Clinics and Practice

19 pages, 6201 KB

Open AccessArticle

Transcranial Doppler Pulsatility Index and MRI Findings in Meningoencephalitis: A Pilot Observational Retrospective Cohort Study in Critically Ill Patients

by Maria Grazia Bocci, Giulia Capecchi, Antonio Lesci, Dorotea Rubino, Ilaria Caravella, Giorgia Taloni, Valerio Sabatini, Candido Porcelli, Giulia Valeria Stazi, Gabriele Garotto, Elena Mattiucci, Emanuele Nicastri, Tommaso Ascoli Bartoli, Gaetano Maffongelli, Emiliano Cingolani, Fabrizio Albarello, Giulia Anello, Paolo Campioni, Stefania Ianniello and Daniele Guerino Biasucci

Clin. Pract. 2026, 16(2), 41; https://doi.org/10.3390/clinpract16020041 (registering DOI) - 14 Feb 2026

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Abstract

Background: Meningoencephalitis is a complex inflammatory condition of the CNS that can result in significant morbidity and mortality in critically ill adults. Accurate and timely neuromonitoring is essential for guiding management and improving outcomes. This study aimed to descriptively evaluate the prognostic value [...] Read more.

Background: Meningoencephalitis is a complex inflammatory condition of the CNS that can result in significant morbidity and mortality in critically ill adults. Accurate and timely neuromonitoring is essential for guiding management and improving outcomes. This study aimed to descriptively evaluate the prognostic value of early TCCD monitoring, particularly the pulsatility index, and its integration with conventional and perfusion MRI in patients with meningoencephalitis. Methods: We present an observational, retrospective, cohort study involving ten adult patients (median age 56 years, IQR 45.5–68.5; mean 55.9, range 35–76) with neurological syndromes caused by suspected or confirmed infectious meningoencephalitis. Etiologies included bacterial meningitis/meningoencephalitis (50%), viral meningoencephalitis (10%), neurotoxoplasmosis (10%), progressive multifocal leukoencephalopathy (10%), and undetermined origin (20%). Patients underwent TCCD and MRI within 24 h. In five cases, standard MRI sequences were acquired, while in the remaining five, perfusion imaging was performed using Arterial Spin Labelling (ASL). A favorable outcome was defined as survival with neurological recovery (Glasgow Outcome Scale > 5) at ICU discharge. Results: TCCD-derived PI provided valuable information on cerebral hemodynamics. PI values ≤ 1.25 were associated with favorable clinical outcomes and symmetrical MRI findings. Conversely, PI > 1.25 correlated with poor prognosis and often preceded MRI-detectable structural damage. When combined with ASL, PI mirrored the detected perfusion asymmetries and was associated with poor prognosis in fatal cases. Conclusions: Bedside TCCD can offer real-time assessment of cerebrovascular dynamics and, when integrated with conventional and ASL MRI, could enhance the understanding of pathophysiological processes in meningoencephalitis, supporting timely and informed decisions in neurocritical care. Full article

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10 pages, 659 KB

Open AccessArticle

Effects of 3D Virtual Reality on Postural Control in Young Adults: Clinical and Practical Implications

by Gustavo Christofoletti, Gabriela Maria da Silva Béé, Otávio Reginato, Nathalia Oliveira Rodrigues, Sidineia Silva Pinheiro Cavalcante Franco and Ana Beatriz Gomes de Souza Pegorare

Clin. Pract. 2026, 16(2), 40; https://doi.org/10.3390/clinpract16020040 - 13 Feb 2026

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Abstract

Background: Previous studies have demonstrated the benefits of virtual reality (VR) as an intervention tool guided by specialists. However, little is known about whether VR may pose risks in uncontrolled environments. Considering its implications for clinics and practice, this study aimed to assess [...] Read more.

Background: Previous studies have demonstrated the benefits of virtual reality (VR) as an intervention tool guided by specialists. However, little is known about whether VR may pose risks in uncontrolled environments. Considering its implications for clinics and practice, this study aimed to assess the potential risks of a 3D VR simulation on postural control in young adults. Methods: Seventy-nine community-dwelling young adults completed a VR program using a head-mounted display that simulated a 3D roller-coaster ride while standing. Postural control was assessed using a force platform measuring frontal and lateral sway, center-of-pressure sway area, and frontal and lateral imbalance speed. The assessments were conducted with and without VR. Statistical analyses were performed using paired comparisons. Significance was set at 5%. Effect sizes (ESs) are reported. Results: Engaging in a VR roller-coaster simulation increased the participants’ imbalance in terms of frontal sway (p = 0.001; ES = 0.919), center-of-pressure sway area (p = 0.001; ES = 0.849), frontal imbalance speed (p = 0.001; ES = 0.910), and lateral imbalance speed (p = 0.001; ES = 0.663). No significant difference was observed in the lateral sway (p = 0.383). During VR exposure, 25% of the participants showed a clinically significant increase in postural instability. Despite having normal baseline parameters, participants with higher postural instability showed greater deterioration in postural control during VR exposure than those with lower postural instability. Conclusions: A 3D VR simulation affected several measures of postural control in community-dwelling young adults. Precautions should be taken when engaging in VR without appropriate specialist supervision. 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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10 pages, 377 KB

Open AccessBrief Report

An Audit of Accessibility and Actionability of Molecular Profiling for Patients with Cancer of Unknown Primary at a Tertiary Care Centre

by Khaled Abdulalem, Jonah Teich, Erika Martinez and Samuel D. Saibil

Clin. Pract. 2026, 16(2), 39; https://doi.org/10.3390/clinpract16020039 - 12 Feb 2026

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Abstract

Background/Objectives: Cancer of unknown primary (CUP) remains a significant challenge in the field of oncology. Despite advances elsewhere in the field, there have been few advances in the treatment of CUP and correspondingly no improvements in patient survival. Recent studies utilizing molecular [...] Read more.

