Clinics and Practice

24 pages, 2125 KiB

Open AccessSystematic Review

Alpha-Synuclein Seed Amplification Assays in Parkinson’s Disease: A Systematic Review and Network Meta-Analysis

by Jamir Pitton Rissardo and Ana Leticia Fornari Caprara

Clin. Pract. 2025, 15(6), 107; https://doi.org/10.3390/clinpract15060107 - 3 Jun 2025

Introduction and objective: Assessment of α-synuclein (αSyn) seed amplification assays (αSyn-SAA) accuracy in distinguishing Parkinson’s disease (PD) from controls using cerebrospinal fluid (CSF), blood, skin, extracellular vesicles (ECV), saliva, olfactory mucosa (OM), gastrointestinal tract (GIT), and submandibular gland (SMG). Methodology: PubMed was searched [...] Read more.

Introduction and objective: Assessment of α-synuclein (αSyn) seed amplification assays (αSyn-SAA) accuracy in distinguishing Parkinson’s disease (PD) from controls using cerebrospinal fluid (CSF), blood, skin, extracellular vesicles (ECV), saliva, olfactory mucosa (OM), gastrointestinal tract (GIT), and submandibular gland (SMG). Methodology: PubMed was searched for articles from 2010 to January 2025. The quality assessment used robvis. Diagnostic values with a 95% confidence interval (CI) were obtained. Z-test, Wald CI, and ANOVA were performed. Diagnostic odds ratio (DOR) was used. Results: αSyn-SAAs showed strong diagnostic performance in distinguishing PD from controls across various tissue and fluid types. Overall, αSyn-SAAs demonstrated high sensitivity (86%) and specificity (92%). Among all biomatrices, CSF, skin, blood, and ECV yielded the highest diagnostic accuracy, with sensitivity and specificity approaching or exceeding 90%. In contrast, saliva, oral mucosa, and gastrointestinal tract samples showed more modest sensitivity, though specificity remained relatively high. ECV, CSF, skin, and blood matrices also demonstrated the highest DOR, supporting their potential clinical utility. Conclusions: ECV and blood warrant priority in αSyn-SAA for high accuracy and minimal invasiveness, while GIT, OM, and oral samples show limited utility; saliva and SMG need refinement. Full article

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14 pages, 616 KiB

Open AccessArticle

Predictors of Major Adverse Cardiovascular Events in Stable Patients After ST Elevation Myocardial Infarction

by Lidija Savic, Damjan Simic, Ratko Lasica, Gordana Krljanac, Sanja Stankovic, Igor Mrdovic and Milika Asanin

Clin. Pract. 2025, 15(6), 106; https://doi.org/10.3390/clinpract15060106 - 30 May 2025

Abstract

Background/aim: The aim of this study was to determine predictors of major adverse cardiovascular events, including MACE (mortality, non-fatal recurrent infarction, non-fatal stroke, and target vessel revascularization-TVR) in stable post-STEMI patients. Method: We analyzed STEMI patients without cardiogenic shock at admission included in [...] Read more.

Background/aim: The aim of this study was to determine predictors of major adverse cardiovascular events, including MACE (mortality, non-fatal recurrent infarction, non-fatal stroke, and target vessel revascularization-TVR) in stable post-STEMI patients. Method: We analyzed STEMI patients without cardiogenic shock at admission included in our STEMI Register. The patients were treated with primary PCI. The follow-up period was eight years. Results: From 1 December 2006 to 31 December 2016, a total of 3079 patients were included in the Register. In the first year, MACE was registered in 348 (11.3%) patients. The remaining patients were considered stable. They were included in further analysis. At eight years, the rates were as follows: MACE 3.9%, non-fatal recurrent infarction 2.1%, TVR 1.8%, non-fatal stroke 0.5%, and mortality 2.1%. Predictors for 8-year MACE were age >60 years (60–69 vs. <60 years HR 1.65; 70–79 vs. <60 years HR 1.82; ≥80 vs. <60 years HR 3.16), EF < 50% (EF 40–49% HR 2.38; EF < 40% HR 2.32), diabetes mellitus (HR 1.49), and 3-vessel coronary artery disease (HR 1.44). Conclusions: Four predictors identified stable post-STEMI patients who remained at a higher risk for the occurrence of MACE. Stable post-STEMI patients with one or more of these risk factors may require more aggressive secondary prevention measures or a personalized approach to improve their prognosis. Full article

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17 pages, 2204 KiB

Open AccessReview

Reverse Linear Neuro Periodization Model for Rehabilitation After Arthroscopic Rotator Cuff Repair: A Narrative Review

by Georgios Kakavas, Emmanouil Brilakis, Maria Papatzikou, Nikolaos Malliaropoulos, Jean Mazeas and Florian Forelli

Clin. Pract. 2025, 15(6), 105; https://doi.org/10.3390/clinpract15060105 - 30 May 2025

Abstract

Periodization is a concept of systematic progression in training and rehabilitation. The rehabilitation literature, however, is scarce, with information about optimally designing resistance training programs based on periodization principles for injured athletes. This periodization model—reverse linear neuro periodization—is a model proposed for the [...] Read more.

