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Clin. Pract., Volume 13, Issue 1 (February 2023) – 21 articles

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Review
Adipose Stem Cells in Modern-Day Ophthalmology
Clin. Pract. 2023, 13(1), 230-245; https://doi.org/10.3390/clinpract13010021 (registering DOI) - 04 Feb 2023
Viewed by 230
Abstract
Stem cells (SCs) have evolved as an interesting and viable factor in ophthalmologic patient care in the past decades. SCs have been classified as either embryonic, mesenchymal, tissue-specific, or induced pluripotent cells. Multiple novel management techniques and clinical trials have been established to [...] Read more.
Stem cells (SCs) have evolved as an interesting and viable factor in ophthalmologic patient care in the past decades. SCs have been classified as either embryonic, mesenchymal, tissue-specific, or induced pluripotent cells. Multiple novel management techniques and clinical trials have been established to date. While available publications are predominantly animal-model-based, significant material is derived from human studies and case-selected scenarios. This possibility of explanting cells from viable tissue to regenerate/repair damaged tissue points to an exciting future of therapeutic options in all fields of medicine, and ophthalmology is surely not left out. Adipose tissue obtained from lipo-aspirates has been shown to produce mesenchymal SCs that are potentially useful in different body parts, including the oculo-visual system. An overview of the anatomy, physiology, and extraction process for adipose-tissue-derived stem cells (ADSC) is important for better understanding the potential therapeutic benefits. This review examines published data on ADSCs in immune-modulatory, therapeutic, and regenerative treatments. We also look at the future of ADSC applications for ophthalmic patient care. The adverse effects of this relatively novel therapy are also discussed. Full article
(This article belongs to the Special Issue 2022 Feature Papers in Clinics and Practice)
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Review
External Ventricular Drainage: A Practical Guide for Neuro-Anesthesiologists
Clin. Pract. 2023, 13(1), 219-229; https://doi.org/10.3390/clinpract13010020 - 31 Jan 2023
Viewed by 190
Abstract
External ventricular drainage is often considered a life-saving treatment in acute hydrocephalus. Given the large number of discussion points, the ideal management of EVD has not been completely clarified. The objective of this study was to review the most relevant scientific evidence about [...] Read more.
External ventricular drainage is often considered a life-saving treatment in acute hydrocephalus. Given the large number of discussion points, the ideal management of EVD has not been completely clarified. The objective of this study was to review the most relevant scientific evidence about the management of EVD in its main clinical scenarios. We reviewed the most recent and relevant articles about indications, timing, management, and complications of EVD in neurocritical care, with particular interest in patients with subarachnoid hemorrhage (SAH), severe traumatic brain injury (TBI), and intraventricular hemorrhage (IVH) using the following keywords alone or matching with one another: intracranial pressure, subarachnoid hemorrhage, traumatic brain injury, intraventricular hemorrhage, external ventricular drainage, cerebrospinal shunt, intracranial pressure monitoring, and ventriculoperitoneal shunt. In the management of EVD in SAH, the intermittent drainage strategy is burdened with an elevated risk of complications (e.g., clogged catheter, hemorrhage, and need for replacement). There seems to be more ventriculoperitoneal shunt dependency in rapid weaning approach-managed patients than in those treated with the gradual weaning approach. Although there is no evidence in favor of either strategy, it is conventionally accepted to adopt a continuous drainage approach in TBI patients. Less scientific evidence is available in the literature regarding the management of EVD in patients with severe TBI and intraparenchymal/intraventricular hemorrhage. EVD placement is a necessary treatment in several clinical scenarios. However, further randomized clinical trials are needed to clarify precisely how EVD should be managed in different clinical scenarios. Full article
(This article belongs to the Special Issue 2022 Feature Papers in Clinics and Practice)
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Opinion
Pathophysiology-Based Management of Acute Heart Failure
Clin. Pract. 2023, 13(1), 206-218; https://doi.org/10.3390/clinpract13010019 - 31 Jan 2023
Viewed by 248
Abstract
Even though acute heart failure (AHF) is one of the most common admission diagnoses globally, its pathogenesis is poorly understood, and there are few effective treatments available. Despite an heterogenous onset, congestion is the leading contributor to hospitalization, making it a crucial therapeutic [...] Read more.
