Clinics and Practice

16 pages, 1636 KB

Open AccessArticle

A Digital Twin Strategy Combined with a Monte Carlo Simulation Framework to Predict Outcomes in Patients with Unusual-Site Venous Thrombosis Treated with Direct Oral Anticoagulants Versus Vitamin K Antagonists Using Data from Real-World Populations

by Anabel Franco-Moreno, Luis Escobar-Curbelo, Juan Torres-Macho, Nuria Muñoz-Rivas, Cristina Lucía Ancos-Aracil, Ana Martínez de la Casa-Muñoz, Ana Bustamante-Fermosel, Paz Arranz-García and Miguel Ángel Casado-Suela

Clin. Pract. 2025, 15(12), 237; https://doi.org/10.3390/clinpract15120237 - 17 Dec 2025

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Abstract

Background/Objectives: Unusual-site venous thrombosis (USVT) lacks robust evidence guiding anticoagulant selection between vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs). This study aimed to evaluate recanalization, recurrence, and major bleeding outcomes in real-world USVT patients and to replicate these findings through a [...] Read more.

Background/Objectives: Unusual-site venous thrombosis (USVT) lacks robust evidence guiding anticoagulant selection between vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs). This study aimed to evaluate recanalization, recurrence, and major bleeding outcomes in real-world USVT patients and to replicate these findings through a validated digital twin model with Monte Carlo simulation. Methods: We conducted a retrospective study of 90 USVT patients (72% VKAs, 28% DOACs). A conditional generative adversarial network was used to generate digital twins matched on age, sex, thrombosis site, and malignancy. Logistic regression was applied to estimate treatment-specific outcome probabilities for recanalization, recurrence, and major bleeding. A nested stochastic simulation framework simulated 500 iterations across clinical scenarios, including increased DOAC use, cancer prevalence, cerebral vein thrombosis proportion, and optimized VKA control. Results: The mean age was 67.5 years, and 54.4% were female. 61.1% of splanchnic vein thrombosis, 36.7% of upper extremity deep vein thrombosis, and 2.2% of cerebral vein thrombosis were included. In the real cohort, complete recanalization occurred in 40.0% of patients with DOACs and 36.0% with VKAs. Recurrence was 8.0% with DOACs and 7.7% with VKAs, and major bleeding occurred in 8.0% and 10.8% of cases, respectively. All-cause mortality was 20% in DOAC-treated patients and 60% in those receiving VKAs. Digital Twin-based predictions replicated these results (recanalization 40.3% versus 38.0%; recurrence 10.9% versus 8.6%; bleeding 7.6% versus 9.1%). Simulated scenarios preserved the directionality effect, with the most significant differences observed in high-cerebral vein thrombosis and cancer-enriched patients. Conclusions: DOACs showed comparable efficacy and slightly lower bleeding risk than VKAs in USVT. Digital twin and Monte Carlo modeling provided robust, reproducible simulations of treatment effects under varying clinical conditions. Separating empirical and simulation-based findings, the digital twin supported the internal consistency of real-world observations and demonstrated the potential of in silico modeling as a complementary tool in rare thrombotic diseases. Full article

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

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17 pages, 524 KB

Open AccessReview

Hyponatraemia After Hip and Knee Replacement: Incidence, Risk Factors, Clinical Consequences and Management in the Era of Enhanced Recovery

by Lauren Thornley, James Craig, Thomas W. Wainwright and Robert G. Middleton

Clin. Pract. 2025, 15(12), 236; https://doi.org/10.3390/clinpract15120236 - 16 Dec 2025

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Abstract

Introduction: Total hip replacements and total knee replacements are among the most frequently performed operations worldwide, and the demand for such procedures is ever-growing. It is essential to focus on preventable medical complications that can arise from these procedures, specifically postoperative hyponatraemia. Postoperative [...] Read more.

Introduction: Total hip replacements and total knee replacements are among the most frequently performed operations worldwide, and the demand for such procedures is ever-growing. It is essential to focus on preventable medical complications that can arise from these procedures, specifically postoperative hyponatraemia. Postoperative hyponatraemia has an incidence of 20–40% in total hip and knee replacement patient cohorts. Even mild postoperative hyponatraemia is clinically relevant, as it is associated with cognitive impairment and gait disturbance and may undermine the aims of enhanced recovery protocols. Severe postoperative hyponatraemia can lead to seizures, coma, intensive care admission, and death. Although uncommon, the high volume of patients treated in busy orthopaedic centres means such cases will inevitably be encountered. This narrative review summarises the current evidence on incidence, risk factors and consequences of postoperative hyponatraemia in total hip and knee replacement populations. Methods: A literature review was performed through the EBSCO and PubMed databases to identify relevant studies. Key search terms included were “hyponatraemia”, “total hip replacement”, and “total knee replacement”. Results: The incidence of postoperative hyponatraemia is largely between 20% and 40%; however, there are some outliers to this. Multiple risk factors have been identified through observational studies, including age, preoperative hyponatraemia, female sex and certain medications, which signal a need for a risk stratification strategy that can assist in preoperative assessment and the early identification of patients at higher risk of developing postoperative hyponatraemia. Evidence is scarce regarding interventional studies for the prevention and management of postoperative hyponatraemia, despite multiple studies highlighting the issue. Conclusion: Future work should focus on testable, quality improvement interventions, such as automatic sodium checks on postoperative day one, weight-based oral fluid protocols, oral salt supplementation, and escalation pathways for high-risk patients. Incorporating these into enhanced recovery frameworks has the potential not only to optimise safe early discharge for the majority but also to prevent rare but significant complications. Full article

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24 pages, 9596 KB

Open AccessArticle

Benign Epithelial Salivary Neoplasms: Single-Centered Histopathologic and Clinicodemographic Romanian Retrospective Study

by Constantin Aleodor Costin, Adriana Grigoraș, Elena Corina Andriescu and Cornelia Amalinei

Clin. Pract. 2025, 15(12), 235; https://doi.org/10.3390/clinpract15120235 - 15 Dec 2025

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Abstract

Background: Epidemiological studies on benign epithelial salivary gland tumors are challenging due to their rarity, pathological heterogeneity, variable tumor locations, and the limited national data collection in Romania. Our study aimed at the evaluation of benign epithelial salivary gland tumors collected over [...] Read more.

