Clinics and Practice

8 pages, 213 KB

Open AccessArticle

Impact of a Nutrition Protocol on Vitamin D Supplementation in a Pediatric Intensive Care Unit: A Retrospective Cohort Study

by Maria Pérez Marin, Vivianne Chanez, Guillaume Maitre, Laurence Boillat, Frida Rizzati, Pauline Lauwers and Maria-Helena Perez

Clin. Pract. 2025, 15(10), 186; https://doi.org/10.3390/clinpract15100186 - 13 Oct 2025

Abstract

Background: Vitamin D deficiency (VDD) is highly prevalent in pediatric critically ill patients and is a potentially modifiable risk factor during critical illness. There are no established national or international recommendations for vitamin D supplementation in Pediatric Intensive Care Unit (PICU) patients. Objectives: [...] Read more.

Background: Vitamin D deficiency (VDD) is highly prevalent in pediatric critically ill patients and is a potentially modifiable risk factor during critical illness. There are no established national or international recommendations for vitamin D supplementation in Pediatric Intensive Care Unit (PICU) patients. Objectives: This monocentric study aims to compare the practices regarding vitamin D supplementation before and after the introduction of a nutrition protocol (NP). Methods: We retrospectively analyzed vitamin D administration (time from PICU admission to initiation, amount of supplementation, accordance with existing guidelines) in children aged 0 to 16 who were admitted to the PICU of Lausanne University Hospital for more than 48 h the year before and the year after the introduction of a NP. Results: Vitamin D supplementation increased after NP introduction (95 IU per day more, p < 0.0001). More patients received vitamin D during their stay (95% after vs. 77% before, p < 0.0001). The dose adhered to NP recommendations for children under 12 and was higher for older children. According to Swiss guidelines for the general pediatric population, vitamin D supplementation was accurate in children under one year old before and after NP implementation. However, it was less than recommended for patients over one year old. Conclusions: The implementation of a NP significantly enhanced the scope of vitamin D supplementation. This study also highlights the practical limitations in meeting the recommended requirements with certain galenic formulations. Full article

13 pages, 872 KB

Open AccessArticle

Corticosteroid Use and Recurrence Risk Factors in Granulomatous Mastitis: A 17-Year Saudi Arabian Cohort Study—Steroids in Granulomatous Mastitis

by Shoag J. Albugami, Rema F. AlRasheed, Hussam A. Alharbi, Sarah S. Alobaid, Hawazin S. Alqahtani, Mays N. Alharbi, Eyad AlKharashi and Khalid Alhajri

Clin. Pract. 2025, 15(10), 185; https://doi.org/10.3390/clinpract15100185 - 6 Oct 2025

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Abstract

Background: Granulomatous mastitis (GM) is a rare, chronic inflammatory breast condition with poorly understood etiology and variable clinical presentation. The efficacy of corticosteroid therapy in reducing recurrence remains controversial, particularly in Middle Eastern populations where the condition appears more prevalent. This study aimed [...] Read more.

Background: Granulomatous mastitis (GM) is a rare, chronic inflammatory breast condition with poorly understood etiology and variable clinical presentation. The efficacy of corticosteroid therapy in reducing recurrence remains controversial, particularly in Middle Eastern populations where the condition appears more prevalent. This study aimed to describe the demographic and clinical characteristics of patients with GM, evaluate the efficacy of corticosteroid therapy in reducing recurrence rates, and identify risk factors associated with disease recurrence. Methods: A retrospective cohort analysis was conducted on 56 patients diagnosed with GM between 2003 and 2020 at a single tertiary referral center. Patients were stratified into two groups based on steroid use (n = 14 with steroids and n = 42 without steroids). Results: The mean age of the cohort was 46.3 ± 13.2 years, with no significant differences in baseline characteristics between the steroid and non-steroid groups. The most common presentation was a breast mass (32.69%), often associated with abscess formation (25%). Core biopsy was the primary diagnostic tool used (51.79%). Recurrence of GM occurred in 10 patients (18%) overall: 7 patients (17%) in the non-steroid group and 3 patients (21%) in the steroid group. The difference in recurrence rates between the treatment groups was not statistically significant (HR = 1.40, 95% CI:0.30–6.52, p = 0.671). A history of infection (HR = 5.85, 95% CI: 1.60–21.44, p = 0.008) and hormonal disorders (hyperprolactinemia in one patient) (HR = 13.90, 95% CI: 1.43–135.52, p = 0.024) were significantly associated with recurrence. Conclusions: GM remains diagnostically challenging with an 18% recurrence rate in our cohort. We observed no statistically significant reduction in recurrence with corticosteroids, though our analysis was limited by sample size. These findings suggest that targeted management of these conditions may be beneficial in GM patients, though larger multicenter studies are needed to confirm these associations and establish standardized treatment protocols. Full article

