Tag: statistics

Ophthalmol Ther. 2025 Nov 23. doi: 10.1007/s40123-025-01275-z. Online ahead of print.

ABSTRACT

INTRODUCTION: Pediatric patients with noninfectious uveitis refractory to standard therapies have limited options. Efficacy and safety of systemic tacrolimus, a calcineurin inhibitor used successfully in adult noninfectious uveitis as an adjuvant immunomodulatory treatment, was investigated in the pediatric population at our institution.

METHODS: This was a retrospective chart review of patients ≤ 18 years old diagnosed with noninfectious uveitis who were intolerant to or failed conventional systemic immunosuppressants between January 2014 and June 2025 at a tertiary referral center. The primary outcome was treatment success, defined as two or more of the following: ≤ 0.5+ anterior chamber cell, ≤ 2 drops of topical steroids per day per eye, improvement or resolution of vitritis, macular edema, papillitis, and angiographic leakage without addition of systemic therapy at 6 and 12 months after tacrolimus initiation. Secondary outcomes included need for dose reduction or discontinuation owing to adverse effects. Descriptive statistics were used to analyze the data.

RESULTS: Data from 11 patients, with median age of 10 years, were analyzed. Treatment success was achieved in 88.9% and 63.6% of patients at 6 and 12 months, respectively. Although seven patients experienced laboratory abnormalities, tacrolimus was not discontinued. An average tacrolimus dose of 0.16 mg/kg/day divided every 12 h achieved therapeutic tacrolimus levels. Median duration (range) of tacrolimus therapy was 24 months (4-93 months).

CONCLUSIONS: Tacrolimus may potentially be a well-tolerated, safe, and effective option for refractory cases of pediatric noninfectious uveitis.

PMID:41275437 | DOI:10.1007/s40123-025-01275-z

Eur J Pediatr. 2025 Nov 23;184(12):782. doi: 10.1007/s00431-025-06639-y.

ABSTRACT

The aim of this study was to assess the socio-economic burden on families of children diagnosed with inflammatory bowel diseases (IBD), particularly ulcerative colitis (UC), and Crohn’s disease (CD). The study was conducted at the 2nd Clinic of Paediatrics, Gastroenterology and Nutrition of Wroclaw Medical University. Anonymous questionnaires were completed by parents of paediatric IBD patients. The survey collected demographic, socio-economic, and treatment-related data. The study identified both material and non-material costs associated with IBD care. These included frequent private medical visits, medication, diet modifications, and transportation. Average monthly travel expenses were PLN 215.9 for UC and PLN 302.3 for CD (PLN = Polish zloty, 1 PLN = 0.25 euro). Limited access to paediatric gastroenterologists, especially in remote areas, led many families to seek private care, with associated monthly costs averaging PLN 312.3 for UC and PLN 513.3 for CD. Additionally, parents reported frequent work absences due to caregiving responsibilities, further impacting income and quality of life.

CONCLUSION: Childhood IBD imposes a considerable financial and psychosocial burden on families. The findings underscore the need for improved access to public healthcare services and financial support mechanisms to reduce the strain on affected families.

WHAT IS KNOWN: • Families of children with IBD (ulcerative colitis, Crohn’s disease) face significant costs related to medical care and lifestyle changes. • Limited access to specialised paediatric gastroenterologists and frequent absences from work add to the overall family burden.

WHAT IS NEW: • This study quantifies the monthly out-of-pocket travel and private care costs for paediatric IBD in Poland (PLN 215.9-513.3), previously rarely documented. • The findings highlight significant non-material impacts, such as caregiver work absences, further reducing family quality of life.

PMID:41275433 | DOI:10.1007/s00431-025-06639-y

Cancer Med. 2025 Nov;14(22):e71400. doi: 10.1002/cam4.71400.

ABSTRACT

OBJECTIVE: To examine the association between adverse childhood events (ACEs) and cannabis use among adult cancer survivors in the United States.

