Journal of Clinical Medicine

15 pages, 1264 KiB

Open AccessArticle

Right Ventricular Diastolic Dysfunction Before Coronary Artery Bypass Grafting: Impact on 5-Year Follow-Up Outcomes

by Alexey N. Sumin, Anna V. Shcheglova, Nazeli D. Oganyan, Evgeniya Yu. Romanenko and Tatjana Yu. Sergeeva

J. Clin. Med. 2025, 14(4), 1398; https://doi.org/10.3390/jcm14041398 - 19 Feb 2025

Viewed by 417

Abstract

Background: The aim of this study was to assess the effect of right ventricular diastolic dysfunction on the results of 5-year follow-up of patients after coronary artery bypass grafting (CABG). Methods: Patients were enrolled in this prospective observational study examined before planned CABG [...] Read more.

Background: The aim of this study was to assess the effect of right ventricular diastolic dysfunction on the results of 5-year follow-up of patients after coronary artery bypass grafting (CABG). Methods: Patients were enrolled in this prospective observational study examined before planned CABG from 2017 to 2018. In addition to the baseline preoperative indicators and perioperative data, the initial parameters of the left and right ventricle (RV) systolic and diastolic function were assessed. The long-term results after CABG were assessed after 5 years. The following endpoints were recorded in the remote period: coronary and non-coronary death, non-fatal myocardial infarction (MI), repeat myocardial revascularization. Results: The results of long-term follow-up were assessed in 148 patients, during which time MACE was registered in 43 patients (29.1%). In the group with MACE before CABG, a history of myocardial infarction (p = 0.008), functional class 3 NYHA of chronic heart failure (CHF) (p = 0.013), an increase in the left ventricle size, a decrease in the e′/a′ ratio (p = 0.041), and the presence of the right ventricle diastolic dysfunction (p = 0.037) were more often detected. Kaplan–Meier analysis revealed a better long-term prognosis (MACE-free survival) in the group without RVDD compared to the group with RVDD (p = 0.026). Conclusions: In patients after coronary artery bypass grafting, the development of adverse events was associated with both clinical factors and the presence of right ventricular diastolic dysfunction. Survival analysis revealed a worse prognosis in patients with preoperative RVDD compared with patients without RVDD. Full article

(This article belongs to the Special Issue Clinical Application of Echocardiography in Heart Disease)

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12 pages, 233 KiB

Open AccessArticle

Cost-Effectiveness of Routine X-Rays After Central Venous Catheter Removal: A Value-Based Analysis of Post-Removal Complications

by Martin Breitwieser, Teresa Wiesner, Vanessa Moore, Florian Wichlas and Christian Deininger

J. Clin. Med. 2025, 14(4), 1397; https://doi.org/10.3390/jcm14041397 - 19 Feb 2025

Viewed by 399

Abstract

Background: Healthcare systems worldwide are increasingly burdened by rising costs, growing patient demand, and limited resources. In this context, cost-effectiveness analysis (CEA) plays a vital role in evaluating the clinical value of medical interventions relative to their costs. Despite the lack of [...] Read more.

Background: Healthcare systems worldwide are increasingly burdened by rising costs, growing patient demand, and limited resources. In this context, cost-effectiveness analysis (CEA) plays a vital role in evaluating the clinical value of medical interventions relative to their costs. Despite the lack of evidence supporting their necessity, routine post-removal chest X-rays for central venous catheters (CVCs) are still performed in some hospitals due to persistent misconceptions about their benefits. This study seeks to address these misconceptions by examining the costs of routine imaging through a cost analysis of complication detection rates in a large inpatient cohort, with the aim of highlighting the inefficiencies of this practice and promoting evidence-based approaches. Methods: A retrospective cohort analysis was performed across four university hospitals in Salzburg, Austria, including 984 CVC removals conducted between 2012 and 2021. Comparisons were made between X-rays after primary catheter insertion and post-removal X-rays to isolate complications specifically associated with CVC removal. A simple cost-per-outcome analysis, a subtype of CEA, was chosen to determine the cost per complication detected. The approach incorporated activity-based costing, adjusted to 2024 price levels via the Austrian Consumer Price Index (CPI), to capture real-world resource utilization. Results: Complications related to CVC removal were identified in five cases (0.5%), including one catheter rupture due to self-removal, two failed removals, one hemothorax, and one case of intrathoracic bleeding. Of these, three complications were detected on X-rays, including a retained catheter fragment, signs of intrathoracic bleeding, and a hemothorax. Additionally, one asymptomatic patient had a likely incidental finding of a small pneumothorax, which required no intervention. The cost of routine X-rays was calculated at EUR 38.20 per X-ray, resulting in a total expenditure of EUR 37,588.80 for 984 X-rays. This corresponds to EUR 7517.76 per detected complication (n = 4). The odds of detecting a complication on an X-ray were 193 times higher in symptomatic patients than in asymptomatic patients (p < 0.001). Conclusions: This study confirms that complications following CVC removal are rare with only five detected cases. Routine imaging did not improve clinical decision-making, as complications were significantly more likely to be identified in symptomatic patients through clinical evaluation alone. Given the high financial cost (EUR 37,588.80 for 984 X-rays, EUR 7517.76 per detected complication), routine post-removal X-rays are unnecessary in asymptomatic patients and should be reserved for symptomatic cases based on clinical judgment. Adopting a symptom-based imaging approach would reduce unnecessary healthcare costs, minimize patient radiation exposure, and optimize resource allocation in high-volume procedures such as CVC removal. Full article

(This article belongs to the Special Issue Clinical Management, Diagnosis and Treatment of Thoracic Diseases)

10 pages, 1199 KiB

Open AccessArticle

Factors Associated with Driving Ability and Changes After Immobilization of the Right Lower Limb: A Driving Simulator Study

by Young Cheol Kim, Moo Sik Lee, Byung Hak Oh, Youn Moo Heo, Tae Gyun Kim, Se Jong Yoo and Hyun Jin Yoo

J. Clin. Med. 2025, 14(4), 1396; https://doi.org/10.3390/jcm14041396 - 19 Feb 2025

Viewed by 350

Abstract

Introduction: Patients with orthopedic injuries often require cast immobilization therapy using casts. Driving with a cast on the right lower limb restricts many things. This study aimed to investigate the factors associated with driving capacity after orthopedic fixation of the right lower limb [...] Read more.

Introduction: Patients with orthopedic injuries often require cast immobilization therapy using casts. Driving with a cast on the right lower limb restricts many things. This study aimed to investigate the factors associated with driving capacity after orthopedic fixation of the right lower limb in healthy adult volunteers. This study’s hypothesis was that the orthopedic splint immobilization would have delayed reaction when in a driving simulation. Materials and Methods: We carried out an experimental study between 17 April 2023 and 19 May 2023. We set up the study in two phases: a driving simulation experiment without immobilization with a cast on the right lower limb and a driving simulation experiment with immobilization with a cast on the right lower limb. The data collected through the questionnaire were then analyzed in R version 4.2.2. Results: A total of 47 individuals participated in the study with a mean height of 167.68, of which 68.09% were females. Overall, 78.7% of the study participants could not drive after immobilization with a cast on the right lower limb. There was a significant difference between participants who could drive and those who could not drive by height (p = 0.04), age (p = 0.038), and body type (p = 0.046). Conclusions: Our study demonstrates that an individual’s height, age, and body type are associated with an individual’s driving ability after orthopedic immobilization of the right lower limb. Our findings suggest that regulations regarding the ability to drive after orthopedic immobilization of the right lower limb must be reconsidered. Full article

(This article belongs to the Special Issue Musculoskeletal Diagnosis and Treatment: Connecting Gaps to Enhance Patient Care)

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18 pages, 328 KiB

Open AccessReview

Benefits and Pitfalls of Uraemic Toxin Measurement in Peritoneal Dialysis

by Aruni Malaweera, Louis Huang and Lawrence McMahon

J. Clin. Med. 2025, 14(4), 1395; https://doi.org/10.3390/jcm14041395 - 19 Feb 2025

Viewed by 316

Abstract

Chronic kidney disease is a global health burden with a rising incidence and prevalence in developed and developing nations. Once established, it results in a progressive accumulation of a myriad of uraemic toxins. Peritoneal dialysis (PD) uses the body’s peritoneal membrane to remove [...] Read more.

