World journal of methodology最新文献

{"title":"Biases of large language models in diagnosing Cushing's syndrome.","authors":"Christos Savvidis, Costas Liakopoulos, Ioannis Ilias","doi":"10.5662/wjm.v16.i2.115059","DOIUrl":"10.5662/wjm.v16.i2.115059","url":null,"abstract":"<p><p>The diagnosis of endogenous Cushing's syndrome (CS) can be complicated and often delayed, given its low incidence (estimated globally at 1.8 cases to 4.5 cases per million people per year) and its clinical features that mimic far more prevalent metabolic disorders, such as central obesity, hypertension, and glucose intolerance. In clinical practice, physicians rely on cognitive heuristics that are prone to error, contributing to diagnostic delays (on average around 34 months pass from symptom onset to diagnosis of CS). Large language models and machine learning algorithms could be potential decision-support tools for screening and differential diagnosis of CS. However, these systems are at risk of inheriting and even amplifying existing cognitive biases and data-driven distortions embedded in their training data. Machine learning models designed for CS could be vulnerable to methodological flaws, notably spectrum bias and the exclusion of clinically relevant demographic variables, demanding attention from the endocrine and medical informatics communities. This paper examines how cognitive and algorithmic biases intersect in diagnostic models for CS, highlighting parallels between human diagnostic heuristics (<i>e.g.</i>, anchoring, availability, and framing) and data-driven distortions (<i>e.g.</i>, spectrum and measurement bias) in artificial intelligence.</p>","PeriodicalId":94271,"journal":{"name":"World journal of methodology","volume":"16 2","pages":"115059"},"PeriodicalIF":0.0,"publicationDate":"2026-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breaking the scalpel ceiling: Gender inequality in global transplant surgery.","authors":"Eleni Avramidou, Georgios Tsoulfas, Maria Alexiou, Christina Papachristou","doi":"10.5662/wjm.v16.i2.114180","DOIUrl":"10.5662/wjm.v16.i2.114180","url":null,"abstract":"<p><strong>Background: </strong>Gender disparities across nearly all surgical specialties have become an issue of increasing attention, reflecting persistent inequities in representation, leadership, and career advancement. Despite growing numbers of female medical graduates worldwide, women continue to remain underrepresented in surgery, particularly in subspecialties such as transplantation surgery.</p><p><strong>Aim: </strong>To explore gender inequalities among transplant surgeons from the perspective of transplant unit directors and female surgeons worldwide.</p><p><strong>Methods: </strong>This study consists of two arms: (1) An 8-item anonymous questionnaire was sent to transplant centers to assess the gender distribution of consultant surgeons' positions and academic roles among female and male surgeons; and (2) A 23-item anonymous questionnaire with closed and open questions was distributed to female transplant surgeons worldwide, addressing demographic profile, working experiences, and suggestions towards professional equality. The questionnaires were promoted through email, social media and professional platforms.</p><p><strong>Results: </strong>Of 46 transplant units participated. Among the 381 board-certified surgeons reported to work in these transplant centers, 102 were women (27%). In the second arm, 75 female transplant surgeons responded. The respondents had a mean age of 43.7 ± 8.8 years (24-70), with most of them working in European transplant centers (65.3%) and self-identifying as White/Caucasian (76%).72% reported gender discrimination, 56% faced verbal sexual harassment from colleagues, and 26.6% from patients, 41.3% were dissatisfied with their work-life balance, with commonly reported challenges including balancing career and family, lack of institutional support and inclusion and sexual harassment. The majority of recommendations involved mentorship, equal opportunities for leadership positions, and flexible working hours.