Clinics and Practice

45 pages, 997 KiB

Open AccessSystematic Review

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

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

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

Abstract

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

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

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17 pages, 1889 KiB

Open AccessSystematic Review

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

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

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

Abstract

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

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

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

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12 pages, 815 KiB

Open AccessArticle

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

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

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

Abstract

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

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

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11 pages, 423 KiB

Open AccessCase Report

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

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

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

Abstract

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

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

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

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14 pages, 1427 KiB

Open AccessSystematic Review

Dupilumab, a Potential Novel Treatment for Hailey–Hailey Disease

by Liliana Gabriela Popa, Calin Giurcaneanu, Florentina Zaharia, Andreea Grigoras, Alexandra Denisa Oprea and Cristina Beiu

Clin. Pract. 2025, 15(3), 48; https://doi.org/10.3390/clinpract15030048 - 26 Feb 2025

Abstract

Background/Objectives: Hailey–Hailey disease (HHD) is an uncommon genodermatosis with autosomal dominant inheritance caused by loss-of-function mutations in the ATP2C1 gene, which lead to disruption in keratinocyte adhesion and intraepidermal acantholysis. The chronic nature of the disease, its frequent recurrences and the lack of [...] Read more.

Background/Objectives: Hailey–Hailey disease (HHD) is an uncommon genodermatosis with autosomal dominant inheritance caused by loss-of-function mutations in the ATP2C1 gene, which lead to disruption in keratinocyte adhesion and intraepidermal acantholysis. The chronic nature of the disease, its frequent recurrences and the lack of specific treatment pose real challenges in the long-term management of these patients. Recent studies have evaluated the effect of dupilumab, a human monoclonal antibody that blocks interleukin-4 and -13 receptor in refractory HHD, with very promising results. The aim of this study was to review the published data on the use of dupilumab for the treatment of HHD, to present our own experience in the field, and to discuss the mechanisms underlying dupilumab’s beneficial effects in HHD and the future treatment perspectives. Methods: A search of the medical literature on the use of dupilumab in the treatment of HHD was conducted. The terms “Hailey–Hailey disease”, “benign familial pemphigus”, “benign chronic pemphigus”, and “dupilumab” were searched across multiple databases (Medline, Chrocane Library, EMBASE) from inception until 30 September 2024. Results: To date, six manuscripts describing 11 refractory HHD cases treated with dupilumab have been published. All the patients experienced significant clinical improvement. The authors reported sustained disease quiescence in seven patients (64%), monitored for 5 to 24 months. None of the patients experienced adverse effects related to dupilumab. To the existing evidence, we add a new case of recalcitrant HHD successfully treated with dupilumab. Conclusions: Mounting evidence indicates dupilumab as a safe and efficient therapeutic alternative in patients with severe, refractory HHD. However, the long-term efficacy of dupilumab and the optimal therapeutic regimen for HHD are yet to be determined. Full article

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16 pages, 804 KiB

Open AccessReview

Extracranial Effects of Traumatic Brain Injury: A Narrative Review

by Nathan K. Evanson, Pratyusha Veldhi, Caitlyn Scherpenberg, John M. Riccobono, Haitham Eid and Jennifer L. McGuire

Clin. Pract. 2025, 15(3), 47; https://doi.org/10.3390/clinpract15030047 - 25 Feb 2025

Abstract

Background: Traumatic brain injury (TBI) is often associated with other injuries and comorbidities. However, even isolated TBI directly leads to dysfunction in multiple body systems outside the central nervous system. These extracranial effects of TBI target systems including the autonomic nervous, cardiovascular, renal, [...] Read more.

Background: Traumatic brain injury (TBI) is often associated with other injuries and comorbidities. However, even isolated TBI directly leads to dysfunction in multiple body systems outside the central nervous system. These extracranial effects of TBI target systems including the autonomic nervous, cardiovascular, renal, pulmonary, immune, gastrointestinal, and hemostasis systems, as well as causing significant alteration to systemic metabolism. Aim: This review is intended to outline the effects of TBI on other body systems, and place these in context with treatment considerations for these patients. Significance: Systemic effects of TBI have implications for acute and critical care management of patients with TBI, including pharmacologic treatment. They also affect treatment decisions in chronic TBI care, as well as TBI-unrelated routine medical care for patients with chronic TBI. In addition, extracranial effects of TBI should be considered in research settings. Conclusions: It is important for clinicians and researchers to be aware of these extracranial effects, and consider their effects on pathology, treatment decisions, and interpretation of research findings. Full article

