Clinics and Practice

12 pages, 223 KiB

Open AccessArticle

Renal Trauma: A 4-Year Retrospective Review of Injury Severity, Treatment Approaches, and Outcomes from a Polish Trauma Center

by Michał Kasperczak, Anita Zaręba, Karolina Pawłowska-Kasperczak, Filip Kasperczak, Monika Zaręba and Andrzej Antczak

Clin. Pract. 2025, 15(4), 67; https://doi.org/10.3390/clinpract15040067 - 21 Mar 2025

Abstract

Background: The management of renal injuries in hemodynamically stable adult patients is moving toward more conservative methods, even in cases of severe grade and/or penetrating trauma. The objective of this study was to analyze the patterns of injury, management, and complications in renal [...] Read more.

Background: The management of renal injuries in hemodynamically stable adult patients is moving toward more conservative methods, even in cases of severe grade and/or penetrating trauma. The objective of this study was to analyze the patterns of injury, management, and complications in renal trauma patients at a Polish trauma center. Methods: Patients diagnosed with renal trauma at the trauma center between January 2019 and December 2023 were identified based on the ICD-10 codes. The information was gathered from digitalized medical records, while imaging data were classified by Radiologists. Results: During a period of 4 years, a total of 81 patients with renal trauma were admitted to the trauma center. 76% of these patients were males, with a mean age of 44.61 ± 16.8 years. The most common concomitant conditions, both among men and women, included retroperitoneal hematoma, rib fractures, as well as chest and lung injuries. Surgical intervention within 8 h of admission was mainly performed on patients with grade IV and V kidney damage, which included a total of 22 people. In deferred treatment, 31 patients underwent surgical intervention. Conclusions: Hemodynamically stable patients, even with penetrating and/or high-grade blunt trauma, were mostly managed non-operatively, with a low rate of complications. Full article

13 pages, 6395 KiB

Open AccessReview

Enhancing Smile Aesthetics and Function with Lithium Disilicate Veneers: A Brief Review and Case Study

by Jose Villalobos-Tinoco, Franciele Floriani, Silvia Rojas-Rueda, Salwa Mekled, Clint Conner, Staley Colvert and Carlos A. Jurado

Clin. Pract. 2025, 15(3), 66; https://doi.org/10.3390/clinpract15030066 - 18 Mar 2025

Abstract

Background: Lithium disilicate ceramic veneers are considered the gold standard in aesthetic dentistry due to their translucency, strength, and adhesive bonding properties. This clinical case report details the aesthetic rehabilitation of a patient through the use of pressed lithium disilicate veneers, highlighting [...] Read more.

Background: Lithium disilicate ceramic veneers are considered the gold standard in aesthetic dentistry due to their translucency, strength, and adhesive bonding properties. This clinical case report details the aesthetic rehabilitation of a patient through the use of pressed lithium disilicate veneers, highlighting the treatment workflow, material selection rationale, and the long-term functional and aesthetic outcomes achieved. Methods: A review was conducted to evaluate the long-term success of lithium disilicate. A case study is presented that involves a 32-year-old female patient with anterior tooth discoloration, minor morphological discrepancies, and a desire for smile enhancement. A conservative approach using pressed lithium disilicate was chosen to restore harmony and enhance natural aesthetics. The treatment involved minimally invasive tooth preparation, digital smile design, and adhesive cementation using a total-etch technique with light-cured resin cement. High-resolution intra-oral and extra-oral photographs documented the case, capturing the preoperative, preparation, and final restoration stages. These images highlight shade matching, margin adaptation, and smile transformation after veneering. Results: Postoperative evaluation showed excellent aesthetic outcomes, color integration, and marginal adaptation, with the patient expressing high satisfaction. The veneers exhibited optimal translucency and strength, ensuring long-term durability. A one-year follow-up revealed no debonding, marginal discoloration, or surface degradation, confirming the clinical reliability of lithium disilicate veneers. Conclusions: Lithium disilicate provides predictability, durability, and high aesthetic results, making it an ideal choice for minimally invasive smile enhancement. The use of photographic documentation emphasizes the importance of case planning, precise preparation, and adhesive bonding for successful outcomes. Future research should focus on long-term survival rates and complication prevention to further refine material selection and bonding protocols. Full article

(This article belongs to the Special Issue New Trends, Materials, and Technologies and Consolidating Best Practices in Dentistry, 2nd Edition)

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37 pages, 2784 KiB

Open AccessReview

A Narrative Review on Biochemical Markers and Emerging Treatments in Prodromal Synucleinopathies

by Jamir Pitton Rissardo and Ana Leticia Fornari Caprara

Clin. Pract. 2025, 15(3), 65; https://doi.org/10.3390/clinpract15030065 - 17 Mar 2025

Abstract

Alpha-synuclein has been associated with neurodegeneration, especially in Parkinson’s disease (PD). This study aimed to review clinical, biochemical, and neuroimaging markers and management of prodromal synucleinopathies. The prodromal state of synucleinopathies can be better understood with PD pathophysiology, and it can be separated [...] Read more.

