Clinics and Practice

14 pages, 337 KB

Open AccessArticle

Knowledge, Attitudes, and Perceptions of Midwives and Obstetricians/Gynecologists on Sexual Activity During Pregnancy: A Cross-Sectional Study in Greece

by Eleni Charitopoulou, Angeliki Bolou, Vikentia Harizopoulou, Antigoni Sarantaki, Athina Diamanti, Irene Athina Avramidou and Giannoula Kyrkou

Clin. Pract. 2026, 16(7), 130; https://doi.org/10.3390/clinpract16070130 - 10 Jul 2026

Abstract

Background: Sexual health is a key component of quality of life and an essential aspect of holistic maternity care. During pregnancy, changes in sexual function are often accompanied by fears and misconceptions, which are influenced by healthcare professionals’ counseling. Objectives: The present [...] Read more.

Background: Sexual health is a key component of quality of life and an essential aspect of holistic maternity care. During pregnancy, changes in sexual function are often accompanied by fears and misconceptions, which are influenced by healthcare professionals’ counseling. Objectives: The present study aimed to investigate the knowledge, attitudes, and perceptions of midwives and obstetricians/gynecologists in Greece regarding sexual activity during pregnancy. Methods: A cross-sectional study was conducted using an anonymous, self-administered questionnaire. Participants included 121 healthcare professionals (73 midwives and 48 obstetricians/gynecologists). Data were analyzed using appropriate non-parametric statistical tests and multiple linear regression analysis. Results: The majority of participants (97.5%) considered sexual activity during pregnancy to be beneficial. Midwives demonstrated significantly higher scores on the knowledge assessment compared to obstetricians/gynecologists (67.7 ± 18.0 vs. 54.8 ± 24.2, p = 0.001) and more frequently selected the questionnaire response indicating benefits for both the couple and the fetus (46.6% vs. 27.1%, p = 0.031). A higher proportion of midwives perceived that pregnant women do not receive adequate information regarding their sexual health (93.2% vs. 68.8%, p < 0.001). Obstetricians/gynecologists were more likely to recommend restrictions even in low-risk pregnancies. Conclusions: The findings highlight the need for improved education and standardized counseling protocols on sexual health during pregnancy, with particular emphasis on strengthening the role of midwives in delivering holistic, woman-centered care. Full article

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

► Show Figures

Figure 1

9 pages, 212 KB

Open AccessArticle

Awareness of Dental Professionals of the Relationship Between Prosthetic Pressure Lesions and Infective Endocarditis: A Cross-Sectional Observational Study

by Francesco Saverio Ludovichetti, Serena Zanatta, Davide Scettri, Valentina Brun, Sergio Mazzoleni, Edoardo Stellini and Christian Bacci

Clin. Pract. 2026, 16(7), 129; https://doi.org/10.3390/clinpract16070129 - 10 Jul 2026

Abstract

Background: Infective endocarditis is a serious disease affecting cardiac tissues and may arise following episodes of transient bacteremia. Oral prosthetic pressure lesions, characterized by mucosal ulcerations, may facilitate the entry of pathogenic microorganisms into the systemic circulation. In predisposed individuals, the presence [...] Read more.

Background: Infective endocarditis is a serious disease affecting cardiac tissues and may arise following episodes of transient bacteremia. Oral prosthetic pressure lesions, characterized by mucosal ulcerations, may facilitate the entry of pathogenic microorganisms into the systemic circulation. In predisposed individuals, the presence of such lesions may therefore contribute to the development of infective endocarditis. The objective of this study was to assess dental professionals’ knowledge, awareness, and self-reported clinical practices related to the possible relationship between oral prosthetic pressure lesions and infective endocarditis. Materials and Methods: A cross-sectional observational study was conducted using an anonymous online questionnaire specifically developed for this study and subjected to preliminary content validation and pilot assessment before administration. The survey was distributed online to oral health professionals working in the Italian public and private sectors; for the present analysis, only complete responses provided by licensed dental professionals practicing in Italy were included. Results: Among the 268 dental professionals analyzed, an overall limited awareness of the possible relationship between oral prosthetic pressure lesions and infective endocarditis emerged. Only 16.8% of participants reported being familiar with the most recent guidelines for the prevention of infective endocarditis. Conclusions: The findings suggest the need to strengthen continuing education, improve familiarity with current infective endocarditis prevention guidelines, and promote more structured clinical protocols for the assessment and management of prosthetic pressure lesions in patients at risk. Full article

20 pages, 1526 KB

Open AccessArticle

Epidemiological Patterns and Determinants of Subclinical and Overt Hypothyroidism in a Clinical Cohort from the Hail Region, Saudi Arabia: A Retrospective Cross-Sectional and Cluster Analysis Study

by Tareq Nafea Alharby, Sultan Almuntashiri, Majd Habib Alshammari, Shahad Hassan Alshammari, Ahad Fhaid Alzabni, Asyah Awad Alnomassi, Hanadi Saleh Alrashidi, Saleh Alghamdi, Nafees Ahemad and Sirajudheen Anwar

Clin. Pract. 2026, 16(7), 128; https://doi.org/10.3390/clinpract16070128 - 9 Jul 2026

Abstract

Background: Hypothyroidism is a globally prevalent disorder with variations in its occurrence. However, few studies have reported its prevalence in Saudi Arabia. This study aimed to establish the prevalence, characteristics, and predictors of subclinical and overt hypothyroidism in a clinical cohort from [...] Read more.