METHODS: We conducted a cross-sectional study of cancer survivors ≥ 18 years old using 2020 Behavioral Risk Factor Surveillance System data. ACEs were categorized as 0, 1, 2-3, and ≥ 4. Weighted multivariable logistic regression estimated the odds of cannabis use by ACE category.

RESULTS: Among 7896 cancer survivors, cannabis use prevalence was 6.0%. ACE distribution was 44.1% (0), 22.7% (1), 20.2% (2-3), and 13.0% (≥ 4). Cannabis use was more common among younger adults, Hispanics, never-married individuals, smokers, and those reporting fair/poor health. Compared to those with 0 ACEs, cancer survivors with 2-3 ACEs (aOR: 2.56, 95% CI: 1.57-4.27) and ≥ 4 ACEs (aOR: 4.10, 95% CI: 2.54-6.64) had significantly higher odds of cannabis use.

CONCLUSIONS: Cancer survivors with a higher number of ACEs reported increased odds of cannabis use. These findings support further study of ACEs and substance use in cancer survivors and may inform trauma-informed survivorship care.

PMID:41275428 | DOI:10.1002/cam4.71400

Cancer Med. 2025 Nov;14(22):e71380. doi: 10.1002/cam4.71380.

ABSTRACT

OBJECTIVE: This study examined all-cause and cause-specific cancer mortality among older migrants and non-migrants in Finland and the role of socioeconomic status in mortality differences.

METHODS: We used the Finnish Causes of Death Register on all deaths (2002-2020) among individuals aged ≥ 70 (N = 718,717) and the corresponding population-at-risk data (N = 13,241,620 person years). Poisson regression was used with two sequential models adjusting for age at death, calendar year, and region of residence in Finland (M1), and personal annual disposable income (M2).

RESULTS: We found an overall cancer mortality advantage for both migrant men (IRR in the full model 0.83, 95% CI: 0.78-0.89) and migrant women (IRR: 0.89, 95% CI: 0.83-0.95) and lung cancer mortality advantage for migrant men (IRR: 0.77, 95% CI: 0.67-0.89) and women (IRR: 0.67, 95% CI: 0.53-0.85). For migrant men, advantage was found in pancreatic cancer (IRR: 0.76, 95% CI: 0.58-0.99), prostate cancer (IRR: 0.78, 95% CI: 0.66-0.93), and leukaemia and lymphoma (IRR: 0.73, 95% CI: 0.58-0.93), and for women in genital cancers (IRR: 0.69, 95% CI: 0.55-0.86). Notable variations were observed by region of origin and in certain cases, migrants’ lower income obscured the full extent of their cancer mortality advantage. A mortality disadvantage was observed in stomach cancer among men (IRR: 2.76, 95% CI: 2.08-3.65) and women (IRR: 2.32, 95% CI: 1.79-3.00) born in the former USSR. Liver cancer mortality disadvantage was found for men from the Global South and East (IRR: 2.00, 95% CI: 1.10-3.61), and this association was attenuated after adjustment for personal disposable income. In cancers of the urinary tract, men born in Sweden had elevated mortality (IRR: 2.09, 95% CI: 1.14-3.81).

CONCLUSION: Finings underscore the need for targeted cancer prevention and screening programmes that account for the diverse backgrounds, sex, socioeconomic status, and health risks of migrant populations, particularly those from higher-risk regions.

PMID:41275426 | DOI:10.1002/cam4.71380

Ann Saudi Med. 2025 Nov-Dec;45(6):381-387. doi: 10.5144/0256-4947.2025.381. Epub 2025 Nov 20.

ABSTRACT

BACKGROUND: Errors in clinical laboratory tests can have a detrimental effect on healthcare delivery. The pre-analytical phase accounts for most laboratory errors, known as pre-analytical errors (PAEs).

OBJECTIVE: This study investigated the causes and frequencies of PAEs occurring within a laboratory of a tertiary care hospital.

DESIGN: A single-center, retrospective, observational study.

SETTING: King Abdul-Aziz Specialist Hospital, Taif, Saudi Arabia.

