Clinics and Practice

9 pages, 866 KiB

Open AccessCase Report

Bone Marrow Aplasia and Neutropenic Fever Following Azathioprine Dose Escalation in a TPMT-Deficient Patient with Crohn’s Disease and Psoriatic Arthritis—A CARE–Compliant Case

by Krzysztof Wroński, Michał Tadeusz Holecki, Natalia Boguszewska, Marzena Skrzypczak-Zielińska and Jerzy Tadeusz Chudek

Clin. Pract. 2025, 15(6), 114; https://doi.org/10.3390/clinpract15060114 - 19 Jun 2025

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Abstract

Background: Myelotoxicity, usually manifested by moderate leukopenia (particularly neutropenia), is a well-known adverse drug reaction to azathioprine (AZA) therapy. Thiopurine methyltransferase (TMPT) and nucleoside diphosphate-linked moiety X-type motif 15 (NUDT15) genotyping are not routinely performed in patients starting AZA therapy [...] Read more.

Background: Myelotoxicity, usually manifested by moderate leukopenia (particularly neutropenia), is a well-known adverse drug reaction to azathioprine (AZA) therapy. Thiopurine methyltransferase (TMPT) and nucleoside diphosphate-linked moiety X-type motif 15 (NUDT15) genotyping are not routinely performed in patients starting AZA therapy due to their low cost-effectiveness. Additionally, the concomitant use of xanthine oxidase inhibitors and 5-aminosalicylates may slow the metabolism of 6-mercaptopurine. Case Description: We describe a case of a 26-year-old Caucasian man with Crohn’s disease and psoriatic arthritis treated with mesalazine and AZA (100 mg daily) who developed prolonged bone marrow aplasia and neutropenic fever after increasing the daily dose of AZA from 100 to 150 mg (from 44 to 66 mg/m²), without frequent total blood count monitoring. Discontinuation of AZA, multiple transfusions of red blood cells and platelet concentrate, filgrastim, empirical antibiotic therapy, and antiviral and antifungal prophylaxis were obtained after 11 days complete recovery of bone marrow aplasia. Methods: Genomic DNA genotyping of coding regions of TPMT (exons 2–9) and NUDT15 (exons 1–3). Results: Heterozygous alleles in the untranslated region (c.460G>A and c.719A>G) associated with TPMT deficiency and a benign variant (c.*7G>A) in the 3′-UTR of NUDT15 with no effect on enzyme activity were found. Conclusions: This case highlights the importance of monitoring the total blood count frequently during the first weeks of treatment with moderate-to-high doses of AZA. Furthermore, the interaction between AZA and mesalazine may play a significant role in the development of prolonged bone marrow aplasia. Full article

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18 pages, 3403 KiB

Open AccessSystematic Review

Comparing Stenting with Medical Therapy Versus Medical Therapy Alone in Patients with Intracranial Atherosclerotic Stenosis: A Current Systematic Review and Meta-Analysis

by Khalid Bin Aziz, Hussam Alhathlol, Fahad Bin Aziz, Mohammed Alshammari, Mohammed Ali Alhefdhi, Abdulrahman M. Alrasheed, Nawwaf Alfayez and Thamer S. Alhowaish

Clin. Pract. 2025, 15(6), 113; https://doi.org/10.3390/clinpract15060113 - 19 Jun 2025

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Abstract

Background: Intracranial atherosclerotic stenosis (ICAS) is a significant cause of ischemic stroke worldwide, with high recurrence rates despite optimal medical therapy. While endovascular stenting has been proposed as an adjunctive treatment, its clinical benefit remains controversial as a first line therapy. Objective: To [...] Read more.

Background: Intracranial atherosclerotic stenosis (ICAS) is a significant cause of ischemic stroke worldwide, with high recurrence rates despite optimal medical therapy. While endovascular stenting has been proposed as an adjunctive treatment, its clinical benefit remains controversial as a first line therapy. Objective: To evaluate the efficacy and safety of stenting plus medical therapy (STN+MT) compared to medical therapy alone (MT) in patients with symptomatic ICAS through a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: We systematically searched PubMed, Web of Science, the Cochrane Library, Embase, Scopus, and EBSCO for RCTs comparing STN+MT with MT in adult patients with symptomatic ICAS. Primary outcomes included transient ischemic attack (TIA), stroke, intracerebral hemorrhage (ICH), and death at 30 days and 1 year. Pooled risk ratios with 95% confidence intervals were calculated using random-effects or fixed-effects models as appropriate. Meta-regression was conducted to assess effect modification by study-level characteristics. Results: Four trials comprising 990 patients were included. STN+MT was associated with significantly higher 30-day risk of stroke and ICH compared to MT alone. No significant differences in TIA, stroke, ICH, or death were found at 1 year. Meta-regression revealed no significant effect modifiers, suggesting consistent findings across subgroups. Conclusions: Our meta-analysis consolidates the evidence that intracranial stenting as a first line therapy offers no significant advantage over medical therapy in preventing stroke in symptomatic ICAS, while it does pose added early risks. This holds true across different trials, patient demographics, and clinical scenarios examined. The consistency of this message across multiple RCTs provides a high level of evidence to guide practice. At present, aggressive medical therapy alone should be the default management for most patients. Endovascular intervention should be reserved for clinical trial settings or carefully selected salvage cases, until and unless new evidence emerges to change the risk–benefit calculus such as the promising use of balloon angioplasty in the BASIS trial. Full article

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14 pages, 219 KiB

Open AccessArticle

Administering Parenteral Medications in Managing Patients with Acute Arousal in the Behavioral Assessment Unit of the Emergency Department in Hospital Settings

by Harshini M. Liyanage, Katy Boyce, Yiting Gong, Theresa Koo, Soumitra Das and Naveen Thomas

Clin. Pract. 2025, 15(6), 112; https://doi.org/10.3390/clinpract15060112 - 16 Jun 2025

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Abstract

Background/Objectives: The administration of parenteral medications is essential in managing acute arousal within the Behavioral Assessment Unit (BAU) of the emergency department (ED), where timely and effective intervention is critical. This study aims to evaluate current practices surrounding the use of parenteral [...] Read more.

