Clinics and Practice

12 pages, 1131 KiB

Open AccessArticle

Characteristics, Management, and Outcomes of Acute Life-Threatening Asthma in Adult Intensive Care

by Adam J. R. Watson, Thomas Roe, Oliver Arscott, Charlotte Thomas, James Ward, Ryan Beecham, David Browning, Kordo Saeed and Ahilanandan Dushianthan

Clin. Pract. 2024, 14(5), 1886-1897; https://doi.org/10.3390/clinpract14050149 - 12 Sep 2024

Abstract

Background: There is limited evidence regarding the management of acute life-threatening asthma in intensive care units (ICUs), and few guidelines have details on this. We aimed to describe the characteristics, management, and outcomes of adults with life-threatening asthma requiring ICU admission. Methods: In [...] Read more.

Background: There is limited evidence regarding the management of acute life-threatening asthma in intensive care units (ICUs), and few guidelines have details on this. We aimed to describe the characteristics, management, and outcomes of adults with life-threatening asthma requiring ICU admission. Methods: In this single-centre retrospective observational study, we included consecutive adults with acute asthma requiring ICU admission between 1 January 2016 and 31 December 2023. Our primary outcome was requirement for invasive mechanical ventilation (IMV). Results: We included 100 patients (median age 42.5 years, 67% female). The median pH, PaCO₂, and white cell count (WCC) on ICU admission were 7.37, 39 mmHg, and 13.6 × 109/L. There were 30 patients (30%) who required IMV, and the best predictors of IMV requirement were pH (AUC 0.772) and PaCO₂ (AUC 0.809). In univariate analysis, IMV requirement was associated with both increasing WCC (OR 1.14) and proven bacterial infection (OR 8.50). A variety of respiratory support strategies were utilised, with 38 patients (38%) receiving only non-invasive respiratory support. Conclusions: Our data highlight key characteristics which may be risk factors for acute asthma requiring ICU admission and suggest that pH, PaCO₂, and WCC are prognostic markers for disease severity. Our overall outcomes were good, with an IMV requirement of 30% and a 28-day mortality of 1%. Full article

(This article belongs to the Special Issue 2024 Feature Papers in Clinics and Practice)

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17 pages, 282 KiB

Open AccessReview

Thoracic Trauma: Current Approach in Emergency Medicine

by Giorgia Caputo, Stefano Meda, Andrea Piccioni, Angela Saviano, Veronica Ojetti, Gabriele Savioli, Gaia Bavestrello Piccini, Chiara Ferrari, Antonio Voza, Lavinia Pellegrini, Miriam Ottaviani, Federica Spadazzi, Gianpietro Volonnino and Raffaele La Russa

Clin. Pract. 2024, 14(5), 1869-1885; https://doi.org/10.3390/clinpract14050148 - 10 Sep 2024

Abstract

Chest trauma is the leading cause of death in people under 40. It is estimated to cause around 140,000 deaths each year. The key aims are to reduce mortality and the impact of associated complications to expedite recovery and to restore patient’s conditions. [...] Read more.

Chest trauma is the leading cause of death in people under 40. It is estimated to cause around 140,000 deaths each year. The key aims are to reduce mortality and the impact of associated complications to expedite recovery and to restore patient’s conditions. The recognition of lesions through appropriate imaging and early treatment already in the emergency department are fundamental. The majority can be managed in a non-surgical way, but especially after traumatic cardiac arrest, a surgical approach is required. One of the most important surgical procedures is the Emergency Department Thoracotomy (EDT). The aim of this review is to provide a comprehensive synthesis about the management of thoracic trauma, the surgical procedures, accepted indications, and technical details adopted during the most important surgical procedures for different thoracic trauma injuries. Literature from 1990 to 2023 was retrieved from multiple databases and reviewed. It is also important to emphasize the medico-legal implications of this type of trauma, both from the point of view of collaboration with the judicial authority and in the prevention of any litigation. Full article

27 pages, 639 KiB

Open AccessSystematic Review

Comparing the Effectiveness of Open and Minimally Invasive Approaches in Coronary Artery Bypass Grafting: A Systematic Review

by Arwa Alsharif, Abdulaziz Alsharif, Ghadah Alshamrani, Abdulhameed Abu Alsoud, Rowaida Abdullah, Sarah Aljohani, Hawazen Alahmadi, Samratul Fuadah, Atheer Mohammed and Fatma E. Hassan

Clin. Pract. 2024, 14(5), 1842-1868; https://doi.org/10.3390/clinpract14050147 (registering DOI) - 10 Sep 2024

Abstract

Coronary artery bypass grafting (CABG) is an essential operation for patients who have severe coronary artery disease (CAD). Both open and minimally invasive CABG methods are used to treat CAD. This in-depth review looks at the latest research on the effectiveness of open [...] Read more.