MATERIALS AND METHODS: All laboratory test orders and repeated or rejected specimens in the Laboratory Information System (LIS) during 2021. The data consisted of the types of PAEs, their distribution across laboratory sections, the patient source among hospital departments, and the working shift during which PAEs were recorded.

MAIN OUTCOME MEASURES: The causes and frequencies of PAEs across laboratory sections, hospital departments, and work shifts were analyzed.

SAMPLE SIZE: 2104 PAEs from a total of 3 346 199 test orders.

RESULTS: Of the 3 346 199 test orders, 3137 were recorded as either repeated or rejected. Of these, 2104 (67.1%) were attributed to PAEs, representing a rate of 0.063% (95% CI: 0.060-0.066%) of the total test orders. ‘Clotted specimens’ (32%) and ‘insufficient quantity’ (31%) were the most frequent PAEs. Significant differences were identified in the error rate and type of PAEs across laboratory sections, hospital departments, and working shifts (P<.001 for each). The highest error rate was in the blood bank (0.4%). The hematology section accounted for the largest proportion of errors (48.4%). Most PAEs were test orders from the inpatient department (47.3%), with a majority occurring in the morning shift (58.2%).

CONCLUSION: Our study revealed a low overall PAE rate of 0.063%. ‘Clotted specimens’ and ‘insufficient quantity’ were the most frequent errors. Importantly, we identified significant differences in the types of PAEs across laboratory sections, hospital departments, and working shifts, indicating their multifaceted and context-dependent nature.

LIMITATIONS: A retrospective, single-center study.

PMID:41275351 | DOI:10.5144/0256-4947.2025.381

Ann Saudi Med. 2025 Nov-Dec;45(6):388-394. doi: 10.5144/0256-4947.2025.388. Epub 2025 Nov 20.

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic disrupted cancer care, resulting in significant diagnostic delays.

OBJECTIVES: While prior studies have examined shifts in clinical stage, limited data exist on the pandemic’s effect on histopathological features and long-term survival in gastric cancer (GC). We aimed to address this gap through a comprehensive comparative analysis.

DESIGN: Retrospective cohort study.

SETTING: Tertiary-care center.

PATIENTS AND METHODS: This single-center study included 317 participants newly diagnosed with GC, divided into pre-pandemic (March 2018-March 2020) and pandemic (March 2020-March 2022) groups. Demographic, clinical, and detailed histopathological characteristics and 1- and 3-year overall survival (OS) rates were compared between groups.

MAIN OUTCOME MEASURES: Comparison of clinical stage, treatment modality, histopathological features, and 1- and 3-year overall survival between GC patients diagnosed before and during the COVID-19 pandemic.

SAMPLE SIZE: 317 patients.

RESULTS: The pandemic group exhibited a significantly higher rate of metastasis at diagnosis (38.0% vs. 26.9%; P=.035), lower rate of surgical resection (54.0% vs. 65.3%; P=.041), and higher rate of palliative therapy (44.0% vs. 31.1%; P=.018). Histopathologically, this cohort had a greater proportion of high-grade (G3) tumors (P=.014), lower median number of dissected lymph nodes (P=.002), and poorer response to neoadjuvant therapy (P=.025). Both 1- and 3-year OS were significantly lower in the pandemic group (P=.009 and .045, respectively).

CONCLUSIONS: The COVID-19 pandemic was associated with more advanced disease at diagnosis and significantly worse long-term survival for patients with GC. These outcomes appear to result from diagnostic and treatment delays rather than substantial changes in tumor biology. These findings underscore the need to establish resilient cancer care systems to reduce vulnerability during health crises.

LIMITATIONS: Single-center retrospective design and selection bias due to histopathological analyses being limited to surgically treated patients.

PMID:41275347 | DOI:10.5144/0256-4947.2025.388

Ann Saudi Med. 2025 Nov-Dec;45(6):421-434. doi: 10.5144/0256-4947.2025.421. Epub 2025 Nov 20.