Background/Objectives: The administration of parenteral medications is essential in managing acute arousal within the Behavioral Assessment Unit (BAU) of the emergency department (ED), where timely and effective intervention is critical. This study aims to evaluate current practices surrounding the use of parenteral medications for patients with acute agitation, focusing on adherence to protocols, medication safety, documentation accuracy, and patient outcomes. Methods: A retrospective analysis was conducted on 177 cases from December 2023 to February 2024. The study assessed the demographics, diagnoses, treatment protocols, and patient outcomes, with a particular emphasis on the use of parenteral medications such as benzodiazepines and antipsychotics. The relationship between medication administration and involuntary admission, mechanical restraint usage, and patient outcomes was also explored. Results: The majority of patients were aged between 21 and 30 years, and there was a predominance of male patients across both groups. Schizophrenia was the most common diagnosis, with a higher prevalence in the parenteral group (34%) compared to the oral-only group (24%), and personality disorders were more frequent in the parenteral group. Intramuscular (IM) medication administration was strongly associated with the use of mechanical restraint, with patients receiving IM medication being 35 times more likely to require restraint, emphasizing the link between more intensive treatment approaches and behavioral challenges. The most frequently administered medications were diazepam (40.6%) and olanzapine (36.5%), with olanzapine, droperidol, and diazepam most commonly used parenterally. Documentation of physical assessments prior to parenteral administration was present in most cases, though comprehensive evaluations such as ECGs were inconsistently performed. Conclusions: Parenteral medications, including benzodiazepines and antipsychotics, were effective in rapidly stabilizing patients, but the study emphasizes reducing dependency on mechanical restraints. Tailoring treatment to patient characteristics and employing alternative de-escalation strategies can improve safety and align with recovery-oriented care. This study highlights the need for evidence-based practices to optimize care and improve patient outcomes in ED settings. Further research is needed to explore long-term outcomes and refine non-coercive care approaches. Full article

18 pages, 273 KiB

Open AccessArticle

Validation, Content Validity, and Reliability of the Spanish SE-OAM Questionnaire: Assessing Nursing Self-Efficacy in Oral Anticoagulant Therapy Management

by Juan Ramón de-Moya-Romero, Raquel Valera-Lloris, Elena Chover-Sierra, Laura Fernández-Puerta, Alexis Caballero-Bonafé and Antonio Martínez-Sabater

Clin. Pract. 2025, 15(6), 111; https://doi.org/10.3390/clinpract15060111 - 16 Jun 2025

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Abstract

Background/Objectives: Oral anticoagulant therapy (OAT) has been prescribed for over seventy years to prevent thromboembolic complications associated with various conditions. The emergence of direct-acting oral anticoagulants (DOACs) has reduced the use of vitamin K antagonists (VKAs), but specific clinical scenarios still necessitate VKAs. [...] Read more.

Background/Objectives: Oral anticoagulant therapy (OAT) has been prescribed for over seventy years to prevent thromboembolic complications associated with various conditions. The emergence of direct-acting oral anticoagulants (DOACs) has reduced the use of vitamin K antagonists (VKAs), but specific clinical scenarios still necessitate VKAs. Nurses play a crucial role in managing OAT, and their self-efficacy is essential for optimal patient outcomes. This study aims to validate and adapt the Nursing Self-Efficacy for Oral Anticoagulant Therapy Management (SE-OAM) questionnaire to Spanish (SE-OAM-SV) to assess nurses’ self-efficacy in managing OAT. Methods: A methodological design was employed to develop the validity and reliability of the SE-OAM-SV. The process included translation and back-translation, expert review, and a pilot study. Content validity was analyzed using the content validity index (CVI), modified kappa coefficient, and Aiken’s V. A descriptive cross-sectional study was conducted with 100 nurses across Spain to test the SE-OAM-SV and identify comprehension issues. Internal consistency was assessed via Cronbach’s alpha. Results: The translation process highlighted some items requiring clarification, which were resolved through expert consultation. The SE-OAM-SV demonstrated adequate content validity with a global CVI of 0.86. The pilot study revealed an average participant age of 41.3 years and 17.3 years of professional experience. The SE-OAM-SV showed high internal consistency with a Cronbach’s alpha of 0.96. The average score of participants on the SE-OAM-SV was 56.8 points, indicating room for improvement in all aspects of the scale. Conclusion: The SE-OAM-SV is a reliable and valid tool for measuring nurses’ self-efficacy in managing OAT in Spanish-speaking communities. This tool can facilitate the development of educational programs and public policies to enhance nurses’ self-efficacy and improve patient outcomes. The availability of the SE-OAM-SV supports larger-scale studies and validation in other Spanish-speaking countries. Full article