Background: Epidemiological studies on benign epithelial salivary gland tumors are challenging due to their rarity, pathological heterogeneity, variable tumor locations, and the limited national data collection in Romania. Our study aimed at the evaluation of benign epithelial salivary gland tumors collected over fifteen years in a tertiary center, in order to characterize their demographic and histopathological profiles and to contribute to their diagnostic and therapeutic strategies. Materials and Methods: A retrospective analysis of 404 cases of benign epithelial salivary gland tumors diagnosed in “Sf. Spiridon” County Hospital, Iasi, from 2010 to 2024, has been performed. Results: The analyzed cases showed a slight female predominance (52.97%) and a mean patient age of 54.55 ± 14.207 years. Tumor frequency increased progressively with age, peaking in the sixth and seventh decades of life. The most common histological types were pleomorphic adenoma (62.62%) and Warthin tumor (29.95%), both types showing a predominant parotid gland involvement (88.51%). The recurrences were rare, being registered only in 1.58% of pleomorphic adenomas. A significant association between tumor histological type and both gender (p < 0.001) and age group (p < 0.001) was registered, while no significant correlation between gender and age group (p = 0.288) or between tumor location and gender or age group (p = 0.382; p = 0.383) was found. Conclusions: The frequency of pleomorphic adenoma is increasing, showing an age-related distribution and parotid gland propensity. Key morphological features in each histological type support a better preoperative stratification, a more confident margin assessment, and an individualized extent of excision with function preservation. Full article

(This article belongs to the Special Issue Clinical Outcome Research in the Head and Neck: 2nd Edition)

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11 pages, 2172 KB

Open AccessArticle

Urine Cytological Diagnostics: Possibilities and Limitations—A 25-Year Review and Overview at Hannover Medical School

by Soudah Bisharah, Mieke Raap and Mahmoud Abbas

Clin. Pract. 2025, 15(12), 234; https://doi.org/10.3390/clinpract15120234 - 12 Dec 2025

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Abstract

Background: Urine cytology is a highly effective, straightforward, and cost-efficient diagnostic tool for identifying neoplastic and non-neoplastic changes in the bladder, ureter, and renal pelvis. The aim of this study is to demonstrate the high sensitivity and specificity of urine cytology in detecting [...] Read more.

Background: Urine cytology is a highly effective, straightforward, and cost-efficient diagnostic tool for identifying neoplastic and non-neoplastic changes in the bladder, ureter, and renal pelvis. The aim of this study is to demonstrate the high sensitivity and specificity of urine cytology in detecting a wide range of urothelial lesions, including metastatic involvement. Material and Methods: Urine cytology was performed on 9639 cases between 2000 and 2025. The samples, collected from patients, were processed at the Institute of Pathology. Cytological slides were prepared using cytocentrifugation and stained with May–Grünwald–Giemsa (MGG) and Papanicolaou stains. The cytological findings were classified according to WHO, 2004 compared with histological specimens. Additionally, selected cases underwent immunohistochemical and molecular analyses. All samples were anonymized and retrospectively analyzed following the guidelines and regulations of the local ethics committee. Results: Of the total cases, 7051 were classified as benign, 1269 as malignant, and 88 as normal findings. Insufficient material was obtained in 336 cases. No complications were reported during sample collection or processing. The concordance with histological findings for neoplastic lesions was over 96%, with a false-negative rate of 1.84%. The diagnostic methods demonstrated a sensitivity of 90.7% and a specificity of 96.64%. Among the 6956 cases analyzed, 3139 were women (45.13%) and 3817 were men (54.87%). Conclusions: The diagnostic value of urine cytology in representative material is relatively high in assessing both the presence or absence of malignancy and, when applicable, the tumor grade. This large 25-year single-center review demonstrates that urine cytology retains high sensitivity and specificity for the detection of urothelial malignancy, particularly high-grade disease. However, the atypical category remains a major diagnostic challenge and contributes substantially to false-positive results. Full article

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18 pages, 546 KB

Open AccessReview

Operationalizing Chronic Inflammation: An Endotype-to-Care Framework for Precision and Equity

by Maria E. Ramos-Nino

Clin. Pract. 2025, 15(12), 233; https://doi.org/10.3390/clinpract15120233 - 10 Dec 2025

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Abstract

Background/Objectives: Chronic inflammation arises from self-reinforcing immune–metabolic circuits encompassing pattern-recognition signaling, inflammasome activation, cytokine networks, immunometabolic reprogramming, barrier–microbiome disruption, cellular senescence, and neuro–immune–endocrine crosstalk. This review synthesizes these mechanistic axes across diseases and introduces an operational endotype-to-care framework designed to translate mechanistic insights [...] Read more.

Background/Objectives: Chronic inflammation arises from self-reinforcing immune–metabolic circuits encompassing pattern-recognition signaling, inflammasome activation, cytokine networks, immunometabolic reprogramming, barrier–microbiome disruption, cellular senescence, and neuro–immune–endocrine crosstalk. This review synthesizes these mechanistic axes across diseases and introduces an operational endotype-to-care framework designed to translate mechanistic insights into precision-based, scalable, and equitable interventions. Methods: A narrative, mechanism-focused review was performed, integrating recent literature on immune–metabolic circuits, including pattern-recognition receptors, inflammasome pathways, cytokine modules, metabolic reprogramming, barrier–microbiome dynamics, senescence, and neuro–immune–endocrine signaling. Validated, low-cost screening biomarkers (hs-CRP, NLR, fibrinogen) were mapped to phenotype-guided endotyping panels and corresponding therapeutic modules, with explicit monitoring targets. Results: We present a stepwise, pragmatic pathway progressing from broad inflammatory screening to phenotype-specific endotyping (e.g., IL-6/TNF for metaflammation; ISG/IFN for autoimmunity; IL-23/17 for neutrophilic disease; IL-1β/NLRP3 or urate for crystal-driven inflammation; permeability markers for barrier–dysbiosis). Each module is paired with targeted interventions and prespecified treat-to-target outcomes: for example, achieving a reduction in hs-CRP (e.g., ~40%) within 8–12 weeks is used here as a pragmatic operational benchmark rather than a validated clinical threshold. Where feasible, cytokine and multi-omic panels further refine classification and prognostication. A tiered implementation model (essential, expanded, comprehensive) ensures adaptability and equity across clinical resource levels. Conclusions: Distinct from prior narrative reviews, this framework defines numeric triage thresholds, minimal endotype panels, and objective monitoring criteria that make chronic inflammation management operationalizable in real-world settings. It embeds principles of precision, equity, and stewardship, supporting iterative, evidence-driven implementation across diverse healthcare environments. Full article