Periodization is a concept of systematic progression in training and rehabilitation. The rehabilitation literature, however, is scarce, with information about optimally designing resistance training programs based on periodization principles for injured athletes. This periodization model—reverse linear neuro periodization—is a model proposed for the long-term rehabilitation needed after an arthroscopic rotator cuff repair. With recent evidence supporting neural contributions to shoulder injuries and the rate of recovery, rehabilitation protocols may benefit from incorporating approaches that target the sensorimotor system. Integrating motor learning principles (external focus and differential learning) and new technologies (virtual reality, laser pointers, stroboscopic glasses) may bolster current shoulder rehabilitation protocols and improve patient recovery times and outcomes. Such an understanding allows well-informed sport rehabilitation specialists to better bridge the gap between the preparation for competition widely used by coaches and the treatment of injuries that may occur. Full article

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14 pages, 1190 KiB

Open AccessArticle

Eleven-Year Incidence of Salivary Gland Tumors—A Retrospective, Single-Centered Study in Croatia

by Anđela Modrić, Mirko Gabelica, Ante Mihovilović, Stipe Dumančić, Ana Dunatov Huljev and Ivana Medvedec Mikić

Clin. Pract. 2025, 15(6), 104; https://doi.org/10.3390/clinpract15060104 - 29 May 2025

Abstract

Background/Objectives: The purpose of this study was to determine the incidence of salivary gland tumors based on age, gender, histological type, and localization over an eleven-year period at the University Hospital of Split. Methods: The medical records of the Department of Otorhinolaryngology with [...] Read more.

Background/Objectives: The purpose of this study was to determine the incidence of salivary gland tumors based on age, gender, histological type, and localization over an eleven-year period at the University Hospital of Split. Methods: The medical records of the Department of Otorhinolaryngology with Head and Neck Surgery and the Department of Maxillofacial Surgery at the University Hospital of Split regarding salivary gland tumors were searched from January 2012 to December 2022. The current fifth World Health Organization (WHO) Classification of Head and Neck Tumors and its criteria were considered during that process. Results: Out of 404 patients, 211 (52.20%) were female and 193 (47.77%) male. The mean age was 60. There were four pediatric patients. Six patients had a combination of two different histological types of salivary gland tumors present simultaneously at the exact localization. Therefore, there were 410 histological types in total, 214 related to females and 196 to males. A total of 361 (88.05%) benign and 49 (11.95%) malignant primary salivary gland tumors were detected. The parotid gland was the predominant location (N = 361, 87.8%). There were no cases affecting the sublingual gland. Pleomorphic adenoma was the most common benign histological type (N = 169, 41.2%). The most common malignant histological types were adenoid cystic carcinoma (N = 9, 2.2%) and mucoepidermoid carcinoma (N = 9, 2.2%). The average incidences of salivary gland tumors in the 11 years for the four Dalmatian counties and the Republic of Croatia were 4.45/100,000 and 0.9/100,000, respectively. Conclusions: The results of this study, primarily the ones concerning histological types and localization, do not deviate from general knowledge about salivary gland tumors. Simultaneous and ipsilateral occurrence of different histological types is a rare and extremely valuable finding. The average incidence for Dalmatian counties and the Republic of Croatia is within the range of the International Agency for Research on Cancer estimates. Full article

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26 pages, 1270 KiB

Open AccessSystematic Review

Where Do We Stand in the Management of Rheumatoid Arthritis Ahead of EULAR/ACR 2025?

by Adriana Liliana Vlad, Corina Popazu, Alina-Maria Lescai, Doina Carina Voinescu and Alexia Anastasia Ștefania Baltă

Clin. Pract. 2025, 15(6), 103; https://doi.org/10.3390/clinpract15060103 - 28 May 2025

Abstract

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease characterised by systemic inflammation and the progressive damage of joints, significantly impacting patients’ quality of life. Managing this condition requires a complex approach that integrates pharmacological and non-pharmacological therapies, alongside psychosocial support and [...] Read more.

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease characterised by systemic inflammation and the progressive damage of joints, significantly impacting patients’ quality of life. Managing this condition requires a complex approach that integrates pharmacological and non-pharmacological therapies, alongside psychosocial support and patient education. Aim: This study aims to highlight the importance of an interdisciplinary approach in the treatment of rheumatoid arthritis, focusing on the role of pharmacological therapies, monitoring treatment response, and the involvement of a multidisciplinary team in the effective management of the disease. Methods: The analysis was based on a review of the specialised literature concerning the role of disease-modifying antirheumatic drugs (DMARDs, both conventional and biological), the use of inflammatory markers (CRP and ESR), advanced imaging techniques, and the contribution of various medical specialities to the holistic management of rheumatoid arthritis. A total of 595,900 records were identified, of which 53 studies were ultimately included in the detailed analysis. Relevant studies from fields such as rheumatology, nutrition, psychology, and physical therapy were included. Results: The findings underline that DMARDs, in combination with other pharmacological therapies, remain essential for slowing disease progression. Monitoring treatment response through inflammatory markers and imaging techniques allows for the adjustment of therapeutic strategies and the prevention of complications. An interdisciplinary approach, involving the rheumatologist, general practitioner, physiotherapist, nutritionist, and psychologist, provides significant benefits, such as reducing inflammation, improving joint function, and offering psychosocial support. Conclusions: The effective management of rheumatoid arthritis requires a personalised interdisciplinary approach. Integrating various specialities, along with patient education and psychosocial support, contributes to better disease management, the prevention of disabilities, and improved quality of life. This review is not registered. Full article

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12 pages, 439 KiB

Open AccessArticle

Maternal Vitamin D Deficiency and the Risk of Placental Abruption: A Cross-Sectional Study in a Greek Obstetric Population

by Artemisia Kokkinari, Evangelia Antoniou, Eirini Orovou, Maria Dagla, Maria Tzitiridou-Chatzopoulou, Antigoni Sarantaki, Kleanthi Gourounti and Georgios Iatrakis

Clin. Pract. 2025, 15(6), 102; https://doi.org/10.3390/clinpract15060102 - 26 May 2025

Abstract

Background: Vitamin D deficiency (VDD) during pregnancy has been associated with various obstetric complications, including preeclampsia, gestational diabetes, and premature rupture of membranes. However, its potential link to placental abruption remains underexplored. The aim of this study was to investigate whether low maternal [...] Read more.

