Journal Description
Clinics and Practice
Clinics and Practice
is an international, scientific, peer-reviewed, open access journal on clinical medicine, published monthly online by MDPI (from Volume 11, Issue 1 - 2021).
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within Scopus, ESCI (Web of Science), PubMed, PMC, Embase, and other databases.
- Journal Rank: JCR - Q2 (Medicine, General and Internal) / CiteScore - Q2 (General Medicine)
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 22.7 days after submission; acceptance to publication is undertaken in 3.8 days (median values for papers published in this journal in the first half of 2025).
- Recognition of Reviewers: APC discount vouchers, optional signed peer review, and reviewer names published annually in the journal.
Impact Factor:
2.2 (2024);
5-Year Impact Factor:
1.9 (2024)
Latest Articles
Neurogenic Dysphagia: Peripheral and Central Neuromodulation
Clin. Pract. 2025, 15(9), 163; https://doi.org/10.3390/clinpract15090163 - 4 Sep 2025
Abstract
Dysphagia is a frequent and potentially life-threatening complication in patients with neurological disorders. Swallowing is a complex neurophysiological mechanism regulated by a widespread network of central nervous system regions. The control of swallowing functions requires the integrity of the central pattern generator located
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Dysphagia is a frequent and potentially life-threatening complication in patients with neurological disorders. Swallowing is a complex neurophysiological mechanism regulated by a widespread network of central nervous system regions. The control of swallowing functions requires the integrity of the central pattern generator located in the brainstem, the sensorimotor cortex, the basal ganglia, and the cerebellum, but also peripheral nerves and swallowing muscles. Neurological diseases affecting either central or peripheral components of this system commonly result in dysphagia. Despite its clinical relevance, the management of neurogenic dysphagia remains challenging. While rehabilitative strategies such as swallowing therapy currently represent the main treatment option, emerging evidence suggests that non-invasive central and peripheral neuromodulation techniques may provide adjunctive beneficial effects. Further research is warranted to better define their efficacy, optimal protocols, and long-term outcomes.
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Open AccessArticle
Prospective Comparison of Short-Term Outcomes in Kinematic and Mechanical Alignment Total Knee Arthroplasty
by
Ofir Vinograd, Ahmad Essa, Netanel Steinberg, Ilan Y. Mitchnik, Dana Avraham, Inon Rotem, Adi Vinograd, Yiftah Beer, Noam Shohat and Yaron Bar-Ziv
Clin. Pract. 2025, 15(9), 162; https://doi.org/10.3390/clinpract15090162 - 31 Aug 2025
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Background: While mechanical alignment total knee arthroplasty (TKA) has long been the conventional surgical technique in patients with advanced osteoarthritis, kinematic alignment TKA has emerged as a promising alternative, designed to restore the knee’s native pre-arthritic anatomy. Since superiority of either technique remains
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Background: While mechanical alignment total knee arthroplasty (TKA) has long been the conventional surgical technique in patients with advanced osteoarthritis, kinematic alignment TKA has emerged as a promising alternative, designed to restore the knee’s native pre-arthritic anatomy. Since superiority of either technique remains inconclusive, we aimed to compare immediate and short-term postoperative outcomes of kinematic versus mechanical alignment TKA. Methods: This prospective cohort study was conducted at a tertiary care centre between January 2020 and August 2022, enrolling kinematic and mechanical alignment TKA patients. Outcomes were assessed during hospitalization and at 14 days postoperatively. Data collected included patient-reported outcome measures (PROMs), functional performance evaluations, pain scores, discharge disposition and hospital length of stay. Both univariate and multivariate regression analyses were conducted, adjusting for potential confounders. Results: The study included 103 patients, with 77 who underwent kinematic alignment and 26 mechanical alignment TKA. Patients in the kinematic alignment group demonstrated statistically significant better postoperative outcomes compared to those in the mechanical alignment group. Kinematic alignment TKA patients demonstrated superior functional performance on the Timed Up and Go test immediately postoperatively and were more frequently discharged home rather than to a rehabilitation facility. Hospital stay length and short-term PROMs also favoured the Kinematic alignment TKA group, showing statistically significant higher scores in the Oxford Knee Score, short form-12 Mental Component Summary, and the Knee Injury and Osteoarthritis Outcome Score Symptoms subscale. Conclusions: Kinematic alignment TKA offers superior immediate and short-term outcomes compared to mechanical alignment TKA, with benefits in functional recovery, hospitalization duration, and discharge disposition. This evidence supports kinematic alignment TKA as a viable alternative, aiding in patient and surgeon decision-making.
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Open AccessArticle
Addressing Healthcare Disparities Among the Homeless: Insights from a Student-Run Clinic in Houston, TX
by
Damien Kelly, Umer Khan, Elizabeth Bixler, Gabriella Becerra and Chakema Carmack
Clin. Pract. 2025, 15(9), 161; https://doi.org/10.3390/clinpract15090161 - 31 Aug 2025
Abstract
Background: Unhoused individuals face significant health disparities and encounter numerous barriers to accessing adequate healthcare, resulting in high rates of chronic disease, mental illness, and untreated conditions in Houston, TX. The purpose of this study was to identify prevalent health conditions within a
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Background: Unhoused individuals face significant health disparities and encounter numerous barriers to accessing adequate healthcare, resulting in high rates of chronic disease, mental illness, and untreated conditions in Houston, TX. The purpose of this study was to identify prevalent health conditions within a sample of unhoused adults and to identify patterns in patient characteristics and clinical health outcomes. Methods: This study utilized clinical and demographic data from n = 191 patients who received care at a student-run clinic embedded within a homeless drop-in center in Houston, TX. Data included patient demographics, chief complaints, social determinants of health (SDOHs), past medical history, on-site diagnoses, and provider actions. Results: The most prevalent issues were housing insecurity (36.1%), cardiovascular conditions (38.7%), and substance use (17.8%). Nearly half of all patients (46.6%) declined treatment or left before receiving care. Significant associations were found between patient demographics and provider responses, including differences by gender and age in treatment type and diagnostic categorization. Conclusions: These findings underscore critical challenges in treatment adherence, diagnostic bias, and retention among unhoused populations. The study provides actionable recommendations for improving care coordination and continuity in low-barrier, student-run clinics serving medically underserved communities.