Background/Objectives: Cancer of unknown primary (CUP) remains a significant challenge in the field of oncology. Despite advances elsewhere in the field, there have been few advances in the treatment of CUP and correspondingly no improvements in patient survival. Recent studies utilizing molecular profiling, including next-generation sequencing (NGS), and molecularly targeted treatment of CUP have shown some promising initial results, but have yet to be integrated into the standard of care in most jurisdictions. This study aimed to assess the use of molecular characterization and targeted treatment of patients with CUP treated at Princess Margaret Cancer Centre (PMCC). Methods: This study is a retrospective audit of patients with CUP treated between January 2019 and April 2024 to build understanding of the accessibility and use of these molecular tools. Results: We found that 82% of the 28 patients identified received NGS analysis, though all received the results late in their disease course and all accessed molecular profiling via either clinical trials, a charitable access programme, or a privately source outside of the hospital network. Only 13% of the patients who received molecular analysis received any modification of care as a result of this profiling, and only as third line of treatment. Conclusions: Our data highlights a lag between current understanding and current practice, and identifies a possible area for improvement of patient care by standardizing the use of molecular analysis in the early workup and targeted therapy in the treatment of CUP. Full article

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12 pages, 760 KB

Open AccessArticle

Overcoming Clopidogrel Resistance in Carotid Artery Stenting: Experience with Ticagrelor and Ticlopidine

by Pavol Vigláš, Jan Raupach, Aleš Hejčl, David Černík, Pavla Bradáčová, Patrik Matras and Filip Cihlář

Clin. Pract. 2026, 16(2), 38; https://doi.org/10.3390/clinpract16020038 - 10 Feb 2026

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Abstract

Objectives: The goal of this study is to establish the incidence of high on-treatment platelet reactivity (HTPR) to aspirin and clopidogrel in patients undergoing carotid stenting and to evaluate the efficacy of ticagrelor and ticlopidine in patients with HTPR to clopidogrel. Methods: In [...] Read more.

Objectives: The goal of this study is to establish the incidence of high on-treatment platelet reactivity (HTPR) to aspirin and clopidogrel in patients undergoing carotid stenting and to evaluate the efficacy of ticagrelor and ticlopidine in patients with HTPR to clopidogrel. Methods: In a single institutional setting spanning eight years, every consecutive patient who underwent carotid artery stenting was incorporated into a study. Subsequently, a retrospective analysis of their platelet function was executed. Prevalence of high on-treatment reactivity to aspirin, clopidogrel, ticlopidine and ticagrelor was assessed. Platelet function testing was conducted by light transmission aggregometry and Multiplate^®. Results: A total of 216 patients were tested for antiplatelet therapy efficacy. The high on-treatment reactivity to clopidogrel was observed in 68 patients (31.4%). No patients with high on-treatment reactivity to ticagrelor or ticlopidine were observed. There was a significant reduction in platelet reactivity with ticagrelor (p < 0.000) and ticlopidine (p < 0.000) in patients with HTPR to clopidogrel. Conclusions: High on-treatment platelet reactivity to clopidogrel is common in patients undergoing carotid artery stenting. Ticagrelor is a viable alternative to overcome HTPR to clopidogrel. These findings suggest that platelet function testing can identify patients who may benefit from tailored antiplatelet therapy in reducing thromboembolic complications after carotid stenting. Full article

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19 pages, 1515 KB

Open AccessArticle

Longitudinal Changes in Depression, Anxiety and Stress Symptoms Among Hemodialysis Patients

by Adriana-Luciana Luca, Felicia Militaru, Mădălina Iuliana Mușat, Ion Udriștoiu and Eugen Moța

Clin. Pract. 2026, 16(2), 37; https://doi.org/10.3390/clinpract16020037 - 8 Feb 2026

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Abstract

Background/Objectives: Chronic kidney disease (CKD) progresses with the gradual and irreversible loss of renal function. In Romania, given the increasing number of patients undergoing hemodialysis (HD), the prevalence of psychiatric symptoms and disorders in this population has become particularly significant. Although important [...] Read more.