Even though acute heart failure (AHF) is one of the most common admission diagnoses globally, its pathogenesis is poorly understood, and there are few effective treatments available. Despite an heterogenous onset, congestion is the leading contributor to hospitalization, making it a crucial therapeutic target. Complete decongestion, nevertheless, may be hard to achieve, especially in patients with reduced end organ perfusion. In order to promote a personalised pathophysiological-based therapy for patients with AHF, we will address in this review the pathophysiological principles that underlie the clinical symptoms of AHF as well as examine how to assess them in clinical practice, suggesting that gaining a deeper understanding of pathophysiology might result in significant improvements in HF therapy. Full article
(This article belongs to the Special Issue 2022 Feature Papers in Clinics and Practice)
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Case Report
Bevacizumab-Induced Thrombotic Microangiopathy (TMA) in Metastatic Lung Adenocarcinoma Patients Receiving Nivolumab Combined with Bevacizumab, Carboplatin and Paclitaxel: Two Case Reports
Clin. Pract. 2023, 13(1), 200-205; https://doi.org/10.3390/clinpract13010018 - 30 Jan 2023
Viewed by 248
Abstract
Anti-programmed death-1 (PD-1)/programmed death ligand 1 (PD-L1) immune checkpoint inhibitors (ICIs), combined with bevacizumab and platinum-based chemotherapy, have shown promising efficacy in treating metastatic non-squamous cell lung cancer in phase 3 clinical trials. However, drug-induced nephrotoxicity is an uncommon but threatening adverse effect [...] Read more.
Anti-programmed death-1 (PD-1)/programmed death ligand 1 (PD-L1) immune checkpoint inhibitors (ICIs), combined with bevacizumab and platinum-based chemotherapy, have shown promising efficacy in treating metastatic non-squamous cell lung cancer in phase 3 clinical trials. However, drug-induced nephrotoxicity is an uncommon but threatening adverse effect when using this combination therapy, and should be evaluated and managed carefully. Here, we present two patients experiencing late-onset asymptomatic heavy proteinuria during the clinical trial. Kidney biopsies performed finally identified bevacizumab-induced thrombotic microangiopathy (TMA), and the proteinuria was decreased after discontinuing bevacizumab permanently. Our report suggests that a kidney biopsy is needed for those receiving ICIs in combination with bevacizumab and chemotherapy and experiencing nephrotoxicity such as heavy proteinuria. Full article
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Article
Which Patients with Chronic Periprosthetic Joint Infection Are Less Suitable to Successful Two Stage Exchange Arthroplasty Surgery? A Retrospective Clinical Trial
Clin. Pract. 2023, 13(1), 190-199; https://doi.org/10.3390/clinpract13010017 - 28 Jan 2023
Viewed by 191
Abstract
Background: Two-stage exchange (TSE) arthroplasty is currently considered the gold standard for chronic periprosthetic joint infections (PJIs), despite a failure rate reported in up to 10% of patients. Little is known about the risk factors that may compromise successful TSE arthroplasty management in [...] Read more.
Background: Two-stage exchange (TSE) arthroplasty is currently considered the gold standard for chronic periprosthetic joint infections (PJIs), despite a failure rate reported in up to 10% of patients. Little is known about the risk factors that may compromise successful TSE arthroplasty management in such patients. The main purpose of the current study was to highlight the potential risk factors of patients with chronic PJIs after THA managed by implant removal, outlining the differences between reimplanted patients and those that were never reimplanted because of a non-eradicated infection. Methods: We conducted a retrospective observational study of patient candidates for TSE arthroplasty surgery, managed at the authors’ institution, over a four-year timeframe. The data were retrieved from the hospital’s information database. The enrolled population was divided into two Groups: A, reimplanted; B, non-reimplanted because of a non-eradicated infection within one year. For each Group, demographic information, PJI-related risk factors, type of pathogen and presence of single or polymicrobial infection, were collected and analyzed. Results: In total, 21 patients were included in the study, 14 patients in Group A and 7 in Group B. Major Depression (p = 0.049) and polymicrobial infection (p = 0.04) were more commonly observed in patients that were not reimplanted in the study period. No differences between the two groups were observed when other characteristics were compared. Conclusions: Patients with major depression, or those hosting polymicrobial periprosthetic hip infections, are more susceptible to failure of TSE arthroplasty procedures for chronic PJIs, hampering THA reimplantation. Current findings may drive further research and contribute to the understanding of the role of these risk factors in chronic PJI patients. Full article
(This article belongs to the Special Issue 2022 Feature Papers in Clinics and Practice)
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Case Report
Treatment in Patients with Psoriatic Disease and Rheumatoid Arthritis: Seven Case Reports
Clin. Pract. 2023, 13(1), 177-189; https://doi.org/10.3390/clinpract13010016 - 28 Jan 2023
Viewed by 256
Abstract
The incidence of psoriasis, an intractable long-lasting inflammatory skin disease, is increasing and has many complications and comorbidities. Approximately 14% of patients have psoriatic arthritis (PsA). Rheumatoid arthritis (RA) is not a rare disease worldwide, and some patients may have both PsA and [...] Read more.