Full article
Open AccessArticle
Implantable Cardioverter–Defibrillator Therapies Following Generator Replacements—Long-Term Remote Monitoring Data
by
Maciej Dyrbuś, Łukasz Pyka, Anna Kurek, Jacek Niedziela, Elżbieta Adamowicz-Czoch, Katarzyna Sokoła, Joanna Machowicz, Mateusz Ostręga, Damian Pres, Michał Skrzypek, Mariusz Gąsior and Mateusz Tajstra
Clin. Pract. 2025, 15(9), 160; https://doi.org/10.3390/clinpract15090160 - 30 Aug 2025
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Background: The rate of long-term outcomes, including arrhythmic episodes following implantable cardioverter–defibrillator (ICD) device replacements, is often unknown. Thus, the aim of this manuscript was to evaluate the risk of ICD or cardiac resynchronization therapy–defibrillator (CRT-D) therapies in remotely monitored patients following
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Background: The rate of long-term outcomes, including arrhythmic episodes following implantable cardioverter–defibrillator (ICD) device replacements, is often unknown. Thus, the aim of this manuscript was to evaluate the risk of ICD or cardiac resynchronization therapy–defibrillator (CRT-D) therapies in remotely monitored patients following device replacement. Methods: Data from 134 patients who underwent ICD/CRT-D replacement or upgrade were analyzed. Kaplan–Meier estimates, as well as Cox proportional hazards regression, were used to present long-term outcomes and predictors of study endpoints, these being all-cause mortality, and appropriate and inappropriate ICD/CRT-D therapies. Results: Among the cohort, 51.5% of patients received ICDs and 48.5% received CRT-Ds; the median (quartile 1–quartile 3) LVEF at replacement was 23.0% (18.0–28.0%). In 11 (8.2%) patients, the LVEF at replacement was higher than 35%. During the median (Q1–Q3) follow-up of 3.0 (1.4–5.0) years, 32.1% experienced appropriate and 6.0% experienced inappropriate therapies. The all-cause mortality rate was 38.0%, and appropriate antitachycardia pacing (ATP), a reduced baseline LVEF, and no history of myocardial infarction were independent predictors of death (odds ratios of 1.87 for appropriate ATP, 0.88 per 1% of the LVEF and 0.54 for a history of MI, respectively). The rate of appropriate device therapies was numerically lower in patients whose LVEF improved (19.8% vs. 33.3% and 0% vs. 6.5%, for appropriate and inappropriate therapies). An LVEF of >35% at replacement did not influence the analyzed outcomes. Conclusions: In patients who underwent ICD/CRT-D replacement, an improvement in LVEF was not identified as either a predictor of improved survival or of a lower risk of needing device therapies. Further stratification models are needed to evaluate the arrhythmic risk in patients after generator replacements.
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Open AccessArticle
Effects of Dietary and Probiotic Interventions in Patients with Metabolic Syndrome and Obstructive Sleep Apnea
by
Amina Venter, Amin-Florin El-kharoubi, Mousa El-kharoubi, Evelin Claudia Ghitea, Marc Cristian Ghitea, Timea Claudia Ghitea and Ciprian Florian Venter
Clin. Pract. 2025, 15(9), 159; https://doi.org/10.3390/clinpract15090159 - 29 Aug 2025
Abstract
Background: Metabolic syndrome (MS) and obstructive sleep apnea (OSA) frequently coexist, exacerbating systemic inflammation, oxidative stress, and metabolic dysregulation. This study evaluates the effects of dietary and probiotic interventions, compared to a non-intervention control group, on metabolic, hemodynamic, and neurochemical parameters, with a
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Background: Metabolic syndrome (MS) and obstructive sleep apnea (OSA) frequently coexist, exacerbating systemic inflammation, oxidative stress, and metabolic dysregulation. This study evaluates the effects of dietary and probiotic interventions, compared to a non-intervention control group, on metabolic, hemodynamic, and neurochemical parameters, with a specific focus on the neurotransmitters GABA and glutamate. Methods: In a prospective randomized study (2020–2023), 120 patients with coexisting MS and OSA were assigned to three groups: control (n = 36), diet therapy (n = 42), and diet therapy combined with probiotics (n = 42). Interventions lasted six months and included personalized dietary plans and probiotic supplementation. Outcome measures included BMI, visceral fat, HOMA index, lipid profile, oxygen saturation, and urinary GABA and glutamate levels. Unsupervised K-means clustering and principal component analysis (PCA) were applied to identify phenotypic response patterns based on delta values. Results: Diet therapy led to significant reductions in BMI (−15.7%, p = 0.001), visceral fat (−17.3%, p = 0.001), triglycerides (−14.6%, p = 0.003), uric acid (−9.5%, p = 0.011), and C-reactive protein (CRP) (−21.4%, p = 0.007). The combined intervention group exhibited further improvements in visceral fat (−22.8%, p = 0.001), glutamate (−18.2%, p = 0.002), and GABA levels (+19.5%, p = 0.001). Oxygen saturation improved across all groups, with the greatest increase in the probiotics group (+2.3%). Clustering analysis revealed three distinct response phenotypes—strong, moderate, and non-responders—highlighting inter-individual variability in treatment efficacy. Conclusions: Personalized dietary interventions, especially when paired with probiotics, effectively improve metabolic, inflammatory, and neurochemical profiles in patients with MS and OSA. Integrating clustering algorithms enables phenotype-specific stratification, offering a step toward precision lifestyle medicine. Future studies should explore long-term outcomes and refine microbiota-targeted approaches to optimize intervention efficacy.