Coronary artery bypass grafting (CABG) is an essential operation for patients who have severe coronary artery disease (CAD). Both open and minimally invasive CABG methods are used to treat CAD. This in-depth review looks at the latest research on the effectiveness of open versus minimally invasive CABG. The goal is to develop evidence-based guidelines that will improve surgical outcomes. This systematic review used databases such as PubMed, MEDLINE, and Web of Science for a full electronic search. We adhered to the PRISMA guidelines and registered the results in the PROSPERO. The search method used MeSH phrases and many different study types to find papers. After removing duplicate publications and conducting a screening process, we collaboratively evaluated the full texts to determine their inclusion. We then extracted data, including diagnosis, the total number of patients in the study, clinical recommendations from the studies, surgical complications, angina recurrence, hospital stay duration, and mortality rates. Many studies that investigate open and minimally invasive CABG methods have shown that the type of surgery can have a large effect on how well the patient recovers and how well the surgery works overall. While there are limited data on the possible advantages of minimally invasive CABG, a conclusive comparison with open CABG is still dubious. Additional clinical trials are required to examine a wider spectrum of patient results. Full article

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15 pages, 982 KiB

Open AccessArticle

Comparative Perceptions of Fluoride Toxicity in Oral Hygiene Products: Insights from the General Population and Healthcare Professionals

by Marija Badrov, Lidia Gavic, Ana Seselja Perisin, Davor Zeljezic, Jasen Vladislavic, Ema Puizina Mladinic and Antonija Tadin

Clin. Pract. 2024, 14(5), 1827-1841; https://doi.org/10.3390/clinpract14050146 - 5 Sep 2024

Abstract

Background: The safety of oral hygiene products is a growing concern, particularly regarding the toxicity of specific ingredients used in their formulations. The purpose of this study was to evaluate the knowledge and attitudes of dentists, physicians, pharmacists, and the general public regarding [...] Read more.

Background: The safety of oral hygiene products is a growing concern, particularly regarding the toxicity of specific ingredients used in their formulations. The purpose of this study was to evaluate the knowledge and attitudes of dentists, physicians, pharmacists, and the general public regarding ingredients in oral hygiene products, especially fluoride. Additionally, this study aimed to identify which ingredients may exhibit potential toxicity based on historical records of any adverse effects being induced by a material/component. Methods: A self-administered questionnaire was used in an online cross-sectional observational study to collect data on sociodemographic characteristics, knowledge of fluoride in dental medicine, fluoride usage practices in oral hygiene products, opinions on ingredient toxicity in oral hygiene products, and personal experiences of adverse reactions to products and their components. The collected data underwent descriptive and regression analyses to reveal patterns and relationships within the dataset. Results: The study found a moderate overall knowledge level regarding fluoride usage in dentistry among participants (Md = 5.00, IQR 2.50–7.00). Healthcare professionals exhibited significantly higher knowledge scores compared to the general population (p ≤ 0.001), with dental professionals displaying the highest scores. Regarding concerns about the usage of fluoride, the majority of respondents (77.0%) did not express any concerns. Minor concerns included the risk of ingestion (6.0%) and dental fluorosis (4.6%). Among the other ingredients in oral hygiene products, respondents named alcohol as the most toxic ingredient (70.3%), followed by artificial colors (53.1%), artificial sweeteners (50.4%), and parabens (50.1%). It is noteworthy that the majority of participants (61.6%) stated that they had never experienced any side effects associated with the use of oral hygiene products. Conclusion: This study underscores disparities in fluoride knowledge between healthcare professionals and the general population in Croatia, with dental experts exhibiting a superior understanding. Despite lingering misconceptions about fluoride content and potential toxicity, the majority of participants acknowledge its oral health benefits and use fluoride products regularly. Full article

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9 pages, 2967 KiB

Open AccessReview

Electric Scooter Falls: The 2023–2024 Experience in the Clinical Emergency Children’s Hospital in Galați

by Cristina-Mihaela Popescu, Virginia Marina, Floriana Popescu and Andreea Oprea

Clin. Pract. 2024, 14(5), 1818-1826; https://doi.org/10.3390/clinpract14050145 - 4 Sep 2024

Abstract

(1) Introduction: Since electric scooters were launched in 2017, they have become increasingly popular worldwide and a cause of childhood trauma. (2) Case reports: This paper has a double-fold purpose: it reports two cases of epidural hematomas and compares them with electric scooter-related [...] Read more.

