Clinics and Practice

13 pages, 636 KB

Open AccessArticle

Intranasal Esketamine Versus Other Pharmacological Strategies in Treatment-Resistant Depression with High Suicide Risk: A Six-Month Naturalistic Study

by Ana María de Granda-Beltrán, Alejandro Porras-Segovia, Daniel Núñez-Arias, Alba Rodríguez-Jover, Maria Paula Jassir Acosta, Philippe Courtet, Enrique Baca-García and Inmaculada Peñuelas-Calvo

Clin. Pract. 2026, 16(6), 110; https://doi.org/10.3390/clinpract16060110 (registering DOI) - 12 Jun 2026

Abstract

Background: Treatment-resistant depression (TRD) poses a major clinical challenge, particularly when accompanied by suicidal behavior. Intranasal esketamine has demonstrated rapid antidepressant effects in TRD, but real-world comparative evidence remains limited. Methods: We conducted a six-month naturalistic prospective cohort study in two Spanish mental [...] Read more.

Background: Treatment-resistant depression (TRD) poses a major clinical challenge, particularly when accompanied by suicidal behavior. Intranasal esketamine has demonstrated rapid antidepressant effects in TRD, but real-world comparative evidence remains limited. Methods: We conducted a six-month naturalistic prospective cohort study in two Spanish mental health centers, including 62 TRD patients with high suicide risk undergoing fourth-line treatment. Thirty patients received intranasal esketamine and thirty-two alternative pharmacological interventions. Suicidal ideation (C-SSRS), depressive symptoms (HAM-D-17) and functional status (FAST) were assessed at baseline and at 1-, 3- and 6-month follow-ups. Results: Both groups showed significant improvement during follow-up; however, esketamine-treated patients exhibited a faster and greater reduction in suicidal ideation and depressive symptoms than those receiving alternative pharmacological strategies. The number needed to treat to prevent one case of high suicide risk was 1.35. Functional improvement was comparable between groups. Conclusions: In real-world clinical settings, intranasal esketamine was associated with a faster and greater reduction in suicidal ideation and depressive symptoms among TRD patients with high suicide risk, supporting its role as a rapid-acting therapeutic option within comprehensive and closely monitored care. Full article

7 pages, 15778 KB

Open AccessCase Report

Clinical and Radiological Findings in Endorectal Migration of a Metallic Ureteral Stent

by Szabolcs André, Daniela Dobru, Árpád-Olivér Vida, Miheler Dora, Rares-Florin Vascul, Călin Chibelean, Lorand Tibor Reman, Raul-Dumitru Gherasim, Edva Anna Frunda and Orsolya Katalin Ilona Martha

Clin. Pract. 2026, 16(6), 109; https://doi.org/10.3390/clinpract16060109 - 11 Jun 2026

Abstract

Hydronephrosis caused by malignant ureteral obstruction or radiotherapy-induced ureteral stenosis is a frequent complication in patients with cervical cancer. Effective management requires continuous urinary drainage, which can be achieved either internally through ureteral stent placement or externally via percutaneous nephrostomy. Among available devices, [...] Read more.

Hydronephrosis caused by malignant ureteral obstruction or radiotherapy-induced ureteral stenosis is a frequent complication in patients with cervical cancer. Effective management requires continuous urinary drainage, which can be achieved either internally through ureteral stent placement or externally via percutaneous nephrostomy. Among available devices, the Allium^TM fully covered nitinol mesh ureteral stent is designed to treat ureteral or urethral strictures while allowing safe and easy removal. However, serious complications have been reported, including uretero-enteric, uretero-arterial, and uretero-vaginal fistulas, pseudoaneurysm, ureteral perforation and sepsis. We report the case of a 44-year-old woman diagnosed in 2020 with stage IIIC1 cervical cancer (FIGO classification) who underwent surgery followed by adjuvant radiotherapy. In 2021, a right metallic ureteral stent was placed to treat ureteral obstruction. Two years later, she presented with right lumbar pain, and abdominal ultrasonography revealed grade III right hydronephrosis. CT scan demonstrated migration of the metallic ureteral stent into the rectal wall. Endoscopic extraction of the migrated stent was successfully performed via colonoscopy. Retrograde pyelography and CT imaging confirmed the presence of a recto-ureteral fistula. A 6 Ch/26 cm double-J ureteral stent was subsequently placed with good positioning and drainage. At the six-month follow-up, replacement of the double-J stent was performed. Imaging studies showed only minor residual hydronephrosis. Although metallic ureteral stents are effective for managing malignant ureteral obstruction, particularly in complex oncologic cases, they are not free of severe complications. The risk appears increased in patients who have undergone radiotherapy, emphasizing the need for careful monitoring and long term follow-up. Full article

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8 pages, 688 KB

Open AccessCase Report

Successful Limb Salvage in MRSA Bacteremic Septic Charcot Midfoot Using Continuous Local Antibiotic Perfusion and Circular External Fixation: A Case Report

by Koji Nozaka and Naohisa Miyakoshi

Clin. Pract. 2026, 16(6), 108; https://doi.org/10.3390/clinpract16060108 - 9 Jun 2026

Abstract

Background: Septic Charcot neuroarthropathy is a limb- and life-threatening condition characterized by the coexistence of neuropathic joint destruction and infection. In patients with severe systemic compromise, major amputation is often considered inevitable. Case Presentation: A 47-year-old man with untreated diabetes mellitus [...] Read more.

