Clinics and Practice

13 pages, 386 KB

Open AccessArticle

Self-Reported Parosmia, Phantosmia, and Gustatory Dysfunction Among Adults with Mild-to-Moderate COVID-19: A Cross-Sectional Study in Saudi Arabia

by Reem A. Alsaqer, Ghazal Y. Dhaher, Rewa L. Alsharif, Razan Y. Almleaky, Khalid S. Menshawi, Turki M. Alqurashi and Abdullah Almaqhawi

Clin. Pract. 2025, 15(9), 167; https://doi.org/10.3390/clinpract15090167 - 15 Sep 2025

Abstract

Background/Objectives: COVID-19 frequently causes olfactory and gustatory dysfunction, including qualitative disorders like parosmia and phantosmia. These distortions affect quality of life and may result from both peripheral and central neural damage. Despite increasing reports, their prevalence, mechanisms, and risk factors remain unclear. [...] Read more.

Background/Objectives: COVID-19 frequently causes olfactory and gustatory dysfunction, including qualitative disorders like parosmia and phantosmia. These distortions affect quality of life and may result from both peripheral and central neural damage. Despite increasing reports, their prevalence, mechanisms, and risk factors remain unclear. The purpose of this study is to evaluate the clinical characteristics and possible predictors of parosmia and phantosmia associated with COVID-19 in Saudi Arabia. Methods: This cross-sectional study utilized an online questionnaire targeting adults in Saudi Arabia with self-reported new-onset olfactory or gustatory dysfunction after COVID-19. Results: Out of 539 participants, 377 were included for analysis. Females slightly outnumbered males (195, 51.7% vs. 182, 48.3%) with a mean age of 34.5 years (SD = 12.7). Comorbidities were present in 86 (23.3%) participants, predominantly including hypertension (39.5%) and diabetes (30.2%). Sudden smell and taste loss were reported by 277 (73.5%) and 267 (70.8%) participants, respectively. Regional residence was significantly associated with both smell (p < 0.001) and taste loss (p < 0.001). Academic qualification exhibited borderline significance in relation to taste loss (p = 0.049). Logistic regression analysis indicated no significant predictors of dysfunction, with male gender exhibiting an odds ratio of 1.276 for smell (p = 0.301) and an odds ratio of 1.401 for taste (p = 0.144). Over 60% of participants experienced a negative impact on their quality of life. Conclusions: This study demonstrates the prevalence of parosmia and phantosmia in COVID-19 patients in Saudi Arabia, with a significant impact on quality of life. While regional differences and education level exhibited certain associations, no demographic or clinical factors independently predicted dysfunction, highlighting the necessity for additional research into underlying mechanisms and long-term effects. Full article

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13 pages, 918 KB

Open AccessArticle

A Retrospective Observational Study of Ephedrine Use in Hip Arthroplasty: Routine Practice at a Secondary Care Hospital in Romania

by Erika Bimbo-Szuhai, Mihai Octavian Botea, Harrie Toms John, Adela Bostan Danciu, Pirvan Titus Razvan, Mihaela Gabriela Bontea, Mihai Pavel, Caius Salajan, Maria Viviana Rusu, Adrian Gheorghe Osiceanu and Iulia Codruta Macovei

Clin. Pract. 2025, 15(9), 166; https://doi.org/10.3390/clinpract15090166 - 15 Sep 2025

Abstract

Background and Objectives: The primary goal of the study is to analyze factors associated with spinal anesthesia-induced hypotension (SAIH), with a focus on ephedrine requirements in relation to patient characteristics and the type of intrathecal opioid used, reflecting real-world clinical practice in a [...] Read more.

Background and Objectives: The primary goal of the study is to analyze factors associated with spinal anesthesia-induced hypotension (SAIH), with a focus on ephedrine requirements in relation to patient characteristics and the type of intrathecal opioid used, reflecting real-world clinical practice in a Romanian secondary care hospital. Bolus ephedrine is often required during spinal anesthesia to maintain hemodynamic stability. We conducted a retrospective observational study of patients undergoing total hip arthroplasty. We analyzed the hemodynamic effects of spinal anesthesia to optimize management of spinal anesthesia-induced hypotension (SAIH). Materials and Methods: A total of 329 patients were included in the study, out of which 113 patients were without high blood pressure (60 cases needed Ephedrine) and 216 patients with high blood pressure were drug controlled (106 cases needed Ephedrine). Each group of patients was divided into two groups based on the type of spinal anesthesia: bupivacaine with morphine (Group M) and bupivacaine with fentanyl (Group F). The study explored perioperative factors associated with spinal anesthesia-induced hypotension and the ephedrine dose required to maintain hemodynamic stability. Results: We found that ephedrine dosage correlated with hypertension in 19% of cases and with patient age in 44.1% of cases. The type of anesthetic mixture did not significantly affect the need for intraoperative ephedrine administration. Conclusions: Ephedrine remains essential for ensuring hemodynamic stability and optimizing perioperative outcomes. Full article

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10 pages, 2218 KB

Open AccessCase Report

Mustardé Cheek Rotation-Advancement Flap: A Case-Based Experience in Reconstruction of a Large Defect of the Lower Eyelid Due to Squamous Cell Carcinoma

by Kostadin Gigov, Ivan Ginev and Petra Kavradzhieva

Clin. Pract. 2025, 15(9), 165; https://doi.org/10.3390/clinpract15090165 - 15 Sep 2025

Abstract

Background: Restoring the integrity of the lower eyelid presents a complex surgical challenge due to its lamellar structure and the high risk of complications. Among these, ectropion is the most frequent and troublesome outcome. Objective: This study aims to present a [...] Read more.