The incidence of psoriasis, an intractable long-lasting inflammatory skin disease, is increasing and has many complications and comorbidities. Approximately 14% of patients have psoriatic arthritis (PsA). Rheumatoid arthritis (RA) is not a rare disease worldwide, and some patients may have both PsA and RA. In the present study, we encountered seven patients with concurrent diagnoses of RA and psoriatic disease and reported the details of clinical data, treatment efficacy, and X-ray findings. The diagnosis may require not only classification criteria but also a comprehensive judgment in collaboration with rheumatology over time. In addition to methotrexate as an anchor drug, anti-tumor necrosis factor-α agents are the first choice of biological agents for treatment, and interleukin (IL)-17 inhibitors may be effective, as IL-17 is also involved in the pathogenesis of RA. When treating patients with both PsA and RA, it may be essential to consider the treatment strategy, depending on which disease is more active. Full article
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Review
The Diagnostic Odyssey of Patients with Chronic Neuropathic Pain—Expert Opinion of Greek Pain Specialists
Clin. Pract. 2023, 13(1), 166-176; https://doi.org/10.3390/clinpract13010015 - 27 Jan 2023
Viewed by 295
Abstract
The diagnosis of chronic neuropathic pain requires a laborious process and can be a very long journey for the patients, one that can be characterized as an “odyssey.” Our aim was to describe the “diagnostic odyssey” associated with chronic neuropathic pain in the [...] Read more.
The diagnosis of chronic neuropathic pain requires a laborious process and can be a very long journey for the patients, one that can be characterized as an “odyssey.” Our aim was to describe the “diagnostic odyssey” associated with chronic neuropathic pain in the Greek context. Specialized clinicians working at dedicated chronic pain and palliative care centers were asked to participate in a survey regarding the diagnostic process in Greece. In total, 44 respondents provided information on the organization of their centers, the diagnostic process, and the perceived obstacles involved in the diagnosis of chronic neuropathic pain. Most respondents reported that their centers were not fully or efficiently organized and believed that additional specialized healthcare personnel should be employed. Raising public awareness about the existence of such centers was also considered key. The two main obstacles in reaching a diagnosis were the difficulty non-experts had in recognizing chronic neuropathic pain and the lack of acknowledgement that chronic neuropathic pain is a condition that needs to be addressed. When considering these responses in light of the extended socioeconomic burden associated with chronic neuropathic pain, efforts should be made to limit the “diagnostic odyssey” of chronic neuropathic pain in Greece. The aim of this study is to explore the experience of patients with chronic neuropathic pain in Greece from the viewpoint of pain specialists. A better organization of pain and palliative care centers, facilitation of communication with previously treating clinicians, increased personnel, utilization of a chronic pain registry, and guidelines development can aid in this venture. Keypoints: The diagnosis of chronic neuropathic pain in Greece is a laborious and time-consuming process that needs to be refined; Greek clinicians believe that their centers were not fully or efficiently organized and think that additional specialized healthcare personnel should be employed; Patient comorbidities and retards in visiting a clinic at the onset of symptoms delay the diagnosis of neuropathic pain and may complicate subsequent care; The diagnostic delay has been reported as three years between the onset of symptoms and seeking general medical help and another nine years before a referral to a pain specialist; Neuropathic pain is associated with patient distress and socioeconomic burdens, and diagnostic delays prolong the condition, may allow it to worsen, and utilize valuable healthcare resources without providing effective solutions. Full article
(This article belongs to the Special Issue 2022 Feature Papers in Clinics and Practice)
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Review
Pathogenesis, Diagnostic Challenges, and Risk Factors of Pott’s Disease
Clin. Pract. 2023, 13(1), 155-165; https://doi.org/10.3390/clinpract13010014 - 25 Jan 2023
Viewed by 282
Abstract
Tuberculosis (TB) prevalence is increasing in developed nations and continuing to cause significant mortality in low- and middle-income countries. As a result of the uptick in cases, there also exists an increased prevalence of extrapulmonary TB. TB is caused by Mycobacterium tuberculosis ( [...] Read more.