Background/Objectives: Chronic kidney disease (CKD) progresses with the gradual and irreversible loss of renal function. In Romania, given the increasing number of patients undergoing hemodialysis (HD), the prevalence of psychiatric symptoms and disorders in this population has become particularly significant. Although important advances have been made in the management of psychiatric conditions in HD patients, their mental health remains relatively poor. The aim of this study was to observe the severity temporal trends of depression, anxiety and stress symptoms and correlations among HD patients. Methods: A total of 173 patients, underwent a detailed anamnesis, with emphasis dialysis duration, comorbidities and a complex psychiatric evaluation, followed by the application of the Socio-economic Scale (SES-3); Mini Mental State Examination (MMSE); and the Depression, Anxiety and Stress Scale 21R (DASS-21R). The dialysis performance (spKt/V) and Charlson Comorbidity (CCI) indices were provided by DIAVERUM Nephrology and Dialysis Center in Craiova. Results: The severity of depression and anxiety symptoms significantly increased over six months, 0.248 ± 1.432 vs. 0.453 ± 1.488 (p < 0.0001; r_rb = 0.296) for depression, and −0.090 ± 1.004 vs. 0.089 ± 1.047 (p < 0.0001; r_rb = 0.252) for anxiety; while stress-like symptoms remained stable 0.080 ± 1.318 vs. 0.164 ± 1.357 (p = 0.0661; r_rb = 0.123), despite improvements in dialysis adequacy (spKt/V). Depression scores were moderately correlated with anxiety and weakly correlated with stress and spKt/V. Anxiety results were moderately correlated with stress, while both anxiety and stress showed negligible correlations with spKt/V. Clinical variables assessed showed moderate predictive value for psychological outcomes in this cohort. Conclusions: Our study confirms the temporal trend of severity of mental symptoms and their persistence among HD patients, highlighting the urge to integrate mental health screening and intervention programs and a multidisciplinary team adapted for each case. Full article

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13 pages, 498 KB

Open AccessArticle

An Assessment of Melatonin Levels in the Saliva of Patients with Chronic Urticaria in Comparison with Their Sleep Quality and Dermatologic Quality of Life

by Iva Bešlić, Alen Vrtarić, Ivana Škrinjar, Ema Barac, Ana-Karla Vodanović and Liborija Lugović-Mihić

Clin. Pract. 2026, 16(2), 36; https://doi.org/10.3390/clinpract16020036 - 6 Feb 2026

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Abstract

Background: For the majority of chronic spontaneous urticaria (CSU) sufferers, nocturnal itch has a profound effect on quality of life (QoL), as it leads to sleep disturbances. To ensure good sleep quality (SQ), the body must produce an adequate amount of melatonin, which [...] Read more.

Background: For the majority of chronic spontaneous urticaria (CSU) sufferers, nocturnal itch has a profound effect on quality of life (QoL), as it leads to sleep disturbances. To ensure good sleep quality (SQ), the body must produce an adequate amount of melatonin, which regulates the sleep cycle. Methods: This study examines the levels of salivary melatonin in 38 CSU patients and 38 healthy controls, as well as the relationship between CSU severity, QoL and SQ. The Enzyme-Linked Immunosorbent Assay (ELISA), Dermatology Quality of Life Index (DLQI), and Pittsburgh Sleep Quality Index (PSQI) were used to determine salivary melatonin levels, QoL, and SQ. In addition, the CSU participants were given the Urticaria Activity Score (UAS) and the Urticaria Control Test. Results: The median value of salivary melatonin in CSU patients was lower than that in healthy individuals (0.2 vs. 15.985 pg/mL; p < 0.001). A decreased melatonin level was seen in 90% of CSU patients and 18% of healthy individuals. Individuals with lower melatonin levels were significantly more likely to have CSU compared with those with higher melatonin levels (OR = 37.6; 95% CI 10.0–141.1). Melatonin was linearly related to QoL and sleep quality in the whole sample (r = −0.606 and −0.536; p < 0.001) but not in CSU patients. Impaired QoL in patients correlated with itch intensity and the number of hives (r = 0.740 and 0.646). The severity and activity of CSU are linearly related to impaired QoL and sleep quality (r = −0.606 and −0.536; p < 0.001). Sleep quality acts as the mediator of the association between QoL and salivary melatonin, when controlling for the effect of age and gender (B = −0.347; 95% CI = −0.679 to −0.080). Conclusions: The data suggest that melatonin may be more a non-specific marker of sleep disturbance than the severity of CSU. Sleep quality may act as a mediator linking dermatology-related QoL, circadian dysregulation and reduced melatonin secretion. Full article

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8 pages, 1013 KB

Open AccessCase Report

Combination Hyaluronidase and Triamcinolone Acetonide Enzymatic Injections for Treatment of Ledderhose Disease: A Novel Technique and Case Series

by Paul Carroll, Alyson Boudreau, Haoning Hu, Ryan P. Lin, Bilal Louzati and Eddie Davis

Clin. Pract. 2026, 16(2), 35; https://doi.org/10.3390/clinpract16020035 - 6 Feb 2026

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Abstract

Background: Ledderhose Disease, or plantar fibromatosis, is a fibroproliferative disorder affecting the plantar fascia with limited effective treatment options. Although hyaluronidase has a long history of clinical use, it has not been previously used for Ledderhose Disease. This study explores the use of [...] Read more.