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13 pages, 558 KB

Open AccessArticle

Asthma Hospitalizations in Children Before and After COVID-19: Insights from Northern Colombia

by Moisés Árquez-Mendoza, Karen Franco-Valencia, Marco Anaya-Romero, Maria Acevedo-Cerchiaro, Stacey Fragozo-Messino, Deiby Luz Pertuz-Guzman and Jaime Luna-Carrascal

Clin. Pract. 2025, 15(10), 184; https://doi.org/10.3390/clinpract15100184 - 6 Oct 2025

Viewed by 317

Abstract

Background: Pediatric asthma is a multifactorial condition influenced by environmental, biological, and social determinants. The COVID-19 pandemic introduced new variables that may have affected the severity and management of asthma in children and adolescents, particularly through changes in healthcare access, treatment adherence, and [...] Read more.

Background: Pediatric asthma is a multifactorial condition influenced by environmental, biological, and social determinants. The COVID-19 pandemic introduced new variables that may have affected the severity and management of asthma in children and adolescents, particularly through changes in healthcare access, treatment adherence, and exposure to environmental risk factors. Objective: To evaluate the association between asthma severity and various factors including nutritional status, corticosteroid use, COVID-19 vaccination, and pollutant exposure before and during the COVID-19 pandemic in a pediatric population. Methods: A retrospective analysis was conducted using 307 medical records of patients aged 3 to 17 years. Data collected included sociodemographic characteristics, nutritional indicators, history of corticosteroid use, vaccination status against COVID-19, and exposure to environmental pollutants. Asthma severity was assessed using the pulmonary score, and multiple statistical analyses, including logistic regression using the Bayesian Logistic Regression Model (BLRM), were employed to identify significant associations. Results: The analysis revealed a statistically significant impact of the pandemic on hospitalization rates (p = 0.0187) and the use of corticosteroids (p = 0.009), indicating changes in asthma management during this period. Notable differences were observed in the geographic distribution of mild versus severe asthma cases prior to the pandemic, associated with nutritional status and gender (p = 0.018). During the pandemic, breastfeeding history, body weight, and hospitalization emerged as significant predictors of asthma severity (p < 0.05). In addition, breastfeeding in young children (aged 3 to 6 years) and hospitalization were strongly associated with pulmonary scores, with significance values of 0.022 and 0.012, respectively, as identified by the BLRM. Conclusions: These findings suggest that the pandemic context influenced both the clinical course and management of pediatric asthma. Preventive strategies should consider individual and environmental factors such as nutrition, early-life health practices (e.g., breastfeeding), and equitable access to appropriate asthma care and vaccination. Tailoring pediatric asthma management to these variables may improve outcomes and reduce disparities in disease severity. Full article

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12 pages, 1208 KB

Open AccessArticle

Impact of Carotid Artery Tortuosity on Technical Aspects of Endovascular Thrombectomy in a Newly Established Thrombectomy-Capable Stroke Center

by Katja Lovoković, Vjekoslav Kopačin, Mihael Mišir, Mateo Grigić, Domagoj Matijević, Tatjana Rotim, Domagoj Kretić, Damir Štimac, Anja Tomić, Lucija Čolaković and Tajana Turk

Clin. Pract. 2025, 15(10), 183; https://doi.org/10.3390/clinpract15100183 - 1 Oct 2025

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Abstract

Background/Objectives: Blood vessel tortuosity can complicate endovascular procedures such as endovascular thrombectomy in acute ischemic stroke. This study aimed to assess the morphometric characteristics of carotid arteries and investigate the association between the tortuosity of the carotid arteries and the technical aspects [...] Read more.

Background/Objectives: Blood vessel tortuosity can complicate endovascular procedures such as endovascular thrombectomy in acute ischemic stroke. This study aimed to assess the morphometric characteristics of carotid arteries and investigate the association between the tortuosity of the carotid arteries and the technical aspects of endovascular thrombectomy, patient demographics and clinical characteristics, and treatment outcome. Methods: This retrospective study included 84 patients with ischemic stroke treated by endovascular thrombectomy at the newly established thrombectomy-capable stroke center. The following data were collected from prethrombectomy computed tomography angiography: aortic arch type, type of carotid artery tortuosity, and tortuosity index (TI). The technical aspects of the procedure, as well as patient demographics, were collected from the radiological information system. Results: Time from arterial puncture to the first pass was significantly shorter in patients with a nontortuous carotid artery compared to a tortuous one (p = 0.006). There were no significant differences in the number of passes, total duration of the procedure, and the difference in National Institutes of Health Stroke Scale (NIHSS) score before and after the procedure regarding the form of tortuosity. Patients with hypertension had significantly higher tortuosity index values compared to those without hypertension (p = 0.008), and patients with a nontortuous carotid tree were significantly younger compared to those with all forms of tortuosity (p = 0.003). Conclusions: The majority of patients had tortuous carotid arteries, which were associated with older age and hypertension. A high index of tortuosity was associated with a longer time from arterial puncture to the first pass, but not to the treatment outcome. Preprocedural recognition of carotid artery tortuosity may aid in endovascular thrombectomy procedural planning. Full article