Alpha-synuclein has been associated with neurodegeneration, especially in Parkinson’s disease (PD). This study aimed to review clinical, biochemical, and neuroimaging markers and management of prodromal synucleinopathies. The prodromal state of synucleinopathies can be better understood with PD pathophysiology, and it can be separated into premotor and pre-diagnostic phases. The incidence of PD in patients with prodromal phase symptoms ranges from 0.07 to 14.30, and the most frequently studied pathology is the REM behavioral disorder (RBD). Neuroimaging markers are related to dopamine denervation, brain perfusion changes, gross anatomy changes, and peripheral abnormalities. α-synuclein assays (SAA) in CSF revealed high sensitivity (up to 97%) and high specificity (up to 92%); in the last decade, there was the development of other matrices (blood, skin, and olfactory mucosa) for obtaining quantitative and qualitative α-synuclein. Other biomarkers are neurofilament light chain, DOPA decarboxylase, and multiplexed mass spectrometry assay. Regarding genetic counseling in α-synucleinopathies, it is an important topic in clinical practice to discuss with patients with high-risk individuals and should involve basic principles of autonomy, beneficence, and non-maleficence. Some of the themes that should be reviewed are the involvement of physical activity, diet (including alcohol, coffee, and vitamin supplementation), smoking, sleep, and stress in the pathophysiology of synucleinopathies. The number of trials related to prodromal symptoms is still scarce, and the number of studies evaluating intervention is even lower. Full article

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17 pages, 2871 KiB

Open AccessArticle

Evaluation of the Effects of Photobiomodulation on Bone Density After Placing Dental Implants: A Pilot Study Using Cone Beam CT Analysis

by Ruxandra-Elena Luca, Alessandro Del Vecchio, Ioana-Roxana Munteanu, Mădălin-Marius Margan and Carmen Darinca Todea

Clin. Pract. 2025, 15(3), 64; https://doi.org/10.3390/clinpract15030064 - 17 Mar 2025

Abstract

Background: One of the parameters of maximum interest regarding the quality of the intraoral hard tissues is represented by the bone density, with direct clinical implications. The evaluation of this extremely important clinical parameter can be achieved by several imaging methods, of which [...] Read more.

Background: One of the parameters of maximum interest regarding the quality of the intraoral hard tissues is represented by the bone density, with direct clinical implications. The evaluation of this extremely important clinical parameter can be achieved by several imaging methods, of which the most known in dentistry is represented by the cone beam computed tomography (CBCT). Objectives: The purpose of the study is to obtain a quantitative analysis of bone mineral density changes in patients who underwent treatments of photobiomodulation (PBM), as complementary to a surgical approach in oral surgery and implantology. Methods: The study included the retrospective analysis of maxillary cone beam computed tomography of 28 patients without pathology or medication known to affect bone metabolism or its qualitative and quantitative properties. All patients from the study group followed the same laser PBM treatment protocol after placing dental implants; the PBM protocol implied the intraoral use of a gallium aluminum arsenide laser (GaAlAs) of 808 nm, 450 mW, in pulsed mode, administering an energy of 6 J in 3 points corresponding to each inserted dental implant—mesial, distal, and apical—totaling 18 J/implant. Treatment sessions were performed immediately postoperatively and at a subsequent distance of 48 h for 2 weeks (a total of eight sessions). For every patient, bone density was analyzed before and after PBM treatment, in the same areas of interest, within the same anatomical landmarks. A comparison was also made between the results obtained for the anterior maxilla and the posterior maxilla. All the measurements made were analyzed statistically, the results being presented in the dedicated section. Results: Based on the data analysis, the comparison between the lasered and non-lasered groups reveals that patients who underwent PBM showed a statistically significant improvement in bone mineral density, with the mean increasing from 530.91 HU before treatment to 842.55 HU after treatment (t-test: p < 0.001). In contrast, the non-lasered group showed no significant improvement, with a slight decrease in bone mineral density, as the mean dropped from 495.19 HU before treatment to 462.16 HU after treatment (t-test: p = 0.47). Conclusions: The study demonstrated results with statistical significance regarding the mineral bone density improvement of patients who underwent laser PBM treatment. This positive effect of laser therapy has been shown, both at the level of the vestibular cortical bone and at level of the trabecular bone, independent of the patient’s sex, for the anterior maxilla and at the lateral areas also. Full article

(This article belongs to the Special Issue New Trends, Materials, and Technologies and Consolidating Best Practices in Dentistry, 2nd Edition)

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16 pages, 775 KiB

Open AccessArticle

Predictors for Poor Outcomes at Six Months on Pain, Disability, Psychological and Health Status in Greek Patients with Chronic Low Back Pain After Receiving Physiotherapy: A Prospective Cohort Study

by Matthaios Petrelis, Georgios Krekoukias, Ioannis Michopoulos, Vasileios Nikolaou and Konstantinos Soultanis

Clin. Pract. 2025, 15(3), 63; https://doi.org/10.3390/clinpract15030063 - 16 Mar 2025

Abstract

Background: Although previous studies have suggested a variety of sociodemographic and psychological factors as predictors of poor outcomes in patients with chronic low back pain (CLBP), longitudinal studies remain rare. Objectives: To examine the prognostic indicators for poor outcome at 6 months [...] Read more.