Tuberculosis (TB) prevalence is increasing in developed nations and continuing to cause significant mortality in low- and middle-income countries. As a result of the uptick in cases, there also exists an increased prevalence of extrapulmonary TB. TB is caused by Mycobacterium tuberculosis (M. tb). When M. tb disseminates to the vertebral column, it is called Pott’s disease or spinal TB. The frequency, symptoms, and severity of the disease range by the location of the spine and the region of the affected vertebrae. While the current literature shows that timely diagnosis is crucial to reduce the morbidity and mortality from Pott’s disease, there is a lack of specific clinical diagnostic criteria for Pott’s disease, and the symptoms may be very non-specific. Studies have shown that novel molecular diagnostic methods are effective and timely choices. Research has implicated the risk factors for the susceptibility and severity of Pott’s disease, such as HIV and immunosuppression, poverty, and malnutrition. Based on the current literature available, our group aims to summarize the pathogenesis, clinical features, diagnostic challenges, as well as the known risk factors for Pott’s disease within this literature review. Full article
(This article belongs to the Special Issue Novel Therapies against Mycobacterium tuberculosis)
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Article
Impact of Japan’s State of Emergency Due to the COVID-19 Pandemic on Trends in Diabetes Care: A Descriptive and Retrospective Study
Clin. Pract. 2023, 13(1), 148-154; https://doi.org/10.3390/clinpract13010013 - 16 Jan 2023
Viewed by 380
Abstract
Objective: This study examined the impact of Japan’s state of emergency on trends in diabetes care during the coronavirus disease 2019 (COVID-19) pandemic. Design: A descriptive and retrospective study. Setting: Showa University Hospital, Japan. Participants: Patients with diabetes who received medical treatment from [...] Read more.
Objective: This study examined the impact of Japan’s state of emergency on trends in diabetes care during the coronavirus disease 2019 (COVID-19) pandemic. Design: A descriptive and retrospective study. Setting: Showa University Hospital, Japan. Participants: Patients with diabetes who received medical treatment from 2018 to 2020. Determinants of interest: Number of patients with diabetes visiting the hospital per week. To examine the impact of the Japan’s state of emergency, the number of hospital visitations by patients with diabetes was summarized from 28 weeks of data for each year, from calendar week 8 to calender week 35. Results: Compared with the mean of 2018 and 2019, no significant difference was found between the three periods (before, during, and after the state of emergency). However, the numbers of patients from both inside and outside Tokyo increased at 7 weeks after the state of emergency was lifted. Conclusions: A significant increase in the numbers of patients with diabetes was seen compared with the same period in 2018 and 2019, suggesting that the state of emergency may have hindered diabetes care. Therefore, patients with diabetes should receive continuous follow-up regarding their diabetes care, keeping a close eye on relvent measurements. Full article
(This article belongs to the Special Issue Diabetes Mellitus and Cardiovascular Diseases)
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Review
Preventing Respiratory Viral Diseases with Antimicrobial Peptide Master Regulators in the Lung Airway Habitat
Clin. Pract. 2023, 13(1), 125-147; https://doi.org/10.3390/clinpract13010012 - 16 Jan 2023
Viewed by 493
Abstract
The vast surface area of the respiratory system acts as an initial site of contact for microbes and foreign particles. The whole respiratory epithelium is covered with a thin layer of the airway and alveolar secretions. Respiratory secretions contain host defense peptides (HDPs), [...] Read more.
The vast surface area of the respiratory system acts as an initial site of contact for microbes and foreign particles. The whole respiratory epithelium is covered with a thin layer of the airway and alveolar secretions. Respiratory secretions contain host defense peptides (HDPs), such as defensins and cathelicidins, which are the best-studied antimicrobial components expressed in the respiratory tract. HDPs have an important role in the human body’s initial line of defense against pathogenic microbes. Epithelial and immunological cells produce HDPs in the surface fluids of the lungs, which act as endogenous antibiotics in the respiratory tract. The production and action of these antimicrobial peptides (AMPs) are critical in the host’s defense against respiratory infections. In this study, we have described all the HDPs secreted in the respiratory tract as well as how their expression is regulated during respiratory disorders. We focused on the transcriptional expression and regulation mechanisms of respiratory tract HDPs. Understanding how HDPs are controlled throughout infections might provide an alternative to relying on the host’s innate immunity to combat respiratory viral infections. Full article
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Concept Paper
An Equity and Justice-Informed Ethical Framework to Guide Incidental Findings in Brain Imaging Research
Clin. Pract. 2023, 13(1), 116-124; https://doi.org/10.3390/clinpract13010011 - 16 Jan 2023
Viewed by 365
Abstract
The handling of incidental findings (IFs) in brain imaging studies has been a source of contention among scientists and bioethicists. A conceptual framework informed by diversity, equity, and inclusion (DEI) and distributive justice approaches, namely EUSTICE, is proposed for the ethical handling and [...] Read more.
