Clinics and Practice

14 pages, 1115 KiB

Open AccessArticle

Artificial Intelligence and Modern Technology in Dentistry: Attitudes, Knowledge, Use, and Barriers Among Dentists in Croatia—A Survey-Based Study

by Ana Ivanišević and Antonija Tadin

Clin. Pract. 2024, 14(6), 2623-2636; https://doi.org/10.3390/clinpract14060207 - 5 Dec 2024

Abstract

Aim: This study aims to assess Croatian dentists’ knowledge, attitudes, and use of artificial intelligence (AI) and modern technology, while also identifying perceived barriers to AI and modern technology adoption and evaluating the need for further education and training. Materials and Methods: A [...] Read more.

Aim: This study aims to assess Croatian dentists’ knowledge, attitudes, and use of artificial intelligence (AI) and modern technology, while also identifying perceived barriers to AI and modern technology adoption and evaluating the need for further education and training. Materials and Methods: A cross-sectional survey was conducted in February 2024 among general dentists in Croatia using a self-structured questionnaire. A total of 200 respondents filled out the questionnaire. It included five sections: socio-demographic and professional information, self-assessment of AI and modern technology use, knowledge of AI in dentistry, current innovations and devices used in practice, and barriers to AI and modern technology integration in practice. Data were analyzed using descriptive statistics and a regression analysis to explore relationships between socio-demographic factors and AI knowledge. Results: The mean knowledge of AI systems was 3.62 ± 2.56 out of a possible score of 7, indicating relatively poor knowledge, with 47.5% demonstrating knowledge below the median. Most respondents (76.0%) did not use AI systems and modern technology in practice; however, prosthodontics (13.0%) and oral surgery (10.0%) were identified as the primary fields utilizing these technologies. Respondents rated their knowledge of modern technologies and AI as weak or moderate, with 60.5% engaged in continuous education. Despite 76.0% not using AI daily, 71.0% believed that these technologies could enhance patient care. Participants interested in further training showed significantly better knowledge of AI applications (p = 0.030). Major barriers included acquisition and maintenance costs (59.0%) and financial constraints (58.0%). Conclusions: The study revealed that most respondents had poor knowledge of AI systems. Despite this, there is a recognition of AI’s and modern technology potential in dentistry, emphasizing the need for enhanced education and training in this field. Full article

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15 pages, 1205 KiB

Open AccessArticle

Body Composition Changes and Factors Influencing the Total Weight Loss Rate After Laparoscopic Sleeve Gastrectomy

by Hironobu Nakaguchi, Bunzo Matsuura, Teruki Miyake, Hidenori Senba, Shinya Furukawa, Motohira Yoshida, Shigehiro Koga, Yuji Watanabe, Taro Oshikiri, Kumiko Toshimitsu and Yoichi Hiasa

Clin. Pract. 2024, 14(6), 2608-2622; https://doi.org/10.3390/clinpract14060206 - 5 Dec 2024

Abstract

Objectives: While the effectiveness of metabolic/bariatric surgery has been confirmed, understanding the factors associated with weight loss is paramount for providing guidance in postoperative treatment strategies. Here, we aimed to examine the factors associated with long-term maintenance of weight loss after laparoscopic sleeve [...] Read more.

Objectives: While the effectiveness of metabolic/bariatric surgery has been confirmed, understanding the factors associated with weight loss is paramount for providing guidance in postoperative treatment strategies. Here, we aimed to examine the factors associated with long-term maintenance of weight loss after laparoscopic sleeve gastrectomy (LSG). Methods: This prospective observational cohort included patients who underwent LSG at a single academic health center between January 2017 and June 2022. We examined their body composition using InBody 720 or 770 and analyzed the factors associated with the percentage of total weight loss (%TWL) for 24 months. Results: The median body mass index (BMI) was 38.8 (interquartile range [IQR]: 35.6–46.7) preoperatively, 32.7 kg/m² (IQR: 28.2–38.7) at 12 months postoperatively, and 33.9 kg/m² (IQR: 29.1–40.1) at 24 months postoperatively. The lowest BMI was observed at 12 months (p < 0.001 vs. preoperative), followed by a significant increase at 24 months (p = 0.003). However, BMI remained significantly lower at 24 months than preoperatively (p < 0.001). The skeletal muscle mass to fat mass ratio (SMM/FM) was 0.59 (IQR: 0.50–0.71) preoperatively, 0.79 (IQR: 0.58–1.26) at 12 months, and 0.70 (IQR: 0.54–1.05) at 24 months, peaking at 12 months (p < 0.001 vs. preoperative) and decreasing significantly by 24 months (p < 0.001). Nevertheless, the SMM/FM ratio at 24 months remained higher than preoperative values (p < 0.001). Median body weight and %TWL were 86.0 kg and 15.6%, respectively, at 24 months after LSG. The SMM/FM ratio at 12 months was positively correlated with %TWL at 24 months after adjusting for age and sex. Conclusions: The effects of LSG persisted for up to 24 months postoperatively. The SMM/FM ratio 12 months after LSG was associated with the rate of weight loss at 24 months. Full article

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7 pages, 620 KiB

Open AccessArticle

The Use of Acetazolamide to Prevent Acute Kidney Injury in Patients with Cancer on High-Dose Methotrexate Treatment: A Retrospective Pilot Analysis

by Lindon Lin, Tracey Batt and Gregory M. Peterson

Clin. Pract. 2024, 14(6), 2601-2607; https://doi.org/10.3390/clinpract14060205 - 28 Nov 2024

Abstract

Background: High-dose methotrexate (HDMTX) chemotherapy is associated with a significant risk of acute kidney injury (AKI). Acetazolamide is thought to increase methotrexate solubility via urinary alkalinisation, potentially reducing the risk of crystalline nephropathy. A tertiary hospital has included acetazolamide in its HDMTX protocols, [...] Read more.