Background: Although previous studies have suggested a variety of sociodemographic and psychological factors as predictors of poor outcomes in patients with chronic low back pain (CLBP), longitudinal studies remain rare. Objectives: To examine the prognostic indicators for poor outcome at 6 months on pain, disability, quality of life, anxiety, depression and somatic symptom disorders (SSDs) in Greek backache patients and to evaluate the medium-term effects of a conservative physiotherapeutic approach (massage, ultrasound, transcutaneous electrical nerve stimulation, low-level laser and exercise program). Methods: A prospective cohort study of 145 volunteers receiving treatment for CLBP in a physiotherapy unit was conducted using random systematic sampling. The intervention was assessed by comparing pre-treatment, post-treatment and six-month measurements with Friedman’s test and the Bonferroni correction, using the pain numerical rating scale (PNRS), Roland–Morris disability questionnaire (RMDQ), EuroQol-5-dimension-5-level (EQ-5D-5L), Hospital Anxiety and Depression Scale (HADS) and Somatic Symptom Scale-8 (SSS-8). Multiple linear regression analysis was carried out to determine the impact of demographics and pre-treatment scores with scores at six months. Results: The mean age was 60.6 years (±14.7). Post-treatment, statistically significant improvements were observed across all outcome measures, including PNRS, RMDQ, EQ-5D-5L and SSS-8 (all p ≤ 0.001), with anxiety showing a notable reduction (p = 0.002). After examining the multiple regression analysis, pre-treatment SSS-8 emerged as a predictor of elevated levels of pain, disability, anxiety and depression at 6 months. Conclusions: The findings yielded not only somatic symptom burden, greater age and pain intensity as prognostic indicators for poor outcomes at six months, but also reported favorable medium-term effects for a conventional physiotherapy regimen in CLBP management, as well. Full article

(This article belongs to the Special Issue Musculoskeletal Pain and Rehabilitation)

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17 pages, 3633 KiB

Open AccessReview

Efficiency and Applicability of Virtual Surgical Planning in Maxillofacial and Mandibular Bone Reconstruction: A Narrative Review

by Mohammed Mahmoud Shalabi, Khaldoun M. A. Darwich, Mohammad Naem Kheshfeh and Mohammad Younis Hajeer

Clin. Pract. 2025, 15(3), 62; https://doi.org/10.3390/clinpract15030062 - 14 Mar 2025

Abstract

Background: Facial structures are critical to aesthetics and function. Deformities can cause significant problems. Advances in surgical techniques, including three-dimensional (3D) computer simulation and virtual surgical planning (VSP), have improved outcomes. VSP accurately predicts surgical outcomes, revolutionizing facial reconstruction. This article reviews VSP [...] Read more.

Background: Facial structures are critical to aesthetics and function. Deformities can cause significant problems. Advances in surgical techniques, including three-dimensional (3D) computer simulation and virtual surgical planning (VSP), have improved outcomes. VSP accurately predicts surgical outcomes, revolutionizing facial reconstruction. This article reviews VSP in facial bone reconstruction, highlighting its advantages and accuracy over traditional methods. Methods: A systematic search using Medline (PubMed), Web of Science, Scopus, and Google Scholar revealed 1645 articles that addressed the topic of this study. Results: The systematic search yielded 64 articles that were highly relevant to the study objective, underscoring the critical importance of virtual surgical planning (VSP) in enhancing surgical precision and patient satisfaction. VSP has become a key player in improving surgical interventions and reducing complications, reinforcing its role as the preferred method in modern reconstructive surgery and thus improving functional and aesthetic outcomes, significantly enhancing patient satisfaction, and ensuring accurate interpretation of treatment plans. When compared to traditional surgical planning (TSP), VSP offers increased accuracy, shorter operating times, and superior aesthetic outcomes. Conclusions: VSP has been shown to effectively manage the complex challenges of facial anatomy and has significantly enhanced the planning and execution of reconstructive surgeries. This has been achieved by leveraging advanced imaging and computer-aided design. Full article

(This article belongs to the Special Issue New Trends, Materials, and Technologies and Consolidating Best Practices in Dentistry, 2nd Edition)

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14 pages, 2442 KiB

Open AccessArticle

Caregivers’ Knowledge and Experiences in Recognizing and Managing Dysphagia in Patients with Myopathy

by Maria Demetriou, Demetra Tziirkalli and Anastasios M. Georgiou

Clin. Pract. 2025, 15(3), 61; https://doi.org/10.3390/clinpract15030061 - 13 Mar 2025

Abstract

Background: Dysphagia is a common complication in myopathy, significantly impacting patients’ quality of life (QoL) and overall health. Caregivers play a critical role in identifying and addressing swallowing difficulties in this population. The main purpose of this study was to assess the knowledge [...] Read more.

Background: Dysphagia is a common complication in myopathy, significantly impacting patients’ quality of life (QoL) and overall health. Caregivers play a critical role in identifying and addressing swallowing difficulties in this population. The main purpose of this study was to assess the knowledge and experiences of professional caregivers of patients with myopathy regarding the recognition and management of dysphagia in Cyprus. Methods: The study was designed as an anonymous, cross-sectional descriptive survey and involved 10 professional caregivers of patients with myopathy in Cyprus. Results: The most common dysphagia symptoms reported in myopathy patients were coughing, chewing difficulties, choking on fluids, and challenges with swallowing boluses. Only one caregiver reported difficulty managing swallowing issues, particularly in cases of reluctance to eat. Approximately 60% had received relevant training, primarily through workplace programs. Overall, caregivers did not perceive dysphagia as a significant burden. Conclusions: Dysphagia is a prevalent phenomenon in myopathy. The study reveals that caregivers of myopathy patients, regardless of their professional backgrounds, face hidden challenges in managing complex neurogenic dysphagia. They often misjudge the severity of the condition and overestimate their own competencies. Providing caregivers of patients with myopathy with targeted education would help them effectively manage swallowing difficulties associated with the condition. Encouragingly, our study also suggests that focused dysphagia education could reduce caregiver stress and enhance their overall well-being. Future efforts should concentrate on ensuring access to well-trained professionals, establishing specialized clinics, and promoting education to enhance MND-related dysphagia management and patient care. Full article

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16 pages, 1164 KiB

Open AccessSystematic Review

Acute Appendicitis or Appendiceal Diverticulitis? A Case Report and Systematic Literature Review

by Stipe Vidović, Nenad Čekić, Ivica Šuvak, Mladen Ugljarević and Zenon Pogorelić

Clin. Pract. 2025, 15(3), 60; https://doi.org/10.3390/clinpract15030060 - 13 Mar 2025

Abstract

Background: Appendiceal diverticulitis is a rare and poorly understood condition of the appendix. The diagnosis of appendiceal diverticulitis is challenging due to its rarity and a clinical presentation that often mimics other ileocecal disorders. Unlike acute appendicitis, appendiceal diverticulitis may be associated [...] Read more.

