Clinics and Practice

25 pages, 1327 KB

Open AccessReview

Vitamin D and Postpartum Depression: A Narrative Review

by Afra Almashghouni, Haydar Hasan and Dimitrios Papandreou

Clin. Pract. 2026, 16(8), 147; https://doi.org/10.3390/clinpract16080147 (registering DOI) - 8 Aug 2026

Background/objective: Postpartum depression (PPD) is a significant public health issue affecting about 19% of mothers globally. It has well-documented impacts on maternal well-being, mother–infant relationships, and child developmental outcomes. At the same time, the level of vitamin D deficiency in women of reproductive [...] Read more.

Background/objective: Postpartum depression (PPD) is a significant public health issue affecting about 19% of mothers globally. It has well-documented impacts on maternal well-being, mother–infant relationships, and child developmental outcomes. At the same time, the level of vitamin D deficiency in women of reproductive age is very high (affecting 60–87 percent of pregnant women globally). The review aims to synthesize current evidence and highlight priority research areas to improve maternal mental health outcomes. Methods: A systematic literature search of PubMed, Scopus, and Google Scholar (2015–2026) was conducted, followed by narrative synthesis of mechanistic, observational, and interventional evidence. Results: Adequate vitamin D status may contribute to a reduced risk of postpartum depression through multiple interacting pathways, including serotonin synthesis and metabolism (via tryptophan hydroxylase 2 (TPH2) and monoamine oxidase-A (MAO-A) regulation), neuroplasticity via brain-derived neurotrophic factor (BDNF) signaling, and suppression of the pro-inflammatory cytokine cascade. Dose–response meta-analyses and large prospective cohort studies indicate consistent negative relationships between maternal vitamin D levels and postpartum depressive and anxiety symptoms with optimal serum 25-hydroxyvitamin D (25(OH)D) levels of 90–110 nmol/L. Conclusions: There is still limited evidence on the intervention; it is still methodologically diverse, and only a few randomized controlled trials have been carried out on specifically postpartum populations. Full article

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11 pages, 514 KB

Open AccessArticle

Guselkumab Every 4 Weeks as a Real-World Therapeutic Option for Psoriatic Arthritis Patients at High Risk of Joint Damage

by Nicoletta Bernardini, Giorgio Marotta, Nevena Skroza, Dario Graceffa, Maria Consiglia Bragazzi, Lucia Finistauri Guacci, Ersilia Tolino, Francesca Paola Sasso, Umberto Gallo, Antonio Giovanni Richetta and Annunziata Dattola

Clin. Pract. 2026, 16(8), 146; https://doi.org/10.3390/clinpract16080146 - 7 Aug 2026

Abstract

Background: Guselkumab, a monoclonal antibody selectively targeting the p19 subunit of interleukin-23, is typically administered with an induction phase at weeks 0 and 4 followed by maintenance dosing every 8 weeks for the treatment of psoriatic arthritis (PsA). In Europe, a four-week regimen [...] Read more.

Background: Guselkumab, a monoclonal antibody selectively targeting the p19 subunit of interleukin-23, is typically administered with an induction phase at weeks 0 and 4 followed by maintenance dosing every 8 weeks for the treatment of psoriatic arthritis (PsA). In Europe, a four-week regimen (Q4W) has recently been approved for patients at high risk of joint damage progression; however, real-world evidence on this intensified schedule remains limited. This study aimed to evaluate the effectiveness and safety of guselkumab Q4W in routine clinical practice. Methods: This retrospective observational study included 18 PsA patients at high risk of structural damage treated with guselkumab Q4W at two psoriasis referral centers in the Lazio region of Italy. Baseline and 24-week clinical data were collected from medical records. Outcome measures included Disease Activity Index for Psoriatic Arthritis (DAPSA), Minimal Disease Activity (MDA), pain Visual Analog Scale (VAS), Dermatology Life Quality Index (DLQI), and Psoriasis Area and Severity Index (PASI). Results: After 24 weeks, mean DAPSA decreased from 34.3 ± 7.6 to 3.7 ± 3.0; 55.6% of patients achieved DAPSA remission and 77.8% achieved MDA. Significant improvements were observed in pain VAS, DLQI, and PASI scores. All patients achieved PASI 75, while 83.3% achieved PASI 90 and PASI 100. Treatment was generally well tolerated, with no adverse events or new safety signals documented during follow-up. Conclusions: In our study, guselkumab Q4W showed marked multidomain effectiveness and a favorable safety profile, supporting its use in PsA patients at high risk of joint damage progression. Full article

