Clinics and Practice

16 pages, 786 KiB

Open AccessReview

The Role of Vitamin D Supplementation in Type 1, Type 2, and Gestational Diabetes: A Comprehensive Updated Narrative Review

by Asala Nasser, Dimitrios Papandreou, Sousana K. Papadopoulou and Leila Cheikh Ismail

Clin. Pract. 2025, 15(8), 148; https://doi.org/10.3390/clinpract15080148 - 7 Aug 2025

Abstract

Vitamin D has emerged as a modulatory factor in the pathogenesis and management of diabetes mellitus due to its influence on pancreatic β-cell function, immune regulation, and inflammatory pathways. This narrative review critically examines mechanistic and clinical evidence linking vitamin D status with [...] Read more.

Vitamin D has emerged as a modulatory factor in the pathogenesis and management of diabetes mellitus due to its influence on pancreatic β-cell function, immune regulation, and inflammatory pathways. This narrative review critically examines mechanistic and clinical evidence linking vitamin D status with type 1 diabetes (T1DM), type 2 diabetes (T2DM), and gestational diabetes (GDM). In T1DM, vitamin D’s immunomodulatory effects are thought to protect β-cells from autoimmune destruction; epidemiological studies associate vitamin D sufficiency with lower T1DM incidence and improved glycemic control, although causality remains under investigation. In T2DM, vitamin D deficiency is associated with worsened metabolic control and may contribute to disease development in at-risk individuals; however, it does not influence the initial onset of T2DM in patients who are already diagnosed. Intervention trials indicate that correcting the deficiency can modestly improve insulin sensitivity, β-cell function, and metabolic parameters. GDM has similarly been linked to hypovitaminosis D, with low maternal vitamin D levels associated with higher GDM risk and adverse perinatal outcomes; mechanistic insights suggest that adequate vitamin D supports glucose homeostasis in pregnancy, and emerging trials demonstrate improved insulin resistance with maternal vitamin D supplementation. Across these diabetes subtypes, maintaining sufficient vitamin D levels appears to confer metabolic benefits and may serve as an adjunct to current preventive and therapeutic strategies. However, definitive evidence from large-scale trials is required to establish optimal vitamin D supplementation protocols and confirm its efficacy in diabetes care. Full article

(This article belongs to the Special Issue The Effect of Dietary Compounds on Inflammation-Mediated Diseases)

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10 pages, 203 KiB

Open AccessArticle

Minimally Invasive Off-Pump Coronary Artery Bypass as Palliative Revascularization in High-Risk Patients

by Magdalena Rufa, Adrian Ursulescu, Samir Ahad, Ragi Nagib, Marc Albert, Rafael Ayala, Nora Göbel, Tunjay Shavahatli, Mihnea Ghinescu, Ulrich Franke and Bartosz Rylski

Clin. Pract. 2025, 15(8), 147; https://doi.org/10.3390/clinpract15080147 - 6 Aug 2025

Abstract

Background: In high-risk and frail patients with multivessel coronary artery disease (MV CAD), guidelines indicated complete revascularization with or without the use of cardiopulmonary bypass (CPB) bears a high morbidity and mortality risk. In cases where catheter interventions were deemed unsuitable and conventional [...] Read more.

Background: In high-risk and frail patients with multivessel coronary artery disease (MV CAD), guidelines indicated complete revascularization with or without the use of cardiopulmonary bypass (CPB) bears a high morbidity and mortality risk. In cases where catheter interventions were deemed unsuitable and conventional coronary artery bypass grafting (CABG) posed an unacceptable perioperative risk, patients were scheduled for minimally invasive direct coronary artery bypass (MIDCAB) grafting or minimally invasive multivessel coronary artery bypass grafting (MICS-CABG). We called this approach “palliative revascularization.” This study assesses the safety and impact of palliative revascularization on clinical outcomes and overall survival. Methods: A consecutive series of 57 patients undergoing MIDCAB or MICS-CABG as a palliative surgery between 2008 and 2018 was included. The decision for palliative surgery was met in heart team after carefully assessing each case. The patients underwent single or double-vessel revascularization using the left internal thoracic artery and rarely radial artery/saphenous vein segments, both endoscopically harvested. Inpatient data could be completed for all 57 patients. The mean follow-up interval was 4.2 ± 3.7 years, with a follow-up rate of 91.2%. Results: Mean patient age was 79.7 ± 7.4 years. Overall, 46 patients (80.7%) were male, 26 (45.6%) had a history of atrial fibrillation and 25 (43.9%) of chronic kidney disease. In total, 13 patients exhibited a moderate EuroSCORE II, while 27 were classified as high risk, with a EuroSCORE II exceeding 5%. Additionally, 40 patients (70.2%) presented with three-vessel disease, 17 (29.8%) suffered an acute myocardial infarction within three weeks prior to surgery and 50.9% presented an impaired ejection fraction. There were 48 MIDCAB and nine MICS CABG with no conversions either to sternotomy or to CPB. Eight cases were planned as hybrid procedures and only 15 patients (26.3%) were completely revascularized. During the first 30 days, four patients (7%) died. A myocardial infarction occurred in only one case, no patient necessitated immediate reoperation. The one-, three- and five-year survival rates were 83%, 67% and 61%, respectively. Conclusions: MIDCAB and MICS CABG can be successfully conducted as less invasive palliative surgery in high-risk multimorbid patients with MV CAD. The early and mid-term results were better than predicted. A higher rate of hybrid procedures could improve long-term outcome in selected cases. Full article

13 pages, 504 KiB

Open AccessArticle

Fear of Falling After Total Knee Replacement: A Saudi Experience

by Turki Aljuhani, Jayachandran Vetrayan, Mohammed A. Alfayez, Saleh A. Alshehri, Mohmad H. Alsabani, Lafi H. Olayan, Fahdah A. Aljamaan and Abdulaziz O. Alharbi

Clin. Pract. 2025, 15(8), 146; https://doi.org/10.3390/clinpract15080146 - 6 Aug 2025

Abstract

Background: Fear of falling (FOF) is a significant concern among older adults, especially after total knee arthroplasty (TKA). FOF can limit daily activities, reduce quality of life, and hinder recovery. This study aimed to investigate the prevalence, severity, and impacts of FOF [...] Read more.