Background: Restoring the integrity of the lower eyelid presents a complex surgical challenge due to its lamellar structure and the high risk of complications. Among these, ectropion is the most frequent and troublesome outcome. Objective: This study aims to present a case of lower eyelid reconstruction following the excision of squamous cell carcinoma using Mohs micrographic surgery combined with the Mustardé cheek rotation flap technique, highlighting its advantages, limitations, and applicability in elderly patients. Case presentation: A 93-year-old female patient with right lower eyelid squamous cell carcinoma underwent Mohs micrographic surgery. The resulting defect was reconstructed using a Mustardé cheek rotation flap, chosen for its suitability in patients with adequate skin laxity. Patient-specific risk factors, including advanced age, a history of ischemic stroke, and class II heart failure (NYHA classification), were considered in the surgical planning stage. Results: The Mustardé cheek rotation flap provided a reliable closure with a favorable esthetic outcome and inconspicuous scarring, aligned with natural anatomical margins. The technique was technically straightforward in this patient owing to age-related skin laxity. No major postoperative complications were observed. Conclusions: The Mustardé cheek rotation flap represents a safe and effective reconstructive option for elderly patients with lower eyelid defects following tumor excision. This case illustrates the esthetic and functional benefits of the technique while emphasizing the need to tailor reconstruction strategies to patient comorbidities and defect characteristics. Full article

(This article belongs to the Special Issue Clinical Outcome Research in the Head and Neck: 2nd Edition)

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15 pages, 1115 KB

Open AccessArticle

Low Vitamin D and High Psychological Distress: Are They Associated with Poor Differentiation in Head and Neck Cancer?

by Bogdan Hirtie, Ana-Maria Stanoiu, Kristine Guran, Norberth-Istvan Varga, Claudia Raluca Balasa Virzob, Delia Hutanu, Adrian Cote, Rodica Anamaria Negrean, Delia Ioana Horhat and Cristian Ion Mot

Clin. Pract. 2025, 15(9), 164; https://doi.org/10.3390/clinpract15090164 (registering DOI) - 12 Sep 2025

Abstract

Background and Objectives: Vitamin D deficiency and psychological distress have been linked to cancer biology, but their relevance to tumor differentiation in head-and-neck squamous cell carcinoma (HNSCC) is uncertain. Materials and Methods: In this cross-sectional study at the Department of Otolaryngology, County Hospital [...] Read more.

Background and Objectives: Vitamin D deficiency and psychological distress have been linked to cancer biology, but their relevance to tumor differentiation in head-and-neck squamous cell carcinoma (HNSCC) is uncertain. Materials and Methods: In this cross-sectional study at the Department of Otolaryngology, County Hospital of Timișoara, Romania, we enrolled newly diagnosed HNC patients from October 2023 to December 2024, analyzing 199 SCC patients after exclusions. Vitamin D status was assessed using serum 25-OH-vitamin D levels, and distress was measured with the validated Romanian version of the Hospital Anxiety and Depression Scale (HADS). Tumor aggressiveness was defined by histological grade (G3 vs. G1–G2). Univariate, multivariate, and subgroup analyses were conducted, adjusting for confounders like smoking. Results: Vitamin D deficiency (<20 ng/mL) was prevalent (80.40%), with median 25-OH-vitamin D levels of 15.1 ng/mL. Univariate analysis revealed a modest association between vitamin D deficiency and poorly differentiated tumors (G3 vs. G1–G2; OR = 1.79, p = 0.055) and between clinically significant anxiety (HADS-A ≥ 8) and G3 tumors (OR = 1.71, p = 0.059). A weak negative correlation was observed between 25-OH-vitamin D levels and HADS-A scores (rho = −0.17, p = 0.052). In multivariate analysis adjusted for age, smoking, and tumor location, these associations weakened (vitamin D deficiency: OR = 1.55, p = 0.082; HADS-A ≥8: OR = 1.56, p = 0.113). Subgroup analysis suggested a trend toward higher odds of G3 tumors in patients with both vitamin D deficiency and high anxiety (OR = 1.72, p = 0.075). Conclusions: Univariate analyses indicated potential links between vitamin D deficiency, psychological distress, and tumor aggressiveness in HNSCC, but these did not reach statistical significance after adjustment for confounders. The observed trends, particularly in subgroups with combined deficiency and distress, suggest a possible interplay worth exploring further. To conclude, neither vitamin-D deficiency nor clinically significant distress independently predicted poor histological differentiation after adjustment; observed trends, including a possible distress–vitamin-D interaction, are hypothesis-generating and warrant testing in larger, longitudinal cohorts. Full article

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12 pages, 240 KB

Open AccessReview

Neurogenic Dysphagia: Peripheral and Central Neuromodulation

by Mario Stampanoni Bassi, Diego Centonze, Bledar Gjikolaj, Angelo Alito, Adriana Tisano, Rosario Marchese-Ragona and Domenico Antonio Restivo

Clin. Pract. 2025, 15(9), 163; https://doi.org/10.3390/clinpract15090163 - 4 Sep 2025

Abstract

Dysphagia is a frequent and potentially life-threatening complication in patients with neurological disorders. Swallowing is a complex neurophysiological mechanism regulated by a widespread network of central nervous system regions. The control of swallowing functions requires the integrity of the central pattern generator located [...] Read more.

