Clin. Pract., Volume 15, Issue 5 (May 2025) – 8 articles

Background: The role of vitamin D deficiency (VDD) in both mothers and neonates has been suggested as a possible factor in the development of allergic conditions in early infancy, however limited research has investigated this link in relation to allergic rhinitis (AR). This study investigates whether VDD in the mother–newborn dyad is associated with the onset of AR in neonates within the first three days after birth. The aim is to contribute to the understanding of neonatal allergic outcomes related to vitamin D status, which may inform future preventive strategies. This study investigates the role of vitamin D in the early onset of allergic rhinitis (AR) in neonates, specifically within the first three days of life. Although AR typically develops after years of allergen exposure and is rare in children under two, we aimed to explore its occurrence at this early stage. While no clear link was found between vitamin D and early AR onset, further research is needed to explore vitamin D levels at later ages and over longer time frames to clarify the relationship. Methods: A cross-sectional study was conducted between September 2019 and January 2022 in a single hospital. The study involved 248 infants born at ≥37 weeks of gestation and their mothers, who were of Greek nationality. The study included mother–infant pairs who met the inclusion criteria. Chi-square tests were applied to analyze the association between maternal or neonatal VDD and the presence of AR in neonates within the first three days after birth. In addition, multiple regression analysis was used to control other potential factors contributing to AR. Results: The results showed an unclear relationship between VDD and the onset of AR in neonates within the first three days of life. Although several factors were analyzed, the effect of VDD on the development of AR remained unclear. Conclusions: The findings highlight the lack of clarity regarding the effect of maternal and neonatal VDD on the incidence of AR in the immediate neonatal period. Few studies to date have specifically examined the role of VDD in neonatal AR. Further research with larger sample sizes is needed to verify these associations and to guide potential interventions aimed at reducing allergic outcomes in neonates. Full article

Background: Early sport specialization, involving intensive focus on a single sport for greater than 8 months per year at a prepubescent age, has become increasingly common in young athletes. While early sport specialization is often regarded as essential for success, there is growing concern that the potential risks to young athletes may outweigh the perceived benefits. Although numerous studies have explored early sport specialization, there has been no summative review on the topic in regard to the comprehensive impact on outcomes in these athletes. This study aims to systematically review the literature to determine the impacts of early specialization on injury, function, performance, sport success, and psychological outcomes. Methods: A review of Medline (PubMed) was conducted to search for studies relating to early sport specialization in pediatric patients (time of specialization < 18 years old) and outcomes. Extracted information included injury outcomes with a focus on overuse injuries, functional outcomes, performance outcomes, sport success, and psychological outcomes. For studies that reported relevant statistics, p < 0.05 was considered statistically significant. All studies were described qualitatively. Results: An initial search resulted in a total of 826 studies. After applying inclusion and exclusion criteria, 93 studies were included. A total of 62,327 athletes were included in the study. The average age of study participants was 15.9 years, with an average age at specialization of 11.6 years. Early sport specialization was associated with increased risk of injury, worse functional and physical performance, decreased or no benefit to sport success, and poor psychological outcomes. Conclusions: Early sport specialization was associated with increased risk of injury and negative impacts on functional and physical performance measures. There was also no clear advantage regarding sport success. Early sport specialization was linked to harmful effects on athlete psychological well-being. Late specialization, multisport participation, and following training volume guidelines can aid in mitigating these risks. Full article

Background: To develop and validate the Tinnitus Qualities and Impact Questionnaire (TQIQ), a new tool for evaluating the perceived qualities of tinnitus sound. Method: The study was part of two clinical trials on internet-based tinnitus interventions, using cross-sectional (n = 380) and pretest–posttest data (n = 280). Participants completed various questionnaires online, including the newly developed TQIQ and measures of tinnitus severity (Tinnitus Functional Index; TFI), anxiety (Generalized Anxiety Disorder 7; GAD-7), depression (Patient Health Questionnaire 9; PHQ-9), insomnia (Insomnia Severity Index; ISI), and health-related quality of life (EQ-5D-5L Visual Analog Scale; VAS). The psychometric properties of the TQIQ were assessed, including construct validity, internal consistency reliability, floor and ceiling effects, interpretability, and responsiveness to treatment. Results: Exploratory factor analysis resulted in two factors that accounted for 57% of the variance—internal and external tinnitus qualities. Overall, 92% convergent validity predictions were confirmed; TQIQ total scores strongly (≥0.6) or moderately (0.30 to 0.59) correlated with the TFI, GAD-7, PHQ-9, and ISI. The known-groups validity prediction was confirmed as individuals with an overall TFI score > 50 (severe) obtained significantly higher TQIQ scores. All internal consistency reliability statistics were within the required range (Cronbach’s α > 0.8). Floor and ceiling effects were negligible. ROC established clinically important cut-off scores, enhancing the interpretability of tinnitus severity classification. Finally, 89% convergent validity predictions were confirmed; TQIQ and TFI change scores were moderately correlated, indicating good responsiveness of the former to treatment. Conclusions: The TQIQ has adequate psychometric properties, providing a standardized measure for the assessment of characteristics of tinnitus sound in clinical practice. Full article

