Tag: statistics

BMC Nurs. 2026 Apr 3. doi: 10.1186/s12912-026-04623-x. Online ahead of print.

ABSTRACT

BACKGROUND: Diabetic foot ulcers (DFUs) are a major cause of morbidity, lower-limb amputation, and mortality among people with diabetes, particularly in low- and middle-income countries. Nurses play a key role in DFU prevention and management; however, evidence on their knowledge, attitudes, and practices (KAP) in Ghana remains limited. This study assessed nurses’ KAP regarding DFU care at a tertiary hospital in Ghana.

METHODS: A hospital-based cross-sectional study was conducted among nurses providing direct patient care from September to November 2025. A structured self-administered online questionnaire assessed socio-demographic characteristics and DFU-related knowledge, attitudes, and practices. Descriptive statistics summarized the data, and chi-square tests examined associations between knowledge levels and selected variables (p < 0.05).

RESULTS: Of the 128 nurses invited, 100 participated (response rate: 78.1%). Most respondents were female (77%), and 90% had not received formal DFU training. Overall, 61% demonstrated good knowledge, 30% moderate knowledge, and 9% poor knowledge. Attitudes toward DFU care were generally positive, though workload constraints were noted. Common practices included patient education (81%), foot inspection (74%), and referral of suspected DFU cases (75%), while use of standardized neuropathy screening tools was low (10%) and documentation of foot-care education inconsistent (52%). Knowledge was significantly associated with academic qualification (χ² = 14.876, p = 0.002), years of practice (χ² = 8.219, p = 0.016), and prior DFU training (χ² = 12.604, p < 0.001).

CONCLUSIONS: Despite positive attitudes toward DFU care, gaps remain in preventive knowledge and evidence-based screening practices. Strengthening structured DFU training and institutional support may improve nursing practice and patient outcomes.

PMID:41933340 | DOI:10.1186/s12912-026-04623-x

Harm Reduct J. 2026 Apr 3. doi: 10.1186/s12954-026-01437-7. Online ahead of print.

ABSTRACT

BACKGROUND: Xylazine prevalence has surged in the unregulated fentanyl supply across the United States. In efforts to inform education initiatives for people who use drugs, this study aimed to identify factors associated with reported xylazine use and knowledge gaps.

METHODS: This Connecticut-based mixed methods study employed both surveys and interviews. Survey participants, recruited from collaborating harm reduction organizations, were adults who used unregulated substances in the last six months. They were asked about their drug use, knowledge of xylazine, service use experience, and demographic information. Purposive sampling of survey participants was then used to select individuals for in-depth interviews. Topic guides were designed to gain a deeper understanding of participants’ xylazine awareness and future learning preferences. Quantitative data were dichotomized based on reported xylazine use and analyzed using descriptive statistics, Chi-square, Fisher’s exact, or t-tests. Simple and multiple logistic regression were used to find correlates of reported use of xylazine. Interviews were analyzed using thematic analysis.

RESULTS: Between August and November 2024, we surveyed 114 respondents. Nearly half reported lifetime xylazine use (49.1%) and almost three-quarters heard of xylazine prior to engaging in the study (71.9%). Multiple logistic regression revealed that unemployment (OR 6.5, 95% CI 2.4-17.8), past-year fentanyl use (OR 41.1, 95% CI 4.8-354.4), and harm reduction service engagement (OR 5.2, 95% CI 1.6-16.8) as predictors of reported xylazine use, after adjustments. We conducted n=31 interviews; thematic analysis identified four major themes: (1) information about xylazine was obtained from many sources, (2) knowledge about xylazine was gained from using xylazine, (3) some misconceptions about xylazine have developed, and (4) multiple mechanisms for xylazine education are desired.

CONCLUSIONS: This study underscores the need for accessible xylazine education to address knowledge and confidence gaps among people who use drugs. Xylazine education should be tailored to one’s likely xylazine exposure. Education must be harm-reduction oriented, stigma-free, and incorporate the voices of people who use drugs.