15 pages, 1389 KiB

Open AccessArticle

Multicenter Study of Comorbidities in Patients with Periprosthetic Fractures After Total Hip Arthroplasty and Their Association with Immediate Postoperative Complications

by Victor Niculescu, Alexandru Lisias Dimitriu, Delia Carmen Nistor-Cseppento, Sebastian Tirla, Anamaria Gherle, Bogdan Uivaraseanu and Cristian Burnei

Clin. Pract. 2025, 15(6), 110; https://doi.org/10.3390/clinpract15060110 - 12 Jun 2025

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Abstract

Background/Objectives: Periprosthetic fractures (PFs) can occur in both the upper and lower limbs, commonly resulting from falls at the same level. The frequency of PFs following total hip arthroplasty (THA) ranges from 0.045% to 4.1%, and this incidence is influenced by several factors, [...] Read more.

Background/Objectives: Periprosthetic fractures (PFs) can occur in both the upper and lower limbs, commonly resulting from falls at the same level. The frequency of PFs following total hip arthroplasty (THA) ranges from 0.045% to 4.1%, and this incidence is influenced by several factors, including age, gender, the type of prosthesis used, and existing comorbidities. Previous studies on this subject have been small in scale and did not adequately address the associated comorbidities, which pose a challenge for the aging population. This study aims to comparatively assess the incidence of THA-related PFs, immediate postoperative complications, and comorbidities in patients with PFs from three emergency hospitals. Methods: A retrospective observational study was conducted from 1 January to 31 December 2024, in which 54 patients with PFs hospitalized in three emergency hospitals (Bucharest, Oradea, and Ploiești) were evaluated, divided into Group B (n = 29), Group O (n = 14), and Group P (n = 11). Results: Of all patients with PFs, 81.48% had minor complications—grade 1, 9.26% had grade 2 complications (complications requiring medical treatment or other minor interventions), and 3.70% had complications requiring surgery or invasive procedures. Clavien–Dindo grade 5 (patient death) had an incidence of 3.70%. Cardiac pathology was the most common pathology; hypertension predominated in Group O (42.85%). Alzheimer’s disease was associated in 7 patients (12.96%). Without associated pathology, about 13% of patients were identified. Diabetes mellitus also occurred frequently in 31.50%. Data analysis indicates a very weak positive correlation between the Dindo Index and the Charlson Comorbidity Index (r = 0.046), which is not statistically significant (p = 0.628). The effect size, measured by Fisher’s z, is also reported as 0.046. Conclusions: No significant differences were found among the evaluated centers regarding therapeutic approaches, postoperative complications, and associated comorbidities. Furthermore, there is insufficient evidence to suggest a significant association between the Charlson Comorbidity Index and the Clavien–Dindo Index. Full article

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18 pages, 7422 KiB

Open AccessReview

Atypically Displaced Meniscal Tears: An Educational Review with Focus on MRI and Arthroscopy

by Paolo Spinnato, Paola Franceschi, Giuseppe Martinese, Anna Parmeggiani, Valerio D’Agostino, Silvia Ferraro, George R. Matcuk, Stefano Zaffagnini and Alberto Grassi

Clin. Pract. 2025, 15(6), 109; https://doi.org/10.3390/clinpract15060109 - 12 Jun 2025

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Abstract

This review article on atypically displaced meniscal tears serves as a critical reminder for radiologists and orthopedic surgeons. It highlights and details uncommon lesions that may be overlooked during MRI evaluation and/or arthroscopic exploration. The knowledge of their existence can enable radiologists to [...] Read more.

This review article on atypically displaced meniscal tears serves as a critical reminder for radiologists and orthopedic surgeons. It highlights and details uncommon lesions that may be overlooked during MRI evaluation and/or arthroscopic exploration. The knowledge of their existence can enable radiologists to critically assess any meniscal abnormality, keeping in mind its possible arthroscopic presentation. This is essential for assisting the surgeon in making an accurate preoperative diagnosis. In fact, these atypical lesions pose great challenges to surgeons in terms of the technical aspects of their treatment. Often, they could require additional arthroscopic portals for their identification or the need for special devices or instrumentations for the repair. Knowing these challenges in advance is thus imperative for properly planning a proficient surgery. The correct diagnosis and description of tear patterns, including extent and location, allow optimal pre-operative planning with the choice of the indicated approach. Radiologists should know how to recognize menisci tears, even with atypical dislocation patterns. Particularly, in the case of ‘minus’ detection or thickness reduction in a meniscus, the possible displaced fragment should be carefully searched for, even in atypical sites. Full article

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11 pages, 768 KiB

Open AccessArticle

Maternal Disorders Associated with Morbidity and Mortality in a Metropolis of Kazakhstan

by Aigerim Turekulova, Nurzhamal Dzhardemaliyeva, Alibek Mereke and Mukhtar Kulimbet

Clin. Pract. 2025, 15(6), 108; https://doi.org/10.3390/clinpract15060108 - 6 Jun 2025

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Abstract

Background/Objectives: Hypertensive disorders of pregnancy, including pre-eclampsia and eclampsia, are leading causes of maternal morbidity and mortality worldwide and in Kazakhstan. This study aims to assess the burden of hypertensive disorders of pregnancy and main maternal disorders in Almaty, Kazakhstan, using the disability [...] Read more.