Full article
(This article belongs to the Special Issue The Effect of Dietary Compounds on Inflammation-Mediated Diseases)
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Graphical abstract
Open AccessCase Report
Plasma Cell Gingivitis: Clinical Presentation, Histopathologic Correlation, and Therapeutic Challenges
by
Davide Gerardi, Diana Torge, Sara Bernardi, Pierangelo Burdo, Maurizio Piattelli and Giuseppe Varvara
Clin. Pract. 2025, 15(9), 158; https://doi.org/10.3390/clinpract15090158 - 28 Aug 2025
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Background/Objectives: Plasma cell gingivitis (PCG) is a rare, benign, non-dental-plaque-induced inflammatory condition characterized by dense subepithelial infiltration of polyclonal plasma cells. Due to its nonspecific clinical presentation, PCG represents a diagnostic challenge. This case report aims to describe a clinical case of PCG,
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Background/Objectives: Plasma cell gingivitis (PCG) is a rare, benign, non-dental-plaque-induced inflammatory condition characterized by dense subepithelial infiltration of polyclonal plasma cells. Due to its nonspecific clinical presentation, PCG represents a diagnostic challenge. This case report aims to describe a clinical case of PCG, highlighting the diagnostic process, histopathological correlation, and therapeutic approach. Methods: A 57-year-old male presented with a polypoid, erythematous, and edematous gingival lesion in the anterior maxillary region, with spontaneous bleeding on probing. Following clinic assessment, an incisional biopsy was performed, alongside complete hematological and inflammatory profiling. Histological and immunohistochemical analyses revealed the presence of an inflammatory infiltrate. Results: Histological evaluation revealed spongiotic squamous epithelium characterized by a dense plasma cell infiltrate with a liquenoid pattern of CD3-positive T and CD20-positive B lymphocytes. A polytypic expression of kappa and lambda light chains was also detected. The patient underwent topical corticosteroid therapy, showing progressive clinical improvement and resolution of symptoms, although minor mucosal involvement persisted. Conclusions: PCG remains a rare and underdiagnosed condition requiring integration of clinical, hematological, and histopathological data for accurate diagnosis. While corticosteroids remain the first-line therapy, emerging treatments, including photobiomodulation, may offer future adjunctive strategies to improve outcomes and reduce recurrence.
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Open AccessArticle
Transcutaneous Electrical Nerve Stimulation for Muscle Recovery: Insights into Delayed Onset Muscle Soreness
by
Sebastian Szajkowski, Jarosław Pasek and Grzegorz Cieślar
Clin. Pract. 2025, 15(9), 157; https://doi.org/10.3390/clinpract15090157 - 28 Aug 2025
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Background: Delayed onset muscle soreness (DOMS) frequently occurs after engaging in strenuous physical activity. The manifestation of DOMS is often associated with changes in the biomechanical and viscoelastic characteristics of the affected muscles. Materials and Methods: Forty participants were enrolled and randomly assigned
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Background: Delayed onset muscle soreness (DOMS) frequently occurs after engaging in strenuous physical activity. The manifestation of DOMS is often associated with changes in the biomechanical and viscoelastic characteristics of the affected muscles. Materials and Methods: Forty participants were enrolled and randomly assigned to two groups: the intervention group receiving transcutaneous electrical nerve stimulation (TENS, n = 20) and a control group (n = 20). A fatigue-inducing protocol targeting the gastrocnemius muscle was implemented to elicit DOMS. The effectiveness of TENS was assessed by evaluating alterations in the biomechanical and viscoelastic properties of the muscle. Pain intensity was recorded using the Numeric Rating Scale (NRS) at five time points: before the study began, three times during the intervention, and once at the conclusion of the study. Results: No statistically significant changes have been found regarding muscle tone (p = 0.162) and stiffness (p = 0.212) in Group 1. However, a statistically significant lower level of stiffness in Group 1 after the end of therapy has been detected (p = 0.008). Decrement values decreased statistically significantly, both in Group 1 (p = 0.015) and in Group 2 (p = 0.014). There were no statistically significant differences in decrement level between Group 1 and 2. Relaxation and creep decreased statistically insignificantly in both groups. At the end of the observation period (Day 4), statistically significant (p = 0.027) lower pain intensity was observed in Group 1. Conclusions: It has been demonstrated that TENS has had limited effectiveness in restoring baseline biomechanical and viscoelastic parameters of muscles that undergo changes during DOMS. TENS significantly relieves pain symptoms occurring in DOMS.
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Open AccessReview
Diagnostic Overshadowing and the Unseen Spectrum: A Narrative Review of Rare Complications in Sickle Cell Disease
by
Abdulrahman Nasiri, Manal Alshammari, Reem Alkharras, Albaraa Madkhali, Mostafa F. Mohammed Saleh and Hazza Alzahrani
Clin. Pract. 2025, 15(9), 156; https://doi.org/10.3390/clinpract15090156 - 27 Aug 2025
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Sickle cell disease (SCD) is a hereditary hemoglobin disorder characterized by chronic hemolysis and recurrent vaso-occlusive crises, leading to a wide spectrum of complications. While common SCD manifestations have well-established management protocols, rare and atypical complications pose significant diagnostic and therapeutic challenges. A
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Sickle cell disease (SCD) is a hereditary hemoglobin disorder characterized by chronic hemolysis and recurrent vaso-occlusive crises, leading to a wide spectrum of complications. While common SCD manifestations have well-established management protocols, rare and atypical complications pose significant diagnostic and therapeutic challenges. A critical barrier is diagnostic overshadowing, where common SCD symptoms (pain, fever, respiratory distress) mask infrequent but life-threatening conditions, resulting in delayed recognition and suboptimal outcomes. This narrative review synthesizes the literature from 2000–2025 on rare SCD complications, including atypical neurological events (e.g., spontaneous epidural or subdural hematoma, central retinal artery occlusion, cerebral arteriovenous malformations, posterior reversible encephalopathy syndrome), uncommon hematologic syndromes (acute leukemia, extramedullary hematopoiesis in unusual sites, hemophagocytic lymphohistiocytosis), severe cardiopulmonary emergencies (acute multiorgan failure and fat embolism syndromes), unusual hepatic crises (acute hepatic sequestration, intrahepatic cholestasis), and others (e.g., compartment syndrome). Key insights underscore the need for high clinical suspicion and prompt use of advanced diagnostics (e.g., MRI, specialized laboratory tests) when patients present with atypical or disproportionate symptoms. Clinical implications: Heightening clinician awareness of these rare complications and implementing structured diagnostic strategies can facilitate earlier intervention, improving outcomes and reducing the high morbidity and mortality associated with these infrequent but severe events.