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11 pages, 203 KB

Open AccessArticle

Teaching Prescribing in the PharmD Curriculum: A Qualitative Analysis

by Rachel E. Barenie, Devin Scott, David Rhys Axon and Alina Cernasev

Clin. Pract. 2025, 15(12), 232; https://doi.org/10.3390/clinpract15120232 - 9 Dec 2025

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Abstract

Background: The scope of practice for pharmacists in the United States (US) is expanding rapidly, with the majority of states allowing pharmacists to prescribe to some degree. Doctor of Pharmacy (PharmD) programs are required to include medication prescribing effective 1 July 2025, ensuring [...] Read more.

Background: The scope of practice for pharmacists in the United States (US) is expanding rapidly, with the majority of states allowing pharmacists to prescribe to some degree. Doctor of Pharmacy (PharmD) programs are required to include medication prescribing effective 1 July 2025, ensuring program alignment with modern pharmacy practice. Objective: This study aimed to characterize student pharmacists’ beliefs about education on prescribing in the US PharmD program. Methods: Focus group discussions (FGDs) were conducted with student pharmacists enrolled in the PharmD curriculum at two different universities in the US. The conceptualization and data collection, guided by Self-Determination Theory, occurred over three months during the 2024 Fall semester. Data analysis was performed using thematic analysis, and themes were identified through inductive and deductive coding. Results: Twenty-two student pharmacists participated in three FGDs. Thematic analysis revealed two major themes: (1) essential role of didactic education in the prescribing process and (2) enhancing student preparedness to prescribe through experiential training. These themes uncover student pharmacists’ beliefs that prescribing education is vitally important to the didactic and experiential curriculum, highlighting the need to take a comprehensive approach to incorporate these topics into the PharmD program. Conclusions: Teaching medication prescribing in the PharmD didactic curriculum using a state’s scope of practice as a framework for its delivery, with reinforcement in their experiential training, to ensure pharmacy students are practice-ready, may be a preferred approach for delivery. This area remains ripe for further study to determine an evidence-based approach to teaching medication prescribing to pharmacy students. Full article

11 pages, 526 KB

Open AccessArticle

Surgical Site Infection After Breast Surgery—A Bicentric Retrospective Case–Control Study in Saudi Arabia

by Moteb AlSaadi, Salem Alghamdi, Fayyaz Mazari, Sabah Alshuhri, Rustom Bashtawi, Raghad Aljehani, Basmah Alwuqaisi, Rawan Almohammadi, Mahmoud Alfirikh, Sameer Desai and Ebrahim Mahmoud

Clin. Pract. 2025, 15(12), 231; https://doi.org/10.3390/clinpract15120231 - 8 Dec 2025

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Abstract

Background: Surgical site infections (SSIs) are common postoperative complications. Data on SSIs following breast surgery in Saudi Arabia are limited because these procedures are not included in the national SSI surveillance system. This study determined the SSI incidence rate, identified associated risk factors, [...] Read more.

Background: Surgical site infections (SSIs) are common postoperative complications. Data on SSIs following breast surgery in Saudi Arabia are limited because these procedures are not included in the national SSI surveillance system. This study determined the SSI incidence rate, identified associated risk factors, and described the microbiological profiles of patients undergoing breast surgery at two tertiary hospitals in Saudi Arabia. Methods: This bicentric retrospective case–control study analyzed 1841 breast surgeries performed at two tertiary hospitals between July 2021 and July 2024. Demographic, surgical, and microbiological data were extracted from electronic medical records. SSIs were defined according to National Healthcare Safety Network criteria. Descriptive statistics summarized patient and surgical characteristics and SSI rates. A matched case–control analysis (1:4 ratio based on age and hospital site) included 172 patients. Multivariable logistic regression was used to identify predictors of SSI. Results: The cumulative SSI incidence was 2.4%, and most infections occurred within 30 days of surgery (69%). Gram-negative organisms were predominant in microbiologically positive cases (53.6%), mainly Klebsiella pneumoniae and Pseudomonas aeruginosa, whereas Staphylococcus aureus (including MRSA) accounted for 25%. Immunocompromised status (OR 3.32, 95% CI 1.35–8.14) and surgical drain use (OR 4.07, 95% CI 1.68–9.87) were independently associated with SSI. Conclusions: The incidence of SSIs after breast surgery in Saudi Arabia was relatively low. The predominance of Gram-negative pathogens and the identification of immunocompromised status and surgical drain use as major risk factors highlight opportunities for targeted infection prevention strategies. Further studies should validate these findings in larger and more diverse populations and healthcare settings. Full article

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8 pages, 5675 KB

Open AccessCase Report

Chronic Maxillary Sinusitis Due to Material Compatible with Hyaluronic Filler—A Case Report

by Marino Lupi-Ferandin, Dinko Martinovic, Ema Puizina, Mislav Usljebrka, Andrija Rados, Lovre Martinovic, Neven Ercegovic, Josko Bozic and Slaven Lupi-Ferandin

Clin. Pract. 2025, 15(12), 230; https://doi.org/10.3390/clinpract15120230 - 8 Dec 2025

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Abstract

Background: Chronic maxillary sinusitis is most often linked to dental, allergic, or anatomical etiologies, with foreign body-induced forms remaining rare. This case report describes a unique occurrence of chronic maxillary sinusitis resulting from misplaced hyaluronic filler due to a facial esthetic procedure. Case [...] Read more.