Background: Hypothyroidism is a globally prevalent disorder with variations in its occurrence. However, few studies have reported its prevalence in Saudi Arabia. This study aimed to establish the prevalence, characteristics, and predictors of subclinical and overt hypothyroidism in a clinical cohort from the Hail region of Saudi Arabia. Methods: A retrospective cross-sectional design was used. Electronic medical records of adults (aged ≥18 years) who underwent thyroid function testing (TSH, FT4, and FT3) at the study institution were reviewed. Participants with missing laboratory or demographic data and those with hyperthyroidism (TSH < 0.4 mIU/L) were excluded. Hypothyroidism was classified biochemically using internationally accepted TSH and FT4 thresholds. The final analysis cohort comprised 724 participants. Results: Of 724 participants, 471 (65.1%) were euthyroid, 234 (32.3%) had subclinical hypothyroidism, and 19 (2.6%) had overt hypothyroidism, yielding a total biochemical hypothyroidism prevalence of 34.9% (n = 253). Women were over-represented (89.6%), and obesity was prevalent (69%). The biochemical results confirmed that overt hypothyroidism showed significantly elevated TSH and decreased FT4 compared to subclinical hypothyroidism. There were non-significant associations between gender, BMI, and hypertension with thyroid status. Age was an independent predictor of hypothyroid status (OR = 0.983, 95% CI: 0.970–0.995, p = 0.008), and systolic blood pressure was also independently associated (OR = 1.011, 95% CI: 1.002–1.019, p = 0.016). Multiple regression showed age, hypertension, gonarthrosis, and chest pain were independently associated with TSH levels. Hierarchical clustering suggested potential regional patterns in hypothyroidism prevalence. Conclusions: Hypothyroidism, mostly subclinical, was prevalent in this clinical cohort. Age and systolic blood pressure were independent predictors, while BMI and gender were not. Biochemical assessment is essential for detection, and larger prospective studies are recommended. Full article

► Show Figures

Figure 1

24 pages, 3648 KB

Open AccessArticle

Beyond National Averages: Spatial and Temporal Patterns in Type 2 Diabetes Dynamics in Romania—A 10-Year Time Series Study

by Cristina Gena Dascalu, Diana Tatarciuc and Magda Ecaterina Antohe

Clin. Pract. 2026, 16(7), 127; https://doi.org/10.3390/clinpract16070127 - 4 Jul 2026

Abstract

Background/Objectives: This study analyzes the temporal and spatial evolution of type 2 diabetes prevalence in Romanian counties over a 10-year period (2012–2021), based on the time series autocorrelation and cross-correlation coefficients. Methods: The autocorrelation coefficients were calculated within each county’s data series, in [...] Read more.

Background/Objectives: This study analyzes the temporal and spatial evolution of type 2 diabetes prevalence in Romanian counties over a 10-year period (2012–2021), based on the time series autocorrelation and cross-correlation coefficients. Methods: The autocorrelation coefficients were calculated within each county’s data series, in order to identify the internal temporal dependencies, and the cross-correlation coefficients were calculated on administrative regions, in order to identify epidemiological patterns. Results: The type 2 diabetes prevalence rates in most counties follow autoregressive series, with significant positive correlations at lag 1, indicating cyclical fluctuations. Cross-correlation analysis revealed 3 regional patterns: North-East and West regions showed highly synchronized dynamics with cross-correlations exceeding 0.9, South-East and South regions showed mixed synchronization, with temporal lags of 1–2 years between counties, while the other regions (Center, South-West and North-West) revealed a synchronized core and an isolated county, with atypical dynamics (e.g., Cluj, Alba, Mehedinți, Ialomița). Conclusions: These findings highlight the utility of time series analysis in understanding the specificity of such data and their practical applicability in customizing the required public health interventions. Full article

(This article belongs to the Topic Health Monitoring in the Context of Medical Big Data)

► Show Figures

Figure 1

15 pages, 265 KB

Open AccessReview

Unusual Manifestations of Sinonasal Osteomas: A Narrative Review

by Spyridon Lygeros, Alkmini Gatsounia, Ioanna Athanasiadou, Aris I. Giotakis, Foteini Tsapardoni and Gerasimos Danielides

Clin. Pract. 2026, 16(7), 126; https://doi.org/10.3390/clinpract16070126 - 4 Jul 2026

Abstract

Background/Objectives: Sinonasal osteomas are benign, slow-growing tumors that are typically asymptomatic and incidentally detected. However, in rare cases, they may present with atypical and potentially serious complications involving other sinonasal, orbital, or intracranial structures. This review aims to synthesize these unusual manifestations [...] Read more.

Background/Objectives: Sinonasal osteomas are benign, slow-growing tumors that are typically asymptomatic and incidentally detected. However, in rare cases, they may present with atypical and potentially serious complications involving other sinonasal, orbital, or intracranial structures. This review aims to synthesize these unusual manifestations and to highlight the underlying mechanisms, diagnostic challenges, and management implications. Methods: A narrative review of the literature was conducted, focusing on reported cases of sinonasal osteomas with rare or complicated presentations. Studies were analyzed with emphasis on clinical features, imaging findings, pathophysiological mechanisms, and treatment strategies. Results: Unusual presentations of sinonasal osteomas are primarily driven by sinus obstruction, progressive expansion, and skull-base erosion. These processes may result in complications such as pneumocephalus, intracranial mucoceles, cerebrospinal fluid leaks, orbital compression, and secondary infections. Clinical manifestations are often nonspecific, including headache, seizures, visual disturbances, or focal neurological deficits, which may delay diagnosis. High-resolution computed tomography is essential for identifying the osseous lesion and associated bone changes, while magnetic resonance imaging is critical for assessing soft-tissue involvement and intracranial extension. Management is individualized, with surgical resection indicated in most symptomatic or complicated cases, using endoscopic, open, or combined approaches. Conclusions: Although rare, atypical manifestations of sinonasal osteomas can result in significant morbidity. A mechanism-based understanding, supported by appropriate imaging, is essential for accurate diagnosis and timely management. Increased clinical awareness is crucial to improving outcomes in these uncommon but clinically significant cases. Full article

9 pages, 3587 KB

Open AccessCase Report

Limb Salvage After Chronic Nonunion Following Deformity Correction in Congenital Fibular Deficiency: A Cautionary 12-Year Follow-Up Case Highlighting Biological and Mechanical Reconstructive Challenges

by Koji Nozaka, Shohei Murata and Naohisa Miyakoshi

Clin. Pract. 2026, 16(7), 125; https://doi.org/10.3390/clinpract16070125 - 3 Jul 2026

Abstract

Background: Congenital fibular deficiency is a rare longitudinal deficiency of the lower extremity associated with limb-length discrepancy, ankle and foot deformity, soft-tissue imbalance, and functional impairment. Reconstruction may be challenging because bone healing, regenerate maturation, and mechanical stability can be less predictable [...] Read more.