Background/Objectives: Hypertensive disorders of pregnancy, including pre-eclampsia and eclampsia, are leading causes of maternal morbidity and mortality worldwide and in Kazakhstan. This study aims to assess the burden of hypertensive disorders of pregnancy and main maternal disorders in Almaty, Kazakhstan, using the disability adjusted life years (DALY) methodology. Methods: We conducted a retrospective analysis of women aged 18 and above in Almaty, Kazakhstan, from 2018 to 2020. The medical claim data were retrieved from the Almaty city branch of the Republican Center for Electronic Health Care. Incidence-based DALY were calculated. Results: The total DALY increased for severe pre-eclampsia from 109.3 in 2018 to 187.2 in 2020 per 100,000 population and eclampsia from 3.1 in 2018 to 159.3 in 2020 per 100,000 population. Also, the 25–29 years age group had the largest increase in percent change (5.8) in the total DALY for hypertensive disorders of pregnancy. In addition, the 20–24 years age groups had the largest increase in percent change in the total DALY for severe pre-eclampsia (25.8) and eclampsia (80.5). Conclusions: Our findings highlight an increase in the burden of maternal disorders, especially for severe pre-eclampsia and eclampsia, in Almaty, Kazakhstan, from 2018 to 2020. Younger women bear a significant share of this burden, compounded by the pandemic’s impact on healthcare services. Full article

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24 pages, 2125 KiB

Open AccessSystematic Review

Alpha-Synuclein Seed Amplification Assays in Parkinson’s Disease: A Systematic Review and Network Meta-Analysis

by Jamir Pitton Rissardo and Ana Leticia Fornari Caprara

Clin. Pract. 2025, 15(6), 107; https://doi.org/10.3390/clinpract15060107 - 3 Jun 2025

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Abstract

Introduction and objective: Assessment of α-synuclein (αSyn) seed amplification assays (αSyn-SAA) accuracy in distinguishing Parkinson’s disease (PD) from controls using cerebrospinal fluid (CSF), blood, skin, extracellular vesicles (ECV), saliva, olfactory mucosa (OM), gastrointestinal tract (GIT), and submandibular gland (SMG). Methodology: PubMed was searched [...] Read more.

Introduction and objective: Assessment of α-synuclein (αSyn) seed amplification assays (αSyn-SAA) accuracy in distinguishing Parkinson’s disease (PD) from controls using cerebrospinal fluid (CSF), blood, skin, extracellular vesicles (ECV), saliva, olfactory mucosa (OM), gastrointestinal tract (GIT), and submandibular gland (SMG). Methodology: PubMed was searched for articles from 2010 to January 2025. The quality assessment used robvis. Diagnostic values with a 95% confidence interval (CI) were obtained. Z-test, Wald CI, and ANOVA were performed. Diagnostic odds ratio (DOR) was used. Results: αSyn-SAAs showed strong diagnostic performance in distinguishing PD from controls across various tissue and fluid types. Overall, αSyn-SAAs demonstrated high sensitivity (86%) and specificity (92%). Among all biomatrices, CSF, skin, blood, and ECV yielded the highest diagnostic accuracy, with sensitivity and specificity approaching or exceeding 90%. In contrast, saliva, oral mucosa, and gastrointestinal tract samples showed more modest sensitivity, though specificity remained relatively high. ECV, CSF, skin, and blood matrices also demonstrated the highest DOR, supporting their potential clinical utility. Conclusions: ECV and blood warrant priority in αSyn-SAA for high accuracy and minimal invasiveness, while GIT, OM, and oral samples show limited utility; saliva and SMG need refinement. Full article

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14 pages, 616 KiB

Open AccessArticle

Predictors of Major Adverse Cardiovascular Events in Stable Patients After ST Elevation Myocardial Infarction

by Lidija Savic, Damjan Simic, Ratko Lasica, Gordana Krljanac, Sanja Stankovic, Igor Mrdovic and Milika Asanin

Clin. Pract. 2025, 15(6), 106; https://doi.org/10.3390/clinpract15060106 - 30 May 2025

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Abstract

Background/aim: The aim of this study was to determine predictors of major adverse cardiovascular events, including MACE (mortality, non-fatal recurrent infarction, non-fatal stroke, and target vessel revascularization-TVR) in stable post-STEMI patients. Method: We analyzed STEMI patients without cardiogenic shock at admission included in [...] Read more.

Background/aim: The aim of this study was to determine predictors of major adverse cardiovascular events, including MACE (mortality, non-fatal recurrent infarction, non-fatal stroke, and target vessel revascularization-TVR) in stable post-STEMI patients. Method: We analyzed STEMI patients without cardiogenic shock at admission included in our STEMI Register. The patients were treated with primary PCI. The follow-up period was eight years. Results: From 1 December 2006 to 31 December 2016, a total of 3079 patients were included in the Register. In the first year, MACE was registered in 348 (11.3%) patients. The remaining patients were considered stable. They were included in further analysis. At eight years, the rates were as follows: MACE 3.9%, non-fatal recurrent infarction 2.1%, TVR 1.8%, non-fatal stroke 0.5%, and mortality 2.1%. Predictors for 8-year MACE were age >60 years (60–69 vs. <60 years HR 1.65; 70–79 vs. <60 years HR 1.82; ≥80 vs. <60 years HR 3.16), EF < 50% (EF 40–49% HR 2.38; EF < 40% HR 2.32), diabetes mellitus (HR 1.49), and 3-vessel coronary artery disease (HR 1.44). Conclusions: Four predictors identified stable post-STEMI patients who remained at a higher risk for the occurrence of MACE. Stable post-STEMI patients with one or more of these risk factors may require more aggressive secondary prevention measures or a personalized approach to improve their prognosis. Full article