(This article belongs to the Special Issue Advances in Thromboembolism: Precision Prevention and Clinical Management)

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15 pages, 514 KB

Open AccessReview

Treating Temporomandibular Disorders Through Orthodontics: A Scoping Review of Evidence, Gaps, and Clinical Guidance

by Man Hung, Jacob Daniel Gardner, Samantha Lee, Wendy C. Birmingham, Richard M. Stevens, Connor Schwartz, Nader Karimi and Amir Mohajeri

Clin. Pract. 2025, 15(10), 182; https://doi.org/10.3390/clinpract15100182 - 30 Sep 2025

Viewed by 488

Abstract

Introduction: Evidence on orthodontic interventions for temporomandibular disorders (TMD) is fragmented and inconclusive, creating a gap in guidance for clinical decision-making. This study addresses that gap by evaluating current knowledge on these interventions. Methods: A PRISMA-ScR scoping review was conducted with a systematic [...] Read more.

Introduction: Evidence on orthodontic interventions for temporomandibular disorders (TMD) is fragmented and inconclusive, creating a gap in guidance for clinical decision-making. This study addresses that gap by evaluating current knowledge on these interventions. Methods: A PRISMA-ScR scoping review was conducted with a systematic search of PubMed, Scopus, and Web of Science (2018–2023). Eligible studies were peer-reviewed, English-language, human studies examining TMD treatment and/or etiology. Three independent reviewers screened records and extracted data and a fourth reviewer performed random audits. Results: Of 899 records, 10 studies met inclusion criteria (non-surgical, n = 7: 4 case reports, 2 prospective, 1 longitudinal; combined orthodontic–surgical, n = 3: 1 case report, 2 longitudinal; participant ages 15–71 years). Diagnostics included imaging, clinical examination, occlusal analysis, and questionnaires, although few used RDC/TMD or DC/TMD criteria. Non-surgical orthodontic modalities (fixed appliances, camouflage, TADs, stabilization splints) showed mixed results, with several studies reporting short-term symptom improvement, while others found no effect on TMD onset or progression. Combined orthodontic–surgical approaches (e.g., bilateral sagittal split osteotomy, Le Fort I) also showed variable outcomes. Conclusions: Low-to-moderate quality evidence suggests that orthodontic-surgical interventions may alleviate TMD symptoms in select patients; however, heterogeneity and limited use of standardized diagnostics constrain the certainty of these findings. Future research should prioritize DC/TMD-based diagnostics, core outcomes, comparative designs, and ≥12–24 months of follow-up to identify prognostic factors and responsive subgroups. Full article

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17 pages, 493 KB

Open AccessArticle

Mobile Technology Adoption in Healthcare—A Behavioral Understanding of Chronic Patients’ Perspective

by Andreea Madalina Serban and Elena Druică

Clin. Pract. 2025, 15(10), 181; https://doi.org/10.3390/clinpract15100181 - 28 Sep 2025

Viewed by 264

Abstract

Background: In an era of unprecedented technology adoption in healthcare, it is imperative to understand and predict factors influencing users’ perspective. This study employs a risk-integrated technology acceptance model aiming to identify the determinants of the intention to use mobile health applications among [...] Read more.

Background: In an era of unprecedented technology adoption in healthcare, it is imperative to understand and predict factors influencing users’ perspective. This study employs a risk-integrated technology acceptance model aiming to identify the determinants of the intention to use mobile health applications among patients with chronic diseases in Romania. Methods: A face-to-face survey method was used to collect research data from 207 subjects, and the partial least squares structural equation modeling approach was employed for data analysis. Results: The behavioral intention to use mobile health applications (INT) was influenced positively by the perceived ease of use (PEOU, f² = 0.358, β = 0.500, p < 0.001) and perceived usefulness (PU, f² = 0.271, β = 0.678, p < 0.001). Another core predictor, with a negative effect on the intention to use, was the user’s perceived risk of using the technology (RISK, f² = 0.239, β = −0.321, p < 0.001), in turn influenced by the perceived degree of cyber-insecurity (CYBER, f² = 0.492, β = 0.639, p < 0.001). Digital self-efficacy (DSE) was identified as an external determinant with strong positive influence on PEOU (f² = 0.486, β = 0.610, p < 0.001). The model shows strong performance, reflected in a high Tenenhaus goodness-of-fit index (0.770) and solid explanatory power for the outcome variable (adjusted R² = 0.718). Conclusions: This study validates an extended risk-integrated technology acceptance model, offering robust insights into the determinants of mobile health application adoption among chronic patients in Romania. The findings provide actionable guidance for designing targeted interventions and healthcare policies to enhance technology adoption in this population. Full article