Background: Appendiceal diverticulitis is a rare and poorly understood condition of the appendix. The diagnosis of appendiceal diverticulitis is challenging due to its rarity and a clinical presentation that often mimics other ileocecal disorders. Unlike acute appendicitis, appendiceal diverticulitis may be associated with a higher risk of perforation, increased mortality, and a potential link to neoplasms. However, further research is necessary to enhance our understanding of its epidemiology, risk factors, clinical presentation, and outcomes. Case Report: A 53-year-old male presented to the emergency department with right lower abdominal pain. On physical examination, tenderness was noted in the right lower quadrant, without rebound tenderness or muscle guarding. Laboratory tests revealed leukocytosis and elevated C-reactive protein (CRP) levels. Ultrasonographic imaging of the ileocecal region suggested acute appendicitis, leading to a decision for surgical intervention. Laparoscopic exploration revealed multiple cylindrical, red, and edematous herniations, up to 4 mm in size, on the surface of the vermiform appendix. An appendectomy was performed. Histopathological examination confirmed appendiceal diverticulitis with surrounding peridiverticulitis. The surgery and early postoperative course were uneventful. Literature review: The study included 5 retrospective studies and 30 case reports, analyzing a total of 112 patients with appendiceal diverticulitis. Of these, 65.5% were male and 34.5% were female, with a median age of 49 years (IQR: 39–59). The most commonly reported clinical findings included pain in the right iliac fossa or right lower abdominal quadrant (56.5%), nausea (18.9%), vomiting (9.8%), rebound tenderness (24.6%), fever (15.6%), leukocytosis (25.4%), and elevated C-reactive protein levels (16.4%). Diagnosis was confirmed histopathologically in 86.9% of the cases via computed tomography imaging in 4.1% and ultrasonography in 1.6%. A histopathological analysis identified five neoplasms (4.1%), including two sessile serrated adenomas, two neuroendocrine carcinoids, and one mucinous tumor. Appendectomy was the treatment of choice, with no intraoperative or postoperative complications recorded and no mortality reported. The median hospital stay was 6.8 days (IQR: 3.0–6.8). Conclusions: Appendiceal diverticulitis should be considered as a differential diagnosis in patients presenting with symptoms resembling acute appendicitis. Early diagnosis and treatment are essential to reduce morbidity and mortality. Appendectomy is a safe and effective treatment approach for appendiceal diverticulitis. Full article

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13 pages, 735 KiB

Open AccessSystematic Review

Triggers, Types, and Treatments for Kounis Syndrome: A Systematic Review

by Erick Rochel-Perez, Miguel Santaularia-Tomas, Mario Martin-Dorantes, Edgar Villareal-Jimenez, Amonario Olivera-Mar, Ely Sanchez-Felix, Adrian Perez-Navarrete, Jose Luis Millet-Herrera, Osvaldo Huchim-Mendez, Ricardo Alejos-Briceño and Nina Mendez-Dominguez

Clin. Pract. 2025, 15(3), 59; https://doi.org/10.3390/clinpract15030059 - 13 Mar 2025

Abstract

Background: Kounis syndrome (KS), also known as allergic myocardial infarction, presents in three variants. This condition is often underrecognized due to limited knowledge and its variable presentation. To address these limitations, the present review aims to describe the triggers, types, management, and [...] Read more.

Background: Kounis syndrome (KS), also known as allergic myocardial infarction, presents in three variants. This condition is often underrecognized due to limited knowledge and its variable presentation. To address these limitations, the present review aims to describe the triggers, types, management, and patient outcomes of KS. Methods: In this systematic review, PubMed and Scopus were used to identify publications of clinical case reports; variables included sociodemographic characteristics, clinical manifestations, triggers, treatments, and outcomes. Data from the articles´ abstracts were assessed by two corresponding authors, and subsequently, each case was analyzed by two coauthors, validated and analyzed with Stata 12. To categorize each Kounis type, mean and proportion comparison tests were performed, and measures of association were obtained using logistic regression and expressed as odds ratios. Results: A global distribution was identified, with predominance in the Northern Hemisphere. Type I KS was the most reported variant, and most of the patients were adult men. Most of the patients presented variability in the treatment and outcomes. Conclusions: KS may represent a diagnostic challenge, and underdiagnosis could explain the lack of uniformity in the diagnostic and assessment process. Our results highlight a need for improved approaches based on patient history for correct diagnosis and preventing recurring events. Full article

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14 pages, 1562 KiB

Open AccessArticle

Microvascular Changes in Full-Thickness Macular Hole Patients Before and After Vitrectomy: An Optical Coherence Tomography–Angiography Study

by Aleksandra Górska, Sebastian Sirek, Dawid Woszczek and Rafał Leszczyński

Clin. Pract. 2025, 15(3), 58; https://doi.org/10.3390/clinpract15030058 - 11 Mar 2025

Abstract

Background: This study evaluates changes in the foveal avascular zone (FAZ) area and vessel density in patients with full-thickness macular hole (FTMH) before and after vitrectomy using optical coherence tomography–angiography (OCT-A). Methods: A prospective analysis was conducted on 39 patients diagnosed with FTMH [...] Read more.