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17 pages, 827 KB

Open AccessArticle

Glycemic Status and Glycemic Variability Related to Mortality and Morbidity in Critically III Diabetic and Non-Diabetic Patients: A Prospective Observational Study

by Mădălina Diana Fehér, Codrin Dan Nicolae Ilea, Cosmin Mihai Vesa, Alina Cristiana Venter, Simona Daciana Birsan, Timea Claudia Ghitea, Rareș Cristian Daina, László Fehér and Cristian Marius Daina

Clin. Pract. 2026, 16(8), 145; https://doi.org/10.3390/clinpract16080145 - 6 Aug 2026

Abstract

Background: Glycemic dysregulation is frequent in critically ill patients and may influence prognosis regardless of pre-existing diabetes status. This study aimed to evaluate the impact of glycemic status and glycemic variability on mortality and morbidity in diabetic and non-diabetic patients admitted to the [...] Read more.

Background: Glycemic dysregulation is frequent in critically ill patients and may influence prognosis regardless of pre-existing diabetes status. This study aimed to evaluate the impact of glycemic status and glycemic variability on mortality and morbidity in diabetic and non-diabetic patients admitted to the intensive care unit (ICU). Methods: This prospective observational study included 244 critically ill patients. Demographic, clinical, biological, and glycemic data were collected during ICU hospitalization. Glycemic parameters included admission glucose, mean glucose, glucose standard deviation, coefficient of glycemic variability, hyperglycemia > 140 mg/dL, hyperglycemia > 180 mg/dL, hypoglycemia < 70 mg/dL, and intravenous insulin requirement. The primary outcome was in-hospital mortality. Results: In-hospital mortality was 58.6%. Non-survivors had significantly higher admission glucose, mean glucose, glycemic standard deviation, and coefficient of glycemic variability compared with survivors. Hyperglycemia > 140 mg/dL, hyperglycemia > 180 mg/dL, poor glycemic control, and intravenous insulin therapy were significantly associated with mortality. Patients with high glycemic variability, defined as coefficient of variation (CV) > 36%, had higher mortality than those with lower variability. In multivariable analysis, mean glucose remained the most robust glycemic predictor associated with mortality, while glycemic variability retained prognostic relevance in alternative models. Conclusions: Glycemic dysregulation was common and clinically relevant in critically ill diabetic and non-diabetic patients. Dynamic glucose monitoring, including mean glucose and glycemic variability, may improve risk stratification and support structured ICU glycemic management. Full article

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20 pages, 18535 KB

Open AccessCase Report

Mediastinal Lymphangioma of the Adult: Case Report and Literature Review

by Mihaela-Beatrice Tivadar, Amir-Andrei Sabha, Vasile Grigorie, Raluca Bobocea and Andrei-Cristian Bobocea

Clin. Pract. 2026, 16(8), 144; https://doi.org/10.3390/clinpract16080144 - 6 Aug 2026

Abstract

Introduction: Mediastinal lymphangiomas are rare, benign vascular malformations of the lymphatic system that are seldom diagnosed in adults. Due to their varied clinical presentation and heterogeneous imaging characteristics, they pose a significant preoperative diagnostic challenge, frequently mimicking other mediastinal masses. Materials and [...] Read more.