Background: Fear of falling (FOF) is a significant concern among older adults, especially after total knee arthroplasty (TKA). FOF can limit daily activities, reduce quality of life, and hinder recovery. This study aimed to investigate the prevalence, severity, and impacts of FOF in patients undergoing TKA and identify factors contributing to increased FOF. Methods: A prospective observational study was conducted at King Abdulaziz Medical City in Riyadh, Saudi Arabia, from April 2024 to December 2024. This study included 52 participants aged 20 to 75 years who had undergone primary TKA. Data were collected at two time points: after TKA and at three months post-surgery. The Short Falls Efficacy Scale-International (SFES-I) was used to assess the severity of FOF, and the Short Form 36 (SF-36) was used to measure the quality of life. Descriptive statistics, t-tests, and logistic regression were used for analysis. Results: This study included 52 participants (mean age: 63.77 ± 6.65 years; 82.7% female). Post-TKA, all participants exhibited high FOF (mean SFES-I score: 56.75 ± 8.30). After three months, the mean SFES-I score decreased significantly to 49.04 ± 12.45 (t = 4.408, p < 0.05). Post-TKA, SF-36 showed significant improvements in the physical function, role of physical limitations, bodily pain, vitality, social function, role of emotional limitations, and mental health subdomains. Bilateral total knee arthroplasty, body mass index, and some SF-36 subcomponents—such as general health, vitality, and role of emotional limitations—were identified as factors leading to increased FOF. Conclusions: FOF remains prevalent and severe in TKA patients, even at three months post-surgery, affecting rehabilitation outcomes. Early identification and tailored interventions for FOF should be considered essential components of comprehensive TKA recovery programs. Full article

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14 pages, 2501 KiB

Open AccessArticle

Therapeutic Patterns and Surgical Decision-Making in Breast Cancer: A Retrospective Regional Cohort Study in Romania

by Ramona Andreea Cioroianu, Michael Schenker, Virginia-Maria Rădulescu, Tradian Ciprian Berisha, George Ovidiu Cioroianu, Mihaela Popescu, Cristina Mihaela Ciofiac, Ana Maria Petrescu and Stelian Ștefăniță Mogoantă

Clin. Pract. 2025, 15(8), 145; https://doi.org/10.3390/clinpract15080145 - 5 Aug 2025

Abstract

Background: Breast cancer is the most prevalent malignancy among women globally. In Romania, it is the most frequent form of cancer affecting women, with approximately 12,000 new cases diagnosed annually, and the second most common cause of cancer-related mortality, second only to [...] Read more.

Background: Breast cancer is the most prevalent malignancy among women globally. In Romania, it is the most frequent form of cancer affecting women, with approximately 12,000 new cases diagnosed annually, and the second most common cause of cancer-related mortality, second only to lung cancer. Methods: This study looked at 79 breast cancer patients from Oltenia, concentrating on epidemiology, histology, diagnostic features, and treatments. Patients were chosen based on inclusion criteria such as histopathologically verified diagnosis, availability of clinical and treatment data, and follow-up information. The analyzed biological material consisted of tissue samples taken from the breast parenchyma and axillary lymph nodes. Even though not the primary subject of this paper, all patients underwent immunohistochemical (IHC) evaluation both preoperatively and postoperatively. Results: We found invasive ductal carcinoma to be the predominant type, while ductal carcinoma in situ (DCIS) and mixed types were rare. We performed cross-tabulations of metastasis versus nodal status and age versus therapy type; none reached significance (all p > 0.05), suggesting observed differences were likely due to chance. A chi-square test comparing surgical interventions (breast-conserving vs. mastectomy) in patients who did or did not receive chemotherapy showed, χ² = 3.17, p = 0.367, indicating that chemotherapy did not significantly influence surgical choice. Importantly, adjuvant chemotherapy and radiotherapy were used at similar rates across age groups, whereas neoadjuvant hormonal (endocrine) therapy was more common in older patients (but without statistical significance). Conclusions: Finally, we discussed the consequences of individualized care and early detection. Romania’s shockingly low screening rate, which contributes to delayed diagnosis, emphasizes the importance of improved population medical examination and tailored treatment options. Also, the country has one of the lowest rates of mammography uptake in Europe and no systematic population screening program. Full article

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15 pages, 980 KiB

Open AccessArticle

Wilson’s Disease in Oman: A National Cohort Study of Clinical Spectrum, Diagnostic Delay, and Long-Term Outcomes

by Said A. Al-Busafi, Juland N. Al Julandani, Zakariya Alismaeili and Juhaina J. Al Raisi

Clin. Pract. 2025, 15(8), 144; https://doi.org/10.3390/clinpract15080144 - 3 Aug 2025

Abstract

Background/Objectives: Wilson’s disease (WD) is a rare autosomal recessive disorder of copper metabolism that results in hepatic, neurological, and psychiatric manifestations. Despite being described globally, data from the Middle East remains limited. This study presents the first comprehensive national cohort analysis of [...] Read more.