Dysphagia is a frequent and potentially life-threatening complication in patients with neurological disorders. Swallowing is a complex neurophysiological mechanism regulated by a widespread network of central nervous system regions. The control of swallowing functions requires the integrity of the central pattern generator located in the brainstem, the sensorimotor cortex, the basal ganglia, and the cerebellum, but also peripheral nerves and swallowing muscles. Neurological diseases affecting either central or peripheral components of this system commonly result in dysphagia. Despite its clinical relevance, the management of neurogenic dysphagia remains challenging. While rehabilitative strategies such as swallowing therapy currently represent the main treatment option, emerging evidence suggests that non-invasive central and peripheral neuromodulation techniques may provide adjunctive beneficial effects. Further research is warranted to better define their efficacy, optimal protocols, and long-term outcomes. Full article

11 pages, 1307 KB

Open AccessArticle

Prospective Comparison of Short-Term Outcomes in Kinematic and Mechanical Alignment Total Knee Arthroplasty

by Ofir Vinograd, Ahmad Essa, Netanel Steinberg, Ilan Y. Mitchnik, Dana Avraham, Inon Rotem, Adi Vinograd, Yiftah Beer, Noam Shohat and Yaron Bar-Ziv

Clin. Pract. 2025, 15(9), 162; https://doi.org/10.3390/clinpract15090162 - 31 Aug 2025

Abstract

Background: While mechanical alignment total knee arthroplasty (TKA) has long been the conventional surgical technique in patients with advanced osteoarthritis, kinematic alignment TKA has emerged as a promising alternative, designed to restore the knee’s native pre-arthritic anatomy. Since superiority of either technique remains [...] Read more.

Background: While mechanical alignment total knee arthroplasty (TKA) has long been the conventional surgical technique in patients with advanced osteoarthritis, kinematic alignment TKA has emerged as a promising alternative, designed to restore the knee’s native pre-arthritic anatomy. Since superiority of either technique remains inconclusive, we aimed to compare immediate and short-term postoperative outcomes of kinematic versus mechanical alignment TKA. Methods: This prospective cohort study was conducted at a tertiary care centre between January 2020 and August 2022, enrolling kinematic and mechanical alignment TKA patients. Outcomes were assessed during hospitalization and at 14 days postoperatively. Data collected included patient-reported outcome measures (PROMs), functional performance evaluations, pain scores, discharge disposition and hospital length of stay. Both univariate and multivariate regression analyses were conducted, adjusting for potential confounders. Results: The study included 103 patients, with 77 who underwent kinematic alignment and 26 mechanical alignment TKA. Patients in the kinematic alignment group demonstrated statistically significant better postoperative outcomes compared to those in the mechanical alignment group. Kinematic alignment TKA patients demonstrated superior functional performance on the Timed Up and Go test immediately postoperatively and were more frequently discharged home rather than to a rehabilitation facility. Hospital stay length and short-term PROMs also favoured the Kinematic alignment TKA group, showing statistically significant higher scores in the Oxford Knee Score, short form-12 Mental Component Summary, and the Knee Injury and Osteoarthritis Outcome Score Symptoms subscale. Conclusions: Kinematic alignment TKA offers superior immediate and short-term outcomes compared to mechanical alignment TKA, with benefits in functional recovery, hospitalization duration, and discharge disposition. This evidence supports kinematic alignment TKA as a viable alternative, aiding in patient and surgeon decision-making. Full article

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17 pages, 251 KB

Open AccessArticle

Addressing Healthcare Disparities Among the Homeless: Insights from a Student-Run Clinic in Houston, TX

by Damien Kelly, Umer Khan, Elizabeth Bixler, Gabriella Becerra and Chakema Carmack

Clin. Pract. 2025, 15(9), 161; https://doi.org/10.3390/clinpract15090161 - 31 Aug 2025

Abstract

Background: Unhoused individuals face significant health disparities and encounter numerous barriers to accessing adequate healthcare, resulting in high rates of chronic disease, mental illness, and untreated conditions in Houston, TX. The purpose of this study was to identify prevalent health conditions within a [...] Read more.

Background: Unhoused individuals face significant health disparities and encounter numerous barriers to accessing adequate healthcare, resulting in high rates of chronic disease, mental illness, and untreated conditions in Houston, TX. The purpose of this study was to identify prevalent health conditions within a sample of unhoused adults and to identify patterns in patient characteristics and clinical health outcomes. Methods: This study utilized clinical and demographic data from n = 191 patients who received care at a student-run clinic embedded within a homeless drop-in center in Houston, TX. Data included patient demographics, chief complaints, social determinants of health (SDOHs), past medical history, on-site diagnoses, and provider actions. Results: The most prevalent issues were housing insecurity (36.1%), cardiovascular conditions (38.7%), and substance use (17.8%). Nearly half of all patients (46.6%) declined treatment or left before receiving care. Significant associations were found between patient demographics and provider responses, including differences by gender and age in treatment type and diagnostic categorization. Conclusions: These findings underscore critical challenges in treatment adherence, diagnostic bias, and retention among unhoused populations. The study provides actionable recommendations for improving care coordination and continuity in low-barrier, student-run clinics serving medically underserved communities. Full article

13 pages, 920 KB

Open AccessArticle

Implantable Cardioverter–Defibrillator Therapies Following Generator Replacements—Long-Term Remote Monitoring Data

by Maciej Dyrbuś, Łukasz Pyka, Anna Kurek, Jacek Niedziela, Elżbieta Adamowicz-Czoch, Katarzyna Sokoła, Joanna Machowicz, Mateusz Ostręga, Damian Pres, Michał Skrzypek, Mariusz Gąsior and Mateusz Tajstra

Clin. Pract. 2025, 15(9), 160; https://doi.org/10.3390/clinpract15090160 - 30 Aug 2025

Abstract

Background: The rate of long-term outcomes, including arrhythmic episodes following implantable cardioverter–defibrillator (ICD) device replacements, is often unknown. Thus, the aim of this manuscript was to evaluate the risk of ICD or cardiac resynchronization therapy–defibrillator (CRT-D) therapies in remotely monitored patients following [...] Read more.