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14 pages, 200 KiB

Open AccessArticle

Assessing Paramedics’ Competence and Training in End-of-Life Care: A Cross-Sectional Study in Saudi Arabia

by Ahmed Alanazy, Fatimah Khalifah Alsahli, Zahra Essam Alhassan, Zahra Hassan Alabdrabulridha, Moneerah Khalifah Aljomaan and Abdullah Alruwaili

Clin. Pract. 2025, 15(3), 46; https://doi.org/10.3390/clinpract15030046 - 25 Feb 2025

Abstract

Background: End-of-life (EOL) care is an integral part of paramedic services, requiring not only medical expertise but also communication skills and emotional support. With the evolving role of paramedics in providing palliative care, understanding their attitudes toward EOL care and the impact [...] Read more.

Background: End-of-life (EOL) care is an integral part of paramedic services, requiring not only medical expertise but also communication skills and emotional support. With the evolving role of paramedics in providing palliative care, understanding their attitudes toward EOL care and the impact of specialized training becomes crucial. Aim: This study aims to assess the attitudes of Saudi Arabian paramedics toward EOL care and evaluate the influence of prior EOL care training on these attitudes. Methods: A cross-sectional study was conducted among paramedics in Saudi Arabia using convenience and snowball sampling. Data were collected via an online survey distributed through emails and social networks, encompassing demographic information and attitudes toward EOL care. The survey was structured into two parts, with the second part developed from the relevant literature. Statistical analysis was performed using STATA version 18, employing chi-squared and Fischer exact tests for comparison. Results: The study involved 1049 paramedics, with the majority being aged 26–35 years (54.43%) and predominantly male (65.59%). About half of the participants (50.43%) had previously participated in EOL care courses. Paramedics who received EOL training demonstrated significantly more positive attitudes toward the role of EOL care in their jobs (98.49% versus 32.12%, p < 0.001) and were more comfortable discussing death with patients (51.42% versus 29.23%, p < 0.001). A significant majority viewed caring for a dying patient as a worthwhile experience (95.42%), and 95.33% agreed on the importance of involving the patient’s family in care. Conclusions: The findings highlight the positive impact of EOL care training on paramedics’ attitudes toward palliative care. Specialized training enhances paramedics’ comfort in discussing death and their perceptions of the role of EOL care, underscoring the need for integrating comprehensive palliative care education into paramedic training programs. Future research should focus on developing standardized EOL care courses to further explore their impact on paramedics’ knowledge, attitudes, and practices. Full article

14 pages, 227 KiB

Open AccessArticle

Self-Reported Physical Activity Behavior and Practice of Healthcare Professionals During the Second and Third Trimester of Pregnancy in Greece

by Vasileios Daglas, Nikolaos Kostopoulos, Michalis Mitrotasios, Antigoni Sarantaki, Maria Iliadou, Athanasios Moustogiannis, Maria Dagla and Evangelia Antoniou

Clin. Pract. 2025, 15(3), 45; https://doi.org/10.3390/clinpract15030045 - 24 Feb 2025

Abstract

Background/Objectives: The primary aim of the study was to investigate the self-reported behavior and practice of healthcare professionals (midwives and obstetricians) regarding physical activity during the second and third trimesters of pregnancy. The secondary goal of the study was to highlight sociodemographic and [...] Read more.

Background/Objectives: The primary aim of the study was to investigate the self-reported behavior and practice of healthcare professionals (midwives and obstetricians) regarding physical activity during the second and third trimesters of pregnancy. The secondary goal of the study was to highlight sociodemographic and professional characteristics affecting the aforementioned behavior. Methods: The study was of cross-sectional design and was conducted between January 2022 and March 2023 with the participation of 235 midwives and obstetricians working in public and private facilities in the region of Attica, Greece. The participants completed a demographic characteristics form as well as a questionnaire structured to serve the aim of the study. Eight independent models of multivariate analyses of variance were performed. Results: Among the participants, over 97% recommended exercising during the second and third trimesters of pregnancy. Cardio exercises were the most commonly suggested type (93.1% in the second trimester and 88.5% in the third trimester), followed by relaxation exercises (87.7% and 89.8%, respectively). The majority recommended exercising 2–3 times per week, with session durations ranging from 15 to 30 min in the second trimester and 30 to 45 min in the third trimester. The intention for recommending physical activity during the second trimester was associated with the profession (p < 0.001), the personal attitude toward the necessity of exercising (p = 0.006), the participants’ belief regarding the importance of being informed about relevant recommendations (p = 0.003), and the degree of knowledge regarding the relevant international guidelines (p = 0.031). With respect to the third trimester, the associated factors included gender (p = 0.011), the participant’s profession (p = 0.006), the degree of knowledge regarding the relevant international guidelines (p = 0.008), their positive attitude toward physical activity during pregnancy (p = 0.011), and the degree of knowledge regarding the relevant international guidelines (p = 0.008). Conclusions: The aforementioned factors should be taken into consideration when designing interventions for the promotion of physical activity during pregnancy. The structure of relevant instruments would facilitate the evaluation of health professionals’ behavior toward physical activity. Full article