Background: Chronic maxillary sinusitis is most often linked to dental, allergic, or anatomical etiologies, with foreign body-induced forms remaining rare. This case report describes a unique occurrence of chronic maxillary sinusitis resulting from misplaced hyaluronic filler due to a facial esthetic procedure. Case presentation: A 60-year-old woman experienced right-sided maxillary sinusitis symptoms for three years after hyaluronic filler injections. Multi-slice computed tomography showed total sinus opacification, a vermicular foreign body, and a small anterior wall perforation. The patient underwent Caldwell-Luc surgery for foreign body removal and mucosal excision, followed by histopathological analysis. Results: The procedure was successful, with complete extraction of the foreign body compatible with hyaluronic filler. Postoperative recovery was uneventful, and symptoms resolved. This rare complication likely resulted from accidental filler penetration into the maxillary sinus during the injection. Conclusions: To the best of our knowledge, after a detailed search of the available literature, this is the first reported case of chronic maxillary sinusitis caused by material that is compatible with misplaced hyaluronic filler. It stresses the critical need to minimize serious complications in the facial esthetic procedures through detailed anatomical knowledge, technical skill, and a strict credentialing protocol of practitioners. Further awareness and regulations could improve patient safety. Full article

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12 pages, 253 KB

Open AccessArticle

Cultural Biases and Clinical Variation

by Óscar Gasulla, Antonio Sarría-Santamera, Ferran A. Mazaira-Font, Cielo García-Montero, Oscar Fraile-Martinez, Diego Cantalapiedra, Manuel F. Carrillo-Rodríguez, Belen Gómez-Valcárcel, Miguel Á. Ortega, Melchor Álvarez-Mon and Angel Asúnsolo

Clin. Pract. 2025, 15(12), 229; https://doi.org/10.3390/clinpract15120229 - 5 Dec 2025

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Abstract

Background: This study investigates the possible role of cultural biases in clinical variation. Methods: An observational, analytical, and retrospective cohort design, using a Spanish primary care database, was used, on which a cross-sectional analysis was performed. Diseases were classified into the [...] Read more.

Background: This study investigates the possible role of cultural biases in clinical variation. Methods: An observational, analytical, and retrospective cohort design, using a Spanish primary care database, was used, on which a cross-sectional analysis was performed. Diseases were classified into the following: generic conditions with established protocols (control group), specialist-diagnosed diseases, women’s diseases, and psychiatric diseases. Diagnostic incidence was calculated across 25 geographical clusters, and variability was measured using the coefficient of variation (CV). To test systematic differences, multivariate linear regression models were adjusted for socio-demographics and healthcare system proxies. Results: The final sample for analysis consisted of 617,222 women aged 15 to 65, with a mean age of 43. The results did not reveal significant variability between generic and specialized diseases, but women’s and psychiatric diseases showed consistently higher CVs in all models (p < 0.05), indicating that approximately 20% to 30% of the clinical variation observed in these groups was unexplained. Conclusions: Although we cannot establish causality, these findings may suggest that cultural taboos and gender biases likely contribute to unjustified clinical variation, highlighting cultural bias as a plausible explanatory factor. Full article

12 pages, 241 KB

Open AccessArticle

Epidemiological and Clinical Behavior of Snakebite in the Pediatric Population, Associated with a Logistic Regression Model

by Cándida Revollo Vargas, Osnamir Bru-Cordero and Karina Pastor-Sierra

Clin. Pract. 2025, 15(12), 228; https://doi.org/10.3390/clinpract15120228 - 5 Dec 2025

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Abstract

Introduction: Snakebite envenomation is recognized by the World Health Organization (WHO) as a neglected tropical disease. In Colombia, snakebites are frequent due to the diversity of ecosystems and snake species, and children represent a particularly vulnerable population. Objective: This study aimed to characterize [...] Read more.

Introduction: Snakebite envenomation is recognized by the World Health Organization (WHO) as a neglected tropical disease. In Colombia, snakebites are frequent due to the diversity of ecosystems and snake species, and children represent a particularly vulnerable population. Objective: This study aimed to characterize the epidemiological and clinical behavior of snakebite envenomation in the pediatric population and to identify factors associated with its severity through the application of a multinomial logistic regression model. Methods: An exploratory analysis was conducted on 170 pediatric patients reported to the Public Health Surveillance System (SIVIGILA) and treated at San Jerónimo Hospital in Montería (HSJ). Sociodemographic and clinical data were collected, and a multinomial logistic regression model was applied to identify risk factors associated with the severity of envenomation. Results: Most cases occurred in children over 12 years of age (51.8%), and males were the most affected. The lower limbs were the most common site of the bite (87.6%). Bothrops was the main genus responsible. Non-medical practices, such as herbal poultices and potions, were reported in 28.2% of cases. Clinically, moderate envenomation was the most frequent (48.2%), with edema (88%) and pain (92%) as the main local manifestations, and nausea (36%) and vomiting (32%) as systemic manifestations. Cellulitis was the most common complication (24%). Student’s t-test showed a significant difference between complications and hospital stays lasting 3 to 7 days. The multinomial logistic regression explained 75% of the severity variability and showed that prior non-medical practices increased the risk of severe cases. Conclusions: Snakebite envenomation in children remains an important public health problem. The statistical model showed that non-medical practices are associated with a higher degree of severity. Full article

15 pages, 2624 KB

Open AccessArticle

Ultrasound Assessment of the Tibial Nerve at the Retromalleolar Level: Influence of Anthropometric Characteristics and Clinical Implications

by María Benimeli-Fenollar, Cecili Macián-Romero, Lucía Carbonell-José, María José Chiva-Miralles, José Maria Montiel-Company, José Manuel Almerich-Silla, Rosa Cibrian and Vicent Tomás-Martínez

Clin. Pract. 2025, 15(12), 227; https://doi.org/10.3390/clinpract15120227 - 3 Dec 2025

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Abstract

Background: Clinical procedures involving the tibial nerve (TN) are complex procedures due to its deep anatomical position and the variability of its course in the retromalleolar region. Few studies have described the ultrasound characteristics of the TN in vivo. This study aims to [...] Read more.