PMID:41933329 | DOI:10.1186/s12954-026-01437-7

BMC Endocr Disord. 2026 Apr 3. doi: 10.1186/s12902-026-02253-7. Online ahead of print.

ABSTRACT

OBJECTIVE: To systematically evaluate the effect of short-term androgen therapy on final adult height in boys with constitutional delay of growth and puberty (CDGP).

METHODS: Original studies investigating androgen therapy in children with CDGP and reporting final adult height as an outcome were retrieved from PubMed, Embase, Web of Science, and SpringerLink. The search period extended from database inception to September 2025. EndNote 20.0 was used for duplicate removal, and study quality was assessed using the Newcastle-Ottawa Scale (NOS). Literature screening, data extraction, and quality assessment were independently conducted by two researchers, with discrepancies resolved through consultation with a third researcher. Meta-analysis was performed using R 4.5.2 and Review Manager 5.4.1.

RESULTS: A total of 13 eligible retrospective cohort studies involving 803 patients were included. Sensitivity analyses demonstrated good robustness of the pooled results, and Egger’s tests indicated no significant publication bias (P₁ = 0.0794, P₂ = 0.3982). Meta-analysis showed that, compared with untreated controls, androgen therapy-including testosterone and oxandrolone-significantly increased measured final adult height [MD = 1.78 cm, 95% CI (0.47, 3.08), P = 0.0076] and significantly improved final height Z-scores [MD = 0.24, 95% CI (0.07, 0.41), P = 0.0057]. Subgroup analyses revealed that the low-dose regimen yielded the most favorable effect [MD = 1.88 cm, 95% CI (0.63, 3.12), P = 0.003], whereas the medium-dose [MD = 1.17 cm, 95% CI (-0.90, 3.25), P = 0.268] and high-dose regimens [MD = 1.68 cm, 95% CI (-5.07, 8.42), P = 0.626] showed no statistically significant benefit. Short-course therapy was associated with greater improvement in final adult height compared with long-course therapy [MD = 2.70 cm, 95% CI (1.30, 4.09), P < 0.001]. In addition, testosterone demonstrated superior efficacy compared with oxandrolone [MD = 2.64 cm, 95% CI (1.44, 3.80), P < 0.001].

CONCLUSION: Short-term androgen therapy can improve final adult height in boys with CDGP, with low-dose, short-course testosterone regimens appearing to be the most favorable option. Given the limited number and retrospective nature of the included studies, these findings require further confirmation through high-quality comparative studies.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41933328 | DOI:10.1186/s12902-026-02253-7

BMC Infect Dis. 2026 Apr 3. doi: 10.1186/s12879-026-13236-3. Online ahead of print.

ABSTRACT

BACKGROUND: Chlamydia pneumoniae is a significant pathogen in pediatric community-acquired pneumonia, with increasing incidence globally, particularly in East Asia. However, gender disparities and the role of bronchoscopy in disease management remain underexplored. This study aimed to analyze the clinical features, risk factors, and outcomes of C. pneumoniae pneumonia in children.

METHODS: We conducted a retrospective analysis of 266 children with C. pneumoniae pneumonia admitted to a tertiary maternal and child health hospital from January 2024 to June 2025. Data included age, gender, fever at admission, cough duration, length of stay, bronchoscopy performance, hematological parameters (white blood cell count, neutrophil ratio, lymphocyte ratio), C-reactive protein, procalcitonin, pulmonary involvement, co-infection status, and medication use. Statistical analyses involved t-tests, chi-square tests, and logistic regression.