ABSTRACT

BACKGROUND: Anthracyclines are widely used in cancer treatment and cause dose-dependent cardiotoxicity 2 different by increasing oxidative stress and RAS activation. Angiotensin converting enzyme inhibitors (ACEIs) show promise in reducing this damage.

OBJECTIVES AND DESIGN: This systematic review and meta-analysis evaluated the efficacy and safety of ACEIs in preserving left ventricular function and reducing cardiotoxicity associated with anthracycline therapy.

METHODS: A comprehensive search of databases up to May 2024 included randomized controlled trials (RCTs) that assessed ACEIs to prevent cardiotoxicity. Random-effects meta-analysis was applied.

MAIN OUTCOME MEASURES: The primary outcome was changes in left ventricular ejection fraction (LVEF). Secondary outcomes included cardiac event incidence and adverse events.

SAMPLE SIZE: Nine RCTs were included, encompassing 869 patients (440 ACEI group, 429 control group).

RESULTS: ACEIs significantly improved LVEF at six months (mean difference of 7.93%; 95% CI 3.18-12.67%; P=.001) but not at 12 months. Moreover, ACEIs were associated with non-statistically significant lower rates of heart failure and arrhythmia development compared to the control, with no significant differences noted in adverse events.

QUALITY OF EVIDENCE: Evidence quality was high for short-term LVEF improvement and moderate-to-low for other outcomes. Egger’s regression test indicated a low risk of publication bias for LVEF.

HETEROGENEITY: High (I²=97%) for LVEF at 6 months.

CONCLUSION: ACEIs prevent cardiotoxicity in the short term without increasing adverse events. More extensive trials are needed to confirm long-term benefits.

LIMITATIONS: The small number of RCTs and high heterogeneity limit the study. Inconsistent reporting of baseline cardiovascular factors and confounders also hindered accurate assessment of treatment effects.

REGISTRATION: PROSPERO CRD42024555546.

PMID:41275346 | DOI:10.5144/0256-4947.2025.421

Ann Saudi Med. 2025 Nov-Dec;45(6):395-405. doi: 10.5144/0256-4947.2025.395. Epub 2025 Nov 20.

ABSTRACT

BACKGROUND: Obstetric anal sphincter injuries (OASIS) are severe complications of vaginal deliveries with long-term physical and psychological sequelae. Data on the prevalence and risk factors of OASIS are limited in Saudi Arabia. This study aimed to assess the incidence of OASIS annually from 2017 to 2020, identify associated maternal and delivery factors, and investigate patients’ characteristics related to OASIS Grades.

OBJECTIVE: To evaluate the annual incidence of OASIS from 2017 to 2020, identify maternal and delivery-related risk factors, and assess characteristics associated with different OASIS grades.

DESIGN: Single-center, retrospective observational study.

SETTING: King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

METHODS: Medical records of all vaginal deliveries from 2017 to 2020 were reviewed. The study included 112 patients with singleton vaginal deliveries complicated by OASIS, out of a total of 12 081 deliveries. Exclusion criteria included preterm births and incomplete records. Data on maternal demographics, obstetric history, labor type, mode of delivery, episiotomy use, and neonatal outcomes were collected. The Royal College of Obstetricians and Gynaecologists (RCOG) classification was used to grade OASIS severity. Chi-square and t-tests were used for analysis.

MAIN OUTCOME MEASURES: Annual incidence of OASIS, distribution of OASIS grades, and associations between clinical variables and injury severity.

SAMPLE SIZE: 112 cases of OASIS among 12081 vaginal deliveries.

RESULTS: The incidence of OASIS was 0.93%, showing a decreasing trend from 2017 to 2020. Most patients were Saudis (78.6%), primigravidae (58%), and nulliparous (67%). Spontaneous vaginal delivery occurred in 73.2% of cases, with episiotomies performed in 62%. Grade III tears were observed in 79.5% of cases, whereas 8.0% were classified as Grade IV. No significant differences were observed between Grades III and IV in terms of maternal and delivery characteristics, except for higher estimated blood loss in Grade IV cases. Incomplete documentation was noted in repair techniques and episiotomy details.