Background: Vitamin D deficiency (VDD) during pregnancy has been associated with various obstetric complications, including preeclampsia, gestational diabetes, and premature rupture of membranes. However, its potential link to placental abruption remains underexplored. The aim of this study was to investigate whether low maternal vitamin D levels are associated with an increased risk of placental abruption in pregnancies considered otherwise low-risk. Methods: We conducted a cross-sectional study involving 248 pregnant women who were admitted for delivery at a public hospital in Athens, Greece. Serum levels of 25-hydroxyvitamin D [25(OH)D] were measured upon admission. Levels below 30 ng/mL were classified as insufficient. Although this threshold corresponds to insufficiency according to the Endocrine Society, for the purposes of this study, levels < 30 ng/mL were treated as indicative of vitamin D deficiency in order to capture broader physiological implications. Cases of placental abruption were identified based on obstetric history and clinical documentation at the time of delivery. A Chi-square test was used to assess the association between vitamin D status and placental abruption, and a multivariate logistic regression model was applied to control for potential confounders, including hypertensive disorders of pregnancy, smoking, and preterm birth. The potential role of vitamin D supplementation during pregnancy was also explored as part of the analysis. Results: Our analysis revealed that women with VDD had a significantly higher incidence of placental abruption (p < 0.05). In the multivariate model, VDD remained an independent risk factor (adjusted OR: 3.2, 95% CI: 1.1–9.6). Additional risk factors that showed significant associations with placental abruption included pregnancy-induced hypertension and maternal smoking. Conclusions: These findings support the hypothesis that insufficient maternal vitamin D levels may contribute to adverse pregnancy outcomes, including placental abruption. Further prospective studies are warranted to clarify the causal mechanisms and to evaluate whether early detection and correction of vitamin D deficiency could serve as a preventive strategy in prenatal care. Full article

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8 pages, 829 KiB

Open AccessBrief Report

Unicortical Locking Screws Provide Comparable Rigidity to Bicortical Compression Screws in Tranverse Mid-Shaft Clavicle Fracture Plate Fixation Constructs

by Curtis W. Hartman, Nicholas C. Branting, Matthew A. Mormino, Timothy J. Lackner, Bradford P. Zitsch, Edward V. Fehringer and Hani Haider

Clin. Pract. 2025, 15(6), 101; https://doi.org/10.3390/clinpract15060101 - 26 May 2025

Abstract

Background: Mid-shaft clavicle fracture fixation carries neurovascular injury risk. The purpose of this study was to compare bicortical compression and unicortical locked clavicle plate constructs biomechanically. Materials and Methods: Ten fourth-generation composite transverse mid-shaft clavicle osteotomy specimens were assigned to two [...] Read more.

Background: Mid-shaft clavicle fracture fixation carries neurovascular injury risk. The purpose of this study was to compare bicortical compression and unicortical locked clavicle plate constructs biomechanically. Materials and Methods: Ten fourth-generation composite transverse mid-shaft clavicle osteotomy specimens were assigned to two groups, and each clavicle was fixed with an eight-hole second-generation 3.5 mm pelvic reconstruction plate placed superiorly. Group one included five fixed with bicortical compression screws and group two included five fixed with unicortical locking screws. All were tested on a four-axis servohydraulic testing frame in three modes: axial rotation, anterior/posterior bending, and cephalad/caudad bending. Results: Mean construct stiffness for AP bending was 1.255 ± 0.058 Nm/deg (group 1) and 1.442 ± 0.065 Nm/deg (group 2) (p = 0.001). Mean construct stiffness for axial rotation was 0.701 ± 0.08 Nm/deg (1) and 0.726 ± 0.03 Nm/deg (2) (p = 0.581). Mean construct stiffness for cephalad bending was 0.889 ± 0.064 Nm/deg (1) and 0.880 ± 0.044 Nm/deg (2) (p = 0.807). Mean construct stiffness for caudal bending was 2.523 ± 0.29 Nm/deg (1) and 2.774 ± 0.25 Nm/deg (2) (p = 0.182). Conclusions: With transverse mid-shaft clavicle fractures, unicortical locking fixation provided comparable rigidity to bicortical compression fixation in axial rotation, cephalad bending, and caudal bending; it provided greater rigidity in AP bending. Full article

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11 pages, 1312 KiB

Open AccessArticle

Rising Threats and Evolving Trends: Five Years of Urinary Tract Infection Prevalence in a Portuguese Hospital

by Francisco José Barbas Rodrigues, Patrícia Coelho, Sónia Mateus and Miguel Castelo-Branco

Clin. Pract. 2025, 15(6), 100; https://doi.org/10.3390/clinpract15060100 - 26 May 2025

Abstract

Background/Objective: Urinary tract infections (UTIs) are a significant public health concern worldwide, yet longitudinal data from Portuguese hospital settings remain limited. This study aimed to characterize epidemiological trends, microbial etiology, antimicrobial resistance patterns, and associated risk factors of UTIs over a five-year period [...] Read more.