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Open AccessArticle
Efficacy of Non-Invasive Monopolar Radiofrequency for Treating Genitourinary Syndrome of Menopause: A Prospective Pilot Study
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Mariachiara Palucci, Marta Barba, Alice Cola, Clarissa Costa, Desirèe De Vicari and Matteo Frigerio
Clin. Pract. 2025, 15(8), 155; https://doi.org/10.3390/clinpract15080155 - 20 Aug 2025
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Introduction: The decline of serum estrogen in postmenopausal women leads to several changes in the vulvovaginal and vesicourethral areas, resulting in the genitourinary syndrome of menopause (GSM), characterized by bothersome symptoms such as vaginal atrophy, lack of lubrication, dyspareunia, urgency, dysuria, and
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Introduction: The decline of serum estrogen in postmenopausal women leads to several changes in the vulvovaginal and vesicourethral areas, resulting in the genitourinary syndrome of menopause (GSM), characterized by bothersome symptoms such as vaginal atrophy, lack of lubrication, dyspareunia, urgency, dysuria, and recurrent urinary tract infections. Nevertheless, this condition could also be experienced by younger women affected by hormone-dependent tumors. Although topical estrogens are considered “the gold standard”, hormonal treatments cannot be indicated in cancer survivors. As a result, energy-based devices using radiofrequency and laser technologies have emerged as alternative options. This prospective study aimed to evaluate the benefits of non-invasive monopolar radiofrequency (RF) in women affected by GSM who have contraindications to, did not respond to, or declined local estrogen therapy. Methods: The patients underwent five weekly sessions of second-generation monopolar RF. At baseline and at the fifth session, two validated questionnaires were administered to the patients: the Visual Analogue Scale (VAS) and the Female Sexual Function Index (FSFI-19). On the other hand, the vaginal mucosa status was evaluated by clinicians through the Vaginal Health Index (VHI). At the end of the cycle, the Patient Global Impression of Improvement (PGI-I) questionnaire was collected. Results: Based on 44 patients who completed five sessions of radiofrequency, a significant improvement was observed in sexual function according to the FSFI scale (22.9 vs. 38.6; p < 0.001) and in VVA atrophy symptoms, as documented by the VAS score (223 vs. 125; p < 0.001). The mean VHI score increased by 3 points (p < 0.001). Moreover, according to PGI-I, 96% of patients reported a perceived improvement (PGI-I score ≤ 3). Conclusions: Radiofrequency could provide an innovative and safe therapeutic approach for patients suffering from GSM and VVA, especially when hormonal strategies are unsuitable.
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Open AccessArticle
Allelic and Genotypic Distribution of MMP13-77 A/G Polymorphism in Salvadoran Children With and Without Caries
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Wendy Escobar-González, Jorge Alegría-Torres, Yolanda Terán-Figueroa, Vianney Castañeda-Monroy, Aurelio Álvarez-Vargas, Carlo Eduardo Medina-Solís and Nuria Patiño-Marín
Clin. Pract. 2025, 15(8), 154; https://doi.org/10.3390/clinpract15080154 - 19 Aug 2025
Abstract
Background/Objectives: Polymorphisms in metalloproteinases (MMPs) have the potential to be probable genetic biomarkers of dental caries. The aim of this study was to evaluate the distribution of the MMP13 A/G rs2252070 single nucleotide polymorphism (SNP) according to caries experience in Salvadoran children.
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Background/Objectives: Polymorphisms in metalloproteinases (MMPs) have the potential to be probable genetic biomarkers of dental caries. The aim of this study was to evaluate the distribution of the MMP13 A/G rs2252070 single nucleotide polymorphism (SNP) according to caries experience in Salvadoran children. Methods: A cross-sectional study was carried out on 185 Salvadorian school children between 7 and 12 years of age. Demographic data, frequency of toothbrushing, dental flossing and consumption of sugar-sweetened beverages were recorded. Caries data were collected by clinical examination. Genomic DNA was obtained from oral cells of the children. Polymorphism genotyping was performed by PCR-RFLP. Allele and genotypic frequencies were compared between the healthy and caries-experiencing groups. Data were analyzed with SPSS 26.0 using the chi-square test, the Kruskal–Wallis test and logistic regression analysis. Results: The allele frequencies of MMP13-77 A/G were 0.7 and 0.3 following the Hardy–Weinberg equilibrium (X2 = 0.22, p = 0.63). 72% of subjects with caries experience were carriers of the A allele. Caries experience was higher for the GG genotype group for permanent and primary surfaces (DMFS = 2.11; dmfs = 5.64) and for permanent teeth (DMFT = 1.50). No significant differences were found in the allelic and/or genotypic frequencies of the SNP polymorphism between subjects with dental caries and healthy subjects (p > 0.05). Conclusions: The distribution of MMP13-77 A/G rs2252070 in the study population showed no association with caries experience. However, our findings highlight the importance of promoting oral hygiene habits from an early age.