Background: High-dose methotrexate (HDMTX) chemotherapy is associated with a significant risk of acute kidney injury (AKI). Acetazolamide is thought to increase methotrexate solubility via urinary alkalinisation, potentially reducing the risk of crystalline nephropathy. A tertiary hospital has included acetazolamide in its HDMTX protocols, although data on the risks and benefits are limited. This study evaluated the role of acetazolamide in managing patients receiving HDMTX and identified risk factors for AKI. Methods: The retrospective cohort pilot study included consecutive hospital patients who received HDMTX (≥500 mg/m²). Data collected from digital medical records included demographics, comorbidities, methotrexate dosages and serum concentrations, and pathology results. The development of AKI was defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Relationships between variables and AKI were initially assessed using Mann–Whitney U-tests and chi-square tests, and significant variables were further analysed using logistic regression to identify independent predictors of AKI. Results: Among 66 HDMTX treatment cycles in 31 patients, AKI occurred in 0/7 cycles with acetazolamide versus 14/59 cycles without (p = 0.33). Increasing age, the presence of hypertension, and concurrent use of beta-lactam antibiotics were associated with the development of AKI. Age was identified as the strongest independent risk factor for AKI (odds ratio 1.12, p = 0.034). Conclusions: Optimising management protocols, especially for older patients, is essential to reduce AKI risk during HDMTX therapy. While acetazolamide did not appear to reduce the risk of AKI, this pilot study was limited by a small sample size. Large randomised controlled trials are needed to assess efficacy and patient outcomes. Full article

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11 pages, 272 KiB

Open AccessArticle

Evaluating the Impact of Maternal Lipid Profiles on Fetal Cardiac Function at Mid-Gestation: An Observational Study

by Biliana Belovan, Zoran Laurentiu Popa, Cosmin Citu, Ioana Mihaela Citu, Ioan Sas and Adrian Ratiu

Clin. Pract. 2024, 14(6), 2590-2600; https://doi.org/10.3390/clinpract14060204 - 27 Nov 2024

Abstract

Background: Maternal dyslipidemia during pregnancy may influence fetal cardiac development and function, potentially predisposing offspring to cardiovascular diseases later in life. This study aims to evaluate the relationship between maternal lipid profiles and fetal cardiac function at mid-gestation, utilizing detailed echocardiographic assessments. Methods: [...] Read more.

Background: Maternal dyslipidemia during pregnancy may influence fetal cardiac development and function, potentially predisposing offspring to cardiovascular diseases later in life. This study aims to evaluate the relationship between maternal lipid profiles and fetal cardiac function at mid-gestation, utilizing detailed echocardiographic assessments. Methods: In this prospective cohort study conducted at the Obstetrics and Gynecology Clinic of the Timișoara Municipal Emergency Hospital, 19 pregnant women aged 27–40 years were recruited and divided into two groups based on their triglyceride levels: Group A (triglycerides ≤ 150 mg/dL, n = 48) and Group B (triglycerides > 150 mg/dL, n = 28). Maternal demographic data and lipid profiles were recorded. Fetal echocardiographic measurements, including global longitudinal strain and ventricular function parameters, were obtained between 20 and 24 weeks of gestation. Statistical analyses, including subgroup comparisons, correlations, and regression analyses, were performed. Results: Maternal BMI was significantly higher in Group B compared to Group A (31.94 ± 2.80 vs. 27.01 ± 2.40 kg/m², p < 0.001). Group B showed higher mean triglyceride levels (163.43 ± 11.34 mg/dL) compared to Group A (131.42 ± 10.57 mg/dL, p < 0.001). Fetal echocardiographic measurements indicated reduced global longitudinal strain in fetuses of Group B mothers (LV strain: −19.86% ± 6.83% vs. −26.14% ± 5.92%, p = 0.017). Significant correlations were found between maternal triglyceride levels and fetal LV strain (r = 0.536, p = 0.019). Regression analysis identified maternal triglyceride levels and BMI as significant predictors of reduced fetal LV strain (β = 0.45, p = 0.021 and β = 0.39, p = 0.038, respectively). Conclusions: Elevated maternal triglyceride levels, LDL cholesterol, and BMI are associated with altered fetal cardiac function parameters at mid-gestation, suggesting that maternal lipid profiles may impact fetal cardiac development. These findings underscore the importance of monitoring lipid levels during pregnancy and suggest potential benefits of managing dyslipidemia to improve fetal cardiac outcomes. However, the study included only a small sample; therefore, the study needs to be continued with a larger group. Full article

10 pages, 270 KiB

Open AccessArticle

Clinical Success of Pulpotomies Using Intermediate Restorations and Preformed Metal Crowns in the Context of a Developing Country: A Retrospective Questionnaire-Based Investigation

by Ana Luisa Montero-Copoya, Norma Leticia Robles-Bermeo, Salvador Eduardo Lucas-Rincón, María de Lourdes Márquez-Corona, Saraí Carmina Guadarrama-Reyes, Nayeli Lovera-Rojas, Juan Fernando Casanova-Rosado, Juan José Villalobos-Rodelo, Mauricio Escoffié-Ramírez and Carlo Eduardo Medina-Solís

Clin. Pract. 2024, 14(6), 2580-2589; https://doi.org/10.3390/clinpract14060203 - 27 Nov 2024

Abstract

Background: Dental caries is one of the most prevalent dental illnesses in children. Untreated severe caries can damage teeth, requiring pulpotomy to save them. Objective: To evaluate the clinical success rate of treatments involving pulpotomies + IRM (Intermediate Restorative Material, composed of reinforced [...] Read more.