Background: Septic Charcot neuroarthropathy is a limb- and life-threatening condition characterized by the coexistence of neuropathic joint destruction and infection. In patients with severe systemic compromise, major amputation is often considered inevitable. Case Presentation: A 47-year-old man with untreated diabetes mellitus presented with progressive painless swelling of the left foot. He had morbid obesity (120 kg, 165 cm; body mass index 44.1 kg/m²), severe hypoalbuminemia, and chronic kidney disease associated with nephrotic syndrome. Laboratory tests showed marked inflammation and poor glycemic control, and blood cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA). Radiographs and computed tomography demonstrated destructive changes involving the talonavicular and subtalar joints, consistent with septic Charcot neuroarthropathy involving the midfoot. Because of sepsis, pulmonary edema, and heart failure, below-knee amputation was proposed at the referring hospital. However, limb salvage was attempted using aggressive debridement, continuous local antibiotic perfusion (CLAP; gentamicin 1200 μg/mL) administered for 14 days, and temporary circular external fixation. Serum gentamicin concentrations and renal function were regularly monitored to ensure systemic safety and avoid nephrotoxicity. Results: Repeat irrigation and final debridement were performed 20 days after the index surgery, at which time the external fixator was removed and intraoperative cultures were negative. The patient was discharged 2 months after surgery without evidence of recurrent infection. At 4-year follow-up, no recurrence had occurred, and the patient was able to walk independently. Conclusions: Limb salvage may be feasible even in severely compromised patients with septic Charcot midfoot and MRSA bacteremia when aggressive debridement, CLAP, and temporary external fixation are combined with careful systemic safety monitoring. This case suggests that limb salvage may be considered in selected high-risk patients, although further studies are required. Full article

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14 pages, 35225 KB

Open AccessCase Report

Rare Implantation Sites of Ectopic Pregnancy: A Case Series of Ovarian and Hepatic Pregnancy and Review of Diagnostic Challenges

by Stefan Ivanovic, Ljubomir Srbinovic, Milica Ivanovic, Dragana Maglic, Nenad Kokošar and Rastko Maglic

Clin. Pract. 2026, 16(6), 107; https://doi.org/10.3390/clinpract16060107 - 31 May 2026

Abstract

Background: Ectopic pregnancy remains a significant cause of maternal morbidity in early pregnancy. While most ectopic pregnancies happen within the fallopian tube, implantation may rarely occur in atypical locations such as the ovary or abdominal cavity. These rare forms often present with nonspecific [...] Read more.

Background: Ectopic pregnancy remains a significant cause of maternal morbidity in early pregnancy. While most ectopic pregnancies happen within the fallopian tube, implantation may rarely occur in atypical locations such as the ovary or abdominal cavity. These rare forms often present with nonspecific clinical findings and may represent a considerable diagnostic challenge. Methods: We report a case series of three rare ectopic pregnancies managed at a tertiary referral center. Two cases involved ovarian pregnancy, and one case represented an exceptionally rare hepatic ectopic pregnancy. Clinical presentation, diagnostic pathway, surgical management, and outcomes were analyzed and compared with available literature. Results: In the first two cases, ovarian pregnancy was confirmed intraoperatively and treated surgically, with ovarian preservation in one patient and adnexectomy in the other due to active bleeding. The third case had an unusual course: initial surgery was performed for hemoperitoneum caused by a ruptured corpus luteum cyst, while persistent β-hCG elevation later led to identification of hepatic ectopic pregnancy, confirmed by imaging and surgery. All patients recovered favorably, with complete β-hCG negativization. Conclusions: Rare ectopic implantation sites may mimic acute abdominal conditions and remain difficult to diagnose preoperatively. High clinical suspicion, serial β-hCG monitoring, and appropriate imaging are essential. Surgical management remains central, particularly in life-threatening bleeding. Standard algorithms for tubal ectopic pregnancy may not be fully applicable and should be adapted to the clinical context. Full article

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

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18 pages, 1443 KB

Open AccessCase Report

Challenges in Diagnosis and Management of Spondylodiscitis of L-5/S-1 Due to Propionibacterium acnes in a Patient with a Twenty-Year History of Tetraplegia

by Vaidyanathan Subramanian, Bakulesh Madhusudan Soni, Peter Lyndon Hughes and Tun Oo

Clin. Pract. 2026, 16(6), 106; https://doi.org/10.3390/clinpract16060106 - 31 May 2026

Abstract

Objectives: To present novel strategies in the diagnosis and management of spondylodiscitis in a patient with tetraplegia. Case Presentation: A 44-year-old man presented with increased spasms despite having a SynchroMed II Medtronic for intrathecal infusion of baclofen. The C-reactive protein level was raised. [...] Read more.