Chronic kidney disease is a global health burden with a rising incidence and prevalence in developed and developing nations. Once established, it results in a progressive accumulation of a myriad of uraemic toxins. Peritoneal dialysis (PD) uses the body’s peritoneal membrane to remove these toxins across a semipermeable membrane to restore and maintain homeostasis. Traditionally, dialysis adequacy has been measured through clearance of urea and creatinine. However, numerous studies have shown marginal links comparing the clearance of urea and creatinine with clinical outcomes reflected in the recent changes to the ISPD guidelines on dialysis adequacy. Instead, attention has focused on protein-bound uraemic toxins (PBTs). Produced by gut bacteria, these molecules are highly protein-bound and poorly removed by either dialysis or absorptive agents. Elevated concentrations of molecules such as p-cresyl sulfate and indoxyl sulfate have been associated with abnormal cellular function and poor patient outcomes. However, widespread use of these measures to determine dialysis adequacy has been limited by the need for specialized techniques required for measurement. Altering the gut microbiome to reduce generation of PBTs through increased dietary fiber might be an alternate approach to better patient outcomes, with some initial positive reports. This report explores advantages and limitations of measuring uraemic toxins in PD, now and in the foreseeable future. Full article

(This article belongs to the Special Issue Kidney Failure: Diagnosis and Treatment of Acute and Chronic Conditions)

17 pages, 643 KiB

Open AccessArticle

Decoding Prejudice: Understanding Patterns of Adolescent Mental Health Stigma

by Sara Albuquerque, Ana Carvalho, Bárbara de Sousa, Leonor Pereira da Costa and Ana Beato

J. Clin. Med. 2025, 14(4), 1394; https://doi.org/10.3390/jcm14041394 - 19 Feb 2025

Viewed by 414

Abstract

Background/Objectives: Mental health problems are a major cause of disability, impacting nearly 20% of adolescents. Nevertheless, they are hesitant to seek help because of stigma and fear of being labelled. Adolescents often have low mental health literacy and perceive mental health problems [...] Read more.

Background/Objectives: Mental health problems are a major cause of disability, impacting nearly 20% of adolescents. Nevertheless, they are hesitant to seek help because of stigma and fear of being labelled. Adolescents often have low mental health literacy and perceive mental health problems as personal failures. To address it, our study aimed to identify subgroups within the adolescent population based on mental health knowledge, social stigma, experiences of intergroup anxiety, and endorsement of stereotypes. Methods: This cross-sectional study included 182 adolescents (50.6% male) aged 10 to 17 years (M = 13.8, SD = 2.4). Participants completed an online survey comprising the Mental Health Knowledge Schedule, Attribution Questionnaire (AQ-8-C), Intergroup Anxiety Scale, and a scale regarding stereotypes towards people with mental health problems. Cluster analysis was used to identify the subgroups. Results: We identified three subgroups: (1) “Potential Advocates”, showing high mental health knowledge, low social stigma, low intergroup anxiety, and moderate endorsement of stereotypes; (2) “Ambivalents”, manifesting high mental health knowledge, moderate social stigma, heightened intergroup anxiety, and low endorsement of stereotypes; and (3) “Stigmatizers”, revealing low mental health knowledge, pronounced social stigma, moderate intergroup anxiety, and tendency to endorse stereotypes. Conclusions: The results highlight the multiplicity of perceptions regarding mental health and the pivotal role of knowledge, stigma, intergroup dynamics, and stereotypes in shaping attitudes. Implications for interventions targeting mental health stigma and fostering positive attitudes among adolescents are discussed, underscoring the importance of customised strategies to address the multiple needs and experiences characteristic of this developmental stage. Full article

(This article belongs to the Special Issue Advances in Stigma and Discrimination in Pediatric Mental Health)

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11 pages, 2306 KiB

Open AccessArticle

Lateralization and Distalization Shoulder Angles in Reverse Shoulder Arthroplasty: Are They Still Reliable and Accurate in All Patients and for All Prosthetic Designs?

by Koray Şahin, Hakan Batuhan Kaya, Christos Koukos, Mehmet Kapıcıoğlu and Kerem Bilsel

J. Clin. Med. 2025, 14(4), 1393; https://doi.org/10.3390/jcm14041393 - 19 Feb 2025

Viewed by 351

Abstract

Background: Recently, the lateralization shoulder angle (LSA) and distalization shoulder angle (DSA) have been proposed to assess lateralization and distalization in reverse shoulder arthroplasty (RSA). However, there is insufficient evidence about the influence of patient anatomy and prosthesis design on these measurements. This [...] Read more.

Background: Recently, the lateralization shoulder angle (LSA) and distalization shoulder angle (DSA) have been proposed to assess lateralization and distalization in reverse shoulder arthroplasty (RSA). However, there is insufficient evidence about the influence of patient anatomy and prosthesis design on these measurements. This study aims to investigate the impact of patient anatomy and implant design on LSA and DSA measurements and to assess the validity of the previously reported “optimal” ranges for these parameters. Methods: Patients who underwent the RSA procedure using four different prosthetic designs between April 2014 and June 2023 were retrospectively evaluated. Postoperative LSA and DSA measurements were compared according to implant design, preoperative glenoid morphology (Favard classification), and the Hamada grade. The correlation of LSA and DSA with preoperative shoulder anatomy (critical shoulder angle, CSA, and acromial index, AI) was also assessed. Results: In total, 135 shoulders were included in the study, with a mean age of 71.7 ± 7.9 years. The mean LSA was 88.4 ± 11.8° and mean DSA was 40.6 ± 12.5°. According to prosthetic design, both mean LSA and DSA values differed significantly (p < 0.05). Lateralized designs (Groups I and IV) had significantly higher mean LSA values. The Favard classification and Hamada grade of shoulders did not show a significant influence on LSA and DSA measurements (p > 0.05). DSA was observed to be significantly correlated with CSA and AI (p < 0.05; r = −0.27 and −0.189, respectively). Conclusions: Prosthetic design and preoperative shoulder anatomy had a significant influence on LSA and DSA measurements in RSA. Optimal LSA and DSA values may lack validity and reliability and should not be applied to all patients. Full article

(This article belongs to the Special Issue Clinical Updates on Shoulder Arthroplasty)

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10 pages, 396 KiB

Open AccessArticle

Endometriosis in Adolescents: A Closer Look at the Pain Characteristics and Atypical Symptoms: A Prospective Cohort Study

by Maria Federica Viscardi, Ilaria Piacenti, Angela Musella, Laura Cacciamani, Maria Grazia Piccioni, Lucia Manganaro, Ludovico Muzii and Maria Grazia Porpora

J. Clin. Med. 2025, 14(4), 1392; https://doi.org/10.3390/jcm14041392 - 19 Feb 2025

Viewed by 363

Abstract

Background/Objectives: Endometriosis affects up to 10% of women of reproductive age and about 47% of adolescents with pelvic pain. Symptoms include dysmenorrhea, dyspareunia, and chronic pelvic pain (CPP). Adolescents often present atypical symptoms that can make endometriosis more difficult to diagnose. This [...] Read more.

Background/Objectives: Endometriosis affects up to 10% of women of reproductive age and about 47% of adolescents with pelvic pain. Symptoms include dysmenorrhea, dyspareunia, and chronic pelvic pain (CPP). Adolescents often present atypical symptoms that can make endometriosis more difficult to diagnose. This study aimed to compare characteristics of pain, atypical symptoms, and the effects of hormonal treatments between adolescents and adults with endometriosis. Methods: A total of 238 women with endometriosis were included: 92 aged 12–18 (group A) and 146 over 18 (group B). Data on menarches, cycle length, comorbidities, dysmenorrhea, dyspareunia, CPP, analgesic use, pain characteristics, atypical symptoms, and endometrioma size were recorded. The efficacy, compliance, and side effects of hormonal treatments were also assessed. Quality of life (QoL) was measured using the SF-12 questionnaire at baseline and after six months of therapy. Results: Adolescents had earlier menarche (p < 0.001), longer menstrual periods (p < 0.001), and higher analgesic use (p = 0.001) compared to adults. Dysmenorrhea was more frequent (p = 0.01), lasted longer (p < 0.001), and was associated with higher pain scores (p < 0.001) in adolescents. CPP was more common in adolescents (p < 0.001), often described as “confined” (p = 0.04) and “oppressive” (p = 0.038), while adults reported it as “widespread” (p = 0.007). Headaches (p < 0.001) and nausea (p = 0.001) were also more frequent in adolescents. Both groups showed significant improvement in QoL with hormonal treatment (p < 0.001) and reported minimal side effects. Conclusions: Adolescents with endometriosis often present with earlier menarche, longer menstrual periods, more severe dysmenorrhea, and atypical symptoms. Hormonal contraceptives and dienogest are effective and safe treatments that improve pain and QoL. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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11 pages, 571 KiB

Open AccessArticle

Course of General Fatigue in Patients with Post-COVID-19 Conditions Who Were Prescribed Hochuekkito: A Single-Center Exploratory Pilot Study

by Kazuki Tokumasu, Nobuyoshi Matsuki, Yuki Otsuka, Yoko Sakamoto, Keigo Ueda, Yui Matsuda, Yasue Sakurada, Hiroyuki Honda, Yasuhiro Nakano, Toru Hasegawa, Ryosuke Takase, Daisuke Omura and Fumio Otsuka

J. Clin. Med. 2025, 14(4), 1391; https://doi.org/10.3390/jcm14041391 - 19 Feb 2025

Viewed by 405

Abstract

Background: After the start of the COVID-19 pandemic, general fatigue in patients with long COVID and post-COVID-19 conditions (PCC) became a medical issue. Although there is a lack of evidence-based treatments, Kampo medicine (traditional Japanese medicine) has gained attention in Japan. At [...] Read more.