</p><p><strong>Conclusion: </strong>This is the first cross-sectional study addressing gender equity within the field of transplantation surgery worldwide, documenting gender disparities, professional conflicts, and concerning experiences of sexual harassment. This study provides preliminary evidence that underscores the need for further research and structural reforms to promote gender equity in transplantation surgery.</p>","PeriodicalId":94271,"journal":{"name":"World journal of methodology","volume":"16 2","pages":"114180"},"PeriodicalIF":0.0,"publicationDate":"2026-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13121975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical insights into levothyroxine overdose: A systematic review.","authors":"Fateen Ata, Haseeb Ahmad Khan, Aamna Kashif, Adeel Ahmad Khan, Rabia Fawad, Hafiz Waqas Younas, Bilal Ahmed, Huzaifa Javed","doi":"10.5662/wjm.v16.i2.111025","DOIUrl":"10.5662/wjm.v16.i2.111025","url":null,"abstract":"<p><strong>Background: </strong>Levothyroxine (LTX) is one of the most commonly used medications due to the high prevalence of hypothyroidism in various age groups. Overdose (OD) with LTX, intentional or unintentional, is rare but can have clinically significant and even life-threatening consequences. Data on clinical outcomes of patients with LTX OD are limited, and guidelines on its management are suboptimal.</p><p><strong>Aim: </strong>To compile all available data on the clinical characteristics, management, and outcomes of patients with LTX OD.</p><p><strong>Methods: </strong>A systematic literature search was conducted to identify English-language articles through PubMed, Scopus, and EMBASE that reported primary patient data on LTX OD in all age groups. All analyses were performed using STATA-18.</p><p><strong>Results: </strong>Forty-nine studies, comprising 95 individual cases and six larger retrospective studies (<i>n</i> = 11513), were analyzed. The median age of patients in case reports was 20 years (3.5-42), with a female preponderance (66.1%). The median ingested dose of LTX was 4250 μg (1250-10000), with a median time to presentation of 4.5 hours (1.5-24). Tachycardia (38.9%), confusion (23.2%), and fever (18.9%) were the most frequent symptoms. Severe complications included atrial fibrillation (5.3%), and one death was reported. Patients with intentional LTX OD were significantly older (median 35.5 <i>vs</i> 3.5 years, <i>P</i> < 0.001) and had higher diastolic blood pressure (<i>P</i> = 0.003), while non-intentional OD cases had higher heart rates (<i>P</i> = 0.02). Among the 11513 patients from larger studies, more than 90% experienced minimal or no symptoms, particularly in pediatric cohorts. Rarely severe outcomes, such as coma and cardiac failure, were observed in adults with high-dose ingestions, requiring interventions such as beta-blockers, corticosteroids, and plasmapheresis.</p><p><strong>Conclusion: </strong>This study provides the first comprehensive dataset on LTX OD. Patients with non-suicidal/accidental LTX OD mainly belong to the pediatric age group, while those with suicidal intent belong to the older age group. Despite the risk of toxicity with ingestion of high doses of LTX, mortality is extremely rare.</p>","PeriodicalId":94271,"journal":{"name":"World journal of methodology","volume":"16 2","pages":"111025"},"PeriodicalIF":0.0,"publicationDate":"2026-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13121991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving diagnostic accuracy of 72-hour supervised fasting test for hypoglycemia evaluation: A quality improvement project.","authors":"Fateen Ata, Adeel Ahmad Khan, Mohammad Zeyad Mohammad Nofal, Elabbass A Abdelmahmuod, Rabia Fawad, Dabia Al Mohanadi, Zeinab Dabbous","doi":"10.5662/wjm.v16.i2.115150","DOIUrl":"10.5662/wjm.v16.i2.115150","url":null,"abstract":"<p><p>The 72-hour supervised fasting test (72-HSFT) remains the gold standard for investigating fasting hypoglycemia in patients without diabetes, which is a rare but potentially fatal clinical condition. However, testing inaccuracies often lead to diagnostic ambiguities and unnecessary healthcare expenditures. Baseline data collection over 1 year revealed that 66% of 72-HSFT tests at our institution were performed incorrectly, with dynamic hormones such as C-peptide being ordered four times per patient. The goal of this quality improvement project (QIP) was to reduce the frequency