Background: Dental caries is one of the most prevalent dental illnesses in children. Untreated severe caries can damage teeth, requiring pulpotomy to save them. Objective: To evaluate the clinical success rate of treatments involving pulpotomies + IRM (Intermediate Restorative Material, composed of reinforced zinc oxide–eugenol polymers) + preformed metal crowns (PMCs) in primary teeth of children treated at a public university in Mexico. Materials and Methods: A cross-sectional ambispective study was conducted on children aged 10 years or younger, treated at a public university in Mexico. A total of 1281 medical records from February 2018 to June 2023 were reviewed, yielding a sample of 199 children treated with pulpotomy + IRM + PMC. Information was collected via telephone interviews with parents/caregivers to inquire about any symptoms following the pulpotomy and metal crown treatments. Success was defined as the absence of pain, inflammation, or infection. Results: During the study period, the number of teeth treated with pulpotomy + IRM + PMC was 414, with follow-ups ranging from 6 to 69 months. Most participants were girls (54.3%), while 45.7% were boys. Out of the 167 pulpotomy + IRM + PMC treatments included in the study, the clinical success rate was 98.2%. Conclusions: The clinical success rate of primary teeth treated with pulpotomy + IRM + PMCs was high, close to 100%, based on evidence and symptom reports from parents/caregivers. It would be beneficial to implement its use in public health institutions in countries such as Mexico. Full article

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

12 pages, 1331 KiB

Open AccessArticle

Immediate Effects of the Mandibular Muscle Energy Technique in Adults with Chronic Temporomandibular Disorder

by Antonio Márquez-Vera, Luis Polo-Ferrero, Ana Silvia Puente-González, Roberto Méndez-Sánchez and José Antonio Blanco-Rueda

Clin. Pract. 2024, 14(6), 2568-2579; https://doi.org/10.3390/clinpract14060202 - 25 Nov 2024

Abstract

Background/Objectives: Temporomandibular disorders affect the muscles used for chewing, the temporomandibular joint, and other related tissues, resulting in pain, limited mobility, and dysfunction of the masticatory muscles. Physical therapy plays a critical role in treatment. Manual therapy can trigger neurophysiological mechanisms that contribute [...] Read more.

Background/Objectives: Temporomandibular disorders affect the muscles used for chewing, the temporomandibular joint, and other related tissues, resulting in pain, limited mobility, and dysfunction of the masticatory muscles. Physical therapy plays a critical role in treatment. Manual therapy can trigger neurophysiological mechanisms that contribute to pain relief and a reduction in muscle activation. Evaluations of different manual therapy techniques are needed on this topic. The main objective of this study was to evaluate the effects of a specific manual therapy technique (the mandibular muscle energy technique) in adults with temporomandibular disorders. Methods: A randomized, parallel clinical trial was conducted, and 31 participants were recruited into an experimental group and 30 were recruited into a control group in order to analyze its effects on outcomes such as pain, pain threshold to pressure, mandibular mobility, and kinesiophobia. Pre- and post-intervention assessments were performed, followed by statistical analyses to verify the intra- and intergroup changes. Results: The results showed that the mandibular muscle energy technique produced positive effects with significant differences in the intra- and intergroup comparisons for pain threshold to pressure, mandibular mobility, and kinesiophobia, demonstrating its efficacy and safety as a treatment option for adults with temporomandibular disorders, with proven effects in the short term. Conclusions: The effects obtained and the absence of side effects showed that this technique can be integrated into multimodal treatment along with other types of interventions in patients with temporomandibular disorders. Full article

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

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9 pages, 215 KiB

Open AccessArticle

Extraperitoneal Open Radical Cystectomy: A New Standard in Frail Patients with Muscle-Invasive Bladder Cancer?

by Daniel Porav-Hodade, Silvestru-Alexandru Big, Vlad-Ilie Barbos, Bogdan Gherle, Ernő Jerzicska, Victor Ona and Bogdan-Ovidiu Feciche

Clin. Pract. 2024, 14(6), 2559-2567; https://doi.org/10.3390/clinpract14060201 - 24 Nov 2024

Abstract

Background/Objectives: Radical cystectomy (RC) represents one of the most complex and morbid surgical procedures in the field of Urology. Extraperitoneal open RC has emerged as an alternative to the traditional transperitoneal approach for the treatment of muscle-invasive bladder cancer. Frailty is one [...] Read more.

Background/Objectives: Radical cystectomy (RC) represents one of the most complex and morbid surgical procedures in the field of Urology. Extraperitoneal open RC has emerged as an alternative to the traditional transperitoneal approach for the treatment of muscle-invasive bladder cancer. Frailty is one of the most important risk factors for perioperative morbidity and mortality, and this category of patients can benefit the most from the extraperitoneal approach. The purpose of this study was to evaluate the feasibility and the safety of extraperitoneal open RC in our experience; Methods: We retrospectively collected the data of 75 frail patients who underwent an extraperitoneal open RC, performed by a single experienced surgeon. We assessed their frailty status using the simplified frailty index (sFI). We recorded data regarding general characteristics, intraoperative, pathological, and postoperative complications, and mortality (within 90 days); Results: We analyzed 61 males and 14 females with an sFI equal to or higher than 3. The median age was 77 years. Fifty-one patients had an ASA score of 3 or more. Sixty procedures were with radical intention, while fifteen were palliative. Cutaneous ureterostomy was performed in 70 cases and extraperitonized ileal conduit in five cases. The median operative time was 150 min. The median blood loss was 400 mL. The median time to flatus was 2 days. The median postoperative stay was 7 days. Thirteen patients had Clavien–Dindo III or IV complications. Two patients died in first 90 days postoperatively; Conclusions: The extraperitoneal open RC in frail patients was demonstrated to be a feasible and safe alternative approach in definitive treatment or a palliative setting in our experience. Full article