Full article
(This article belongs to the Topic Advances in Diagnosis and Treatment of Dental Diseases and Temporomandibular Joints)
Open AccessArticle
Association Between Emotional Intelligence and Stress Management in Hemodialysis Patients
by
Orchan Impis, Afroditi Zartaloudi, Eirini Grapsa and Georgia Gerogianni
Clin. Pract. 2025, 15(8), 153; https://doi.org/10.3390/clinpract15080153 - 19 Aug 2025
Abstract
Background: Emotional intelligence refers to individuals’ ability to recognize and manage their own emotions as well as those of others, playing a crucial role in stress management. This study aimed to investigate the relationship between different dimensions of emotional intelligence and stress management
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Background: Emotional intelligence refers to individuals’ ability to recognize and manage their own emotions as well as those of others, playing a crucial role in stress management. This study aimed to investigate the relationship between different dimensions of emotional intelligence and stress management strategies in patients undergoing hemodialysis. Methods: In this cross-sectional study, 468 patients on hemodialysis completed the (i) Wong and Law Emotional Scale (WLEIS) and (ii) Trait Emotional Intelligence Questionnaire Short Form (TEIQue-SF) for the assessment of emotional intelligence as an emotional ability or as a personality trait, respectively; (iii) the Brief COPEQuestionnaire (Brief- COPE) for the assessment of stress management strategies; and (iv) a questionnaire about demographic characteristics. Spearman’s correlations coefficients were used to explore associations between two continuous variables. Multiple linear regression analysis was used with Brief-COPE dimensions as the dependent variable. Results: High levels of emotionality were associated with an active approach to coping with stress (p = 0.018), while increased well-being and high regulation of emotions were associated with decreased behavioral disengagement (p < 0.001). Moreover, high emotional appraisal of others was linked to an increased use of humor (p = 0.042), while self-control and use and regulation of emotions were associated with decreased expression of negative feelings (p < 0.001). Conclusions: The current findings suggest potential links between emotional intelligence and stress management strategies in patients undergoing hemodialysis.
Full article
Open AccessArticle
Macrovascular Involvement in Systemic Sclerosis: Association Between Carotid Ultrasound Hemodynamics Parameters and Digital Ulcers
by
Eugenio Capparelli, Francesco Lapia, Luca Clerici, Eleonora Zaccara, Giusy Cinzia Moltisanti, Francesca Capelli, Daniela Bompane, Laura Castelnovo, Antonio Tamburello, Maria Iacovantuono, Maria Sole Chimenti, Paola Maria Luigia Faggioli and Antonino Mazzone
Clin. Pract. 2025, 15(8), 152; https://doi.org/10.3390/clinpract15080152 - 18 Aug 2025
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Background: Digital ulcers (DUs) are among the most debilitating vascular complications in SSc and are commonly attributed to microvascular damage. However, recent evidence suggests a potential involvement of macrovascular abnormalities, including subclinical atherosclerosis and altered hemodynamic parameters. Objectives: This study aimed to investigate
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Background: Digital ulcers (DUs) are among the most debilitating vascular complications in SSc and are commonly attributed to microvascular damage. However, recent evidence suggests a potential involvement of macrovascular abnormalities, including subclinical atherosclerosis and altered hemodynamic parameters. Objectives: This study aimed to investigate the association between a history of DUs and macrovascular involvement in SSc patients through carotid and vertebral Doppler ultrasonography, with a focus on hemodynamic indices such as Peak Systolic Velocity (PSV), End-Diastolic Velocity (EDV), Resistive Index (RI), and Intima–Media Thickness (IMT). Methods: A cross-sectional study was conducted on 107 SSc patients. Clinical, serological, cardiovascular, and metabolic data were collected, and carotid–vertebral ultrasound was performed. Patients were stratified based on DU history. Statistical analyses assessed associations between DU status and carotid–vertebral US findings. Results: Patients with DUs showed a significantly higher PSV in both right (86.9 ± 67.9 vs. 64.2 ± 20.5 cm/s, p = 0.010) and left ICA (78.9 ± 29.6 vs. 63.4 ± 18.2 cm/s, p = 0.002). Right ICA RI vas elevated in the DU group (p = 0.021). PSV in the external carotid arteries was also bilaterally increased in DU patients (p < 0.005). DU-positive patients had a higher prevalence of left carotid plaques (p = 0.012) and right-sided ICA RI > 0.75 (p = 0.01). Logistic regression identified DU history as an independent predictor of PSV at ICA (β = 31.89, p = 0.043) and carotid plaque presence at any side (OR 14.34, p = 0.012). Conclusions: A history of digital ulcers in SSc patients is associated with altered carotid hemodynamics and an increased subclinical atherosclerotic burden. These findings suggest that DUs may reflect not only microvascular damage, but also macrovascular dysfunction, supporting the need for integrated vascular assessment in SSc clinical practice.
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Open AccessSystematic Review
Prevalence of Free Flap Failure in Patients Undergoing Reconstruction for Medication-Related Osteonecrosis of the Jaw: A Systematic Review and Meta-Analysis
by
Evangelos Kostares, Georgia Kostare, Michael Kostares, Fani Pitsigavdaki, Athanassios Kyrgidis, Christos Perisanidis and Maria Kantzanou
Clin. Pract. 2025, 15(8), 151; https://doi.org/10.3390/clinpract15080151 - 14 Aug 2025
Abstract
Background/Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication in patients treated with antiresorptive or antiangiogenic agents, particularly those with cancer-related comorbidities. This systematic review and meta-analysis aimed to estimate the prevalence of free flap failure in patients undergoing microvascular
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Background/Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication in patients treated with antiresorptive or antiangiogenic agents, particularly those with cancer-related comorbidities. This systematic review and meta-analysis aimed to estimate the prevalence of free flap failure in patients undergoing microvascular reconstruction for MRONJ. Methods: A comprehensive literature search was conducted across Medline/PubMed, Scopus, and Web of Science up to 30 January 2025. Inclusion criteria were observational studies involving MRONJ patients treated with free flap reconstruction. Risk of bias was assessed using the Newcastle–Ottawa Scale. The pooled prevalence of free flap failure was calculated using a random-effects model with Freeman–Tukey double arcsine transformation. Results: Twelve studies were included in the quantitative analysis. The fibula free flap was the most frequently used flap. The pooled prevalence of free flap failure was 0.1% (95% CI: 0–2.3%), with no significant associations observed in meta-regression analyses for publication year, patient age, or sex. All included studies were of moderate methodological quality. Conclusions: These findings suggest that free flap reconstruction is a reliable and effective surgical option for managing advanced MRONJ in well-resourced and specialized healthcare settings; however, limitations such as small sample sizes and heterogeneity in protocols must be considered. Further high-quality, multicenter studies are needed to evaluate long-term outcomes and refine perioperative management strategies.