Background: After the start of the COVID-19 pandemic, general fatigue in patients with long COVID and post-COVID-19 conditions (PCC) became a medical issue. Although there is a lack of evidence-based treatments, Kampo medicine (traditional Japanese medicine) has gained attention in Japan. At an outpatient clinic in Japan specializing in long COVID, 24% of all prescriptions were Kampo medicines, and 72% of Kampo medicine prescriptions were hochuekkito. However, there has been no prospective, quantitative study on the course of fatigue in patients with long COVID and PCC who were prescribed hochuekkito. The aim of this study was to clarify the course of fatigue in those patients. Methods: This study included patients aged 18 years or older with general fatigue who visited the long COVID specialized outpatient clinic at Okayama University Hospital and consented to participate after being prescribed hochuekkito. We reviewed the backgrounds of the patients, and we evaluated the patients’ fatigue assessment scale in person or online. Results: Twenty patients were enrolled in this study from September to December in 2023. The average age of the patients was 42.9 years (SD: 15.8 years) and 12 patients (60%) were female. After hochuekkito administration, the fatigue assessment scale score decreased from 35.9 (SD: 5.9) at the initial visit to 31.2 (SD: 9.4) after 8 weeks, indicating a trend for improvement in fatigue (difference: 4.7; 95% CI: 0.5–8.9). Conclusions: A trend for improvement in fatigue was observed in patients with long COVID and PCC who were prescribed hochuekkito, indicating a potential benefit of hochuekkito for general fatigue in such patients. General fatigue in patients with long COVID or PCC can be classified as post-infectious fatigue syndrome and is considered a condition of qi deficiency in Kampo medicine, for which hochuekkito is appropriately indicated. Full article

(This article belongs to the Special Issue Novel Insights into COVID-19-Associated Complications and Sequelae)

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11 pages, 449 KiB

Open AccessArticle

Validation of the Japanese Version of Obstetric Quality of Recovery-11 Questionnaire and Its Association with Postpartum Depression and Functional Outcomes: A Prospective Observational Study

by Ayu Ishida, Mitsuru Ida, Yusuke Naito, Akane Kinomoto and Masahiko Kawaguchi

J. Clin. Med. 2025, 14(4), 1390; https://doi.org/10.3390/jcm14041390 - 19 Feb 2025

Viewed by 333

Abstract

Background/Objectives: The aim was to develop a Japanese version of the Obstetric Quality of Recovery-11 questionnaire (ObsQoR-11J), assess its feasibility, reliability, and validity, and investigate its association with postpartum depression and functionality. The need for this study is underscored by the limited [...] Read more.

Background/Objectives: The aim was to develop a Japanese version of the Obstetric Quality of Recovery-11 questionnaire (ObsQoR-11J), assess its feasibility, reliability, and validity, and investigate its association with postpartum depression and functionality. The need for this study is underscored by the limited availability of the ObsQoR-11 in different languages and the lack of documentation on its associations with early postpartum recovery and mid-term postpartum patient-reported outcomes. Methods: After translating the ObsQoR-11J into Japanese, 138 patients who underwent non-emergent cesarean delivery were enrolled in this study. ObsQoR-11J scores were evaluated at 24 h, 3 days, and 5 days post-surgery. The associations between ObsQoR-11J scores and postpartum depression and functionality, which were assessed using the Edinburgh Postnatal Depression Scale (EPDS) at 1 and 3 months and the 12-item World Health Organization Disability Assessment Schedule (WHODAS) 2.0, respectively, at three months after cesarean delivery, were evaluated. Results: The questionnaire completion rate at 24 h was 97.1% (134/138), and the mean ObsQoR-11 scores at 24 h and 3 and 5 days post-surgery were 67.2, 89.0, and 96.3, respectively. Cronbach’s alpha was 0.77, and the Spearman correlation coefficient between ObsQoR-11J scores and global health visual analog scale scores was 0.43 (p = 0.03) at 24 h. The ObsQoR-11 score at any measurement point was significantly associated with the EPDS and 12-item WHODAS2.0 after adjusting for clinically relevant factors (all p < 0.05). Conclusions: The ObsQoR-11J is a valid assessment tool, and its scores are associated with patient-reported outcome measures. Full article

(This article belongs to the Section Anesthesiology)

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10 pages, 484 KiB

Open AccessArticle

Trends of Pediatric Anterior Cruciate Ligament Reconstruction Surgery in Korea: Nationwide Population-Based Study

by Jihyun Hwang, Young-Min Kwon, Collin Lee, Sung Jae Kim and Young-Jin Seo

J. Clin. Med. 2025, 14(4), 1389; https://doi.org/10.3390/jcm14041389 - 19 Feb 2025

Viewed by 243

Abstract

Background/Objective: The rise in sports participation among children and adolescents has led to an increase in ACL injuries in skeletally immature individuals. This study analyzed nationwide trends in the anterior cruciate ligament (ACL) reconstruction surgeries in pediatric and adolescent populations, [...] Read more.

Background/Objective: The rise in sports participation among children and adolescents has led to an increase in ACL injuries in skeletally immature individuals. This study analyzed nationwide trends in the anterior cruciate ligament (ACL) reconstruction surgeries in pediatric and adolescent populations, addressing concerns about growth plate disturbances with surgery and risks of secondary injuries with nonoperative treatment. Methods: We conducted a retrospective population-based cohort study using the National Health Insurance Corporation database in South Korea, analyzing ACL reconstruction trends from 2011 to 2018. Patients were categorized into four age groups (≤12 years, 13–15 years, 16–17 years, and ≥18 years). The Chi-square linear-by-linear association test was used to analyze trends in procedural volumes, age groups, and regions. Poisson regression was used to examine whether differences over time were statistically significant by modeling count data and estimating incidence rate ratios (IRRs) with 95% confidence intervals (CIs). It also evaluates the statistical differences by age, gender, and hospital location. Results: A total of 83,132 patients underwent ACL reconstruction during the study period. The ≤12-year-old group accounted for a stable, low percentage of surgeries (16.6% in 2011 to 23.7% in 2018) with no significant trends observed (IRR = 0.99, p = 0.683). Conversely, significant increases were noted in patients aged 13–15 years (IRR = 1.04, p < 0.001), 16–17 years (IRR = 1.03, p < 0.001), and aged ≥18 years (IRR = 1.03, p < 0.001). Male patients and urban hospital locations were associated with higher surgical rates. Conclusions: During the study period, ACL reconstruction is rare in children ≤12 years old due to concerns about growth disturbances, while adolescents 13–17 years old show increased surgical rates due to evolving practices supporting early intervention. These findings emphasize the need for individualized treatment balancing early benefits and growth plate risks. Full article

(This article belongs to the Section Orthopedics)

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15 pages, 1294 KiB

Open AccessReview

Smoking Cessation Strategies After Acute Coronary Syndrome

by Anum Nazir, Smrthi Shetty Ujjar, Moncef Oualid Seddiki, Mala Jheinga and Lampson Fan

J. Clin. Med. 2025, 14(4), 1388; https://doi.org/10.3390/jcm14041388 - 19 Feb 2025

Viewed by 389

Abstract

Smoking is one of the strongest modifiable risk factors for coronary artery disease. It is the cause of approximately 10–30% of deaths due to cardiovascular disease around the world. There is a 50% reduction in the risk of myocardial infarction by one year [...] Read more.

Smoking is one of the strongest modifiable risk factors for coronary artery disease. It is the cause of approximately 10–30% of deaths due to cardiovascular disease around the world. There is a 50% reduction in the risk of myocardial infarction by one year for people who successfully quit smoking. Considering the risk associated with smoking and the benefits of smoking cessation, it is important to identify and implement effective smoking cessation strategies. There are pharmacological as well as non-pharmacological interventions to assist in smoking cessation. Pharmacological therapies including nicotine replacement therapy; bupropion and varenicline have generally been studied more in patients with cardiovascular disease than the non-pharmacological interventions. Non-pharmacological strategies for smoking cessation include behavioural interventions such as counselling sessions and cognitive behavioural therapy. Studies and randomised controlled trials have demonstrated the safety of most of the pharmacological interventions. Nonetheless, the success rates are variable for the different pharmacological options. Data suggest that greater success can be achieved in smoking cessation with a combination of pharmacological and non-pharmacological treatment. However, more studies are needed to explore the best therapeutic options to improve the success of smoking cessation. Full article

(This article belongs to the Section Cardiology)

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19 pages, 707 KiB

Open AccessSystematic Review

Changes in Respiratory Viruses’ Activity in Children During the COVID-19 Pandemic: A Systematic Review

by Marco Maglione, Vincenzo Tipo, Emiliano Barbieri, Roberta Ragucci, Agnese Sara Ciccarelli, Chiara Esposito, Ludovica Carangelo and Antonietta Giannattasio

J. Clin. Med. 2025, 14(4), 1387; https://doi.org/10.3390/jcm14041387 - 19 Feb 2025

Viewed by 338

Abstract

Background/Objectives: The impact of the coronavirus disease 2019 (COVID-19) pandemic on health was significant worldwide. The measures adopted to limit the spread of the virus had an indirect effect on the epidemiology of other infectious diseases with similar mechanisms of inter-human transmission. [...] Read more.