Background/Objective: Urinary tract infections (UTIs) are a significant public health concern worldwide, yet longitudinal data from Portuguese hospital settings remain limited. This study aimed to characterize epidemiological trends, microbial etiology, antimicrobial resistance patterns, and associated risk factors of UTIs over a five-year period (2018–2022) in a central Portuguese hospital. Methods: In this retrospective observational study, 23,682 positive urine cultures were analyzed from specimens collected between January 2018 and December 2022. Data were extracted from the laboratory information system and included patient demographics, clinical service of origin, isolated microorganisms, resistance profiles, and annual antibiotic consumption (Defined Daily Dose (DDD) per 1000 patient-days). UTI prevalence was calculated as the proportion of positive cultures among all urine samples processed annually. Results: The positivity rate increased from 18.7% in 2018 to 22.7% in 2022, with a peak in 2019. Women represented around 70% of cases throughout the study period. Most infections originated from inpatient wards, followed by emergency services. Escherichia coli remained the leading pathogen (≈62%), followed by Klebsiella pneumoniae (≈14%) and Enterococcus faecalis (≈8%). Risk factors included catheterization (37.2%), prior UTI history (22.1%), and diabetes mellitus (18.5%). Longer hospital stays (>7 days) were associated with increased positivity. For E. coli, resistance ranged from 2% (amikacin) to 41% (ampicillin), with increasing resistance to ertapenem and fosfomycin and decreasing resistance to several key antibiotics. K. pneumoniae showed 4–36% resistance across antimicrobials, with notable increases for fosfomycin, meropenem, and cefuroxime axetil. Antibiotic usage trends reflected these patterns, with declining use of amikacin and rising use of cefuroxime axetil and meropenem. Conclusions: Over the five-year period, both UTI prevalence and resistance to critical antimicrobials increased, reinforcing the need to update empirical treatment guidelines. Identified risk factors may inform targeted prevention strategies. Ongoing surveillance and antimicrobial stewardship are crucial to mitigate the rising burden of UTIs and resistance Full article

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9 pages, 925 KiB

Open AccessSystematic Review

Spontaneous Bowel Evisceration Through Umbilical Hernia Sites in Adult Patients: A Systematic Review of the Literature

by Simone Gianazza, Niccolò Grappolini, Marika Morabito, Andrea Palillo, Marta Ripamonti and Davide Inversini

Clin. Pract. 2025, 15(6), 99; https://doi.org/10.3390/clinpract15060099 - 26 May 2025

Abstract

Background: The literature reports few instances of spontaneous bowel eviscerations through umbilical hernia sites. Spontaneous rupture of the hernia sac is a less common complication, primarily associated with persistent ascites or congenital wall defects. Materials and methods: A systematic review was conducted using [...] Read more.

Background: The literature reports few instances of spontaneous bowel eviscerations through umbilical hernia sites. Spontaneous rupture of the hernia sac is a less common complication, primarily associated with persistent ascites or congenital wall defects. Materials and methods: A systematic review was conducted using the PubMed database—the United States National Library of Medicine, with the search terms “spontaneous bowel evisceration” and “umbilical hernia evisceration”. However, several results were deemed unsuitable for this manuscript. From a total of 185 cases, this review was narrowed down to 9 usable reports. Non-English language cases, duplicates, and cases unrelated to the pathology, including pediatrics, malformations, herniation through other organs, and animal cases, were excluded. Conclusions: Spontaneous evisceration in a hernia is an uncommon yet serious condition. A major risk factor appears to be underlying liver disease with its complications, such as ascites, chronic malnutrition with hypoalbuminemia, and collateral circulation formation. These factors contribute to the susceptibility of the sac and the hernia wall to rupture. However, the limited number of reported cases precludes the establishment of a preferred treatment approach. In the acute phase, the use of prosthetics may be less advisable, but in an elective setting, the cirrhotic patient could be offered repair. Full article

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17 pages, 1195 KiB

Open AccessSystematic Review

Online Occupational Therapy as a Rehabilitation Intervention for Parkinson’s Disease: A Systematized Review

by Antigoni Kountoura, Thomas Tegos, Marianthi Arnaoutoglou and Magdalini Tsolaki

Clin. Pract. 2025, 15(6), 98; https://doi.org/10.3390/clinpract15060098 - 23 May 2025

Abstract

Background/Objectives: Occupational therapy (OT) plays a crucial role in addressing functional limitations and promoting independence in Parkinson’s disease (PD) patients. OT interventions target motor skills, daily activities, and engagement in meaningful tasks. Telehealth, the remote delivery of healthcare services, has expanded access to [...] Read more.