19 pages, 2577 KiB

Open AccessReview

Mental Health and Malocclusion: A Comprehensive Review

by Osama A. Alsulaiman, Maha I. Alghannam, Dalal M. Almazroua, Abdulaziz S. Alamri, Suliman Y. Shahin, Essam A. Nassar, Naif N. Almasoud, Abdulrahman T. Alsulaiman and Ahmed A. Alsulaiman

Clin. Pract. 2025, 15(3), 44; https://doi.org/10.3390/clinpract15030044 - 24 Feb 2025

Abstract

The purpose of this study is to comprehensively review the relationship between malocclusion and anxiety and depression. While the physical implications of malocclusion are well documented, recent scholarship has shifted focus to examining the direct relationship between malocclusion and both anxiety and depression. [...] Read more.

The purpose of this study is to comprehensively review the relationship between malocclusion and anxiety and depression. While the physical implications of malocclusion are well documented, recent scholarship has shifted focus to examining the direct relationship between malocclusion and both anxiety and depression. It has been hypothesized that individuals with skeletal or dental malocclusion experience a range of psychological sequelae, including diminished quality of life (QoL), reduced oral-health-related quality of life (OHRQoL), increased vulnerability and appearance-related bullying, and impaired body image. Furthermore, these factors are postulated to collectively contribute to overall mental health, with malocclusion potentially serving as a contributing etiological factor in the development of elevated levels of anxiety and depression. Contemporary scholarship has established a complex relationship between dentofacial deviations and the psychological well-being of affected individuals. Evidence shows that malocclusion may contribute to increased depression and anxiety levels in some individuals, influencing their social functioning and treatment-seeking behavior. Dentofacial disharmony has also been associated with altered self-perception, potentially impacting an individual’s OHQOL and overall quality of life. While the findings exhibit some inconsistency, a modest body of evidence indicates a possible correlation between pronounced skeletal or dental malocclusion and anxiety and depression. These adverse psychosocial impacts, in turn, contribute to an elevated risk of anxiety and depression, underscoring the far-reaching consequences of malocclusion beyond oral health. Therefore, clinicians need to consider these issues in their treatment plans, incorporating interdisciplinary approaches that address both orthodontic and psychological aspects of patient care. Full article

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

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13 pages, 250 KiB

Open AccessArticle

Factors Associated with Mental Health Problems Among Tuberculosis Patients Attending Tertiary Care Hospitals in the Bangkok Metropolitan Region, Thailand: A Hospital-Based Survey

by Kanjana Konsaku, Titaporn Luangwilai and Parichat Ong-Artborirak

Clin. Pract. 2025, 15(3), 43; https://doi.org/10.3390/clinpract15030043 - 22 Feb 2025

Abstract

Background: Little is known about mental health among tuberculosis (TB) patients in Thailand. This study aimed to identify factors associated with mental health problems in TB patients in urban Thailand. Methods: This cross-sectional study collected data from 210 TB patients receiving treatment at [...] Read more.

Background: Little is known about mental health among tuberculosis (TB) patients in Thailand. This study aimed to identify factors associated with mental health problems in TB patients in urban Thailand. Methods: This cross-sectional study collected data from 210 TB patients receiving treatment at two tertiary care hospitals in the Bangkok Metropolitan Region of Thailand using consecutive sampling. The General Health Questionnaire (GHQ-12) and the Patient Health Questionnaire (PHQ-9) were used to assess mental health problems and probable depression, respectively. Results: Among TB patients, 34.3% had mental health problems (95% CI: 27.8–40.8), and 23.8% had depression (95% CI: 18.0–29.6). The final model from logistic regression with forward selection identified factors significantly associated with mental health problems, including high family support (OR = 0.45; 95% CI: 0.24–0.83) and perceived stigma: low (OR = 2.77; 95% CI: 1.16–6.60), moderate (OR = 3.56; 95% CI: 1.66–7.65), and high (OR = 3.56; 95% CI: 1.31–9.67) versus no stigma. Depression was associated with income ≥10,000 baht (OR = 0.43; 95% CI: 0.21–0.87), alcohol consumption (OR = 2.90; 95% CI: 1.27–6.64), and high social support from healthcare providers (OR = 0.44; 95% CI: 0.22–0.87). Conclusion: This study highlights the need to integrate mental health services into the TB care program to address the TB challenge in Thailand. Policies such as routine mental health screening and psychological counseling alongside treatment, as well as expanded social support and stigma reduction interventions, should be implemented to reduce the risk of mental health issues, particularly depression, and improve treatment outcomes among Thai TB patients. Full article