Background/Objectives: Wilson’s disease (WD) is a rare autosomal recessive disorder of copper metabolism that results in hepatic, neurological, and psychiatric manifestations. Despite being described globally, data from the Middle East remains limited. This study presents the first comprehensive national cohort analysis of WD in Oman, examining clinical features, diagnostic challenges, treatment patterns, and long-term outcomes. Methods: A retrospective cohort study was conducted on 36 Omani patients diagnosed with WD between 2013 and 2020 at Sultan Qaboos University Hospital using AASLD diagnostic criteria. Clinical presentation, biochemical parameters, treatment regimens, and progression-free survival were analyzed. Results: The median age at diagnosis was 14.5 years, with a slight female predominance (55.6%). Clinical presentation varied: 25% had hepatic symptoms, 22.2% had mixed hepatic-neurological features, and 16.7% presented with neurological symptoms alone. Asymptomatic cases identified via family screening accounted for 33.3%. Diagnostic delays were most pronounced among patients presenting with neurological symptoms. A positive family history was reported in 88.9% of cases, suggesting strong familial clustering despite a low rate of consanguinity (5.6%). Regional distribution was concentrated in Ash Sharqiyah North and Muscat. Chelation therapy with trientine or penicillamine, often combined with zinc, was the mainstay of treatment. Treatment adherence was significantly associated with improved progression-free survival (p = 0.012). Conclusions: WD in Oman is marked by heterogeneous presentations, frequent diagnostic delays, and strong familial clustering. Early detection through cascade screening and sustained treatment adherence are critical for favorable outcomes. These findings support the need for national screening policies and structured long-term care models for WD in the region. Full article

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14 pages, 2736 KiB

Open AccessCase Report

Renal Malacoplakia Following Obstetric Intervention: A Rare Cause of Acute Kidney Injury in a Young Woman

by Letícia Miyuki Ito, Juliana Miki Oguma, André Kiyoshi Miyahara, Marco Aurélio Sales da Veiga, Leandro Favaro, David Wesley de Godoy, Bárbara Antunes Bruno da Silva, Luiz Antônio Moura, Marcelino de Souza Durão and Érika Bevilaqua Rangel

Clin. Pract. 2025, 15(8), 143; https://doi.org/10.3390/clinpract15080143 - 3 Aug 2025

Abstract

Introduction: Renal malacoplakia is a rare chronic granulomatous disease, often associated with immunosuppression and persistent Gram-negative infections, particularly Escherichia coli. Case Presentation: We present a case involving a 31-year-old woman with hypertension, gestational diabetes, and prior uterine curettage after labor [...] Read more.

Introduction: Renal malacoplakia is a rare chronic granulomatous disease, often associated with immunosuppression and persistent Gram-negative infections, particularly Escherichia coli. Case Presentation: We present a case involving a 31-year-old woman with hypertension, gestational diabetes, and prior uterine curettage after labor induction for preeclampsia at 23 weeks. She developed urinary sepsis post-procedure. Imaging revealed bilateral nephromegaly, while laboratory tests showed acute kidney injury (KDIGO stage III), anemia, and thrombocytopenia. Blood and urine cultures grew Escherichia coli. Renal biopsy confirmed malacoplakia, demonstrating PAS-positive Michaelis–Gutmann bodies and Von Hansemann cells. The patient responded to prolonged antibiotic therapy and supportive care. Discussion and Conclusion: This case highlights the importance of considering renal malacoplakia in patients with atypical urinary tract infections and nephromegaly, particularly in obstetric settings. Histopathological confirmation is essential, and timely treatment with intracellularly active antibiotics can lead to favorable outcomes. Early diagnosis is critical to prevent irreversible renal damage. Full article

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21 pages, 936 KiB

Open AccessArticle

Reframing Polypharmacy: Empowering Medical Students to Manage Medication Burden as a Chronic Condition

by Andreas Conte, Anita Sedghi, Azeem Majeed and Waseem Jerjes

Clin. Pract. 2025, 15(8), 142; https://doi.org/10.3390/clinpract15080142 - 31 Jul 2025

Abstract

Aims/Background: Polypharmacy, or the concurrent intake of five or more medications, is a significant issue in clinical practice, particularly in multimorbid elderly individuals. Despite its importance for patient safety, medical education often lacks systematic training in recognising and managing polypharmacy within the framework [...] Read more.

Aims/Background: Polypharmacy, or the concurrent intake of five or more medications, is a significant issue in clinical practice, particularly in multimorbid elderly individuals. Despite its importance for patient safety, medical education often lacks systematic training in recognising and managing polypharmacy within the framework of patient-centred care. We investigated the impact of a structured learning intervention introducing polypharmacy as a chronic condition, assessing whether it enhances medical students’ diagnostic competence, confidence, and interprofessional collaboration. Methods: A prospective cohort study was conducted with 50 final-year medical students who received a three-phase educational intervention. Phase 1 was interactive workshops on the principles of polypharmacy, its dangers, and diagnostic tools. Phase 2 involved simulated patient consultations and medication review exercises with pharmacists. Phase 3 involved reflection through debriefing sessions, reflective diaries, and standardised patient feedback. Student knowledge, confidence, and attitudes towards polypharmacy management were assessed using pre- and post-intervention questionnaires. Quantitative data were analysed through paired t-tests, and qualitative data were analysed thematically from reflective diaries. Results: Students demonstrated considerable improvement after the intervention in identifying symptoms of polypharmacy, suggesting deprescribing strategies, and working in multidisciplinary teams. Confidence in prioritising polypharmacy as a primary diagnostic problem increased from 32% to 86% (p < 0.01), and knowledge of diagnostic tools increased from 3.1 ± 0.6 to 4.7 ± 0.3 (p < 0.01). Standardised patients felt communication and patient-centredness had improved, with satisfaction scores increasing from 3.5 ± 0.8 to 4.8 ± 0.4 (p < 0.01). Reflective diaries indicated a shift towards more holistic thinking regarding medication burden. The small sample size limits the generalisability of the results. Conclusions: Teaching polypharmacy as a chronic condition in medical school enhances diagnostic competence, interprofessional teamwork, and patient safety. Education is a structured way of integrating the management of polypharmacy into routine clinical practice. This model provides valuable insights for designing medical curricula. Future research must assess the impact of such training on patient outcomes and clinical decision-making in the long term. Full article