Background/Objectives: Occupational therapy (OT) plays a crucial role in addressing functional limitations and promoting independence in Parkinson’s disease (PD) patients. OT interventions target motor skills, daily activities, and engagement in meaningful tasks. Telehealth, the remote delivery of healthcare services, has expanded access to rehabilitation, including OT for PD. While several studies have examined the benefits of online OT, a comprehensive assessment of its impact on functional outcomes and quality of life (QoL) is needed. This review aimed to evaluate the effects of online OT interventions on functional outcomes and QoL of patients with PD. Methods: This review employed a systematized approach, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, though it did not constitute a full systematic review or meta-analysis. A comprehensive search was conducted across PubMed, Web of Science, Scopus, and Embase databases between August 2023 and September 2024. The search targeted randomized controlled trials (RCTs) investigating telerehabilitation interventions in OT for individuals with PD. Studies were excluded if they were not published in English, did not employ an RCT design, or lacked a focus on telerehabilitation within the scope of occupational therapy for PD. Additionally, systematic reviews, meta-analyses, qualitative studies, and studies without measurable outcomes were excluded. Nine studies met the inclusion criteria, with four involving occupational therapists directly and five evaluating interventions within the scope of OT practice. Results: The primary outcomes of this review focused on mobility improvements in PD patients, assessed through gait metrics such as gait speed, stride length, and gait variability. Secondary outcomes evaluated the impact of telerehabilitation on QoL, using tools such as the Parkinson’s Disease Questionnaire (PDQ-39) and other disease-specific instruments. The findings demonstrated that online OT interventions significantly improved motor skills, cognitive function, and activities of daily living in PD patients. Furthermore, these interventions enhanced overall well-being and QoL. The remote format fostered sustained engagement and adherence to therapy, contributing to better long-term outcomes. Conclusions: Online OT interventions show promising potential for improving functional outcomes and QoL in PD patients. These findings underscore the potential of telehealth to expand access to OT services, thereby enhancing long-term rehabilitation outcomes for this population. Full article

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20 pages, 1257 KiB

Open AccessArticle

Evaluating the Impact of Community-Based Medical Education on Health Literacy and Patient Empowerment in Underserved Populations: A Pilot Cohort Study

by Aida Aljafri, Persia Abba, Anita Sedghi, Andreas Conte and Waseem Jerjes

Clin. Pract. 2025, 15(6), 97; https://doi.org/10.3390/clinpract15060097 - 22 May 2025

Abstract

Background: Traditionally, community-based education (CBE) programmes have been utilised for teaching medical students clinical and interpersonal skills through placement in underserved environments. This pilot cohort study tested an extended model of CBE by infusing patient education into student-conducted consultations with the dual objectives [...] Read more.

Background: Traditionally, community-based education (CBE) programmes have been utilised for teaching medical students clinical and interpersonal skills through placement in underserved environments. This pilot cohort study tested an extended model of CBE by infusing patient education into student-conducted consultations with the dual objectives of stimulating improved learning for the students and improved health literacy for the patients. Methods: The intervention involved 38 final-year medical students and 85 adult patients and from underprivileged communities in North West London. The students first undertook online preparatory workshops on health literacy, communication skills, and cultural competence. Subsequently, they imparted 20–30 min educational sessions on chronic disease management and preventive care to the patients on their clinical placements. The quantitative measurement used pre- and post-intervention questionnaires, and the qualitative measurement was based on reflective diaries and patient feedback. Paired t-tests were used for statistical comparisons, while a thematic analysis was used for textual answers. Results: Student confidence in breaking down medical jargon improved from 2.8 ± 0.7 to 4.4 ± 0.5 (p < 0.01), and confidence in making use of visual aids improved from 2.5 ± 0.8 to 4.2 ± 0.6 (p < 0.01). Understanding among the patients of their health conditions improved from 27% to 74% (p < 0.001), and self-confidence in their ability to manage their health improved from 31% to 79% (p < 0.001). The qualitative feedback noted improved empathy, cultural sensitivity, and a positive effect on patient empowerment through tailored education. Conclusions: This CBE intervention had two benefits: improving teaching and communication skills in students and greatly enhancing health literacy in underserved patients. The integration of structured education into usual care encounters holds the promise of a scalable, sustainable method for addressing health disparities. Longer longitudinal studies are necessary to assess its long-term success and incorporation into medical education. Full article

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9 pages, 188 KiB

Open AccessArticle

Intra-Articular Injection of Bupivacaine and Adrenaline Reduces Intraoperative and Postoperative Blood Loss in Total Knee Arthroplasty: A Retrospective Case-Control Study

by Ahmad Biadsi, Mor Bracha Akselrad, David Segal, Shanny Gur, Michael Markushevich and Yaron Shraga Brin

Clin. Pract. 2025, 15(5), 96; https://doi.org/10.3390/clinpract15050096 - 20 May 2025

Abstract

Objective: To evaluate the effect of preoperative intra-articular injection of bupivacaine and adrenaline (BAD) on blood loss and postoperative hemoglobin levels in primary total knee replacement. Methods: We retrospectively assessed 38 consecutive patients who underwent primary total knee arthroplasty at our [...] Read more.