Background: Congenital fibular deficiency is a rare longitudinal deficiency of the lower extremity associated with limb-length discrepancy, ankle and foot deformity, soft-tissue imbalance, and functional impairment. Reconstruction may be challenging because bone healing, regenerate maturation, and mechanical stability can be less predictable in selected patients. Case Presentation: A man with congenital fibular deficiency developed chronic distal tibial nonunion after corrective osteotomy at another institution. The nonunion persisted for four years, and the patient presented to our hospital with inability to bear weight and wheelchair dependence. A comprehensive salvage strategy was performed, including Achilles tendon lengthening using the Vulpius technique, removal of retained fixation material, debridement and refreshment of the nonunion site, negative bacteriological cultures, autologous cancellous iliac bone grafting, acute shortening and compression of the docking site, circular external fixation, proximal tibial osteotomy, and gradual lengthening. Low-intensity pulsed ultrasound was applied postoperatively as an adjunctive biological stimulus. Results: Bone union was achieved, and the external fixator was removed approximately one year after surgery. A total lengthening of 78 mm was achieved. At 12-year follow-up, the AOFAS ankle-hindfoot score was 90, ankle range of motion was 5° dorsiflexion and 40° plantarflexion, and the JOA knee score was 95. The patient walked independently without assistive devices and continued to work. Mild residual varus deformity of the proximal tibia was present, but the patient reported no knee pain, ankle pain, or ankle instability, and radiographs showed no progressive osteoarthritic changes. Conclusions: In selected patients with congenital fibular deficiency and chronic nonunion after previous treatment, durable limb salvage may be achieved using an individualized strategy that addresses both biological and mechanical factors. Full article

► Show Figures

Figure 1

14 pages, 2563 KB

Open AccessSystematic Review

Serum or Plasma Oncostatin M for Predicting Primary Non-Response to Tumor Necrosis Factor-α Antagonist Therapy in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

by Maxwell A. Barffour, Elizabeth Karanja, Mustafa Gandhi, Susan S. Kais, Saurabh Kapur and Yezaz A. Ghouri

Clin. Pract. 2026, 16(7), 124; https://doi.org/10.3390/clinpract16070124 - 2 Jul 2026

Abstract

Background: Over 30% of patients with inflammatory bowel disease (IBD) experience primary non-response to tumor necrosis factor-α antagonists (anti-TNFs). Oncostatin M (OSM), a TNF-α-independent pro-inflammatory signaling cytokine, is emerging as a potential predictive biomarker of treatment response. Through a systematic review and [...] Read more.

Background: Over 30% of patients with inflammatory bowel disease (IBD) experience primary non-response to tumor necrosis factor-α antagonists (anti-TNFs). Oncostatin M (OSM), a TNF-α-independent pro-inflammatory signaling cytokine, is emerging as a potential predictive biomarker of treatment response. Through a systematic review and meta-analysis, we assessed the utility of baseline serum or plasma OSM for predicting anti-TNF response in IBD patients. Methods: We searched PubMed, Embase, Cochrane Library, and Web of Science through March 2026 for studies reporting associations between baseline serum/plasma OSM and endoscopic or clinical response to anti-TNF therapy in adult IBD patients. We used a bivariate random-effects model to estimate pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the receiver operating characteristic (ROC) curve (AUC). Quality was assessed using QUADAS-2. Results: Data from four studies (n = 441 patients) were pooled. We estimated a pooled sensitivity of 82.8% (95% CI 71.4–90.3%) and a specificity of 88.4% (95% CI 82.7–92.4%) for predicting anti-TNF non-response. The pooled AUC was 0.899 (95% CI 0.858–0.940), with low heterogeneity (I² = 16.0%). The pooled DOR was 36.7 (95% CI 15.7–85.8), with a positive likelihood ratio of 7.1 and a negative likelihood ratio of 0.19. Risk of bias was low across the studies. Conclusions: Higher serum OSM was associated with treatment failure in IBD patients receiving anti-TNF therapy, with a pooled AUC of 0.899 in assay-stratified analysis and 0.820 when all studies were included. However, the small number of available studies, substantial variability in OSM cutoffs (14–233.6 pg/mL) and assay heterogeneity limit the robustness and generalizability and call for additional prospective data to more-robustly characterize the clinical utility of OSM. Full article

► Show Figures

Figure 1

15 pages, 2278 KB

Open AccessArticle

Accessory Navicular on MRI in an Adult Ankle MRI Referral Cohort (N = 1988): Prevalence, Subtypes, and Edema Correlates

by Zülküf Akdemir, Amed Çekdar Altındağ, Rıdvan Çeçen and Harun Arslan

Clin. Pract. 2026, 16(7), 123; https://doi.org/10.3390/clinpract16070123 - 2 Jul 2026

Abstract

Purpose: To determine the prevalence and subtype distribution of accessory navicular (AN) on adult ankle MRI and to evaluate MRI factors associated with AN-related bone marrow edema (BME); bilaterality was explored in patients with available contralateral MRI data. Methods: In this retrospective cross-sectional [...] Read more.