(1) Introduction: Since electric scooters were launched in 2017, they have become increasingly popular worldwide and a cause of childhood trauma. (2) Case reports: This paper has a double-fold purpose: it reports two cases of epidural hematomas and compares them with electric scooter-related head trauma in the literature. An overview of the literature on this topic was performed to make such a comparison. Our cases are one of almost 52 cm³ and one of 129 cm^3, both in two eight-year-olds. (3) Discussion: Although usually mild, traumatic brain injuries following e-scooter falls can also be moderate and severe. Reduced helmet use, high speed, and a lack of experience are the perfect set-up for potential severe injuries. Intracranial bleeds are not frequent, and epidural hematomas are rare in such cases, but they can significantly impact the individual, community, and healthcare system. No other medium- or large-sized epidural hematomas were reported in children sustaining electric scooter-related head trauma. (4) Conclusions: Our review parallels the literature and our hospital’s experience. Although there are both similarities and discrepancies between our cases and the literature, mild trauma should not be disregarded, for it may hide serious complications requiring immediate surgery. Full article

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17 pages, 1295 KiB

Open AccessArticle

Is It Possible to Prevent the Thanatogenetic Processes in Premature Babies?

by Sinziana Andra Ghitoi, Mariana Deacu, Mariana Aschie, Manuela Enciu, Anca Florentina Mitroi, Georgeta Camelia Cozaru, Antonela Anca Nicolau, Cristian Ionut Orasanu, Oana Andreea Ursica and Raluca Ioana Voda

Clin. Pract. 2024, 14(5), 1801-1817; https://doi.org/10.3390/clinpract14050144 - 2 Sep 2024

Abstract

Preterm births comprise all pregnancies coming to an end before the gestational age of 37 weeks and remain the leading cause of death in children under 5 years old despite efforts to reduce their occurrence. We aim to analyze all morbidity and mortality [...] Read more.

Preterm births comprise all pregnancies coming to an end before the gestational age of 37 weeks and remain the leading cause of death in children under 5 years old despite efforts to reduce their occurrence. We aim to analyze all morbidity and mortality data to understand causes and risk factors, helping in prevention efforts. This study includes 140 cases collected during 2018–2022. Demographic, maternal, and thanatogenetic data were statistically analyzed. We observed an upward slope of stillborn babies. In the case of live-born premature, the average survival was 301.76 h. The multivariate analysis noted that extremely low birth weight (HR = 5.141) and very low birth weight (HR = 4.177) are risk factors involved in mortality. Increased parity was associated with premature births with low and very low birth weight (p = 0.019). We observed that a mother’s age of over 30 years is predictable for the development of pregnancy-induced hypertension. Cerebral and pulmonary hemorrhages were the most common intermediate morbid conditions, with prematurity and plurivisceral hemorrhages serving as their root causes. We have identified that anthropometric measurements have a high predictability on malformed babies. The identified associations indicate a shared mechanism for certain lesion processes, which can help optimize resources for predicting and preventing preterm neonatal issues. Full article

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11 pages, 253 KiB

Open AccessArticle

Robotic-Assisted Radical Cystectomy: Single-Center Analysis of Factors Impacting Clavien ≥ II Complications

by Maria Chiara Sighinolfi, Tommaso Calcagnile, Enrico Panio, Simone Assumma, Luca Sarchi, Marco Sandri, Emanuela Santangelo, Michele Petix, Mattia Sangalli, Filippo Turri, Giorgio Bozzini, Marcio Covas Moschovas, Vipul Patel and Bernardo Rocco

Clin. Pract. 2024, 14(5), 1790-1800; https://doi.org/10.3390/clinpract14050143 - 31 Aug 2024

Abstract

Despite the advent of robotics and the decreasing rate of complications after radical cystectomy, several factors are renowned to impair the early outcomes of this procedure. The aim of this paper is to provide a multivariate analysis (MVA) of patient and surgical procedure-related [...] Read more.

Despite the advent of robotics and the decreasing rate of complications after radical cystectomy, several factors are renowned to impair the early outcomes of this procedure. The aim of this paper is to provide a multivariate analysis (MVA) of patient and surgical procedure-related variables likely to affect postoperative course and 30-day complication rate. Fifty-five robotic-assisted radical cystectomies (RARCs) performed at a single center from July 2021 to March 2023 were enrolled. Baseline demographics, comorbidities, and intraoperative and postoperative data were collected. Uni- and multivariate analyses were performed to evaluate the relationship with Clavien ≥ II complications arising within 30 days of surgery. A postoperative Clavien ≥ II complication was evident in 15 patients (28%), whereas Clavien ≥ III occurred only in 5 (9%). At MVA, the only independent predictor of Clavien ≥ II complications was a prior neoadjuvant chemotherapy (OR 5.6; 95% CI 1.22–25.3, p = 0.026). Recognized the small sample size, patients who received a prior NAC should deserve special care within the postoperative course. Full article

(This article belongs to the Special Issue 2023 Feature Papers in Clinics and Practice)

11 pages, 241 KiB

Open AccessArticle

Demographic Profile and Clinical Characteristics of Adults with Down Syndrome in North-Eastern Romania

by Nicoleta Lefter, Irina Mihaela Abdulan, Alexandra Maștaleru, Maria-Magdalena Leon and Cristina Rusu

Clin. Pract. 2024, 14(5), 1779-1789; https://doi.org/10.3390/clinpract14050142 - 30 Aug 2024

Abstract

(1) Background: Down syndrome is characterized by physical abnormalities, intellectual disability (ID), and specific patterns of other health issues. Additionally, individuals with DS are known to experience premature aging and early onset of certain age-related medical conditions. These conditions are linked to higher [...] Read more.