Introduction: Mediastinal lymphangiomas are rare, benign vascular malformations of the lymphatic system that are seldom diagnosed in adults. Due to their varied clinical presentation and heterogeneous imaging characteristics, they pose a significant preoperative diagnostic challenge, frequently mimicking other mediastinal masses. Materials and Methods: We conducted a thorough search of the PubMed/MEDLINE, PubMed Central, and Google Scholar databases. We included articles from 2000 to 2026. Our search yielded 150 articles, out of which we selected 45 articles. Inclusion criteria were strictly limited to adult patients with a solitary mediastinal lymphangioma. Cases involving diffuse systemic lymphangiomatosis, mixed histological features such as lymphangiomyomas or hemangiolymphangioma or studies on pediatric populations were explicitly excluded from the analysis. We also reported a case of mediastinal lymphangioma in a 42-year-old patient, which was surgically resected at the “Marius Nasta” National Institute of Pneumology in Bucharest, Romania. Case Description: An asymptomatic 42-year-old male presenting with exertional chest discomfort following minor trauma demonstrated a lower left hemithorax opacity on chest X-ray. Imagistic studies revealed a 13 × 9 × 6 cm cystic mass in the left supradiaphragmatic costophrenic recess. The patient underwent a complete radical excision. The postoperative recovery was uneventful. Histopathology confirmed a benign cystic mediastinal lymphangioma. Conclusions: Adult mediastinal lymphangiomas are rare entities that require a high index of clinical suspicion. While advanced cross-sectional imaging is invaluable for delineating their characteristics, definitive diagnosis relies on histopathological confirmation. Complete surgical resection, increasingly performed via minimally invasive approaches or standard thoracotomy, remains the therapeutic gold standard, offering an excellent long-term prognosis with virtually no risk of recurrence. For inoperable cases, several non-surgical approaches are available. Full article

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15 pages, 1074 KB

Open AccessArticle

A Multidomain Prediction Model Integrating Myocardial Injury, Ventricular Function, and Inflammation for Short-Term Risk Stratification in Patients with NSTEMI

by Emir Bećirović, Minela Bećirović, Amir Bećirović, Amir Tursunović, Ajla Bajrić, Amil Softić, Adna Mujkić, Elma Mujaković, Admir Abdić and Lamija Ferhatbegović

Clin. Pract. 2026, 16(8), 143; https://doi.org/10.3390/clinpract16080143 - 4 Aug 2026

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Abstract

Background/Objectives: Early risk stratification remains challenging in patients with non-ST-segment elevation myocardial infarction (NSTEMI). The present study evaluated the prognostic value of 24 h high-sensitivity cardiac troponin I (hs-Troponin I) and assessed whether combining biomarkers and echocardiographic parameters improves short-term risk prediction. [...] Read more.

Background/Objectives: Early risk stratification remains challenging in patients with non-ST-segment elevation myocardial infarction (NSTEMI). The present study evaluated the prognostic value of 24 h high-sensitivity cardiac troponin I (hs-Troponin I) and assessed whether combining biomarkers and echocardiographic parameters improves short-term risk prediction. Methods: This prospective observational cohort study included 170 consecutive adult patients with confirmed NSTEMI who were admitted to a Medical Intensive Care Unit and prospectively enrolled between February 2022 and January 2023. Clinical, routine biochemical, inflammatory, hematological, lipid, and echocardiographic data were collected during index hospitalization. High-sensitivity cardiac troponin I was measured at admission and again 24 h after hospitalization, with the 24 h value used as the principal marker of myocardial injury in the prediction analyses. The primary endpoint was major adverse cardiovascular events (MACEs), defined as cardiovascular death, recurrent myocardial infarction, ischemic stroke, urgent coronary revascularization, or hospitalization for worsening heart failure, within 3 months. Multivariable logistic regression, Cox regression, sequential prediction modeling, and internal bootstrap validation were performed. Results: MACEs occurred in 88 patients (51.8%). Twenty-four-hour hs-Troponin I, but not admission hs-Troponin I, was independently associated with MACEs (OR 1.57, 95% CI 1.09–2.26; p = 0.015) and a shorter time to the first MACE event (HR 1.38, 95% CI 1.07–1.78; p = 0.012). Lower left ventricular ejection fraction (LVEF) was also independently associated with adverse outcomes. The addition of 24 h hs-Troponin I, LVEF, and C-reactive protein improved discrimination from an AUC of 0.665 to 0.759 (optimism-corrected AUC, 0.717), with corresponding improvements in reclassification. A simplified multimarker score was independently associated with event-free survival (HR 2.36, 95% CI 1.53–3.64; p < 0.001). Conclusions: In patients admitted to a medical intensive care unit with NSTEMI, the integration of 24 h hs-Troponin I, LVEF, and C-reactive protein improved short-term risk prediction beyond that of clinical variables alone. A practical multimarker model based on routinely available parameters identified patients at increased risk of adverse cardiovascular outcomes during early follow-up. Full article