Purpose: To determine the prevalence and subtype distribution of accessory navicular (AN) on adult ankle MRI and to evaluate MRI factors associated with AN-related bone marrow edema (BME); bilaterality was explored in patients with available contralateral MRI data. Methods: In this retrospective cross-sectional study, consecutive adult patients (≥18 years) who underwent ankle MRI between January 2022 and January 2025 at a single institution in Van, eastern Türkiye, were identified from the institutional archive. Two blinded readers assessed AN presence, classified subtypes using Coughlin criteria, measured maximal ossicle dimension for types 1–2, and recorded BME on fluid-sensitive sequences. Prevalence with 95% CIs was estimated, and multivariable logistic regression assessed factors associated with BME in patients with types 1–2. Results: Among 1988 unique patients (mean age: 42.2 ± 14.2 years; 42.6% male and 57.4% female), AN prevalence was 24.4% (95% CI: 22.6–26.4%), and type 2 predominated (50.2%). In the subgroup of AN-positive patients with available contralateral MRI data, AN was bilateral in 61 of 69 patients (88.4%). Interobserver agreement was excellent for AN detection and subtype classification (κ = 1.00 and κ = 0.98). Among types 1–2 included in the BME analysis (n = 385), BME occurred in 81 patients (21.0%). In the multivariable model, the adjusted ORs for BME were 4.46 for type 2 morphology, 1.24 per 1 mm increase in maximal dimension, 2.08 for female sex, and 0.71 per 10-year increase in age; concomitant os trigonum was not associated with BME. Conclusions: AN was common on ankle MRI, and type 2 was most strongly associated with BME; however, because this was a retrospective, cross-sectional, symptom-blinded study, causality and clinical correlation could not be established. Clinical Significance: Type 2 AN, particularly with a larger ossicle dimension, should prompt careful evaluation for MRI-detected BME, which should be interpreted as an imaging finding requiring clinical correlation. Full article

► Show Figures

Figure 1

20 pages, 319 KB

Open AccessArticle

Exploratory Associations of Personality Traits, Cognitive Emotion Regulation, and Quality of Life with DSM-Related Symptom Burden in Gambling Disorder

by Ioana Ioniță, Mădălina Iuliana Mușat, Bogdan Cătălin, Dan Adrian Lutescu, Constantin Alexandru Ciobanu and Adela Magdalena Ciobanu

Clin. Pract. 2026, 16(7), 122; https://doi.org/10.3390/clinpract16070122 - 29 Jun 2026

Abstract

Background and Objectives: Gambling disorder (GD) is a behavioral addiction associated with distress, comorbidity, and functional impairment. This exploratory cross-sectional study examined associations between DSM-5-TR symptom burden, personality dimensions, cognitive emotion regulation, quality of life, and sociodemographic variables in a Romanian clinical sample. [...] Read more.

Background and Objectives: Gambling disorder (GD) is a behavioral addiction associated with distress, comorbidity, and functional impairment. This exploratory cross-sectional study examined associations between DSM-5-TR symptom burden, personality dimensions, cognitive emotion regulation, quality of life, and sociodemographic variables in a Romanian clinical sample. Materials and Methods: The sample included 122 adults with psychiatrist-confirmed pathological gambling/GD recruited from “Prof. Dr. Alexandru Obregia” Clinical Hospital of Psychiatry, Bucharest. Personality was assessed with the Personality Clinical Form (PCF; 109 valid profiles), cognitive emotion regulation with the Cognitive Emotion Regulation Questionnaire, and quality of life with the Quality of Life Inventory. Symptom burden was measured using a nine-item binary DSM-5 symptom burden index. Results: The symptom burden index showed a pronounced ceiling effect: median = 9.00 (IQR = 9.00–9.00; range = 4–9), with 91.0% classified as severe and 77.9% meeting all nine criteria. In PCF analyses, symptom burden was positively associated, after Benjamini–Hochberg correction, with broad personality pathology, including maladaptive personality dimensions, personality-functioning indicators, and personality-disorder feature scales; the strongest association involved borderline features. Catastrophizing and Blaming Others were positively associated with severity, whereas Positive Reappraisal, Putting into Perspective, and Positive Refocusing were negatively associated. Quality of life was very low overall and associated with personality and coping variables, but not directly with symptom burden. Criterion-count rank distributions differed by marital status and perceived social support; occupational status showed an omnibus distributional difference, but no pairwise contrast survived correction. Conclusions: GD was characterized by severe symptom burden and restricted score variability. Findings support multidimensional assessment of personality functioning, emotion regulation, quality of life, and social–contextual vulnerability. Full article

16 pages, 298 KB

Open AccessReview

Acute Aortic Syndrome: From Risk Factors to Hospital Burden and Healthcare Resource Utilization

by Cosmin Marian Banceu, Diana Mariana Banceu, Marius Mihai Harpa, Daiana Cristutiu, Mihai Calinescu and Horatiu Suciu

Clin. Pract. 2026, 16(7), 121; https://doi.org/10.3390/clinpract16070121 - 27 Jun 2026

Abstract

Acute aortic syndrome (AAS) comprises acute aortic dissection, intramural haematoma, penetrating atherosclerotic ulcer, and limited intimal tear, conditions that require rapid recognition because mortality and resource use are strongly influenced by time to diagnosis, anatomical extent, malperfusion, and the need for emergency surgical [...] Read more.

Acute aortic syndrome (AAS) comprises acute aortic dissection, intramural haematoma, penetrating atherosclerotic ulcer, and limited intimal tear, conditions that require rapid recognition because mortality and resource use are strongly influenced by time to diagnosis, anatomical extent, malperfusion, and the need for emergency surgical or endovascular intervention. This revised narrative review synthesizes contemporary evidence on clinical, genetic, environmental, and health-system determinants of prolonged hospitalisation, intensive care unit (ICU) utilisation, bed occupancy, and costs in patients with AAS. Beyond summarising established risk factors, the review adds a resource-oriented framework that links hypertension, advanced age, female sex, smoking-related comorbidity, hereditary aortopathies, haemodynamic instability, malperfusion, delayed diagnosis, operative complexity, and postoperative complications to measurable downstream outcomes such as ICU length of stay, total hospital length of stay, reoperation, readmission, and longitudinal imaging surveillance. We searched PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar for relevant studies, registries, guideline documents, and cost analyses published between January 2000 and May 2026, with particular emphasis on studies from the last five years. The review was not designed as a meta-analysis; therefore, effect estimates are interpreted according to study design and generalisability. AAS imposes a disproportionate burden on hospital systems because high-risk patients often require advanced imaging, prolonged haemodynamic monitoring, complex open or endovascular repair, ICU care, and lifelong follow-up. Earlier diagnosis, structured risk stratification, targeted genetic evaluation, aggressive control of modifiable risk factors, and system-level pathways such as dedicated aortic networks may shorten hospital stay and reduce avoidable costs. Full article