(1) Background: Down syndrome is characterized by physical abnormalities, intellectual disability (ID), and specific patterns of other health issues. Additionally, individuals with DS are known to experience premature aging and early onset of certain age-related medical conditions. These conditions are linked to higher incident disability and reduced survival rates compared to the general population. (2) Methods: Between July 2022 and February 2024, we conducted a prospective, observational study in the Cardiovascular Rehabilitation Clinic at Iasi Clinical Rehabilitation Hospital. The study included 28 patients diagnosed with Down Syndrome and a control group. Interdisciplinary interventions were tailored to address the needs of a complex patient, incorporating cardiological, endocrinological, genetical, biological and developmental support. Data on physical health, cognitive development, and psychosocial well-being were collected. (3) Results: Our DS group consisted of 11 (39%) females and 17 (61%) males. Their age ranged from 20 to 55 years with a mean of 28.07 ± 9.51. All patients were unmarried, living in urban areas, without a partner but with family support. In the study sample, 96.4% of participants had three or more comorbidities. (4) Conclusions: The high prevalence of multimorbidity, combined with little medication, contributes to a high level of clinical complexity, which appears to be similar to the one of the older non-trisomic population. As individuals with Down syndrome transition into adulthood, they may require a more comprehensive and holistic approach to their healthcare. Full article

12 pages, 1332 KiB

Open AccessArticle

Electrolyte Imbalance in Acute Traumatic Brain Injury: Insights from the First 24 h

by Alina Săcărescu and Mihaela-Dana Turliuc

Clin. Pract. 2024, 14(5), 1767-1778; https://doi.org/10.3390/clinpract14050141 - 30 Aug 2024

Abstract

Background/Objectives: Electrolyte disturbances are common in patients with traumatic brain injury (TBI), particularly affecting sodium, potassium, chloride, and calcium levels. This study aims to provide insights into these disturbances within the first 24 h post-injury. Methods: We conducted a cross-sectional analysis of 50 [...] Read more.

Background/Objectives: Electrolyte disturbances are common in patients with traumatic brain injury (TBI), particularly affecting sodium, potassium, chloride, and calcium levels. This study aims to provide insights into these disturbances within the first 24 h post-injury. Methods: We conducted a cross-sectional analysis of 50 TBI patients, excluding those with conditions affecting electrolyte balance. Electrolyte levels were measured, and correlations with demographic data, trauma mechanisms, imaging findings, and Glasgow Coma Scale (GCS) scores were analyzed. Results: The results indicated that chloride levels inversely correlated with GCS scores (ρ = −0.515; p = 0.002), suggesting that elevated chloride may indicate severe neurological impairment. Potassium levels were significantly associated with subdural hematoma (p = 0.032) and subarachnoid hemorrhage (p = 0.043), highlighting their potential as markers for severe brain injuries. No significant associations were found between sodium or calcium levels and the studied variables. Conclusions: These findings underscore the importance of early monitoring of chloride and potassium levels in TBI patients to improve management and outcomes. Future research should focus on larger, multi-center studies to validate these findings and develop comprehensive guidelines for managing electrolyte imbalances in TBI patients. Full article

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14 pages, 1541 KiB

Open AccessArticle

A Survey of Practice and Factors Affecting Physiotherapist-Led Health Promotion for People at Risk or with Cardiovascular Disease in Cameroon

by Etienne Ngeh Ngeh, Sionnadh McLean, Christopher Kuaban, Rachel Young and Joanne Lidster

Clin. Pract. 2024, 14(5), 1753-1766; https://doi.org/10.3390/clinpract14050140 - 29 Aug 2024

Abstract

Background: Cardiovascular diseases (CVDs) and associated risk factors are a growing concern in Cameroon. Physiotherapists (PTs) can play a crucial role in prevention and management. However, the extent of Cameroonian PT involvement in health promotion (HP) activities remains unclear. This study assessed Cameroonian [...] Read more.