Objectives: To present novel strategies in the diagnosis and management of spondylodiscitis in a patient with tetraplegia. Case Presentation: A 44-year-old man presented with increased spasms despite having a SynchroMed II Medtronic for intrathecal infusion of baclofen. The C-reactive protein level was raised. Infection was suspected, but there were no localising signs. Positron Emission Tomography (PET) was performed to identify the focus of infection. PET showed an increased Fluorodeoxyglucose uptake in the L-5 vertebral body and the associated ill-defined soft tissue anteriorly. There was significant erosion and destruction of the S-1 vertebra. Magnetic Resonance Imaging of the lumbo-sacral spine revealed destruction and collapse of the S-1 vertebral body and a 6 cm × 2 cm anterior paravertebral abscess collection. This patient was managed in his home. Intravenous administration of 1 g of Ertapenem daily was provided by community nurses for eight weeks. Blood tests were performed in the community setting, and the patient was monitored by spinal unit doctors. Results: Follow-up CT revealed abnormal soft tissue, expanding and replacing the S-1 vertebral body, with appearances in keeping with an infective process. Using CT guidance and the Madison bone biopsy kit, multiple cores were obtained from the left sacral bone. Four of the five specimens showed no growth after extended incubation. Propionibacterium acnes were isolated after 10 days of incubation from the tissue from the sacral bone biopsy only. A shared decision was made towards active surveillance. Follow-up CT of the abdomen showed a stable appearance of the lumbar and sacral spine. Conclusions: A complex case of spondylodiscitis can be diagnosed and managed while the patient stays mainly in their home, avoiding prolonged admission to the spinal unit, in alignment with the “hospital to community” aspect of the National Health Service’s 10-year Health Plan for England. A diagnostic pathway with PET-CT as the first approach proved useful when the site of infection was unclear. Active surveillance obviated the need for extended periods of antibiotic therapy, which could have led to complications such as antibiotic-induced toxicity and microbial resistance to antibiotics. Full article

(This article belongs to the Topic Advances in Chronic Disease Management)

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13 pages, 979 KB

Open AccessArticle

Factors Associated with Long COVID in the Pediatric Population: A Retrospective Case–Control Study

by Ioana Maria Otilia Lică, Iulia Florentina Țincu, Anca Cristina Drăgănescu and Doina Anca Pleșca

Clin. Pract. 2026, 16(6), 105; https://doi.org/10.3390/clinpract16060105 - 31 May 2026

Abstract

Background: Long COVID in children is increasingly recognized, yet its clinical predictors and objective biological correlates remain insufficiently characterized. Objectives: The objective was to compare clinical, demographic, and laboratory characteristics between children with and without long COVID and to identify associated variables. Methods: [...] Read more.

Background: Long COVID in children is increasingly recognized, yet its clinical predictors and objective biological correlates remain insufficiently characterized. Objectives: The objective was to compare clinical, demographic, and laboratory characteristics between children with and without long COVID and to identify associated variables. Methods: We conducted a retrospective observational case–control study at the “Dr. Victor Gomoiu” Children’s Clinical Hospital, including pediatric patients with confirmed SARS-CoV-2 infection. Cases were defined as children with symptoms persisting ≥12 weeks after acute infection, while controls had no persistent symptoms at ≥12 weeks. Results: Eighty-nine children with long COVID and 88 matched controls were included. Children with long COVID were significantly older (1.79 ± 0.90 vs. 1.14 ± 0.80 years, p < 0.001) and more frequently from urban areas (86.5% vs. 69.3%, p = 0.0099). Lymphocyte, monocyte, and basophil counts were significantly lower in the Long COVID group, while D-dimer, ferritin, serum iron, urea, and creatinine levels were significantly higher. A multivariate predictive model demonstrated excellent discrimination (AUC = 0.94), with optimal sensitivity (84.3%) and specificity (89.8%) at a probability threshold of 0.48. Conclusions: Long COVID in children was associated with identifiable clinicobiological features. An exploratory composite model showed good discrimination but requires external validation. Full article

(This article belongs to the Topic Advances in Chronic Disease Management)

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17 pages, 299 KB

Open AccessArticle

Developing the Spanish Version of the Fraboni Scale of Ageism: Cross-Cultural Adaptation with Initial Reliability and Content Validity Findings

by Juan Ramón de-Moya-Romero, Alexis Caballero-Bonafé, Laura Fernández-Puerta, Raquel Valera-Lloris and Antonio Martínez-Sabater

Clin. Pract. 2026, 16(6), 104; https://doi.org/10.3390/clinpract16060104 - 31 May 2026

Abstract

Background: Ageism is a global public health concern associated with poorer health outcomes and inequities in care. Culturally adapted instruments are needed to assess ageist attitudes among healthcare professionals in Spain. This study aimed to cross-culturally adapt and evaluate the preliminary psychometric properties [...] Read more.

Background: Ageism is a global public health concern associated with poorer health outcomes and inequities in care. Culturally adapted instruments are needed to assess ageist attitudes among healthcare professionals in Spain. This study aimed to cross-culturally adapt and evaluate the preliminary psychometric properties of the Spanish version of the Fraboni Scale of Ageism (FSA-SV). Methods: A methodological study was conducted, including translation and back-translation, expert review, and a pilot test. Content validity was assessed using the content validity index (CVI), the modified kappa coefficient, and Aiken’s V. A descriptive cross-sectional pilot study was conducted with 101 healthcare professionals from a single health department in Valencia to evaluate comprehension and reliability. Internal consistency was examined using Cronbach’s alpha and McDonald’s omega. Results: Content validity indices indicated acceptable agreement among experts (S-CVI = 0.745; Aiken’s V = 0.770). All items were retained to preserve conceptual and structural equivalence with the original instrument. The FSA-SV demonstrated high internal consistency (Cronbach’s alpha = 0.903; McDonald’s omega = 0.915). The mean total score was 51.2 (SD = 9.62), with no significant associations observed between ageism and participants’ sociodemographic or professional variables. Conclusions: This pilot study represents a first step in the cross-cultural adaptation and preliminary psychometric evaluation of the FSA-SV for use among healthcare professionals in Spain. The results suggest that the instrument shows promising initial properties for the preliminary assessment of ageism, supporting its potential utility in future research and in evaluating educational and organizational interventions aimed at reducing ageism and improving the quality and safety of care for older adults. Further studies with larger, more diverse samples are required to evaluate additional psychometric properties, including the factorial structure. Full article