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17 pages, 2204 KiB

Open AccessReview

Reverse Linear Neuro Periodization Model for Rehabilitation After Arthroscopic Rotator Cuff Repair: A Narrative Review

by Georgios Kakavas, Emmanouil Brilakis, Maria Papatzikou, Nikolaos Malliaropoulos, Jean Mazeas and Florian Forelli

Clin. Pract. 2025, 15(6), 105; https://doi.org/10.3390/clinpract15060105 - 30 May 2025

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Abstract

Periodization is a concept of systematic progression in training and rehabilitation. The rehabilitation literature, however, is scarce, with information about optimally designing resistance training programs based on periodization principles for injured athletes. This periodization model—reverse linear neuro periodization—is a model proposed for the [...] Read more.

Periodization is a concept of systematic progression in training and rehabilitation. The rehabilitation literature, however, is scarce, with information about optimally designing resistance training programs based on periodization principles for injured athletes. This periodization model—reverse linear neuro periodization—is a model proposed for the long-term rehabilitation needed after an arthroscopic rotator cuff repair. With recent evidence supporting neural contributions to shoulder injuries and the rate of recovery, rehabilitation protocols may benefit from incorporating approaches that target the sensorimotor system. Integrating motor learning principles (external focus and differential learning) and new technologies (virtual reality, laser pointers, stroboscopic glasses) may bolster current shoulder rehabilitation protocols and improve patient recovery times and outcomes. Such an understanding allows well-informed sport rehabilitation specialists to better bridge the gap between the preparation for competition widely used by coaches and the treatment of injuries that may occur. Full article

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14 pages, 1190 KiB

Open AccessArticle

Eleven-Year Incidence of Salivary Gland Tumors—A Retrospective, Single-Centered Study in Croatia

by Anđela Modrić, Mirko Gabelica, Ante Mihovilović, Stipe Dumančić, Ana Dunatov Huljev and Ivana Medvedec Mikić

Clin. Pract. 2025, 15(6), 104; https://doi.org/10.3390/clinpract15060104 - 29 May 2025

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Abstract

Background/Objectives: The purpose of this study was to determine the incidence of salivary gland tumors based on age, gender, histological type, and localization over an eleven-year period at the University Hospital of Split. Methods: The medical records of the Department of Otorhinolaryngology with [...] Read more.

Background/Objectives: The purpose of this study was to determine the incidence of salivary gland tumors based on age, gender, histological type, and localization over an eleven-year period at the University Hospital of Split. Methods: The medical records of the Department of Otorhinolaryngology with Head and Neck Surgery and the Department of Maxillofacial Surgery at the University Hospital of Split regarding salivary gland tumors were searched from January 2012 to December 2022. The current fifth World Health Organization (WHO) Classification of Head and Neck Tumors and its criteria were considered during that process. Results: Out of 404 patients, 211 (52.20%) were female and 193 (47.77%) male. The mean age was 60. There were four pediatric patients. Six patients had a combination of two different histological types of salivary gland tumors present simultaneously at the exact localization. Therefore, there were 410 histological types in total, 214 related to females and 196 to males. A total of 361 (88.05%) benign and 49 (11.95%) malignant primary salivary gland tumors were detected. The parotid gland was the predominant location (N = 361, 87.8%). There were no cases affecting the sublingual gland. Pleomorphic adenoma was the most common benign histological type (N = 169, 41.2%). The most common malignant histological types were adenoid cystic carcinoma (N = 9, 2.2%) and mucoepidermoid carcinoma (N = 9, 2.2%). The average incidences of salivary gland tumors in the 11 years for the four Dalmatian counties and the Republic of Croatia were 4.45/100,000 and 0.9/100,000, respectively. Conclusions: The results of this study, primarily the ones concerning histological types and localization, do not deviate from general knowledge about salivary gland tumors. Simultaneous and ipsilateral occurrence of different histological types is a rare and extremely valuable finding. The average incidence for Dalmatian counties and the Republic of Croatia is within the range of the International Agency for Research on Cancer estimates. Full article

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26 pages, 1270 KiB

Open AccessSystematic Review

Where Do We Stand in the Management of Rheumatoid Arthritis Ahead of EULAR/ACR 2025?

by Adriana Liliana Vlad, Corina Popazu, Alina-Maria Lescai, Doina Carina Voinescu and Alexia Anastasia Ștefania Baltă

Clin. Pract. 2025, 15(6), 103; https://doi.org/10.3390/clinpract15060103 - 28 May 2025

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Abstract

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease characterised by systemic inflammation and the progressive damage of joints, significantly impacting patients’ quality of life. Managing this condition requires a complex approach that integrates pharmacological and non-pharmacological therapies, alongside psychosocial support and [...] Read more.

