosis. The poor therapeutic outcomes of SCCE reveal the need for more rational therapies.

METHODS: We retrospectively reviewed 15,463 patients with esophageal carcinoma from January 2015 to December 2020. 235 (1.52%) patients were pathologically diagnosed with primary SCCE. Clinical characteristics and treatment information were extracted from medical records. All statistical analyses were performed with the SPSS software. Patients were divided into radiotherapy (RT) group and non-RT group. The chi-square test was conducted to analyze the difference in baseline characteristics and propensity score matching (PSM) was used to balance the patient characteristics. Univariate and multivariate analysis was used to identify independent prognostic factors and calculated the estimated hazard ratio (HR) and 95% confidence interval (CI). The Kaplan-Meier method was used to draw survival curves, calculate the median overall survival (OS), and compare prognosis between groups with the log-rank p test. The two-tailed p value less than 0.05 indicated a significant difference.

RESULTS: The median OS was 15.2 months (range:13.4-17.1 months). The addition of RT improved median OS from 14.3 months to 16.5 months, but the difference was not statistically significant (p = 0.657). After PSM, the median OS of the RT group was longer than the non-RT group (16.5 months vs. 11.5 months, p < 0.001). Multivariate analysis identified RT (HR: 0.711, 95%CI: 0.533-0.949, p = 0.020), surgery (HR: 0.490, 95%CI: 0.365-0.660, p < 0.001), and smoking history (HR: 1.335, 95%CI: 1.010-1.765, p = 0.042) as independent prognostic factors. Subgroup analysis showed that RT was not a prognostic factor in patients with surgery (p = 0.450), but could significantly improve OS in patients without surgery (HR: 0.585, 95%CI: 0.415-0.824, p = 0.002). Both middle and lower thoracic SCCE patients could benefit from the addition of RT. RT could improve OS regardless of Ki67 expression level. Subgroup analyses also indicated that stage IV, age ≥ 60, no smoking history, pure SCCE, Syn-positive, CgA-positive, CD56-positive patients could benefit from RT.

CONCLUSIONS: SCCE patients could benefit from RT, especially those without surgery. Further studies are required for confirmation of the conclusion.

PMID:40390071 | DOI:10.1186/s13014-025-02662-3

J Eat Disord. 2025 May 19;13(1):86. doi: 10.1186/s40337-025-01282-2.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the dynamics of the neutrophil-to-lymphocyte ratio (NLR) during the initial hospitalization of patients with eating disorders (EDs) and to assess its potential as a biomarker for monitoring disease severity and treatment response.

METHODS: A retrospective chart review was conducted with 55 patients aged ≤ 16 years diagnosed with anorexia nervosa or avoidant/restrictive food intake disorder and admitted to Jichi Medical University Hospital between 2015 and 2021. Sociodemographic and clinical characteristics including sex, age, rate of weight gain, percentage of ideal body weight (%IBW), tube feeding treatment, and NLR were obtained. Statistical analyses used a mixed model for repeated measures to assess NLR changes regarding %IBW and other clinical factors.

RESULTS: The NLR at admission was lower in the malnourished state but increased with weight recovery. MMRM revealed that tube feeding treatment (β = 0.538) and restoration of %IBW (β = 0.029) significantly predicted an increase in the NLR. The interaction between tube feeding and the quadratic term of %IBW was also significant, indicating distinct patterns of NLR changes: without tube feeding, NLR increased linearly with weight recovery, whereas with tube feeding, NLR exhibited a non-linear, upward-convex parabolic trend.

DISCUSSION: These findings suggest that NLR may offer an objective recovery marker less influenced by patient self-report. Monitoring NLR before and after tube feeding may help distinguish true physiological recovery from transient stress responses, providing complementary information to conventional assessments. Further research is warranted to establish its clinical relevance.

PMID:40390065 | DOI:10.1186/s40337-025-01282-2

Trials. 2025 May 19;26(1):163. doi: 10.1186/s13063-025-08862-2.

ABSTRACT

BACKGROUND: Uncontrolled hypertension is the leading cause of cardiovascular and cerebrovascular diseases in Ethiopia. Early detection and referral of hypertensive patients for clinical care is critical for initiating lifestyle changes and antihypertensive medications. This study aimed to evaluate the effects of health extension workers led home-based multicomponent intervention on linkage to hypertension care in patients with hypertension in rural districts of northwest Ethiopia.

METHODS: A parallel group, cluster randomized controlled trial was conducted in 20 rural communities. A total of 456 (228 in the intervention and 228 in the control clusters) participants were enrolled and followed for nine months. Participants in the intervention clusters received the interventions (home health education, behavioral and medication adherence counseling, and referral to nearby health facility) four times every other month for 40-60 min. The primary outcome was clinical linkage for hypertension care and the secondary outcome was initiation of antihypertensive treatment. Generalized estimating equation was used to evaluate the intervention’s effect using an intention-to-treat approach. Effect sizes of relative benefit increases, absolute benefit increases, and attributable benefit were used. All statistical analyses were two-sided with a p-value of < 0.05.