Background: Clinical procedures involving the tibial nerve (TN) are complex procedures due to its deep anatomical position and the variability of its course in the retromalleolar region. Few studies have described the ultrasound characteristics of the TN in vivo. This study aims to describe the ultrasound position of the TN and its relationship with the posterior tibial artery (PTA) at the retromalleolar level, evaluating the influence of sex, weight, height, and body mass index (BMI). Methods: A cross-sectional ultrasound study was performed on 100 volunteers. Anthropometric variables were recorded. Ultrasound measurements included the TN perimeter, distance from the medial malleolus to the TN center, depth, and spatial relationship with the PTA. Statistical analyses included Student’s t-test, ANOVA, Chi-square test, and Pearson’s correlation coefficient, with a significance level of p < 0.05. Results: The mean distance from the TN to the medial malleolus was 2.17 cm, and its mean depth was 0.91 cm. The most common anatomical pattern was Type I (TN posterior to the PTA) (60%). Sex influenced TN position, with men showing greater distances from the medial malleolus to the TN center (2.42 vs. 1.99 cm) and women showing greater depth from the skin surface to the upper edge of the tibial nerve perimeter (0.94 vs. 0.86 cm). Weight (p = 0.004), height (p < 0.001), and ankle circumference (p = 0.006) correlated significantly with TN location, whereas BMI did not (p = 0.253). Conclusion: These findings provide clinically relevant reference data that may improve the precision and safety of different tibial nerve procedures. Full article

(This article belongs to the Topic The Use of New Technologies, Artificial Intelligence and Digital Twin in Health and Clinical Practice)

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17 pages, 502 KB

Open AccessArticle

Systemic and Oral Factors Relating to Stress in Later Life: A Study Using the Japanese National Statistics Database

by Kanako Seino, Akira Komatsuzaki, Kanako Mitomi, Mio Susuga, Sachie Ono, Yukika Enoki, Asami Iguchi, Hiromi Fujita and Naru Komatsuzaki

Clin. Pract. 2025, 15(12), 226; https://doi.org/10.3390/clinpract15120226 - 1 Dec 2025

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Abstract

Background: The psychosomatic effects of stress are risk factors for a range of dental and systemic diseases. This study used the massive Japanese national statistics database to clarify the association of psychological stress with subjective symptoms and conditions requiring hospital visits. Methods [...] Read more.

Background: The psychosomatic effects of stress are risk factors for a range of dental and systemic diseases. This study used the massive Japanese national statistics database to clarify the association of psychological stress with subjective symptoms and conditions requiring hospital visits. Methods: Anonymized data from 93,690 respondents of the 2019 Japanese survey were provided for this study. From these data, those of 29,777 respondents aged 40–89 years were classified into stress groups based on their responses to the Kessler Psychological Distress Scale (K6). The response rates for symptoms and diseases were compared and analyzed using contingency tables and binomial logistic regression. Results: The items with the largest odds ratios in the univariate analysis were depression/other mental disease (7.60), followed by irritability (6.86) and health perception QOL (6.31). Among those with subjective symptoms, the proportion in the high-stress group was higher (15.1%), with a univariate odds ratio of 3.17. The results of the binomial logistic regression analysis, with subjective QOL as the dependent variable, were as follows: The explanatory variables with the highest adjusted odds ratios were stress group classification (3.14), followed by feeling physically tired (2.44) and sleep satisfaction (2.22). The stress group was associated with subjective symptoms, such as irritability and depression/other mental diseases, as well as with social factors, such as household structure and work hours. These results suggest the existence of specific symptoms, diseases, and environmental factors associated with high stress. Conclusions: The results suggest that stress may have a substantial impact on quality of life in later life. Therefore, healthcare measures for older adults should focus on the symptoms and diseases that tend to be associated with stress to mitigate their effects. Full article

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9 pages, 214 KB

Open AccessBrief Report

Sjogren Disease and Nephrolithiasis: A Case Series and Review of the Literature

by Ben Schroeder, Chokkalingam Siva and Chen-Chung Steven Liu

Clin. Pract. 2025, 15(12), 225; https://doi.org/10.3390/clinpract15120225 - 28 Nov 2025

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Abstract

Background: Primary Sjogren Disease (pSD) is a chronic autoimmune disease characterized by a classic triad of keratoconjunctivitis sicca, xerostomia, and polyarthritis. The primary pathological feature of pSD is lymphoplasmacytic infiltration in glandular epithelial tissue, often affecting the salivary and lacrimal glands, leading to [...] Read more.

Background: Primary Sjogren Disease (pSD) is a chronic autoimmune disease characterized by a classic triad of keratoconjunctivitis sicca, xerostomia, and polyarthritis. The primary pathological feature of pSD is lymphoplasmacytic infiltration in glandular epithelial tissue, often affecting the salivary and lacrimal glands, leading to classic sicca symptoms (ocular and oral dryness). Sjogren Disease (SD) can be categorized as “primary” when occurring independently or “secondary” when accompanying another autoimmune connective tissue disorder such as rheumatoid arthritis, systemic lupus erythematosus, or systemic sclerosis. Additionally, systemic disease is common in pSD and can manifest with kidney dysfunction resulting in nephrolithiasis and distal renal tubular acidosis (dRTA). Methods: This report details a case series drawing patients from the literature as well as patients from our institution which serves to demonstrate key points in clinical hallmarks. We utilize a literature search with key words Sjogren Disease, nephrolithiasis, renal tubular acidosis, and nephrocalcinosis in addition to pSD patients with concomitant nephrolithiasis at our institution to characterize clinical and serologic findings as well as treatment modalities. Results: We find well demonstrated clinical hallmarks such as female predominance and presence of dRTA amongst the cohort of pSD patients. We also find that further research on pSD serologies could prove beneficial in risk stratifying those most likely to develop renal disease and nephrolithiasis. Furthermore, we review signs, symptoms, pathophysiology, and management of SD with added emphasis on associated renal disease including nephrolithiasis and dRTA. Conclusion: Overall, pSD associated renal disease remains an area of ongoing research and further study on patient serologies may aid clinicians in better serving and surveilling patients at risk of systemic involvement. Full article