Background: The rate of long-term outcomes, including arrhythmic episodes following implantable cardioverter–defibrillator (ICD) device replacements, is often unknown. Thus, the aim of this manuscript was to evaluate the risk of ICD or cardiac resynchronization therapy–defibrillator (CRT-D) therapies in remotely monitored patients following device replacement. Methods: Data from 134 patients who underwent ICD/CRT-D replacement or upgrade were analyzed. Kaplan–Meier estimates, as well as Cox proportional hazards regression, were used to present long-term outcomes and predictors of study endpoints, these being all-cause mortality, and appropriate and inappropriate ICD/CRT-D therapies. Results: Among the cohort, 51.5% of patients received ICDs and 48.5% received CRT-Ds; the median (quartile 1–quartile 3) LVEF at replacement was 23.0% (18.0–28.0%). In 11 (8.2%) patients, the LVEF at replacement was higher than 35%. During the median (Q1–Q3) follow-up of 3.0 (1.4–5.0) years, 32.1% experienced appropriate and 6.0% experienced inappropriate therapies. The all-cause mortality rate was 38.0%, and appropriate antitachycardia pacing (ATP), a reduced baseline LVEF, and no history of myocardial infarction were independent predictors of death (odds ratios of 1.87 for appropriate ATP, 0.88 per 1% of the LVEF and 0.54 for a history of MI, respectively). The rate of appropriate device therapies was numerically lower in patients whose LVEF improved (19.8% vs. 33.3% and 0% vs. 6.5%, for appropriate and inappropriate therapies). An LVEF of >35% at replacement did not influence the analyzed outcomes. Conclusions: In patients who underwent ICD/CRT-D replacement, an improvement in LVEF was not identified as either a predictor of improved survival or of a lower risk of needing device therapies. Further stratification models are needed to evaluate the arrhythmic risk in patients after generator replacements. Full article

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21 pages, 1922 KB

Open AccessArticle

Effects of Dietary and Probiotic Interventions in Patients with Metabolic Syndrome and Obstructive Sleep Apnea

by Amina Venter, Amin-Florin El-kharoubi, Mousa El-kharoubi, Evelin Claudia Ghitea, Marc Cristian Ghitea, Timea Claudia Ghitea and Ciprian Florian Venter

Clin. Pract. 2025, 15(9), 159; https://doi.org/10.3390/clinpract15090159 - 29 Aug 2025

Abstract

Background: Metabolic syndrome (MS) and obstructive sleep apnea (OSA) frequently coexist, exacerbating systemic inflammation, oxidative stress, and metabolic dysregulation. This study evaluates the effects of dietary and probiotic interventions, compared to a non-intervention control group, on metabolic, hemodynamic, and neurochemical parameters, with a [...] Read more.

Background: Metabolic syndrome (MS) and obstructive sleep apnea (OSA) frequently coexist, exacerbating systemic inflammation, oxidative stress, and metabolic dysregulation. This study evaluates the effects of dietary and probiotic interventions, compared to a non-intervention control group, on metabolic, hemodynamic, and neurochemical parameters, with a specific focus on the neurotransmitters GABA and glutamate. Methods: In a prospective randomized study (2020–2023), 120 patients with coexisting MS and OSA were assigned to three groups: control (n = 36), diet therapy (n = 42), and diet therapy combined with probiotics (n = 42). Interventions lasted six months and included personalized dietary plans and probiotic supplementation. Outcome measures included BMI, visceral fat, HOMA index, lipid profile, oxygen saturation, and urinary GABA and glutamate levels. Unsupervised K-means clustering and principal component analysis (PCA) were applied to identify phenotypic response patterns based on delta values. Results: Diet therapy led to significant reductions in BMI (−15.7%, p = 0.001), visceral fat (−17.3%, p = 0.001), triglycerides (−14.6%, p = 0.003), uric acid (−9.5%, p = 0.011), and C-reactive protein (CRP) (−21.4%, p = 0.007). The combined intervention group exhibited further improvements in visceral fat (−22.8%, p = 0.001), glutamate (−18.2%, p = 0.002), and GABA levels (+19.5%, p = 0.001). Oxygen saturation improved across all groups, with the greatest increase in the probiotics group (+2.3%). Clustering analysis revealed three distinct response phenotypes—strong, moderate, and non-responders—highlighting inter-individual variability in treatment efficacy. Conclusions: Personalized dietary interventions, especially when paired with probiotics, effectively improve metabolic, inflammatory, and neurochemical profiles in patients with MS and OSA. Integrating clustering algorithms enables phenotype-specific stratification, offering a step toward precision lifestyle medicine. Future studies should explore long-term outcomes and refine microbiota-targeted approaches to optimize intervention efficacy. Full article

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

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Graphical abstract

9 pages, 5694 KB

Open AccessCase Report

Plasma Cell Gingivitis: Clinical Presentation, Histopathologic Correlation, and Therapeutic Challenges

by Davide Gerardi, Diana Torge, Sara Bernardi, Pierangelo Burdo, Maurizio Piattelli and Giuseppe Varvara

Clin. Pract. 2025, 15(9), 158; https://doi.org/10.3390/clinpract15090158 - 28 Aug 2025

Abstract

Background/Objectives: Plasma cell gingivitis (PCG) is a rare, benign, non-dental-plaque-induced inflammatory condition characterized by dense subepithelial infiltration of polyclonal plasma cells. Due to its nonspecific clinical presentation, PCG represents a diagnostic challenge. This case report aims to describe a clinical case of PCG, [...] Read more.