(This article belongs to the Section Cardiac and Cardiovascular Systems)

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19 pages, 3699 KB

Open AccessArticle

Reproducibility of Mandibular Cortical Index Classification Among Dental Examiners and a Single Generative AI Platform: An Observer Agreement Study

by Keisuke Seki, Minori Kashima, Taiki Akiyama, Atsushi Kobayashi, Ko Dezawa, Yoshimasa Takeuchi, Mika Furuchi and Atsushi Kamimoto

Clin. Pract. 2026, 16(8), 142; https://doi.org/10.3390/clinpract16080142 - 31 Jul 2026

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Abstract

Background/Objectives: The mandibular cortical index (MCI) is a valuable screening tool for osteoporosis on dental panoramic radiographs, but its assessment is subject to inter-examiner variability. This study evaluated the reproducibility and inter-rater agreement of MCI classification by a closed-source generative AI tool (NotebookLM, [...] Read more.

Background/Objectives: The mandibular cortical index (MCI) is a valuable screening tool for osteoporosis on dental panoramic radiographs, but its assessment is subject to inter-examiner variability. This study evaluated the reproducibility and inter-rater agreement of MCI classification by a closed-source generative AI tool (NotebookLM, Google) compared with eight dentists of varying clinical experience. Methods: One hundred panoramic radiographs were classified according to the three-category MCI in two sessions held at least two weeks apart. Intra-examiner reliability, inter-examiner agreement, and agreement with a reference radiologist were assessed using linearly weighted kappa coefficients. The study was designed as a descriptive reliability study rather than a formal equivalence trial. Results: The intra-examiner reliability of the AI was exceptionally high (κ = 0.987). However, agreement between the AI and the dentists remained at “slight agreement” or lower (κ < 0.2) for every pairing, with 95% confidence intervals that included zero; no formal global hypothesis test was performed, and these individual interval estimates should not be interpreted as proof of the absence of agreement beyond chance. A “two-level discrepancy,” in which the AI interchanged Class 1 (normal) and Class 3 (severe), occurred in 10–18% of cases. The dentists showed a possible learning effect, with inter-examiner agreement improving between sessions. Conclusions: Despite the high reproducibility of the NotebookLM configuration evaluated in this study, agreement with the dentists remained at “slight” or lower (κ < 0.2) in MCI classification. As classifications were not validated against bone mineral density or an adjudicated reference standard, these findings concern reproducibility and agreement rather than diagnostic or screening performance and characterize a single LLM-based platform rather than generative AI in general. Full article

(This article belongs to the Topic Artificial Intelligence in Public Health: Current Trends and Future Possibilities, 3rd Edition)

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28 pages, 1267 KB

Open AccessArticle

Myoprotective Fat-Loss Phenotypes in Obesity-Associated Type 2 Diabetes: A 12-Month Real-World Cohort Study of Metformin-Based Treatment Regimens

by Ioana Bujdei-Tebeică, Anca Mihaela Pantea-Stoian, Doina Andrada Mihai, Simona Diana Ștefan and Cristian Serafinceanu

Clin. Pract. 2026, 16(8), 141; https://doi.org/10.3390/clinpract16080141 - 28 Jul 2026

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Abstract

Background/Objectives: In obesity-associated type 2 diabetes (T2DM), therapeutic benefit increasingly requires assessment of not only HbA1c and total body weight, but also the composition and functional quality of weight change. We evaluated a myoprotective fat-loss phenotype, defined as a reduction in adiposity [...] Read more.