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18 pages, 1352 KiB

Open AccessStudy Protocol

Effects of Hydrodilatation at Different Volumes on Adhesive Capsulitis in Phases 1 and 2: Clinical Trial Protocol HYCAFVOL

by Javier Muñoz-Paz, Ana Belén Jiménez-Jiménez, Francisco Espinosa-Rueda, Amin Wahab-Albañil, María Nieves Muñoz-Alcaraz, José Peña-Amaro and Fernando Jesús Mayordomo-Riera

Clin. Pract. 2025, 15(8), 141; https://doi.org/10.3390/clinpract15080141 - 26 Jul 2025

Abstract

Background: Adhesive capsulitis (AC) causes a global limitation of both active and passive range of motion (ROM) in the shoulder, with or without pain, and no specific radiographic findings. Its course is self-limiting and progresses through three or four stages. The diagnosis [...] Read more.

Background: Adhesive capsulitis (AC) causes a global limitation of both active and passive range of motion (ROM) in the shoulder, with or without pain, and no specific radiographic findings. Its course is self-limiting and progresses through three or four stages. The diagnosis is primarily clinical, since imaging tests are nonspecific. Treatment options include physical therapy (PT), intra-articular corticosteroid injections, suprascapular nerve block (SSNB), and hydrodilatation (HD). The latter is useful for expanding and reducing inflammation of the joint capsule through the insufflation of saline solution, anesthetics, and corticosteroids. Objectives: To compare whether patients with AC, stratified by phase 1 and 2, who receive high-volume HD as treatment achieve better outcomes in terms of shoulder pain and function compared to patients who receive low-volume HD. To compare whether there are differences in PT times and to determine mean axillary recess (AR) values. Methods: A randomized, parallel-block, triple-blind clinical trial will be conducted in 64 patients with AC in phases 1 and 2, aged 30 to 70 years, with limited active and passive ROM in two planes, and shoulder pain lasting more than 3 months. HD will be administered with volumes of 20 mL or 40 mL, followed by a conventional rehabilitation program. Outcomes will be reviewed at the 1st, 3rd, and 6th months of HD. Variables collected will include Shoulder Pain and Disability Index (SPADI), Visual Analog Scale (VAS), Range of motion (ROM), Lattinen index (LI), AR size, and time to completion of PT. Results: HD has been gaining clinical relevance in interventional rehabilitation as a treatment for AC, although its medium- and long-term efficacy remains a matter of debate. The variability in the volumes used for capsular expansion, with studies ranging from 18 mL to 47 mL, is compounded by the fact that most of these studies do not differentiate between AC stages. This could influence treatment effectiveness. Furthermore, diagnosis remains a challenge since valid and specific diagnostic parameters are lacking. Conclusions: Understanding the differences between HD techniques, considering the influence of certain factors such as the volume used or the stages of AC, as well as improving diagnosis and the coordination of scientific work. This could facilitate the development of protocols for the use of HD in AC. Full article

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19 pages, 967 KiB

Open AccessArticle

Clinical–Biological Assessment of Prosthetic Field Following Pre-Prosthetic Phase Related to Prosthetic Treatment Solutions

by Petruţa Siminiuc, Doriana Agop-Forna, Cristina Dascălu and Norina Forna

Clin. Pract. 2025, 15(8), 140; https://doi.org/10.3390/clinpract15080140 - 26 Jul 2025

Abstract

Background. Extensive partial edentulism alters the biological and functional balance of the stomatognathic system, requiring targeted pre-prosthetic procedures to optimize treatment outcomes. Objectives. The aim of this study was to assess the extent of improvement in the clinical–biological scores of the [...] Read more.

Background. Extensive partial edentulism alters the biological and functional balance of the stomatognathic system, requiring targeted pre-prosthetic procedures to optimize treatment outcomes. Objectives. The aim of this study was to assess the extent of improvement in the clinical–biological scores of the prosthetic field in patients with extensive edentulism, following pre-prosthetic interventions. Materials and Method. This prospective, cross-sectional study investigated 194 subjects with extensive partial edentulism. Clinical–biological scores, initially and following the pre-prosthetic phase, were recorded using a scoring system that evaluated dental and periodontal status, bone and mucosal support, occlusion, and mandibulo-cranial relationships. Statistical comparisons of clinical–biological scores were related to the type of prosthetic therapy. Statistical significance was considered at a p-value < 0.05. Results. There was an overall significant improvement in the clinical–biological scores initially (mean value 20.2) and after pre-prosthetic procedures (mean value 23.22) (p < 0.001). When treatment groups were divided, the implant-assisted prosthesis group showed the best improvement in all domains, followed by the conventional fixed-prostheses group (p < 0.01). Dental support improved significantly in those with semi-rigid composite prostheses (p = 0.014), while periodontal support was improved in both fixed- and hybrid-implant groups. Mucosal and bone support improved mostly in the fixed-implant groups (p = 0.014). Conclusions. Pre-prosthetic procedures significantly enhance the biological and functional readiness of the prosthetic field, with the degree of improvement influenced by the complexity and type of planned prosthetic rehabilitation. The findings underscore the value of individualized pre-prosthetic protocols as an essential component of prosthetic treatment planning. 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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10 pages, 207 KiB