of unnecessary or incorrect 72-HSFT for hypoglycemia from 66% to 25% within 24 months. To achieve the goals of the QIP, educational interventions targeting patients, nurses, physicians, and laboratory staff on accurate 72-HSFT were implemented. Further interventions included the introduction of an auto-text protocol in Cerner^®, standardization of lab testing <i>via</i> a bundle order set for 72-HSFT, and multiple different models of interactive educational sessions. The project was conducted in the emergency department and the inpatient wards of the medicine department. In a plan-do-study-act 1 cycle, testing inaccuracy was reduced from 66% to 20%, with C-peptide orders reducing from 4 tests to 1.2 tests per patient. In plan-do-study-act 2, testing inaccuracy dropped to 0% with one C-peptide test ordered per patient. This QIP demonstrates that system-level changes, combined with conventional interventions such as targeted education and advanced technology-based interventions like clinical decision support tools, can significantly improve test accuracy and reduce unnecessary resource utilization in endocrinological diagnostics.</p>","PeriodicalId":94271,"journal":{"name":"World journal of methodology","volume":"16 2","pages":"115150"},"PeriodicalIF":0.0,"publicationDate":"2026-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cortical arousal and autonomic regulation: The role of cold <i>vs</i> tepid caffeinated beverages during prolonged orthostasis.","authors":"Mayowa J Adeniyi, Ayoola Awosika","doi":"10.5662/wjm.v16.i2.115219","DOIUrl":"10.5662/wjm.v16.i2.115219","url":null,"abstract":"<p><strong>Background: </strong>The interplay between caffeine ingestion, beverage temperature, and orthostatic stress on cortical arousal and autonomic regulation remains poorly understood. Understanding these distinctions is critical in identifying non-pharmacologic strategies for mitigating orthostatic intolerance, presyncope, and fatigue. Furthermore, electroencephalogram (EEG) biomarkers may provide objective insights into cortical-autonomic coupling during prolonged standing. This emerging perspective offers a novel translational pathway for optimizing performance and well-being in both clinical and occupational settings.</p><p><strong>Aim: </strong>To investigate the effect of ingesting cold and tepid caffeinated beverages on brain waves during prolonged orthostasis.</p><p><strong>Methods: </strong>Thirty-six male individuals, averaging 20 years old, who satisfied the inclusion criteria were selected using respondent-driven sampling. Caffeinated beverages containing 10-12 mg of caffeine per 100 mL at 10 °C (cold) or 37 °C (tepid) were used for the study. Baseline EEG and pulse rate in a sitting position were recorded. Orthostasis was defined as standing upright from a sitting position and lasting 20 min. An EEG was conducted using PowerLab 26T.</p><p><strong>Results: </strong>Pulse rate was significantly elevated by orthostasis when compared with the baseline. Cold caffeinated beverages decreased the alpha/beta ratio and increased beta wave frequency when compared with tepid caffeinated drinks. Orthostasis also increased beta wave frequency but decreased alpha wave frequency and the alpha/beta ratio when compared with baseline. However, orthostatic individuals administered tepid caffeinated beverage showed no significant difference in the alpha/beta ratio with orthostatic individuals administered a cold caffeinated beverage.</p><p><strong>Conclusion: </strong>Neither cold nor tepid caffeinated beverages altered EEG responses to prolonged orthostasis; caution is advised during standing, particularly for elderly individuals and patients prone to orthostatic syncope or autonomic disorders.