Background: Ledderhose Disease, or plantar fibromatosis, is a fibroproliferative disorder affecting the plantar fascia with limited effective treatment options. Although hyaluronidase has a long history of clinical use, it has not been previously used for Ledderhose Disease. This study explores the use of combined hyaluronidase and triamcinolone acetonide enzymatic injections as a novel and promising technique for managing Ledderhose Disease. Methods: This paper investigates the use of combination therapy with hyaluronidase, triamcinolone acetonide, and lidocaine injections in three patients with Ledderhose Disease. Injection protocols, dosage, frequency, and patient outcomes are all discussed. Additionally, this study explores the underlying mechanisms of hyaluronidase action in Ledderhose Disease, shedding light on its potential to modulate fibrotic tissue and alleviate symptoms. Results: All three patients treated with a series of hyaluronidase, triamcinolone acetonide, and lidocaine anesthetic injections experienced either a significant reduction in or elimination of nodules and associated pain within 6 weeks after initial injection. Patients were asymptomatic at two years follow-up after injections. Conclusions: The combination of hyaluronidase and triamcinolone acetonide injections significantly decreased pain and softened fibromas faster than triamcinolone acetonide injection alone, as explored in previous studies. Large prospective studies are needed to further compare enzymatic injection therapies in the management of Ledderhose Disease. Full article

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2 pages, 250 KB

Open AccessCorrection

Correction: Saramantos et al. Clinical Efficacy of Prolotherapy for Temporomandibular Joint Disorders: A Systematic Review and Meta-Analysis. Clin. Pract. 2025, 15, 51

by Antonios Saramantos, Athanassios Kyrgidis, Gregorios Venetis, Georgios Hatziantoniou, Anestis Chrysostomidis, Chrysanthi Sardeli and Ioannis Tilaveridis

Clin. Pract. 2026, 16(2), 34; https://doi.org/10.3390/clinpract16020034 - 3 Feb 2026

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Abstract

In the original publication [...] Full article

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9 pages, 408 KB

Open AccessReview

Fracture of Rotary Instruments in Third Molar Extraction: Evidence from a Scoping Review

by Luca Gentili, Roberto Fontanella, Marco Messi, Cosimo Galletti, Roberto Lo Giudice and Francesco Puleio

Clin. Pract. 2026, 16(2), 33; https://doi.org/10.3390/clinpract16020033 - 2 Feb 2026

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Abstract

Background: Rotary instrument fracture during third molar extraction is rare but clinically relevant, presenting diagnostic and therapeutic challenges. Aim: This scoping review summarizes available evidence on bur breakage and displacement during third molar surgery, focusing on causes, clinical manifestations, and management strategies. Materials [...] Read more.

Background: Rotary instrument fracture during third molar extraction is rare but clinically relevant, presenting diagnostic and therapeutic challenges. Aim: This scoping review summarizes available evidence on bur breakage and displacement during third molar surgery, focusing on causes, clinical manifestations, and management strategies. Materials and Methods: A systematic search of PubMed, Virtual Health Library, and Google Scholar was conducted for studies published from January 2008 to March 2025 reporting rotary instrument fracture during third molar extraction. Extracted data were qualitatively analyzed. Results: Eight studies reporting eleven clinical cases were included. All fractures occurred during mandibular third molar extractions. Pain was the most frequent symptom (45%), followed by swelling (27%) and trismus (18%). Management varied from immediate surgical retrieval to conservative observation. Conclusions: Although uncommon, rotary bur fracture during third molar extraction requires preventive attention and accurate reporting. Adherence to manufacturer recommendations, single-use bur policies, and adequate irrigation should be considered. Prospective multicenter and mechanical studies are needed to establish standardized management protocols. 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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17 pages, 830 KB

Open AccessArticle

Age at Menarche and Risk of Hypertensive Disorders of Pregnancy: A Retrospective Cohort Study

by Erick Ordoñez-Villordo, Monica Alethia Cureño-Díaz, Erika Gómez-Zamora, Miguel Trujillo-Martínez, Ricardo Castrejón-Salgado, Fani Villa-Rivas, Rocío Castillo-Díaz, Nadia Velázquez-Hernández, Juan Carlos Fernando Sánchez-Velázquez, Ximena Solis-Gómez and José Ángel Hernández-Mariano

Clin. Pract. 2026, 16(2), 32; https://doi.org/10.3390/clinpract16020032 - 29 Jan 2026

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Abstract

Background/Objectives: Hypertensive disorders of pregnancy (HDP) remain a major contributor to maternal morbidity and mortality worldwide, yet early-life reproductive factors such as age at menarche have been insufficiently explored in relation to HDP. Therefore, we aimed to evaluate the association between age [...] Read more.

Background/Objectives: Hypertensive disorders of pregnancy (HDP) remain a major contributor to maternal morbidity and mortality worldwide, yet early-life reproductive factors such as age at menarche have been insufficiently explored in relation to HDP. Therefore, we aimed to evaluate the association between age at menarche and the risk of HDP in a cohort of Mexican pregnant women. Methods: We conducted a retrospective cohort study among 1344 women with singleton pregnancies receiving care at a tertiary hospital in Mexico City in 2024. Age at menarche was categorized as <12, 12–14, and >14 years. HDP diagnoses were extracted from clinical records. Poisson regression with robust variance was used to estimate adjusted risk ratios (RRs). Sensitivity analyses included alternative menarche categorizations and restricted cubic spline models. Counterfactual mediation analyses assessed indirect effects through reconstructed prepregnancy BMI and gestational diabetes. Results: Both early (<12 years) and late (>14 years) menarche were associated with higher HDP risk than the 12–14-year reference (adjusted RR = 1.81; 95% CI 1.42–2.30, and 1.74; 95% CI 1.27–2.38, respectively). Spline models confirmed a U-shaped association. Mediation analyses indicated that prepregnancy BMI did not meaningfully mediate the association for either early or late menarche (<5% mediated). Gestational diabetes explained a modest proportion of the association for early menarche (≈14%), but not for late menarche. Conclusions: Age at menarche showed a robust U-shaped association with HDP, mostly independent of adiposity and gestational diabetes, within the limits of the available measurements. Incorporating pubertal timing into routine reproductive history taking may enhance contextual risk assessment for HDP. Full article