Open AccessStudy Protocol

Assessment of Physical Activity During Chemotherapy and/or Immunotherapy for Non-Small Cell Lung Cancer (NSCLC): Protocol of the APACHIE-01 Study

by Dirk Rades, Laura Doehring, Christian Staackmann, Maria Karolin Streubel, Stefan Janssen, Tobias Bartscht and Sabine Bohnet

Clin. Pract. 2025, 15(8), 139; https://doi.org/10.3390/clinpract15080139 - 25 Jul 2025

Abstract

Background/Objectives: Most patients with non-small cell lung cancer (NSCLC) receive chemo- and/or immunotherapy, which can be associated with adverse events including fatigue. Affected patients may not be able to receive the complete chemo- and/or immunotherapy as planned. In this context, patients may benefit [...] Read more.

Background/Objectives: Most patients with non-small cell lung cancer (NSCLC) receive chemo- and/or immunotherapy, which can be associated with adverse events including fatigue. Affected patients may not be able to receive the complete chemo- and/or immunotherapy as planned. In this context, patients may benefit from maintaining their physical activity, which can be challenging. An app reminding patients to perform a certain number of steps may have a positive effect on physical activity during chemo- and/or immunotherapy. Such an app is under development and will be tested in a prospective trial. The current APACHIE-01 study (NCT06993896) is required for proper sample size calculation and design of the planned trial. Methods: The main goal of the APACHIE-01 study is to evaluate patterns and predictors of physical activity during chemo- and/or immunotherapy for locally advanced or metastatic NSCLC. The primary endpoint is the assessment of the mean number of steps per week during the first three cycles of chemo- and/or immunotherapy for lung cancer. The baseline value is represented by the mean number of steps during the last week prior to chemotherapy and/or immunotherapy. Secondary endpoints include associations between mean number of steps per week and a pain score, a distress score, and a fatigue score. The recruitment of the required 38 patients should be completed within 4 months and the treatment period will be 9–10 weeks (three cycles of chemo- and/or immunotherapy), resulting in a total running time of approximately 6 months. The APACHIE-01 study will contribute to the optimal design of a subsequent prospective trial. Full article

19 pages, 290 KiB

Open AccessArticle

Artificial Intelligence in Primary Care: Support or Additional Burden on Physicians’ Healthcare Work?—A Qualitative Study

by Stefanie Mache, Monika Bernburg, Annika Würtenberger and David A. Groneberg

Clin. Pract. 2025, 15(8), 138; https://doi.org/10.3390/clinpract15080138 - 25 Jul 2025

Abstract

Background: Artificial intelligence (AI) is being increasingly promoted as a means to enhance diagnostic accuracy, to streamline workflows, and to improve overall care quality in primary care. However, empirical evidence on how primary care physicians (PCPs) perceive, engage with, and emotionally respond [...] Read more.

Background: Artificial intelligence (AI) is being increasingly promoted as a means to enhance diagnostic accuracy, to streamline workflows, and to improve overall care quality in primary care. However, empirical evidence on how primary care physicians (PCPs) perceive, engage with, and emotionally respond to AI technologies in everyday clinical settings remains limited. Concerns persist regarding AI’s usability, transparency, and potential impact on professional identity, workload, and the physician–patient relationship. Methods: This qualitative study investigated the lived experiences and perceptions of 28 PCPs practicing in diverse outpatient settings across Germany. Participants were purposively sampled to ensure variation in age, practice characteristics, and digital proficiency. Data were collected through in-depth, semi-structured interviews, which were audio-recorded, transcribed verbatim, and subjected to rigorous thematic analysis employing Mayring’s qualitative content analysis framework. Results: Participants demonstrated a fundamentally ambivalent stance toward AI integration in primary care. Perceived advantages included enhanced diagnostic support, relief from administrative burdens, and facilitation of preventive care. Conversely, physicians reported concerns about workflow disruption due to excessive system prompts, lack of algorithmic transparency, increased cognitive and emotional strain, and perceived threats to clinical autonomy and accountability. The implications for the physician–patient relationship were seen as double-edged: while some believed AI could foster trust through transparent use, others feared depersonalization of care. Crucial prerequisites for successful implementation included transparent and explainable systems, structured training opportunities, clinician involvement in design processes, and seamless integration into clinical routines. Conclusions: Primary care physicians’ engagement with AI is marked by cautious optimism, shaped by both perceived utility and significant concerns. Effective and ethically sound implementation requires co-design approaches that embed clinical expertise, ensure algorithmic transparency, and align AI applications with the realities of primary care workflows. Moreover, foundational AI literacy should be incorporated into undergraduate health professional curricula to equip future clinicians with the competencies necessary for responsible and confident use. These strategies are essential to safeguard professional integrity, support clinician well-being, and maintain the humanistic core of primary care. Full article

12 pages, 620 KiB

Open AccessReview

Manganese-Based Contrast Agents as Alternatives to Gadolinium: A Comprehensive Review

by Linda Poggiarelli, Caterina Bernetti, Luca Pugliese, Federico Greco, Bruno Beomonte Zobel and Carlo A. Mallio

Clin. Pract. 2025, 15(8), 137; https://doi.org/10.3390/clinpract15080137 - 25 Jul 2025

Abstract

Background/Objectives: Magnetic resonance imaging (MRI) is a powerful, non-invasive diagnostic tool capable of capturing detailed anatomical and physiological information. MRI contrast agents enhance image contrast but, especially linear gadolinium-based compounds, have been associated with safety concerns. This has prompted interest in alternative contrast [...] Read more.