Background/Objectives: The impact of the coronavirus disease 2019 (COVID-19) pandemic on health was significant worldwide. The measures adopted to limit the spread of the virus had an indirect effect on the epidemiology of other infectious diseases with similar mechanisms of inter-human transmission. The present literature review analyzed the scenario of pediatric acute respiratory infections in the post-lockdown period compared to the pre-pandemic and lockdown periods. The different patterns of viruses’ outbreaks were evaluated according to the type of local COVID-19 restrictive measures and to the type of pathogen. Methods: Relevant scientific literature published between March 2020 and November 2024 was identified by means of electronic keyword searches in the PubMed, Scopus, and Cochrane Library databases. Results: Worldwide implementation of non-pharmacological public health interventions aimed at limiting the COVID-19 pandemic resulted in a measurable effect on the circulation of other common respiratory viruses, significantly affecting their usual seasonality. Most viruses significantly reduced their activity during the lockdown period but returned to or exceeded historical levels after discontinuation of preventive non-pharmacological measures. For many respiratory viruses, particularly respiratory syncytial virus, an off-season increase was reported. Conclusions: The non-pharmacological interventions, which effectively helped limit the COVID-19 pandemic, resulted in relevant epidemiologic changes in most common respiratory viruses. Given the different seasonality and clinical severity observed for some pathogens after lockdown, possible future off-season or more severe epidemics should be expected. Full article

(This article belongs to the Section Clinical Pediatrics)

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25 pages, 622 KiB

Open AccessReview

Physiotherapy in Text Neck Syndrome: A Scoping Review of Current Evidence and Future Directions

by Joanna Piruta and Wojciech Kułak

J. Clin. Med. 2025, 14(4), 1386; https://doi.org/10.3390/jcm14041386 - 19 Feb 2025

Viewed by 437

Abstract

Background: Musculoskeletal disorders associated with excessive smartphone use represent a significant health issue. Text neck syndrome is one such disorder within that group, increasingly affecting individuals worldwide across various age groups. The phenomenon of text neck may occur in individuals who frequently and [...] Read more.

Background: Musculoskeletal disorders associated with excessive smartphone use represent a significant health issue. Text neck syndrome is one such disorder within that group, increasingly affecting individuals worldwide across various age groups. The phenomenon of text neck may occur in individuals who frequently and for prolonged periods adopt a forward-flexed neck and head position while looking at the screens of mobile electronic devices. Various therapeutic methods are used in the treatment of text neck syndrome. However, there is no consensus on text neck rehabilitation, which poses a challenge for physiotherapists. Objective: The aim of this study is to analyze the phenomenon of text neck, with a particular emphasis on current scientific reports regarding the rehabilitation of text neck syndrome. The scoping review was conducted to determine the physiotherapy methods currently used in the treatment of individuals with text neck, assess their impact on symptom reduction, and identify existing knowledge gaps and limitations in the current literature on the rehabilitation of text neck syndrome. Design: A scoping review was conducted on the treatment of text neck syndrome based on electronic databases: PubMed, ResearchGate, Physiotherapy Evidence Database (PEDro), and the Cochrane Library. The databases were searched up to 1 December 2024. The inclusion criteria comprised studies investigating physiotherapy interventions for individuals with text neck, published between 2018 and 2024 and written in English. Results: A total of fifteen papers were reviewed, focusing on various methods used in text neck rehabilitation, including postural correction exercises, stabilization exercises, strengthening and stretching exercises, Pilates, PNF (Proprioceptive Neuromuscular Facilitation), kinesiology taping, Bowen therapy, and manual therapy. Nearly all studies were conducted in the adult population (93%), with the majority of studies taking place in India (60%). Conclusions: In summary, all studies suggest that appropriate physiotherapeutic interventions can provide significant benefits, including pain reduction, posture correction, and improved range of motion in the cervical spine. The best outcomes appear to be achieved by combining various therapeutic techniques. However, further high-quality research is needed to strengthen the evidence and offer reliable recommendations for clinical practice. Additionally, there is limited research on physiotherapy for text neck in the pediatric population, presenting a potential area for future studies. Full article

(This article belongs to the Special Issue Clinical Updates in Physiotherapy for Musculoskeletal Disorders)

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22 pages, 1003 KiB

Open AccessReview

Comprehensive Review of Endometrial Cancer: New Molecular and FIGO Classification and Recent Treatment Changes

by Maria-Bianca Anca-Stanciu, Andrei Manu, Maria Victoria Olinca, Cătălin Coroleucă, Diana-Elena Comandașu, Ciprian Andrei Coroleuca, Calina Maier and Elvira Bratila

J. Clin. Med. 2025, 14(4), 1385; https://doi.org/10.3390/jcm14041385 - 19 Feb 2025

Viewed by 522

Abstract

Endometrial cancer (EC) is the most common gynecologic malignancy in developed countries, with rising incidence due to aging populations and obesity-related factors. This review explores the evolving molecular and FIGO classifications of EC, highlighting their significance in diagnosis, prognosis, and personalized treatment strategies. [...] Read more.

Endometrial cancer (EC) is the most common gynecologic malignancy in developed countries, with rising incidence due to aging populations and obesity-related factors. This review explores the evolving molecular and FIGO classifications of EC, highlighting their significance in diagnosis, prognosis, and personalized treatment strategies. Molecular subtyping based on The Cancer Genome Atlas (TCGA) classification offers a more precise understanding of EC, dividing it into POLE ultramutated, microsatellite instability-high (MSI-H), copy-number low (CNL), and copy-number high (CNH) subtypes. Each subgroup has distinct genetic, histological, and prognostic characteristics. Recent updates to the FIGO staging system incorporate molecular features, allowing for more tailored treatment approaches. Advances in immunotherapy, targeted therapies, and novel therapeutic combinations have reshaped clinical management. This review emphasizes the integration of molecular diagnostics into routine practice, outlining challenges and future perspectives in managing EC for improved patient outcomes. Full article

(This article belongs to the Special Issue Advances in the Surgical Management of Gynecological Malignancies)

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13 pages, 789 KiB

Open AccessArticle

Prevalence and Risk Factors for Acute Kidney Injury in COVID-19-Hospitalized Patients in Poland Across Three Pandemic Periods

by Paweł Edyko, Marta Zdunek, Maja Nowicka and Ilona Kurnatowska

J. Clin. Med. 2025, 14(4), 1384; https://doi.org/10.3390/jcm14041384 - 19 Feb 2025

Viewed by 330

Abstract

Background/Objectives: Acute kidney injury (AKI) is a serious and prevalent complication of COVID-19. This study examines the prevalence, risk factors, and outcomes of AKI in hospitalized COVID-19 patients. Methods: We analyzed the data of 1223 adult COVID-19 hospitalized patients from a [...] Read more.

Background/Objectives: Acute kidney injury (AKI) is a serious and prevalent complication of COVID-19. This study examines the prevalence, risk factors, and outcomes of AKI in hospitalized COVID-19 patients. Methods: We analyzed the data of 1223 adult COVID-19 hospitalized patients from a single district hospital during three pandemic periods: 3 November 2020–31 December 2020, 17 March 2021–8 May 2021, and 4 November 2021–21 February 2022. The analysis included demographic data, comorbidities, laboratory results, chest radiographs (CT lung scans), and outcomes. Results: We found an overall AKI incidence of 29.02%. AKI patients versus non-AKI ones were significantly older (median age 76.0 vs. 71.0, p < 0.001) and had more comorbidities, especially previous renal diseases, heart failure, coronary artery disease, and hypertension; they also significantly more often used diuretics, angiotensin receptor blockers (ARBs), and angiotensin-converting enzyme inhibitors (ACE-Is). AKI patients more frequently presented with abnormal CT lung scans and had higher white blood cell counts, lower lymphocytes percentages, higher C-reactive protein (CRP) levels, and lower platelet counts. They more often required oxygen therapy, more days of hospitalization, and had higher mortality rates. Conclusions: Older age, comorbidities, the use of diuretics, and renin-angiotensin system inhibitors (RASI) are key risk factors for AKI, which is consequently linked to a more severe disease course and poorer prognosis. Full article

(This article belongs to the Special Issue Acute Kidney Injury (AKI): Novel Strategies of Diagnosis and Treatments)

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12 pages, 636 KiB

Open AccessArticle

Diabetes in Peripheral Artery Disease: Prevalence, Complications, and Polypharmacy

by Mason Baty, Ritesh Chimoriya, Sophie James, Leonard Kritharides, Samim Behdasht, Avinash Suryawanshi and Sarah J. Aitken

J. Clin. Med. 2025, 14(4), 1383; https://doi.org/10.3390/jcm14041383 - 19 Feb 2025

Viewed by 444

Abstract

Background: Patients with peripheral artery disease (PAD) and diabetes face high risks of comorbidities, tissue loss, and cardiovascular events. As global type 2 diabetes (T2DM) prevalence rises, so does its incidence in symptomatic patients with PAD, though this population is under-studied in [...] Read more.