RESULTS: The overall average systolic and diastolic blood pressure at baseline were 145.81 (± 13.89) mmHg and 87.11 (± 7.42) mmHg, respectively. The proportion of linkage to hypertension care increased from 11.0% at baseline to 66.2% at 9 months in the intervention group and from 12.3 to 39.7% in the control group, with an absolute benefit increase of 27.5% (95% CI: 19.6%, 35.4%; P-value < 0.001). The attributable benefit associated with the intervention was 40.1% (95% CI 20.7%, 59.5%) which means that more than a third of linkage to hypertension care was due to the HEWs led home-based multicomponent intervention. However, it is noteworthy that only 10.3% of patients initiated antihypertensive medication.

CONCLUSIONS: In this study, health extension workers led home-based multicomponent interventions that provided home health education, behavioral counseling, and referral to a nearby health facility to improve linkage to hypertension care. A multicomponent intervention implemented on a large scale is likely to improve linkage to hypertension care and reduce hypertension-related morbidity and mortality in the country.

TRIAL REGISTRATION: PACTR202102729454417.

PMID:40390051 | DOI:10.1186/s13063-025-08862-2

BMC Health Serv Res. 2025 May 19;25(1):720. doi: 10.1186/s12913-024-11743-0.

ABSTRACT

BACKGROUND: Recently, the demand for care has risen, while in contrast, healthcare resources remain limited. These resources include health expenditure, the number of physicians, nurses, and hospital beds. Many studies have revealed that healthcare resources are one of the most critical factors contributing to a population’s health status. The healthcare system plays a key role in transforming these resources into health outcomes, which are widely used as indicators to measure population health and the performance of healthcare systems. Previous work has primarily investigated the relationship between health expenditure or the number of doctors and population health. However, the association between healthcare resources as a whole has yet to be widely examined.

METHODS: This study utilized multilevel regression analysis to explore the association between healthcare resources, healthcare systems, and population health outcomes across 25 European countries. The healthcare systems in these countries are primarily categorized into two types: Beveridge-type and Bismarck-type. In addition to regression analysis, descriptive statistics were used to analyze the allocation patterns of healthcare resources. Welch’s t-test was employed to compare the performance metrics of the Beveridge-type and Bismarck-type healthcare systems, providing a statistical basis for understanding differences in their effectiveness.

RESULTS: The regression analysis revealed positive correlations between health expenditure per capita, the number of physicians, and nurses, and life expectancy at birth, while the number of hospital beds showed a negative correlation. Conversely, infant mortality was negatively correlated with health expenditure per capita and the number of physicians and nurses, and positively correlated with the number of hospital beds. The models did not find statistical significance in the effects of healthcare system type (Beveridge-type or Bismarck-type) on life expectancy at birth or infant mortality rates. Additionally, Welch’s t-test indicated that the Beveridge-type healthcare system generally showed better performance outcomes compared to the Bismarck-type system.

CONCLUSIONS: The findings indicate that higher allocations of certain healthcare resources, such as hospital beds, are associated with poorer health outcomes, which suggests potential inefficiencies in resource utilization. Observations also show that countries using the same healthcare systems tend to have similar patterns of resource allocation, which may influence the performance of these systems. Policymakers should consider these associations when planning resource allocation and when selecting or modifying healthcare system models in their countries.

PMID:40390026 | DOI:10.1186/s12913-024-11743-0

Trials. 2025 May 19;26(1):162. doi: 10.1186/s13063-025-08863-1.

ABSTRACT

BACKGROUND: Observational evidence suggests both low and high iodine intakes in pregnancy are associated with poorer neurodevelopment in children. This raises concern that blanket recommendations for iodine supplementation in pregnancy may negatively impact child neurodevelopment in women with sufficient iodine intake from food alone.

METHODS: PoppiE (Prenatal Iodine Supplementation and Early Childhood Neurodevelopment) is a multi-centre, parallel, two-arm, clinician, researcher and participant blinded randomised controlled trial. Seven hundred fifty-four consenting pregnant women ≤ 13 weeks of gestation with an iodine intake of > 165 μg/day from food will be randomised to receive a multivitamin and mineral supplement containing 20 µg/day (intervention) or 200 µg/day (control) of iodine from enrolment until delivery. The primary outcome is the developmental quotient of infants at 24 months of age as assessed with the Cognitive Scale Score of the Bayley Scales of Infant Development, 4th Edition, to be analysed using linear regression with generalised estimating equations to account for multiple births. In this article, we comprehensively detail the planned statistical analyses of the PoppiE trial, including approaches to intercurrent events, methods for handling missing data and planned sensitivity analyses.

CONCLUSIONS: PoppiE is the first trial to examine the effect of prenatal iodine supplementation on early childhood development in women with sufficient iodine intake from food. At the time of writing (February 2025), recruitment into the trial is complete and data collection is due to conclude in July 2026. The statistical analysis plan was finalised before the database lock, which will ensure study conclusions are not subject to bias due to data-driven analyses.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04586348. Registered on October 14, 2020.

PMID:40390018 | DOI:10.1186/s13063-025-08863-1