Tag: statistics

Cureus. 2025 Nov 16;17(11):e96939. doi: 10.7759/cureus.96939. eCollection 2025 Nov.

ABSTRACT

Background Leaving against medical advice (LAMA) in pediatric intensive care units (PICUs) carries substantial risks, yet limited data exist from Indian settings. This study aimed to determine the incidence, demographic and clinical characteristics, and contributory factors for LAMA in a tertiary care PICU. Methods A prospective observational study was conducted at the PICU of King George’s Medical University, Lucknow, India, over 12 months. All children aged between one month and 12 years discharged against medical advice (DAMA) were included. Data on demographics, socioeconomic status, diagnosis, reasons for LAMA, and outcomes at 15 days were analyzed using IBM SPSS Statistics, version 23.0 (IBM Corp., Armonk, NY). Results Of 932 admissions, 135 (14.5%) left against medical advice. Among these patients, the mean age was 62.8 months; most were male, 76 (56.3%), and from rural areas, 78 (57.8%), and a total of 31 (23.0%) belonged to the lower socioeconomic class. The main reasons cited for LAMA were perceived poor survival, 85 (63.0%), and financial burden, 58 (43.0%). Parental illiteracy was reported in 27 (29.7%), and low income also showed significant associations for mortality among patients who left against medical advice. Conclusion LAMA rates in this PICU were high, predominantly driven by socioeconomic hardship and pessimism regarding prognosis. Interventions combining financial assistance, strengthened caregiver communication, and structured support services may help reduce LAMA and improve outcomes in critically ill children.

PMID:41409962 | PMC:PMC12706387 | DOI:10.7759/cureus.96939

Cureus. 2025 Nov 16;17(11):e96955. doi: 10.7759/cureus.96955. eCollection 2025 Nov.

ABSTRACT

BACKGROUND: Intrauterine growth restriction (IUGR) has been linked to disturbances in growth after birth and various developmental anomalies. However, its impact on the shape of the face and dental health is still a question. Exploring these links can be helpful for the early prevention and orthodontic treatment of a pediatric population.

OBJECTIVE: Comparison of differences in craniofacial morphometric parameters and dental abnormalities of children with IUGR and healthy children.

METHODS: A cross-sectional case-control study was performed in 60 children aged between 3 and 7 years (30 IUGR; 30 controls matched for age and sex). Lateral cephalometric radiograph standardization was done for assessment of craniofacial parameters, and dental anomalies were confirmed by clinical examinations. The statistical analysis consisted of Student’s t-test, chi-square test, and logistic regression with significance set at p <0.05.

RESULTS: Children with IUGR had a markedly reduced cranial base length (91.3 ± 4.9 mm vs. 99.6 ± 5.4 mm, p < 0.001) and mandibular length (65.2 ± 4.0 mm vs. 73.9 ± 4.5 mm, p < 0.001) and an increased lower facial height (54.6 ± 3.1 mm vs. 51.0 ± 3.2 mm, p < 0.001). Enamel defects in the IUGR group (33.3%) were twice as many as in the control group (10.0%), and the adjusted odds were almost five times higher (OR = 4.83, 95% CI 1.04 – 22.36, p = 0.044). The occurrences of caries, hypodontia, and microdontia in the IUGR group have increased, but their differences are not statistically significant.

CONCLUSION: IUGR is related to changed patterns of craniofacial development that feature shortening of the cranial base and mandibular lengths and lengthening of the lower facial height. It is also associated with a greater number of cases of enamel defects. Screening of children with IUGR and their cephalometric evaluation at an early stage will provide better preventive and orthodontic interceptive treatment guidance.

PMID:41409956 | PMC:PMC12706629 | DOI:10.7759/cureus.96955

Cureus. 2025 Nov 16;17(11):e96960. doi: 10.7759/cureus.96960. eCollection 2025 Nov.