Background/Objectives: Plasma cell gingivitis (PCG) is a rare, benign, non-dental-plaque-induced inflammatory condition characterized by dense subepithelial infiltration of polyclonal plasma cells. Due to its nonspecific clinical presentation, PCG represents a diagnostic challenge. This case report aims to describe a clinical case of PCG, highlighting the diagnostic process, histopathological correlation, and therapeutic approach. Methods: A 57-year-old male presented with a polypoid, erythematous, and edematous gingival lesion in the anterior maxillary region, with spontaneous bleeding on probing. Following clinic assessment, an incisional biopsy was performed, alongside complete hematological and inflammatory profiling. Histological and immunohistochemical analyses revealed the presence of an inflammatory infiltrate. Results: Histological evaluation revealed spongiotic squamous epithelium characterized by a dense plasma cell infiltrate with a liquenoid pattern of CD3-positive T and CD20-positive B lymphocytes. A polytypic expression of kappa and lambda light chains was also detected. The patient underwent topical corticosteroid therapy, showing progressive clinical improvement and resolution of symptoms, although minor mucosal involvement persisted. Conclusions: PCG remains a rare and underdiagnosed condition requiring integration of clinical, hematological, and histopathological data for accurate diagnosis. While corticosteroids remain the first-line therapy, emerging treatments, including photobiomodulation, may offer future adjunctive strategies to improve outcomes and reduce recurrence. Full article

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13 pages, 1060 KB

Open AccessArticle

Transcutaneous Electrical Nerve Stimulation for Muscle Recovery: Insights into Delayed Onset Muscle Soreness

by Sebastian Szajkowski, Jarosław Pasek and Grzegorz Cieślar

Clin. Pract. 2025, 15(9), 157; https://doi.org/10.3390/clinpract15090157 - 28 Aug 2025

Abstract

Background: Delayed onset muscle soreness (DOMS) frequently occurs after engaging in strenuous physical activity. The manifestation of DOMS is often associated with changes in the biomechanical and viscoelastic characteristics of the affected muscles. Materials and Methods: Forty participants were enrolled and randomly assigned [...] Read more.

Background: Delayed onset muscle soreness (DOMS) frequently occurs after engaging in strenuous physical activity. The manifestation of DOMS is often associated with changes in the biomechanical and viscoelastic characteristics of the affected muscles. Materials and Methods: Forty participants were enrolled and randomly assigned to two groups: the intervention group receiving transcutaneous electrical nerve stimulation (TENS, n = 20) and a control group (n = 20). A fatigue-inducing protocol targeting the gastrocnemius muscle was implemented to elicit DOMS. The effectiveness of TENS was assessed by evaluating alterations in the biomechanical and viscoelastic properties of the muscle. Pain intensity was recorded using the Numeric Rating Scale (NRS) at five time points: before the study began, three times during the intervention, and once at the conclusion of the study. Results: No statistically significant changes have been found regarding muscle tone (p = 0.162) and stiffness (p = 0.212) in Group 1. However, a statistically significant lower level of stiffness in Group 1 after the end of therapy has been detected (p = 0.008). Decrement values decreased statistically significantly, both in Group 1 (p = 0.015) and in Group 2 (p = 0.014). There were no statistically significant differences in decrement level between Group 1 and 2. Relaxation and creep decreased statistically insignificantly in both groups. At the end of the observation period (Day 4), statistically significant (p = 0.027) lower pain intensity was observed in Group 1. Conclusions: It has been demonstrated that TENS has had limited effectiveness in restoring baseline biomechanical and viscoelastic parameters of muscles that undergo changes during DOMS. TENS significantly relieves pain symptoms occurring in DOMS. Full article

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20 pages, 523 KB

Open AccessReview

Diagnostic Overshadowing and the Unseen Spectrum: A Narrative Review of Rare Complications in Sickle Cell Disease

by Abdulrahman Nasiri, Manal Alshammari, Reem Alkharras, Albaraa Madkhali, Mostafa F. Mohammed Saleh and Hazza Alzahrani

Clin. Pract. 2025, 15(9), 156; https://doi.org/10.3390/clinpract15090156 - 27 Aug 2025

Abstract

Sickle cell disease (SCD) is a hereditary hemoglobin disorder characterized by chronic hemolysis and recurrent vaso-occlusive crises, leading to a wide spectrum of complications. While common SCD manifestations have well-established management protocols, rare and atypical complications pose significant diagnostic and therapeutic challenges. A [...] Read more.