17 pages, 8205 KiB

Open AccessReview

Metabolic Dysfunction-Associated Steatotic Liver Disease in Chronic Hepatitis C Virus Infection: From Basics to Clinical and Nutritional Management

by Karina Gonzalez-Aldaco, Luis A. Torres-Reyes, Claudia Ojeda-Granados, Leonardo Leal-Mercado, Sonia Roman and Arturo Panduro

Clin. Pract. 2024, 14(6), 2542-2558; https://doi.org/10.3390/clinpract14060200 - 24 Nov 2024

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely associated with obesity and other cardiometabolic risk factors. MASLD has rapidly become the most common cause of liver disease worldwide, currently affecting 38% of the global population. Excess weight causes chronic inflammation and the activation [...] Read more.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely associated with obesity and other cardiometabolic risk factors. MASLD has rapidly become the most common cause of liver disease worldwide, currently affecting 38% of the global population. Excess weight causes chronic inflammation and the activation of different pathways involved in liver damage. MASLD can progress from simple steatosis to steatohepatitis, giving way to its inflammatory component, metabolic dysfunction-associated steatohepatitis (MASH), previously recognized as non-alcoholic steatosis hepatitis (NASH). Chronic hepatitis C virus (HCV) infection remains a significant challenge to liver health as it triggers hepatic inflammation, metabolic disruption, and hepatic steatosis. The convergence of MASLD and chronic HCV infection can significantly alter the course of liver disease and accelerate the progression to severe liver damage. Currently, HCV treatment has a high cure rate. However, in patients who achieve a sustained virological response after treatment with direct-acting antivirals, weight gain, and excessive calorie intake may contribute to increased liver steatosis and a higher risk of liver disease progression. Therefore, the effective clinical and nutritional management of HCV patients, both before and after viral eradication, is crucial to reducing the risk of death from hepatocellular carcinoma. Understanding the complex interactions between MASLD and HCV infection is crucial for managing these patients appropriately. Herein, host and viral mechanisms inducing liver damage during the coexistence of MASLD and HCV infection are described, and their therapeutic and dietary management are discussed. Full article

(This article belongs to the Special Issue Clinical Nutrition in Metabolic Disorders)

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9 pages, 525 KiB

Open AccessArticle

Clinical Acceptance of Digitally Produced Zirconia and Metal Post and Cores, Based on the Impression Method

by Paula Perlea, Cosmin Stefanescu and Alexandru Eugen Petre

Clin. Pract. 2024, 14(6), 2533-2541; https://doi.org/10.3390/clinpract14060199 - 20 Nov 2024

Abstract

Background: The existing literature predominantly examines post and core assessments post-cementation, neglecting the critical pre-cementation phase. Research on the clinical acceptance of dental posts received from dental laboratories before cementation is notably lacking. This study investigates the percentage of zirconia and metal dental [...] Read more.

Background: The existing literature predominantly examines post and core assessments post-cementation, neglecting the critical pre-cementation phase. Research on the clinical acceptance of dental posts received from dental laboratories before cementation is notably lacking. This study investigates the percentage of zirconia and metal dental posts that are deemed suitable for cementation by clinicians, among the total received from the dental laboratory. Additionally, it aims to examine whether this percentage varies based on the type of impression made by the clinician: digital impression versus conventional impression. Methods: This article introduces the application of computer-aided design-computer-aided manufacturing (CAD-CAM) technology for manufacturing customized zirconia and Cobalt–Chromium (Co-Cr) post and cores. Intraoral scanning is employed to capture the canal anatomy. In contrast to the traditional casting process, a three-dimensional (3D) metal printer machine is utilized to 3D print the metal post and core from Co-Cr, resulting in enhanced toughness and superior adaptability to the canal. Two null hypotheses were formulated, investigating the clinical acceptance of zirconia and metal posts obtained through traditional versus digital impressions. Results: Among 577 post and cores, 95% of metal posts from both impression methods received clinical approval. However, for zirconia posts, a significantly higher acceptance rate (95% versus 88%) was observed for those from traditional impressions. The Chi-squared test yielded a p-value < 0.05, underscoring the clinical superiority of conventionally obtained zirconia posts and supporting the null hypothesis for metal posts. Conclusions: A significantly higher acceptance rate is apparent among zirconia post and cores manufactured through conventional impressions, in contrast to zirconia post and cores produced via digital impressions. No statistically significant difference was identified between metal post and cores obtained through digital impressions and those acquired through conventional impressions. Full article

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

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11 pages, 771 KiB

Open AccessArticle

Knowledge, Attitudes, and Practices of Parents Regarding Ophthalmological Screening of Preschool-Aged Children in Jazan, Saudi Arabia

by Mohamed Salih Mahfouz, Samy Shaban Mahmoud, Saleha Qaseem Haroobi, Latifah Mohammed Bahkali, Shahad Ibrahim Numan, Areen Mohsen Taheri, Ohoud Ali Hakami, Orjuwan Adel Zunquti and Sarah Mohammed Khered

Clin. Pract. 2024, 14(6), 2522-2532; https://doi.org/10.3390/clinpract14060198 - 20 Nov 2024

Abstract

Background: Children’s eye disorders are a major cause of irreversible vision loss. Delays in diagnosing eye problems in children are recurring problems that require quick attention. This study assesses parents’ knowledge, attitudes, and practices regarding the early ophthalmological screening of preschool-aged children in [...] Read more.