Background/Objectives: In obesity-associated type 2 diabetes (T2DM), therapeutic benefit increasingly requires assessment of not only HbA1c and total body weight, but also the composition and functional quality of weight change. We evaluated a myoprotective fat-loss phenotype, defined as a reduction in adiposity accompanied by preservation of lean mass and handgrip strength. Methods: This secondary patient-level analysis included 166 adults with T2DM who completed 12 months of follow-up without changing treatment in a real-world tertiary diabetes cohort. Patients received metformin alone or metformin combined with a sulfonylurea, a DPP-4 inhibitor, an SGLT2 inhibitor, a GLP-1 receptor agonist, or insulin. Body composition was assessed by bioimpedance and muscle function by handgrip dynamometry. The primary phenotype required a reduction in fat mass ≥5%, a loss of lean mass <3%, and a decrease in handgrip ≤1 kg. Phenotype distributions were compared between treatment groups; patient-level associations and adjusted contrasts were explored using correlation analyses and baseline-adjusted regression models with robust HC3 standard errors. Results: Fat-mass reduction ≥5% occurred in 58/166 patients (34.9%), lean-mass preservation in 129/166 (77.7%), and handgrip preservation in 143/166 (86.1%). The complete myoprotective phenotype was present in 35/166 patients (21.1%) and differed significantly across treatment groups (χ² = 131.58; permutation p < 0.0001). It was most frequent in the GLP-1 receptor agonist group (13/23; 56.5%) and the SGLT2 inhibitor group (12/25; 48.0%), less frequent with metformin monotherapy (9/46; 19.6%) and DPP-4 inhibitors (1/17; 5.9%), and absent in the sulfonylurea and insulin groups. GLP-1 receptor agonists showed the greatest crude fat-mass loss, whereas lean-mass loss, skeletal-muscle-mass change, and handgrip change did not differ significantly across groups after false-discovery-rate correction. Conclusions: Myoprotective fat-loss phenotypes can be identified in obesity-associated T2DM using body composition and handgrip measures. These observational findings support the assessment of the quality, not just the magnitude, of weight loss in diabetes care and require validation in larger prospective studies. Full article

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21 pages, 494 KB

Open AccessReview

The Interplay of Quality of Life and Satisfaction with Nursing Care in Cancer Patients: A Narrative Review

by Efthymia Vlachothanasi, Ioanna Tsatsou, Theocharis I. Konstantinidis, Maria Saridi, Evangelos C. Fradelos, Georgios Goumas and Pavlos Sarafis

Clin. Pract. 2026, 16(8), 140; https://doi.org/10.3390/clinpract16080140 - 27 Jul 2026

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Abstract

This narrative review explores the interconnected relationship between quality of life (QoL) and satisfaction with nursing care (SNC) among cancer patients, recognizing that cancer’s burden extends beyond survival and significantly affects physical, psychological, and social well-being. A non-systematic search of PubMed, CINAHL, Scopus, [...] Read more.