(This article belongs to the Special Issue Digital Health and Virtual Care Innovations: Applications for Long-Term Care and Self-Management Support)

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14 pages, 1188 KB

Open AccessSystematic Review

The Effects of Physical Exercise on Depression and Anxiety in Cancer Patients: A Systematic Review

by Giacomo Farì, Annatonia Fai, Francesco Quarta, Morena Pitruzzella, Cristiano Sconza, Matteo Luigi Giuseppe Leoni, Giustino Varrassi, Marco Filipponi, Giuseppe Rollo, Alessio Baricich and Andrea Bernetti

Clin. Pract. 2025, 15(10), 180; https://doi.org/10.3390/clinpract15100180 - 28 Sep 2025

Viewed by 624

Abstract

Background: Depression affects around 280 million people globally and is one of the main causes of disability. Among people with cancer, depression and anxiety affect 20–25%, significantly reducing quality of life, adherence to treatments, and survival. Despite the availability of pharmacological and [...] Read more.

Background: Depression affects around 280 million people globally and is one of the main causes of disability. Among people with cancer, depression and anxiety affect 20–25%, significantly reducing quality of life, adherence to treatments, and survival. Despite the availability of pharmacological and psychological treatments, their application can be limited by side effects, accessibility, and costs—especially in low- and middle-income countries. Physical exercise is emerging as a valuable complementary strategy, improving both physical and mental well-being. Nevertheless, structured exercise programs are still rarely implemented in oncology. This review aims to provide evidence-based recommendations for integrating physical activity into mental health support for people with cancer. Methods: This review includes six randomized controlled trials (RCTs) evaluating physical exercise interventions for depression and anxiety in people with cancer aged over 18 years. Included studies compared exercise interventions to control or standard care and reported outcomes related to psychological well-being and adverse effects. Exclusion criteria included non-original studies, non-English articles, and works not focused on exercise. The search was conducted in PubMed, Scopus, Google Scholar, and the Cochrane Library using MeSH terms and Boolean operators. The review protocol was registered in PROSPERO (CRD42025637522). Results: Exercise interventions—such as aerobic, resistance, and mind–body practices—proved effective and feasible across cancer types. Benefits were seen in both psychological and physical outcomes. However, variations in protocols and outcome measures, as well as a lack of long-term data, limit generalizability. Conclusions: Personalized exercise programs can significantly reduce depression and anxiety in people with cancer. Standardized core methods, long-term research, and systemic support are needed to integrate exercise into routine oncology care. Full article

(This article belongs to the Special Issue Exercise and Sports for Chronic Diseases)

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14 pages, 848 KB

Open AccessArticle

Vitamin D and Postoperative Recovery in Elderly Ribeirinhos—Riverside Amazon Communities with Femur Fractures

by Elca Silvania da Silva Abreu, Caroline Oliveira dos Anjos, Zafirah Muhammad Rahman, Renata Miyabara, Ovidiu Constantin Baltatu and Luciana Aparecida Campos

Clin. Pract. 2025, 15(10), 179; https://doi.org/10.3390/clinpract15100179 - 28 Sep 2025

Viewed by 229

Abstract

Background/Objectives: Vitamin D deficiency is prevalent in elderly populations and may impact surgical recovery. Despite the equatorial location, vitamin D insufficiency affects many elderly Ribeirinhos in the Brazilian Amazon. This study investigated whether pre-existing vitamin D supplementation influences postoperative outcomes in elderly [...] Read more.