Background: Children’s eye disorders are a major cause of irreversible vision loss. Delays in diagnosing eye problems in children are recurring problems that require quick attention. This study assesses parents’ knowledge, attitudes, and practices regarding the early ophthalmological screening of preschool-aged children in Jazan, KSA. Methods: An observational cross-sectional study was conducted among 522 parents of preschool-aged children in the Jazan region. A self-administered web-based questionnaire was randomly distributed to the parents via WhatsApp. The survey tool consisted of four main sections: socio-demographic data, knowledge about eye care, attitudes toward eye screening, and eye care practices. Results: Parents’ level of knowledge regarding children’s eye care was distributed as follows: low (21.5%), medium (40.2%), and high (38.4%). Parent gender, age, occupation, level of income, and nationality showed no statistically significant association with the knowledge level (p > 0.05 for all). However, parent education played a significant role (p = 0.013). Further, parents expressed a positive attitude toward the early screening of eye problems, as more than 90% agreed that early eye examinations for children reduce complications from visual problems and that the increased use of electronic devices requires early eye examinations. Almost 47.0% of the parents had examined their children’s eyes when they were between 1 and 5 years of age, compared with only 10.3% of parents of children less than 1 year of age. The multiple linear regression model for factors that predict knowledge level among the study participants showed that having a child undergo early screening is positively associated with an increased knowledge score (p < 0.05). Conclusions: Jazan parents showed a positive attitude toward the early screening of eye problems, and one-third had a high level of knowledge regarding children’s eye care. However, the proportion of those who practiced early eye screening was low. More health education is necessary to increase parents’ awareness regarding early eye care practices. Full article

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15 pages, 2232 KiB

Open AccessArticle

Artificial Intelligence Applied in Early Prediction of Lower Limb Fracture Complications

by Aurelian-Dumitrache Anghele, Virginia Marina, Liliana Dragomir, Cosmina Alina Moscu, Iuliu Fulga, Mihaela Anghele and Cristina-Mihaela Popescu

Clin. Pract. 2024, 14(6), 2507-2521; https://doi.org/10.3390/clinpract14060197 - 14 Nov 2024

Abstract

Background: Artificial intelligence has become a valuable tool for diagnosing and detecting postoperative complications early. Through imaging and biochemical markers, clinicians can anticipate the clinical progression of patients and the risk of long-term complications that could impact the quality of life or [...] Read more.

Background: Artificial intelligence has become a valuable tool for diagnosing and detecting postoperative complications early. Through imaging and biochemical markers, clinicians can anticipate the clinical progression of patients and the risk of long-term complications that could impact the quality of life or even be life-threatening. In this context, artificial intelligence is crucial for identifying early signs of complications and enabling clinicians to take preventive measures before problems worsen. Materials and methods: This observational study analyzed medical charts from the electronic archive of the Clinical Emergency Hospital in Galați, Romania, covering a four-year period from 2018 to 2022. A neural network model was developed to analyze various socio-demographic and paraclinical data. Key features included patient demographics, laboratory investigations, and clinical outcomes. Statistical analyses were performed to identify significant risk factors associated with deep venous thrombosis (DVT). Results: The analysis revealed a higher prevalence of female patients (60.78%) compared to male patients, indicating a potential gender-related risk factor for DVT. The incidence of DVT was highest among patients aged 71 to 90 years, affecting 56.86% of individuals in this age group, suggesting that advanced age significantly contributes to the risk of developing DVT. Additionally, among the DVT patients, 15.69% had a body mass index (BMI) greater than 30, categorizing them as obese, which is known to increase the risk of thrombotic events. Furthermore, this study highlighted that the highest frequency of DVT was associated with femur fractures, occurring in 52% of patients with this type of injury. The neural network analysis indicated that elevated levels of direct bilirubin (≥1.5 mg/dL) and prothrombin activity (≤60%) were strong predictors of fracture-related complications, with sensitivity and specificity rates of 78% and 82%, respectively. These findings underscore the importance of monitoring these laboratory markers in at-risk populations for early intervention. Conclusions: This study identified critical risk factors for developing DVT, including advanced age, high BMI, and femur fractures, which necessitate longer recovery periods. Additionally, the findings indicate that elevated direct bilirubin and prothrombin activity play a significant role in predicting DVT development. These results suggest that AI can effectively enhance the anticipation of clinical evolution in patients, aiding in early intervention and management strategies. Full article

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8 pages, 213 KiB

Open AccessArticle

Oral Diadochokinesis, Tongue Pressure, and Lip-Seal Strength Among Japanese Male Workers in the Taxi Industry: A Cross-Sectional Study

by Akira Minoura, Yoshiaki Ihara, Hirotaka Kato, Kouzou Murakami, Yoshio Watanabe, Kojiro Hirano, Yoshinori Ito and Akatsuki Kokaze

Clin. Pract. 2024, 14(6), 2499-2506; https://doi.org/10.3390/clinpract14060196 - 14 Nov 2024

Abstract

Background/Objectives: Health management in workers in the taxi industry is particularly challenging due to irregular working hours and the need to prevent fatal accidents. In addition, drivers in Japan are aging, and the early prevention of age-related deterioration in oral health is an [...] Read more.