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9 pages, 1100 KB

Open AccessCase Report

A New Case of PITX1-Related Mandibular–Pelvic–Patellar (MPP) Syndrome

by Evgeniya Melnik, Ekaterina Petrova, Tatiana Markova, Ksenya Zabudskaya and Elena Dadali

Clin. Pract. 2026, 16(2), 31; https://doi.org/10.3390/clinpract16020031 - 29 Jan 2026

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Abstract

Background: The PITX1 gene encodes a transcription factor that plays a crucial role in the development of the lower limbs, pelvis, and structures derived from the first branchial arch. Pathogenic variants in PITX1 are associated with a limited spectrum of rare disorders, [...] Read more.

Background: The PITX1 gene encodes a transcription factor that plays a crucial role in the development of the lower limbs, pelvis, and structures derived from the first branchial arch. Pathogenic variants in PITX1 are associated with a limited spectrum of rare disorders, including congenital talipes equinovarus with or without long bone anomalies and/or mirror-image polydactyly, and Liebenberg syndrome. In 2020, a novel clinical phenotype, Mandibular–Pelvic–Patellar (MPP) syndrome, resulting PITX1 missense variants, was proposed. Case presentation: We report the fourth documented case of MPP syndrome worldwide, identified in a 17-year-old female patient presenting with congenital lower limb deformities, patellar aplasia, and micrognathia. Whole-genome sequencing revealed a heterozygous PITX1 missense variant NM_002653.5: c.412A>C, p.(Lys138Gln). The clinical phenotype included knee flexion contractures and severe equinovarus and planovalgus foot deformities requiring multiple staged reconstructive surgical procedures. Conclusions: This case supports recognition of MPP syndrome as a clinically and genetically distinct PITX1-related disorder. Our findings expand the phenotypic spectrum of MPP syndrome and suggest that severe congenital foot deformities represent a consistent and clinically relevant feature of this condition. Full article

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10 pages, 346 KB

Open AccessArticle

Reconstruction Versus Hemiarthroplasty in Comminuted (Three- and Four-Part) Proximal Humerus Fractures: A Retrospective Functional Outcome Analysis at 6 Months

by Alexandru Lisias Dimitriu, Monica Georgiana Roman, Elisa Georgiana Popescu, Eduard Cătălin Georgescu, Dragoș Ene and Răzvan Ene

Clin. Pract. 2026, 16(2), 30; https://doi.org/10.3390/clinpract16020030 - 29 Jan 2026

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Abstract

Background: The optimal management of comminuted proximal humerus fractures in the elderly remains controversial. Although hemiarthroplasty is widely used for complex fracture patterns, its functional superiority over reconstruction is not consistently demonstrated. The aim of this study was to compare early functional outcomes [...] Read more.

Background: The optimal management of comminuted proximal humerus fractures in the elderly remains controversial. Although hemiarthroplasty is widely used for complex fracture patterns, its functional superiority over reconstruction is not consistently demonstrated. The aim of this study was to compare early functional outcomes following open reduction and internal fixation (ORIF) versus hemiarthroplasty in elderly patients with three- and four-part proximal humerus fractures. Methods: This retrospective single-center study included elderly patients with comminuted proximal humerus fractures treated between 2020 and 2024 by either ORIF or hemiarthroplasty. Functional outcomes were assessed at 6 months using the Constant–Murley and DASH scores. Secondary outcomes included complication rates, range of motion, and early reintervention. Results: At 6 months, the ORIF group showed a mean Constant–Murley score of 62.1 ± 9.4 compared with 58.0 ± 10.2 in the hemiarthroplasty group. DASH scores were 34.2 ± 10.8 for ORIF and 38.5 ± 11.3 for hemiarthroplasty. Pain levels were similarly low in both groups (VAS 2.6 ± 1.1 vs. 2.9 ± 1.2). Complication rates were comparable, with fixation-related issues occurring in 17% of ORIF cases and tuberosity-related complications in 11% of hemiarthroplasty cases. Conclusions: Hemiarthroplasty should not be regarded as the default treatment strategy for comminuted proximal humerus fractures in elderly patients. When stable anatomic reduction is achievable, ORIF can yield comparable early functional results, emphasizing that patient selection and tuberosity management remain more important than the choice of implant. Full article

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14 pages, 1022 KB

Open AccessSystematic Review

Endoscopically Treated Third Ventricle Colloid Cysts: A Systematic Review of Surgical and Clinical Outcomes

by Edoardo Agosti, Sara Antonietti, Michael Viola, Marco Maria Fontanella and Alessandro Fiorindi

Clin. Pract. 2026, 16(2), 29; https://doi.org/10.3390/clinpract16020029 - 29 Jan 2026

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Abstract

Background/Objectives: Third ventricle colloid cysts (TVCCs) are benign lesions that may cause acute hydrocephalus and, rarely, sudden death. Endoscopic resection has emerged as a minimally invasive alternative to microsurgical approaches. This systematic review aimed to evaluate the safety and efficacy of endoscopic resection [...] Read more.