Background/Objectives: Vitamin D deficiency is prevalent in elderly populations and may impact surgical recovery. Despite the equatorial location, vitamin D insufficiency affects many elderly Ribeirinhos in the Brazilian Amazon. This study investigated whether pre-existing vitamin D supplementation influences postoperative outcomes in elderly Ribeirinhos following femur fracture surgery, while examining metabolic parameters and documenting chronic disease prevalence. Methods: This prospective cohort study enrolled 60 elderly Ribeirinhos patients (≥65 years) admitted for femur fracture surgery at the Regional Hospital of Lower Amazon. Twenty-two patients had participated in a vitamin D supplementation program (50,000 IU monthly, 3–6 months) prior to admission; 38 had not. Primary outcomes were hospitalization duration and serum 25-hydroxyvitamin D levels. Secondary outcomes included ionized calcium, blood glucose, and comorbidity documentation. Results: The supplementation group was associated with significantly shorter hospitalization (14.32 ± 0.79 vs. 22.61 ± 0.88 days, p < 0.0001), representing 37% reduction. Vitamin D levels were markedly higher in supplemented patients (50.26 ± 2.55 vs. 21.74 ± 0.84 ng/mL, p < 0.0001). Ionized calcium was elevated in the supplementation group (1.29 ± 0.01 vs. 1.08 ± 0.02 mmol/L, p < 0.001) without hypercalcemia. Blood glucose was lower in supplemented patients (83.8 ± 1.4 vs. 152.2 ± 9.6 mg/dL, p < 0.001). Medical records revealed that 73.3% had hypertension and 31.7% had diabetes, with 25% having both conditions. Conclusions: Pre-existing vitamin D supplementation was associated with reduced hospitalization duration following femur fracture surgery, though causality cannot be inferred due to observational design. Community-based vitamin D programs may warrant further investigation in vulnerable populations, with randomized trials needed. Full article

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36 pages, 2093 KB

Open AccessReview

Serum Sickness-Like Reaction: A Narrative Review of Epidemiology, Immunopathogenesis, Diagnostic Challenges, and Therapeutic Approaches

by Christodoulos Chatzigrigoriadis, Emmanouil Koufopoulos, Prodromos Avramidis, Ioannis Erginousakis, Vasiliki Karakoida, Theofanis Papadopoulos, Despoina Sperdouli, Myrsini-Eirini Tachliabouri, Kyriakos Vilanakis, Dimitrios Zampounidis, Vasiliki Michou, Panagiotis Eskitzis, Panagis Galiatsatos, Lazaros Lavasidis and Doxakis Anestakis

Clin. Pract. 2025, 15(10), 178; https://doi.org/10.3390/clinpract15100178 - 26 Sep 2025

Viewed by 689

Abstract

Serum sickness-like reaction (SSLR) is a rare immune-mediated condition that typically affects the skin and joints after exposure to certain drugs, infections, or vaccines. Although it shares clinical similarities with serum sickness (SS), SSLR differs in its underlying mechanisms, histopathology, and causes. Despite [...] Read more.

Serum sickness-like reaction (SSLR) is a rare immune-mediated condition that typically affects the skin and joints after exposure to certain drugs, infections, or vaccines. Although it shares clinical similarities with serum sickness (SS), SSLR differs in its underlying mechanisms, histopathology, and causes. Despite its generally benign and self-limiting nature, SSLR is frequently misdiagnosed and may lead to unnecessary hospitalization. This narrative review summarizes current knowledge on epidemiology, pathophysiology, clinical features, diagnosis, treatment, and long-term considerations related to SSLR. The condition is most often associated with antibiotics, monoclonal antibodies, and vaccines, particularly in pediatric populations. Its pathogenesis remains incompletely understood, but proposed mechanisms include immune complex formation, altered drug metabolism, lymphocyte toxicity, and the development of anti-drug antibodies. Diagnosis is primarily clinical, although novel diagnostic tools are emerging. Management involves discontinuation of the offending agent and supportive care, such as antihistamines or nonsteroidal anti-inflammatory drugs (NSAIDs) in mild cases, and corticosteroids in more severe cases. Long-term management, especially in cases requiring potential re-exposure to the causative agent, remains challenging. Skin testing and graded oral challenges appear promising within a structured clinical framework. Increased awareness of SSLR is essential for timely recognition and appropriate care, and further research is needed to elucidate its mechanisms and inform evidence-based management strategies. Full article

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17 pages, 1273 KB

Open AccessArticle

Clinical and Histopathological Correlates of Endometrial Proliferative Lesions in Perimenopausal Women: A Retrospective Study with Internal Validation of a Risk Model

by Anca Daniela Brăila, Viorica Tudor, Cristian-Viorel Poalelungi, Constantin Marian Damian, Claudia Florina Bogdan-Andreescu, Alexandru Burcea, Andreea-Mariana Bănățeanu, Emin Cadar and Cristina-Crenguţa Albu

Clin. Pract. 2025, 15(10), 177; https://doi.org/10.3390/clinpract15100177 - 26 Sep 2025

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Abstract

Background: Endometrial proliferative lesions are common in the menopausal transition and carry a measurable risk of carcinoma. Early risk stratification may guide evaluation and follow-up. Methods: We performed a single-center retrospective study of 315 women aged 45–55 years (May 2021–May 2024) at a [...] Read more.