Sickle cell disease (SCD) is a hereditary hemoglobin disorder characterized by chronic hemolysis and recurrent vaso-occlusive crises, leading to a wide spectrum of complications. While common SCD manifestations have well-established management protocols, rare and atypical complications pose significant diagnostic and therapeutic challenges. A critical barrier is diagnostic overshadowing, where common SCD symptoms (pain, fever, respiratory distress) mask infrequent but life-threatening conditions, resulting in delayed recognition and suboptimal outcomes. This narrative review synthesizes the literature from 2000–2025 on rare SCD complications, including atypical neurological events (e.g., spontaneous epidural or subdural hematoma, central retinal artery occlusion, cerebral arteriovenous malformations, posterior reversible encephalopathy syndrome), uncommon hematologic syndromes (acute leukemia, extramedullary hematopoiesis in unusual sites, hemophagocytic lymphohistiocytosis), severe cardiopulmonary emergencies (acute multiorgan failure and fat embolism syndromes), unusual hepatic crises (acute hepatic sequestration, intrahepatic cholestasis), and others (e.g., compartment syndrome). Key insights underscore the need for high clinical suspicion and prompt use of advanced diagnostics (e.g., MRI, specialized laboratory tests) when patients present with atypical or disproportionate symptoms. Clinical implications: Heightening clinician awareness of these rare complications and implementing structured diagnostic strategies can facilitate earlier intervention, improving outcomes and reducing the high morbidity and mortality associated with these infrequent but severe events. Full article

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12 pages, 528 KB

Open AccessArticle

Efficacy of Non-Invasive Monopolar Radiofrequency for Treating Genitourinary Syndrome of Menopause: A Prospective Pilot Study

by Mariachiara Palucci, Marta Barba, Alice Cola, Clarissa Costa, Desirèe De Vicari and Matteo Frigerio

Clin. Pract. 2025, 15(8), 155; https://doi.org/10.3390/clinpract15080155 - 20 Aug 2025

Abstract

Introduction: The decline of serum estrogen in postmenopausal women leads to several changes in the vulvovaginal and vesicourethral areas, resulting in the genitourinary syndrome of menopause (GSM), characterized by bothersome symptoms such as vaginal atrophy, lack of lubrication, dyspareunia, urgency, dysuria, and [...] Read more.

Introduction: The decline of serum estrogen in postmenopausal women leads to several changes in the vulvovaginal and vesicourethral areas, resulting in the genitourinary syndrome of menopause (GSM), characterized by bothersome symptoms such as vaginal atrophy, lack of lubrication, dyspareunia, urgency, dysuria, and recurrent urinary tract infections. Nevertheless, this condition could also be experienced by younger women affected by hormone-dependent tumors. Although topical estrogens are considered “the gold standard”, hormonal treatments cannot be indicated in cancer survivors. As a result, energy-based devices using radiofrequency and laser technologies have emerged as alternative options. This prospective study aimed to evaluate the benefits of non-invasive monopolar radiofrequency (RF) in women affected by GSM who have contraindications to, did not respond to, or declined local estrogen therapy. Methods: The patients underwent five weekly sessions of second-generation monopolar RF. At baseline and at the fifth session, two validated questionnaires were administered to the patients: the Visual Analogue Scale (VAS) and the Female Sexual Function Index (FSFI-19). On the other hand, the vaginal mucosa status was evaluated by clinicians through the Vaginal Health Index (VHI). At the end of the cycle, the Patient Global Impression of Improvement (PGI-I) questionnaire was collected. Results: Based on 44 patients who completed five sessions of radiofrequency, a significant improvement was observed in sexual function according to the FSFI scale (22.9 vs. 38.6; p < 0.001) and in VVA atrophy symptoms, as documented by the VAS score (223 vs. 125; p < 0.001). The mean VHI score increased by 3 points (p < 0.001). Moreover, according to PGI-I, 96% of patients reported a perceived improvement (PGI-I score ≤ 3). Conclusions: Radiofrequency could provide an innovative and safe therapeutic approach for patients suffering from GSM and VVA, especially when hormonal strategies are unsuitable. Full article

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10 pages, 251 KB

Open AccessArticle

Allelic and Genotypic Distribution of MMP13-77 A/G Polymorphism in Salvadoran Children With and Without Caries

by Wendy Escobar-González, Jorge Alegría-Torres, Yolanda Terán-Figueroa, Vianney Castañeda-Monroy, Aurelio Álvarez-Vargas, Carlo Eduardo Medina-Solís and Nuria Patiño-Marín

Clin. Pract. 2025, 15(8), 154; https://doi.org/10.3390/clinpract15080154 - 19 Aug 2025

Abstract

Background/Objectives: Polymorphisms in metalloproteinases (MMPs) have the potential to be probable genetic biomarkers of dental caries. The aim of this study was to evaluate the distribution of the MMP13 A/G rs2252070 single nucleotide polymorphism (SNP) according to caries experience in Salvadoran children. [...] Read more.

Background/Objectives: Polymorphisms in metalloproteinases (MMPs) have the potential to be probable genetic biomarkers of dental caries. The aim of this study was to evaluate the distribution of the MMP13 A/G rs2252070 single nucleotide polymorphism (SNP) according to caries experience in Salvadoran children. Methods: A cross-sectional study was carried out on 185 Salvadorian school children between 7 and 12 years of age. Demographic data, frequency of toothbrushing, dental flossing and consumption of sugar-sweetened beverages were recorded. Caries data were collected by clinical examination. Genomic DNA was obtained from oral cells of the children. Polymorphism genotyping was performed by PCR-RFLP. Allele and genotypic frequencies were compared between the healthy and caries-experiencing groups. Data were analyzed with SPSS 26.0 using the chi-square test, the Kruskal–Wallis test and logistic regression analysis. Results: The allele frequencies of MMP13-77 A/G were 0.7 and 0.3 following the Hardy–Weinberg equilibrium (X² = 0.22, p = 0.63). 72% of subjects with caries experience were carriers of the A allele. Caries experience was higher for the GG genotype group for permanent and primary surfaces (DMFS = 2.11; dmfs = 5.64) and for permanent teeth (DMFT = 1.50). No significant differences were found in the allelic and/or genotypic frequencies of the SNP polymorphism between subjects with dental caries and healthy subjects (p > 0.05). Conclusions: The distribution of MMP13-77 A/G rs2252070 in the study population showed no association with caries experience. However, our findings highlight the importance of promoting oral hygiene habits from an early age. Full article