Background: Cardiovascular diseases (CVDs) and associated risk factors are a growing concern in Cameroon. Physiotherapists (PTs) can play a crucial role in prevention and management. However, the extent of Cameroonian PT involvement in health promotion (HP) activities remains unclear. This study assessed Cameroonian physiotherapists’ current HP practices for people at risk of or with CVDs (pwCVDs). Methods: A cross-sectional survey was administered online to PTs practising in Cameroon. Results: Out of 181 PT responses, 95% reported providing a variety of HP activities, including weight management (74%), dietary advice (73%), physical activity (69%), smoking cessation (69%), stress management (61%), and sleep promotion (48%). While PTs were confident in lifestyle assessments, they felt less confident about sleep interventions. Strong beliefs, confidence, team support, and time allocation enhanced HP practice. However, preference for passive modalities, patient adherence issues, organisational challenges, role ambiguity among healthcare providers, inadequate training opportunities, and the absence of established guidelines for CVD prevention negatively affect HP practice. Conclusions: These findings highlight the challenges and opportunities for enhancing HP delivery within the physiotherapy profession in Cameroon. The findings are useful for future strategies by clinical practitioners and policy makers to address barriers and leverage facilitators effectively for scaling up HP initiatives in Cameroon. Full article

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9 pages, 941 KiB

Open AccessArticle

Disciplinary Imbalances in Urology and Gynecology Research Publications within Functional Urology

by Sümeyye Kozan, Mohammad Sajjad Rahnamai, Jasmin Ataei, Janina Dombrowski and Laila Najjari

Clin. Pract. 2024, 14(5), 1744-1752; https://doi.org/10.3390/clinpract14050139 - 29 Aug 2024

Abstract

(1) Background: This study aimed to quantify and evaluate the publication rate and discrepancies of functional urology abstracts from international conferences, and to explore the interdisciplinary contributions of urology and gynecology to the field. (2) Methods: A retrospective bibliometric and content analysis was [...] Read more.

(1) Background: This study aimed to quantify and evaluate the publication rate and discrepancies of functional urology abstracts from international conferences, and to explore the interdisciplinary contributions of urology and gynecology to the field. (2) Methods: A retrospective bibliometric and content analysis was conducted on abstracts presented between 2015 and 2019 at the EAU and ICS congresses, focusing on functional-urological keywords. A discrepancy scoring system ranging from 0 (minor discrepancies) to 3 (significant discrepancies) assessed the consistency between conference abstracts and full-text publications, and an in-depth analysis determined the disciplinary origin of these publications. (3) Results: Between 2015 and 2019, 53% of EAU and 57% of ICS congress abstracts were published as full-text articles, with minor discrepancies in 38% of EAU and 49% of ICS publications, and significant discrepancies in 17% from both. Urology departments dominated publications, contributing 68% at EAU and 55% at ICS, whereas gynecology contributed only 1% at EAU and 12% at ICS. (4) Conclusions: This study illuminates the need for improved reporting standards and interdisciplinary collaboration in functional urology, as well as increased gynecology research in functional urology-related fields, suggesting that addressing these issues is crucial for advancing the field and enhancing patient care. Full article

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7 pages, 2296 KiB

Open AccessTechnical Note

A Safety-Centric Study on the Use of Inflatable Abdominal Binders for Managing Orthostatic Hypotension

by Milan Toma, Rejath Jose, Faiz Syed and Timothy Devine

Clin. Pract. 2024, 14(5), 1737-1743; https://doi.org/10.3390/clinpract14050138 - 29 Aug 2024

Abstract

The study focuses on the design and evaluation of inflatable abdominal binders for managing Orthostatic Hypotension. Orthostatic hypotension is a condition characterized by a significant drop in blood pressure when a person stands up, leading to symptoms such as dizziness, lightheadedness, and even [...] Read more.

The study focuses on the design and evaluation of inflatable abdominal binders for managing Orthostatic Hypotension. Orthostatic hypotension is a condition characterized by a significant drop in blood pressure when a person stands up, leading to symptoms such as dizziness, lightheadedness, and even fainting. The management of orthostatic hypotension typically involves a combination of pharmacological and non-pharmacological strategies. In the context of this research, an inflatable abdominal binder was designed, leveraging components that are not only economically viable but also easily obtainable. The evaluation of this device was conducted using a medical education manikin, specifically the CAE iStan manikin. The results demonstrated a correlation between the inflation values of the belt and the resulting pressure values exerted on the body. The general recommendation for an abdominal binder is to exert a pressure of 20–40 mmHg. Contrary to this, the study found that to maintain safe external pressure on the abdomen, the binder should not be inflated over 25 mmHg. This safety threshold was used as a reference point in the study, suggesting a potential need to revisit the standard recommendations for abdominal binder pressure. Further research is needed to assess the device’s effectiveness in human subjects and to potentially redefine the safe and effective pressure range for abdominal binders. Full article

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21 pages, 4127 KiB

Open AccessArticle

Accelerated Orthodontics: A Descriptive Bibliometric Analysis of the Top 50 Cited Articles from 2012 to 2023

by Ahmed A. Alsulaiman and Osama A. Alsulaiman

Clin. Pract. 2024, 14(5), 1716-1736; https://doi.org/10.3390/clinpract14050137 - 29 Aug 2024

Abstract

Background and Objectives: Accelerated orthodontics represents a significant shift in dental practice aimed at reducing treatment times while maintaining optimal patient outcomes. This bibliometric analysis evaluated the research landscape of accelerated orthodontics from 2012 to 2023, focusing on publication trends, citation patterns, influential [...] Read more.