ABSTRACT

Objectives The main objective of this study is to examine how environmental and demographic factors shape regional prescription patterns of circadian-related hypnotics, and to develop a pharmacoepidemiological indicator for detecting potential regional overuse. Methods A nationwide ecological cross-sectional study was conducted using 2022 data from all 47 prefectures of Japan. Population-adjusted prescription volumes of ramelteon, suvorexant, and lemborexant were obtained from the National Database of Health Insurance Claims. Environmental (annual sunlight duration and ultraviolet index) and demographic (aging rate and outpatient clinic density) variables were extracted from governmental statistics. Pearson correlation and multivariable linear regression analyses were conducted, and residuals were geographically visualized to identify regional deviations from model expectations. Results Ramelteon and suvorexant prescriptions were significantly associated with shorter sunlight duration and higher aging rates (r = -0.64 and -0.61, both p < 0.001). In multivariable analysis, sunlight duration and aging rate independently predicted prescription volumes (adjusted R² = 0.46), with improved performance (adjusted R² = 0.51) after exclusion of high-influence outliers. Residual analysis revealed that unexplained positive deviations were concentrated in urban prefectures, suggesting locally elevated prescribing tendencies. Conclusions Regional prescription volumes of circadian-related hypnotics can, to some extent, be anticipated from environmental determinants such as sunlight duration. The proposed indicator-based pharmacoepidemiological framework may help identify regions at risk of potential overuse and guide climate-sensitive strategies for optimizing hypnotic use in older adults.

PMID:41409951 | PMC:PMC12706815 | DOI:10.7759/cureus.96960

Cureus. 2025 Nov 13;17(11):e96807. doi: 10.7759/cureus.96807. eCollection 2025 Nov.

ABSTRACT

BACKGROUND: Glaucoma is a leading cause of irreversible blindness, yet awareness and early detection remain poor in rural India. Data from North-Eastern India, particularly Tripura, is scarce.

OBJECTIVE: This study aims to assess awareness, knowledge, and practices (AKP) regarding glaucoma and identify predictors of awareness among adults in rural North Tripura.

METHODS: A community-based cross-sectional survey (April-June 2025) was conducted in four randomly selected villages under the District Residency Programme. Multistage cluster random sampling targeted adults aged ≥30 years. A pretested questionnaire (Bengali/Kokborok) captured demographics, awareness, knowledge, practices, and information sources. Descriptive statistics and binary logistic regression identified determinants of awareness.

RESULTS: Of the 420 eligible adults, 368 completed the survey (response rate: 87.6%). A total of 72/368 (19.6%) had ever heard of glaucoma. Among the aware, 25/72 (34.7%) achieved a good awareness score, and 9/72 (12.5%) had good knowledge. Across the full sample, 39/368 (10.6%) reported an eye examination in the past year; among the aware, 17/72 (23.6%) had an exam. Information sources among the aware included health workers, 29/72 (40.3%); eye camps, 20/72 (27.8%); mass media, 13/72 (18.1%); and family/friends, 10/72 (13.8%). Higher education (adjusted odds ratio (AOR): 3.05; 95% CI: 1.87-4.98; p < 0.001) and prior ophthalmic consultation (AOR: 4.92; 95% CI: 2.68-9.02; p < 0.001) independently predicted awareness.

CONCLUSIONS: Less than one-fifth of rural adults in North Tripura were aware of glaucoma, and misconceptions were common. Educational status and prior eye-care contact strongly influenced awareness. Community-based education led by trained health workers and integration of glaucoma messaging into routine eye camps may enhance early detection and reduce avoidable blindness.

PMID:41409948 | PMC:PMC12708009 | DOI:10.7759/cureus.96807

Cureus. 2025 Nov 15;17(11):e96879. doi: 10.7759/cureus.96879. eCollection 2025 Nov.