Background/Objectives: Third ventricle colloid cysts (TVCCs) are benign lesions that may cause acute hydrocephalus and, rarely, sudden death. Endoscopic resection has emerged as a minimally invasive alternative to microsurgical approaches. This systematic review aimed to evaluate the safety and efficacy of endoscopic resection of TVCCs. Methods: Following PRISMA guidelines, a systematic search of major databases was performed to identify studies reporting clinical outcomes of endoscopic resection of TVCCs. Extracted data included the surgical technique, extent of resection, complications, recurrence, and reoperations. Results: Thirty-four studies comprising 1123 patients were included. Gross total resection (GTR) was achieved in 767 patients (68.3%), with higher rates for the transforaminal (88.4%) and transeptal (86.9%) approaches (z = 0.309; p = 0.76). Capsule removal was performed in 87.4% and coagulation alone in 11.6%. Postoperative remnants occurred in 172 patients (17.1%). Recurrence was observed in 41 cases (3.7%) after a mean follow-up of 46.3 months, with 33 patients (2.9%) requiring reoperation. Preoperative hydrocephalus was present in 51% of cases. Septostomy and external ventricular drainage were performed in 15.7% and 15.5% of patients, respectively. Complications included memory deficits (3.6%), meningitis (3.6%), intraventricular hemorrhage (2.7%), ischemia (1.1%), shunt dependency (2.1%), and seizures (0.6%). Mortality occurred in eight patients (0.7%). Conclusions: Endoscopic management of TVCCs is associated with a low complication rate and favorable long-term outcomes. Capsule resection reduces the risk of recurrence and the need for reoperation. Full article

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9 pages, 621 KB

Open AccessCase Report

Psoriasis Course in Patients with Alopecia Areata Undergoing Baricitinib Therapy

by Enrico Matteini, Fabio Artosi, Giacomo Caldarola, Lorenzo Maria Pinto, Alfredo Rossi, Lorenzo Ala, Gaetana Costanza, Luca Bianchi, Elena Campione and Laura Diluvio

Clin. Pract. 2026, 16(2), 28; https://doi.org/10.3390/clinpract16020028 - 28 Jan 2026

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Abstract

Background/Objectives: Alopecia areata (AA) and psoriasis are immune-mediated diseases that can coexist, suggesting shared pathogenic mechanisms. While Janus kinase inhibitors (JAKi) are approved for AA treatment, their role in managing concomitant psoriasis and psoriatic arthritis (PsA) remains unclear. This study evaluates the efficacy [...] Read more.

Background/Objectives: Alopecia areata (AA) and psoriasis are immune-mediated diseases that can coexist, suggesting shared pathogenic mechanisms. While Janus kinase inhibitors (JAKi) are approved for AA treatment, their role in managing concomitant psoriasis and psoriatic arthritis (PsA) remains unclear. This study evaluates the efficacy and safety of baricitinib in patients with severe AA and coexisting psoriasis and/or PsA. Materials and Methods: A retrospective case series of five patients (mean age 53.2 years) with severe AA (SALT > 80) or alopecia universalis (AU) and concomitant psoriasis (n = 2) and/or PsA (n = 3) was conducted in the Dermatology Unit of Policlinico of Tor Vergata, Catholic University of the Sacred Heart and La Sapienza University of Rome, Italy. Patients received baricitinib 4 mg/day and were assessed at weeks 4, 24, and 52 using SALT, PASI, and pVAS scores. Results: At week 52, one patient achieved complete AA remission, while two improved to SALT < 20 (mean SALT 83 to 8.75). Psoriasis remained stable (mean PASI 1.4 to 0.5). However, one PsA patient worsened (pVAS 9) and discontinued the treatment. Conclusions: Baricitinib was effective for AA, with potential benefits for psoriasis, but it may not be optimal for PsA. Further studies are needed to define its role in multiple immune diseases. Full article

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9 pages, 2262 KB

Open AccessCase Report

Effectiveness of the Temporal Flap in Reconstruction After Advanced External Ear Tumor Resection: A Case Report

by Kostadin Gigov, Petra Kavradzhieva, Ivan Ginev and Mihaela Bogdanova

Clin. Pract. 2026, 16(2), 27; https://doi.org/10.3390/clinpract16020027 - 28 Jan 2026

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Abstract

Background: Auricular carcinoma is a malignant neoplasm arising from the epithelial or adnexal tissues of the external ear, most commonly representing cutaneous squamous cell carcinoma, basal cell carcinoma, or, less frequently, melanoma, characterized by early cartilage invasion and regional spread due to [...] Read more.