</p>","PeriodicalId":94271,"journal":{"name":"World journal of methodology","volume":"16 2","pages":"115219"},"PeriodicalIF":0.0,"publicationDate":"2026-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why does hepatitis B remain underprioritized? A view through lived experience.","authors":"Yasmin Ibrahim, Anousha Qureshi, Michaela Jackson, Beatrice Zovich, Catherine Freeland, Monue Flomo, Kenson Alik, Ravshan Yakubov, Li-Hui Chen, Philip Kwame Yeboah, Chari Cohen","doi":"10.5662/wjm.v16.i2.114604","DOIUrl":"10.5662/wjm.v16.i2.114604","url":null,"abstract":"<p><p>Nearly 259 million people are living with chronic hepatitis B globally, with just 7 million of them receiving life-saving treatment. In 2022, 83% of all viral hepatitis deaths were attributed to hepatitis B. Despite the availability of effective vaccines, diagnostics, and treatments, hepatitis B continues to be underprioritized on the global health agenda. Stigma and discrimination have been pervasive and entrenched in numerous countries, resulting in economic and social setbacks for people living with hepatitis B. Through the personal stories of several individuals living with hepatitis B worldwide, this article explores the question: Why does hepatitis B remain underprioritized? It walks through the roadblocks hindering the progress towards hepatitis B elimination efforts and draws lessons from other diseases - such as human immunodeficiency virus, coronavirus disease 2019, and Ebola, where advocacy, political commitment, and sustained funding led to meaningful progress in prevention, diagnosis, and treatment. This evidence-backed perspective is based on decades-long efforts of the Hepatitis B Foundation, collaborating with international partners to prevent new infections, documenting the lived experiences of those living with hepatitis B and supporting them, and advocating for better care and policies affecting those impacted by the disease. Beyond identifying persistent challenges to eliminating hepatitis B, the article succinctly issues a call to action for greater investment, cross-sector collaboration, integration of disease programs to improve efficiency, and inclusion of patient-reported outcomes in hepatitis B management and evaluation, to better support those living with hepatitis B.</p>","PeriodicalId":94271,"journal":{"name":"World journal of methodology","volume":"16 2","pages":"114604"},"PeriodicalIF":0.0,"publicationDate":"2026-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subareolar breast abscess in males.","authors":"Imtiaz Wani, Gulam Naikoo, Rauf A Wani, Munir A Wani","doi":"10.5662/wjm.v16.i2.114950","DOIUrl":"10.5662/wjm.v16.i2.114950","url":null,"abstract":"<p><strong>Background: </strong>Subareolar breast abscess is extremely rare in males. Only a few cases of male breast abscess are reported in the literature till date. The clinical presentation of male breast include pain, periareolar swelling, tenderness and abscess formation.</p><p><strong>Aim: </strong>To study occurrence of subareolar breast abscess in males.</p><p><strong>Methods: </strong>A retrospective study of 11 males from April 2014 to July 2024 is reported who presented with subareolar breast abscess.</p><p><strong>Results: </strong>Nine cases had uncomplicated and idiopathic abscess, and one has diabetes and another has underlying carcinoma breast. Incision drainage was done in 7 cases and one who has underlying carcinoma was managed by local toilet and antibiotics whereas rest two had needle aspiration for pus and other two had conservative treatment by antibiotics only. Pus culture predominantly yielded growth of <i>Staphylococus</i>.</p><p><strong>Conclusion: </strong>Subareolar breast abscess is rare in males. Incision and drainage is treatment of choice in an uncomplicated cases.</p>","PeriodicalId":94271,"journal":{"name":"World journal of methodology","volume":"16 2","pages":"114950"},"PeriodicalIF":0.0,"publicationDate":"2026-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct oral anticoagulants <i>vs</i> LMWH for cancer-associated thrombosis - updated evidence on bleeding risk, recurrence and patient-reported outcomes: A systematic review.","authors":"Duaa Asad, Ahris Abid, Muhammad Bari Hassan, Munesh Kumar Nenwani, Sunil Dev, Sanjeet Kumar, Fnu Sapna, Payal Bai, Sadia Siddique, Inshal Jawed, Farah Alam, Farah Abdul Razzaq, Favour C Mekowulu, Shafaq Jabeen, Agha Mw Mirza","doi":"10.5662/wjm.v16.i2.110380","DOIUrl":"10.5662/wjm.v16.i2.110380","url":null,"abstract":"<p><strong>Background: </strong>Cancer increases the risk of developing dangerous and sometimes deadly blood clots, which are known as cancer-associated thrombosis (CAT). While direct oral anticoagulants (DOACs) can be considered for CAT, evidence is limited regarding their use in comparison to low molecular weight heparin (LMWH).