15 pages, 2317 KiB

Open AccessArticle

A Retrospective Study on the Incidence of Periprosthetic Fractures Related to Total Hip Arthroplasty and Postoperative Complications During Hospitalization

by Victor Niculescu, Delia Carmen Nistor-Cseppento, Sebastian Tirla, Brigitte Osser, Cristina Aur, Diana Mocuta, Gheorghe Ion Popescu and Radu Dan Necula

Clin. Pract. 2025, 15(3), 42; https://doi.org/10.3390/clinpract15030042 - 21 Feb 2025

Abstract

Background/Objectives: Periprosthetic fractures (PFs) are serious complications that can occur after total hip arthroplasty (THA), particularly in elderly patients who often have multiple comorbidities and low bone density. The surgical treatment of PFs typically involves internal fixation or revision arthroplasty, depending on the [...] Read more.

Background/Objectives: Periprosthetic fractures (PFs) are serious complications that can occur after total hip arthroplasty (THA), particularly in elderly patients who often have multiple comorbidities and low bone density. The surgical treatment of PFs typically involves internal fixation or revision arthroplasty, depending on the fracture type categorized by the Vancouver classification. This study examines the annual incidence of PFs and the complications that arise during hospitalization, as well as the predictive role of age in the occurrence of these fractures and their associated complications. Methods: Based on a retrospective observational study conducted over three years (2021–2023) at the Bihor County Emergency Hospital in Oradea, we analyzed 783 patients who underwent various hip surgeries. Results: The retrospective analysis identified 38 cases of PF out of 768 hip surgeries, resulting in an incidence of PF of 4.5%. Most PFs were classified as Vancouver B, with surgeries mainly involving internal fixation. Complications occurred in 23.68% of cases, including a mortality rate of 7.90%. A correlation analysis examining the relationship between age and post-surgical complications demonstrates a weak and statistically insignificant association (r = 0.120, p = 0.478). To highlight whether age is a predictive factor for PFs, we used the linear regression model; this suggests that older age explains 2.7% of the total variability in the incidence of PFs, being statistically significant ([F(1, 766) = 20.923], p < 0.001). Conclusions: The rising incidence of periprosthetic fractures is closely linked to the increasing number of total hip arthroplasties and the aging population. Fractures of this type are more common in elderly women, with no statistically significant differences have been found between the sexes. Full article

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20 pages, 668 KiB

Open AccessArticle

Effects of a Multimodal Program on Frailty Syndrome and Psychological Alterations in Breast Cancer Women Treated with Aromatase Inhibitors

by Pedro Céspedes, Francisco M. Martínez-Arnau, María Dolores Torregrosa, Omar Cauli and Cristina Buigues

Clin. Pract. 2025, 15(3), 41; https://doi.org/10.3390/clinpract15030041 - 21 Feb 2025

Abstract

Background/Objectives: Treatment with aromatase inhibitors can worsen frailty syndrome and psychological symptoms in women diagnosed with breast cancer (BC) receiving these drugs to prevent cancer recurrence. We analyze whether postmenopausal women with localized BC receiving aromatase inhibitors (AIs) treatment can achieve improvements in [...] Read more.