Full article
(This article belongs to the Special Issue Clinical Outcome Research in the Head and Neck: 2nd Edition)
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Open AccessReview
Cognitive Impairment in Adult Attention Deficit Hyperactivity Disorder: Clinical Implications and Novel Treatment Strategies
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Alexis J. Vega, Gabriel V. Hernandez, Ahmed I. Anwar, Bahareh Sharafi, Rahib K. Islam, Sahar Shekoohi and Alan D. Kaye
Clin. Pract. 2025, 15(8), 150; https://doi.org/10.3390/clinpract15080150 - 12 Aug 2025
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is a lifelong condition; however, traditional treatment focuses on hyperactivity and inattention, which is largely a manifestation of pediatric ADHD. Studies are limited regarding cognitive difficulties, as seen in adult ADHD, as well as treatment strategies for this
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Attention Deficit Hyperactivity Disorder (ADHD) is a lifelong condition; however, traditional treatment focuses on hyperactivity and inattention, which is largely a manifestation of pediatric ADHD. Studies are limited regarding cognitive difficulties, as seen in adult ADHD, as well as treatment strategies for this population. This review of the literature examines multiple recent studies that discuss various novel treatment strategies for cognitive impairment in adults with ADHD. A targeted literature review was conducted using PubMed to identify recent studies on cognitive dysfunction in adults with ADHD, with an emphasis on emerging treatment strategies. Data collected included sample size, intervention strategies, cognitive function, and side effects. Studies on non-invasive brain stimulation revealed significant effects on executive function in adult ADHD patients. Other studies revealed statistically significant improvements in cognitive flexibility and response inhibition in modafinil users. Another study demonstrated significant improvement in working memory with off label use of viloxazine for adults. This review of the literature describes the effectiveness of novel treatment strategies of adult ADHD including non-stimulant medications, behavioral therapies and neurofeedback. This highlights the need for treatment modalities that enhance cognitive outcomes and further research into long-term efficacy and safety of these novel interventions and implementing psychological treatment into medical management of adult ADHD.
Full article
Open AccessArticle
Creating and Validating a Questionnaire on Dentists’ Perceptions Regarding Periodontics–Prosthodontics Interdisciplinary Clinical Practice
by
Gabriel Rotundu, Dragos Ioan Virvescu, Zinovia Surlari, Dana Gabriela Budala, Florin Razvan Curca, Carina Balcos, Cristian Cojocaru, Vlad Constantin, Razvan Gradinariu and Ionut Luchian
Clin. Pract. 2025, 15(8), 149; https://doi.org/10.3390/clinpract15080149 - 7 Aug 2025
Abstract
Background: The interaction between prosthetic restorations and periodontal health is a critical factor for the long-term success of dental treatments. A biologically compatible prosthetic design supports periodontal stability, whereas neglecting periodontal principles can compromise treatment outcomes. This study aimed to validate a questionnaire
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Background: The interaction between prosthetic restorations and periodontal health is a critical factor for the long-term success of dental treatments. A biologically compatible prosthetic design supports periodontal stability, whereas neglecting periodontal principles can compromise treatment outcomes. This study aimed to validate a questionnaire designed to assess dentists’ perceptions regarding the influence of prosthetic restorations on the periodontium. Material and Methods: An observational cross-sectional study was conducted using a self-administered questionnaire distributed to licensed dentists across Romania. The questionnaire underwent expert review, pilot testing (n = 50), and statistical validation, including the Content Validity Index (CVI), Cronbach’s alpha for internal consistency, and Exploratory Factor Analysis (EFA) using Principal Component Analysis (PCA) with Varimax rotation. The final sample included 39 respondents. Data was analyzed using SPSS v26.0. Results: The questionnaire demonstrated excellent internal consistency (Cronbach’s alpha = 0.900; standardized alpha = 0.917). Most items had corrected item-total correlations > 0.40. EFA revealed eight coherent factors explaining 81.68% of total variance, with high communalities (0.549–0.966), strong Kaiser–Meyer–Olkin test (KMO) values, and significant Bartlett’s test values, confirming construct validity. Descriptive statistics showed predominantly positive attitudes among dentists regarding the periodontal considerations in prosthetic treatment. The highest-rated items emphasized oral hygiene, periodontal stability, and biological adaptation of restorations. Lower scores were associated with routine use of periodontal indices and recognition of failures due to insufficient evaluation. Conclusions: The validated instrument proved reliable and demonstrated strong psychometric properties in this exploratory validation, supporting its use in research and education. Romanian dentists demonstrated a favorable perception of the role of periodontal health in prosthetic success. This tool can inform curriculum development and interdisciplinary clinical protocols in prosthodontics and periodontology.