12 pages, 240 KB

Open AccessArticle

Clinical Characteristics, Risk Score Distribution, and Hospitalization Status in Emergency Department Patients with Acute Chest Pain: A Single-Center Retrospective Four-Year Study

by Gabriela-Florentina Țapoș, Dan Iliescu, Mihaela Cristina Negru, Florin Borcan, Silvia Luca, Simina Crișan and Constantin Tudor Luca

Clin. Pract. 2026, 16(6), 103; https://doi.org/10.3390/clinpract16060103 - 29 May 2026

Abstract

Background/Objectives: Cardiovascular diseases are a major cause of morbidity and mortality worldwide. Acute chest pain is a frequent reason for emergency department presentation and requires structured evaluation to identify life-threatening conditions. This study evaluated clinical characteristics, cardiovascular risk profile, risk stratification patterns, and [...] Read more.

Background/Objectives: Cardiovascular diseases are a major cause of morbidity and mortality worldwide. Acute chest pain is a frequent reason for emergency department presentation and requires structured evaluation to identify life-threatening conditions. This study evaluated clinical characteristics, cardiovascular risk profile, risk stratification patterns, and hospitalization status in adults with acute chest pain. Methods: We conducted a retrospective study using registry data from Arad County Clinical Emergency Hospital between January 2021 and December 2024. Adult patients with documented acute chest pain were included according to predefined criteria. Demographics, comorbidities, clinical presentation, troponin values, hospitalization status, and HEART, and EDACS categories were extracted when available. The Marburg Heart Score was also assessed as an exploratory complementary score. Statistical analysis used descriptive statistics, contingency tables, and chi-square testing, with available-case analysis. Results: Overall, 2070 patients were included. Most patients were aged 35–54 or 55–69 years. Hypertension and diabetes mellitus were the most common comorbidities, and pressure-like chest pain predominated. In unadjusted analyses, HEART and EDACS categories were significantly associated with hospitalization status across all study years. Score categories were significantly associated with hospitalization status across all study years. Age was consistently associated with cardiovascular comorbidity burden and higher-risk score categories. Conclusions: Structured risk stratification scores were associated with hospitalization status, while age was associated with cardiovascular risk burden. Full article

16 pages, 6548 KB

Open AccessCase Report

Random-Pattern Skin Paddle on a Free Latissimus Dorsi Flap as an Intraoperative Backup for Distal Lower-Limb Reconstruction: A Case Report

by Ivan Budimir, Borna Vojvodić, Rado Žic, Zlatko Vlajčić, Domagoj Eljuga, Božo Gorjanc, Željka Roje, Hrvoje Tucaković, Željka Godeč, Marko Barić, Josip Jaman, Rhea Marie Mužar and Krešimir Martić

Clin. Pract. 2026, 16(6), 102; https://doi.org/10.3390/clinpract16060102 - 28 May 2026

Abstract

Background: The latissimus dorsi free flap is a workhorse for extensive lower-extremity soft tissue defects. Conventionally, the skin paddle is designed according to the anticipated defect and left in place on the muscle as a single composite unit. This report describes an alternative [...] Read more.

Background: The latissimus dorsi free flap is a workhorse for extensive lower-extremity soft tissue defects. Conventionally, the skin paddle is designed according to the anticipated defect and left in place on the muscle as a single composite unit. This report describes an alternative approach in which the skin paddle is secondarily mobilized through subcutaneous undermining and rotated as a separate propeller-type local extension flap on random-pattern vascularization, without a specifically identified perforator—a technique that has not been previously reported. Case Presentation: A 38-year-old male with a high-energy distal lower-extremity defect exposing bone, Achilles tendon, and hardware underwent free latissimus dorsi reconstruction with an empirically designed skin paddle over the constant perforator zone. The skin paddle was subsequently mobilized and rotated as a separate propeller-type extension flap to cover the Achilles region, with additional areas managed using split-thickness skin graft and a reverse soleus flap. Results: The latissimus dorsi flap and skin paddle remained viable, providing stable coverage of the defect. The additional reverse soleus flap achieved durable medial coverage, and the limb was ultimately preserved with satisfactory soft-tissue stability. Conclusion: A random-pattern latissimus dorsi skin paddle designed within the anatomically constant perforator zone can provide a feasible new option offering intraoperative flexibility in complex lower-extremity trauma when perforator mapping is impractical. Full article

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22 pages, 4604 KB

Open AccessReview

Artificial Intelligence in Rare Diseases: Workflow-Integrated Precision Kidney Care

by Charat Thongprayoon, Francesco Pesce and Wisit Cheungpasitporn

Clin. Pract. 2026, 16(6), 101; https://doi.org/10.3390/clinpract16060101 - 27 May 2026

Abstract

Rare diseases affect over 300 million individuals worldwide yet remain underdiagnosed and poorly characterized due to fragmented data, small cohorts, and phenotypic heterogeneity. Advances in artificial intelligence (AI) are enabling integration of genomics, imaging, electronic health records, and patient-generated data to support diagnosis, [...] Read more.