Background/Objectives: Treatment with aromatase inhibitors can worsen frailty syndrome and psychological symptoms in women diagnosed with breast cancer (BC) receiving these drugs to prevent cancer recurrence. We analyze whether postmenopausal women with localized BC receiving aromatase inhibitors (AIs) treatment can achieve improvements in their mental health and their level of frailty through a multimodal program that includes supervised physical exercise and health education workshops. Methods: A total of 52 postmenopausal women with a prior diagnosis of BC and receiving hormonal treatment with AIs were included in the multimodal physical exercise and health education program and evaluated before and after it. The assessment included the following five frailty syndrome (FS) criteria: involuntary weight loss, weakness, low physical activity, slow gait speed, and low muscle strength. Mental health was assessed using the Goldberg scale, with its subscales for anxiety and depressive symptoms. The Athens scale was used to assess subjective sleep quality. Results: There was a significant difference in the number of robust, pre-frail and frail women after the program compared to the baseline. Six women did not fulfill any criteria for (robust) FS before the program (11.5%), and thirty-three women (63.5%) after the program did not fulfill any criteria for FS. A total of 33 (63.5%) women met one or two FS criteria (pre-frail) before the program, and 18 (34.6%) met one or two FS criteria after the program; thirteen (25%) women met three or more FS criteria (frail) before the program and one (1.9%) after it (p < 0.001). A statistically significant improvement on the Goldberg scale was observed (on both the subscales for anxiety and depressive symptoms) (p < 0.001). A statistically significant improvement was also noted on the Athens insomnia scale (p < 0.001). A multivariate regression model analysis identified marital status (being married) (p = 0.047, beta coefficient= −0.249, 95% CI −1.4844–−0.14) and the percentage of attendance at training sessions (p = 0.041, beta coefficient = −0.290, 95% CI 0.104–0.002) as associated variables, with a lower score on the Goldberg depression subscale. Conclusions: Mental health and frailty, common in postmenopausal women diagnosed with BC on hormonal treatment with AI, can be improved with multimodal programs of supervised physical exercise and health education. Full article

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10 pages, 219 KiB

Open AccessStudy Protocol

Evaluation of Reminder App for Optimization of Bladder Filling Status During Hypo-Fractionated Irradiation for Prostate Cancer: Protocol of REFILL-PAC-HYPO Trial

by Dirk Rades, Jan-Dirk Küter, Michael von Staden, Ahmed Al-Salool, Christian Ziemann, Stefan Janssen, Julia Koeck, Justus Domschikowski, Charlotte Kristiansen, Christine Vestergård Madsen, Marciana N. Duma, Tobias Bartscht, Jon Cacicedo and Florian Cremers

Clin. Pract. 2025, 15(3), 40; https://doi.org/10.3390/clinpract15030040 - 20 Feb 2025

Abstract

Background/Objectives: During radiotherapy for prostate cancer, the risk of radiation cystitis is increased if the volume of the bladder is small. According to previous studies, it is important that bladder volumes are ≥200 mL. Drinking protocols may be helpful in this context. Adherence [...] Read more.

Background/Objectives: During radiotherapy for prostate cancer, the risk of radiation cystitis is increased if the volume of the bladder is small. According to previous studies, it is important that bladder volumes are ≥200 mL. Drinking protocols may be helpful in this context. Adherence to such protocols can be challenging, and may be improved by an app reminding patients before each session of radiotherapy to drink a certain amount of water. Our prospective phase 2 trial (REFILL-PAC-HYPO, NCT06784115) evaluates the impact of a reminder app on bladder filling in prostate cancer patients treated with hypo-fractionated radiotherapy. Methods: Twenty-seven patients need to be recruited for the REFILL-PAC-HYPO trial. Radiotherapy, preferably with volumetric-modulated arc therapy, uses hypo-fractionation with 20 × 3.0 Gy over four weeks. An app reminds patients to drink water (300 mL) 45 min before each session of hypo-fractionated irradiation. On the last day of their treatment, patients are asked about their satisfaction with the app. In the case of a dissatisfaction rate of >20%, the app requires modifications. If this rate is >40%, the app is considered not useful. Additionally, patients are asked about the impact of their participation in the trial and using the app on their general attitude towards health technology. Furthermore, the phase 2 cohort is compared to a historical control group treated with hypo-fractionated radiotherapy during recent years but not supported by an app. The REFILL-PAC-HYPO trial will contribute to identifying the potential value of a reminder app for bladder filling during hypo-fractionated radiotherapy for prostate cancer. Full article

7 pages, 1941 KiB

Open AccessCase Report

Surgical Treatment of Cranial Fasciitis in an Atypical Maxillary Region of a Pediatric Patient: A Case Report

by Jetsi Marlen González-Fuentes, Miguel Angel Noyola-Frías, Oscar Arturo Benítez-Cárdenas, Elhi Manuel Torres-Hernández, Jessika Arlina González-Macías, Andreu Comas-García, Ricardo Martínez-Rider and Marlen Vitales-Noyola

Clin. Pract. 2025, 15(3), 39; https://doi.org/10.3390/clinpract15030039 - 20 Feb 2025

Abstract

Objective: The aim of this case report is to show the surgical treatment of cranial fasciitis in a 2-year-old patient. Cranial fasciitis is an uncommon, nonmalignant, and swiftly proliferating lesion that primarily involves the cranium, predominantly in the temporoparietal area. It mostly comprises [...] Read more.