10 pages, 1403 KB

Open AccessCase Report

Erythroderma, Alopecia, Anhidrosis, and Vitiligo as Complications of a Red Ink Tattoo—A Case Report

by Mateusz K. Mateuszczyk, Magdalena Łyko, Andrzej Bieniek, Joanna Maj and Alina Jankowska-Konsur

Clin. Pract. 2025, 15(12), 224; https://doi.org/10.3390/clinpract15120224 - 28 Nov 2025

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Abstract

Background: Adverse reactions to tattoo pigments are increasingly recognized, yet severe systemic complications remain rare and poorly characterized. Red tattoo ink, in particular, is associated with delayed hypersensitivity reactions, but widespread manifestations affecting multiple organ systems have not been documented. This case report [...] Read more.

Background: Adverse reactions to tattoo pigments are increasingly recognized, yet severe systemic complications remain rare and poorly characterized. Red tattoo ink, in particular, is associated with delayed hypersensitivity reactions, but widespread manifestations affecting multiple organ systems have not been documented. This case report aims to describe an unusual constellation of erythroderma, alopecia universalis, anhidrosis, and vitiligo triggered by red tattoo ink and to highlight the diagnostic and therapeutic challenges associated with such reactions. Case presentation: This case report describes a 36-year-old Caucasian male who developed erythroderma, alopecia, anhidrosis, and vitiligo as complications of a red ink tattoo, marking a rare and previously unreported case of such extensive reactions. Four months after getting the tattoo, the patient began to develop itchy eczematous changes, which progressed to erythroderma over several months, along with alopecia universalis and anhidrosis. Results: After months of ineffective treatment with glucocorticosteroids, cyclosporine, methotrexate, and acitretin, patch tests confirmed hypersensitivity to possible components of the red tattoo ink, prompting surgical removal of the inflamed tattoo fragments. Unfortunately, aside from resolving the erythroderma, this did not improve the patient’s clinical condition, and he developed vitiligo. Only after the complete removal of the red tattoo ink from the same series that caused the sensitization and the use of immunosuppressive and immunomodulatory drugs, including JAK inhibitors, was hair growth restored and the progression of vitiligo halted, but with no effect on anhidrosis. Conclusions: This case highlights the challenges in managing systemic reactions to tattoo ink and the importance of thorough evaluation and treatment strategies. Full article

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9 pages, 1390 KB

Open AccessCase Report

A Case of Extensive Airway Necrosis Following Esophagectomy Successfully Treated with Airway Stenting

by Tatsuki Tsuruga, Hajime Fujimoto, Esteban C. Gabazza, Masaki Ohi, Masahide Oki and Tetsu Kobayashi

Clin. Pract. 2025, 15(12), 223; https://doi.org/10.3390/clinpract15120223 - 27 Nov 2025

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Abstract

Background: Airway stenting is an alternative therapy for patients with complicated esophagectomy. Case presentation: A 60-year-old man with clinical stage IIIA esophageal cancer underwent neoadjuvant chemotherapy followed by robot-assisted subtotal esophagectomy with cervical esophagogastrostomy and jejunostomy. During surgery, both bronchial arteries were ligated [...] Read more.

Background: Airway stenting is an alternative therapy for patients with complicated esophagectomy. Case presentation: A 60-year-old man with clinical stage IIIA esophageal cancer underwent neoadjuvant chemotherapy followed by robot-assisted subtotal esophagectomy with cervical esophagogastrostomy and jejunostomy. During surgery, both bronchial arteries were ligated to facilitate esophageal mobilization. Bronchoscopy on the first postoperative day showed no abnormalities; however, by the second postoperative day, the patient developed pneumonia and septic shock, requiring mechanical ventilation. On the fifth postoperative day, bronchoscopy revealed extensive epithelial injury extending from the trachea to both main bronchi, indicating ischemic airway damage. He was diagnosed with airway necrosis and referred to our respiratory department. Serial bronchoscopic examinations and suctioning of the sloughed epithelium were performed, and a tracheostomy enabled weaning from mechanical ventilation. By the twenty-fourth postoperative day, bronchoscopy revealed the accumulation of large, hardened secretions within the trachea, carina, and both main bronchi, resulting in airway narrowing and a high risk of asphyxiation. A silicone Y-shaped airway stent was inserted to maintain patency. Following stent placement, airway secretions progressively decreased, and the patient was discharged on the sixty-third postoperative day. The stent was removed six months later, with no recurrence of airway or respiratory complications. Conclusion: This case illustrates a rare but severe complication of extensive airway necrosis, likely caused by intraoperative bronchial artery ligation and dissection of the tracheal membranous portion. Although preservation of the bronchial arteries and meticulous surgical technique are essential preventive strategies, such complications may be unavoidable. In cases of extensive airway necrosis, airway stenting can serve as an effective therapeutic option to prevent obstruction and support recovery. Full article

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23 pages, 654 KB

Open AccessSystematic Review

The Effectiveness and Safety of Stem Cell-Based Tissue Engineering in the Regeneration of Periodontal Bone Lesions: A Systematic Review

by Marouan Fanid, Ana Sofia Vinhas, Cátia Reis, Marta Relvas, Rosana Costa and Cristina Cabral

Clin. Pract. 2025, 15(12), 222; https://doi.org/10.3390/clinpract15120222 - 26 Nov 2025

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Abstract

Background/Objectives: Periodontal diseases are highly prevalent worldwide, causing progressive destruction of the alveolar bone and eventual tooth loss when not treated. Despite advances in conventional periodontal therapies, complete tissue regeneration remains limited. This review aims to evaluate the efficacy, safety, and clinical relevance [...] Read more.