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(This article belongs to the Special Issue New Trends, Materials, and Technologies and Consolidating Best Practices in Dentistry, 2nd Edition)
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The Role of Vitamin D Supplementation in Type 1, Type 2, and Gestational Diabetes: A Comprehensive Updated Narrative Review
by
Asala Nasser, Dimitrios Papandreou, Sousana K. Papadopoulou and Leila Cheikh Ismail
Clin. Pract. 2025, 15(8), 148; https://doi.org/10.3390/clinpract15080148 - 7 Aug 2025
Abstract
Vitamin D has emerged as a modulatory factor in the pathogenesis and management of diabetes mellitus due to its influence on pancreatic β-cell function, immune regulation, and inflammatory pathways. This narrative review critically examines mechanistic and clinical evidence linking vitamin D status with
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Vitamin D has emerged as a modulatory factor in the pathogenesis and management of diabetes mellitus due to its influence on pancreatic β-cell function, immune regulation, and inflammatory pathways. This narrative review critically examines mechanistic and clinical evidence linking vitamin D status with type 1 diabetes (T1DM), type 2 diabetes (T2DM), and gestational diabetes (GDM). In T1DM, vitamin D’s immunomodulatory effects are thought to protect β-cells from autoimmune destruction; epidemiological studies associate vitamin D sufficiency with lower T1DM incidence and improved glycemic control, although causality remains under investigation. In T2DM, vitamin D deficiency is associated with worsened metabolic control and may contribute to disease development in at-risk individuals; however, it does not influence the initial onset of T2DM in patients who are already diagnosed. Intervention trials indicate that correcting the deficiency can modestly improve insulin sensitivity, β-cell function, and metabolic parameters. GDM has similarly been linked to hypovitaminosis D, with low maternal vitamin D levels associated with higher GDM risk and adverse perinatal outcomes; mechanistic insights suggest that adequate vitamin D supports glucose homeostasis in pregnancy, and emerging trials demonstrate improved insulin resistance with maternal vitamin D supplementation. Across these diabetes subtypes, maintaining sufficient vitamin D levels appears to confer metabolic benefits and may serve as an adjunct to current preventive and therapeutic strategies. However, definitive evidence from large-scale trials is required to establish optimal vitamin D supplementation protocols and confirm its efficacy in diabetes care.
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(This article belongs to the Special Issue The Effect of Dietary Compounds on Inflammation-Mediated Diseases)
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Open AccessArticle
Minimally Invasive Off-Pump Coronary Artery Bypass as Palliative Revascularization in High-Risk Patients
by
Magdalena Rufa, Adrian Ursulescu, Samir Ahad, Ragi Nagib, Marc Albert, Rafael Ayala, Nora Göbel, Tunjay Shavahatli, Mihnea Ghinescu, Ulrich Franke and Bartosz Rylski
Clin. Pract. 2025, 15(8), 147; https://doi.org/10.3390/clinpract15080147 - 6 Aug 2025
Abstract
Background: In high-risk and frail patients with multivessel coronary artery disease (MV CAD), guidelines indicated complete revascularization with or without the use of cardiopulmonary bypass (CPB) bears a high morbidity and mortality risk. In cases where catheter interventions were deemed unsuitable and conventional
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Background: In high-risk and frail patients with multivessel coronary artery disease (MV CAD), guidelines indicated complete revascularization with or without the use of cardiopulmonary bypass (CPB) bears a high morbidity and mortality risk. In cases where catheter interventions were deemed unsuitable and conventional coronary artery bypass grafting (CABG) posed an unacceptable perioperative risk, patients were scheduled for minimally invasive direct coronary artery bypass (MIDCAB) grafting or minimally invasive multivessel coronary artery bypass grafting (MICS-CABG). We called this approach “palliative revascularization.” This study assesses the safety and impact of palliative revascularization on clinical outcomes and overall survival. Methods: A consecutive series of 57 patients undergoing MIDCAB or MICS-CABG as a palliative surgery between 2008 and 2018 was included. The decision for palliative surgery was met in heart team after carefully assessing each case. The patients underwent single or double-vessel revascularization using the left internal thoracic artery and rarely radial artery/saphenous vein segments, both endoscopically harvested. Inpatient data could be completed for all 57 patients. The mean follow-up interval was 4.2 ± 3.7 years, with a follow-up rate of 91.2%. Results: Mean patient age was 79.7 ± 7.4 years. Overall, 46 patients (80.7%) were male, 26 (45.6%) had a history of atrial fibrillation and 25 (43.9%) of chronic kidney disease. In total, 13 patients exhibited a moderate EuroSCORE II, while 27 were classified as high risk, with a EuroSCORE II exceeding 5%. Additionally, 40 patients (70.2%) presented with three-vessel disease, 17 (29.8%) suffered an acute myocardial infarction within three weeks prior to surgery and 50.9% presented an impaired ejection fraction. There were 48 MIDCAB and nine MICS CABG with no conversions either to sternotomy or to CPB. Eight cases were planned as hybrid procedures and only 15 patients (26.3%) were completely revascularized. During the first 30 days, four patients (7%) died. A myocardial infarction occurred in only one case, no patient necessitated immediate reoperation. The one-, three- and five-year survival rates were 83%, 67% and 61%, respectively. Conclusions: MIDCAB and MICS CABG can be successfully conducted as less invasive palliative surgery in high-risk multimorbid patients with MV CAD. The early and mid-term results were better than predicted. A higher rate of hybrid procedures could improve long-term outcome in selected cases.
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Open AccessArticle
Fear of Falling After Total Knee Replacement: A Saudi Experience
by
Turki Aljuhani, Jayachandran Vetrayan, Mohammed A. Alfayez, Saleh A. Alshehri, Mohmad H. Alsabani, Lafi H. Olayan, Fahdah A. Aljamaan and Abdulaziz O. Alharbi
Clin. Pract. 2025, 15(8), 146; https://doi.org/10.3390/clinpract15080146 - 6 Aug 2025
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Background: Fear of falling (FOF) is a significant concern among older adults, especially after total knee arthroplasty (TKA). FOF can limit daily activities, reduce quality of life, and hinder recovery. This study aimed to investigate the prevalence, severity, and impacts of FOF
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Background: Fear of falling (FOF) is a significant concern among older adults, especially after total knee arthroplasty (TKA). FOF can limit daily activities, reduce quality of life, and hinder recovery. This study aimed to investigate the prevalence, severity, and impacts of FOF in patients undergoing TKA and identify factors contributing to increased FOF. Methods: A prospective observational study was conducted at King Abdulaziz Medical City in Riyadh, Saudi Arabia, from April 2024 to December 2024. This study included 52 participants aged 20 to 75 years who had undergone primary TKA. Data were collected at two time points: after TKA and at three months post-surgery. The Short Falls Efficacy Scale-International (SFES-I) was used to assess the severity of FOF, and the Short Form 36 (SF-36) was used to measure the quality of life. Descriptive statistics, t-tests, and logistic regression were used for analysis. Results: This study included 52 participants (mean age: 63.77 ± 6.65 years; 82.7% female). Post-TKA, all participants exhibited high FOF (mean SFES-I score: 56.75 ± 8.30). After three months, the mean SFES-I score decreased significantly to 49.04 ± 12.45 (t = 4.408, p < 0.05). Post-TKA, SF-36 showed significant improvements in the physical function, role of physical limitations, bodily pain, vitality, social function, role of emotional limitations, and mental health subdomains. Bilateral total knee arthroplasty, body mass index, and some SF-36 subcomponents—such as general health, vitality, and role of emotional limitations—were identified as factors leading to increased FOF. Conclusions: FOF remains prevalent and severe in TKA patients, even at three months post-surgery, affecting rehabilitation outcomes. Early identification and tailored interventions for FOF should be considered essential components of comprehensive TKA recovery programs.