Background: Patients with peripheral artery disease (PAD) and diabetes face high risks of comorbidities, tissue loss, and cardiovascular events. As global type 2 diabetes (T2DM) prevalence rises, so does its incidence in symptomatic patients with PAD, though this population is under-studied in Australia. This cross-sectional analysis sought to characterize PAD patients with diabetes regarding prevalence, major complications, medication use, and prescribing patterns, comparing them to non-diabetic PAD patients. We also examined PAD complications in relation to diabetic control. Methods: This cross-sectional study looked at the baseline data from 105 PAD participants in the TEAM-PAD randomized controlled trial that were analyzed using descriptive statistics, prevalence odds ratios and regression analysis. Participants were recruited between June 2023 and August 2024 from public clinics, private surgeons, and Concord Repatriation General Hospital, Sydney. Results: Diabetes prevalence was 52.83% (n = 56) with 29.5% (n = 31) of participants with T2DM having uncontrolled hyperglycemia (HbA1c ≥ 7%), which was weakly negatively correlated with age (r = −0.372, p = 0.039). Participants with T2DM were twice as likely to have a history of coronary artery disease (POR 2.43; 95% with a 95% confidence interval (CI) between 1.09–5.43, and over three times as likely to have tissue loss (POR 3.39; 95% CI 1.22–9.43). The odds of polypharmacy (≥5 medications) were 10 times greater in participants with T2DM (POR 10.8; 95% CI 2.31–50.4), affecting 96.4% of this group. Conclusions: Diabetes prevalence and associated complications were higher than previous estimates, underscoring the challenges in managing diabetes and polypharmacy in participants with PAD. A multidisciplinary approach may improve outcomes. Full article

(This article belongs to the Special Issue European Independent Foundation in Angiology/Vascular Medicine (VAS) Collection on Vascular Medicine)

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8 pages, 539 KiB

Open AccessReview

Simultaneous Medullary and Papillary Thyroid Carcinomas: Personal Experience Report and Literature Review

by Nadia De Falco, Massimo Agresti, Massimo De Falco, Pasquale Sperlongano, Giancarlo Moccia, Pasquale Luongo, Alessio Cece, Francesco Bove, Francesco Miele, Alfredo Allaria, Francesco Torelli, Paola Bassi, Antonella Sciarra, Stefano Avenia, Paola Della Monica, Federica Colapietra, Marina Di Domenico, Ludovico Docimo and Domenico Parmeggiani

J. Clin. Med. 2025, 14(4), 1382; https://doi.org/10.3390/jcm14041382 - 19 Feb 2025

Viewed by 322

Abstract

While the frequency of papillary thyroid carcinoma (PTC) has increased in recent decades, both due to improvements in diagnostic procedures and a real, effective percentage increase in cases, the frequency of medullary thyroid carcinoma (MTC), however, has remained almost unchanged, representing 3–5% of [...] Read more.

While the frequency of papillary thyroid carcinoma (PTC) has increased in recent decades, both due to improvements in diagnostic procedures and a real, effective percentage increase in cases, the frequency of medullary thyroid carcinoma (MTC), however, has remained almost unchanged, representing 3–5% of thyroid cancer cases. Our experience relates to the observation of cases with the synchronous presence of PTC and MTC, also in chronic autoimmune thyroiditis, and this led us to carry out a brief review of the literature on the subject, with the aim above all of identifying the most correct postoperative therapeutic process. Full article

(This article belongs to the Special Issue Innovative Research on Thyroid Cancer Diagnosis and Therapy)

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13 pages, 968 KiB

Open AccessArticle

Sentinel Lymph Node Detection in Cervical Cancer: Challenges in Resource-Limited Settings with High Prevalence of Large Tumours

by Szilárd Leó Kiss, Mihai Stanca, Dan Mihai Căpîlna, Tudor Emil Căpîlna, Maria Pop-Suciu, Botond Istvan Kiss, Szilárd Leó Kiss, Sr. and Mihai Emil Căpîlna

J. Clin. Med. 2025, 14(4), 1381; https://doi.org/10.3390/jcm14041381 - 19 Feb 2025

Viewed by 294

Abstract

Background/Objectives: Cervical cancer primarily disseminates through the lymphatic system, with the metastatic involvement of pelvic and para-aortic lymph nodes significantly impacting prognosis and treatment decisions. Sentinel lymph node (SLN) mapping is critical in guiding surgical management. However, resource-limited settings often lack advanced [...] Read more.

Background/Objectives: Cervical cancer primarily disseminates through the lymphatic system, with the metastatic involvement of pelvic and para-aortic lymph nodes significantly impacting prognosis and treatment decisions. Sentinel lymph node (SLN) mapping is critical in guiding surgical management. However, resource-limited settings often lack advanced detection tools like indocyanine green (ICG). This study evaluated the feasibility and effectiveness of SLN biopsy using alternative techniques in a high-risk population with a high prevalence of large tumours. Methods: This prospective, observational study included 42 patients with FIGO 2018 stage IA1–IIA1 cervical cancer treated between November 2019 and April 2024. SLN mapping was performed using methylene blue alone or combined with a technetium-99m radiotracer. Detection rates, sensitivity, and false-negative rates were analysed. Additional endpoints included tracer technique comparisons, SLN localization patterns, and factors influencing detection success. Results: SLNs were identified in 78.6% of cases, with bilateral detection in 57.1%. The combined technique yielded higher detection rates (93.3% overall, 80% bilateral) compared to methylene blue alone (70.4% overall, 40.7% bilateral, p < 0.05). The sensitivity and negative predictive values were 70% and 93.87%, respectively. Larger tumours (>4 cm), deep stromal invasion, and prior conization negatively impacted detection rates. False-negative SLNs were associated with larger tumours and positive lymphovascular space invasion. Conclusions: SLN biopsy is feasible in resource-limited settings, with improved detection rates using combined tracer techniques. However, sensitivity remains suboptimal due to a steep learning curve and challenges in high-risk patients. Until a high detection accuracy is achieved, SLN mapping should complement, rather than replace, pelvic lymphadenectomy in high-risk cases. Full article

(This article belongs to the Special Issue Laparoscopy and Surgery in Gynecologic Oncology)

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18 pages, 274 KiB

Open AccessArticle

Mortality and Predictive Factors for Death Following the Diagnosis of Interstitial Lung Disease in Patients with Rheumatoid Arthritis: A Retrospective, Long-Term Follow-Up Study

by Shunsuke Mori, Fumikazu Sakai, Mizue Hasegawa, Kazuyoshi Nakamura and Kazuaki Sugahara

J. Clin. Med. 2025, 14(4), 1380; https://doi.org/10.3390/jcm14041380 - 19 Feb 2025

Viewed by 673

Abstract

Objective: The aim of this study was to determine mortality and predictive factors for death in patients with rheumatoid arthritis (RA) diagnosed with and without interstitial lung disease (ILD). Methods: We retrospectively performed a long-term follow-up study of patients diagnosed with RA at [...] Read more.

Objective: The aim of this study was to determine mortality and predictive factors for death in patients with rheumatoid arthritis (RA) diagnosed with and without interstitial lung disease (ILD). Methods: We retrospectively performed a long-term follow-up study of patients diagnosed with RA at our medical center between April 2001 and June 2023. The diagnosis and classification of ILD were made based on pulmonary high-resolution computed tomography (HRCT), taken at RA diagnosis and during follow-up. Results: Among 781 patients with RA, 78 were diagnosed with ILD; all cases except one were subclinical. The most common HRCT pattern was definite usual interstitial pneumonia (UIP) followed by nonspecific interstitial pneumonia (NSIP)/UIP, probable UIP, NSIP, and early UIP. During follow-up (mean of 10.0 years), the crude incidence rate of death (95% confidence interval [CI]) was 7.1 (5.2–10.0) and 1.5 (1.0–1.9) per 100 person-years in RA patients with and without ILD. Poor control of RA activity was associated with increased incidence rates of death. The standardized mortality ratio (95% CI) compared with the general population was 1.32 (1.11–1.53) for all RA patients, 2.09 (1.45–2.73) for RA-ILD patients, and 1.16 (0.95–1.38) for non-ILD RA patients. Lung cancer and respiratory failure were the most common causes of death in RA-ILD patients. The Multivariable Fine-Gray regression analysis revealed that ILD (adjusted hazard ratio [HR] 2.97 [95% CI 1.95–4.53]), advanced age (1.08 per additional year [1.05–1.10]), and low body mass index (3.07 [2.10–4.49]) were strong predictive factors for mortality in RA patients. HRCT patterns did not affect the risk of death in RA-ILD patients. Conclusions: Regardless of HRCT pattern, RA-ILD contributes to the increased mortality risk in patients with RA. Full article

(This article belongs to the Special Issue Rheumatoid Arthritis: Clinical Updates on Diagnosis and Treatment)

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Open AccessArticle

The Maxillomandibular Sagittal Assessment: The ABwise Appraisal and Its Correlation with ANB Angle

by Elisa Boccalari, Ornella Rossi, Benedetta Baldini, Cinzia Tripicchio, Marco Serafin and Alberto Caprioglio

J. Clin. Med. 2025, 14(4), 1379; https://doi.org/10.3390/jcm14041379 - 19 Feb 2025

Viewed by 265

Abstract

The ANB angle, the cephalometric parameter of choice for assessing the anteroposterior relationship between the maxilla and mandible, is subject to several limitations, prompting the investigation of alternative parameters. Objective: This study aimed to investigate the ABwise measurement as an alternative to the [...] Read more.