Background/Objectives: Magnetic resonance imaging (MRI) is a powerful, non-invasive diagnostic tool capable of capturing detailed anatomical and physiological information. MRI contrast agents enhance image contrast but, especially linear gadolinium-based compounds, have been associated with safety concerns. This has prompted interest in alternative contrast agents. Manganese-based contrast agents offer a promising substitute, owing to manganese’s favorable magnetic properties, natural biological role, and strong T1 relaxivity. This review aims to critically assess the structure, mechanisms, applications, and challenges of manganese-based contrast agents in MRI. Methods: This review synthesizes findings from preclinical and clinical studies involving various types of manganese-based contrast agents, including small-molecule chelates, nanoparticles, theranostic platforms, responsive agents, and controlled-release systems. Special attention is given to pharmacokinetics, biodistribution, and safety evaluations. Results: Mn-based agents demonstrate promising imaging capabilities, with some achieving relaxivity values comparable to gadolinium compounds. Targeted uptake mechanisms, such as hepatocyte-specific transport via organic anion-transporting polypeptides, allow for enhanced tissue contrast. However, concerns remain regarding the in vivo release of free Mn²⁺ ions, which could lead to toxicity. Preliminary toxicity assessments report low cytotoxicity, but further comprehensive long-term safety studies should be carried out. Conclusions: Manganese-based contrast agents present a potential alternative to gadolinium-based MRI agents pending further validation. Despite promising imaging performance and biocompatibility, further investigation into stability and safety is essential. Additional research is needed to facilitate the clinical translation of these agents. Full article

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13 pages, 1565 KiB

Open AccessCase Report

A Mixed-Methods Case Report on Oral Health Changes and Patient Perceptions and Experiences Following Treatment at the One Smile Research Program: A 2-Year Follow-Up

by Mona Abdelrehim, ZhuZhen (Hellen) Huang, Christiana Martine, Imon Pal, Kamini Kaura, Anuj Aggarwal and Sonica Singhal

Clin. Pract. 2025, 15(8), 136; https://doi.org/10.3390/clinpract15080136 - 23 Jul 2025

Abstract

Background: In Canada, despite universal healthcare coverage, dental care remains predominantly privately financed, creating financial barriers that prevent many from accessing essential services. This case study is part of a larger initiative, the One Smile Research program, which evaluates the impact of [...] Read more.

Background: In Canada, despite universal healthcare coverage, dental care remains predominantly privately financed, creating financial barriers that prevent many from accessing essential services. This case study is part of a larger initiative, the One Smile Research program, which evaluates the impact of cost-free dental care on the oral health and overall well-being of individuals who have been unable to access dental services in the past two years due to financial constraints. Participants in the program receive necessary dental care and attend follow-up appointments to assess the long-term effects of continuous cost-free care. Clinical Case: This mixed-methods case report focuses on a 26-year-old male participant and integrates a qualitative semi-structured interview with clinical and self-reported data, providing an in-depth understanding of his experiences. Results: Clinical outcomes demonstrated the effectiveness of the provided dental treatments, while self-reported measures indicated improved oral health, satisfaction with dental appearance, enhanced psychosocial well-being, increased self-esteem, reduced dental anxiety, and better oral hygiene habits. The qualitative interview identified three key themes reflecting positive experiences with the program: ease of admission, staff kindness, and overall well-being improvement. The integration of both quantitative and qualitative analyses revealed significant advancements in both objective and subjective measures, particularly regarding overall well-being. Conclusions: The continuity of cost-free dental care effectively addressed the participant’s oral health and overall well-being, with most benefits sustained even at the two-year follow-up. These individual-level outcomes offer preliminary insight into the potential advantages of universal dental coverage within the Canadian healthcare system. Full article

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Graphical abstract

12 pages, 508 KiB

Open AccessArticle

Responders to Cervical Facet Platelet-Rich Plasma Demonstrate Synergistic Improvements in Pain and Isometric Strength in Chronic Whiplash-Associated Disorders: A Series of Mediation Analyses

by Ashley D. Smith, Benjamin Andruski, George Deng, Colin Bouma, Marc Pesant, Fiona Magill and Robert Burnham

Clin. Pract. 2025, 15(8), 135; https://doi.org/10.3390/clinpract15080135 - 23 Jul 2025

Abstract

Background/Objectives: Platelet-rich plasma (PRP) is emerging as a safe and effective treatment for facet-mediated pain. Studies have demonstrated reductions in pain and improvements in function, both in the short (3 months) and longer term (6 and 12 months). The mechanisms underlying clinical improvements [...] Read more.