Background: Endometrial proliferative lesions are common in the menopausal transition and carry a measurable risk of carcinoma. Early risk stratification may guide evaluation and follow-up. Methods: We performed a single-center retrospective study of 315 women aged 45–55 years (May 2021–May 2024) at a private clinic in Bucharest. Lesions were classified per WHO 2014 as hyperplasia without atypia, atypical hyperplasia/endometrial intraepithelial neoplasia (AH/EIN), or adenocarcinoma; “advanced pathology” was defined as AH/EIN or adenocarcinoma. Clinical comorbidities and transvaginal ultrasound endometrial thickness were recorded. Associations were tested with χ²; odds were estimated with multivariable logistic regression (adjusted ORs), with a modified Poisson sensitivity analysis for adjusted relative risk. Thickness differences were compared by one-way ANOVA, and severity correlations by Spearman’s ρ. Internal validation used 1000-bootstrap resampling. Results: Hyperplasia without atypia comprised 74.6% of cases, AH/EIN 20.0%, and adenocarcinoma 5.4% (advanced pathology 25.4%). Diabetes was independently associated with advanced pathology (aOR 2.75; 95% CI 1.14–6.61; p = 0.0237), while a history of non-atypical hyperplasia was inversely associated (aOR 0.31; 95% CI 0.13–0.72; p = 0.0068). Obesity showed a borderline association (aOR 1.79; 95% CI 0.98–3.26; p = 0.058), and long-term oral contraceptive use also approached significance (aOR 0.42; 95% CI 0.18–1.00; p = 0.051). Endometrial thickness increased stepwise with histopathological severity (ANOVA p < 0.0001; η² = 0.44) and correlated with ordered severity (ρ = 0.634). The multivariable model showed moderate discrimination (AUC 0.68; optimism-corrected 0.66) with acceptable calibration (slope 0.92; Hosmer–Lemeshow p = 0.052) and overall accuracy (Brier 0.18). Conclusions: In perimenopausal abnormal bleeding, metabolic comorbidities—especially diabetes—together with increased endometrial thickness identify women at higher risk of AH/EIN or carcinoma. Histopathology remains the diagnostic reference. The model can aid clinical prioritization but requires external validation and should not be used as the sole basis for decisions. Full article

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12 pages, 627 KB

Open AccessArticle

Gender-Pain Questionnaire: Internal Validation of a Scale for Assessing the Influence of Chronic Pain Experience on Gender Identity and Roles

by Ana M. Peiró, Noelia Serrano-Gadea, Daniel García-Torres, María Teresa Ruiz-Cantero and Virtudes Pérez-Jover

Clin. Pract. 2025, 15(10), 176; https://doi.org/10.3390/clinpract15100176 - 25 Sep 2025

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Abstract

Background/Objectives: Gender (roles as household load and job strain, and identity) represent an effect modifier of the interference between pain experience and sex because it is different between men and women. This study validates a new scale developed to assess how life functioning [...] Read more.

Background/Objectives: Gender (roles as household load and job strain, and identity) represent an effect modifier of the interference between pain experience and sex because it is different between men and women. This study validates a new scale developed to assess how life functioning is impacted by Chronic Non-Cancer Pain (CNCP) due to gender. Methods: A total of 193 Spanish ambulatory CNCP patients (60 [51–73] years old, 69.4% women, 31% retired) were interviewed. Exploratory Factor Analysis (EFA) yielded 3-factor structure: Gender Self-identity, Roles, and Chronic Pain Impact on Social, Familial, Work and Sexual Life. Results: The Gender-Pain Questionnaire, with the presented factor structure, is an evaluation instrument with enough reliability and internal validity for CNCP patients. Conclusions: This study presents the psychometric properties of a scale for assessing the interference of CNCP patients’ experience on gender and how it affects their daily life activities, relationships and self-identity. It represents the first original questionnaire known in Spanish language to date. This measure could potentially help researchers and clinicians to obtain gender key information to design appropriate and equity healthcare interventions. Full article

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11 pages, 539 KB

Open AccessArticle

Hyperkalemia in Heart Failure with Reduced Ejection Fraction Patients Treated with Sacubitril/Valsartan: Experience from a Tertiary Cardiac Center in Riyadh, Saudi Arabia

by Sarah M. Alyousif, Naif K. Alaqil, Mohamad Abdelshafy, Turki Alasmari, Naif H. Alqadhy, Nawaf S. Alzahrani, Mohammed A. Alhefdhi, Nawaf A. Alqahtani, Aamir Omair and Ahmed Alsaileek

Clin. Pract. 2025, 15(10), 175; https://doi.org/10.3390/clinpract15100175 - 24 Sep 2025

Viewed by 374

Abstract

Background/Objectives: Heart failure with reduced ejection fraction (HFrEF) remains a major global health burden. Sacubitril/valsartan, an angiotensin receptor neprilysin inhibitor (ARNI), improves outcomes in HFrEF but may cause hyperkalemia. Methods: A single-center retrospective cohort study was conducted at King Abdulaziz Cardiac [...] Read more.