Background: Heart failure (HF) is a leading cause of mortality across the globe, prompting ongoing research into novel biomarkers for improved risk stratification and patient management. Methods: This cross-sectional study aimed to investigate the relationship between two promising biomarkers, tetranectin and paraoxonase 1, and the severity of heart failure in a cohort of 87 patients with cardiovascular risk factors. Participants were categorized into three groups based on their New York Heart Association (NYHA) classification: no HF (Control), NYHA class I (G1), and NYHA class II-IV (G2). Results: Our analysis revealed a stepwise decrease in both TETRA and PON1 levels with increasing HF severity, with the Control group exhibiting the highest levels and the G2 group the lowest. Interestingly, a significant positive correlation between TETRA and PON1 was observed only in the Control group, suggesting a potential interplay between these biomarkers in healthy individuals that may be disrupted with the onset of HF. Furthermore, both TETRA and PON1 were positively associated with left ventricular ejection fraction (LVEF) and negatively associated with diastolic dysfunction, indicating their potential involvement in both systolic and diastolic cardiac function. Conclusions: These findings suggest that TETRA and PON1 may serve as valuable biomarkers for assessing HF severity and prognosis. Further research is warranted to validate these findings in larger, prospective studies and to explore their clinical utility in guiding treatment decisions. Full article

Introduction: Post-tonsillectomy hemorrhage is a serious complication that varies according to the surgical technique used, potentially compromising patient safety and recovery. Even though several techniques were frequently used, including cold steel dissection, coblation, monopolar diathermy, and bipolar diathermy, there were certain discrepancies in hemorrhage rates in the literature. This meta-analysis aims to compare the rates of primary and secondary hemorrhage among these surgical techniques, with a focus on guiding clinical decision-making. Methodology: A total of 12 studies, published between 2005 and 2024, were selected from the PubMed, Web of Science, Scopus, and Cochrane Library databases, comprising 1684 participants from both pediatric and adult groups. Primary and secondary hemorrhage rates, surgical techniques, and study characteristics were extracted as data. Therefore, the aim of performing this meta-analysis with random-effects models was to calculate pooled estimates for hemorrhage rates and the heterogeneity index (I²). The techniques studied included cold steel dissection, coblation, monopolar diathermy, and bipolar diathermy. Results: The pooled primary hemorrhage rate across all techniques was 1.0% (95% Cl: 0.5–1.4%), with insignificant heterogeneity (I² = 0.0%, p < 0.665). By contrast, pooled secondary hemorrhage occurred at a rate of 5.8% (95% CI: 3.9–7.6%). Cold steel tonsillectomy was associated with the lowest secondary hemorrhage rate of 3.7% (95% CI: 0.8–6.6%, I² = 43.558%, p = 0.115), while bipolar diathermy had the highest secondary hemorrhage rate of 8.6% (95% CI: 2.3–15.0%, I² = 86.448%, p < 0.001). Conclusions: This meta-analysis underscores the considerable variability in rates of post-tonsillectomy hemorrhage frequency among various surgical techniques. Cold steel dissection appears to be the safest regarding secondary hemorrhage, while coblation likely minimizes primary bleeding. Bipolar diathermy comes across as the technique with the highest risk for primary hemorrhage and requires special caution during its use. Such results emphasize the need for careful selection of the surgical technique concerning patients’ particular conditions and the need to enhance care periods to reduce the bearing of any hemorrhagic complications. Full article