ABSTRACT

The optimal management of localized diverticular perforation remains uncertain, with ongoing debate between surgical intervention and conservative antibiotic therapy. While randomized trials have addressed uncomplicated diverticulitis, evidence specific to perforated disease is limited and heterogeneous. This study aimed to evaluate the effectiveness of surgical intervention compared to antibiotic therapy in managing localized diverticular perforation in adults, focusing on key clinical outcomes including adverse events, stoma creation, mortality, and intra-abdominal abscess formation. We conducted a systematic review and meta-analysis of studies comparing surgical versus antibiotic therapy in adults with localized diverticular perforation. Major outcomes included composite adverse events, stoma creation, all-cause mortality, and intra-abdominal abscess. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity was assessed using the I² statistic. Four comparative studies (n = 12,922 patients) were included. For composite adverse outcomes, no significant pooled difference was observed (Pooled OR 3.79, 95% CI 0.36-39.56, p = 0.266; I² = 97.4%), though individual studies showed conflicting results. Surgical intervention was associated with a significantly higher risk of stoma creation compared to antibiotics (Pooled OR 16.16, 95% CI 4.11-63.63, p < 0.001; I² = 43.3%). Mortality did not differ significantly between groups (Pooled OR 3.68, 95% CI 0.28-47.99, p = 0.320; I² = 88.8%). Intra-abdominal abscess rates were also comparable (Pooled OR 3.01, 95% CI 0.53-17.07, p = 0.212; I² = 87.8%). Surgical management of localized diverticular perforation provides definitive treatment but significantly increases the risk of stoma creation. Antibiotic therapy may be effective in carefully selected patients, particularly when initiated promptly, although study findings remain inconsistent. Given the high heterogeneity across available studies, further randomized trials are needed to establish evidence-based guidance for treatment selection in this patient population.

PMID:41409946 | PMC:PMC12706538 | DOI:10.7759/cureus.96879

BMC Pregnancy Childbirth. 2025 Dec 17. doi: 10.1186/s12884-025-08579-9. Online ahead of print.

ABSTRACT

INTRODUCTION: Group Antenatal Care (G-ANC) has emerged as an innovative model for improving maternal health service delivery in low- and middle-income countries (LMICs). This study assessed the utilization, satisfaction, and perceived effectiveness of G-ANC among pregnant women attending selected primary healthcare centers in Karu Metropolis, Nasarawa State, Nigeria.

METHODOLOGY: A descriptive cross-sectional study was conducted among 450 pregnant women systematically sampled from primary healthcare facilities. Data were collected using structured interviewer-administered questionnaires and analyzed using descriptive statistics and chi-square tests for associations (p < 0.05). Variables explored included socio-demographics, obstetric history, complications, G-ANC experiences, and perceived barriers to care.

RESULTS AND DISCUSSION: Most respondents (72.9%) were aged 20-25, with a majority being married (81.1%) and housewives (80%). A high proportion (85.8%) reported experiencing complications during pregnancy, notably hemorrhage (28.9%) and infections (52%). G-ANC was widely utilized, with 88.4% attending 7-9 sessions. Satisfaction with G-ANC services was high (88.4%), and 75.6% strongly agreed that G-ANC improved their understanding of antenatal care. Institutional delivery uptake was 95.6%, and 84.9% perceived that G-ANC contributed to reducing maternal morbidity and mortality. However, financial (36%) and geographic barriers (49.3%) persisted, and 28.4% reported delays in seeking care. G-ANC was well-accepted, enhanced maternal health literacy, and improved institutional delivery rates. However, barriers such as transportation and financial constraints limited optimal care-seeking. The findings align with similar Nigerian studies showing high satisfaction with G-ANC but call for system-level interventions. Integration of financial support schemes, community engagement, male involvement, and improved infrastructure are necessary for broader impact.

CONCLUSION: G-ANC presents a promising strategy to enhance maternal health outcomes in LMICs. Strategic scale-up, system-wide support, and longitudinal evaluations are essential to optimize its potential and address persistent health system barriers.

PMID:41408528 | DOI:10.1186/s12884-025-08579-9

BMC Pediatr. 2025 Dec 17. doi: 10.1186/s12887-025-06396-9. Online ahead of print.

ABSTRACT

INTRODUCTION: Valsalva maneuvers are the initial line in management of paroxysmal supraventricular tachycardia in hemodynamically stable children. This study aimed to compare the efficacy of modified versus standard Valsalva maneuvers on the clinical outcomes and satisfaction of children with paroxysmal supraventricular tachycardia.