CONCLUSION: Incidence of OASIS shows a decreasing trend in both the number of cases and the incidence rate over the four years between 2017 and 2020. Further research is necessary to address documentation gaps and refine regional prevention and management practices.

LIMITATION: Retrospective design and missing values limited the ability to analyze some variables thoroughly.

PMID:41275344 | DOI:10.5144/0256-4947.2025.395

Med Sci Monit. 2025 Nov 23;31:e950460. doi: 10.12659/MSM.950460.

ABSTRACT

BACKGROUND Intrauterine devices (IUDs) are widely used for contraception and are generally well tolerated. A rare complication is spontaneous fracture of the IUD while in situ. This study aimed to evaluate the prevalence of spontaneous IUD fractures and compare occurrence between 2 IUD types. MATERIAL AND METHODS This retrospective study included 463 women who underwent IUD insertion and follow-up between January 1, 2011, and December 31, 2021. Two IUDs were evaluated: Type 1, a copper IUD with a gold core (375 mm²), and Type 2, a copper IUD (300 mm²) without a gold core. Spontaneous fractures were identified based on symptoms or routine annual ultrasonography. Statistical analyses included descriptive statistics, normality testing, and comparisons using chi-square, t-tests, or Mann-Whitney U tests. A p value <0.05 was considered significant. RESULTS Among 463 patients, 183 used a Type 1 IUD and 280 used Type 2. Spontaneous fractures were observed in 12 of 183 Type 1 users (6.56%, 95% CI: 2.97-10.15%), while no fractures occurred among Type 2 users. Overall fracture prevalence was 2.59% (95% CI: 1.49-4.48%). Fractured arms were often located in the uterine cornua (n=9) and cervical canal (n=3). Fragments in the canal were removed using Novak extraction, while those in the cornua required hysteroscopy. CONCLUSIONS Spontaneous IUD fractures can occur without symptoms and must be considered during follow-up. Prompt recognition is essential to avoid complications. Hysteroscopy and Novak extraction are effective for fragment removal. Clinicians should consider routine ultrasonographic evaluation to detect asymptomatic IUD fractures, especially in users of Type 1 devices.

PMID:41275328 | DOI:10.12659/MSM.950460

J Psychosom Obstet Gynaecol. 2025 Dec 31;46(1):2584909. doi: 10.1080/0167482X.2025.2584909. Epub 2025 Nov 22.

ABSTRACT

OBJECTIVE: This study aims to systematically analyze the disease burden and epidemiological characteristics of depression among women of childbearing age (WCBA) globally and across regions from 1990 to 2021, as well as explore the current research status and hotspots.

METHODS: Data from the 2021 Global Burden of Disease, Injuries, and Risk Factors Study (GBD 2021) were used to examine age-standardized incidence rates (ASIR) and disability-adjusted life years (DALYs) of depression among WCBA by region, age, and socio-demographic index (SDI) level. Relevant literature was retrieved from the Web of Science Core Collection, with bibliometric analyses (temporal-spatial distribution, themes, keywords) performed via VOSviewer and CiteSpace.

RESULTS: In 2021, there were ~133 million new global cases of depression among WCBA, with an ASIR of 6,808.01 per 100,000 population. Incidence rose significantly since 1990, accelerating from 2019 to 2021. High SDI regions had higher ASIR, age-standardized DALY rates (ASDR), and average annual percentage change (AAPC). Globally, incidence peaked at 45-49 years with age growth, but younger WCBA (15-29 years) in high SDI regions had higher ASIR. Bibliometric analysis showed rapid research expansion in recent years, covering pregnancy, risk factors, and obesity, with “polycystic ovary syndrome” and “oxidative stress” as emerging hotspots.

CONCLUSION: The study highlights the rising global burden of depression among WCBA and disparities across regions, socioeconomic backgrounds, and age groups, providing scientific evidence for targeted public health interventions.

PMID:41275327 | DOI:10.1080/0167482X.2025.2584909