Background/Objectives: Platelet-rich plasma (PRP) is emerging as a safe and effective treatment for facet-mediated pain. Studies have demonstrated reductions in pain and improvements in function, both in the short (3 months) and longer term (6 and 12 months). The mechanisms underlying clinical improvements are largely unknown. It is also unclear whether reported outcomes are due to the PRP administered or concurrently applied rehabilitation. Methods: A prospective case series was conducted in a single, multidisciplinary chronic pain centre. Forty-two participants with chronic WAD and cervical facet-mediated pain who received PRP (64% female; mean age (SD) 42.8 (11.6) years; median WAD duration [IQR] 23 [18,29] mths), attended rehabilitation, and reported successful outcomes 3 months post-PRP fulfilled the inclusion criteria. Measures of pain, cervical isometric strength, and range of motion were collected at baseline and 3 months post-PRP. Mediation analyses were performed to determine how these factors influenced disability. Results: Participants demonstrated clinically significant and relevant improvements in pain, disability, and isometric strength measures (all p < 0.01). Causative mediation analyses demonstrated independent direct, but not indirect, effects of both pain and strength on disability (both p < 0.001), with no direct or indirect effects of cervical ROM on disability. Full article

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14 pages, 514 KiB

Open AccessArticle

Mechanical and Biological Complications Two Years After Full-Arch Implant-Supported Prosthetic Rehabilitation: A Retrospective Clinical Study

by Denisa Tabita Sabău, Petra Saitos, Rahela Tabita Moca, Raluca Iulia Juncar and Mihai Juncar

Clin. Pract. 2025, 15(7), 134; https://doi.org/10.3390/clinpract15070134 - 18 Jul 2025

Abstract

Background/Objectives: Full-arch implant-supported prostheses have become a widely accepted solution for edentulous patients, yet long-term biological and mechanical complications remain a clinical concern. Methods: This retrospective study included 70 fully edentulous patients (362 implants) rehabilitated with either fixed or removable implant-supported prostheses. [...] Read more.

Background/Objectives: Full-arch implant-supported prostheses have become a widely accepted solution for edentulous patients, yet long-term biological and mechanical complications remain a clinical concern. Methods: This retrospective study included 70 fully edentulous patients (362 implants) rehabilitated with either fixed or removable implant-supported prostheses. Data were collected on demographics, medical status, type and location of prostheses, implant type, abutments, method of fixation, and complications. Statistical analysis included Fisher’s exact test, the Mann–Whitney U test, and chi-squared tests, with a significance level set at p < 0.05. Results: Mechanical complications occurred in 41.4% of patients (29 out of 70), with framework fractures reported in eight cases (27.6%), ceramic chipping in six cases (20.7%), and resin discoloration in four cases (13.8%). The prostheses were fabricated using monolithic zirconia, metal–ceramic crowns, zirconia on titanium bars, and hybrid resin/PMMA on cobalt–chromium frameworks. Gingival inflammation was also noted in 41.4% of cases (n = 29), predominantly in posterior implant regions. Younger patients and those without systemic diseases showed a significantly higher incidence of mechanical complications. Conclusions: Two years post-treatment, mechanical and biological complications appear to be independent phenomena, not significantly associated with most prosthetic variables. Patient-specific factors, particularly age and general health status, may have greater predictive value than prosthetic design. Limitations of the study include its retrospective design and the lack of radiographic data to assess peri-implant bone changes. 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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15 pages, 272 KiB

Open AccessArticle

Assessment of Associations Between Sociodemographic and Clinical Factors and Edentulism Complications in Patients Scheduled for Hybrid Prosthetic Therapy: A Cross-Sectional Study

by Shokraei Gholamreza, Doriana Agop-Forna, Cristina Dascălu and Norina Forna

Clin. Pract. 2025, 15(7), 133; https://doi.org/10.3390/clinpract15070133 - 17 Jul 2025

Abstract

Background/Objectives: Complications of edentulism include bone resorption, muscular dysfunction, temporomandibular joint disorders (TMJ), and stomatognathic system dysfunctional syndrome (SSDS). The objectives of the study were as follows: to analyze the distribution of edentulism complications related to sociodemographic and clinical parameters and to quantify [...] Read more.

Background/Objectives: Complications of edentulism include bone resorption, muscular dysfunction, temporomandibular joint disorders (TMJ), and stomatognathic system dysfunctional syndrome (SSDS). The objectives of the study were as follows: to analyze the distribution of edentulism complications related to sociodemographic and clinical parameters and to quantify the strength of relationships between edentulism complications and these socio-demographic or clinical variables. Materials and Methods: This cross-sectional study investigated 150 edentulous subjects (mean age 61.54 +/− 8.99 years) scheduled for hybrid prosthetic therapy. The distribution of edentulism complications was assessed in relation to sex-specific and age-specific patterns, edentulism location (maxillary vs. mandibular), edentulism extension (partial reduced, partial extended, subtotal, complete edentulism), and Kennedy classification (class I vs. class II vs. class IV). Cramér’s V was used to measure the strength of the association between edentulism complications and sociodemographic and clinical factors. Results: The most prevalent complications were more frequent in males—bone resorption (74.2% vs. 40.9%), malocclusion (97.5% vs. 84.9%), TMJ disorders (74.2% vs. 57.0%), muscular disorders (62.5% vs. 31.2%), dyshomeostasis (64.2% vs. 31.2%), and SSDS (79.2% vs. 53.8%). The most relevant associations were found between age group and clinical variables such as irregular ridge (Cramer’s V = 0.737), long/thick frenum (0.711), and SSDS (0.544), while edentulism category was strongly associated with irregular ridge (0.585), TMJ disorders (0.493), and bone resorption (0.492). Conclusions: The type and stage of edentulism emerged as key determinants of complication severity, with complete and subtotal edentulism being associated with the highest rates of muscular and temporomandibular joint dysfunctions. Full article

11 pages, 1250 KiB

Open AccessArticle

Optimizing Multivariable Logistic Regression for Identifying Perioperative Risk Factors for Deep Brain Stimulator Explantation: A Pilot Study

by Peyton J. Murin, Anagha S. Prabhune and Yuri Chaves Martins

Clin. Pract. 2025, 15(7), 132; https://doi.org/10.3390/clinpract15070132 - 17 Jul 2025

Abstract

Background/Objectives: Deep brain stimulation (DBS) is an effective surgical treatment for Parkinson’s Disease (PD) and other movement disorders. Despite its benefits, DBS explantation occurs in 5.6% of cases, with costs exceeding USD 22,000 per implant. Traditional statistical methods have struggled to identify [...] Read more.