Background and Objectives: Accelerated orthodontics represents a significant shift in dental practice aimed at reducing treatment times while maintaining optimal patient outcomes. This bibliometric analysis evaluated the research landscape of accelerated orthodontics from 2012 to 2023, focusing on publication trends, citation patterns, influential journals, leading institutions, and key contributors. Materials and Methods: A comprehensive search in Scopus identified 600 relevant articles, with the top 50 most-cited papers encompassing systematic reviews, randomized controlled trials, and experimental studies. Key techniques, such as corticotomy and piezocision, have been frequently highlighted for their effectiveness in expediting tooth movement. Results: The analysis revealed fluctuating annual scientific outputs, with notable peaks driven by technological advancements and increased patient demand for quicker orthodontic solutions. However, the production of high-impact papers was hindered by delays in citation accumulation and disruptions caused by the COVID-19 pandemic. Keyword analysis identified critical themes, such as orthodontic tooth movement, malocclusion, and demographic factors, while a global collaboration map underscored extensive international research partnerships. Leading journals included the American Journal of Orthodontics and Dentofacial Orthopedics, and prominent institutions such as the University of California at Los Angeles played significant roles in advancing the field. Conclusions: This study provides a comprehensive overview of the current state of accelerated orthodontics, emphasizing the need for continued research, particularly RCTs, to further refine and validate accelerated orthodontic techniques and improve clinical outcomes. Full article

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

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9 pages, 1650 KiB

Open AccessBrief Report

Hard and Soft Tissue Facial Landmarks for Mandibular Angle Reduction: A Clinical Study

by Fei-Fan Tseng, Yu-Hsuan Li and Yuan-Wu Chen

Clin. Pract. 2024, 14(5), 1707-1715; https://doi.org/10.3390/clinpract14050136 - 27 Aug 2024

Abstract

Background: Square faces, which are influenced by genetic factors and structural features, are considered undesirable among the Asian population. Surgical interventions, such as mandibular angle reduction, aim to alter these characteristics, though complications may arise. We aimed to investigate the morphology of the [...] Read more.

Background: Square faces, which are influenced by genetic factors and structural features, are considered undesirable among the Asian population. Surgical interventions, such as mandibular angle reduction, aim to alter these characteristics, though complications may arise. We aimed to investigate the morphology of the mandibular angle and masseter muscle thickness using computed tomography (CT) and to analyze hard and soft tissue correlations to enhance surgical outcomes for patients with square faces. Methods: This retrospective clinical study included 100 Taiwanese patients aged 18–50 years. CT was used to analyze key clinical parameters, including bilateral mandibular width, mandibular divergence angle, ramus height, distance from the mandibular angle to the inferior alveolar nerve (IAN), and the thickness of the masseter muscle. Results: Significant correlations were noted between the patients’ physical height and weight, mandibular width, ramus height, masseter thickness, and distance from the angle to the IAN. Males exhibited a significantly longer and thicker ramus height (66.48 ± 4.28 mm), greater masseter thickness (15.46 ± 2.35 mm), and greater safety range for mandibular angle reduction surgery (18.35 ± 3.19 mm) (p < 0.00008). Significant correlations were observed among all parameters, except between mandibular width and gonial angle and the distance from the angle to the IAN and between mandibular divergence and masseter muscle thickness (p > 0.1). Conclusions: Our study highlighted the complex interplay among factors that contribute to square facial morphology. Careful preoperative assessments and customized surgical planning are essential for addressing this multifaceted clinical challenge. Full article

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11 pages, 804 KiB

Open AccessArticle

Assessing the Role of Adalimumab in Treating Hidradenitis Suppurativa: Findings from a Retrospective Study at a Reference Center

by Austėja Šakaitytė, Inga Česnavičiūtė and Tadas Raudonis

Clin. Pract. 2024, 14(5), 1696-1706; https://doi.org/10.3390/clinpract14050135 - 27 Aug 2024

Abstract

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by inflammatory lesions, often leading to scarring. Managing HS can be difficult, requiring biological therapy, specifically adalimumab. Methods: A retrospective study was conducted on patients diagnosed with HS and treated with the [...] Read more.