The handling of incidental findings (IFs) in brain imaging studies has been a source of contention among scientists and bioethicists. A conceptual framework informed by diversity, equity, and inclusion (DEI) and distributive justice approaches, namely EUSTICE, is proposed for the ethical handling and reporting of IFs in brain imaging research. I argue that EUSTICE provides a systematic and inclusive approach to addressing the ethical conundrum around IF disclosure and managing IFs proportionately and sensitively in brain imaging research. The EUSTICE framework may have implications for the field of neurosciences or human studies broadly in guiding ethics of IFs in research. Full article
(This article belongs to the Special Issue 2022 Feature Papers in Clinics and Practice)
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Review
Monkeypox 2022 Outbreak: How Alarming Is the Situation? Epidemiological and Clinical Review
Clin. Pract. 2023, 13(1), 102-115; https://doi.org/10.3390/clinpract13010010 - 13 Jan 2023
Viewed by 527
Abstract
Monkeypox is a disease caused by Orthopoxvirus, which also includes the smallpox virus. Several endemics have been reported on the African continent, typically in the western and central regions. However, since 13 May 2022, there have been several cases reported from different member [...] Read more.
Monkeypox is a disease caused by Orthopoxvirus, which also includes the smallpox virus. Several endemics have been reported on the African continent, typically in the western and central regions. However, since 13 May 2022, there have been several cases reported from different member states; the number of confirmed cases in 1 month exceeded the total number of cases reported outside the African continent since the first case in 1970. The World Health Organization (WHO) and Centers for Disease Control (CDC) consider monkeypox as an important disease for global public health. The clinical manifestations and laboratory findings in patients with monkeypox remain unclear. In this brief review, we investigated and compared the different characteristics already reported in cases of monkeypox. Full article
Article
Gelatin–Curcumin Nanocomposites as a Coating for Implant Healing Abutment: In Vitro Stability Investigation
Clin. Pract. 2023, 13(1), 88-101; https://doi.org/10.3390/clinpract13010009 - 12 Jan 2023
Viewed by 445
Abstract
Regarding the importance of preventing peri-implantitis in dental implants, the current study aimed to coat a healing abutment with gelatin–curcumin nanocomposites, and the stability of this coating on the healing abutment was evaluated. A cell viability measuring test was used to determine the [...] Read more.
Regarding the importance of preventing peri-implantitis in dental implants, the current study aimed to coat a healing abutment with gelatin–curcumin nanocomposites, and the stability of this coating on the healing abutment was evaluated. A cell viability measuring test was used to determine the cytotoxicity of nanocomposites against dental pulp stem cells. To show the pattern of curcumin release from nanocomposites, drug dissolution apparatus two was applied. Then, 16 healing abutments were examined in vitro. Titanium healing abutments were coated with the gelatin–curcumin nanocomposite. The dip coating method was applied for coating and the consistency of coated cases was evaluated at intervals of one, 30, and 60 days after coating inside the simulated body fluid (SBF) solution. A scanning electron microscope (SEM) was used for investigating the microstructure and morphology of coatings, and an energy dispersive X-ray (EDX) was applied for determining the combination of the coating. Moreover, the healings were weighed before and after coating via an accurate digital scale with an accuracy of 0.0001. Finally, the data were analyzed using SPSS software. The prepared nanocomposite was non-cytotoxic against tested cells. The nanocomposite showed a relatively rapid release pattern in the first 10 days for curcumin. The release of curcumin from the nanoparticles continued slowly until the 30th day. The weight changes were statistically significant (p-value < 0.001) during this time. Based on the post hoc test, the weight between two times immediately after coating and 30 days after coating, and also one day after coating and 30 days after coating, was statistically insignificant. The results revealed that the coating of the gelatin–curcumin nanocomposite on the healing was successful and this consistency was kept for at least one month. It is necessary to investigate more evaluations in different fields of physicochemical, mechanical, and antimicrobial aspects for coated healing abutments. Full article
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Editorial
Acknowledgment to the Reviewers of Clinics and Practice in 2022
Clin. Pract. 2023, 13(1), 84-87; https://doi.org/10.3390/clinpract13010008 - 12 Jan 2023
Viewed by 402
Abstract
High-quality academic publishing is built on rigorous peer review [...] Full article
Review
Illness Perception and Medication Adherence among Adult Patients with Type 2 Diabetes Mellitus: A Scoping Review
Clin. Pract. 2023, 13(1), 71-83; https://doi.org/10.3390/clinpract13010007 - 03 Jan 2023
Viewed by 440
Abstract
(1) Background: Type 2 diabetes mellitus (T2DM) is a global disease with a compelling impact on developed and developing economies across the globe. The World Health Organization (WHO) (2020) reported a global prevalence of 8.5% in 2014 among adults aged at least 18 [...] Read more.