METHODS: The study used randomized controlled trial and recruited ninety children with paroxysmal supraventricular tachycardia from Pediatric Emergency Department and Pediatric Cardiac Intensive Care Unit at Tanta University Hospitals, El-Gharbia Governorate, Egypt. The researchers divided the studied children into three equal groups of thirty. A control group that received conventional hospital care, an intervention group I that received modified Valsalva maneuver plus conventional hospital care, and an intervention group II that received standard Valsalva maneuver plus conventional hospital care. The primary outcome was the return to sinus rhythm within the first 5 min of admission and the secondary outcomes were decreased dyspnea, decreased antiarrhythmic therapy use, length of stay time in hospital as well as children’s satisfaction.

RESULTS: More than half (53.3%) of the children who received the modified Valsalva maneuver returned to sinus rhythm within the first five minutes post-implementation compared to 33.3% of the children who received the standard Valsalva maneuver. Children within modified Valsalva maneuver group had a mean satisfaction score of 25.56 ± 1.67 that was significantly higher than those in the standard Valsalva maneuver group’s score of 20.10 ± 2.57 (P = 0.0001).

CONCLUSION: The modified version of the Valsalva maneuver was significantly more effective than the standard Valsalva maneuver in terminating supraventricular tachycardia and improving children’s clinical outcomes. This included a decrease in the degree of dyspnea within the first minute from severe to moderate and reducing the need for administering antiarrhythmic drugs for management of SVT episodes. Additionally, children in the MVM group had a higher mean satisfaction score than those in the SVM group, with highly statistically significant differences.

TRIAL REGISTRATION: PACTR202407479098909. Registered 15/07/2024.

PMID:41408522 | DOI:10.1186/s12887-025-06396-9

BMC Cancer. 2025 Dec 17. doi: 10.1186/s12885-025-15458-1. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: Melanomagenesis involves genetic alterations affecting multiple oncogenic pathways, with BRAF and NRAS mutations representing frequently studied drivers. Recent evidence suggests melanoma development encompasses a broader spectrum including KIT mutations and novel variants exhibiting population-specific patterns. This study aimed to characterize the genetic landscape of melanomagenesis by analyzing BRAF, NRAS, KIT and novel mutations across melanoma subtypes in a Turkish cohort.

METHODS: Sixty-six genetic materials from 55 melanoma patients (2000-2016) were analyzed using targeted next-generation sequencing of 17 melanoma-relevant genes. Mutation profiling characterized genetic diversity across histological subtypes, with associations between molecular alterations and clinicopathological parameters evaluated using Fisher’s exact test and Kruskal-Wallis test.

RESULTS: Significant genetic diversity was observed, with 60% of cases harboring mutations. Analysis identified 22 wild-type cases, 13 BRAF mutations (23.6%), 4 NRAS mutations (7.3%), 6 KIT mutations (10.9%), and various alterations in TP53, KNSTRN, KRAS, PIK3CA, CDKN2A, OXA1L, and RAC1. Multiple concurrent mutations occurred in 5 cases (9.1%). Notably, BRAF mutation patterns differed substantially from Western populations: complete absence in superficial spreading melanomas (0.0% versus 50-70% in Caucasian cohorts) with enrichment in nodular melanomas (36.4%). KIT mutations showed significant enrichment in mucosal melanomas (33.3%, P = 0.003). A novel OXA1L frameshift mutation (p.A54Sfs*100) was identified.

CONCLUSION: Melanomagenesis in the Turkish population demonstrates substantial genetic diversity with population-specific mutation patterns that diverge from Western paradigms. The absence of BRAF mutations in superficial spreading melanomas suggests distinct genetic pathways potentially related to different UV exposure patterns, genetic susceptibility, or gene-environment interactions. These findings have important implications for precision medicine, as therapeutic strategies developed in Western populations may require adaptation for diverse ethnic groups. Comprehensive genomic profiling including NF1 in larger multi-institutional cohorts is needed to fully characterize population-specific melanomagenesis mechanisms.