Objective: The aim of this case report is to show the surgical treatment of cranial fasciitis in a 2-year-old patient. Cranial fasciitis is an uncommon, nonmalignant, and swiftly proliferating lesion that primarily involves the cranium, predominantly in the temporoparietal area. It mostly comprises smooth muscle tissue, connective tissue, and diverse immune cells. The lesion often manifests as an indurated, asymptomatic mass, averaging approximately 2.5 cm in size, although it may exceed 15 cm. Cranial fasciitis predominantly manifests in children below the age of 6. The diagnosis is validated via histological investigation, which identifies a benign tumor defined by the proliferation of spindle-shaped cells organized in a myxoid matrix, frequently displaying a storiform pattern. Methods: We present a case of cranial fasciitis in a 2-year-old pediatric patient, characterized by an atypical manifestation in the maxillary region. The lesion underwent surgical intervention resulting in total excision. Results: Three years after the surgery, the patient is asymptomatic and shows no signs of recurrence. Regular clinical follow-up and imaging are scheduled biannually, and the patient is anticipated to have a favorable long-term prognosis. Conclusions: Cranial fasciitis is a very rare benign lesion that occurs more commonly in childhood. In this case, surgical resection was effective, and three years later, the patient remains asymptomatic and free of recurrence, with a favorable long-term prognosis. Full article

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

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12 pages, 772 KiB

Open AccessArticle

Effects of Protamine Reversal on Coagulation Parameters After High-Dose Heparin Administration in Percutaneous Hepatic Chemosaturation Intervention

by Michael Metze, Silke Zimmermann, Holger Kirsten, Robert Werdehausen, Rhea Veelken, Florian van Bömmel, Timm Denecke, Hans-Jonas Meyer, Sebastian Ebel and Manuel Florian Struck

Clin. Pract. 2025, 15(2), 38; https://doi.org/10.3390/clinpract15020038 - 17 Feb 2025

Abstract

Background: Intravenous protamine administration for heparin reversal after percutaneous hepatic chemosaturation intervention is generally recommended, but its effectiveness on coagulation parameters remains unclear. Methods: In a single-center retrospective observational study, the effects of different postinterventional protamine doses on the activated partial thromboplastin time [...] Read more.

Background: Intravenous protamine administration for heparin reversal after percutaneous hepatic chemosaturation intervention is generally recommended, but its effectiveness on coagulation parameters remains unclear. Methods: In a single-center retrospective observational study, the effects of different postinterventional protamine doses on the activated partial thromboplastin time (aPTT), international normalized ratio (INR), prothrombin time (PT), fibrinogen, platelet count (PLT), and hemoglobin (Hb) were analyzed in consecutive patients who underwent high-dose heparin administration (>300 U/kg body weight) and extracorporeal circulation for chemosaturation treatment. Due to the multiple treatments of individual patients, linear mixed-effects models were applied. Results: Thirty-one patients underwent 90 chemosaturation interventions, 68 (75.6%) of which involved heparin reversal with protamine. All investigated variables showed significant postinterventional alterations, while protamine use was associated with significantly lower aPTT, lower INR, higher PT, and higher fibrinogen levels, whereas PLT and Hb levels were comparable to those in procedures without protamine use. After adjustment for aPTT, significant independent effects of protamine remained for the INR and PT. Dose-dependent effects of protamine were observed for reductions in aPTT and an increase in fibrinogen levels, which were confirmed after adjustment for the heparin dose. A 10% higher protamine dose resulted in a 3% decrease in aPTT and a 4% increase in fibrinogen. An increase of 0.1 in the protamine-to-heparin ratio was associated with an increase of 9% in fibrinogen. Conclusions: The present results suggest that protamine contributes to the normalization of the aPTT, INR, PT, and fibrinogen levels. Further prospective studies should be conducted to determine optimal dosing ratios. Full article

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11 pages, 583 KiB

Open AccessArticle

The Development and Psychometric Validation of the Fainareti Screening Tool for Perinatal Mental Health in Greek Pregnant Women

by Maria Dagla, Irina Mrvoljak-Theodoropoulou, Vassilis Daglas, Evangelia Antoniou, Eleni Rigoutsou, Alexandros Papatrechas, Calliope Dagla, Eleni Tsolaridou and Despoina Karagianni

Clin. Pract. 2025, 15(2), 37; https://doi.org/10.3390/clinpract15020037 - 14 Feb 2025

Abstract

Background/Objectives: It would be helpful for primary healthcare professionals to have access to a brief, general screening tool allowing them to detect patients suffering from major mental illness. This also holds for organizations and institutions at which pregnant women ask for support [...] Read more.