Background/Objectives: Periodontal diseases are highly prevalent worldwide, causing progressive destruction of the alveolar bone and eventual tooth loss when not treated. Despite advances in conventional periodontal therapies, complete tissue regeneration remains limited. This review aims to evaluate the efficacy, safety, and clinical relevance of stem cell-based tissue engineering approaches for regeneration of periodontal bone lesions. Methods: Following PRISMA guidelines, a systematic search was conducted across multiple databases, resulting in the inclusion of 17 studies in humans that met predefined PICO criteria. The study protocol was registered on PROSPERO (CRD420251229271). These studies assessed various stem cell sources, including dental and bone marrow-derived cells among others, both on their own and in combination with scaffolds or growth factors. Results: Most studies reported favorable outcomes in terms of clinical attachment gain, radiographic bone fill, probing depth reduction, and implant stability. No major adverse effects were noted, indicating good safety. However, results varied based on cell type, culture protocols, and defect characteristics. Conclusions: Stem cell therapy shows strong potential for periodontal regeneration, with outcomes that may potentially surpass those of conventional methods in selected cases. Further standardization, cost reduction, and long-term clinical trials are essential to confirm these findings and support their integration into daily dental practice. Full article

(This article belongs to the Special Issue New Trends, Materials, and Technologies and Consolidating Best Practices in Dentistry, 2nd Edition)

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15 pages, 930 KB

Open AccessSystematic Review

Preventive Strategies for Upper Extremity Deep Venous Thrombosis Following Elective Upper Limb Surgery: A Systematic Review

by Aeshah Salem Alsharidah, Alya Ali Aljubran, Maha Alkharisi, Taif Alnafie, Dhai Almuteri, Zahra Almarhabi, Noor Alawami, Shaykhah Alkulaib, Hashmiah Aljarash, Zain Abdullah and Abdullah Almaqhawi

Clin. Pract. 2025, 15(12), 221; https://doi.org/10.3390/clinpract15120221 - 26 Nov 2025

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Abstract

Background/Objectives: Upper extremity deep vein thrombosis (UEDVT) is a harmful complication of elective upper limb surgeries. Different strategies are employed to prevent this condition. The aim of the review is to quantify the effectiveness of various preventive interventions and investigate correlated factors that [...] Read more.

Background/Objectives: Upper extremity deep vein thrombosis (UEDVT) is a harmful complication of elective upper limb surgeries. Different strategies are employed to prevent this condition. The aim of the review is to quantify the effectiveness of various preventive interventions and investigate correlated factors that affect the incidence of UEDVT (upper extremity deep vein thrombosis). Methods: We performed a systematic search using the PubMed, EBSCO, Ovid, EMBASE, Cochrane, and Google Scholar databases. Randomized controlled trials (RCTs), prospective or retrospective cohort studies, or case–control studies were examined. We included adult patients over 18 years old undergoing elective upper limb surgery and receiving Prophylactic measures for Upper Extremity Deep Venous Thrombosis. Results: After a literature search and quality assessment, 6 studies were included. All the studies were of good quality but significantly heterogeneous in terms of sample size, population size, treatment modalities, and baseline characteristics. In these studies, the reported incidence of symptomatic venous thromboembolism (VTE) varied widely, ranging from 0.41% to 13%. However, thromboprophylaxis did not have a significant impact on the rates of deep vein thrombosis (DVT). Certain factors such as older age and trauma as the cause of surgery were identified as notable risk factors for symptomatic VTE. Conclusions: This systematic review highlights the complexity of preventing upper extremity deep vein thrombosis (UEDVT) following elective upper limb surgeries. The reported incidence of symptomatic VTE varies considerably across studies, and thromboprophylaxis was not associated with a significant reduction in its rates. The evidence is characterized by substantial heterogeneity in patient populations and surgical contexts. More research is needed to better understand the role of thromboprophylaxis in preventing DVT. Full article

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

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17 pages, 308 KB

Open AccessArticle

Assessment of Associations Between Sociodemographic and Analysis of Risk Factors for Oral Infectious Pathology in Patients Scheduled for Total Hip and Knee Arthroplasty

by Dana Nicoleta Mihai, Paul Dan Sîrbu, Liliana Savin, Norin Forna, Claudiu Topoliceanu, Cristina Dascălu and Norina Consuela Forna

Clin. Pract. 2025, 15(12), 220; https://doi.org/10.3390/clinpract15120220 - 24 Nov 2025

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Abstract

The aim of this study was to evaluate the factors associated with the occurrence of oral infection sources in patients scheduled for total hip or knee arthroplasty, with the purpose of establishing standardized preoperative dental triage criteria. Materials and Methods: A retrospective research [...] Read more.

The aim of this study was to evaluate the factors associated with the occurrence of oral infection sources in patients scheduled for total hip or knee arthroplasty, with the purpose of establishing standardized preoperative dental triage criteria. Materials and Methods: A retrospective research was conducted on a study group of 89 patients diagnosed with hip osteoarthritis and knee osteoarthritis at the Clinical Rehabilitation Hospital (Iasi, Romania). Patients were divided according to the status of their oral cavity: study group (n = 51)—patients with diagnosed oral infection sites (oral foci of infection); control group (n = 38)—patients without oral foci of infection. The statistical analysis included a univariate stage followed by a multivariate binary logistic regression to identify demographic and clinical factors associated with the presence of oral foci of infection. Results: The strongest predictor of the presence of oral foci of infection was and Oral Hygiene Index (OHI) scorer of 2, which increased the risk 14.583-fold, followed by being aged between 50 and 65 years (OR = 4.038), tooth brushing once a day or less (OR = 3.488), and male sex (OR = 3.433). An OHI score of 2 raises the probability of oral infectious pathology to 30.3%, which increases to 85.1% when combined with being aged between 50 and 65 years. Conclusions: The risk factors for the presence or oral foci of infection in patients scheduled for total knee or hip arthroplasty support the inclusion of the preoperative assessment and management of these factors in order to reduce the risk of the postoperative periprosthetic joint infections. Full article