RESULTS: A significant surge in cases was observed since January 2025. Gender-based analysis showed girls (n = 127) had longer hospitalization (mean difference:7.0, p < 0.05) and cough duration at admission (median value: 7, p < 0.05), with higher co-infection rates (48% vs. 30.9% in boys, n = 139, p < 0.05). Among 102 co-infected cases, rhinovirus was predominant (37.3%, n = 38). Logistic regression identified younger age as an independent risk factor for co-infection (OR 0.91 per year, p < 0.05). Children undergoing bronchoscopy (n = 86) had prolonged hospital stays, lower lymphocyte and monocyte ratios, and higher neutrophil ratios (p < 0.05). Bronchoscopic findings revealed viscous yellowish secretions, which were looser than Mycoplasma pneumoniae-induced plastic bronchitis and effectively managed with lavage. Younger age and lower neutrophil ratios predicted multi-lobar involvement (p < 0.05).

CONCLUSION: C. pneumoniae pneumonia in children exhibits gender-specific severity, with girls showed trends of prolonged hospitalization and cough duration. Younger age increases co-infection risk, and bronchoscopy indicates more severe disease but aids in targeted therapy. These findings underscore the need for early diagnosis and personalized interventions in high-risk groups.

PMID:41933307 | DOI:10.1186/s12879-026-13236-3

BMC Infect Dis. 2026 Apr 3. doi: 10.1186/s12879-026-13223-8. Online ahead of print.

ABSTRACT

OBJECTIVE: To characterize immune alterations in PLWH across disease stages and identify laboratory indicators for diagnosing fungal co-infections.

METHODS: We conducted a comprehensive cross-sectional study comparing laboratory immunological parameters-including lymphocyte subsets, activation/exhaustion markers, and plasma cytokines-across patient groups stratified by co-infection type and CD4⁺ T cell count. Statistical significance was assessed using false discovery rate correction.

RESULTS: The most severe immunological compromise was observed in patients with advanced HIV disease (CD4⁺ ≤199 cells/µL) and co-infections, who exhibited profound pan-lymphopenia and a dissociated T cell profile featuring both hyperactivation (HLA-DR/CD38) and exhaustion (loss of CD28). Compared to patients with other opportunistic infections, those with fungal co-infections displayed a distinct immune phenotype characterized by significantly lower CD4⁺ T cell counts (51.32 ± 47.41 vs. 134.27 ± 130.12 cells/µL, q = 0.004) and B cell counts (65.74 ± 56.13 vs. 108.30 ± 101.10 cells/µL, q = 0.024), alongside elevated CD8⁺ T cell activation. Patients with localized Talaromyces marneffei infection had significantly higher CD4⁺ T, CD8⁺ T, and natural killer cell counts than those with disseminated disease, underscoring the importance of preserved cellular immunity in pathogen containment. No significant differences were observed across fungal pathogens or sites of cryptococcal disease. Correlation analysis revealed a strong positive association between HIV viral load and interleukin-10(R² = 0.587, r = 0.632, 95% CI: 0.473 to 0.755, P = 0.014).

CONCLUSION: Specific immunological parameters-particularly severe CD4⁺ and B cell lymphopenia with concurrent CD8⁺ T cell hyperactivation-provide an objective basis for identifying PLWH at high risk for fungal infections. These findings highlight the potential value of adjunctive immunomodulatory strategies alongside antiviral therapy in this patient population.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41933298 | DOI:10.1186/s12879-026-13223-8

Gut Microbes. 2026 Dec 31;18(1):2653290. doi: 10.1080/19490976.2026.2653290. Epub 2026 Apr 3.

ABSTRACT

Clostridioides difficile infection (CDI) can elicit varying degrees of intestinal inflammation. To investigate the association between CDI and Th17/Treg cell imbalance, fecal DNA was extracted for the specific detection of C. difficile toxins and combined with fecal bacterial culture to identify the presence of CDI. Peripheral blood samples were collected from CDI-positive and CDI-negative patients, and flow cytometry was performed to quantify the proportions of Th17 and Treg cells, as well as to measure the serum levels of IL-17A, IL-23, IL-6, and other cytokines. Moreover, peripheral blood mononuclear cell mRNA was isolated for reverse transcription and real-time PCR analysis to determine the relative expression levels of ROR-γt and Foxp3. Statistical analyses were conducted to evaluate the differences between CDI-positive and CDI-negative groups. The results revealed that CDI-positive patients exhibited an increased proportion of Th17 cells, along with elevated levels of Th17-related cytokines such as IL-23 and IL-17A. Additionally, these patients showed an upregulation in the expression of ROR-γt. a specific transcription factor (TF) for Th17 cells as well as an increased ratio of Th17 and Treg cells. These findings provide phenotypic evidence suggesting that CDI is potentially associated with a dynamic interplay between Th17 and Treg cells, a finding supported by measuring key TFs and proteins. Our experiments examining the effects of TcdA toxin-induced Th17 differentiation in peripheral blood also provide further evidence highlighting the importance of this CDI-triggered immune imbalance via Th17-mediated inflammatory responses.