Objective: To evaluate the effect of preoperative intra-articular injection of bupivacaine and adrenaline (BAD) on blood loss and postoperative hemoglobin levels in primary total knee replacement. Methods: We retrospectively assessed 38 consecutive patients who underwent primary total knee arthroplasty at our institution between 2018 and 2019, as performed by two chief orthopedic surgeons. The study group included 22 patients who received an intra-articular injection of 40 mL solution of BAD 0.25% preoperatively. The control group included 16 patients who did not receive the BAD injection preoperatively. Both groups received an IV tranexamic acid (TXA) 1 g treatment prior to the first incision. The posterior capsule and soft tissues were infiltrated after femoral chamfer cuts with a 60 mL BAD solution in both groups. Blood loss was evaluated in all patients by measuring the volume collected in the suction container before the first irrigation and prior to cementation. Additional assessments included the volume of blood drained during the first 24 h postoperatively, as well as changes in hemoglobin levels (delta hemoglobin) 24 h after surgery and at hospital discharge. Results: The study and the control groups were similar in age, sex, demographics, and comorbidities. The mean patient age was 71.4 ± 6.5 in the injected group and 70.6 ± 7.5 in the control group. The volume of blood suctioned during surgery was significantly lower in the study group compared to the control group (201 ± 84.3 mL vs. 261.25 ± 83.3 mL; p = 0.04). Similarly, the amount of blood drained within the first 24 h postoperatively was also reduced in the study group (204.3 ± 91.1 mL vs. 363.44 ± 131.9 mL; p = 0.0001). Ultimately, the decrease in hemoglobin levels from baseline to discharge was less pronounced in the study group compared to the control group (1.7 ± 0.9 g/dL vs. 2.44 ± 1.3 g/dL; p = 0.038). Conclusions: Intra-articular injection of 40 mL bupivacaine and 0.25% adrenaline solution before skin incision may reduce intraoperative and postoperative blood loss among patients undergoing total knee arthroplasty. Full article

11 pages, 206 KiB

Open AccessArticle

Association Between Diabetes and Vertical Bone Defects in Periodontitis Using Cone Beam Computed Tomography: A Cross-Sectional Study in the Eastern Province, Saudi Arabia

by Eman Aljoghaiman, Abdullah Alzahrani, Rakan Albarqi, Saad Alqbbani, Hamad Alshiddi, Mishali AlSharief, Mohammed Alsaati and Faisal E. Al Jofi

Clin. Pract. 2025, 15(5), 95; https://doi.org/10.3390/clinpract15050095 - 19 May 2025

Abstract

Background: The association between diabetes and periodontal disease is well established, but its impact on intrabony periodontal defects remains unclear. Aims: This study examines the relationship between diabetes and intrabony periodontal defects using cone beam computed tomography (CBCT). Methods: A retrospective analysis [...] Read more.

Background: The association between diabetes and periodontal disease is well established, but its impact on intrabony periodontal defects remains unclear. Aims: This study examines the relationship between diabetes and intrabony periodontal defects using cone beam computed tomography (CBCT). Methods: A retrospective analysis of 99 CBCT images from Imam Abdurrahman bin Faisal University (2010–2022) was conducted. Intrabony periodontal defects were assessed, and logistic regression was used to analyze their association with diabetes. Results: Intrabony periodontal defects were detected in 66% of the sample, with 36% exhibiting multiple defects. Crude logistic regression showed a significant association between diabetes and intrabony periodontal defects (OR 3.986, 95% CI 1.454–10.922) and defect count (OR 3.382, 95% CI 1.430–8.003). However, multiple regression analysis did not confirm diabetes as an independent predictor (adjusted OR 0.740, 95% CI 0.087–6.314). Conclusions: Diabetes was not significantly associated with the prevalence or number of intrabony periodontal defects after adjusting for the confounders. However, these findings highlight the multifactorial nature of periodontal bone loss and the need for comprehensive patient assessment. Clinically, this underscores the importance of integrating both systemic and local periodontal evaluations in diabetic patients to improve early detection and personalized treatment planning. Further research with larger, more diverse samples and integrated clinical assessments is needed to refine our understanding of this relationship and enhance patient management. Full article

24 pages, 1229 KiB

Open AccessArticle

“Walking a Day in My Shoes”: A Clinical Shadowing Program to Enhance Medical Students’ Understanding of Chronic Disease Management Beyond Clinical Settings

by Aidan Hilton and Waseem Jerjes

Clin. Pract. 2025, 15(5), 94; https://doi.org/10.3390/clinpract15050094 - 13 May 2025

Abstract

Aims/Background: Medical education is largely clinical and biomedical with little emphasis being put upon the social determinants of health (SDH) and patient-centredness. A programme entitled “Walking a Day in My Shoes” was devised as a pilot cohort study with the view of evaluating [...] Read more.

Aims/Background: Medical education is largely clinical and biomedical with little emphasis being put upon the social determinants of health (SDH) and patient-centredness. A programme entitled “Walking a Day in My Shoes” was devised as a pilot cohort study with the view of evaluating the impact of a clinical shadowing experience upon the empathy, SDH awareness, and patient-centredness of medical students. Methods: A prospective cohort study, involving 28 final-year London-area medical students, employing a three-phase teaching programme comprising preparation, observation, and reflection was carried out. Students’ confidence in the management of non-medical barriers, SDH awareness, and empathy before and after shadowing were measured using pre- and post-shadowing questionnaires. Qualitative analysis of patient feedback and journals also occurred. Results: Statistically significant improvements were observed in students’ empathy (mean score increase from 6.8 to 8.9, p < 0.001), understanding of SDH (advanced comprehension rose from 35% to 93%), confidence in addressing non-clinical barriers (from 39% to 86%), and awareness of logistical challenges (from 31% to 81%). Qualitative analysis highlighted key themes, including systemic barriers (transportation, polypharmacy, and social isolation) and students’ increased awareness of the emotional toll of chronic illness. Patients expressed high satisfaction, with 97% agreeing that the programme improved students’ understanding of chronic disease management. These findings suggest the programme’s practicality and scalability in medical education. Conclusions: This pilot cohort study demonstrated the significant enhancement of the students’ empathy, perception of SDH, and patient-centredness preparation through immersive shadowing. The findings support the use of experiential learning programmes as curricular interventions. Full article