Background: Auricular carcinoma is a malignant neoplasm arising from the epithelial or adnexal tissues of the external ear, most commonly representing cutaneous squamous cell carcinoma, basal cell carcinoma, or, less frequently, melanoma, characterized by early cartilage invasion and regional spread due to the thin soft-tissue envelope of the ear. Such malignancies involve radical resection, producing wide defects, which require complex reconstructive approach. Case Presentation and Methods: We describe a 45-year-old male patient who presented with a basal cell carcinoma, affecting the lobulus of the ear and the retroauricular and mastoid region. He underwent successful tumor resection with clear resection margins in an ENT department with a subsequent referral to our department for reconstruction. This report presents a successful reconstruction of a large post-excisional defect, 10 × 10 cm in diameter, with mastoid process exposure. Temporal muscle flip flap and skin graft, along with the preservation of the external auditory canal with Z-plasty, were incorporated for reconstruction after subtotal auricular amputation due to BCC. It highlights the importance of a diligent long-term follow-up, the preservation of the canal, preventing meatal stenosis, and the reconstructive potential of the muscle flap in patients with mastoid bone exposure in a single stage. Conclusions: A temporalis muscle flap with skin graft coverage offers a reliable, vascularized solution for large post-oncologic auricular defects while preserving the external auditory canal. Z-plasty remains a critical technique for preventing meatal stenosis. Full article

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16 pages, 1096 KB

Open AccessArticle

Elevated Serum LPS in Newly Diagnosed Hashimoto’s Thyroiditis: A Case–Control Study in Bulgaria

by Desislav Tomov, Boryana Levterova, Valentina Mihailova, Dimitar Troev, Zlatina Tomova, Yordanka Uzunova and Maria Orbetzova

Clin. Pract. 2026, 16(2), 26; https://doi.org/10.3390/clinpract16020026 - 26 Jan 2026

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Abstract

Background: Hashimoto’s thyroiditis (HT) is a prevalent autoimmune disorder, often diagnosed late due to its asymptomatic or nonspecific presentation. Emerging evidence suggests that gut-derived lipopolysaccharides (LPS) may contribute to autoimmune activation. Objective: The primary objective of this study was to assess circulating [...] Read more.

Background: Hashimoto’s thyroiditis (HT) is a prevalent autoimmune disorder, often diagnosed late due to its asymptomatic or nonspecific presentation. Emerging evidence suggests that gut-derived lipopolysaccharides (LPS) may contribute to autoimmune activation. Objective: The primary objective of this study was to assess circulating LPS concentrations and dietary patterns in patients with Hashimoto’s thyroiditis compared to healthy controls. Methods: A hospital-based case–control study was conducted involving 105 HT patients and 25 healthy controls. Serum LPS concentrations, thyroid hormone profiles, and autoantibody levels were assessed. Dietary patterns were evaluated using the validated KomPAN questionnaire. Results: HT patients exhibited significantly higher serum LPS levels, particularly those with elevated anti-TPO and TRAB antibodies. A positive correlation was found between LPS and the fT3/fT4 ratio (r = 0.247, p = 0.006), and a negative correlation with fT4 (r = −0.314, p < 0.001). Dietary analysis revealed lower Pro-Healthy Diet Index scores in HT patients (3.94 vs. 5.34, p = 0.001), with increased consumption of processed foods and reduced intake of whole grains and oats. Conclusions: Elevated levels of lipopolysaccharides (LPS) and unhealthy dietary patterns may play a role in the development of thyroid autoimmunity. Taken together, these observations are consistent with a multifactorial model that potentially involves gut barrier dysfunction, endotoxemia, and nutritional factors in HT pathogenesis. Full article

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14 pages, 813 KB

Open AccessCase Report

Comprehensive Conservative Management as Rescue Therapy After Haemodialysis Failure: Two Case Reports

by Francesca K. Martino, Alessandro Martella, Francesca Fioretti, Leda Cattarin, Federica L. Stefanelli and Federico Nalesso

Clin. Pract. 2026, 16(2), 25; https://doi.org/10.3390/clinpract16020025 - 25 Jan 2026

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Abstract

Background: Comprehensive conservative management (CCM) is a possible option in end-stage clinical disease, requiring multidisciplinary support and offering survival comparable to dialysis while improving quality of life in frail patients. Despite its potential benefits, CCM is often underutilized because nephrologists may perceive it [...] Read more.

Background: Comprehensive conservative management (CCM) is a possible option in end-stage clinical disease, requiring multidisciplinary support and offering survival comparable to dialysis while improving quality of life in frail patients. Despite its potential benefits, CCM is often underutilized because nephrologists may perceive it as less effective compared to dialysis. We present two case reports of hemodialysis failure and of successful CCM. Case presentation: We present two case reports of elderly female patients—referred to as Patient 1 and Patient 2—who had multiple comorbidities but preserved urine output. Both patients, in accordance with their medical team, chose to discontinue hemodialysis due to poor treatment tolerance and declining overall health. They were successfully managed with CCM, leading to follow-up that revealed survival beyond 24 months, improvements in metabolic complications and quality of life, and a reduction in hospitalizations. Conclusions: These case reports demonstrate the effectiveness of dietary and medical management for end-stage kidney disease, particularly when dialysis negatively affects patients’ clinical conditions and quality of life. They also highlight the importance of considering CCM as a preferable option for frail elderly patients facing kidney failure. Full article

(This article belongs to the Special Issue Clinical Nutritional Management of Patients with Kidney Disease)