Rare diseases affect over 300 million individuals worldwide yet remain underdiagnosed and poorly characterized due to fragmented data, small cohorts, and phenotypic heterogeneity. Advances in artificial intelligence (AI) are enabling integration of genomics, imaging, electronic health records, and patient-generated data to support diagnosis, phenotyping, prognosis, and therapeutic discovery. In kidney care, these capabilities are reflected in tools for genomic variant prioritization, AI-assisted histopathology, and integrated risk stratification models for rare and complex kidney diseases. This review synthesizes current AI applications across the rare disease continuum and proposes a clinically grounded framework to distinguish exploratory models from systems that are methodologically robust and operationally deployable. We highlight advances that address data sparsity and heterogeneity, alongside persistent challenges in validation, generalizability, equity, and workflow integration. Finally, we outline future directions, including federated learning, digital twins, and AI-driven clinical decision agents, as pathways toward precision-guided, workflow-integrated rare disease care. Full article

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

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20 pages, 615 KB

Open AccessArticle

A Pilot Study of Circulating microRNA Expression in Newly Diagnosed Type 2 Diabetes Using a Pooled Sample Approach

by Loredana Deaconu, Romulus Zorin Timar, Cristiane Dragomir, Edward Seclaman, Anca Marcu and Diana Nitusca

Clin. Pract. 2026, 16(6), 100; https://doi.org/10.3390/clinpract16060100 - 26 May 2026

Abstract

Background and Objectives: MicroRNAs (miRNAs) are small non-coding RNAs that regulate gene expression and have emerged as potential biomarkers in type 2 diabetes mellitus and its complications. This pilot exploratory study aimed to identify circulating miRNAs with differential expression in plasma from [...] Read more.

Background and Objectives: MicroRNAs (miRNAs) are small non-coding RNAs that regulate gene expression and have emerged as potential biomarkers in type 2 diabetes mellitus and its complications. This pilot exploratory study aimed to identify circulating miRNAs with differential expression in plasma from patients with newly diagnosed type 2 diabetes mellitus compared to age- and sex-matched healthy controls. Materials and Methods: Peripheral venous blood samples were collected from diabetic patients (n = 24) and controls (n = 12). Due to the exploratory nature of the study and limited sample material, samples were pooled within each group prior to plasma separation. Total RNA, including miRNAs, was extracted from plasma and analyzed using a high-throughput qPCR panel. Two normalization methods were applied to assess miRNA expression, and overlapping results were used for downstream analysis. Fold regulation was calculated using the 2^(−ΔCt) method. Results: A total of 33 and 42 miRNAs were identified as differentially expressed using the first and second normalization methods, respectively. Fourteen miRNAs were consistently downregulated across both methods. Several of these miRNAs, including hsa-miR-26a-5p, hsa-miR-146a-5p, hsa-miR-186-5p, hsa-miR-19a-3p, and hsa-miR-652-3p, have been previously associated with glucose metabolism, inflammation, and diabetic complications, such as retinopathy, neuropathy, and endothelial dysfunction. The pooling strategy enabled an efficient exploratory assessment of miRNA expression patterns while reducing inter-individual variability. Conclusions: This exploratory pilot study identifies a panel of circulating miRNAs with altered expression in pooled plasma samples from patients with newly diagnosed type 2 diabetes mellitus. These findings provide preliminary insights that warrant further validation in larger, individual-level studies to assess their diagnostic and prognostic potential. Full article

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Graphical abstract

10 pages, 1016 KB

Open AccessCase Report

Segmental Arterial Mediolysis Associated with Renal Allograft Artery Dissection and Thrombosis During Kidney Transplantation

by Matteo Zanchetta, Natale Calomino, Giuseppe Ietto, Vanessa Borgogni, Giorgio Micheletti, Sergio Antonio Tripodi, Daniele Marrelli, Franco Roviello and Gian Luigi Adani

Clin. Pract. 2026, 16(6), 99; https://doi.org/10.3390/clinpract16060099 - 24 May 2026

Abstract

Background: Segmental arterial mediolysis (SAM) is a rare, non-inflammatory, non-atherosclerotic, non-hereditary arteriopathy of unknown etiology that typically affects medium-sized visceral arteries. The absence of reliable diagnostic criteria poses a significant challenge. Consequently, the diagnosis of SAM should be considered in the setting [...] Read more.