Background/Objectives: Health management in workers in the taxi industry is particularly challenging due to irregular working hours and the need to prevent fatal accidents. In addition, drivers in Japan are aging, and the early prevention of age-related deterioration in oral health is an increasingly important issue. The aim of this cross-sectional study was to investigate the relationships between oral diadochokinesis (OD), tongue pressure, and lip-seal strength in Japanese male taxi workers. Methods: Measurements of tongue pressure and lip-seal strength were performed by dentists using specialized equipment. OD was measured using the number of consecutive “Pa”, “Ta”, and “Ka” vocalizations that could be produced in 5 s. We performed multiple regression analysis to examine the effects of lip-seal strength and tongue pressure on OD. Results: The study included 437 participants, excluding 17 who could not complete all oral cavity measurements. Tongue pressure showed a significant positive correlation with “Pa”, “Ta”, and “Ka” (correlation coefficients: 0.527–0.680). Lip-seal strength was not significantly correlated with OD. Tongue pressure showed a significant positive correlation with “Pa”, “Ta”, and “Ka”. In the results of multiple regression analyses without the elderly participants, tongue pressure was associated with “Pa” (β[95% confidence interval]: 0.574[0.304, 0.843]), “Ta” (0.436[0.231, 0.640]), and “Ka” (0.424[0.210, 0.639]), and lip-seal strength was associated with “Pa” (0.128[0.032, 0.224]) and “Ka” (0.083[0.006, 0.160]). Conclusions: OD may be associated with lip-seal strength and tongue pressure even without including elderly workers. Regardless of age, maintaining good OD may help maintain lip-seal strength and tongue pressure, which may play a role in reducing the risk of age-related oral disorders. Full article

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

8 pages, 436 KiB

Open AccessArticle

Running Cadence and the Influence on Frontal Plane Knee Deviations

by Jacob R. Peterson, Collin R. Sanders, Nathan S. Reynolds, Conner A. Alford, Michael J. Platt, Jeffrey J. Parr, Felix Twum, James R. Burns and David R. Dolbow

Clin. Pract. 2024, 14(6), 2491-2498; https://doi.org/10.3390/clinpract14060195 - 14 Nov 2024

Abstract

Background: Patellofemoral pain is one of the most common injuries in recreational runners, with significant implications for dynamic knee valgus. The knee valgus angle can be corrected surgically or with a more conservative non-operative approach. Increasing running cadence may be an effective biomechanical [...] Read more.

Background: Patellofemoral pain is one of the most common injuries in recreational runners, with significant implications for dynamic knee valgus. The knee valgus angle can be corrected surgically or with a more conservative non-operative approach. Increasing running cadence may be an effective biomechanical gait retraining intervention to reduce knee valgus and thus patellofemoral pain. The primary purpose of this study was to examine if an increase in cadence could change the knee valgus angle. Methods: Ten asymptomatic recreational runners were recorded running on a treadmill during control and experimental intervals. Each interval lasted five minutes, and participants ran at 100% and 110% of their baseline cadence. Peak angles of knee valgus were compared between both intervals using the video analysis software application Dartfish Express. A paired sample, a two-tailed t-test, was used to determine the significant difference between bilateral frontal plane knee angle measurements during both intervals. Results: The average decrease in knee valgus measured in control versus experimental intervals was 2.23° for the right leg and 2.05° for the left leg, with a significance of p < 0.001 and p < 0.001, respectively. Conclusion: The results indicated a statistically significant decrease in angles of dynamic knee valgus, attributable to increased cadence. These changes in knee valgus angle are likely to have a positive impact on preventing and reducing pain associated with PFP. Full article

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7 pages, 8271 KiB

Open AccessCase Report

Micropulse Laser Therapy in Central Serous Chorioretinopathy

by Flaviu Bodea, Andrei-Flavius Radu, Ruxandra-Florina Bodog, Teodora Maria Bodog and Cristina Ariadna Nicula

Clin. Pract. 2024, 14(6), 2484-2490; https://doi.org/10.3390/clinpract14060194 - 14 Nov 2024

Abstract

Background: Central serous chorioretinopathy (CSCR) is a retinal condition characterized by the accumulation of subretinal fluid, often linked to elevated levels of endogenous corticosteroids and stress-related hormones, which can lead to visual disturbances. This connection may explain the association of CSCR with [...] Read more.

Background: Central serous chorioretinopathy (CSCR) is a retinal condition characterized by the accumulation of subretinal fluid, often linked to elevated levels of endogenous corticosteroids and stress-related hormones, which can lead to visual disturbances. This connection may explain the association of CSCR with high stress levels and the use of corticosteroid medications. Although many cases resolve spontaneously, persistent or severe instances may require intervention. Case Description: Our report presents a case of acute CSCR in a 33-year-old male who developed the condition following corticosteroid treatment for acute parotiditis and left submandibular lymphadenopathy. Initial presentation was 6 weeks after corticosteroid treatment was initiated. Diagnostic evaluation with optical coherence tomography (OCT) and fluorescein angiography confirmed the presence of subretinal fluid at the retinal pigment epithelium–Bruch’s membrane complex. Micropulse laser therapy (MPLT) was applied to address the leakage points, leading to significant fluid reduction at a two-week follow-up. By six weeks, the complete resolution of subretinal fluid was documented, with substantial visual recovery. Conclusions: This case confirms MPLT as an effective treatment for CSCR, particularly when conservative management is insufficient. Unlike traditional photocoagulation, MPLT offers a safer alternative, minimizing the risk of retinal damage, such as permanent scotomas. Clinical Significance: This case underscores the importance of carefully monitoring patients undergoing corticosteroid therapy for potential ocular complications and highlights the role of MPLT as a safe and effective option for managing persistent CSCR, protecting the surrounding retinal tissue from damage while achieving significant therapeutic outcomes. Full article