21 pages, 2554 KB

Open AccessReview

Prevention of Gastrointestinal Bleeding in Patients Receiving Direct Oral Anticoagulants: A Narrative Review and Practical Framework for Prescribers

by Nicoleta Dubei, Larisa Anghel, Laura-Cătălina Benchea, Radu Andy Sascău, Cristina Prisacariu, Mircea Ovanez Balasanian, Bogdan-Sorin Tudurachi, Bianca-Ștefania Profire and Cristian Stătescu

Clin. Pract. 2026, 16(7), 120; https://doi.org/10.3390/clinpract16070120 - 26 Jun 2026

Abstract

Background/Objectives: As population aging increases the prevalence of atrial fibrillation (AF), the use of direct oral anticoagulants (DOACs) has expanded for thromboembolism prevention. Although DOACs offer advantages over vitamin K antagonists (VKAs), gastrointestinal bleeding (GIB) remains the most common extracranial adverse event. [...] Read more.

Background/Objectives: As population aging increases the prevalence of atrial fibrillation (AF), the use of direct oral anticoagulants (DOACs) has expanded for thromboembolism prevention. Although DOACs offer advantages over vitamin K antagonists (VKAs), gastrointestinal bleeding (GIB) remains the most common extracranial adverse event. Current guidelines address global bleeding risk but provide limited guidance on site-specific gastrointestinal risk assessment and prevention. This narrative review aims to summarize current evidence on the mechanisms, etiologies, and risk factors for DOAC-associated gastrointestinal bleeding and to propose a pragmatic, risk-based framework to support clinicians in individualized bleeding prevention. Methods: A narrative review of studies published between 2004 and 2025 was conducted, including randomized clinical trials, real-world evidence, meta-analyses, and major society guidelines. Evidence addressing DOAC safety profiles, gastrointestinal bleeding etiologies, patient-level risk factors, medication interactions, and preventive strategies was analyzed. Results: Gastrointestinal bleeding in patients treated with DOAC is strongly influenced by underlying gastrointestinal pathology, comorbid conditions, and concomitant medications. Established risk factors include prior gastrointestinal hemorrhage, Helicobacter pylori infection, gastrointestinal malignancy, diverticulosis, and angiodysplasia, as well as the use of nonsteroidal anti-inflammatory drugs (NSAIDs), antiplatelet therapy, or selective serotonin reuptake inhibitors (SSRIs). DOACs differ in gastrointestinal safety: apixaban consistently demonstrates the most favorable profile, whereas rivaroxaban and high-dose dabigatran show higher GIB rates. Preventive strategies such as H. pylori testing and eradication, proton pump inhibitor use in high-risk individuals, avoidance of NSAIDs and unnecessary antiplatelet therapy, and individualized DOAC selection may help reduce bleeding risk. Conclusions: Gastrointestinal bleeding risk in patients receiving DOAC therapy should be assessed using a site-specific and dynamic approach. A structured strategy integrating baseline risk evaluation, correction of modifiable factors, tailored anticoagulant selection, and risk-adapted follow-up may improve the safety of anticoagulation. The proposed framework may provide a pragmatic approach to individualized bleeding risk mitigation while preserving the benefits of DOAC therapy; however, prospective validation is required before its routine implementation can be recommended. Full article

► Show Figures

Figure 1

10 pages, 2091 KB

Open AccessArticle

Effectiveness of Guselkumab for the Treatment of Moderate-to- Severe Psoriasis in Elderly Patients: A Retrospective, Real-World Multicenter Study in the Lazio Region

by Giuseppe P. A. Gemma, Nicoletta Bernardini, Francesca Paola Sasso, Giacomo Caldarola, Eleonora De Luca, Maria Elisabetta Greco, Viviana Lora, Annamaria Mazzotta, Emanuele Miraglia, Diego Orsini, Gianluca Pagnanelli, Antonio Giovanni Richetta, Nevena Skroza and Annunziata Dattola

Clin. Pract. 2026, 16(7), 119; https://doi.org/10.3390/clinpract16070119 - 26 Jun 2026

Abstract

Background: Guselkumab, a selective interleukin-23 inhibitor, is effective in moderate-to-severe plaque psoriasis, but real-world long-term data in elderly patients remain limited. Objective: To evaluate the long-term effectiveness of guselkumab in elderly patients with moderate-to-severe psoriasis in a real-world setting. Methods: This retrospective, multicenter [...] Read more.

Background: Guselkumab, a selective interleukin-23 inhibitor, is effective in moderate-to-severe plaque psoriasis, but real-world long-term data in elderly patients remain limited. Objective: To evaluate the long-term effectiveness of guselkumab in elderly patients with moderate-to-severe psoriasis in a real-world setting. Methods: This retrospective, multicenter study included 102 patients aged 65 years or older treated with guselkumab across seven Italian centers. PASI scores and PASI 75/90/100 responses were assessed as observed cases at weeks 4, 16, 28, and 52, and annually up to 4 years, with last-observation-carried-forward and non-responder imputation as sensitivity analyses. Subgroups by biologic experience and BMI were analyzed. Results: Mean PASI decreased from 12.4 to 0.3 at week 52, remaining low through year 4 (p < 0.001). At week 52 and year 4, PASI 90 was achieved by 89.7% and 86.5%, and PASI 100 by 79.3% and 73.0%, respectively. Responses were comparable between biologic-naïve and biologic-experienced patients. Obese patients had higher baseline PASI; after adjustment for baseline severity, responses did not differ from non-obese patients. Conclusions: Guselkumab was associated with high and durable PASI improvement in elderly patients, regardless of prior biologic exposure or body weight. The retrospective design and absence of systematic safety data warrant cautious interpretation. Full article

► Show Figures

Figure 1

17 pages, 909 KB

Open AccessSystematic Review

Bilateral Iris Metastasis of Small Cell Lung Carcinoma: A Case Report and Systematic Review

by Stipe Vidović, Egon Biuk, Greta Biuk, Marija Jelić Vuković, Maja Vinković, Andrijana Kopić and Dubravka Biuk

Clin. Pract. 2026, 16(7), 118; https://doi.org/10.3390/clinpract16070118 - 23 Jun 2026

Abstract

Objective: To report a rare case of bilateral iris metastasis from small cell lung carcinoma (SCLC) and systematically review the literature on SCLC-associated iris metastases, with emphasis on clinical presentation, management, and outcomes. Materials and Methods: A systematic literature review was conducted in [...] Read more.