Background: Segmental arterial mediolysis (SAM) is a rare, non-inflammatory, non-atherosclerotic, non-hereditary arteriopathy of unknown etiology that typically affects medium-sized visceral arteries. The absence of reliable diagnostic criteria poses a significant challenge. Consequently, the diagnosis of SAM should be considered in the setting of a distinctive combination of clinical features, angiographic findings, and histopathology. Renal artery involvement is uncommon, and its occurrence in the donor graft during kidney transplantation (KT) has not previously been reported. Case presentation: We report the case of a kidney graft from a deceased donor in her seventh decade of life, transplanted into a recipient in her seventh decade of life. Donor–recipient ABO compatibility was confirmed, and both complement-dependent cytotoxicity crossmatch and flow cytometry crossmatch were negative. Cold ischemia time was 14 h, and warm ischemia time was 20 min. Immediately after declamping, massive thrombosis of the graft renal artery was observed and confirmed using an intraoperative flowmeter. The arterial anastomosis was taken down, the thrombus was removed, the artery was flushed with heparin, and the anastomosis was reconstructed using interrupted sutures. Despite revision, no arterial flow was detected, and the graft was deemed unsalvageable and explanted. Histopathological examination showed thinning of the tunica media, reduced smooth muscle cells on desmin staining, medial-adventitial dissection, and occlusive thrombosis, findings considered likely attributable to SAM. Conclusions: This case suggests that occult donor arterial wall disease compatible with SAM may present catastrophically during KT and may lead to immediate graft loss despite standard surgical salvage attempts. Although no validated strategy currently exists to screen for or prevent occult SAM in asymptomatic donors, awareness of this entity may assist transplant surgeons and pathologists in the evaluation of unexplained early graft arterial thrombosis, donor-graft vascular pathology, and communication with centres receiving paired organs from the same donor. Full article

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12 pages, 602 KB

Open AccessArticle

Non-Invasive Monitoring of Hemodialysis Patients: Challenges and Benefits in the Real World

by Orsolya Sáfár, Viktor Horváth, Árpád Kézdi, Péter Kevei and Ákos Géza Pethő

Clin. Pract. 2026, 16(6), 98; https://doi.org/10.3390/clinpract16060098 - 22 May 2026

Abstract

Background: Cardiovascular complications are the leading cause of death in patients with end-stage renal disease (ESRD). Hemodialysis involves rapid electrolyte shifts and sudden fluid removal, which can affect ventricular repolarization and trigger arrhythmias in patients with ESRD. To enhance patient care, it [...] Read more.

Background: Cardiovascular complications are the leading cause of death in patients with end-stage renal disease (ESRD). Hemodialysis involves rapid electrolyte shifts and sudden fluid removal, which can affect ventricular repolarization and trigger arrhythmias in patients with ESRD. To enhance patient care, it is crucial to regularly assess cardiac function using noninvasive and painless methods, such as Holter electrocardiography (ECG) and routine cardiac ultrasound. These evaluations may inform improved prevention strategies to reduce the risk of elevated cardiovascular mortality rates. Methods: In total, 40 patients with ESRD on chronic hemodialysis (HD) were approached, and only 18 were enrolled from September 2024 to July 2025. Detailed medical information was provided, and written informed consent was obtained from the patient. The median duration of Holter ECG recording was 84.65 h, and cardiac ultrasound examinations were conducted. Blood gas samples were collected hourly during the second dialysis session. Results: Surprisingly, one-third of the patients opted to withdraw their consent for this painless investigation. No significant differences were observed in the QT and QTc intervals between the dialysis and non-dialysis days (p = 0.184 and p = 0.446, respectively). However, a significant increase was observed during the first 3 h of dialysis when analyzing the intradialytic period. Conclusion: Some patients showed clinically significant changes in QT and QTc intervals during treatment, which could not be confirmed statistically. Although we did not formulate a hypothesis, it is essential to recognize that patient compliance significantly influences the cardiovascular outcomes of individuals undergoing hemodialysis. Full article

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13 pages, 481 KB

Open AccessArticle

Changes in Coagulation Parameters and Metabolic Profile in Hospitalized Patients with Metabolic Dysfunction-Associated Steatohepatitis Receiving Vitamin K: A Retrospective Observational Study

by Magdalena Lixandru, George Maniu, Cosmin Ionut Lixandru and Florin Grosu

Clin. Pract. 2026, 16(5), 97; https://doi.org/10.3390/clinpract16050097 - 21 May 2026

Abstract

Background/Objectives: Metabolic dysfunction-associated steatohepatitis (MASH) is frequently accompanied by disturbances in coagulation and metabolic homeostasis, partly related to impaired handling of vitamin K-dependent pathways. Although vitamin K is often administered to correct abnormal coagulation tests, its biochemical impact in hospitalized patients with [...] Read more.

Background/Objectives: Metabolic dysfunction-associated steatohepatitis (MASH) is frequently accompanied by disturbances in coagulation and metabolic homeostasis, partly related to impaired handling of vitamin K-dependent pathways. Although vitamin K is often administered to correct abnormal coagulation tests, its biochemical impact in hospitalized patients with MASH remains insufficiently characterized. This study aimed to evaluate changes in coagulation and metabolic parameters in hospitalized patients with MASH receiving vitamin K supplementation. Methods: We conducted a retrospective study of 84 hospitalized MASH patients who received vitamin K supplementation. Biochemical parameters were recorded at admission and discharge to assess short-term changes during hospitalization. Results: Vitamin K supplementation was associated with modest changes in coagulation parameters, including reductions in PT, INR, and aPTT (e.g., PT decreased from 13.00 s to 11.00 s). Small numerical changes in transaminases, fasting glucose, and total cholesterol were observed during hospitalization, with limited clinical relevance. These patterns were comparable across fibrosis stages, with no significant differences between groups. Discussion: The observed biochemical findings are likely in-hospital factors rather than a direct metabolic effect of vitamin K. Conclusions: Vitamin K supplementation was associated with modest changes in coagulation parameters and small, clinically negligible variations in selected metabolic markers in patients with MASH, irrespective of fibrosis stage. These findings suggest a supportive biochemical effect in selected contexts; further prospective studies are needed to clarify their clinical relevance. Full article