Background/Objectives: It would be helpful for primary healthcare professionals to have access to a brief, general screening tool allowing them to detect patients suffering from major mental illness. This also holds for organizations and institutions at which pregnant women ask for support during the perinatal period. An evaluation of the psychometric properties, validity, and reliability of the Fainareti mental health screening tool was carried out in Greek women in this study. Methods: The study participants consisted of 518 women retrospectively followed from pregnancy to their first year postpartum as part of a health intervention at the Day Center for Women’s Mental Health Care (Perinatal Mental Health Disorders), operated by the non-profit organization Fainareti. Alongside the newly developed screening tool, this study utilized the Perinatal Anxiety Screening Scale (PASS), the Patient Health Questionnaire (PHQ-9), and the Edinburgh Postnatal Depression Scale (EPDS). Results: The assessment of the tool’s internal reliability included computing two separate internal consistency indices, with both indicating its significant level of reliability. The correlation analysis between the tool and the scales included in this study demonstrated the tool’s strong convergent validity, while factor analyses confirmed its satisfactory construct validity. Conclusions: Overall, these findings suggest that the one-factor Fainareti mental health screening tool is suitable for initial assessments of the mental health of Greek women. Full article

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15 pages, 1672 KiB

Open AccessArticle

Left Atrial Strain Value Versus Tissue Doppler Echocardiography and the Left Atrium Volume Index in the Evaluation of Left Ventricular Diastolic Function in Patients with Chronic Kidney Disease

by Eman Elsheikh, Zainab Amjad, Samah I Abohamr, Muthana Al Sahlawi and Ibtsam Khairat

Clin. Pract. 2025, 15(2), 36; https://doi.org/10.3390/clinpract15020036 - 13 Feb 2025

Abstract

Background: In heart failure with preserved ejection fraction (HFpEF) and decreased ejection fraction (HFrEF), LA strain, an indicator of the filling and discharge of the left atrium (LA), was recently identified as a sign of diastolic dysfunction. Our objective was to examine the [...] Read more.

Background: In heart failure with preserved ejection fraction (HFpEF) and decreased ejection fraction (HFrEF), LA strain, an indicator of the filling and discharge of the left atrium (LA), was recently identified as a sign of diastolic dysfunction. Our objective was to examine the significance of left atrial (LA) strain relative to tissue Doppler echocardiography and the left atrial volume index (LAVI) in evaluating left ventricular (LV) diastolic performance in individuals with chronic kidney disease (CKD). Methods: A prospective cross-sectional study was conducted on 220 outpatients with CKD who fulfilled the inclusion criteria and were referred to the cardiology clinic at Tanta University for routine echocardiographic assessment during a period of 6 months (April to September 2024). Based on their estimated glomerular filtration rate (eGFR), patients were divided into five groups: GFR ranges from 90 to 120 mL/min/1.73 m² in Group 1, 60 to 90 mL/min/1.73 m² in Group 2, 30 to 60 mL/min/1.73 m² in Group 3, 15 to 29 mL/min/1.73 m² in Group 4, and less than 15 mL/min/1.73 m² in Group 5. All participants were evaluated using echocardiographic measurements, such as the E/e ratio, left ventricular systolic and diastolic volumes, left atrial strain, left atrial volume index (LAVI), and ejection fraction (EF). Results: LA strain conduit and reservoir strain can significantly diagnose LV diastolic function in CKD patients (p < 0.001; AUC = 0.819 and 0.869, respectively) using cutoffs of ≤36 and ≥23, with 86% and 95.5% sensitivity, 65% and 60% specificity, 96.1% and 96% PPV, and 31.7% and 57.1%, NPV respectively. An AUC = 0.926 was observed with LAVI among grade 1 vs. grade 0 (0.9 is considered excellent in diagnosing patients with and without the disease). Other markers had AUC values of 0.5–0.6 among the grades of the diastolic function, suggesting no discrimination in diagnosing the disease. Conclusions: LA conduit strain and reservoir strain are independent markers that represent a superior and more sensitive approach than LAVI and tissue Doppler echocardiography for evaluating LV diastolic dysfunction in patients with CKD, even in the early stages. Full article