Background/Objectives: Heart failure with reduced ejection fraction (HFrEF) remains a major global health burden. Sacubitril/valsartan, an angiotensin receptor neprilysin inhibitor (ARNI), improves outcomes in HFrEF but may cause hyperkalemia. Methods: A single-center retrospective cohort study was conducted at King Abdulaziz Cardiac Center, Riyadh, including 238 HFrEF patients initiated on sacubitril/valsartan (2016–2021). Potassium levels were assessed pre-initiation and at 0–3, 3–6, and 6–12 months post-initiation. Hyperkalemia was analyzed at thresholds >5.0, >5.5, and >6.0 mmol/L. Results: Median age was 58 years (IQR 48–69); 75.2% were male. Hyperkalemia >5.0 mmol/L occurred in 44.4% (95% CI: 38.1–51.0) within three months post-initiation versus 8.2% (95% CI: 5.3–12.4) pre-initiation. Only 17.3% exceeded 5.5 mmol/L. Treatment discontinuation occurred in 7.1% of patients, with 1.3% stopping due to clinically significant hyperkalemia. McNemar’s test confirmed a significant increase in prevalence across time points (p < 0.0001). Conclusions: Despite increased hyperkalemia incidence, discontinuation rates were low, consistent with prior trials (PARADIGM-HF, PARAGON-HF). Sacubitril/valsartan remains an effective and generally safe therapy for HFrEF, with hyperkalemia manageable through monitoring. Limitations include missing potassium data, potential confounding factors, and the lack of a control group; future prospective studies with regular electrolyte monitoring are recommended. Full article

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18 pages, 1167 KB

Open AccessArticle

Bridging Gaps in Occupational Respiratory Disease Management: A Comparative Survey of Pulmonologists and Occupational Physicians in Italy

by Alessandra Tortorella, Alessio Marinelli, Luigi De Maria, Silvano Dragonieri, Giuseppe Del Vecchio, Vitaliano Nicola Quaranta, Andrea Portacci, Giovanna Elisiana Carpagnano and Luigi Vimercati

Clin. Pract. 2025, 15(10), 174; https://doi.org/10.3390/clinpract15100174 - 24 Sep 2025

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Abstract

Background: Themanagement of occupational respiratory diseases (ORDs) requires a multidisciplinary approach, yet collaboration between pulmonologists and occupational physicians is often fragmented, potentially compromising patient outcomes. This study aimed to systematically compare the management strategies for ORDs between these two specialties in Italy [...] Read more.

Background: Themanagement of occupational respiratory diseases (ORDs) requires a multidisciplinary approach, yet collaboration between pulmonologists and occupational physicians is often fragmented, potentially compromising patient outcomes. This study aimed to systematically compare the management strategies for ORDs between these two specialties in Italy to identify gaps and opportunities for integration. Methods: A cross-sectional survey was conducted using a structured 12-item questionnaire distributed to board-certified pulmonologists and occupational physicians across Italy. The questionnaire assessed diagnostic pathways, therapeutic strategies, preventive measures, and patterns of interdisciplinary collaboration. A total of 102 specialists (51 pulmonologists and 51 occupational physicians) completed the survey. Comparative analyses were performed using Pearson’s

χ^{2}

tests. Results: Significant divergences in practice were identified. Pulmonologists primarily focused on clinical diagnosis, utilizing pulmonary function tests (34.3%) and imaging (11.8%), and favored pharmacotherapy (27.5%) as the first-line treatment, in alignment with clinical guidelines. Conversely, occupational physicians prioritized detailed occupational and exposure histories (15.7%) and preventive interventions aimed at exposure reduction (15.7%). While both groups acknowledged the importance of collaboration, a substantial number reported that it occurred only occasionally (17.6% of pulmonologists and 12.7% of occupational physicians), indicating a significant gap in integrated care. Shared barriers included poor patient adherence and limited access to advanced diagnostic tools. Conclusions: While sharing a common foundation in diagnostic and preventive principles, pulmonologists and occupational physicians in Italy operate with distinct, complementary approaches that remain insufficiently integrated. The observed fragmentation in diagnostic and therapeutic pathways underscores an urgent need for shared national guidelines, structured interdisciplinary training, and formalized communication protocols. Bridging this disciplinary divide is essential to delivering holistic care, optimizing worker health, and preserving work ability. Full article