28 pages, 1331 KB

Open AccessReview

ECM Remodeling in Direct Inguinal Hernia: The Role of Aging, Oxidative Stress, and Antioxidants Defenses

by John Dawi, Yura Misakyan, Edgar Gonzalez, Kevin Kafaja, Scarlet Affa, Kevin Tumanyan, Kyla Qumsieh and Vishwanath Venketaraman

Clin. Pract. 2025, 15(12), 219; https://doi.org/10.3390/clinpract15120219 - 24 Nov 2025

Cited by 1 | Viewed by 694

Abstract

Inguinal hernia represents a multifactorial condition driven by extracellular matrix (ECM) dysregulation, collagen imbalance, and oxidative stress. Across studies, a consistent reduction in the collagen I:III ratio, coupled with altered expression of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs), underpins weakened [...] Read more.

Inguinal hernia represents a multifactorial condition driven by extracellular matrix (ECM) dysregulation, collagen imbalance, and oxidative stress. Across studies, a consistent reduction in the collagen I:III ratio, coupled with altered expression of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs), underpins weakened fascia and hernia susceptibility. Aging further impairs ECM remodeling through fibroblast senescence, cross-linking deficits, and elastic fiber attrition, while oxidative stress and inflammation amplify tissue degradation and impair repair mechanisms. Evidence from clinical and experimental studies underscores the interplay between surgical technique, mesh choice, redox balance, and recurrence risk. Understanding the combined impact of aging and oxidative stress provides a mechanistic framework for targeted therapeutic and surgical strategies aimed at preventing hernia development and recurrence. Full article

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9 pages, 4869 KB

Open AccessCase Report

Urinary Bladder Hamartoma: Narrative Literature Review of an Exotic Pathology and Rare Cause of LUTS

by Mohammed Rafea Kanaan, Meryem Akkoyun, Marcel Lafos, Markus Antonius Kuczyk and Hossein Tezval

Clin. Pract. 2025, 15(12), 218; https://doi.org/10.3390/clinpract15120218 - 24 Nov 2025

Viewed by 234

Abstract

Urinary bladder hamartoma is an exceptionally rare benign lesion composed of disorganized yet mature tissue elements native to the bladder, including urothelium, fibrous stroma, smooth muscle, and occasionally adipose tissue. Unlike malignant tumors, it lacks cytological atypia, mitotic activity, or necrosis. Patients most [...] Read more.

Urinary bladder hamartoma is an exceptionally rare benign lesion composed of disorganized yet mature tissue elements native to the bladder, including urothelium, fibrous stroma, smooth muscle, and occasionally adipose tissue. Unlike malignant tumors, it lacks cytological atypia, mitotic activity, or necrosis. Patients most often present with lower urinary tract symptoms (LUTS) or hematuria, though some cases are incidental findings. Associations with syndromic conditions such as Peutz–Jeghers, Beckwith–Wiedemann, Goldenhar, and Loeys–Dietz have been reported. Transurethral resection is the preferred treatment and has generally been curative. We report the first case in Germany—and the 16th worldwide—of urinary bladder hamartoma, occurring in a young adult male with bothersome LUTS. Because of its proximity to both ureteral orifices, only partial transurethral resection was performed, which provided durable symptom relief at 14 months of follow-up. This case highlights partial TUR as a pragmatic, organ-preserving alternative when complete resection is anatomically unsafe, while emphasizing that TURBT remains the standard of care. We provide a detailed discussion of the histopathological features, differential diagnosis, treatment considerations, and an updated narrative review of all reported cases. Full article

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14 pages, 1368 KB

Open AccessArticle

Biomarker-Based Diagnosis of Contact Dermatitis: A Step Towards More Accurate and Patient-Friendly Testing

by Nique Grob, Thomas Rustemeyer and Florentine de Boer

Clin. Pract. 2025, 15(12), 217; https://doi.org/10.3390/clinpract15120217 - 21 Nov 2025

Viewed by 519

Abstract

Background: Contact dermatitis (CD) is a prevalent inflammatory skin condition, with diagnostic challenges in distinguishing allergic (ACD) from irritant contact dermatitis (ICD). This study aimed to explore cholesterol-derived biomarkers as potential diagnostic tools. As cholesterol derivatives play key roles in skin barrier integrity [...] Read more.

Background: Contact dermatitis (CD) is a prevalent inflammatory skin condition, with diagnostic challenges in distinguishing allergic (ACD) from irritant contact dermatitis (ICD). This study aimed to explore cholesterol-derived biomarkers as potential diagnostic tools. As cholesterol derivatives play key roles in skin barrier integrity and inflammation, they are promising candidates for assessing skin barrier disruption in CD. Methods: Stratum corneum samples were collected by tape stripping from experimentally induced and chronic lesions, as well as healthy non-lesional skin. Biomarkers Cholesterol Sulfate (Chol-Sulf), Cholesterol Glucosyl (Chol-Glc) and their ratio were quantified. Data were analyzed using ANOVA, Pearson’s correlation, logistic regression and ROC curves. Results: Chol-Glc and the Chol-Glc/Chol-Sulf ratio differed significantly across the diagnostic groups, while Chol-Sulf did not. Logistic regression and ROC analyses revealed a limited standalone diagnostic accuracy for the individual biomarkers (all AUC < 0.6). Conclusions: Chol-Glc and the ratio exhibit disease-specific patterns relevant for subtype discrimination. Although insufficient as independent diagnostic tools, these markers may contribute to future multivariate diagnostic models for CD diagnosis. Full article

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Clin. Pract., Volume 15, Issue 12 (December 2025) – 21 articles

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