Background: This study evaluates changes in the foveal avascular zone (FAZ) area and vessel density in patients with full-thickness macular hole (FTMH) before and after vitrectomy using optical coherence tomography–angiography (OCT-A). Methods: A prospective analysis was conducted on 39 patients diagnosed with FTMH who underwent pars plana vitrectomy. OCT-A imaging was performed preoperatively and at 1 and 3 months postoperatively. Parameters analyzed included FAZ area, superficial (SCP) and deep retinal vessel density (DCP), and central retinal thickness (CRT). Results: Preoperative OCT-A images showed a significant difference in the mean FAZ area between affected and healthy eyes (p < 0.01). However, a significant reduction in superficial capillary plexus (SCP) vessel density was noted after vitrectomy. Visual acuity improved significantly after surgery (p < 0.001), but no significant changes in FAZ or total vessel density were observed postoperatively. Postoperative distance visual acuity (DBCVA) correlated with preoperative macular hole size (p < 0.01). Conclusions: Vitrectomy for FTMH does not significantly alter the FAZ area or DCP vessel density, but does reduce SCP vessel density. OCT-A is a valuable tool for assessing retinal microvascular changes post-vitrectomy. Full article

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13 pages, 1579 KiB

Open AccessSystematic Review

Pyoderma Gangrenosum in a Patient with Crohn’s Disease Treated with Adalimumab: A Case-Based Review and Systematic Review of the Current Literature

by Fotios S. Fousekis, Konstantinos Mpakogiannis, Emmanouil Karampinis, Ioanna Nefeli Mastorogianni, Dimitrios K. Christodoulou, Marina Papoutsaki, Evanthia Zampeli and Konstantinos H. Katsanos

Clin. Pract. 2025, 15(3), 57; https://doi.org/10.3390/clinpract15030057 - 11 Mar 2025

Abstract

Background: Pyoderma gangrenosum (PG) is a rare inflammatory cutaneous disorder that frequently occurs in association with systemic diseases such as inflammatory bowel disease (IBD). This case report describes a 23-year-old female with Crohn’s disease (CD) who developed PG and was successfully treated with [...] Read more.

Background: Pyoderma gangrenosum (PG) is a rare inflammatory cutaneous disorder that frequently occurs in association with systemic diseases such as inflammatory bowel disease (IBD). This case report describes a 23-year-old female with Crohn’s disease (CD) who developed PG and was successfully treated with adalimumab. The objective of this study is to present the clinical course, treatment approach, and outcomes while reviewing the existing literature on the efficacy of adalimumab in PG management. Methods: A case report is presented, detailing clinical presentation, diagnostic evaluation, and treatment strategy. Additionally, a systematic review was conducted using PubMed to assess studies on adalimumab in PG, focusing on treatment response, remission rates, and adverse effects. Results: The patient presented with ulcerative lesions on her lower extremities and sacroiliitis. After corticosteroid therapy, adalimumab was initiated, leading to significant ulcer healing, reduced back pain, and CD remission. The systematic review identified seven studies on adalimumab in PG. Findings suggest that adalimumab is effective in steroid-refractory cases, with remission achieved in a significant proportion of patients. The most common adverse effects were infections, but overall, adalimumab showed a favorable safety profile. Conclusions: This case highlights the importance of early diagnosis and multidisciplinary management of PG in CD patients. Adalimumab appears to be a promising therapeutic option, particularly for steroid-resistant PG, though further research is needed to establish standardized treatment protocols. Full article

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12 pages, 2095 KiB

Open AccessArticle

Exploring the Role of Guilt in Eating Disorders: A Pilot Study

by Fabiola Raffone, Danilo Atripaldi, Eugenia Barone, Luigi Marone, Marco Carfagno, Francesco Mancini, Angelo Maria Saliani and Vassilis Martiadis

Clin. Pract. 2025, 15(3), 56; https://doi.org/10.3390/clinpract15030056 - 10 Mar 2025

Abstract

Background/Objectives: Eating disorders (EDs) are complex psychopathological conditions involving dysfunctional eating behaviors, excessive body image concerns, and impaired emotional regulation. Among moral emotions, guilt plays a significant role in ED dynamics, influencing both symptomatology and interpersonal relationships. This study examines specific guilt subtypes [...] Read more.