Background/Objectives: Deep brain stimulation (DBS) is an effective surgical treatment for Parkinson’s Disease (PD) and other movement disorders. Despite its benefits, DBS explantation occurs in 5.6% of cases, with costs exceeding USD 22,000 per implant. Traditional statistical methods have struggled to identify reliable risk factors for explantation. We hypothesized that supervised machine learning would more effectively capture complex interactions among perioperative factors, enabling the identification of novel risk factors. Methods: The Medical Informatics Operating Room Vitals and Events Repository was queried for patients with DBS, adequate clinical data, and at least two years of follow-up (n = 38). Fisher’s exact test assessed demographic and medical history variables. Data were analyzed using Anaconda Version 2.3.1. with pandas, numpy, sklearn, sklearn-extra, matplotlin. pyplot, and seaborn. Recursive feature elimination with cross-validation (RFECV) optimized factor selection was used. A multivariate logistic regression model was trained and evaluated using precision, recall, F1-score, and area under the curve (AUC). Results: Fisher’s exact test identified chronic pain (p = 0.0108) and tobacco use (p = 0.0026) as risk factors. RFECV selected 24 optimal features. The logistic regression model demonstrated strong performance (precision: 0.89, recall: 0.86, F1-score: 0.86, AUC: 1.0). Significant risk factors included tobacco use (OR: 3.64; CI: 3.60–3.68), primary PD (OR: 2.01; CI: 1.99–2.02), ASA score (OR: 1.91; CI: 1.90–1.92), chronic pain (OR: 1.82; CI: 1.80–1.85), and diabetes (OR: 1.63; CI: 1.62–1.65). Conclusions: Our study suggests that supervised machine learning can identify risk factors for early DBS explantation. Larger studies are needed to validate our findings. Full article

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11 pages, 897 KiB

Open AccessArticle

Assessment of the Effect of Kinesiology Taping on Scar Treatment in Children

by Justyna Pogorzelska, Agata Michalska and Anna Zmyślna

Clin. Pract. 2025, 15(7), 131; https://doi.org/10.3390/clinpract15070131 - 14 Jul 2025

Abstract

Background: The consequences of injuries resulting from accidents are among the most common health disorders in children. A scar forms at the site of the injury. In the treatment of scars, not all methods used in adults can be used in children. [...] Read more.

Background: The consequences of injuries resulting from accidents are among the most common health disorders in children. A scar forms at the site of the injury. In the treatment of scars, not all methods used in adults can be used in children. The authors attempted to assess the effectiveness of using KT kinesiology taping on scars in children. The aim of the work is to assess the effect of KT on the treatment of keloid, hypertrophic scars, and postoperative adhesions in children. Methods: The study included 30 patients aged 4 to 10 years. The subjects were divided into three groups: group G1-9 patients with keloid scars, group G2-14 with hypertrophic scars, group G3-7 with postoperative adhesions. The patients underwent kinesiology taping for 8 weeks. The analyzed parameters were determined using the VSS scale and ultrasonography. Results: The analysis of the VSS scale results in relation to the type of scars showed a significant (p < 0.001) downward trend in the measured parameters for keloid and hypertrophic scars. Analysis of ultrasound results in relation to the type of scars showed a significant (p < 0.001) downward trend in the measured parameters, comparing parameters I and II for all types of scars. Conclusions: Kinesiology taping significantly changes the following scar parameters: deformability, pigmentation, and perfusion in the case of keloid and hypertrophic scars. Full article

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9 pages, 211 KiB

Open AccessOpinion

Pelvic Fractures in Adults and the Importance of Associated Injuries—A Current Multi-Disciplinary Approach

by Jakub Ohla, Piotr Walus, Michał Wiciński, Bartłomiej Małkowski, Bartosz Turoń, Adam Jabłoński, Michał Gawryjołek, Katie Kellett and Jan Zabrzyński

Clin. Pract. 2025, 15(7), 130; https://doi.org/10.3390/clinpract15070130 - 11 Jul 2025

Abstract

Background: Pelvic ring fractures are a significant and growing health problem in the field of trauma and orthopedic surgery. The aim of this paper was to present a concise description of these musculoskeletal injuries, available classification systems, and vascular and genitourinary complications. Results: [...] Read more.

Background: Pelvic ring fractures are a significant and growing health problem in the field of trauma and orthopedic surgery. The aim of this paper was to present a concise description of these musculoskeletal injuries, available classification systems, and vascular and genitourinary complications. Results: The most common complications of serious pelvic ring fractures are arterial and venous hemorrhages, as well as urethral injuries. Arterial hemorrhages most often originate from the trunk or branches of the iliac artery, and the standard treatment is pelvic stabilization and implementation of intravascular procedures. In the case of venous hemorrhages, peritoneal pelvic packing is the most important. Conclusions: A multi-disciplinary approach and treatment algorithmization are important to facilitate the prioritization of therapeutic procedures. Treatment of patients with pelvic ring fractures should take place in specialized trauma centers. Full article

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