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by inflammatory lesions, often leading to scarring. Managing HS can be difficult, requiring biological therapy, specifically adalimumab. Methods: A retrospective study was conducted on patients diagnosed with HS and treated with the TNF-α inhibitor adalimumab. Data from 21 patients were included in this study. International Hidradenitis Suppurativa Severity Score System (IHS4); Dermatology Life Quality Index (DLQI); pain intensity according to the Visual Analogue Scale (VAS); and number of nodules, abscesses, and fistulas were assessed. Results: Notably, 47.62% of patients achieved Hidradenitis Suppurativa Clinical Response. The mean number of inflamed nodules decreased from 5.62 ± 4.12 to 3 ± 3.46, abscesses decreased from 1.76 ± 2.63 to 0.81 ± 1.4, and fistulas decreased from 2.62 ± 1.86 to 2 ± 1.9 (p < 0.05). The IHS4 score decreased from 19 ± 10.78 to 12.62 ± 11.13 (p = 0.001), DLQI from 15.76 ± 7.73 to 7.43 ± 7.76 (p < 0.001), and VAS from 6.69 ± 1.56 to 3.64 ± 2.65 (p < 0.001). There was a significant difference in the baseline IHS4 scores between patients who had prior surgery with a mean score of 23.86 ± 9.4 versus non-surgical patients with a mean IHS4 score of 9.29 ± 5.53 (p = 0.001). Conclusions: About half of HS patients responded positively to adalimumab treatment; the use of the drug reduces inflammatory lesions, and pain, and improves quality of life. Full article

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14 pages, 1817 KiB

Open AccessArticle

Comparison between Conventional and Simple Measuring Methods of Mean Nocturnal Baseline Impedance in Pediatric Gastroesophageal Reflux Disease

by Radu Samuel Pop, Lăcrămioara Eliza Chiperi, Vlad-Ionuț Nechita, Sorin Claudiu Man and Dan Lucian Dumitrașcu

Clin. Pract. 2024, 14(5), 1682-1695; https://doi.org/10.3390/clinpract14050134 - 27 Aug 2024

Abstract

(1) Background: Multichannel intraluminal impedance–pH (MII-pH) monitoring is commonly used to diagnose gastroesophageal reflux disease (GERD). The mean nocturnal baseline impedance (MNBI) is an important parameter, reflecting the esophageal mucosal integrity and improvement in GERD. This study aims to evaluate the correlation between [...] Read more.

(1) Background: Multichannel intraluminal impedance–pH (MII-pH) monitoring is commonly used to diagnose gastroesophageal reflux disease (GERD). The mean nocturnal baseline impedance (MNBI) is an important parameter, reflecting the esophageal mucosal integrity and improvement in GERD. This study aims to evaluate the correlation between conventionally measured MNBI and a recently described simple MNBI measurement method in diagnosing pediatric GERD. (2) Methods: This prospective observational study enrolled 64 children aged one month to 18 years who underwent 24 h MII-pH monitoring. Conventional MNBI was measured during stable 10 min intervals at night, while the simple MNBI method averaged impedance throughout the nocturnal supine period. (3) Results: Strong correlations were found between conventional and simple MNBI values across all impedance channels in both infants (r > 0.85) and older children (r > 0.9). Conventional and simple MNBIs in the most distal channel (Z6) effectively differentiated non-erosive reflux disease (NERD) from other phenotypes, with AUCs of 0.864 and 0.860, respectively. The simple MNBI demonstrated good diagnostic performance with similar sensitivity and specificity to the conventional MNBI. (4) Conclusions: Including MNBI measurements into routine MII-pH monitoring may enhance GERD diagnosis and reduce the need for more invasive procedures. Full article

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13 pages, 8678 KiB

Open AccessCase Report

Intraductal Papillary Neoplasms of the Bile Duct: Clinical Case Insights and Literature Review

by Luca Toti, Tommaso Maria Manzia, Francesca Di Giuliano, Eliseo Picchi, Laura Tariciotti, Domiziana Pedini, Luca Savino, Giuseppe Tisone and Roberta Angelico

Clin. Pract. 2024, 14(5), 1669-1681; https://doi.org/10.3390/clinpract14050133 - 27 Aug 2024

Abstract

Background: Intraductal papillary neoplasms of the bile duct (IPNB) are rare precancerous lesions with implications for the development of cholangiocarcinoma (CCA). Recognizing IPNB and managing its recurrence pose challenges in clinical practice. We present two cases. Case 1: a 60-year-old man presented with [...] Read more.

Background: Intraductal papillary neoplasms of the bile duct (IPNB) are rare precancerous lesions with implications for the development of cholangiocarcinoma (CCA). Recognizing IPNB and managing its recurrence pose challenges in clinical practice. We present two cases. Case 1: a 60-year-old man presented with an 8 × 8 × 9 cm hepatic cyst initially suspected to be a hydatid cyst. Histology post-resection revealed an IPNB with foci of adenocarcinoma. Despite negative oncologic margins, recurrence occurred eight years later as an rT2N0 lesion. Surgical resection was performed without adjuvant chemotherapy, resulting in the patient’s survival at 48 months post-surgery. Case 2: a 28-year-old female with cognitive impairment was admitted with pulmonary embolism and a liver lesion diagnosed as a simple cyst. Subsequent evaluation revealed adenocarcinoma with local metastases, extensive vascular involvement, and thrombosis. Despite aggressive management, including thrombectomy and chemotherapy, the patient’s condition deteriorated, leading to hepatic failure and eventual demise. Conclusion: IPNB represents a rare premalignant subtype with a propensity for progression to CCA. R0 surgical resection typically offers favorable oncological outcomes with a minimal recurrence risk. Surgical intervention for localized resectable recurrence is both safe and feasible. International registries tracking IPNB recurrence are essential for advancing understanding and optimizing diagnosis, management, and treatment strategies. Full article