Background/Objectives: Eating disorders (EDs) are complex psychopathological conditions involving dysfunctional eating behaviors, excessive body image concerns, and impaired emotional regulation. Among moral emotions, guilt plays a significant role in ED dynamics, influencing both symptomatology and interpersonal relationships. This study examines specific guilt subtypes (normative and altruistic guilt) using a specific psychometric tool. Methods: Forty-three adults with anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED) were recruited from the Eating Disorder Center of the University of Campania “Luigi Vanvitelli” or referred by psychotherapists. Diagnoses followed DSM-5 criteria. Participants completed the Moral Orientation Guilt Scale (MOGS), assessing guilt subtypes, and the Eating Disorder Inventory-2 (EDI-2), measuring ED symptomatology. Spearman’s rank correlation and stepwise multiple regression analyses were used to identify relationships between guilt dimensions and ED-related symptoms. Results: MOGS subscales were positively correlated with ED symptomatology. Normative guilt was significantly associated with binging and purging (ρ = 0.26, p < 0.05), while altruistic guilt predicted higher interpersonal distrust (t = 3.4, p < 0.01). Regression analysis revealed that age negatively influenced interpersonal distrust (t = −2.9, p < 0.01). Conclusions: In the population examined, guilt significantly influences ED symptomatology and interpersonal functioning, with specific dimensions linked to distinct behaviors and traits. Therapeutic interventions targeting guilt may enhance treatment outcomes by addressing ED emotional underpinnings. However, the results should be interpreted with caution due to the small sample size and lack of longitudinal data to establish causality. Further research with larger samples and longitudinal designs is necessary to validate these findings. Full article

(This article belongs to the Special Issue Innovations in Youth Psychiatry and Psychology: Challenges and Advances)

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11 pages, 217 KiB

Open AccessCase Report

Two Long-Acting Antipsychotics in a Patient with Treatment-Resistant Schizophrenia: A Case Report

by Salvatore Cipolla, Flora Delli Carpini, Pierluigi Catapano, Valeria De Santis, Antonio Volpicelli, Francesco Perris and Francesco Catapano

Clin. Pract. 2025, 15(3), 55; https://doi.org/10.3390/clinpract15030055 - 10 Mar 2025

Abstract

Treatment-resistant schizophrenia (TRS) poses significant therapeutic challenges due to persistent symptoms, poor adherence, and high relapse rates. Long-acting injectable (LAI) antipsychotics offer a promising approach, yet limited evidence exists regarding the combination of two LAI formulations. We report the case of a 62-year-old [...] Read more.

Treatment-resistant schizophrenia (TRS) poses significant therapeutic challenges due to persistent symptoms, poor adherence, and high relapse rates. Long-acting injectable (LAI) antipsychotics offer a promising approach, yet limited evidence exists regarding the combination of two LAI formulations. We report the case of a 62-year-old woman with TRS, characterized by recurrent hospitalizations and inadequate responses to oral and monotherapy treatments. During her latest hospitalization, she received alternating intramuscular administrations of haloperidol decanoate (100 mg/28 days) and aripiprazole (400 mg/28 days). The dual LAI strategy resulted in a marked improvement in psychotic symptoms, functional recovery, and treatment adherence, with no reported side effects. This case highlights the potential benefits of dual LAI therapy in managing TRS, particularly in patients with non-adherence to oral medications or limited response to standard treatments. Additional studies are required to evaluate the long-term effectiveness and safety of this innovative therapeutic approach. Full article

19 pages, 1090 KiB

Open AccessReview

High Polyphenol Extra Virgin Olive Oil and Metabolically Unhealthy Obesity: A Scoping Review of Preclinical Data and Clinical Trials

by Konstantina Liva, Athanasios A. Panagiotopoulos, Alexandra Foscolou, Charalampia Amerikanou, Alkistis Vitali, Stavros Zioulis, Konstantina Argyri, Georgios I. Panoutsopoulos, Andriana C. Kaliora and Aristea Gioxari

Clin. Pract. 2025, 15(3), 54; https://doi.org/10.3390/clinpract15030054 - 7 Mar 2025

Abstract

Background/Objectives: During the last decade, there has been an increased interest in phenolic compound-rich natural products as natural therapies for regulating the molecular pathways behind central obesity and associated metabolic disorders. The present scoping review presents the outcomes of clinical and preclinical [...] Read more.

Background/Objectives: During the last decade, there has been an increased interest in phenolic compound-rich natural products as natural therapies for regulating the molecular pathways behind central obesity and associated metabolic disorders. The present scoping review presents the outcomes of clinical and preclinical studies examining the anti-obesity effects of high phenolic extra virgin olive oil (HP-EVOO) and its possible underlying molecular mechanisms. Methods: Studies published between 2014 and 2024 were searched via MEDLINE, Scopus, Cochrane, the Web of Science, Semantic Scholar, Google Scholar, Science.gov, and Clinicaltrials.gov databases. A combination of keywords and Boolean logic was used to search throughout the last decade in all databases, including “hyperglycemia” or “hypertension” or “metabolic syndrome” or “dyslipidemia” or “hyperlipidemia” or “hypoglycemia” or “obesity” or “macrovascular diabetic complications” or “microvascular diabetic complications” or “cardiovascular disease” or “overweight” or “insulin sensitivity” or “insulin resistance” and “extra virgin olive oil” or “high phenolic olive oil” and “human” or “animal model”. Results: The 10-year literature survey identified 21 studies in both animal models and humans, indicating that HP-EVOO improves inflammation, glycemic control, oxidative stress and endothelial function, potentially protecting against metabolic syndrome, hypertension and type 2 diabetes, even compared to EVOO. Moreover, HP-EVOO’s antiplatelet effect and improvement in HDL functionality reduce cardiovascular risk. Conclusions: The evidence presented in this study demonstrates that HP-EVOO represents an effective preventive and therapeutic dietary approach to cardiometabolic diseases. Full article

(This article belongs to the Special Issue The Effect of Dietary Compounds on Inflammation-Mediated Diseases)

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12 pages, 2033 KiB

Open AccessProtocol

The Effect of Nordic Walking Intervention (NORDIN-JOY) on Individuals with Intellectual Disabilities and Their Families: A Multicenter Randomized Crossover Study

by Daniel González-Devesa, Carlos Ayán-Pérez, Eva González-Devesa and Jose Carlos Diz-Gómez

Clin. Pract. 2025, 15(3), 53; https://doi.org/10.3390/clinpract15030053 - 6 Mar 2025

Abstract

Background: We aim to evaluate the effect of the Nordic Walking program on the quality of life and functionality of individuals with intellectual disabilities; Methods: The NORDIN-JOY study is designed as a multicenter, randomized crossover trial. Participants in the experimental group will engage [...] Read more.