PMID:41933277 | DOI:10.1080/19490976.2026.2653290

Eur Radiol. 2026 Apr 3. doi: 10.1007/s00330-026-12500-z. Online ahead of print.

ABSTRACT

OBJECTIVES: The role of low muscle mass in acute neck infections is underexplored. This study aimed to validate the reliability of MRI-based masseter muscle area (MMA) measurements, derive normative age-related data in a diverse patient cohort, and evaluate the association between MMA measurements and infection severity and clinical outcomes in patients with acute neck infections.

MATERIALS AND METHODS: In this retrospective single-center study, 526 patients with clinically confirmed acute neck infections who underwent emergency neck MRI had bilateral MMA measured on T2-weighted Dixon images at the mandibular foramen level. MMA was normalized to height squared (MMA/h²). Interobserver reliability of MMA was assessed between two readers using intraclass correlation coefficients (ICC). Among adults, associations with infection severity markers and clinical outcomes were examined using univariable and multivariable tests.

RESULTS: The interobserver agreement for MMA was excellent (ICC = 0.991). MMA/h² declined significantly with age (r = -0.21, p < 0.01). In adults, MMA/h² correlated negatively with age, maximal abscess diameter, and length of hospital stay (LOS; p < 0.01 for all); patients with abscesses had lower MMA/h² than those without (p = 0.002). Multivariable analysis confirmed that MMA/h² independently predicted abscess diameter after adjustment for age and C-reactive protein (CRP) (p = 0.001), but not LOS (p = 0.136).

CONCLUSION: Opportunistic MRI-based MMA measurements are highly reliable and associated with age, LOS, and abscess presence and size in acute neck infections. Our findings suggest a link between low masseter muscle mass and disease severity in patients with acute neck infections.

KEY POINTS: Question Low muscle mass associates with adverse outcomes in various diseases, yet its prognostic role in acute neck infections remains underexplored. Findings MRI-based masseter muscle area measurements showed excellent reliability, declined with age, and predicted larger abscess diameter and longer hospital stay in adult patients. Clinical relevance Opportunistic MRI measurement of masseter muscle area is reliable and clinically associated with abscess size and length of hospital stay in patients with acute neck infections, providing clinically relevant information and supporting early risk stratification.

PMID:41933254 | DOI:10.1007/s00330-026-12500-z

J Antibiot (Tokyo). 2026 Apr 3. doi: 10.1038/s41429-026-00914-2. Online ahead of print.

ABSTRACT

Four new hydroxyl fatty acids (HFAs), gambaoic acids A – C (1 – 3) and gambaoic B methyl ester (4), were isolated from Bacillus sp. SNB-066, a bacterium derived from shrimp jeotgal. The chemical structures of these HFAs were elucidated through extensive spectroscopic data analysis, including mass spectrometry (MS), ultraviolet (UV), and nuclear magnetic resonance (NMR) spectroscopy data. The relative configurations of compounds 2 and 3 were determined using quantum mechanics-based computational analysis with DP4⁺ statistical calculations. Further specific rotation analyses revealed the absolute configurations of both compounds 2 and 4 as 14 R and 15 R, while compound 3 was assigned as 14S and 15S. Antibacterial activity evaluated by the minimal inhibitory concentration (MIC) assay indicated that only compound 4 exhibited weak activity against the Gram-positive bacteria B. subtilis KCTC 1021 and K. rhizophila KCTC 1915, with MIC values of 64 μg/mL. Further, gambaoic acids B (2) and C (3) exhibited dose-dependent cytotoxicity toward Caco-2 cells, with gambaoic acid C (3) demonstrating a pronounced anti-invasive effect. These findings highlight the diverse bioactivities of the isolated hydroxyl fatty acids and reveal structural features underlying their antimicrobial and anticancer properties.