</p><p><strong>Aim: </strong>To compare the efficacy, bleeding risks, reoccurrence rate, and patient-reported outcomes of DOACs compared to LMWH in CAT of different cancer types.</p><p><strong>Methods: </strong>The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 checklist was followed during the search and screening of publications. Articles were searched systematically through biomedical databases such as PubMed, Scopus, and Cochrane covering studies published from January 1, 2003 to December 31, 2024. Articles were carefully chosen and studied according to the set Population Intervention Comparator Outcomes criteria. The research we analyzed examined the use of anticoagulants in cancer patients with venous thromboembolism (VTE) in comparison LMWH. The outcomes were cases of bleeding, VTE recurrence in patients, and their level of satisfaction with the treatment results.</p><p><strong>Results: </strong>The 21371 cancer patients were included in 29 studies (15 randomized clinical trials and 14 observational studies). Rates of VTE recurrence between DOAC (5.6%-11%) and LMWH (7.9%-11%) in major trials were similar. There was a lot of difference to bleeding risks based on subtypes of cancers. In upper gastrointestinal (6.2%) and genitourinary (4.5%) cancers, the rate of significant bleeding was greater with DOACs, and the risk ratio compared to LMWH was 1.5 or 3-fold. Conversely, the rate of bleeding was lower in remitting patients (2.1% DOACs <i>vs</i> 3.0% LMWH). DOACs consistently outperformed LMWH in terms of patient satisfaction (75%-83% <i>vs</i> 45%-65%), as well as quality of life indicators (48%-57% <i>vs</i> 29-39%), and medication adherence (15%-25% improvement).</p><p><strong>Conclusion: </strong>Doctors use both LMWH and DOACs for CAT, the decision of which patient to use DOACs depends on bleeding risk, with a specific focus on the risk by cancer subtypes. CAT management needs to be tailored to the specific cancer sub-type (especially upper <i>vs</i> lower gastrointestinal cancers), the risk of bleeding, and the patient's preferences or abilities.</p>","PeriodicalId":94271,"journal":{"name":"World journal of methodology","volume":"16 2","pages":"110380"},"PeriodicalIF":0.0,"publicationDate":"2026-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13121976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From understanding to agreement: The current state of informed consent in Nigerian endoscopic practice.","authors":"Kenechukwu C Okonkwo, Pantong Mark Davwar, Yusuf Musa, Matthew O Bojuwoye, Chinwe Philomena Onyia, Stella-Maris C Egboh, Shirley N Chukwurah, Emmanuel Obasi, Olutoyin I Asaolu, Winnifred N Adiri, Uchenna F Okeke, Nasiru Altine Dankiri, Chioma F Udigwe","doi":"10.5662/wjm.v16.i2.109312","DOIUrl":"10.5662/wjm.v16.i2.109312","url":null,"abstract":"<p><strong>Background: </strong>Informed consent is a cornerstone of ethical endoscopic practice, ensuring that patients understand and agree to the procedures that they undergo. Despite its importance, studies suggest that variations in consent practices persist. There is also a paucity of information on endoscopic consent practices in sub-Saharan Africa.</p><p><strong>Aim: </strong>To investigate current practices around consent taking among endoscopists in Nigeria.</p><p><strong>Methods: </strong>This cross-sectional survey was conducted from August to September 2024 among endoscopists practicing in Nigeria. The participants completed a 32-part self-administered online questionnaire that documented the experiences of endoscopists concerning consent taking in endoscopy practice. These included the location of practice, awareness of legislation concerning informed consent in Nigeria, patient autonomy, various procedural risks discussed with patients, and challenges faced. At the end of the survey, the responses were analyzed using tables, pie charts, and figures.