Background and Objectives: Uveitis-masked syndromes or masquerade syndromes (UMSs) are a group of ocular conditions with several systemic underlying causes, malignant or nonmalignant, that mimic the inflammatory status of the uvea. They are often difficult to detect and diagnose with traditional techniques, such as ophthalmic exams. Ocular B (bidimensional)-ultrasound (OBU) is a non-invasive, repeatable, rapid ultrasound method effective in indirect signs that lead back to systemic diseases. It is comparable in effectiveness with other imaging tools. The cause of UMSs can often be serious, and therefore early diagnosis and prompt treatment are critical. This study aimed to identify the sonographic signs of these forms, which can help physicians discover the cause underlying UMS. Materials and Methods: This was a consecutive, retrospective, nonrandomized study. This study was conducted at the University Hospital Polyclinic of Bari, Italy, from January 2022 to December 2024. A total of 186 patients were included, from 10 to 85 years old. They all underwent B-scan ultrasonography (Quantel Medical ABSolu Ocular Ultrasound). Results: All patients reported blurred vision, which could be accompanied by visual reduction (<20/40, Snellen charts), photophobia, floaters, flashes, proptosis, and redness. In all cases, we noted peculiar ultrasonographic signs, which allowed us to discriminate the underlying systemic diagnosis, such as vitreous corpuscles, choroid thickening, and primitive or metastatic solid tumors. Finally, we identified different diseases, such as primary intraocular lymphoma (PIOL), other lymphoproliferative conditions, orbital plasmacytoma, uveal melanoma, metastasis, endogenous endophthalmitis, retinal detachment, central serous retinopathy, metallic foreign bodies, ocular amyloidosis, and drug-induced UMSs. The sensitivity and specificity of ocular ultrasound compared to multimodal ocular imaging in UMSs were as follows: for primary intraocular lymphoma (PIOL) and other lymphoproliferative conditions, 0.98 (95% CI, 0.80–1) and 0.68 (90% CI, 0.40–0.92), respectively; for orbital plasmacytoma, 0.64 (92% CI, 0.52–0.86) and 0.66 (93% CI, 0.48–0.89), respectively; uveal melanoma, 1.00 (98% CI, 0.88–1.00) and 0.98 (95% CI, 0.86–0.98), respectively; metastasis, 0.75 (95% CI, 0.53–0.85) and 0.85 (95% CI, 0.48–0.98), respectively; endogenous endophthalmitis, 1.00 (95% CI, 0.50–1.00) and 0.83 (95% CI, 0.48–0.98), respectively; retinal detachment, both were 1.00 (95% CI, 0.87–1.00 and 0.84–0.97, respectively); central serous retinopathy, 0.60 (80% CI, 0.41–0.88) and 0.85 (95% CI, 0.52–0.98), respectively; metallic foreign bodies, 1.00 (95% CI, 0.78–1.00) and 0.99 (95% CI, 0.99–1.00), respectively; ocular amyloidosis, 0.77 (82% CI, 0.52–0.90) and 0.83 (80% CI, 0.49–0.88), respectively; and drug-induced UMSs, 0.64 (95% CI, 0.49–0.88) and 0.85 (95% CI, 0.52–0.98), respectively. Conclusions: Diagnosing UMS accurately can be quite challenging, and many of its different types frequently go undetected. This complexity in identification often leads to underdiagnosis, meaning it is essential to improve awareness and understanding of the condition in order to achieve better recognition and treatment. Early detection of these forms is imperative. The use of OBU can help diagnose indirect signs of these forms early and treat them promptly. It compares well with other diagnostic imaging techniques, such as MRI, but this does not mean that it replaces them; it can offer added value in multimodal imaging. Full article

Background/Objectives: Cumulus cells have been proposed to be indicators of oocyte quality. In this study, oocyte cumulus cells were analyzed for SERPINE gene expression. High SERPINE gene expression in cumulus cells is associated with reduced oocyte maturity. However, high mRNA levels in granulosa cells are associated with follicles that result in pregnancy. This study aimed to evaluate SERPINE gene expression in cumulus cells across different ovarian stimulation protocols and its potential impact on follicle number, oocyte maturity, and embryo quality. Methods: The sample of the study consisted of 93 infertile women that underwent a five-day fixed antagonist protocol. Detection of SERPINE gene expression levels in cumulus cells was performed by extracting and isolating the total RNA produced in granulosa cells, and conducting cDNA synthesis and Real-Time Polymerase Chain Reaction. Results: The SERPINE gene expression in CCs was assessed in 71 samples. The SERPINE gene expression levels in CCs were categorized based on the ΔCp values. Most participants (65.9%) exhibited a high expression of the SERPINE gene, with ΔCp values greater than 2. Higher gene expression resulted in a higher number of follicles. However, no statistically significant results were observed regarding the number of follicles and the number of embryos. Conclusions: The study results provide insights into the expression patterns of the SERPINE gene in CCs and underscore the complexity of fertility-related biomarkers and the need for further investigation. SERPINE expression appears to be associated with follicle count, while its role in predicting oocyte quality and pregnancy success remains inconclusive. Full article

Background: Microsurgery is a demanding surgical field requiring precision and extensive training. There is a continued need for standardized training models to improve skill acquisition and efficiency in microvascular anastomosis. Objectives: This study aimed to assess whether a standardized microsurgery training protocol, focusing on technique-specific objectives, improves performance among beginner trainees. Material and Methods: A three-month, non-randomized cohort study was conducted with entry-level plastic surgery residents. Participants were assigned to either a control group, practicing without structured guidance, or a test group, using a predefined microsurgery curriculum. Skill performance was measured at baseline, three weeks, and three months using a modified University of Western Ontario Microsurgical Skills Assessment (UWOMSA) tool. Results: While both groups improved over time, the test group demonstrated significantly greater improvement at the three-month mark (mean score: 59 vs. 38; p = 0.00027). The structured training model promoted more consistent progress and superior microsurgical technique. Conclusions: A standardized training protocol significantly enhances microsurgical proficiency over time. These findings suggest value in structured, low-cost training models for microsurgical education. Limitations include the small sample size, use of non-living models, and a non-randomized design. Full article