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22 pages, 1336 KB

Open AccessSystematic Review

Effectiveness and Safety of Hormonal Treatments in Children with Growth Disorders: A Systematic Review of Clinical Evidence

by Isidro Miguel Martín Pérez and Sebastián Eustaquio Martín Pérez

Clin. Pract. 2026, 16(5), 96; https://doi.org/10.3390/clinpract16050096 - 20 May 2026

Abstract

Background: Growth disorders, including central precocious puberty and delayed puberty, can significantly affect linear growth, skeletal maturation, metabolic regulation, and psychosocial development during childhood and adolescence. This systematic review synthesizes the current evidence regarding the effectiveness and safety of hormone-based therapies used [...] Read more.

Background: Growth disorders, including central precocious puberty and delayed puberty, can significantly affect linear growth, skeletal maturation, metabolic regulation, and psychosocial development during childhood and adolescence. This systematic review synthesizes the current evidence regarding the effectiveness and safety of hormone-based therapies used in children with disorders of pubertal maturation. Methods: A PRISMA-guided systematic search was carried out between January 2016 and March 2026 in different databases, such as MEDLINE (PubMed), EMBASE, CENTRAL, Scopus, Web of Science, CINAHL, LILACS and OpenGrey; the protocol was previously registered in the PROSPERO database (CRD420251068048). Non-randomized, randomized controlled trials and observational research including participants aged 0–18 years receiving hormone therapies were eligible. Risk of bias was assessed using validated, design-specific tools. Results: Twenty studies involving 21,812 participants were included. GnRHa therapy improved final adult height (+3.5 to +4.5 cm) and reduced bone age advancement (−0.6 to −1.3 years) in children with central precocious puberty. rhGH therapy increased growth velocity (+3.0 to +5.0 cm/year) and height SDS (+0.3 to +0.9), particularly in idiopathic short stature and Prader–Willi syndrome. Combined GnRHa plus rhGH therapy showed greater short-term growth benefits than GnRHa alone. Both therapies showed favorable safety profiles, with predominantly mild adverse events and discontinuation rates below 2%. However, the evidence was limited by substantial heterogeneity and moderate-to-serious risk of bias. Conclusions: GnRHa and rhGH therapies are generally effective and safe for improving growth and pubertal outcomes in pediatric endocrine disorders. However, further long-term studies are needed to clarify their metabolic and psychosocial effects in adulthood. Nevertheless, these conclusions should be interpreted with caution due to the study’s moderate-to-serious risk of bias and heterogeneity. Full article

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10 pages, 3517 KB

Open AccessCase Report

Intestinal Neuronal Dysplasia Type B as Rare Organic Cause of Refractory Constipation in Adults: A Case Report and Literature Review

by Rosana Troskot Perić, Branko Bakula, Nensi Orlandini, Tomislav Pavlović, Mato Perić and Gabrijela Stanić

Clin. Pract. 2026, 16(5), 95; https://doi.org/10.3390/clinpract16050095 - 20 May 2026

Abstract

Background: Intestinal neuronal dysplasia type B is an entity characterized by disturbances in the enteric plexus, it most often occurs in childhood and can appear as an isolated disease or in combination with other neuropathies. The main symptoms are chronic constipation and intestinal [...] Read more.

Background: Intestinal neuronal dysplasia type B is an entity characterized by disturbances in the enteric plexus, it most often occurs in childhood and can appear as an isolated disease or in combination with other neuropathies. The main symptoms are chronic constipation and intestinal obstruction. Case presentation: This paper presents the diagnostic work-up of a 40-year-old patient who was referred to a tertiary center due to refractory chronic constipation. A diagnosis of intestinal neuronal dysplasia type B was made after a surgical procedure based on pathohistological findings. Discussion: In a further multi-year follow-up, the patient was symptom-free with regular bowel movements, with a significant quality of life improvement. Conclusion: This confirmed that the chosen type of surgical procedure was appropriate. Full article

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13 pages, 2739 KB

Open AccessArticle

OSCAR-Assessing Individual Risk Profiles of MRONJ Patients

by Felix Pitka and Florian Böhrnsen

Clin. Pract. 2026, 16(5), 94; https://doi.org/10.3390/clinpract16050094 - 19 May 2026

Abstract

Objective: To develop an individual assessment for patients suffering from medication-related osteonecrosis of the jaw (MRONJ), we developed a scoring system that integrates anamnestic, clinical, and radiological parameters to facilitate the process of therapeutic decisions during MRONJ therapy. Methods: In this study, clinical [...] Read more.