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease characterised by systemic inflammation and the progressive damage of joints, significantly impacting patients’ quality of life. Managing this condition requires a complex approach that integrates pharmacological and non-pharmacological therapies, alongside psychosocial support and patient education. Aim: This study aims to highlight the importance of an interdisciplinary approach in the treatment of rheumatoid arthritis, focusing on the role of pharmacological therapies, monitoring treatment response, and the involvement of a multidisciplinary team in the effective management of the disease. Methods: The analysis was based on a review of the specialised literature concerning the role of disease-modifying antirheumatic drugs (DMARDs, both conventional and biological), the use of inflammatory markers (CRP and ESR), advanced imaging techniques, and the contribution of various medical specialities to the holistic management of rheumatoid arthritis. A total of 595,900 records were identified, of which 53 studies were ultimately included in the detailed analysis. Relevant studies from fields such as rheumatology, nutrition, psychology, and physical therapy were included. Results: The findings underline that DMARDs, in combination with other pharmacological therapies, remain essential for slowing disease progression. Monitoring treatment response through inflammatory markers and imaging techniques allows for the adjustment of therapeutic strategies and the prevention of complications. An interdisciplinary approach, involving the rheumatologist, general practitioner, physiotherapist, nutritionist, and psychologist, provides significant benefits, such as reducing inflammation, improving joint function, and offering psychosocial support. Conclusions: The effective management of rheumatoid arthritis requires a personalised interdisciplinary approach. Integrating various specialities, along with patient education and psychosocial support, contributes to better disease management, the prevention of disabilities, and improved quality of life. This review is not registered. Full article

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9 pages, 925 KiB

Open AccessSystematic Review

Spontaneous Bowel Evisceration Through Umbilical Hernia Sites in Adult Patients: A Systematic Review of the Literature

by Simone Gianazza, Niccolò Grappolini, Marika Morabito, Andrea Palillo, Marta Ripamonti and Davide Inversini

Clin. Pract. 2025, 15(6), 99; https://doi.org/10.3390/clinpract15060099 - 26 May 2025

Viewed by 456

Abstract

Background: The literature reports few instances of spontaneous bowel eviscerations through umbilical hernia sites. Spontaneous rupture of the hernia sac is a less common complication, primarily associated with persistent ascites or congenital wall defects. Materials and methods: A systematic review was conducted using [...] Read more.

Background: The literature reports few instances of spontaneous bowel eviscerations through umbilical hernia sites. Spontaneous rupture of the hernia sac is a less common complication, primarily associated with persistent ascites or congenital wall defects. Materials and methods: A systematic review was conducted using the PubMed database—the United States National Library of Medicine, with the search terms “spontaneous bowel evisceration” and “umbilical hernia evisceration”. However, several results were deemed unsuitable for this manuscript. From a total of 185 cases, this review was narrowed down to 9 usable reports. Non-English language cases, duplicates, and cases unrelated to the pathology, including pediatrics, malformations, herniation through other organs, and animal cases, were excluded. Conclusions: Spontaneous evisceration in a hernia is an uncommon yet serious condition. A major risk factor appears to be underlying liver disease with its complications, such as ascites, chronic malnutrition with hypoalbuminemia, and collateral circulation formation. These factors contribute to the susceptibility of the sac and the hernia wall to rupture. However, the limited number of reported cases precludes the establishment of a preferred treatment approach. In the acute phase, the use of prosthetics may be less advisable, but in an elective setting, the cirrhotic patient could be offered repair. Full article

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12 pages, 439 KiB

Open AccessArticle

Maternal Vitamin D Deficiency and the Risk of Placental Abruption: A Cross-Sectional Study in a Greek Obstetric Population

by Artemisia Kokkinari, Evangelia Antoniou, Eirini Orovou, Maria Dagla, Maria Tzitiridou-Chatzopoulou, Antigoni Sarantaki, Kleanthi Gourounti and Georgios Iatrakis

Clin. Pract. 2025, 15(6), 102; https://doi.org/10.3390/clinpract15060102 - 26 May 2025

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Abstract

Background: Vitamin D deficiency (VDD) during pregnancy has been associated with various obstetric complications, including preeclampsia, gestational diabetes, and premature rupture of membranes. However, its potential link to placental abruption remains underexplored. The aim of this study was to investigate whether low maternal [...] Read more.

Background: Vitamin D deficiency (VDD) during pregnancy has been associated with various obstetric complications, including preeclampsia, gestational diabetes, and premature rupture of membranes. However, its potential link to placental abruption remains underexplored. The aim of this study was to investigate whether low maternal vitamin D levels are associated with an increased risk of placental abruption in pregnancies considered otherwise low-risk. Methods: We conducted a cross-sectional study involving 248 pregnant women who were admitted for delivery at a public hospital in Athens, Greece. Serum levels of 25-hydroxyvitamin D [25(OH)D] were measured upon admission. Levels below 30 ng/mL were classified as insufficient. Although this threshold corresponds to insufficiency according to the Endocrine Society, for the purposes of this study, levels < 30 ng/mL were treated as indicative of vitamin D deficiency in order to capture broader physiological implications. Cases of placental abruption were identified based on obstetric history and clinical documentation at the time of delivery. A Chi-square test was used to assess the association between vitamin D status and placental abruption, and a multivariate logistic regression model was applied to control for potential confounders, including hypertensive disorders of pregnancy, smoking, and preterm birth. The potential role of vitamin D supplementation during pregnancy was also explored as part of the analysis. Results: Our analysis revealed that women with VDD had a significantly higher incidence of placental abruption (p < 0.05). In the multivariate model, VDD remained an independent risk factor (adjusted OR: 3.2, 95% CI: 1.1–9.6). Additional risk factors that showed significant associations with placental abruption included pregnancy-induced hypertension and maternal smoking. Conclusions: These findings support the hypothesis that insufficient maternal vitamin D levels may contribute to adverse pregnancy outcomes, including placental abruption. Further prospective studies are warranted to clarify the causal mechanisms and to evaluate whether early detection and correction of vitamin D deficiency could serve as a preventive strategy in prenatal care. Full article