PMID:41408518 | DOI:10.1186/s12885-025-15458-1

J Dent Res. 2025 Dec 17:220345251399558. doi: 10.1177/00220345251399558. Online ahead of print.

ABSTRACT

Chronic apical periodontitis (CAP) is a persistent inflammatory condition caused by microbial infections in the root canal system, leading to bone loss and tissue damage. In this study, we tested the hypothesis that maresin 1 (MaR1), a specialized proresolving mediator, facilitates inflammatory resolution and promotes bone healing in CAP. We developed a CAP model in mice through pulp exposure. Animals received intracanal administration of either MaR1 or a vehicle. Micro-computed tomography (micro-CT) was used to analyze lesion size and bone volume changes. Inflammatory cell infiltration was assessed in hematoxylin and eosin-stained sections, and microbial diversity was analyzed using next-generation sequencing. The role of regulatory T cells (Tregs) was further explored through diphtheria toxin-induced depletion of Tregs in Foxp3eGFP/IL17 transgenic mice. All statistical analyses were performed using parametric methods, as confirmed by the Shapiro-Wilk test for data normality. Analysis of variance with Tukey’s post hoc and Bonferroni-corrected t tests was applied. P < 0.05 was considered significant. In 2-dimensional analyses, a significant difference was observed between the control and lesion groups, supporting the validity of the experimental model. MaR1 treatment significantly reduced lesion size (P < 0.0001). The bone volume/total volume ratio was significantly higher in the MaR1 group than in the vehicle group (P < 0.05). Bone mass was reduced in the lesion group, whereas MaR1 treatment significantly alleviated this loss (P < 0.05). The number of inflammatory cells was significantly lower in the MaR1 group compared to the vehicle group (P < 0.05). MaR1 also reduced Enterococcus faecalis, a key pathogen in persistent infections. This study highlights MaR1 as a promising treatment for chronic apical periodontitis, showing benefits in resolving inflammation, preserving bone, and reducing E. faecalis. Unlike conventional therapies, MaR1 supports immune modulation and tissue repair.

PMID:41408494 | DOI:10.1177/00220345251399558

J Robot Surg. 2025 Dec 18;20(1):97. doi: 10.1007/s11701-025-03063-0.

ABSTRACT

Buccal mucosa graft (BMG) ureteroplasty has emerged as a versatile technique for managing long-segment or complex ureteral strictures. However, the optimal surgical approach-Robotic-Assisted (RAS), Laparoscopic, or Open surgery-remains debated. We aimed to systematically evaluate and compare the perioperative outcomes and safety profiles of these three modalities. A systematic literature search was conducted in PubMed, Embase, and Web of Science up to November 2025, following PRISMA 2020 guidelines. Studies reporting outcomes of BMG ureteroplasty via robotic, laparoscopic, or open approaches were included. The primary outcome was surgical success rate. Secondary outcomes included operative time, hospital stay, and complication rates (total and Clavien-Dindo ≥ 3). Statistical analysis was performed using R software with a Generalized Linear Mixed Model (GLMM). Sixteen studies involving 398 patients (Robotic: n = 256; Laparoscopic: n = 98; Open: n = 44) were included. The pooled surgical success rates were uniformly high across all groups: Robotic (90.4%), Laparoscopic (92.5%), and Open (90.9%), with no statistically significant differences (P > 0.05). However, regarding safety, the robotic approach demonstrated a superior profile. Despite managing complex cases, the robotic cohort exhibited a minimal incidence of major complications (Clavien-Dindo ≥ 3) compared to laparoscopic and open groups. Sensitivity analysis confirmed the robustness of these findings, indicating that the efficacy of RAS is generalizable and not driven by single-center data. Robotic-assisted BMG ureteroplasty achieves excellent functional outcomes comparable to the open gold standard and the laparoscopic approach. In terms of safety, RAS demonstrates a favorable profile with a marked reduction in severe perioperative complications compared to laparoscopic and historical open cohorts. Consequently, RAS represents a safe and effective minimally invasive alternative for complex ureteral reconstruction, offering durability comparable to open repair with minimized morbidity.

PMID:41408485 | DOI:10.1007/s11701-025-03063-0