(1) Background: Type 2 diabetes mellitus (T2DM) is a global disease with a compelling impact on developed and developing economies across the globe. The World Health Organization (WHO) (2020) reported a global prevalence of 8.5% in 2014 among adults aged at least 18 years. Consequently, the condition led to a 5% increase in premature mortality from 2000 to 2016. Aim: The scoping review sought to examine illness perception and medication adherence among adult patients with T2DM. (2) Methods: The study was conducted in 2021 and covered articles published in English in the last five years. PubMed, MEDLINE, CINAHL, and ScienceDirect were the primary search engines used to generate the required scholarly records. A total of 20 studies met the inclusion criteria. (3) Results: The 20 studies selected for the scoping review covered different themes on the overall concept of illness perception and medication adherence in adults with Type 2 Diabetes Mellitus. Each study presented unique implications for research and influence on the policymaking relating to the treatment or the management of type 2 diabetes mellitus in adults of different aged groups. (4) Conclusions: The studies reveal both high and low adherence to medications in adults with type 2 diabetes mellitus. The management and treatment of the condition depend on the uptake of oral hypoglycemic agents or insulin as well as the recommended therapies to enhance the clinical outcomes of the patients. Full article
(This article belongs to the Special Issue Diabetes Mellitus and Cardiovascular Diseases)
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Article
The Role of Hypertonic Saline in Ablative Radiofrequency of the Sacroiliac Joint: Observational Study of 40 Patients
Clin. Pract. 2023, 13(1), 65-70; https://doi.org/10.3390/clinpract13010006 - 30 Dec 2022
Viewed by 531
Abstract
Background: The aim of this retrospective uncontrolled article is to illustrate a technique of neurotomy of the sensitive branches of S1 S2 S3 in RFA that appears to result in a better success rate and longer-lasting pain relief. Methods: 40 patients were treated, [...] Read more.
Background: The aim of this retrospective uncontrolled article is to illustrate a technique of neurotomy of the sensitive branches of S1 S2 S3 in RFA that appears to result in a better success rate and longer-lasting pain relief. Methods: 40 patients were treated, 26 females and 14 males, with an average age of 74 (92–55). After the examination, the patients underwent an ultrasound-guided diagnostic block of the affected sacroiliac joint. Only patients who presented pain relief greater than 60% after the diagnostic block were candidates for the RFA procedure. The procedure was always performed in the operating room on an outpatient basis. After obtaining the best fluoroscopic visualization of the joint to be treated, two RFA cannulae were placed starting from the lower medial margin parallel to the SIJ to perform a bipolar RFA along the entire medial margin of the SIJ. Lidocaine 2% and hypertonic saline 2 mEq/mL were used for each RFA level. Patients were followed-up at 3, 6, 12, 18, and 24 months by evaluating the NRS and SF-12. Results: Patients reported extreme satisfaction with the procedure performed and reported a significant improvement in NRS and SF-12 at FU visits. No adverse events occurred. Conclusions: Bipolar RFA treatment of the sacroiliac joint with the use of a hypertonic saline solution appears to improve the success of the method and its durability. We are inclined to believe that the use of hypertonic saline may significantly increase the lesion area and result in a greater effect on the sensory branches. Full article
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Article
University Students’ Satisfaction with the Quality of Primary Dental Healthcare Services and Dentists in Croatia: A Cross-Sectional Study
Clin. Pract. 2023, 13(1), 52-64; https://doi.org/10.3390/clinpract13010005 - 30 Dec 2022
Viewed by 525
Abstract
Measuring satisfaction can be an essential method for evaluating and improving healthcare quality. Therefore, this survey aimed to determine university students’ satisfaction with dental care at the primary healthcare level and the factors that influence students’ decisions when choosing a dental provider. A [...] Read more.