The ANB angle, the cephalometric parameter of choice for assessing the anteroposterior relationship between the maxilla and mandible, is subject to several limitations, prompting the investigation of alternative parameters. Objective: This study aimed to investigate the ABwise measurement as an alternative to the ANB angle for evaluating maxillomandibular relationships in orthodontics, particularly addressing the impact of skeletal discrepancies on conventional methods. Methods: A retrospective analysis was performed on a CBCT dataset of patients attending the University of Milan’s Department of Orthodontics and Maxillofacial Surgery, selected based on high-quality imaging, a full-cranium field of view, and a slice thickness between 150 and 300 μm. Eight craniofacial landmarks were annotated using the 3D Slicer software to calculate the ANB values and the new ABwise measurement. Statistical analyses included Spearman’s correlation (ρ), linear regression, and inter-rater agreement (Cohen’s κ score), with data classified into skeletal Classes I, II, and III based on defined thresholds. Results: 354 CBCT were selected and analyzed (mean age: 18.6 years). ABwise showed a strong correlation with the ANB angle (ρ = 0.805) and new normative ranges for ABwise were established: Class I (−1.4 ± 2.3 mm), Class II (>0.9 mm), and Class III (<−3.7 mm). Moderate agreement was observed between the ABwise and ANB classifications (κ = 0.527). ABwise effectively addressed limitations associated with divergence and vertical discrepancies, providing a more reliable assessment of skeletal sagittal relationships. Conclusions: ABwise presents a viable alternative to the ANB angle for three-dimensional cephalometric analysis, offering improved accuracy and alignment with radioprotection principles by reducing the CBCT field of view needed for its measurement. Further research is required in order to validate these findings across diverse populations and clinical scenarios. Full article

(This article belongs to the Special Issue Orthodontics: Current Advances and Future Options)

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18 pages, 928 KiB

Open AccessArticle

Dyspnea Management in Patients Presenting to the Emergency Department at Cantonal Hospital Baselland—A Retrospective Observational Study and Medical Audit

by Emanuele Debernardi, Fabienne Jaun, Maria Boesing, Joerg Daniel Leuppi and Giorgia Lüthi-Corridori

J. Clin. Med. 2025, 14(4), 1378; https://doi.org/10.3390/jcm14041378 - 19 Feb 2025

Viewed by 360

Abstract

Background/Objectives: Dyspnea, the subjective experience of breathing discomfort, accounts for approximately 5% of emergency department (ED) presentations, 10% of general ward admissions, and 20% of intensive care unit (ICU) admissions. Despite its prevalence, dyspnea remains a challenging clinical manifestation for physicians. To the [...] Read more.

Background/Objectives: Dyspnea, the subjective experience of breathing discomfort, accounts for approximately 5% of emergency department (ED) presentations, 10% of general ward admissions, and 20% of intensive care unit (ICU) admissions. Despite its prevalence, dyspnea remains a challenging clinical manifestation for physicians. To the best of our knowledge, there are no international guidelines for the assessment and management of patients with dyspnea coming to the ED. In this study, we aim to evaluate how dyspnea cases are assessed and managed at Cantonal Hospital Baselland in Liestal (KSBL) and to audit these practices. Methods: We conducted a retrospective, observational study of hospital records from KSBL, including all patients presenting to the ED with dyspnea as their primary symptom who were subsequently admitted to the internal medicine ward for at least one night between January and December 2022. Data on assessment and management practices were compared using the medStandards algorithm. Results: A total of 823 cases were included. The median age at admission was 76 years (with a range of 15–99), and 57% of the patients were male. Blood pressure and heart rate were documented in 93.8% of the cases, respiratory rate in 61.4%, oxygen saturation in 96.1%, and body temperature in 86.3%. The patient’s subjective dyspnea description was recorded in 14.8% of the cases, while the temporal onset (timing of symptoms) was documented in 98.8%, and the intensity of effort triggering dyspnea was noted in 36.2% of cases. A dyspnea index scale was used in 7.8% and smoking status was documented in 41.1% of the cases. Lung percussion was performed in 2.6% of the cases, while a lung auscultation was performed in 94.4% and a heart auscultation was performed in 85.3% of cases. A complete blood count with a basic metabolic panel and TSH test was collected in 86.9% of the cases, while a blood gas analysis was collected in 34.0% of the cases. An ECG was reported in 87.5% of the cases. From the 337 patients who should have received an emergency ultrasound, 10.1% received one. The three most frequent final diagnoses were decompensated heart failure (28.4%), pneumonia (26.4%), and COVID-19 (17.0%). None of the three patients with a known neuromuscular disease were admitted to the shock room. Conclusions: Our findings reveal that the medStandards algorithm was only partially followed at the ED in KSBL Liestal, highlighting gaps in detailed history taking, respiratory rate measurement, lung percussion, and emergency ultrasound use. Given the frequency of dyspnea-related presentations, systematic improvements in the adherence to assessment protocols are urgently needed to enhance patient outcomes. Full article

(This article belongs to the Section Emergency Medicine)

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18 pages, 253 KiB

Open AccessFeature PaperArticle

Clinical and Economic Impact of a First Major Bleeding Event in Non-Anticoagulated Patients in Spain: A 3-Year Retrospective Observational Cohort Study

by Carlos Escobar, Beatriz Palacios, Miriam Villarreal, Martín Gutiérrez, Margarita Capel, Ignacio Hernández, María García, Laura Lledó and Juan F. Arenillas

J. Clin. Med. 2025, 14(4), 1377; https://doi.org/10.3390/jcm14041377 - 19 Feb 2025

Viewed by 409

Abstract

Objective: To analyze clinical characteristics of non-anticoagulated subjects with major bleeding, and to determine the incidence of adverse events, healthcare resource utilization (HCRU) and associated costs following a major bleeding event. Methods: Retrospective observational cohort study that analyzed secondary data from electronic [...] Read more.

Objective: To analyze clinical characteristics of non-anticoagulated subjects with major bleeding, and to determine the incidence of adverse events, healthcare resource utilization (HCRU) and associated costs following a major bleeding event. Methods: Retrospective observational cohort study that analyzed secondary data from electronic health records in Spain. Non-anticoagulated patients with a first major bleeding during the study period (between January 2013 and December 2022) were analyzed for 3 years. Results: A total of 4089 patients (mean age 57.26 (12.87) years, 58.47% female) were included. A proportion of 27.63% presented with genitourinary bleeding, 22.43% with gastrointestinal bleeding, 5.16% with respiratory bleeding and 3.11% with intracranial hemorrhage. At the end of the first major bleeding event, 0.56% of patients died (5.51% after intracranial hemorrhage, 3.23% in case of trauma-related bleeding). The incidence rates of clinical outcomes per 100 person-years within the first 3 months of the major bleeding were death from any cause 7.51 (95% CI 6.70–8.32), cardiovascular death 1.80 (95% CI 1.39–2.21), acute myocardial infarction 4.53 (95% CI 3.89–5.17), and ischemic stroke 3.52 (95% CI 2.96–4.08), and decreased over time. At year 3, mean overall major bleeding cost per patient was EUR 13,310.00 (5153.05), of which EUR 7648.20 (2674.46) (57.46%) accounted for in-hospital costs to treat the major bleeding event. Conclusions: Among non-anticoagulated patients presenting with a first major bleeding, <1% of patients died during index hospitalization. However, these patients had a substantial risk of adverse clinical events during the follow-up, as well as high associated HCRU and costs. Full article

(This article belongs to the Section Cardiovascular Medicine)

19 pages, 1122 KiB

Open AccessReview

Unlocking the Mystery of Patella Dislocation—Diagnostic Methods in Pediatric Populations: A Comprehensive Narrative Review

by Ewa Tramś, Ignacy Tołwiński, Marcin Tyrakowski, Dariusz Grzelecki, Jacek Kowalczewski and Rafał Kamiński

J. Clin. Med. 2025, 14(4), 1376; https://doi.org/10.3390/jcm14041376 - 19 Feb 2025

Viewed by 319

Abstract

Background/Objectives: The diagnostic guidelines for pediatric patellofemoral instability (PFI) remain incomplete. PFI remains a challenging issue as it affects the biomechanics of the knee joint, triggers anterior knee pain, and is linked to the development of early-onset osteoarthritis. The diagnostic process is complicated [...] Read more.