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9 pages, 823 KiB

Open AccessArticle

Incidence Trends of Rheumatoid Arthritis in Korea for 11 Years (2006–2017)

by Hanna Lee, Sang-Il Lee, Hyunjin Lim, Hyun-Ok Kim, Rock Bum Kim and Yun-Hong Cheon

Clin. Pract. 2024, 14(6), 2475-2483; https://doi.org/10.3390/clinpract14060193 - 13 Nov 2024

Abstract

Background/Objectives: Rheumatoid arthritis (RA) is a chronic inflammatory disorder characterized by joint damage. However, no incidence analyses have been conducted on a Korean population since 2013. We aimed to calculate the incidence of RA and examine trends using complete Korean National Health Insurance [...] Read more.

Background/Objectives: Rheumatoid arthritis (RA) is a chronic inflammatory disorder characterized by joint damage. However, no incidence analyses have been conducted on a Korean population since 2013. We aimed to calculate the incidence of RA and examine trends using complete Korean National Health Insurance Service claims data from 2007. Methods: We used 16 years of Korean NHIS claims data from 1 January 2002 to 31 December 2017. Patients were defined as having RA when diagnosed with ICD-10 codes M05 and M06. We set the 5-year period prior to 2006 as disease-free. Results: From 2007 to 2017, the incidence rate of RA was 35 to 43 per 100,000 individuals. The female-to-male ratio was approximately 3–3.5 to 1. The sex-standardized incidence rate was highest in the 60–69 age group but gradually declined, resulting in a reversal in 2017, with the highest incidence rate observed in the 50–59 age group. The incidence of elderly onset RA (EORA) in individuals aged >60 years exhibited a decreasing trend during the study period (age 60–69, −6.45, 95% CI = −8.27 to −4.62, p < 0.001; age ≥70, −6.09, 95% CI = −7.66 to −4.53, p < 0.001). Conclusions: This study is the first to analyze the incidence trend of RA over an 11-year period. In South Korea, the incidence of RA has shown a decreasing trend since 2011; the same trend was observed in the EORA group. Young-onset RA showed the opposite trend, suggesting that RA is diagnosed earlier, due to the new RA classification criteria. Full article

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12 pages, 514 KiB

Open AccessArticle

Impact of Body Mass Index on the Outcomes of Cryoballoon Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation

by Konstantinos A. Papathanasiou, Dimitrios A. Vrachatis, Charalampos Kossyvakis, Sotiria G. Giotaki, Gerasimos Deftereos, Maria Kousta, Ioannis Anagnostopoulos, Dimitrios Avramides, George Giannopoulos, Vaia Lambadiari, Gerasimos Siasos and Spyridon Deftereos

Clin. Pract. 2024, 14(6), 2463-2474; https://doi.org/10.3390/clinpract14060192 - 12 Nov 2024

Abstract

Background: Atrial fibrillation (AF) is prevalent among obese patients, and cryoballoon ablation (CBA) is an effective strategy for the rhythm control of AF. The impact of body mass index (BMI) on the clinical outcomes of CBA for AF is not fully explored. Methods: [...] Read more.

Background: Atrial fibrillation (AF) is prevalent among obese patients, and cryoballoon ablation (CBA) is an effective strategy for the rhythm control of AF. The impact of body mass index (BMI) on the clinical outcomes of CBA for AF is not fully explored. Methods: 85 consecutive patients with paroxysmal AF were enrolled and were categorized into three groups as per their BMI: normal weight (BMI 18.5–25 kg/m²), overweight (BMI 25–30 kg/m²), and obese patients (BMI > 30 kg/m²). The primary study endpoint was a late (12 month) recurrence of AF. Early recurrence of AF, symptom improvement, and procedural outcomes were some key secondary outcomes. Results: 20 patients had normal weight, 35 were overweight, and 30 were obese. Obese patients featured a higher prevalence of diabetes mellitus, heavier exposure to smoking, and worse baseline symptoms (as assessed through EHRA class at admission and 12 months before CBA) compared to overweight and normal weight patients. Both late and early (<3 months) AF recurrence rates were comparable across the three groups. Of note, obese patients showed greater improvement in their symptoms post-CBA, defined as improvement by at least one EHRA class, compared to normal weight patients; this might be explained by improved diastolic function. Total procedure time and dose area product were significantly increased in obese patients. The multivariate logistic regression analysis indicated that early AF recurrence and the duration of hypertension are independent predictors of late AF recurrence. Conclusion: CBA is effective in overweight and obese patients with paroxysmal AF. Procedure time and radiation exposure are increased in obese patients undergoing CBA. Full article

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18 pages, 313 KiB

Open AccessReview

Progress and Challenges in the Management of Congenital Cytomegalovirus Infection

by Weronika Szulc, Natalia Szydłowska, Julia M. Smyk and Anna Majewska

Clin. Pract. 2024, 14(6), 2445-2462; https://doi.org/10.3390/clinpract14060191 - 12 Nov 2024

Abstract

Congenital cytomegalovirus (CMV) infection is the most common intrauterine viral infection with a significant impact on the foetus and newborn. Current diagnostic practice includes serological testing for specific antibodies, but there are no global screening protocols. Maternal CMV screening is often performed in [...] Read more.

