The rapid diffusion of large language models (LLMs) is reshaping many aspects of biomedical research, prompting reflection on the evolving role of biostatisticians in a changing landscape. This commentary addresses this transformation from two complementary perspectives. First, we examine how LLMs can assist biostatisticians in professional practice, highlighting their potential to enhance efficiency, support complex analytical reasoning, and facilitate communication and training. Second, we discuss the limitations and risks associated with LLM use, including challenges to reproducibility, susceptibility to bias, data protection and regulatory constraints, and limited accountability. Finally, we outline a vision for the role of scientific societies in actively guiding this transition. By promoting methodological competence, ethical awareness, and professional identity, they can help ensure that generative AI becomes an instrument of responsible innovation rather than a source of methodological bias and epistemic uncertainty.
Background: Helicobacter pylori infection is an acquired infection in children and most children test positive by adulthood in developing countries. Its effect on growth in children remains unclear and requires evaluation. Our aim is to determine the effect of Helicobacter pylori infection on growth parameters and nutritional status among children with gastrointestinal symptoms. Subjects and Methods: This hospital-based study was conducted among 100 children younger than 18 years visiting the gastroenterology outpatient clinic at Raparin Pediatric Teaching Hospital. The study was conducted from May 1st 2024 to November 1st 2024. Children were recruited while visiting the outpatient clinic and presenting with signs and symptoms suspicious for H. pylori infection. Results: Half of the participants showed positive stool results for H. pylori infection, while the other half showed negative results. The prevalence rate increased with age from six to eight years, then declined at nine years. Another decrease in proportion was detected at the age of fourteen years. The proportions of positive and negative test results were 50% each. The first predictor of H. pylori infection was family income, with an odds ratio of five-fold. Poor family income provided no protection against infection. Other factors, such as overcrowding and educational level increased the risk of infection. Conclusion: The stool H. pylori test was an effective tool for detecting positive cases among children. The infection insignificantly affected height, weight, skinfold thickness, and mid-arm circumference. However, there was a significant reduction in hemoglobin concentration and iron levels in H. pylori-infected children.
High-dose Methotrexate (MTX) is commonly used in the treatment of hematologic malignancies but can be complicated by acute kidney injury (AKI), most often due to MTX-induced crystal nephropathy. Direct visualization of MTX crystals on urine microscopy is rarely reported and likely underrecognized. We describe a case of an elderly woman with diffuse large B-cell lymphoma (DLBCL) and central nervous system metastasis who developed AKI after receiving high-dose MTX as part of the MTX, Cytarabine, Thiotepa, Rituximab (MATRIX) chemotherapy regimen. This was followed by significant supratherapeutic levels of MTX with progressive decline in kidney function reflecting AKI, which was attributed to intratubular crystal precipitation. Management consisted of high dose leucovorin, aggressive intravenous hydration, and urinary alkalinization with sodium bicarbonate and acetazolamide, resulting in gradual MTX clearance. The diagnosis was supported by delayed drug clearance, worsening kidney function, and the direct visualization of MTX crystals on urine microscopy, a finding that makes this case unique.
Abstract Background and aims Atrial fibrillation is common in patients with end-stage renal disease (ESRD), however, the optimal stroke prevention modality is unclear. This meta-analysis compares left atrial appendage occlusion (LAAO) to oral anticoagulation (OAC) in stroke prevention and associated bleeding and mortality rates in ESRD adults. Methods A systematic search of major databases was conducted up to December 2025. Analysis was performed using the generic inverse variance method with a random-effects model on RevMan software. Results The analysis incorporated 22,512 patients. LAAO displayed a significantly lower risk of stroke/systemic embolism [Relative Risk (RR): 0.74; 95% Confidence interval (CI): 0.64, 0.86; I^2 = 0%; p= 0.0001], and study-defined Major bleeding [RR: 0.73, 95% CI: 0.57, 0.93; I^2 = 80%; p= 0.01]. Notably, subgroup analysis revealed significantly higher reduction in major bleeding in studies with patients predominantly on warfarin [RR: 0.59, 95% CI: 0.52, 0.67; I^2 = 0%; p< 0.00001] compared to studies with patients predominantly on direct oral anticoagulants [RR: 0.88, 95% CI: 0.77, 0.99; I^2 = 0%; p= 0.04] (p-value for subgroup differences <0.0001). However, there was no significant difference between the interventions in all-cause mortality [RR: 0.8, 95% CI: 0.59, 1.07] or cardiovascular deaths [RR: 0.95, 95% CI: 0.82, 1.11]. Conclusions LAAO is associated with superior stroke prevention compared to OAC in patients with ESRD. While LAAO reduces bleeding risk compared to both warfarin and DOACs, the benefit is most pronounced against warfarin. Future randomized controlled trials comparing LAAO to DOACs and warfarin are recommended. Conflict of interest Zeyad Bady: nothing to disclose, Mahmoud Refaey: nothing to disclose, Ahmed Talkhan: nothing to disclose, Abdullah Al Kahil: nothing to disclose, Ahmed Nasreldein: nothing to disclose.
e18553 Background: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative therapy for hematologic malignancies; it is also associated with severe adverse outcomes including thrombotic microangiopathy (TMA) and mortality. Several studies have reported risk factors associated with these complexities. The objective of our study is to estimate overall survival (OS) for patients with an underlying malignant disease using a joint shared frailty model with TMA. Methods: This is a retrospective analysis of an existing CIBMTR dataset (Epperla et al 2020) that included patients who underwent first allo-HSCT for an underlying malignant disease between the years 2008-2016. All known significant risk factors for OS after allo-HSCT were included as covariates in the joint shared frailty model developed at the disease level. This model allowed for studying survival processes of correlated time-to event outcomes death and TMA. Frailty, a latent variable accounting for heterogeneity between patients, captures the shared risk that affects both the outcomes (mortality and TMA) in a similar way within each patient. Patients were classified into three risk groups based on the distribution of predicted frailty scores (FS) —low (FS < Q1), moderate (Q1 < FS < Q3) and high (FS > Q3) risk. Analyses were performed using frailtypack, an R package and SAS 9.4. Results: A total of 20095 allo-HSCT patients with an underlying malignant disease, with 10142 (50.5%) deaths and 561 (2.8%) TMA cases were included in the analysis. Frailty effect, the combined effect of unobserved covariates, was significant (p<0.0001) along with other previously reported significant risk factors for mortality and TMA. One-year OS and median survival (MS in months) from HSCT of low (N=5077), moderate (N=10011), and high-risk (5007) patients was 99.6% (not estimable), 73.1% (26.6) and 8.0% (3.3), respectively, as compared to observed 63.7% (31.3). One-year OS and MS (in months) from TMA diagnosis of low (N=141), moderate (280), and high-risk (140) patients was 77.0% (88.5), 38.8% (6.2) and 5.2% (1.2), respectively, as compared to observed 41.0% (5.9). Overall survival from HSCT and from TMA were significantly (p<0.0001) inferior (HR 13.5, 95% CI12.9-14.1 and HR 4.7, 95% CI 3.8-6.0, respectively) for the high-risk patients as compared to the low and moderate risk patients. Conclusions: Our study highlights the importance of accounting for the effect of unobserved risk factors in patients, while assessing all observable covariates. Predicting frailty scores is crucial for identifying patients who may need more intensive monitoring and intervention to avoid adverse effects following allo-HSCT. Future avenues of research include possibly developing an interactive shiny app to enable clinicians to estimate individualized survival, decision-making and risk mitigation.