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23 pages, 2794 KiB

Open AccessReview

The Role of Ancient Greek Physicians in the Development of Tracheostomy: Pioneering Airway Interventions and Early Thoracic Surgery

by Vasileios Leivaditis, Francesk Mulita, Nikolaos G. Baikoussis, Elias Liolis, Andreas Antzoulas, Levan Tchabashvili, Konstantinos Tasios, Dimitrios Litsas and Manfred Dahm

Clin. Pract. 2025, 15(5), 93; https://doi.org/10.3390/clinpract15050093 - 13 May 2025

Abstract

Tracheostomy, a critical airway intervention, has a long and complex history that dates back to antiquity. While the earliest references to the procedure appear in Egyptian and Indian medical texts, its development within ancient Greek medicine remains a subject of historical debate. This [...] Read more.

Tracheostomy, a critical airway intervention, has a long and complex history that dates back to antiquity. While the earliest references to the procedure appear in Egyptian and Indian medical texts, its development within ancient Greek medicine remains a subject of historical debate. This study explores the evolution of tracheostomy in ancient Greece, analyzing its theoretical foundations, historical accounts, and surgical advancements. Despite Hippocratic opposition, which largely discouraged invasive airway procedures due to the risk of fatal complications, later physicians such as Asclepiades, Aretaeus, and Antyllus made significant contributions to refining airway management techniques. The anatomical studies of Galen further advanced the understanding of respiratory physiology, including early concepts of artificial ventilation. Additionally, this study examines archaeological evidence, such as a marble relief discovered in Abdera, which may depict an early attempt at tracheostomy, providing valuable insight into the practical application of airway interventions in antiquity. By comparing ancient Greek surgical techniques with modern tracheostomy practices, this research highlights the continuity of medical knowledge and innovation. It underlines the role of ancient Greek physicians in shaping the principles of thoracic surgery, offering a broader understanding of how early medical practices have influenced contemporary airway management. The findings contribute to the historical perspective on tracheostomy, emphasizing the timeless pursuit of life-saving surgical advancements and the evolving relationship between theoretical medical knowledge and practical surgical application. Full article

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28 pages, 309 KiB

Open AccessArticle

Job Demands and Resources Perceived by Dentists in a Digital Dental Workplace and Perceived Effects on Job Satisfaction and Stress: A Qualitative Study

by Julia Sofie Gebhardt, Volker Harth, David A. Groneberg and Stefanie Mache

Clin. Pract. 2025, 15(5), 92; https://doi.org/10.3390/clinpract15050092 - 12 May 2025

Abstract

Background: Digitalisation is becoming increasingly integrated into the field of dentistry; therefore, it is crucial to understand both the challenges it introduces and the opportunities it provides. By doing so, the research will offer insights into how digital tools can affect the work [...] Read more.

Background: Digitalisation is becoming increasingly integrated into the field of dentistry; therefore, it is crucial to understand both the challenges it introduces and the opportunities it provides. By doing so, the research will offer insights into how digital tools can affect the work environment and contribute to the overall well-being and performance of dental professionals. Objectives: The present study aims to explore how dentists perceive the demands and resources within a digitalised dental practice. Methods: The present study adopted a qualitative design, incorporating guideline-based interviews. A total of 30 interviews were conducted with dentists from various German dental practices, with a focus on key topics such as job demands, job resources, digital stress factors, job satisfaction, and support needs in the context of digital dentistry. The interview data were analysed using qualitative content analysis. Results: The findings highlight that digital systems in dental practices offer benefits such as reduced errors and time savings, but also pose challenges, especially for less experienced users. While they improve efficiency, precision, and professional development, they can also lead to negative effects like dependence on technology, loss of manual skills, technical failures, and increased stress, particularly during the adaptation phase. These results suggest that successful integration of digital technologies requires adequate support to overcome initial learning curves and ensure long-term benefits. Conclusions: The results of the study underline the importance of effective implementation, comprehensive staff training, and technological reliability to maximise the benefits of digital tools and minimise their drawbacks. Maintaining a balance between digital stressors and resources is crucial to promoting a healthy work environment. Future research should focus on the long-term effects of training programmes and the integration of digital technologies into dental practices to increase their effectiveness in terms of job satisfaction and reduce potential risks. Full article

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

19 pages, 6719 KiB

Open AccessReview

Bullous Pemphigoid Overlapping Psoriasis Vulgaris: A Rare Case Report and Literature Review

by Maria-Alexandra Timofte, Constantin Căruntu, Beatrice Bălăceanu-Gurău, Irina Mărgăritescu, Călin Giurcăneanu and Mara Mădălina Mihai

Clin. Pract. 2025, 15(5), 91; https://doi.org/10.3390/clinpract15050091 - 8 May 2025

Abstract

Bullous pemphigoid (BP) is a rare autoimmune disease, primarily affecting elderly individuals, that significantly impacts the patient’s quality of life. In contrast, psoriasis vulgaris (PV) is a common, chronic, immune-mediated skin condition recognized as a systemic T-cell-mediated disorder. We aim to present the [...] Read more.