(This article belongs to the Topic Advances in Diagnosis and Treatment of Dental Diseases and Temporomandibular Joints)

13 pages, 252 KB

Open AccessArticle

Association Between Emotional Intelligence and Stress Management in Hemodialysis Patients

by Orchan Impis, Afroditi Zartaloudi, Eirini Grapsa and Georgia Gerogianni

Clin. Pract. 2025, 15(8), 153; https://doi.org/10.3390/clinpract15080153 - 19 Aug 2025

Abstract

Background: Emotional intelligence refers to individuals’ ability to recognize and manage their own emotions as well as those of others, playing a crucial role in stress management. This study aimed to investigate the relationship between different dimensions of emotional intelligence and stress management [...] Read more.

Background: Emotional intelligence refers to individuals’ ability to recognize and manage their own emotions as well as those of others, playing a crucial role in stress management. This study aimed to investigate the relationship between different dimensions of emotional intelligence and stress management strategies in patients undergoing hemodialysis. Methods: In this cross-sectional study, 468 patients on hemodialysis completed the (i) Wong and Law Emotional Scale (WLEIS) and (ii) Trait Emotional Intelligence Questionnaire Short Form (TEIQue-SF) for the assessment of emotional intelligence as an emotional ability or as a personality trait, respectively; (iii) the Brief COPEQuestionnaire (Brief- COPE) for the assessment of stress management strategies; and (iv) a questionnaire about demographic characteristics. Spearman’s correlations coefficients were used to explore associations between two continuous variables. Multiple linear regression analysis was used with Brief-COPE dimensions as the dependent variable. Results: High levels of emotionality were associated with an active approach to coping with stress (p = 0.018), while increased well-being and high regulation of emotions were associated with decreased behavioral disengagement (p < 0.001). Moreover, high emotional appraisal of others was linked to an increased use of humor (p = 0.042), while self-control and use and regulation of emotions were associated with decreased expression of negative feelings (p < 0.001). Conclusions: The current findings suggest potential links between emotional intelligence and stress management strategies in patients undergoing hemodialysis. Full article

19 pages, 671 KB

Open AccessArticle

Macrovascular Involvement in Systemic Sclerosis: Association Between Carotid Ultrasound Hemodynamics Parameters and Digital Ulcers

by Eugenio Capparelli, Francesco Lapia, Luca Clerici, Eleonora Zaccara, Giusy Cinzia Moltisanti, Francesca Capelli, Daniela Bompane, Laura Castelnovo, Antonio Tamburello, Maria Iacovantuono, Maria Sole Chimenti, Paola Maria Luigia Faggioli and Antonino Mazzone

Clin. Pract. 2025, 15(8), 152; https://doi.org/10.3390/clinpract15080152 - 18 Aug 2025

Abstract

Background: Digital ulcers (DUs) are among the most debilitating vascular complications in SSc and are commonly attributed to microvascular damage. However, recent evidence suggests a potential involvement of macrovascular abnormalities, including subclinical atherosclerosis and altered hemodynamic parameters. Objectives: This study aimed to investigate [...] Read more.

Background: Digital ulcers (DUs) are among the most debilitating vascular complications in SSc and are commonly attributed to microvascular damage. However, recent evidence suggests a potential involvement of macrovascular abnormalities, including subclinical atherosclerosis and altered hemodynamic parameters. Objectives: This study aimed to investigate the association between a history of DUs and macrovascular involvement in SSc patients through carotid and vertebral Doppler ultrasonography, with a focus on hemodynamic indices such as Peak Systolic Velocity (PSV), End-Diastolic Velocity (EDV), Resistive Index (RI), and Intima–Media Thickness (IMT). Methods: A cross-sectional study was conducted on 107 SSc patients. Clinical, serological, cardiovascular, and metabolic data were collected, and carotid–vertebral ultrasound was performed. Patients were stratified based on DU history. Statistical analyses assessed associations between DU status and carotid–vertebral US findings. Results: Patients with DUs showed a significantly higher PSV in both right (86.9 ± 67.9 vs. 64.2 ± 20.5 cm/s, p = 0.010) and left ICA (78.9 ± 29.6 vs. 63.4 ± 18.2 cm/s, p = 0.002). Right ICA RI vas elevated in the DU group (p = 0.021). PSV in the external carotid arteries was also bilaterally increased in DU patients (p < 0.005). DU-positive patients had a higher prevalence of left carotid plaques (p = 0.012) and right-sided ICA RI > 0.75 (p = 0.01). Logistic regression identified DU history as an independent predictor of PSV at ICA (β = 31.89, p = 0.043) and carotid plaque presence at any side (OR 14.34, p = 0.012). Conclusions: A history of digital ulcers in SSc patients is associated with altered carotid hemodynamics and an increased subclinical atherosclerotic burden. These findings suggest that DUs may reflect not only microvascular damage, but also macrovascular dysfunction, supporting the need for integrated vascular assessment in SSc clinical practice. Full article

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10 pages, 793 KB

Open AccessSystematic Review

Prevalence of Free Flap Failure in Patients Undergoing Reconstruction for Medication-Related Osteonecrosis of the Jaw: A Systematic Review and Meta-Analysis

by Evangelos Kostares, Georgia Kostare, Michael Kostares, Fani Pitsigavdaki, Athanassios Kyrgidis, Christos Perisanidis and Maria Kantzanou

Clin. Pract. 2025, 15(8), 151; https://doi.org/10.3390/clinpract15080151 - 14 Aug 2025

Abstract

Background/Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication in patients treated with antiresorptive or antiangiogenic agents, particularly those with cancer-related comorbidities. This systematic review and meta-analysis aimed to estimate the prevalence of free flap failure in patients undergoing microvascular [...] Read more.