Measuring satisfaction can be an essential method for evaluating and improving healthcare quality. Therefore, this survey aimed to determine university students’ satisfaction with dental care at the primary healthcare level and the factors that influence students’ decisions when choosing a dental provider. A cross-sectional survey was conducted using a self-administered electronic questionnaire that assessed satisfaction with various aspects of dental care (patient–staff interaction, professional and technical competence, and administrative efficiency) on a 5-point Likert scale. A total of 806 students participated in the survey, of whom 56.6% were from a biomedical science background, and 43.4% from other scientific fields. Near-minimal differences were found between respondents studying in biomedical fields and those from other scientific fields, when evaluating satisfaction with dental services. More significant differences were found in the factors influencing their choice of dentist. The dentist’s experience (p = 0.031), cost of service (p ≤ 0.001), office location (p = 0.034), waiting time (p = 0.029), qualifications (p = 0.033), and gender (p = 0.007) were more important for students pursuing one of the non-health-related majors. Overall, respondents were very satisfied with their dentists and the services provided. The highest satisfaction score was found on the “professional and technical competence” and “administrative efficiency” subscales, while the lowest satisfaction score was found on the “patient–staff interaction” subscale. Full article
Article
Effects of Mediterranean Diet, DASH Diet, and Plant-Based Diet on Outcomes among End Stage Kidney Disease Patients: A Systematic Review and Meta-Analysis
Clin. Pract. 2023, 13(1), 41-51; https://doi.org/10.3390/clinpract13010004 - 28 Dec 2022
Viewed by 1071
Abstract
Background: The Mediterranean, Dietary Approach to Stop Hypertension (DASH), and plant-based diets may provide cardiovascular benefit to the general population. However, data on their effect on end stage kidney disease (ESKD) patients are limited. This systematic review aims to assess the impact of [...] Read more.
Background: The Mediterranean, Dietary Approach to Stop Hypertension (DASH), and plant-based diets may provide cardiovascular benefit to the general population. However, data on their effect on end stage kidney disease (ESKD) patients are limited. This systematic review aims to assess the impact of Mediterranean, DASH, and plant-based diets on outcomes among ESKD patients. Methods: A literature review was conducted in EMBASE, MEDLINE, and Cochrane databases from inception through September 2022 to identify studies that assess the clinical outcomes of Mediterranean, DASH, or plant-based diets on ESKD patients on hemodialysis (HD) or peritoneal dialysis (PD). Effect estimates from the individual studies were derived utilizing the random-effect, generic inverse variance approach of DerSimonian and Laird. Results: Seven studies with 9400 ESKD patients (8395 HD and 1005 PD) met the eligibility criteria and were included in the data analysis. Pooled odds ratios (ORs) of mortality for ESKD patients who adhered to the Mediterranean versus plant-based diet were 0.49 (95% CI: 0.07–3.54; two studies, I2 = 67%) and 0.87 (95% CI: 0.75–1.01; two studies, I2 = 0%), respectively. Data on mortality for ESKD patients on a DASH diet were limited to one study with an OR of 1.00 (95% CI: 0.89–1.12). The pooled OR of cardiovascular mortality among ESKD patients who adhered to a plant-based diet was 0.86 (95% CI: 0.68–1.08; two studies, I2 = 0%), compared to those who did not. Data on cardiovascular mortality among those with Mediterranean and DASH diet were limited to one study with ORs of 1.14 (95% CI: 0.90–1.43) and 1.19 (95% CI: 0.99–1.43), respectively. Mediterranean diet adherence was found to be associated with reduced risk of left ventricular hypertrophy (LVH) with an OR of 0.82 (95% CI: 0.68–0.99) in a study including 127 ESKD patients. The risk of hyperkalemia was not significant among those with a plant-based diet with an OR of 1.00 (95% CI: 0.94–1.07) in a study including 150 ESKD patients. Conclusions: While our systematic review demonstrated no significant associations of Mediterranean, DASH, and plant-based diets with reduced all-cause mortality or cardiovascular mortality, there was also no evidence that suggested harmful effects of these diets to ESKD patients. Full article
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Review
The Role of Immune Checkpoint Inhibitors in Cancer Therapy
Clin. Pract. 2023, 13(1), 22-40; https://doi.org/10.3390/clinpract13010003 - 27 Dec 2022
Viewed by 526
Abstract
Over the years, immune checkpoint inhibitors (CPIs) have become a powerful treatment strategy in the field of cancer immunotherapy. In the last decade, the number of FDA-approved CPIs has been increasing prominently, opening new horizons for the treatment of a wide range of [...] Read more.