This narrative review explores the interconnected relationship between quality of life (QoL) and satisfaction with nursing care (SNC) among cancer patients, recognizing that cancer’s burden extends beyond survival and significantly affects physical, psychological, and social well-being. A non-systematic search of PubMed, CINAHL, Scopus, and Google Scholar (2000–2025) identified relevant literature using keywords related to oncology nursing, QoL, SNC and patient satisfaction. Inclusion criteria encompassed peer-reviewed studies (quantitative, qualitative, and reviews) involving adult cancer populations and validated assessment instruments. Pediatric and non-nursing studies were excluded. Both QoL and SNC are critical outcomes in cancer care. QoL is an individual’s subjective perception and SNC reflects the patient’s subjective evaluation of how well nursing services align with their expectations, encompassing empathy, competence, and responsiveness. Research consistently demonstrates a strong positive association between high SNC and superior QoL outcomes, particularly through effective pain and symptom management, reducing psychological distress, and fostering patient empowerment. This relationship, however, is moderated by factors such as the patient’s disease stage, the type of care (hospital vs. palliative/home care), and organizational deficits like high nurse workload, which can undermine the delivery of high-quality care. Ultimately, ethical nursing practices are crucial for translating professional duty into positive patient experiences that are favorably linked with both SNC and QoL outcomes for cancer patients. Full article

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12 pages, 269 KB

Open AccessArticle

Optimal Timing for Intrauterine Device Insertion During the Menstrual Cycle: A Comparative Study of Pain, Bleeding, and Postprocedural Outcomes

by Lucian Șerbănescu, Sebastian Mirea, Vadym Rotar, Ștefan-Adrian Vrîncianu, Elena Mocanu, Maria Fulina, Stere Popescu, Cosmin Nișcoveanu and Radu-Andrei Baz

Clin. Pract. 2026, 16(8), 139; https://doi.org/10.3390/clinpract16080139 - 27 Jul 2026

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Abstract

Background: Intrauterine device (IUD) insertion is a highly effective contraceptive procedure but is frequently associated with pain and bleeding, which may negatively influence patient acceptance and continuation rates. Although traditionally performed during menstruation, the optimal timing of insertion within the menstrual cycle remains [...] Read more.

Background: Intrauterine device (IUD) insertion is a highly effective contraceptive procedure but is frequently associated with pain and bleeding, which may negatively influence patient acceptance and continuation rates. Although traditionally performed during menstruation, the optimal timing of insertion within the menstrual cycle remains uncertain, with limited data regarding patient-centered outcomes. Objective: The aim of this study was to evaluate the impact of menstrual cycle timing on pain, intra-procedural bleeding, and postprocedural outcomes in women undergoing IUD insertion. Methods: A comparative observational study was conducted including 200 parous women aged 20–40 years. Participants were consecutively enrolled and classified into two groups according to the day of the menstrual cycle at presentation for IUD insertion: Group A (days 3–7 of the menstrual cycle) and Group B (days 10–14). All procedures were performed by the same experienced gynecologist using a standardized technique. Pain was assessed using a Visual Analog Scale (VAS), intra-procedural bleeding was graded on a 0–3 scale, and postprocedural outcomes included analgesic use and bleeding characteristics. Statistical analysis was performed using independent t-tests and chi-square tests. Results: Baseline characteristics were comparable between groups (p > 0.05). Mean pain scores were significantly lower in Group B compared to Group A (3.1 ± 1.2 vs. 5.8 ± 1.4, p < 0.001). Intra-procedural bleeding was also significantly reduced in the mid-cycle group, with higher rates of minimal or no bleeding (85% vs. 20%, p < 0.001). The need for postprocedural anti-inflammatory medication was significantly lower in Group B (22% vs. 76%, p < 0.001). Additionally, postprocedural bleeding duration and intensity were reduced in the mid-cycle group. Conclusions: IUD insertion performed during the mid-cycle phase was associated with significantly better tolerability, including reduced pain, less bleeding, and decreased need for analgesia. While current guidelines allow flexible timing, these findings suggest that mid-cycle insertion may be associated with improved patient comfort when clinically feasible to improve patient experience without compromising access to contraception. Further randomized studies are warranted to confirm these results. Full article

(This article belongs to the Section Reproductive Medicine and Women’s Health)