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11 pages, 403 KiB

Open AccessArticle

Public Awareness of Ocular Chemical Injuries: A Cross-Sectional Study in Lithuania

by Justina Skruodyte, Martyna Sveikataite, Jurate Sveikatiene and Pranas Serpytis

Clin. Pract. 2025, 15(2), 35; https://doi.org/10.3390/clinpract15020035 - 13 Feb 2025

Abstract

Background: Ophthalmic emergencies are acute conditions that progress rapidly, posing a significant threat to a patient’s vision and requiring urgent intervention to prevent permanent visual impairment. This study aimed to assess the general awareness of ocular chemical burns and the adequacy of the [...] Read more.

Background: Ophthalmic emergencies are acute conditions that progress rapidly, posing a significant threat to a patient’s vision and requiring urgent intervention to prevent permanent visual impairment. This study aimed to assess the general awareness of ocular chemical burns and the adequacy of the immediate response measures while also seeking to improve the understanding of these injuries and contribute to promoting a healthier society. Methods: A comprehensive literature review was performed, and the most frequently reported questions were incorporated into the original survey. An anonymous questionnaire, available both online and in print, was developed to conduct a cross-sectional study to assess the general knowledge of the causes, symptoms, and appropriate first aid measures to be applied in cases of chemical ocular trauma. Results: Between April and May 2024, 175 individuals completed the questionnaire and were included in the study. More than half (54%) of the tested population demonstrated a poor level of knowledge about chemical ocular injuries, and only 30.9% of the respondents correctly indicated the need for imminent treatment. Twenty percent of the respondents could not identify whether alkalis or acids are more hazardous. Additionally, 5.7% of the respondents falsely considered consultation with an emergency department a priority before thorough irrigation. Most of the respondents (60.6%) incorrectly indicated that the appropriate first aid measures and treatment depend on the substance involved, and 68.1% of the respondents stated that treatment in the emergency department should be delayed, allowing for anamnesis collection and thorough examination. Conclusions: Ocular chemical injuries can substantially impact an individual’s quality of life. The present study found that the public knowledge concerning ocular chemical trauma, and the necessary immediate treatment is insufficient. Public education is vital, as delaying prompt and thorough irrigation at the chemical injury site may result in irreversible complications. Full article

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6 pages, 1258 KiB

Open AccessCase Report

A Case Study and Concise Literature Review: Adult Patient’s Initial Manifestation of Complicated Acute Otitis Media Presenting as Jugular Foramen Syndrome

by Sabri El-Saied, Oren Ziv, Aviad Sapir, Daniel Yafit and Daniel M. Kaplan

Clin. Pract. 2025, 15(2), 34; https://doi.org/10.3390/clinpract15020034 - 12 Feb 2025

Abstract

Background: Jugular foramen syndrome (JFS) is a rare condition characterized by the compression or impairment of one or more terminal cranial nerves passing through the jugular foramen. Although malignancies are the primary cause of JFS. Methods: In this report, we present the first [...] Read more.

Background: Jugular foramen syndrome (JFS) is a rare condition characterized by the compression or impairment of one or more terminal cranial nerves passing through the jugular foramen. Although malignancies are the primary cause of JFS. Methods: In this report, we present the first documented case of JFS caused by acute otitis media in an adult patient. Results: A 74-year-old woman presented with ear pain, hoarseness, dysphagia, dizziness, tinnitus, and hearing loss. A physical examination revealed a reddish-bulging tympanic membrane, left-sided hearing loss, right uvula deviation, and cranial nerve palsies affecting the ninth and tenth nerves. Imaging studies confirmed temporal bone inflammation, thrombosis of the sigmoid sinus extending into the internal jugular vein, and signs of thrombophlebitis of the jugular vein. The patient underwent a cortical mastoidectomy, sigmoid sinus decompression, and ventilation tube insertion, along with antibiotic, steroid, and anticoagulant therapy. Postoperatively, the patient’s condition improved significantly. Conclusions: This case highlights the importance of considering complicated acute otitis media in the differential diagnosis of neurological abnormalities associated with JFS. A thorough evaluation of the patient’s medical history and radiological imaging can assist in identifying the cause of the symptoms and guide appropriate surgical or conservative treatment. Further research is essential to gain more comprehensive insights into the pathophysiology and therapeutic interventions of JFS affecting the ears. Full article

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