Objective: To report a rare case of bilateral iris metastasis from small cell lung carcinoma (SCLC) and systematically review the literature on SCLC-associated iris metastases, with emphasis on clinical presentation, management, and outcomes. Materials and Methods: A systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, ScienceDirect, Scopus, and Web of Science were comprehensively searched on 10 July 2025. Eligible studies included English-language reports of iris metastasis originating from SCLC in human subjects. Case report: A 58-year-old woman with previously treated SCLC developed bilateral iris metastases one year after complete remission of the primary tumor. Ophthalmic examination revealed whitish-gray, vascularized iris masses with iridocorneal angle involvement, associated with secondary angle-closure glaucoma and markedly elevated intraocular pressure (48 mm Hg) in the left eye. Cyclocryotherapy, preceded by systemic and topical antiglaucoma therapy, resulted in pain relief and a reduction in intraocular pressure; the patient died four months later due to pneumonia. Results (Systematic Review): Seventeen studies comprising 17 patients were included; the median age was 60 years, and 64.7% were male. The median interval from SCLC diagnosis to ocular presentation was 4 months, although iris metastasis was occasionally the initial or concurrent manifestation of disease. The most common presenting features were visual impairment (58.8%), ocular pain (41.2%), and elevated intraocular pressure (41.2%), while iris neovascularization (35.3%) and synechiae (29.4%) were also frequent. Bilateral involvement was reported in only one previous case. Treatment approaches were heterogeneous and included antiglaucoma therapy, systemic chemotherapy, local radiotherapy, anti-VEGF therapy, and enucleation. Among patients with available follow-up (n = 12), 58.3% died within a median follow-up of 7.5 months. Conclusions: Bilateral iris metastasis from SCLC is rare and may occur as a manifestation of recurrent disease after remission. It is an aggressive condition characterized by nonspecific ocular symptoms, variable management, and poor survival, underscoring the importance of early recognition and the need for evidence-based diagnostic and therapeutic strategies. Full article

► Show Figures

Figure 1

14 pages, 16160 KB

Open AccessCase Report

Vasa Vasorum—A Silent Enemy After EVAR: A Case Report and Review of the Literature

by Ilias Prentzas, Vasileios Leivaditis, Chrysa Andrikopoulou, Konstantinos Nikolakopoulos, Chrysanthi Papageorgopoulou, Kate Tabaku, Melina Stathopoulou, Zafeiria Papathanassiou, Polyzois Tsantrizos, Francesk Mulita, Konstantinos Katsanos and Spyros Papadoulas

Clin. Pract. 2026, 16(6), 117; https://doi.org/10.3390/clinpract16060117 - 18 Jun 2026

Abstract

Background/Objectives: Type II endoleaks (T2ELs) remain one of the most frequent causes of aneurysm sac enlargement following endovascular abdominal aortic aneurysm repair (EVAR). While embolization may be effective in typical T2ELs with a clearly identifiable feeding vessel, management becomes more challenging when no [...] Read more.

Background/Objectives: Type II endoleaks (T2ELs) remain one of the most frequent causes of aneurysm sac enlargement following endovascular abdominal aortic aneurysm repair (EVAR). While embolization may be effective in typical T2ELs with a clearly identifiable feeding vessel, management becomes more challenging when no visible communication with a side branch can be demonstrated. Emerging evidence suggests that hypertrophic vasa vasorum may contribute to aneurysm sac expansion in these atypical cases. We present a case of refractory atypical T2EL treated by open conversion and discuss the potential role of the vasa vasorum network in its pathophysiology. Case Presentation: A 77-year-old man presented with lumbar pain ten years after EVAR for a symptomatic abdominal aortic aneurysm. Computed tomography angiography demonstrated progressive aneurysm sac enlargement to 8.5 cm despite three previous translumbar embolization procedures. Multiple areas of contrast pooling were identified within the aneurysm sac, but no clear communication with a feeding side branch was observed. Owing to persistent sac expansion and symptoms, open conversion was performed with partial endograft explantation and reconstruction using a bifurcated PTFE graft. Results: After opening the aneurysm sac and evacuating the thrombus, diffuse bleeding was observed from numerous small vascular orifices distributed throughout the inner sac surface. These findings were considered consistent with a prominent vasa vasorum network. Hemostasis was achieved using a combination of figure-of-eight sutures and electrocautery. The postoperative course was uneventful, and the patient was discharged on postoperative day five. Follow-up imaging demonstrated normal graft patency without complications. Conclusions: This case supports the hypothesis that an extensive vasa vasorum network may contribute to aneurysm sac expansion in atypical T2ELs and possibly endotension after EVAR. In patients with refractory sac enlargement, open conversion remains a definitive treatment option. Further research is needed to clarify the underlying mechanisms and to explore targeted therapeutic strategies aimed at modulating angiogenesis and vascular remodeling. Full article

► Show Figures

Figure 1

14 pages, 1303 KB

Open AccessArticle

Post-Levothyroxine Thyroid Dysfunction in Saudi Arabian Patients with Hypothyroidism: A Cross-Sectional Study

by Baraah Ghssan AlHassan, Maujid Masood Malik, Ahmed Mohamedain, Adnan Jehangir, Farhana Ayub, Omer Musa, Ahmed Ibrahim, Habib Ahmad Qureshi and Hayder A. Giha

Clin. Pract. 2026, 16(6), 116; https://doi.org/10.3390/clinpract16060116 - 17 Jun 2026

Abstract

Background: Post-thyroxine treatment of thyroid dysfunction remains a clinical concern, especially in Middle Eastern populations. Methods: This descriptive cross-sectional study was conducted in 2023 at King Fahad Hospital, Hufof, Kingdom of Saudi Arabia. Of the 237 patients treated with L-thyroxine (L-T4) for hypothyroidism, [...] Read more.