20 pages, 24710 KB

Open AccessPerspective

Bringing the Line Home: A Perspective on Establishing At-Home PICC (Peripherally Inserted Central Catheter) Insertion in Oncology Patients

by Orestis Ioannidis, Antonia Aikaterini Bourtzinakou, Elissavet Anestiadou, Evangelia Ioannidou, Konstantinos Siozos, Georgios Gemousakakis, Stefanos Bitsianis, Savvas Symeonidis, Efstathios Kotidis, Manousos Georgios Pramateftakis, Ioannis Mantzoros and Stamatios Angelopoulos

Clin. Pract. 2026, 16(8), 138; https://doi.org/10.3390/clinpract16080138 - 27 Jul 2026

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Abstract

Background and Objectives: Vascular access in cancer patients with limited mobility remains a persistent clinical challenge, although both devices and insertion methods have improved considerably. We present our clinical experience with at-home PICC placement, supported by real-world data from routine practice, in oncology [...] Read more.

Background and Objectives: Vascular access in cancer patients with limited mobility remains a persistent clinical challenge, although both devices and insertion methods have improved considerably. We present our clinical experience with at-home PICC placement, supported by real-world data from routine practice, in oncology patients unable to attend hospital care, exploring its feasibility, safety, and practical applicability. Materials and Methods: All PICC insertions were performed at patients’ bedside by a trained surgeon using sterile technique. A single- or double-lumen PICC catheter was inserted under ultrasound guidance, magnetic tracking, and intracavitary ECG confirmation to secure optimal venous entry and accurate tip positioning. Results: A total of 28 PICC lines were successfully inserted in 26 oncologic patients. Two patients required catheter re-insertion, one following accidental removal and one due to infection. In 26 of 28 cases (92.9%), insertions were completed on the first attempt, while two cases required a second attempt. Insertion in the Green Zone per the ZIM classification was achieved in 26 of 28 cases (92.9%), and only two required insertions in the Yellow Zone. The basilic vein was chosen in 75% of patients. A total of 23 single-lumen and five double-lumen catheters were inserted. In terms of complications, four cases of systemic infection occurred more than 15 days after insertion and were not considered insertion-related; two patients developed localized edema requiring anticoagulation, and four catheter occlusions were managed conservatively. Conclusions: At-home PICC placement appears to be a feasible and clinically applicable approach when performed by qualified and credentialed professionals. These observations, derived from real-world clinical experience, suggest a potential role for this model in selected patient populations. Using proper sterile technique and real-time tip confirmation tools, this intervention may contribute to improved continuity of care and reduced hospital visits in selected patients. These observations suggest a potential role for expanding outpatient vascular access programs in selected patient populations. Full article

(This article belongs to the Special Issue Advances in Clinical Nursing: Integrating Advanced Surgical and Medical Nursing for Enhanced Patient Outcomes)

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22 pages, 1052 KB

Open AccessReview

Gambling Disorder as a Behaviorally Driven Systemic Medical Condition: From Reward Circuitry to Multi-System Morbidity

by Martina Ballerio, Piercarlo Minoretti and Enzo Emanuele

Clin. Pract. 2026, 16(8), 137; https://doi.org/10.3390/clinpract16080137 - 26 Jul 2026

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Abstract

Historically framed as a behavioral addiction, gambling disorder (GD) has had its somatic dimension neglected by standard clinical evaluation. This is a narrative, hypothesis-generating review focusing on the somatic aspects of GD. Cross-sectional and prospective evidence increasingly shows a somatic phenotype distributed across [...] Read more.