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8 pages, 829 KiB

Open AccessBrief Report

Unicortical Locking Screws Provide Comparable Rigidity to Bicortical Compression Screws in Tranverse Mid-Shaft Clavicle Fracture Plate Fixation Constructs

by Curtis W. Hartman, Nicholas C. Branting, Matthew A. Mormino, Timothy J. Lackner, Bradford P. Zitsch, Edward V. Fehringer and Hani Haider

Clin. Pract. 2025, 15(6), 101; https://doi.org/10.3390/clinpract15060101 - 26 May 2025

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Abstract

Background: Mid-shaft clavicle fracture fixation carries neurovascular injury risk. The purpose of this study was to compare bicortical compression and unicortical locked clavicle plate constructs biomechanically. Materials and Methods: Ten fourth-generation composite transverse mid-shaft clavicle osteotomy specimens were assigned to two [...] Read more.

Background: Mid-shaft clavicle fracture fixation carries neurovascular injury risk. The purpose of this study was to compare bicortical compression and unicortical locked clavicle plate constructs biomechanically. Materials and Methods: Ten fourth-generation composite transverse mid-shaft clavicle osteotomy specimens were assigned to two groups, and each clavicle was fixed with an eight-hole second-generation 3.5 mm pelvic reconstruction plate placed superiorly. Group one included five fixed with bicortical compression screws and group two included five fixed with unicortical locking screws. All were tested on a four-axis servohydraulic testing frame in three modes: axial rotation, anterior/posterior bending, and cephalad/caudad bending. Results: Mean construct stiffness for AP bending was 1.255 ± 0.058 Nm/deg (group 1) and 1.442 ± 0.065 Nm/deg (group 2) (p = 0.001). Mean construct stiffness for axial rotation was 0.701 ± 0.08 Nm/deg (1) and 0.726 ± 0.03 Nm/deg (2) (p = 0.581). Mean construct stiffness for cephalad bending was 0.889 ± 0.064 Nm/deg (1) and 0.880 ± 0.044 Nm/deg (2) (p = 0.807). Mean construct stiffness for caudal bending was 2.523 ± 0.29 Nm/deg (1) and 2.774 ± 0.25 Nm/deg (2) (p = 0.182). Conclusions: With transverse mid-shaft clavicle fractures, unicortical locking fixation provided comparable rigidity to bicortical compression fixation in axial rotation, cephalad bending, and caudal bending; it provided greater rigidity in AP bending. Full article

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11 pages, 1312 KiB

Open AccessArticle

Rising Threats and Evolving Trends: Five Years of Urinary Tract Infection Prevalence in a Portuguese Hospital

by Francisco José Barbas Rodrigues, Patrícia Coelho, Sónia Mateus and Miguel Castelo-Branco

Clin. Pract. 2025, 15(6), 100; https://doi.org/10.3390/clinpract15060100 - 26 May 2025

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Abstract

Background/Objective: Urinary tract infections (UTIs) are a significant public health concern worldwide, yet longitudinal data from Portuguese hospital settings remain limited. This study aimed to characterize epidemiological trends, microbial etiology, antimicrobial resistance patterns, and associated risk factors of UTIs over a five-year period [...] Read more.

Background/Objective: Urinary tract infections (UTIs) are a significant public health concern worldwide, yet longitudinal data from Portuguese hospital settings remain limited. This study aimed to characterize epidemiological trends, microbial etiology, antimicrobial resistance patterns, and associated risk factors of UTIs over a five-year period (2018–2022) in a central Portuguese hospital. Methods: In this retrospective observational study, 23,682 positive urine cultures were analyzed from specimens collected between January 2018 and December 2022. Data were extracted from the laboratory information system and included patient demographics, clinical service of origin, isolated microorganisms, resistance profiles, and annual antibiotic consumption (Defined Daily Dose (DDD) per 1000 patient-days). UTI prevalence was calculated as the proportion of positive cultures among all urine samples processed annually. Results: The positivity rate increased from 18.7% in 2018 to 22.7% in 2022, with a peak in 2019. Women represented around 70% of cases throughout the study period. Most infections originated from inpatient wards, followed by emergency services. Escherichia coli remained the leading pathogen (≈62%), followed by Klebsiella pneumoniae (≈14%) and Enterococcus faecalis (≈8%). Risk factors included catheterization (37.2%), prior UTI history (22.1%), and diabetes mellitus (18.5%). Longer hospital stays (>7 days) were associated with increased positivity. For E. coli, resistance ranged from 2% (amikacin) to 41% (ampicillin), with increasing resistance to ertapenem and fosfomycin and decreasing resistance to several key antibiotics. K. pneumoniae showed 4–36% resistance across antimicrobials, with notable increases for fosfomycin, meropenem, and cefuroxime axetil. Antibiotic usage trends reflected these patterns, with declining use of amikacin and rising use of cefuroxime axetil and meropenem. Conclusions: Over the five-year period, both UTI prevalence and resistance to critical antimicrobials increased, reinforcing the need to update empirical treatment guidelines. Identified risk factors may inform targeted prevention strategies. Ongoing surveillance and antimicrobial stewardship are crucial to mitigate the rising burden of UTIs and resistance Full article