</p><p><strong>Results: </strong>A total of 68 participants responded to the questionnaire. The mean age of the participants was 45.2 ± 6.6 years. There were 26 (38.2%) females and 42 (61.8%) males. Participants practicing in the northern part of the country comprised 41.1% (30) of the participants, while those practicing in southern Nigeria were 58.9% (38). Only 49.3% were aware of legislation about informed consent in Nigeria. The majority of the study participants (69.1%) gave the patients a few minutes to digest information before the procedure. A variety of risks were reported to be discussed, with abdominal discomfort being the most common (83.8%). The challenge to adequate consent was inadequate time for consent taking due to high patient burden (60.6%).</p><p><strong>Conclusion: </strong>Consent taking for endoscopy in Nigeria is not ideal; many healthcare workers only gave patients a few minutes to understand information about the procedure. To address this, training workshops and online webinars should be organized to train medical staff on how to do it properly. This will help improve patient care, ensure safety, and lead to better health results for patients.</p>","PeriodicalId":94271,"journal":{"name":"World journal of methodology","volume":"16 2","pages":"109312"},"PeriodicalIF":0.0,"publicationDate":"2026-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum procalcitonin as a predictor of severity of pneumonia in under-five children: A prospective observational study.","authors":"Sapan Kumar Kanungo, Gobinda Hembram, Pratima Kumari Sahu, Rashmi Ranjan Das","doi":"10.5662/wjm.v16.i2.115754","DOIUrl":"10.5662/wjm.v16.i2.115754","url":null,"abstract":"<p><strong>Background: </strong>Despite recent advancements in healthcare facilities, the early identification and assessment of pneumonia severity remain major challenges that affect clinical outcomes. These challenges emphasise the necessity for reliable biomarkers that can predict disease severity promptly and precisely. Unlike other markers like C-reactive protein or white blood cell count, procalcitonin (PCT) levels specifically increase in bacterial infections, which are a common cause of severe pneumonia in children.</p><p><strong>Aim: </strong>To evaluate the predictive value of serum PCT in assessing pneumonia severity and clinical outcomes in under-five children.</p><p><strong>Methods: </strong>This prospective observational study was conducted in a tertiary care teaching hospital in Eastern India from August 2022 to July 2024. Children aged 2 to 59 months admitted with pneumonia underwent serum PCT estimation on day 1 and day 5 of admission. The pneumonia severity was classified as follows: (1) Very severe (intubation, shock, or death); (2) Severe (intensive care admission without very severe features and/or high-flow nasal canula); (3) Moderate (hospitalization without very severe or severe features); and (4) Mild (discharge). Correlation analysis and receiver operating characteristic (ROC) curve analysis were performed to assess the predictive utility of PCT.</p><p><strong>Results: </strong>Two hundred children were included. Majority were < 6 months of age, and male (64%). Children in the viral pneumonia group were significantly younger. The pneumonia severity was as follows: (1) Very severe (18%); (2) Severe (24.5%); and (3) Moderate (57.5%). Eighteen (9%) children died. On day 1, the mean ± SD level of serum PCT level for different pneumonia severity was as follows: (1) Moderate (0.47 ± 0.42); (2) Severe (2.04 ± 1.5); and (3) Very severe (4.29 ± 2.37). The differences across the groups were statistically significant (<i>P</i> < 0.01). By day 5, the pattern of increasing PCT levels with greater disease severity persisted: (1) Moderate (0.26 ± 0.18); (2) Severe (3.14 ± 4.1); and (3) Very severe (9.51 ± 3.62). The differences observed on day 5 were statistically significant (<i>P</i> < 0.01). PCT levels were significantly higher in bacterial pneumonia compared to viral and atypical pneumonia. On day 1, the AUC of PCT in predicting mortality was 0.946 (95%CI: 0.905-0.973), and on day 5, the AUC was 0.948 (95%CI: 0.908-0.975).</p><p><strong>Conclusion: </strong>The present study found that serum PCT can predict pneumonia severity including mortality in under-five children. The PCT elevation was significantly higher in bacterial pneumonia compared to viral and atypical pneumonia.</p>","PeriodicalId":94271,"journal":{"name":"World journal of methodology","volume":"16 2","pages":"115754"},"PeriodicalIF":0.0,"publicationDate":"2026-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}