Background/Objectives: The diagnostic guidelines for pediatric patellofemoral instability (PFI) remain incomplete. PFI remains a challenging issue as it affects the biomechanics of the knee joint, triggers anterior knee pain, and is linked to the development of early-onset osteoarthritis. The diagnostic process is complicated by numerous anatomical factors that must be considered. This review aims to consolidate current knowledge presented in the literature on radiological diagnostics for PFI in pediatric populations, with the application of all imaging techniques—including ultrasonography (US), magnetic resonance imaging (MRI), computed tomography (CT), and radiography (RTG)—which enable the evaluation of anatomical risk factors critical for the diagnosis, prevention, and treatment of PFI. Methods: A search of the PubMed/MEDLINE database was conducted to identify relevant studies from 1975 to 2024. The search terms were as follows: (patellar or patella) and (instability or displacement or dislocation) and (diagnostic or diagnosis or imaging or radiographic). A total of 2743 articles were retrieved, which were screened to yield 29 studies for further review. These studies were then divided into seven categories regarding the diagnostic methods: risk factors, tibial tubercle trochlear groove (TT-TG)/tibial tubercle posterior cruciate ligament (TT-PCL), MPFL injury and cartilage damage, patella and trochlear dysplasia, torsional abnormalities, coronal plane alignment, and genetics. Results: The methods presented statistically significant differences, with those most commonly used for the diagnosis of patella dislocation being TT-TG index, MPFL rapture, and trochlear dysplasia. Conclusions: In summary, multiple diagnostic tools, including MRI, CT, X-ray, and physical examination, are available for the assessment of PFI, each contributing to treatment decisions. Although MRI remains the primary diagnostic tool, further research is needed to establish more precise diagnostic criteria. Full article

(This article belongs to the Special Issue Novel Developments on Diagnostics and Treatment of Knee Instability and Osteoarthritis)

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15 pages, 259 KiB

Open AccessArticle

Adaptation and Linguistic Validation of Angioedema PROMs in Latvian for Assessing Recurrent Angioedema

by Lāsma Lapiņa, Adīne Kaņepa, Maksims Zolovs, Thomas Buttgereit and Nataļja Kurjāne

J. Clin. Med. 2025, 14(4), 1375; https://doi.org/10.3390/jcm14041375 - 19 Feb 2025

Viewed by 210

Abstract

Background: Angioedema (AE) is a localized, non-pitting swelling affecting subcutaneous and/or submucosal tissues. Despite varying underlying mechanisms, AE significantly impacts patients’ quality of life (QoL), which is closely linked to disease activity and control. Objectives: This study aimed to translate and linguistically validate [...] Read more.

Background: Angioedema (AE) is a localized, non-pitting swelling affecting subcutaneous and/or submucosal tissues. Despite varying underlying mechanisms, AE significantly impacts patients’ quality of life (QoL), which is closely linked to disease activity and control. Objectives: This study aimed to translate and linguistically validate the angioedema activity score (AAS), angioedema control test (AECT), and angioedema quality of life (AE-QoL) questionnaires into Latvian, and to use these validated tools to assess disease activity, control, and quality of life within the study population. Methods: PROMs, including the AECT, AAS, and AE-QoL, underwent a standardized linguistic validation process. Patients with hereditary angioedema (HAE), mast cell-mediated angioedema (AE-MC), and angioedema of unknown origin (AE-UNK) were recruited from two separate studies conducted at Riga Stradiņš University. Results: We enrolled 41 participants (90.2% women) with a mean age of 46.3 years. AE-MC was the most common (63.4%), followed by HAE (19.5%) and AE-UNK (17.1%). The mean AAS score was 15.8, with no significant differences regarding AE type, gender, or age. The mean AECT score was 8.29, revealing significant gender differences (women: 7, men: 13.5). The AE-QoL total score was 45.5, with significant gender differences in most domains. Strong correlations were found between AE-QoL scores and both AAS and AECT, highlighting the impact of both disease activity and control on QoL. Conclusions: The Latvian adaptation of the AAS, AECT, and AE-QoL questionnaires effectively assesses AE activity, control, and disease-related QoL. Our study reveals poor disease control, underscoring the need for tailored interventions and regular PROM evaluations, with the Latvian version of the AE-QoL questionnaire identifying five distinct domains compared to four in the original version. Full article

(This article belongs to the Section Dermatology)

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13 pages, 1423 KiB

Open AccessSystematic Review

The Risk of Metabolic Dysfunction-Associated Steatotic Liver Disease in Moderate-to-Severe Psoriasis: A Systematic Review and Meta-Analysis

by Suvijak Untaaveesup, Piyawat Kantagowit, Patompong Ungprasert, Nitchanan Kitlertbanchong, Tanyatorn Vajiraviroj, Tanpichcha Sutithavinkul, Gynna Techataweewan, Wongsathorn Eiumtrakul, Rinrada Threethrong, Thanaboon Chaemsupaphan, Walaiorn Pratchyapruit and Chutintorn Sriphrapradang

J. Clin. Med. 2025, 14(4), 1374; https://doi.org/10.3390/jcm14041374 - 19 Feb 2025

Viewed by 383

Abstract

Background/Objectives: Psoriasis is a chronic immune-mediated skin disease associated with several metabolic comorbidities. Metabolic dysfunction-associated steatotic liver disease (MASLD) is also linked to psoriasis, but evidence regarding the severity of this association remains inconclusive. This meta-analysis aimed to investigate the relationship between [...] Read more.

Background/Objectives: Psoriasis is a chronic immune-mediated skin disease associated with several metabolic comorbidities. Metabolic dysfunction-associated steatotic liver disease (MASLD) is also linked to psoriasis, but evidence regarding the severity of this association remains inconclusive. This meta-analysis aimed to investigate the relationship between MASLD and varying severities of psoriasis. Methods: We conducted an extensive search of four databases, MEDLINE, EMBASE, OSF, and ClinicalTrials.gov to identify relevant published articles assessing the risk of prevalent MASLD in patients with moderate-to-severe psoriasis up to April 2024. Effect estimates from each included study were combined together to calculate a pooled effect estimate for the meta-analysis using the generic inverse variance method of DerSimonian and Laird. Results: This meta-analysis included eight studies with a total of 109,806 participants. A 4.01-fold increased risk of prevalent MASLD was observed in patients with moderate-to-severe psoriasis compared to those without psoriasis (95% CI: 2.17, 7.77; I² = 67%, p < 0.0001). The evidence supporting this outcome had low certainty. Conclusions: An incremental trend of MASLD was observed in patients with moderate-to-severe psoriasis. Routine screening for MASLD should be emphasized in this population. Full article

(This article belongs to the Section Dermatology)

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13 pages, 240 KiB

Open AccessArticle

Cone-Beam Computed Tomography Assessment of the Prevalence and Association of Pulp Calcification with Dental and Periodontal Pathology: A Descriptive Study

by José Luis Sanz, Lucía Callado, Stefana Mantale, Jenifer Nicolás, James Ghilotti and Carmen Llena

J. Clin. Med. 2025, 14(4), 1373; https://doi.org/10.3390/jcm14041373 - 19 Feb 2025

Viewed by 229

Abstract

Background/Objectives: Pulp stones (PSs) are calcified masses, with rounded or oval shapes, ranging from small particles to masses larger than the chamber and/or canals. There are limited data regarding the prevalence of pulp stones in the Iberian population. Our aim was to [...] Read more.

Background/Objectives: Pulp stones (PSs) are calcified masses, with rounded or oval shapes, ranging from small particles to masses larger than the chamber and/or canals. There are limited data regarding the prevalence of pulp stones in the Iberian population. Our aim was to determine the prevalence of PSs, using CBCT, in an Iberian population, and its association with gender, age, tooth location (arch and hemiarch), dental group, the presence of caries, restorations, alveolar bone loss, and a history of orthodontic treatment. Methods: In total, 300 CBCTs were analyzed, selected from the database of the Dental Clinic of the University of Valencia. A total of 5485 teeth were included. The images were obtained by NewTom equipment and visualized using NNT software 11 by a single calibrated examiner in the axial, sagittal, and coronal planes. The Chi-square test, ANOVA, and t-test were used to analyze the study variables for a significance level of p < 0.05. Results: The prevalence of PSs was 88.3% from the total number of patients assessed and 61.2% from the total number of teeth assessed. No differences were found by gender or age. A significant association was found within tooth groups between arches and hemiarches. The proportion of PSs was 3.7 times higher in teeth with caries, 4.7 times higher in teeth with fillings, and 2.3 times higher in teeth with alveolar bone loss. Conclusions: PSs were more prevalent in molars. The presence of caries, fillings, and bone loss increased the chance of presenting PSs. Maxillary teeth had a higher prevalence of PSs than mandibular teeth. Full article

(This article belongs to the Special Issue Endodontic and Periodontal Medicine: Systemic Implications of Oral Infections)

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Open AccessArticle

Clinical Care Delivery in Chest Pain Patients Without an Acute Coronary Syndrome—A Retrospective Cohort Study

by Anas Alrefaee, Sherif Eltawansy, Abbas Alshami, Paweł Łajczak, Ndausung Udongwo, George Ayob and Jeffrey Selan

J. Clin. Med. 2025, 14(4), 1372; https://doi.org/10.3390/jcm14041372 - 19 Feb 2025

Viewed by 239

Abstract

Background: Chest pain is a prevalent and critical complaint among patients in emergency departments (EDs) across the United States. Professional societies have refined clinical guidelines to establish the most effective diagnostic pathways for identifying obstructive coronary artery disease. However, many healthcare systems do [...] Read more.