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17 pages, 1195 KiB

Open AccessSystematic Review

Online Occupational Therapy as a Rehabilitation Intervention for Parkinson’s Disease: A Systematized Review

by Antigoni Kountoura, Thomas Tegos, Marianthi Arnaoutoglou and Magdalini Tsolaki

Clin. Pract. 2025, 15(6), 98; https://doi.org/10.3390/clinpract15060098 - 23 May 2025

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Abstract

Background/Objectives: Occupational therapy (OT) plays a crucial role in addressing functional limitations and promoting independence in Parkinson’s disease (PD) patients. OT interventions target motor skills, daily activities, and engagement in meaningful tasks. Telehealth, the remote delivery of healthcare services, has expanded access to [...] Read more.

Background/Objectives: Occupational therapy (OT) plays a crucial role in addressing functional limitations and promoting independence in Parkinson’s disease (PD) patients. OT interventions target motor skills, daily activities, and engagement in meaningful tasks. Telehealth, the remote delivery of healthcare services, has expanded access to rehabilitation, including OT for PD. While several studies have examined the benefits of online OT, a comprehensive assessment of its impact on functional outcomes and quality of life (QoL) is needed. This review aimed to evaluate the effects of online OT interventions on functional outcomes and QoL of patients with PD. Methods: This review employed a systematized approach, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, though it did not constitute a full systematic review or meta-analysis. A comprehensive search was conducted across PubMed, Web of Science, Scopus, and Embase databases between August 2023 and September 2024. The search targeted randomized controlled trials (RCTs) investigating telerehabilitation interventions in OT for individuals with PD. Studies were excluded if they were not published in English, did not employ an RCT design, or lacked a focus on telerehabilitation within the scope of occupational therapy for PD. Additionally, systematic reviews, meta-analyses, qualitative studies, and studies without measurable outcomes were excluded. Nine studies met the inclusion criteria, with four involving occupational therapists directly and five evaluating interventions within the scope of OT practice. Results: The primary outcomes of this review focused on mobility improvements in PD patients, assessed through gait metrics such as gait speed, stride length, and gait variability. Secondary outcomes evaluated the impact of telerehabilitation on QoL, using tools such as the Parkinson’s Disease Questionnaire (PDQ-39) and other disease-specific instruments. The findings demonstrated that online OT interventions significantly improved motor skills, cognitive function, and activities of daily living in PD patients. Furthermore, these interventions enhanced overall well-being and QoL. The remote format fostered sustained engagement and adherence to therapy, contributing to better long-term outcomes. Conclusions: Online OT interventions show promising potential for improving functional outcomes and QoL in PD patients. These findings underscore the potential of telehealth to expand access to OT services, thereby enhancing long-term rehabilitation outcomes for this population. Full article

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20 pages, 1257 KiB

Open AccessArticle

Evaluating the Impact of Community-Based Medical Education on Health Literacy and Patient Empowerment in Underserved Populations: A Pilot Cohort Study

by Aida Aljafri, Persia Abba, Anita Sedghi, Andreas Conte and Waseem Jerjes

Clin. Pract. 2025, 15(6), 97; https://doi.org/10.3390/clinpract15060097 - 22 May 2025

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Abstract

Background: Traditionally, community-based education (CBE) programmes have been utilised for teaching medical students clinical and interpersonal skills through placement in underserved environments. This pilot cohort study tested an extended model of CBE by infusing patient education into student-conducted consultations with the dual objectives [...] Read more.

Background: Traditionally, community-based education (CBE) programmes have been utilised for teaching medical students clinical and interpersonal skills through placement in underserved environments. This pilot cohort study tested an extended model of CBE by infusing patient education into student-conducted consultations with the dual objectives of stimulating improved learning for the students and improved health literacy for the patients. Methods: The intervention involved 38 final-year medical students and 85 adult patients and from underprivileged communities in North West London. The students first undertook online preparatory workshops on health literacy, communication skills, and cultural competence. Subsequently, they imparted 20–30 min educational sessions on chronic disease management and preventive care to the patients on their clinical placements. The quantitative measurement used pre- and post-intervention questionnaires, and the qualitative measurement was based on reflective diaries and patient feedback. Paired t-tests were used for statistical comparisons, while a thematic analysis was used for textual answers. Results: Student confidence in breaking down medical jargon improved from 2.8 ± 0.7 to 4.4 ± 0.5 (p < 0.01), and confidence in making use of visual aids improved from 2.5 ± 0.8 to 4.2 ± 0.6 (p < 0.01). Understanding among the patients of their health conditions improved from 27% to 74% (p < 0.001), and self-confidence in their ability to manage their health improved from 31% to 79% (p < 0.001). The qualitative feedback noted improved empathy, cultural sensitivity, and a positive effect on patient empowerment through tailored education. Conclusions: This CBE intervention had two benefits: improving teaching and communication skills in students and greatly enhancing health literacy in underserved patients. The integration of structured education into usual care encounters holds the promise of a scalable, sustainable method for addressing health disparities. Longer longitudinal studies are necessary to assess its long-term success and incorporation into medical education. Full article

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Clin. Pract., Volume 15, Issue 6 (June 2025) – 18 articles

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