Over the years, immune checkpoint inhibitors (CPIs) have become a powerful treatment strategy in the field of cancer immunotherapy. In the last decade, the number of FDA-approved CPIs has been increasing prominently, opening new horizons for the treatment of a wide range of tumor types. Pointedly, three immune checkpoint molecules have been under extensive research, which include cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death protein-1 (PD-1) and its ligand-1 (PD-L1). Despite remarkable success, not all patients respond positively to therapy, which highlights the complexity of the tumor microenvironment (TME) and immune system. This has led to the identification of molecular biomarkers to predict response and toxicity. In addition, there has been an emerging focus on developing new delivery and targeting approaches for better drug efficacy and potency. In this review, we highlight the mechanism of action of major CPIs, their clinical impact, variation in effectiveness, response prediction, updated clinical indications, current challenges and limitations, promising novel approaches, and future directions. Full article
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Review
Advantages and Limitations in the Evaluation of the Neurological and Functional Deficit in Patients with Spinal Cord Injuries
Clin. Pract. 2023, 13(1), 14-21; https://doi.org/10.3390/clinpract13010002 - 27 Dec 2022
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Abstract
(1) Background: Vertebro-medullary trauma (VMT) causes osteo-articular injuries in a varied anatomical lesion associated with multiple clinical manifestations and therapeutic indications. The neurological evaluation of patients who have suffered a spinal cord injury (SCI) is costly in testing the motor and sensory function. [...] Read more.
(1) Background: Vertebro-medullary trauma (VMT) causes osteo-articular injuries in a varied anatomical lesion associated with multiple clinical manifestations and therapeutic indications. The neurological evaluation of patients who have suffered a spinal cord injury (SCI) is costly in testing the motor and sensory function. To standardize the assessment, several scales are used that measure the neurological deficit in order to guide subsequent treatment according to complete or incomplete SCI. The aim of this study is to identify and present the relevant tools for assessing SCI. (2) Methods: Relevant SCI studies were used for a fact-finding investigation from a rational and critical perspective of this field of research. The relationship between clinical tools and those with a psychosocial component was assessed based on studies reported in the literature. (3) Results: SCI severity scales have been proposed throughout to be able to estimate the functional prognosis of victims of these traumatic events. These tools can be divided into scales for assessing the neurological deficit due to trauma, and functional scales that assess the ability to perform daily activities, self-care, etc. (4) Conclusions: The closest scale to the need for standardization and the most accurate assessment of neurological deficits secondary to SCI is ASIA/IMSOP. Full article
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Article
Depression in Male Inmates
Clin. Pract. 2023, 13(1), 1-13; https://doi.org/10.3390/clinpract13010001 - 27 Dec 2022
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Abstract
Introduction: The prevalence of psychiatric morbidity is high among incarcerated individuals. Severe mental disorder is five to ten times higher among prisoners compared to the general population. Several factors are held to be responsible for the high prevalence of depression in prison: mainly [...] Read more.
Introduction: The prevalence of psychiatric morbidity is high among incarcerated individuals. Severe mental disorder is five to ten times higher among prisoners compared to the general population. Several factors are held to be responsible for the high prevalence of depression in prison: mainly poor living conditions (narrow room, loss of privacy), limited interpersonal relationships, and lack of mental health access. Inmates are at increased risk of all-cause mortality, suicide, self-harm, violence, and victimization while those with mental disorders are involved in conflicts and are more likely to be charged with prison rules. Purpose: To explore depression among male inmates. Methods and material: In the study, 101 male inmates were enrolled. Data were collected by the completion of a “self-rating depression scale (SDS)-Zung” which included participants’ characteristics. The statistical significance level was p < 0.05. Results: Of the 101 participants, 51.4% of inmates were under 40 years old, 54.5% were married, 45.6% had been convicted of homicide and 38.6% had a life sentence. Normal depression levels were experienced by 62.4% of the participants, while 21.8% were mildly depressed, 14.9% were moderately depressed and 1.0% severely depressed. Foreign prisoners had statistically significant higher scores of depression compared to Greeks (median 48 vs. 45, p = 0.012); those suffering from a chronic disease compared to those who did not (median 48 vs. 45, p = 0.038); those who had spent time in solitary confinement compared to those who had not (median 46 vs. 43.5, p = 0.038) as well as those who had not considered harming themselves compared to those who had thought of it (median 46 vs. 44, p = 0.017). Conclusion: Given that prison populations are marginalized and deprived of the rights that people in the community benefit from, establishing the prevalence of depression in male inmates and its associated characteristics may help to formulate recommendations for future prison health care services. Clinical, research, and policy efforts are needed to improve prison mental health. Full article
(This article belongs to the Special Issue Clinical Nursing and Quality of Healthcare)
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