Bullous pemphigoid (BP) is a rare autoimmune disease, primarily affecting elderly individuals, that significantly impacts the patient’s quality of life. In contrast, psoriasis vulgaris (PV) is a common, chronic, immune-mediated skin condition recognized as a systemic T-cell-mediated disorder. We aim to present the case of a patient suffering from a dermatologic association of BP and PV, which unveiled hepatitis C viral infection as a potential trigger and led to complex therapeutic challenges. A literature review is also included, exploring previous cases of overlapping BP and PV, along with a discussion of the unique pathogenic mechanisms and an analysis of the available therapeutic options. The patient, a 53-year-old male with a seven-year history of PV, presented with tense bullae overlying the psoriatic papules and plaques, with a generalized distribution. The presence of hepatitis C infection was considered a potential trigger for the concurrent presentation of BP and PV. Recent GWASs have demonstrated a potential causal relationship between PV and the subsequent development of BP, suggesting shared genetic susceptibility and immune pathways. However, the exact mechanisms driving this transition remain incompletely understood. Our case is particularly relevant as it exemplifies how environmental triggers—such as chronic hepatitis C infection—together with chronic cutaneous inflammation may act as cofactors in this process, possibly through the ‘epitope spreading’ phenomenon. This case underlines the importance of identifying triggering factors in patients with overlapping autoimmune diseases and reinforces the need for future research to further elucidate the pathogenic link between genotype and phenotype, in order to improve personalized therapeutic strategies. Full article

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11 pages, 1579 KiB

Open AccessArticle

Clinical Study of Biostimulation with Low-Power Diode Laser After Dental Extractions

by Yolanda Collado Murcia, Pia Lopez-Jornet and Francisco Parra Perez

Clin. Pract. 2025, 15(5), 90; https://doi.org/10.3390/clinpract15050090 - 6 May 2025

Abstract

Introduction: The objective of the present work is to assess the efficacy of photobiomodulation (PBM) with respect to pain, inflammation, and healing after tooth extractions as compared with a sham treatment. Method: A single-blinded, randomized clinical study conducted in a private dental clinic [...] Read more.

Introduction: The objective of the present work is to assess the efficacy of photobiomodulation (PBM) with respect to pain, inflammation, and healing after tooth extractions as compared with a sham treatment. Method: A single-blinded, randomized clinical study conducted in a private dental clinic in Murcia, it included 124 patients who needed a tooth extraction, excluding those with medical conditions that could affect healing (such as non-controlled diabetes, immunosuppression, or hemorrhagic disorders). Group I (Experimental): extraction and PBM session with a diode laser (power: 0.5 W, energy 15 J/cm² for 10–30 s at 1 mm from the tissue). Group II (Sham treatment): tooth extraction and application of inactive PBM. Results: Pain and inflammation decreased similarly in both groups over time. Anxiety decreased in both groups without significant differences (p = 0.776; p = 0.246). There was no evidence that the treatment or location of the extraction had an influence on healing. Suturing the socket increased the likelihood of good healing (p = 0.048), while long procedures reduced it (p = 0.040). Conclusions: PBM is a non-invasive and safe therapy. This study did not show significant differences with respect to the sham treatment. More research is needed with a standardized methodology to better assess its efficacy. Full article

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11 pages, 211 KiB

Open AccessArticle

The Role of Prenatal Vitamin D Deficiency in Early Allergic Rhinitis in Neonates in Greece: Insights from a Cross-Sectional Study at the “Tzaneio” General Hospital

by Artemisia Kokkinari, Evangelia Antoniou, Eirini Orovou, Maria Tzitiridou-Chatzopoulou, Maria Dagla and Georgios Iatrakis

Clin. Pract. 2025, 15(5), 89; https://doi.org/10.3390/clinpract15050089 - 30 Apr 2025

Abstract

Background: The role of vitamin D deficiency (VDD) in both mothers and neonates has been suggested as a possible factor in the development of allergic conditions in early infancy, however limited research has investigated this link in relation to allergic rhinitis (AR). This [...] Read more.

Background: The role of vitamin D deficiency (VDD) in both mothers and neonates has been suggested as a possible factor in the development of allergic conditions in early infancy, however limited research has investigated this link in relation to allergic rhinitis (AR). This study investigates whether VDD in the mother–newborn dyad is associated with the onset of AR in neonates within the first three days after birth. The aim is to contribute to the understanding of neonatal allergic outcomes related to vitamin D status, which may inform future preventive strategies. This study investigates the role of vitamin D in the early onset of allergic rhinitis (AR) in neonates, specifically within the first three days of life. Although AR typically develops after years of allergen exposure and is rare in children under two, we aimed to explore its occurrence at this early stage. While no clear link was found between vitamin D and early AR onset, further research is needed to explore vitamin D levels at later ages and over longer time frames to clarify the relationship. Methods: A cross-sectional study was conducted between September 2019 and January 2022 in a single hospital. The study involved 248 infants born at ≥37 weeks of gestation and their mothers, who were of Greek nationality. The study included mother–infant pairs who met the inclusion criteria. Chi-square tests were applied to analyze the association between maternal or neonatal VDD and the presence of AR in neonates within the first three days after birth. In addition, multiple regression analysis was used to control other potential factors contributing to AR. Results: The results showed an unclear relationship between VDD and the onset of AR in neonates within the first three days of life. Although several factors were analyzed, the effect of VDD on the development of AR remained unclear. Conclusions: The findings highlight the lack of clarity regarding the effect of maternal and neonatal VDD on the incidence of AR in the immediate neonatal period. Few studies to date have specifically examined the role of VDD in neonatal AR. Further research with larger sample sizes is needed to verify these associations and to guide potential interventions aimed at reducing allergic outcomes in neonates. Full article

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