Background: Post-thyroxine treatment of thyroid dysfunction remains a clinical concern, especially in Middle Eastern populations. Methods: This descriptive cross-sectional study was conducted in 2023 at King Fahad Hospital, Hufof, Kingdom of Saudi Arabia. Of the 237 patients treated with L-thyroxine (L-T4) for hypothyroidism, 163 patients, almost exclusively females (152 females, 11 males), met the inclusion criteria and were enrolled. Thyroid hormones, lipid profiles, and 25-hydroxyvitamin D (25OH-D) were measured using standard laboratory assays. Results: Only 57% of patients achieved euthyroid status following L-T4 treatment, while 12.3% developed post-thyroxine-treatment (PTT) hyperthyroidism, and 30.7% developed PTT hypothyroidism. Older age was significantly associated with dysthyroidism (p = 0.018), whereas obesity (p = 0.937) and vitamin D levels (p = 0.982) were not. Total cholesterol (TC) and LDLc positively correlated with TSH levels, while elevated triglycerides (TGs) were significantly associated with PTT hyperthyroidism. The two dysthyroid subgroups were comparable across all non-thyroid parameters, including age, BMI, 25(OH)D levels, and lipid fractions. However, free T4 was significantly higher in PTT hyperthyroidism (p < 0.001); free T3 showed a trend toward higher levels in PTT hyperthyroidism (p = 0.052); and TSH was significantly higher in PTT hypothyroidism (p < 0.001). Conclusions: The proportions of patients with PTT hypo- and hyperthyroidism are aligned with international observations. Furthermore, the age was significantly associated with dysthyroidism, and dyslipidemia is the most consistent biochemical correlate of suboptimal thyroid status; however, the associations of PTT dysthyroidism with hypovitaminosis D and BMI were not noticed in this setting. Full article

► Show Figures

Figure 1

8 pages, 1446 KB

Open AccessCase Report

Pycnodysostosis: Report of Two Novel CTSK Variants in a Child

by Daniela Trotta, Rossella Ferrante, Michele Sallese, Marianna Viele, Claudia Rossi, Vincenzo Scorrano, Sara Savelli, Milena Catenaro, Vincenzo De Laurenzi and Maurizio Aricò

Clin. Pract. 2026, 16(6), 115; https://doi.org/10.3390/clinpract16060115 - 16 Jun 2026

Abstract

Background: Pycnodysostosis is a rare autosomal recessive skeletal disorder caused by biallelic pathogenic variants in CTSK, which encodes cathepsin K, a lysosomal cysteine protease required for osteoclast-mediated degradation of bone matrix. Case Report: We describe a girl with short stature, skeletal deformities, [...] Read more.

Background: Pycnodysostosis is a rare autosomal recessive skeletal disorder caused by biallelic pathogenic variants in CTSK, which encodes cathepsin K, a lysosomal cysteine protease required for osteoclast-mediated degradation of bone matrix. Case Report: We describe a girl with short stature, skeletal deformities, osteosclerosis, craniofacial features, clavicular dysplasia, and radiological evidence of fractures. Clinical exome sequencing identified two heterozygous CTSK variants, c.85T > C (p.Trp29Arg) and c.679A>T (p.Ile227Phe), both currently classified as variants of uncertain significance. Segregation analysis showed that the variants were inherited in trans. Computational modeling and in silico prediction tools supported a possible deleterious effect on cathepsin K structure or function. Serum cathepsin K was higher in the patient than in two age-matched controls; this result is reported as an exploratory observation only. Increased serum cathepsin K may reflect altered expression, secretion, clearance, or accumulation of dysfunctional protein, but cannot be interpreted as proof of compensatory upregulation. Conclusions: The patient’s clinical and radiographic features, the biallelic trans configuration of the CTSK variants, their rarity in population databases, and computational predictions support p.Trp29Arg and p.Ile227Phe as strong candidate disease-associated variants. Functional studies are required to confirm their effect on cathepsin K expression, maturation, and enzymatic activity. Full article

► Show Figures

Figure 1

14 pages, 968 KB

Open AccessArticle

Prevalence of and Factors Associated with Overactive Bladder, Anxiety, and Depression Among Patients with Multiple Sclerosis: A Cross-Sectional Study in Saudi Arabia

by Mohammed Alqwaifly, Samer A. Almuqairsha, Emad Alwashmi, Yousef M. Alharbi, Adi A. Aldubaiyan, Raghad H. Aldligan, Abdulmajeed A. Alkhamees, Ayham Abazid, Rehana Khalil and Osama Al-Wutayd

Clin. Pract. 2026, 16(6), 114; https://doi.org/10.3390/clinpract16060114 - 15 Jun 2026

Abstract

Background: Over the years, it has become increasingly clear that neurological conditions, such as multiple sclerosis (MS), commonly exhibit other health problems. Therefore, this is the first study aimed at investigating the prevalence of and factors associated with three binary outcomes: depression, anxiety, [...] Read more.