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Open AccessArticle
Therapeutic Patterns and Surgical Decision-Making in Breast Cancer: A Retrospective Regional Cohort Study in Romania
by
Ramona Andreea Cioroianu, Michael Schenker, Virginia-Maria Rădulescu, Tradian Ciprian Berisha, George Ovidiu Cioroianu, Mihaela Popescu, Cristina Mihaela Ciofiac, Ana Maria Petrescu and Stelian Ștefăniță Mogoantă
Clin. Pract. 2025, 15(8), 145; https://doi.org/10.3390/clinpract15080145 - 5 Aug 2025
Abstract
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Background: Breast cancer is the most prevalent malignancy among women globally. In Romania, it is the most frequent form of cancer affecting women, with approximately 12,000 new cases diagnosed annually, and the second most common cause of cancer-related mortality, second only to
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Background: Breast cancer is the most prevalent malignancy among women globally. In Romania, it is the most frequent form of cancer affecting women, with approximately 12,000 new cases diagnosed annually, and the second most common cause of cancer-related mortality, second only to lung cancer. Methods: This study looked at 79 breast cancer patients from Oltenia, concentrating on epidemiology, histology, diagnostic features, and treatments. Patients were chosen based on inclusion criteria such as histopathologically verified diagnosis, availability of clinical and treatment data, and follow-up information. The analyzed biological material consisted of tissue samples taken from the breast parenchyma and axillary lymph nodes. Even though not the primary subject of this paper, all patients underwent immunohistochemical (IHC) evaluation both preoperatively and postoperatively. Results: We found invasive ductal carcinoma to be the predominant type, while ductal carcinoma in situ (DCIS) and mixed types were rare. We performed cross-tabulations of metastasis versus nodal status and age versus therapy type; none reached significance (all p > 0.05), suggesting observed differences were likely due to chance. A chi-square test comparing surgical interventions (breast-conserving vs. mastectomy) in patients who did or did not receive chemotherapy showed, χ2 = 3.17, p = 0.367, indicating that chemotherapy did not significantly influence surgical choice. Importantly, adjuvant chemotherapy and radiotherapy were used at similar rates across age groups, whereas neoadjuvant hormonal (endocrine) therapy was more common in older patients (but without statistical significance). Conclusions: Finally, we discussed the consequences of individualized care and early detection. Romania’s shockingly low screening rate, which contributes to delayed diagnosis, emphasizes the importance of improved population medical examination and tailored treatment options. Also, the country has one of the lowest rates of mammography uptake in Europe and no systematic population screening program.
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Open AccessArticle
Wilson’s Disease in Oman: A National Cohort Study of Clinical Spectrum, Diagnostic Delay, and Long-Term Outcomes
by
Said A. Al-Busafi, Juland N. Al Julandani, Zakariya Alismaeili and Juhaina J. Al Raisi
Clin. Pract. 2025, 15(8), 144; https://doi.org/10.3390/clinpract15080144 - 3 Aug 2025
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Background/Objectives: Wilson’s disease (WD) is a rare autosomal recessive disorder of copper metabolism that results in hepatic, neurological, and psychiatric manifestations. Despite being described globally, data from the Middle East remains limited. This study presents the first comprehensive national cohort analysis of
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Background/Objectives: Wilson’s disease (WD) is a rare autosomal recessive disorder of copper metabolism that results in hepatic, neurological, and psychiatric manifestations. Despite being described globally, data from the Middle East remains limited. This study presents the first comprehensive national cohort analysis of WD in Oman, examining clinical features, diagnostic challenges, treatment patterns, and long-term outcomes. Methods: A retrospective cohort study was conducted on 36 Omani patients diagnosed with WD between 2013 and 2020 at Sultan Qaboos University Hospital using AASLD diagnostic criteria. Clinical presentation, biochemical parameters, treatment regimens, and progression-free survival were analyzed. Results: The median age at diagnosis was 14.5 years, with a slight female predominance (55.6%). Clinical presentation varied: 25% had hepatic symptoms, 22.2% had mixed hepatic-neurological features, and 16.7% presented with neurological symptoms alone. Asymptomatic cases identified via family screening accounted for 33.3%. Diagnostic delays were most pronounced among patients presenting with neurological symptoms. A positive family history was reported in 88.9% of cases, suggesting strong familial clustering despite a low rate of consanguinity (5.6%). Regional distribution was concentrated in Ash Sharqiyah North and Muscat. Chelation therapy with trientine or penicillamine, often combined with zinc, was the mainstay of treatment. Treatment adherence was significantly associated with improved progression-free survival (p = 0.012). Conclusions: WD in Oman is marked by heterogeneous presentations, frequent diagnostic delays, and strong familial clustering. Early detection through cascade screening and sustained treatment adherence are critical for favorable outcomes. These findings support the need for national screening policies and structured long-term care models for WD in the region.
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