Objective: To develop an individual assessment for patients suffering from medication-related osteonecrosis of the jaw (MRONJ), we developed a scoring system that integrates anamnestic, clinical, and radiological parameters to facilitate the process of therapeutic decisions during MRONJ therapy. Methods: In this study, clinical data as well as diagnostic CT scans from 41 MRONJ patients undergoing antiresorptive therapy were analyzed to develop an Osteonecrosis Scoring Clinical Assessment and Radiological Report (OSCAR). Results: Total OSCAR scores ranged from 4 to 30, with lower scores demonstrating less severe disease progression following a de-escalated therapy. OSCAR scores above 15 were associated with higher bone density and an increased need for surgical intervention, with 70% of Denosumab and 71% of bisphosphonate patients requiring surgical intervention. Conclusions: Patients with an OSCAR below 12 were unlikely to require multiple surgical interventions. Since OSCAR parameters are routinely collected during hospitalization, this opens the possibility for future AI-assisted patient assessment and treatment planning. Full article

(This article belongs to the Section Dentistry and Oral Medicine)

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15 pages, 1467 KB

Open AccessReview

A Clinical Decision Support System for Post-Surgical Cardiovascular Remote Monitoring

by Charalampia Pylarinou, Francesk Mulita, Efstratios Koletsis, Vasileios Leivaditis, Elias Liolis, Lefteris Gortzis and Dimosthenis Mavrilas

Clin. Pract. 2026, 16(5), 93; https://doi.org/10.3390/clinpract16050093 - 15 May 2026

Abstract

Background: Post-surgical cardiovascular monitoring places a heavy information burden on clinical teams, requiring the rapid synthesis of patient history, intraoperative data, monitoring streams, and surgical outcome evidence. Existing clinical decision support systems handle this integration poorly, and most offer little visibility into their [...] Read more.

Background: Post-surgical cardiovascular monitoring places a heavy information burden on clinical teams, requiring the rapid synthesis of patient history, intraoperative data, monitoring streams, and surgical outcome evidence. Existing clinical decision support systems handle this integration poorly, and most offer little visibility into their reasoning. We present a Retrieval-Augmented Generation (RAG) architecture designed specifically for this domain, with a focus on evidence traceability and practical workflow integration. Methods: We describe a three-layer RAG architecture comprising a retrieval layer that creates 768-dimensional representations of clinical scenarios; an augmentation layer using a stacking ensemble (Random Forest and XGBoost base learners with a logistic-regression meta-learner) to integrate patient-specific data with retrieved evidence and produce calibrated probability estimates; and a generative layer using a fine-tuned BERT classifier together with Gemini 2.5 Pro to synthesise actionable clinical recommendations. Components were prototyped on publicly available, de-identified data from MIMIC-III and the MIMIC-III-Ext-PPG benchmark to verify pipeline integrity. Proposed Evaluation Framework: This paper presents a system architecture rather than a clinically validated implementation. We outline a structured evaluation framework to assess the technical performance and clinical applicability of the RAG architecture, encompassing the technical validation of system components, expert assessment of clinical workflow integration potential, and analysis of interpretability features essential for healthcare deployment. Specific technical targets include retrieval precision >90% for relevant evidence, query response time <3 s, and a clinical appropriateness rating of >85% from expert review. Conclusions: We describe a RAG architecture for post-surgical cardiovascular monitoring in which every recommendation is linked to retrievable source documents, making the reasoning visible and challengeable. A structured evaluation framework is proposed to guide the system towards clinical validation. Full article

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12 pages, 496 KB

Open AccessSystematic Review

An Update on Umbilical Cord Abnormalities and Associated Thrombosis: A Systematic Review

by Marco La Verde, Eleonora Braca, Antonio Cerillo, Maria Fatigati, Pasquale De Franciscis, Davide Pisani, Mario Fordellone, Mariavictoria De Simone, Carlo Pietro Campobasso and Alessandro Feola

Clin. Pract. 2026, 16(5), 92; https://doi.org/10.3390/clinpract16050092 - 14 May 2026

Abstract

Background and objective: Umbilical cord abnormalities (UCAs) such as hypercoiling, velamentous or marginal cord insertion, or reduced Wharton’s jelly are associated with umbilical thrombosis. UCAs increase the risk of vascular obstruction and impaired fetal blood flow, resulting in hypoxia or stillbirth. We [...] Read more.

Background and objective: Umbilical cord abnormalities (UCAs) such as hypercoiling, velamentous or marginal cord insertion, or reduced Wharton’s jelly are associated with umbilical thrombosis. UCAs increase the risk of vascular obstruction and impaired fetal blood flow, resulting in hypoxia or stillbirth. We examined the association between the UCAs and the umbilical cord thrombosis. Methods: According to PRISMA, five electronic databases (PubMed, Scopus, Embase, Cochrane Library, and Clinicaltrial.gov) were screened. Only studies that analyzed umbilical cord insertion abnormalities and abnormalities of the umbilical cord associated with thrombosis were included in this systematic review. Studies without thrombosis were excluded (PROSPERO ID: CRD420251087525). Results: Only 12 articles out of 1105 screened records satisfied the inclusion criteria, comprising 3 retrospective cohort studies, 3 case series and 6 case reports. The publication years ranged from 1983 to 2025. A total of 126 cases of umbilical vascular thromboembolism (UVTE) were identified, among which 84 cases of UCAs represented by 16 cases of stricture, 14 cases of hypercoiling, 16 cases of too-short cords (≤40 cm), 11 cases of too-long cords (≥70 cm), 5 cases of velamentous or furcate cord insertions, 12 cases of nuchal cord insertions, 13 cases of funistisis, 11 cases of true knots, and 3 cases of Wharton jelly abnormalities. Conclusions: UCAs, including true knots, abnormal coiling, and furcate or velamentous cord insertion, were highly associated with UVTE. Future studies should involve developing standardized criteria for the diagnosis and reporting of UCAs. Full article

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

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