Background: We aim to evaluate the effect of the Nordic Walking program on the quality of life and functionality of individuals with intellectual disabilities; Methods: The NORDIN-JOY study is designed as a multicenter, randomized crossover trial. Participants in the experimental group will engage in a Nordic Walking intervention, while those in the control group will participate in a Fit 5-Fitness Cards intervention. Both physical training programs will consist of two 60 min sessions per week over a three-month period. The study will assess measures of quality of life and physical fitness. Additionally, the feasibility and cost-effectiveness of both programs, as well as the average weekly physical activity levels during the six months following the intervention, will be evaluated; Results: The results of this study are anticipated to provide valuable insights into the effects of structured exercise interventions on individuals with intellectual disabilities. These findings will be disseminated through peer-reviewed journals and academic conferences; Conclusions: This protocol seeks to establish evidence on the impact of exercise programs in individuals with intellectual disabilities. The findings have the potential to inform specific recommendations for healthcare professionals, caregivers, and policymakers, promoting physical activity as a cost-effective strategy for improving care and quality of life in this population. Full article

(This article belongs to the Special Issue Musculoskeletal Pain and Rehabilitation)

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45 pages, 997 KiB

Open AccessSystematic Review

Insurance Payor Status and Outcomes in Pediatric Sports-Related Injuries: A Rapid Review

by Katherine M. Kutzer, Lulla V. Kiwinda, Daniel Yang, John Kyle Mitchell, Emily J. Luo, Emily J. Harman, Stephanie Hendren, Kendall E. Bradley and Brian C. Lau

Clin. Pract. 2025, 15(3), 52; https://doi.org/10.3390/clinpract15030052 - 4 Mar 2025

Abstract

Introduction: The rise in youth sports participation has led to an increase in pediatric sports-related injuries in the United States, contributing to growing healthcare costs and exacerbating socioeconomic disparities. Insurance payor status is a critical factor influencing access to care, treatment delays, [...] Read more.

Introduction: The rise in youth sports participation has led to an increase in pediatric sports-related injuries in the United States, contributing to growing healthcare costs and exacerbating socioeconomic disparities. Insurance payor status is a critical factor influencing access to care, treatment delays, and health outcomes. This study examines the association between insurance payor status and outcomes in pediatric sports-related injuries. Methods: A systematic review of the Medline database was conducted. Included studies reported insurance payor status and pediatric sports orthopedic patient outcomes following surgery. Outcomes included time to be seen by a provider, treatment access, complication and revision rates, postoperative Emergency Department (ED)/Urgent Care utilization, readmission rates, hospital length of stay, pain, functional scores, discharge destinations, return to activity, and follow-up. Results: A total of 35 studies comprising 535,891 pediatric patients were included. Publicly insured or uninsured patients consistently experienced significant delays in accessing care, with average wait times for clinic visits, imaging, and surgery up to six times longer compared to privately insured patients. These delays were associated with worsened injury severity, higher rates of postoperative complications, and poorer functional outcomes. Publicly insured patients were less likely to receive advanced treatments such as bracing or physical therapy, further compounding disparities. Minority groups faced delays even when controlling for insurance status. Conclusions: Public and uninsured pediatric patients face systemic barriers to timely and equitable care, resulting in worse outcomes following sports-related injuries. Future research should explore targeted solutions to ensure equitable care for this vulnerable population. Full article

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17 pages, 1889 KiB

Open AccessSystematic Review

Clinical Efficacy of Prolotherapy for Temporomandibular Joint Disorders: A Systematic Review and Meta-Analysis

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

Clin. Pract. 2025, 15(3), 51; https://doi.org/10.3390/clinpract15030051 - 27 Feb 2025

Abstract

Background: Temporomandibular disorders (TMDs) encompass a group of conditions characterized by anatomical, histological, and/or functional abnormalities that affect the muscular and/or articular components of the temporomandibular joint. Prolotherapy is an injectable treatment modality for chronic musculoskeletal pain that involves dextrose solution administration in [...] Read more.