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30 pages, 1199 KB

Open AccessReview

Cancer Pain Is Not One-Size-Fits-All: Evolving from Tradition to Precision

by Nidha Shapoo, Abdul Rehman, Carlos Izaguirre-Rojas, Vladimir Gotlieb and Noella Boma

Clin. Pract. 2025, 15(10), 173; https://doi.org/10.3390/clinpract15100173 - 23 Sep 2025

Viewed by 814

Abstract

Cancer pain remains a significant challenge in oncology, profoundly affecting patients’ quality of life, function, and prognosis. Historically under-recognized and managed with a uniform, opioid-centric approach, cancer pain was often inadequately treated. Advances in pain assessment, multimodal analgesia, and supportive care have improved [...] Read more.

Cancer pain remains a significant challenge in oncology, profoundly affecting patients’ quality of life, function, and prognosis. Historically under-recognized and managed with a uniform, opioid-centric approach, cancer pain was often inadequately treated. Advances in pain assessment, multimodal analgesia, and supportive care have improved outcomes, yet traditional algorithms frequently fail to address the complex, heterogeneous nature of cancer pain. Contemporary management is shifting toward precision and personalized medicine, integrating genetic, molecular, and biomarker data with individual patient characteristics to inform treatment decisions. To address this complexity, we propose a five-domain framework encompassing biological, pharmacologic, psychological, sociocultural, and functional domains. This multidimensional approach enables clinicians to tailor pain management strategies to each patient’s unique profile, aiming for equitable and individualized care. However, challenges remain, including tumor and patient heterogeneity, limited biomarker validation, data integration, disparities in access, and the need for multidisciplinary coordination. This review traces the evolution of cancer pain management, highlights the promise of precision and personalized strategies, and presents a comprehensive framework for optimizing pain control in oncology. Full article

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Open AccessArticle

Safety and Efficacy of Citrate Anticoagulation in Therapeutic Plasma Exchange: A Clinical Study

by Ciprian Gîndac, Tamara Mirela Poroșnicu, Nilima Rajpal Kundnani, Nicoleta Sgăvârdea, Claudiu Rafael Bârsac, Vlad Meche, Adelina Băloi, Laura Alexandra Nussbaum, Ovidiu Horea Bedreag, Dorel Săndesc and Marius Păpurică

Clin. Pract. 2025, 15(10), 172; https://doi.org/10.3390/clinpract15100172 - 23 Sep 2025

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Abstract

Introduction: TPE (therapeutic plasma exchange) has proven to be an extremely effective treatment for a range of conditions, especially over the past 20 years. Anticoagulation with heparin is currently the accepted recommendation for therapeutic plasma exchange sessions. However, the hypercoagulable state and hyperviscosity [...] Read more.

Introduction: TPE (therapeutic plasma exchange) has proven to be an extremely effective treatment for a range of conditions, especially over the past 20 years. Anticoagulation with heparin is currently the accepted recommendation for therapeutic plasma exchange sessions. However, the hypercoagulable state and hyperviscosity in some patients requiring TPE present a challenge, particularly during the first session, due to an increased risk of circuit clotting. Citrate anticoagulation has been proposed for extracorporeal therapies such as hemodiafiltration where heparin is contraindicated. Nevertheless, citrate anticoagulation is still generally avoided in patients undergoing TPE. Materials and Methods: A total of 26 patients underwent 52 TPE sessions using citrate. Fifteen patients received citrate from the beginning of therapy, accounting for 29 sessions, and eleven patients were switched to citrate after initially starting with heparin, when an imminent risk of circuit clotting quickly became evident—23 sessions in total. The imminent risk of circuit clotting was assessed by a continuous and accelerated increase in transmembrane pressure despite heparin anticoagulation. The effectiveness of citrate anticoagulation and its safety for patients were evaluated. Results: Of the 23 sessions where there was a risk of circuit clotting, citrate was added on top of heparin in those sessions; 21 sessions were successfully completed. It can be said that the kits were saved in these cases. Among the 29 TPE sessions that used citrate from the start, 27 were completed successfully, even though the patients were considered to have a hypercoagulable status. No cases of citrate toxicity were identified. Conclusions: TPE with citrate is a safe option for patients. It can preserve TPE kits from the beginning or during treatment in patients with hypercoagulability. Citrate can be also be used when heparin is contraindicated or ineffective. Full article

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Clin. Pract., Volume 15, Issue 10 (October 2025) – 15 articles

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