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15 pages, 1537 KB

Open AccessArticle

Clinical Outcome of Endoscopic Transpapillary Drainage for Biliary Obstruction Due to Non-Hepato-Pancreato-Biliary Cancer: A Two-Center Retrospective Cohort Study

by Kensuke Kitsugi, Kazuhito Kawata, Yoshisuke Hosoda, Yashiro Yoshizawa, Masaharu Kimata, Yosuke Kobayashi, Shuhei Unno, Yosuke Yamada, Hidenao Noritake, Takeshi Chida and Go Murohisa

Clin. Pract. 2026, 16(2), 24; https://doi.org/10.3390/clinpract16020024 - 23 Jan 2026

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Abstract

Objective: Although non-hepato-pancreato-biliary (non-HPB) cancer, such as gastric and colorectal cancer, may cause biliary obstruction, the efficacy of endoscopic transpapillary drainage remains unclear. We investigated the clinical outcomes of endoscopic transpapillary drainage for biliary obstruction due to non-HPB cancer. Methods: This [...] Read more.

Objective: Although non-hepato-pancreato-biliary (non-HPB) cancer, such as gastric and colorectal cancer, may cause biliary obstruction, the efficacy of endoscopic transpapillary drainage remains unclear. We investigated the clinical outcomes of endoscopic transpapillary drainage for biliary obstruction due to non-HPB cancer. Methods: This was a two-center retrospective observation study. We evaluated the technical success, clinical success, recurrent biliary obstruction (RBO), time to RBO (TRBO), adverse events (AEs), and overall survival (OS). OS was determined using the Kaplan–Meier method, and the significance was tested using the log-rank test. Cox regression hazard models were performed to identify the independent association of clinical parameters with OS. Results: This study included 43 cases. The technical success was achieved in all cases (100%), and the clinical success was achieved in 35 cases (81%). The occurrence rate of RBO and non-RBO AEs were 33% and 12%, respectively. The median TRBO was 176 days. Systemic chemotherapy was introduced in 17 cases (40%) after biliary drainage, and cases with the introduction of systemic chemotherapy had a significantly longer OS. C-reactive protein <3.4 mg/dL and biliary obstruction due to lymph node metastasis were independently associated with the introduction of systemic chemotherapy. In survival analysis, serum albumin >3.1 g/dL and the introduction of systemic chemotherapy were significant and independent predictive factors for the prolongation of OS. Conclusions: The endoscopic transpapillary drainage for biliary obstruction due to non-HPB cancer can provide favorable outcomes with appropriate patient selection. Full article

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17 pages, 1794 KB

Open AccessArticle

Sedation Strategies for Awake Carotid Endarterectomy: An Exploratory Retrospective Study Comparing Dexmedetomidine and Remifentanil

by Rosanna Carmela De Rosa and Antonio Romanelli

Clin. Pract. 2026, 16(2), 23; https://doi.org/10.3390/clinpract16020023 - 23 Jan 2026

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Abstract

Background: Awake carotid endarterectomy (CEA) under local anesthesia demands an optimal sedation strategy that ensures patient comfort while preserving the ability for real-time neurological assessment. Dexmedetomidine (DEX) and remifentanil (REMI) are widely used agents, but direct comparisons in this setting remain scarce. Methods: [...] Read more.

Background: Awake carotid endarterectomy (CEA) under local anesthesia demands an optimal sedation strategy that ensures patient comfort while preserving the ability for real-time neurological assessment. Dexmedetomidine (DEX) and remifentanil (REMI) are widely used agents, but direct comparisons in this setting remain scarce. Methods: Exploratory, retrospective, single-center study of awake CEA (March–July 2019). DEX or REMI infusions were titrated to a Richmond Agitation–Sedation Scale (RASS) of −1 to −2. Outcomes were sedation failure (RASS ≥ +2 despite maximum infusion rate), bradycardia, hypotension, and neurologic events. Statistical analyses used χ² test (categorical variables) and Student’s t-test or Mann–Whitney test (continuous variables). Associations were assessed with Firth’s logistic regression (univariable and bivariate models), reporting odds ratios (OR) with 95% confidence intervals (CI_95%). Trends in the Bispectral Index (BIS), hemodynamic, and respiratory parameters were assessed using two-way repeated-measures Analysis of Variance (ANOVA). A p-value < 0.05 was considered significant. Results: Fifty-two patients were included (DEX = 25; REMI = 27). DEX group showed more frequent sedation failure (32.0% vs. 3.7%; p = 0.020), bradycardia (36.0% vs. 3.7%; p = 0.009), and hypotension (28.0% vs. 0%; p = 0.011). DEX was associated with increased risk in sedation failure (OR 8.58, CI_95% 1.70–85.81), bradycardia (OR 10.17, CI_95% 2.05–101.21), and hypotension (OR 22.30, CI_95% 2.46–2959.60); the direction of associations remained consistent in bivariate models adjusted for baseline confounders. ANOVA showed group-by-time interactions for BIS, heart rate, mean arterial pressure, and end-tidal CO₂. No intraoperative complications or adverse outcomes were observed. Conclusions: In this retrospective cohort of awake CEA, DEX was associated with higher rates of sedation failure and hemodynamic adverse events compared with REMI, without an apparent impact on procedural success. Given non-random allocation and baseline imbalances, these findings are hypothesis-generating and warrant confirmation in larger, robust, and prospective studies. Full article

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Clin. Pract., Volume 16, Issue 2 (February 2026) – 19 articles

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