Background: Temporomandibular disorders (TMDs) encompass a group of conditions characterized by anatomical, histological, and/or functional abnormalities that affect the muscular and/or articular components of the temporomandibular joint. Prolotherapy is an injectable treatment modality for chronic musculoskeletal pain that involves dextrose solution administration in the joint. Aims: To summarize, the aims involve considering the existing quality of clinical evidence on the efficacy of prolotherapy versus placebo and other active comparators, such as autologous blood products or botulinum toxin, in improving the outcomes of TMDs. Methods: A literature search in MEDLINE, Scopus, and Cochrane databases was performed, following the PRISMA statement guidelines, to identify randomized controlled trials (RCTs) of patients with TMDs receiving prolotherapy. The maximal incisor opening (MIO), visual analogue score (VAS) for pain, and frequency of dislocations were analyzed as the outcomes. The weighted mean difference was used to pool outcomes. The risk of bias was recorded for the included studies. Results: Six studies comparing prolotherapy to placebo were identified. Prolotherapy is uniformly more efficient in reducing the VAS for pain when compared to the placebo (mean difference = 1.20, 95%CI: 0.56–1.84, p < 0.001). Perceived jaw mobility was improved among prolotherapy patients, (mean difference = 0.47, 95%CI: 0.05–0.90, p = 0.003) when compared to the placebo. A beneficial effect for prolotherapy with regard to MIO (mean difference = 0.84, 95%CI: −2.12–3.80, p = 0.58) was not confirmed. Prolotherapy appears to be more efficient than autologous blood products in reducing VAS for pain (mean difference = 0.49, 95%CI: 0.11–0.87, p = 0.01). Prolotherapy was found to be more effective in reducing pain, MIO, and clicking when compared to an occlusal splint in a single study. Conclusions: Prolotherapy is also a promising modality for TMDs, despite the limited number of randomized clinical trials. Existing evidence supports its use to reduce TMD-related pain, even against other modalities. Further research is needed to better describe the benefit of prolotherapy for other outcomes. Full article

(This article belongs to the Special Issue Clinical Outcome Research in the Head and Neck)

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12 pages, 815 KiB

Open AccessArticle

Investigation of Electroencephalographic Aspects, Adaptive Features, and Clinical Phenotypes in a Group of Children with Autism—A Pilot Study

by Alexandru Capisizu, Leon Zăgrean, Elena Poenaru, Elena Tudorache, Mihaela Anca Bulf and Adriana Sorina Capisizu

Clin. Pract. 2025, 15(3), 50; https://doi.org/10.3390/clinpract15030050 - 27 Feb 2025

Abstract

(1) Background: Autism, as an important global problem that affects many phenotypically different individuals, is associated with electroencephalographic (EEG) abnormalities and adaptability impairment. (2) Materials and Methods: In this retrospective study of a group of 101 autistic children, we aimed to evaluate the [...] Read more.

(1) Background: Autism, as an important global problem that affects many phenotypically different individuals, is associated with electroencephalographic (EEG) abnormalities and adaptability impairment. (2) Materials and Methods: In this retrospective study of a group of 101 autistic children, we aimed to evaluate the presence of EEG abnormalities, adaptive features, and clinical phenotypes via EEG, the Adaptive Behavior Assessment System II (ABAS II) scale, and neurological examination. (3) Results: Our results showed statistically significant associations between the level of adaptability obtained through the ABAS II scale and neurological deficit, specifically in terms of coordination impairment. There were also statistically significant differences between the level of adaptability and clinical phenotypes between autism type groups. (4) Conclusions: This study shows that children with autism are likely to exhibit neurological and adaptive abnormalities. Non-invasive assessment tools, such as EEG recordings, the ABAS II scale, and neurological examination offer valuable support for improved diagnosis and management. Full article

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11 pages, 423 KiB

Open AccessCase Report

Metastasis of Squamous Cell Carcinoma of the Larynx to the Right Adrenal Gland—A Case Report

by Eliza Działach, Michał Simlot, Karolina Osowiecka, Elżbieta Nowara, Jarosław Markowski and Mateusz Grajek

Clin. Pract. 2025, 15(3), 49; https://doi.org/10.3390/clinpract15030049 - 26 Feb 2025

Abstract

Background/Objectives: Malignant adrenal tumors comprise both primary adrenal neoplasms and metastatic lesions, with the latter being significantly more common. Squamous cell carcinoma (SCC) of the larynx is a prevalent head and neck cancer that typically spreads to the cervical lymph nodes, with [...] Read more.

Background/Objectives: Malignant adrenal tumors comprise both primary adrenal neoplasms and metastatic lesions, with the latter being significantly more common. Squamous cell carcinoma (SCC) of the larynx is a prevalent head and neck cancer that typically spreads to the cervical lymph nodes, with distant metastases being rare. Among such metastases, adrenal gland involvement is particularly uncommon, presenting unique diagnostic and therapeutic challenges. The study aimed to explore the progression, diagnostic process, and therapeutic management of a rare case of SCC of the larynx metastasizing to the adrenal gland, highlighting the role of advanced diagnostic imaging and a multidisciplinary approach in patient care. Methodology: A 66-year-old male with grade 3 SCC of the larynx underwent total laryngectomy, selective cervical lymphadenectomy, and radiotherapy with a dose of 70 Gy. Chemotherapy was discontinued due to hematological complications. Post-treatment monitoring included CT and PET-CT imaging, leading to the detection of a large adrenal mass. Surgical biopsy confirmed metastatic SCC in the adrenal gland, as resection was not feasible due to extensive invasion. Diagnostic imaging and histopathological examination were complemented by biochemical evaluations to assess hormonal activity. Results: The adrenal mass was identified as a metastasis from the laryngeal SCC. Imaging studies provided detailed insights into the lesion’s size, metabolic activity, and non-functional status. Despite comprehensive efforts, the tumor was deemed unresectable, highlighting the aggressive nature of the disease and the limitations of current therapeutic modalities. Conclusions: This rare case emphasizes the importance of early detection, advanced imaging techniques, and interdisciplinary collaboration in managing complex metastatic presentations. It underscores the critical need for further research into systemic treatments, such as immunotherapy, and the development of standardized protocols for rare metastatic patterns. The study contributes to the growing body of literature on the management of uncommon cancer metastases, advocating for individualized patient care and innovation in treatment strategies. Full article

(This article belongs to the Special Issue Clinical Outcome Research in the Head and Neck)

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