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19 pages, 556 KiB

Open AccessArticle

Fonseca’s Questionnaire Is a Useful Tool for Carrying Out the Initial Evaluation of Temporomandibular Disorders in Dental Students

by Valeria Mitro, Angela Rosa Caso, Federica Sacchi, Massimiliano Gilli, Guido Lombardo, Gabriele Monarchi, Stefano Pagano and Antonio Tullio

Clin. Pract. 2024, 14(5), 1650-1668; https://doi.org/10.3390/clinpract14050132 - 26 Aug 2024

Abstract

Background: Temporomandibular disorders (TMDs) represent a prevalent multifactorial condition that impacts a significant portion of the global population. The objective of this study was to employ Fonseca’s questionnaire for an initial assessment of TMDs. Methods: A cross-sectional study was conducted on a [...] Read more.

Background: Temporomandibular disorders (TMDs) represent a prevalent multifactorial condition that impacts a significant portion of the global population. The objective of this study was to employ Fonseca’s questionnaire for an initial assessment of TMDs. Methods: A cross-sectional study was conducted on a sample of 250 undergraduates from the Dental School of the University of Perugia, Italy. The chi-square test, with a significance level set at p < 0.05, was used to evaluate a statistically significant relationship between TMDs and several variables such as gender, age, employed/unemployed, and physically active or not. Results: The data obtained through the questionnaire indicated that a considerable percentage of students (78%) exhibited signs consistent with TMDs. The most frequently reported signs and symptoms included psychological stress (49.6%), dental clenching and grinding (34%), joint clicking (33.6%), frequent headaches (15.2%), and neck pain (23.2%). Notably, when considering moderate to severe symptoms of TMDs, females were more significantly affected than males. Furthermore, factors such as age, employment status, and physical activity did not appear to influence the prevalence of TMDs. Conclusions: The high prevalence of TMDs identified within this young population (university students), as measured by this questionnaire (albeit warranting validation through more rigorous methodologies) underscores the necessity for the implementation of new preventive strategies that specifically address this demographic. Full article

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

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25 pages, 607 KiB

Open AccessSystematic Review

Assessment of the Validity and Quality of Polycystic Ovarian Syndrome (PCOS) Screening Tools Available for Women Globally: A Systematic Review

by Lea Sacca, Diana Lobaina, Elisheva Knopf, Sara Burgoa, Samantha Jimenez, Goodness Okwaraji, Madison Etzel, Vartiter Vardanyan, Madison Tharp, Meera Rao, Vama Jhumkhawala, Joshua Sohmer, Sebastian Densley, Niko Linzer, Pranav Meka, Daniella Diaz, Michelle Knecht, Dawn Kimberly Hopkins, Panagiota Kitsantas, Maria Mejia and Candy Wilson Show full author list Hide full author list

Clin. Pract. 2024, 14(5), 1625-1649; https://doi.org/10.3390/clinpract14050131 - 23 Aug 2024

Abstract

Background: This systematic review has the following aims: (1) to identify measurement tools used globally by healthcare providers to diagnose PCOS in women at elevated risk; (2) to assess the comprehensiveness of these tools regarding mental health and chronic pain; (3) to list [...] Read more.

Background: This systematic review has the following aims: (1) to identify measurement tools used globally by healthcare providers to diagnose PCOS in women at elevated risk; (2) to assess the comprehensiveness of these tools regarding mental health and chronic pain; (3) to list strategies for validating, disseminating, and implementing these tools; and (4) to provide future recommendations for experts in healthcare settings. Methods: This review utilized the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and the Arksey and O’Malley York methodology. Studies were sourced from the PubMed, Embase, and Cochrane Library databases, with inclusion criteria focusing on peer-reviewed articles addressing PCOS diagnosis and associated comorbidities. Data extraction and analysis followed the Joanna Briggs Institute (JBI) recommendations. Results: A total of 63 studies met the inclusion criteria. Findings indicate that current screening tools for PCOS often lack comprehensive integration of mental health and chronic pain assessments. Tools like the PCOSQ and its updated version, PCOSQ-50, inadequately address pain-related symptoms, highlighting a gap in holistic patient evaluation. This review identified significant associations between PCOS and mental health disorders, including anxiety and depression, emphasizing the need for mental health screenings as part of PCOS management. Conclusions: There is a critical need for validated PCOS screening tools that encompass both physical and psychological aspects of the condition. Educating healthcare providers on the cultural and social determinants influencing PCOS can improve diagnosis and patient outcomes. Future research should focus on developing holistic screening tools and culturally relevant educational resources, aiming to enhance the overall quality of life for women with PCOS. Full article

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