Background: Chest pain is a prevalent and critical complaint among patients in emergency departments (EDs) across the United States. Professional societies have refined clinical guidelines to establish the most effective diagnostic pathways for identifying obstructive coronary artery disease. However, many healthcare systems do not adhere to the guideline-validated clinical pathways and instead order repeat diagnostic testing. This study evaluated the efficiency of care delivered to chest pain patients in our tertiary medical center. Methods: We performed a retrospective chart review of patients presenting to our ED with acute chest pain between November and December 2022, collecting information about chest pain, the testing received, and their outcomes. The data were then reviewed to determine clinical practice patterns. Results: We included 342 patients, with a mean age of 54 years; 54.7% of study participants were females. Patients who were eventually admitted from the ED (46.5%, n = 159) were either under observation or inpatient status. Furthermore, 16.6%, n = 57, of patients had an ischemic evaluation within the preceding year. Physicians documented a HEART score in 24.6%, n = 84 of the patients. While HEART score is a considerable factor utilized by admitting physicians to triage incoming patients, 39%, n = 62, of all admitted patients had a low HEART score (<3) and a negative ischemic evaluation within the past year. Conclusions: This single-center retrospective analysis of care delivery for non-ACS (acute coronary syndrome) chest pain patients demonstrated that the HEART score was not thoroughly documented in the study population. This resulted in an overperformance of inpatient ischemic testing, with an increased length of stay and costs for the institution and healthcare system. This study serves as a quality improvement initiative to explore similar data within their institutions and as a reminder of the importance of utilizing validated clinical pathways to streamline clinical care and reduce healthcare costs. Full article

(This article belongs to the Section Cardiovascular Medicine)

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11 pages, 854 KiB

Open AccessArticle

Triglycerides/High-Density Lipoprotein Ratio and Coronary Artery Disease: Results from a Large Single-Center Study

by Giuseppe De Luca, Matteo Nardin, Antonino Micari, Elvin Kedhi, Gennaro Galasso, Monica Verdoia and on behalf of the Novara Atherosclerosis Study Group (NAS)

J. Clin. Med. 2025, 14(4), 1371; https://doi.org/10.3390/jcm14041371 - 19 Feb 2025

Viewed by 523

Abstract

Background. Despite the achievement of therapeutic goals regarding low-density lipoprotein cholesterol (LDL-C) levels with statins, high residual risk of events was reported in patients with coronary artery disease (CAD). Widespread attention has recently been focused on low plasmatic levels of high-density lipoproteins [...] Read more.

Background. Despite the achievement of therapeutic goals regarding low-density lipoprotein cholesterol (LDL-C) levels with statins, high residual risk of events was reported in patients with coronary artery disease (CAD). Widespread attention has recently been focused on low plasmatic levels of high-density lipoproteins (HDLs) and high levels of triglycerides as risk factors for cardiovascular disease and as potential pharmacological targets, with particular attention paid to their ratio. Therefore, the aim of the current study was to investigate the association between triglycerides and HDLs and the TG/HDL ratio and their association with the prevalence and extent of CAD. Methods. We included patients undergoing non-urgent coronary angiography at Azienda Ospedaliera-Universitaria “Maggiore della Carità”, Novara, Italy, from 2007 to 2018. Patients chronically treated with triglyceride-lowering therapies (PUFA and Fibrates) were excluded from this analysis. Fasting samples were collected at the moment of angiography. CAD was defined as at least one vessel stenosis >50%. Results. Our study population of 5997 patients was divided according to TG/HDL ratio quartiles. The TG/HDL ratio was significantly associated with age, gender, smoking status, hypercholesterolemia, diabetes, and the chronic use of ACE inhibitors, statins, beta-blockers, aspirin, ADP antagonists, and diuretics. The TG/HDL ratio was additionally associated with several laboratory parameters. In multiple logistic regression analysis, HDLs but not the TG/HDL ratio were independently associated with the prevalence and extent of CAD. Conclusions. Our study showed that HDLs but not the TG/HDL ratio are independently associated with the extent and prevalence of CAD. Therefore, this ratio does not provide additional prognostic information to HDLs in the prediction of the prevalence and extent of this disease. Full article

(This article belongs to the Section Cardiovascular Medicine)

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14 pages, 2370 KiB

Open AccessArticle

The Interaction Among Effector, Regulatory, and Tγδ Cells Determines the Development of Allergy or Tolerance to Chromium

by Magdalena Zemelka-Wiacek

J. Clin. Med. 2025, 14(4), 1370; https://doi.org/10.3390/jcm14041370 - 19 Feb 2025

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Abstract

Background/Objectives: Chromium, a common environmental and occupational sensitizer, frequently induces allergic contact dermatitis (ACD). This study investigates the role of CD4⁺ (T helper), CD8⁺ (T cytotoxic), regulatory (Tregs: CD4⁺CD25⁺ and CD8⁺CD25⁺), and gamma [...] Read more.

Background/Objectives: Chromium, a common environmental and occupational sensitizer, frequently induces allergic contact dermatitis (ACD). This study investigates the role of CD4⁺ (T helper), CD8⁺ (T cytotoxic), regulatory (Tregs: CD4⁺CD25⁺ and CD8⁺CD25⁺), and gamma delta (Tγδ) T cells in chromium tolerance versus hypersensitivity. Methods: Six chromium-allergic patients and six healthy controls were recruited, confirmed via patch testing. Peripheral blood mononuclear cells (PBMCs) were isolated and cultured, with chromium exposure and proliferation assays conducted. Specific T cell subtypes were isolated and analyzed for chromium-specific proliferative responses, cytokine production, and metabolic activity. Results: Chromium-allergic individuals exhibited broad proliferation across PBMC and T cell subsets, contrasting with restricted responses in controls. Treg cells in healthy subjects effectively suppressed T cell proliferation in response to chromium, while allergic individuals showed unmodulated T cell activity, indicative of impaired regulatory function. Cytokine analysis revealed elevated IL-2 and TNF-α but absent IL-10 in allergic patients. Metabolic assessments showed higher glycolytic activity in Tregs of healthy controls, suggesting enhanced regulatory potential. Conclusions: These findings highlight the importance of balanced effector and regulatory T cell interactions for chromium tolerance. Dysregulated Treg and Tγδ cell functions in allergic individuals may contribute to hypersensitivity, with implications for targeted therapeutic strategies to restore immune balance and reduce allergic responses in chromium-sensitive patients. Full article

(This article belongs to the Section Immunology)

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12 pages, 1816 KiB

Open AccessArticle

A Mid-Term Result of the Treatment of Intra-Articular Calcaneal Fractures with the Use of Intramedullary Nailing

by Piotr Sypien and Dariusz Grzelecki

J. Clin. Med. 2025, 14(4), 1369; https://doi.org/10.3390/jcm14041369 - 19 Feb 2025

Viewed by 261

Abstract

Background: Intra-articular calcaneal fracture (CF) treatment is associated with a high risk of complications, but closed reduction and internal fixation (CRIF) is a minimally invasive alternative for treatment. Methods: Forty-eight patients treated with CRIF and CALCAnail^® due to intra-articular CF between [...] Read more.

Background: Intra-articular calcaneal fracture (CF) treatment is associated with a high risk of complications, but closed reduction and internal fixation (CRIF) is a minimally invasive alternative for treatment. Methods: Forty-eight patients treated with CRIF and CALCAnail^® due to intra-articular CF between 2016 and 2021 were analyzed to check union time, complication rate, and functionality after the intervention. Functional and pain outcomes were assessed, including the Maryland Foot Score (MFS), American Orthopedic Foot & Ankle Society (AOFAS) scale questionnaires, and the numerical pain scale (NRS) at mid-term follow-ups 2–5 years after the intervention. Results: Intervention increased median Böhler’s angle from 21.5° to 32° (p < 0.01). The median bone union time was 12 weeks. The risk of malunion was higher in patients with Sanders type 4 (RR = 2.28; 95% CI 1.11–4.72) and those operated on later than the 2nd day after injury (RR = 2.1; 95% CI 1.08–4.09). Patients with at least one of the comorbidities (nicotinism, diabetes, obesity) had a higher risk of intensive pain (NRS > 3) 2–5 years after surgery (RR = 1.69; 95% CI 1.06–2.68), and 84% were satisfied with their treatment. Other complications included complex regional pain syndrome in two patients (4%), malunion in three (6%), and surgical site infection in two (4%). The MFS had a median score of 85 points, while that of the AOFAS was 82 points. Conclusions: CRIF, with the use of the CALCAnail^® implant, allows doctors to restore anatomical relationships around the subtalar joint, resulting in good clinical and functional results. Full article

(This article belongs to the Special Issue Clinical Perspectives in Trauma and Orthopedic Surgery)

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J. Clin. Med., Volume 14, Issue 4 (February-2 2025) – 363 articles

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