PMID:41933253 | DOI:10.1038/s41429-026-00914-2

J Immigr Minor Health. 2026 Apr 3. doi: 10.1007/s10903-026-01914-y. Online ahead of print.

ABSTRACT

Childhood obesity-a risk factor for heart disease, type 2 diabetes, other non-communicable diseases and adverse psychosocial experiences-is especially high among children of Mexican immigrants, and among these children, boys have an obesity risk nearly twice as high as girls. Yet little research has examined whether there are also gender differences in the proximate determinants of obesity for this population. This study uses structural equation modeling and the 2003/4-2017/18 National Health and Nutrition Examination Survey to investigate gender differences in a key proximate determinant of obesity-diet-among adolescents with Mexican immigrant parents. We examine (1) whether there are gender differences in dietary quality and dietary acculturation, (2) whether gender differences in the settings in which adolescents eat explain gender differences in these outcomes, and (3) whether these patterns vary by parental acculturation (household language). We find that among adolescents in Spanish-speaking households, boys have significantly lower dietary quality and significantly higher dietary acculturation than girls and that gender differences in some meal settings outside the home contribute to these differences. We do not find statistically significant gender differences in the dietary outcomes or meal settings for adolescents in English-speaking households. Results highlight the importance of considering how gender and social contexts shape the health behaviors of children of Mexican immigrants.

PMID:41933227 | DOI:10.1007/s10903-026-01914-y

Pediatr Res. 2026 Apr 3. doi: 10.1038/s41390-026-04879-8. Online ahead of print.

ABSTRACT

BACKGROUND: Recent studies have shown that from the 23rd week of gestation onward, the fetus becomes progressively more hypoxic, with oxygenation levels rising again after 33-34 weeks. The biological significance of this biphasic oxygenation pattern has remained unclear.

METHODS: Umbilical cord blood samples from 100 preterm and 100 full-term neonates were analyzed for blood gas parameters and for HIF1A, ADRB3 (β3-adrenoceptor), and VEGFA gene expression.

RESULTS: A progressive increase in mRNA expression of all three genes was observed with advancing gestational age, followed by a decline during the final weeks of pregnancy. This gene expression trend was inversely correlated with fetal oxygenation status.

CONCLUSION: This study demonstrates that β3-adrenoceptor expression progressively increases with gestational age, supporting the concept that this receptor plays a key role in fetal development and well-being. These findings strengthen the evidence from animal models showing that pharmacological activation of β3-adrenoceptors can reproduce, even after birth, some of the beneficial effects normally provided by the intrauterine environment. Collectively, this work supports the conceptual framework for developing a “pharmacological artificial placenta” aimed at mimicking intrauterine conditions to promote physiological neonatal adaptation.

IMPACT: Recent studies have shown that from the 23rd week of gestation onward, the fetus becomes progressively more hypoxic, with oxygenation levels rising again after 33-34 weeks. However, the biological significance of this biphasic oxygenation pattern had remained unclear. This study demonstrates for the first time that fetal oxygen fluctuations are accompanied by a synchronous and coordinated increase in the mRNA expression of HIF1A, ADRB3 (β3-adrenoceptor), and VEGFA genes. These findings support a mechanistic link between intrauterine hypoxia, β3-adrenergic signaling, and fetal maturation. This work contributes to ongoing research suggesting that pharmacological β3-adrenoceptor activation may help recreate intrauterine-like conditions, potentially promoting physiological fetal development in adverse environments.

PMID:41933214 | DOI:10.1038/s41390-026-04879-8