Background: Over the years, it has become increasingly clear that neurological conditions, such as multiple sclerosis (MS), commonly exhibit other health problems. Therefore, this is the first study aimed at investigating the prevalence of and factors associated with three binary outcomes: depression, anxiety, and an overactive bladder (OAB) among MS patients in the Qassim region, Saudi Arabia. Methods: This cross-sectional study was conducted in the neurological department of King Fahad Specialist Hospital in the Qassim region, Saudi Arabia, from January to December 2024. Data on age, sex, marital status, occupation, body mass index (BMI), MS duration, comorbidities, anxiety, depression, and OAB symptoms (frequency, nocturia, urgency, and urge incontinence) were obtained. Results: Of the 262 MS patients in this study, 184 (70.2%) were females, and 78 (29.8%) were males. The median values [IQR] of age and MS duration were 34 [26–40] and 5 [2–9] years, respectively. The prevalence of depression, anxiety, and OAB were 53.4%, 43.9%, and 50%, respectively. Nocturia was the most frequent urinary symptom, and urge incontinence was significantly higher among females. Multiple logistic regression analyses were conducted to assess factors associated with three binary outcomes: depression, anxiety, and OAB. For depression, being single and anxiety were associated with increased risk. Regarding anxiety, being a student was related to decreased risk, while being female and having depression were associated with increased risk. For OAB, only anxiety was associated with increased risk. Conclusions: Approximately one in two MS patients experience either depression or OAB, while anxiety was reported by fewer than half of the patients. This high prevalence of the three outcomes has critical implications for healthcare policy and resource allocation. Thus, screening, early diagnosis, and intervention, as well as integrated care, should be prioritized by healthcare institutions and practitioners to address these conditions and improve MS patients’ quality of life. Full article

► Show Figures

Figure 1

13 pages, 600 KB

Open AccessArticle

Trends in Comorbidity for Patients with Venous Thromboembolism in a General Hospital: 2018 to 2022

by Luisa Jiménez Reyes, José Javier Jareño Esteban, Lara Almudena Fernández Bermejo, Carlos Gutiérrez Ortega and Javier de Miguel-Díez

Clin. Pract. 2026, 16(6), 113; https://doi.org/10.3390/clinpract16060113 - 15 Jun 2026

Abstract

Background/Objectives: Recent trends show a rising incidence of venous thromboembolism (VTE) that does not correlate with increased mortality; however, population aging and the proliferation of comorbidities are fundamentally reshaping the VTE patient landscape. The aim of this study is to evaluate potential [...] Read more.

Background/Objectives: Recent trends show a rising incidence of venous thromboembolism (VTE) that does not correlate with increased mortality; however, population aging and the proliferation of comorbidities are fundamentally reshaping the VTE patient landscape. The aim of this study is to evaluate potential differences in clinical characteristics, comorbidities, and survival rates between patients diagnosed with pulmonary embolism (PE) during the pre-pandemic period (2018–2019) and those diagnosed during the pandemic era (2020–2022). Additionally, as a secondary objective, we analyze the clinical profiles, risk factors, and survival outcomes of patients with and without COVID-19 infection during the 2020–2022 period. Methods: A retrospective observational study was conducted to analyze survival and comorbidities in patients admitted for PE at the Hospital Central de la Defensa ‘Gómez Ulla’ between 2018 and 2022, comparing two periods (2018–2019 and 2020–2022). In addition, a sub-analysis was performed within the second period group comparing patients with and without COVID-19. Results: It was observed that the majority of patients in the first period were men, while in the second period, 55% were women. With regard to comorbidity and risk factors, thrombophilia and dementia were more prevalent in the first period, while asthma was more prevalent in the second period. No differences were found with regard to mortality. Conclusions: Significant differences were observed between the two periods of the study with regard to some comorbidities. Patients with COVID-19 showed a greater tendency toward immobilization and a higher prescription of thromboprophylaxis during hospitalization. Full article

(This article belongs to the Special Issue Advances in Thromboembolism: Precision Prevention and Clinical Management)

► Show Figures

Graphical abstract

11 pages, 772 KB

Open AccessArticle

Beyond Coiling: A Comparative Analysis of Survey-Reported Preferences for Endovascular Cerebral Aneurysm Occlusion

by Sanjana R. Salwi, Thilan Tudor, Oleg Shekhtman, Georgios S. Sioutas, Pious D. Patel, Irina-Mihaela Matache, Mohamed Salem, Sonia Ajmera, Sandeep Kandregula, Jan-Karl Burkhardt and Visish M. Srinivasan

Clin. Pract. 2026, 16(6), 112; https://doi.org/10.3390/clinpract16060112 - 15 Jun 2026

Abstract

Background: Aneurysm treatment options are rapidly evolving, as evidenced by the recent introduction and widespread adoption of flow diversion and intrasaccular devices. However, there is a need to understand how these newer technologies are used for difficult-to-treat aneurysms. The main aims of this [...] Read more.

Background: Aneurysm treatment options are rapidly evolving, as evidenced by the recent introduction and widespread adoption of flow diversion and intrasaccular devices. However, there is a need to understand how these newer technologies are used for difficult-to-treat aneurysms. The main aims of this study were to investigate the variation in aneurysm treatment recommendations among neurosurgeons, interventional radiologists, and interventional neurologists and to generally describe trends in endovascular treatment. Methods: In this survey-based study conducted from June to September 2024, participants were presented with clinical vignettes and asked to choose preferred treatment options, with responses analyzed based on demographic variables including specialty, age, and training prior to and after the introduction of flow diversion. Results: A total of 108 respondents completed the study with a representative mix of specialties—(45 (42.5%) radiologists, 22 (20.8%) neurologists, and 39 (36.8%) neurosurgeons. Sixty-six (61.1%) trained after the introduction of flow diversion. Treatment recommendations were significantly different by specialty (p < 0.001). The Kappa statistic to assess variation in responses showed significant variation in treatment preferences across aneurysm subtypes, ranging from poor (κ = 0.07) to fair (0.31). Treatment of ruptured aneurysms varied by specialty with radiologists opting for stent-assisted coiling at a higher rate than neurologists or neurosurgeons (p < 0.001). There was no significant difference in rates of recommending flow diversion or intrasaccular devices between those who had trained before and after their introduction (p = 0.97). Conclusion: The study highlights the dynamic nature of aneurysm management and considerable variability among different specialties. Further exploration into the rationale for each decision is needed to understand how specialty training affects these decisions. Full article

► Show Figures

Figure 1

Journal Description

Clinics and Practice

Latest Articles

Journal Menu

Journal Browser

Highly Accessed Articles

Latest Books

E-Mail Alert

News

Topics

Conferences

Special Issues

Further Information

Guidelines

MDPI Initiatives

Follow MDPI