Historically framed as a behavioral addiction, gambling disorder (GD) has had its somatic dimension neglected by standard clinical evaluation. This is a narrative, hypothesis-generating review focusing on the somatic aspects of GD. Cross-sectional and prospective evidence increasingly shows a somatic phenotype distributed across four axes: cardiovascular (hypertension, angina, stroke, acute stress-induced cardiac events), metabolic (obesity, type 2 diabetes, chronic liver disease), sleep-related (insomnia, poor sleep quality, daytime sleepiness), and—as an emerging and insufficiently characterized dimension—neurological (clustering with seizures and frontal lobe epilepsy). Three candidate biological systems may translate this exposure into multi-system physiology: (i) a hyperreactive mesostriatal reward circuit hypothesized to sustain a behavioral cluster of smoking, hazardous alcohol use, low physical activity, and unhealthy diet; (ii) an integrated stress response postulated to shift from acute hyperreactivity to chronic basal cortisol blunting and reduced vagal tone; and (iii) putative alterations in peripheral neurotrophic signaling and frontal-callosal structure, marked by elevated peripheral brain-derived neurotrophic factor and by frontal-callosal white-matter alterations—with cumulative allostatic load serving as a conceptual integrating frame. We propose that GD can be a behaviorally driven systemic medical condition, warranting internal medicine involvement alongside addiction psychiatry. Within this framework, glucagon-like peptide-1 receptor agonists emerge as an exploratory therapeutic hypothesis warranting dedicated evaluation in GD, given their action on the mesolimbic reward substrate and phase 3 evidence in adjacent cardiometabolic, hepatic, and sleep conditions. Full article

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15 pages, 781 KB

Open AccessArticle

Nontherapeutic INR After Hospital Discharge: A Repeated-Measures Analysis of Warfarin-Treated Patients and Potential Drug–Drug Interactions

by Kanthida Methaset, Pattamawan Kosuma and Arom Jedsadayanmata

Clin. Pract. 2026, 16(8), 136; https://doi.org/10.3390/clinpract16080136 - 25 Jul 2026

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Abstract

Background: Warfarin remains widely used in specific clinical situations. Its management is complicated by multiple factors that affect anticoagulant response, particularly during the early period after hospital discharge. This study examined the prevalence, patterns, and factors associated with nontherapeutic international normalized ratio (INR) [...] Read more.

Background: Warfarin remains widely used in specific clinical situations. Its management is complicated by multiple factors that affect anticoagulant response, particularly during the early period after hospital discharge. This study examined the prevalence, patterns, and factors associated with nontherapeutic international normalized ratio (INR) among patients discharged on warfarin from a tertiary-care hospital. Methods: Electronic health records of adult patients discharged home with warfarin who had at least one INR measurement within 90 days (N = 1222) were retrospectively analyzed. Nontherapeutic INR was defined as INR outside the therapeutic range: 2.5–3.5 for mitral valve replacement and 2.0–3.0 otherwise. All available INR measurements were included. Major warfarin potential drug–drug interactions (pDDIs) were defined as DDIs with major severity according to the Micromedex^® database. Factors associated with nontherapeutic INR were examined using repeated-measures generalized estimating equations (GEEs), with generalized linear mixed models (GLMMs) as confirmatory analyses. Results: Of 3704 INR measurements within 90 days after discharge, 49.4% were subtherapeutic, while 30.5% were therapeutic and 20.1% were supratherapeutic. The proportion of therapeutic INR values did not show a substantial improvement over time. In GEEs, discharge from surgical service (adjusted odds ratio (aOR) 1.24, 95%CI: 1.05–1.48, p = 0.014) and presence of major warfarin pDDIs at discharge (aOR 1.36, 95%CI: 1.11–1.67, p = 0.003) were associated with nontherapeutic INR. GLMM analyses produced consistent results with the GEE model. Conclusions: Suboptimal INR control was prevalent within 90 days post-discharge. Discharge from surgical services and presence of major warfarin pDDIs at discharge were associated with nontherapeutic INRs. Major warfarin pDDIs may serve as markers of medication complexity at discharge and may help identify patients requiring closer anticoagulation monitoring. Full article

(This article belongs to the Section Cardiac and Cardiovascular Systems)

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Clin. Pract., Volume 16, Issue 8 (August 2026) – 12 articles

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