Congenital cytomegalovirus (CMV) infection is the most common intrauterine viral infection with a significant impact on the foetus and newborn. Current diagnostic practice includes serological testing for specific antibodies, but there are no global screening protocols. Maternal CMV screening is often performed in conjunction with antenatal ultrasound. While most infections are asymptomatic, severe cases can lead to long-term disability or death. Antiviral therapies, mainly ganciclovir and valganciclovir, are reserved for symptomatic patients, especially those with central nervous system involvement. Although effective, these treatments are associated with significant side effects such as neutropenia and hepatotoxicity. Foscarnet and cidofovir are used as alternatives, but their efficacy and safety require further study in paediatric patient populations. The effectiveness of passive prophylaxis is still uncertain. The lack of universally accepted guidelines for diagnosis, treatment, and prevention and the risk of serious side effects highlight the need for continued research. This review evaluates current therapeutic strategies, discusses their efficacy and associated risks, and highlights the need for innovative approaches to improve outcomes for affected neonates. Full article

12 pages, 765 KiB

Open AccessArticle

Enhancing Outcomes and Efficiency in Large Epidermal Cyst Management: Quality Improvement Approach in Primary Care

by Waseem Jerjes, Pratik Ramkumar and Yousuf Yaqub

Clin. Pract. 2024, 14(6), 2433-2444; https://doi.org/10.3390/clinpract14060190 - 12 Nov 2024

Abstract

Background: Epidermal cysts are common benign lesions encountered in primary care, especially in minor surgery clinics. The management of large epidermal cysts (>5 cm in diameter) poses significant challenges, including surgical intervention requirements, potential for complications, and impacts on patient care and clinic [...] Read more.

Background: Epidermal cysts are common benign lesions encountered in primary care, especially in minor surgery clinics. The management of large epidermal cysts (>5 cm in diameter) poses significant challenges, including surgical intervention requirements, potential for complications, and impacts on patient care and clinic workflow. The prevalence of these cysts underlines the need for optimised management strategies that are essential for enhancing patient outcomes and clinic efficiency. This quality improvement initiative sought to better manage large epidermal cysts in primary care settings. Patients and methods: The initiative utilised the Plan-Do-Study-Act (PDSA) cycle over three distinct phases, with an emphasis on improving surgical techniques and postoperative care, optimising clinic workflow, and enhancing patient education and involvement. Over the course of this eighteen-month study, 100 patients who required surgical excision of large epidermal cysts were included. The interventions focused on standardising surgical protocols, implementing a new scheduling system, and developing comprehensive educational materials for patients. Results: The programme contributed to major efficiency gains for surgeries: the average operative time was reduced from 45 min to 30. The postoperative complication rate decreased dramatically while patient and clinician satisfaction went up, as did clinic throughput. With patient education enhancements, follow-up adherence rose to 92% while the postoperative complication rate declined from 18% to 9% with the overall approach to patient engagement. Conclusions: The successful application of the PDSA cycles in this work demonstrates that quality improvement methodologies have a potential role in optimising management for large epidermal cysts in primary care settings. Developed interventions can therefore be put into routine care that will indeed improve patient outcome, clinician experience, and operational efficiency in minor surgery clinics. Full article

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14 pages, 252 KiB

Open AccessArticle

Psycho-Somatic Evolution of Patients with Multiple Traumatic Injuries

by Mihaela Anghele, Virginia Marina, Cosmina Alina Moscu, Aurelian-Dumitrache Anghele and Liliana Dragomir

Clin. Pract. 2024, 14(6), 2419-2432; https://doi.org/10.3390/clinpract14060189 - 11 Nov 2024

Abstract

Background and Objective: In this study, we aimed to identify the factors that could impact the Stress-Related Growth Scale (SRGS) questionnaire administered to patients. Materials and Methods: Participants were asked to complete a written SRGS questionnaire (a translated and approved version in Romania) [...] Read more.

Background and Objective: In this study, we aimed to identify the factors that could impact the Stress-Related Growth Scale (SRGS) questionnaire administered to patients. Materials and Methods: Participants were asked to complete a written SRGS questionnaire (a translated and approved version in Romania) at varying time intervals relative to the traumatic event. The questionnaire was developed in accordance with legal regulations of the World Health Organization and the European Union for research involving human subjects for medical purposes. It took approximately 15 min to complete. The questionnaire was filled out by the patient or their legal guardian/parent for minors between January 2021 and January 2022. Results: The findings revealed the individual dimensions in the context of the traumatic impact, and the subsequent conclusions could be applied to a larger group with similar traumatic experiences. It is recognized that psychosomatic pathologies can hinder posttraumatic rehabilitation, leading to slower and more challenging recovery. Conclusions: Posttraumatic stress disorder often manifests as chronic development of symptoms characterized by reexperiencing traumatic scenes, avoidance behaviors, negative alterations in cognition, and heightened arousal. Posttraumatic stress disorder (PTSD) is a prevalent, persistent, and psychologically debilitating syndrome that can significantly impair an individual’s ability to cope with life. The etiology and manifestation of this disorder present numerous challenges due to the complexity of defining and diagnosing these conditions. The distribution of men and women affected by posttraumatic stress disorder varies across different sources and cannot be simplified into one explanation. While sex distribution is an important factor, it is not the sole determinant for understanding the various aspects of these disorders. The diversity of stressors has been shown to correlate with changes in SRGS scores, including subtle emotions like shame and guilt, which contribute to the moral injury resulting from trauma. Full article

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