Background/Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication in patients treated with antiresorptive or antiangiogenic agents, particularly those with cancer-related comorbidities. This systematic review and meta-analysis aimed to estimate the prevalence of free flap failure in patients undergoing microvascular reconstruction for MRONJ. Methods: A comprehensive literature search was conducted across Medline/PubMed, Scopus, and Web of Science up to 30 January 2025. Inclusion criteria were observational studies involving MRONJ patients treated with free flap reconstruction. Risk of bias was assessed using the Newcastle–Ottawa Scale. The pooled prevalence of free flap failure was calculated using a random-effects model with Freeman–Tukey double arcsine transformation. Results: Twelve studies were included in the quantitative analysis. The fibula free flap was the most frequently used flap. The pooled prevalence of free flap failure was 0.1% (95% CI: 0–2.3%), with no significant associations observed in meta-regression analyses for publication year, patient age, or sex. All included studies were of moderate methodological quality. Conclusions: These findings suggest that free flap reconstruction is a reliable and effective surgical option for managing advanced MRONJ in well-resourced and specialized healthcare settings; however, limitations such as small sample sizes and heterogeneity in protocols must be considered. Further high-quality, multicenter studies are needed to evaluate long-term outcomes and refine perioperative management strategies. Full article

(This article belongs to the Special Issue Clinical Outcome Research in the Head and Neck: 2nd Edition)

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11 pages, 221 KB

Open AccessReview

Cognitive Impairment in Adult Attention Deficit Hyperactivity Disorder: Clinical Implications and Novel Treatment Strategies

by Alexis J. Vega, Gabriel V. Hernandez, Ahmed I. Anwar, Bahareh Sharafi, Rahib K. Islam, Sahar Shekoohi and Alan D. Kaye

Clin. Pract. 2025, 15(8), 150; https://doi.org/10.3390/clinpract15080150 - 12 Aug 2025

Abstract

Attention Deficit Hyperactivity Disorder (ADHD) is a lifelong condition; however, traditional treatment focuses on hyperactivity and inattention, which is largely a manifestation of pediatric ADHD. Studies are limited regarding cognitive difficulties, as seen in adult ADHD, as well as treatment strategies for this [...] Read more.

Attention Deficit Hyperactivity Disorder (ADHD) is a lifelong condition; however, traditional treatment focuses on hyperactivity and inattention, which is largely a manifestation of pediatric ADHD. Studies are limited regarding cognitive difficulties, as seen in adult ADHD, as well as treatment strategies for this population. This review of the literature examines multiple recent studies that discuss various novel treatment strategies for cognitive impairment in adults with ADHD. A targeted literature review was conducted using PubMed to identify recent studies on cognitive dysfunction in adults with ADHD, with an emphasis on emerging treatment strategies. Data collected included sample size, intervention strategies, cognitive function, and side effects. Studies on non-invasive brain stimulation revealed significant effects on executive function in adult ADHD patients. Other studies revealed statistically significant improvements in cognitive flexibility and response inhibition in modafinil users. Another study demonstrated significant improvement in working memory with off label use of viloxazine for adults. This review of the literature describes the effectiveness of novel treatment strategies of adult ADHD including non-stimulant medications, behavioral therapies and neurofeedback. This highlights the need for treatment modalities that enhance cognitive outcomes and further research into long-term efficacy and safety of these novel interventions and implementing psychological treatment into medical management of adult ADHD. Full article

17 pages, 241 KB

Open AccessArticle

Creating and Validating a Questionnaire on Dentists’ Perceptions Regarding Periodontics–Prosthodontics Interdisciplinary Clinical Practice

by Gabriel Rotundu, Dragos Ioan Virvescu, Zinovia Surlari, Dana Gabriela Budala, Florin Razvan Curca, Carina Balcos, Cristian Cojocaru, Vlad Constantin, Razvan Gradinariu and Ionut Luchian

Clin. Pract. 2025, 15(8), 149; https://doi.org/10.3390/clinpract15080149 - 7 Aug 2025

Abstract

Background: The interaction between prosthetic restorations and periodontal health is a critical factor for the long-term success of dental treatments. A biologically compatible prosthetic design supports periodontal stability, whereas neglecting periodontal principles can compromise treatment outcomes. This study aimed to validate a questionnaire [...] Read more.

Background: The interaction between prosthetic restorations and periodontal health is a critical factor for the long-term success of dental treatments. A biologically compatible prosthetic design supports periodontal stability, whereas neglecting periodontal principles can compromise treatment outcomes. This study aimed to validate a questionnaire designed to assess dentists’ perceptions regarding the influence of prosthetic restorations on the periodontium. Material and Methods: An observational cross-sectional study was conducted using a self-administered questionnaire distributed to licensed dentists across Romania. The questionnaire underwent expert review, pilot testing (n = 50), and statistical validation, including the Content Validity Index (CVI), Cronbach’s alpha for internal consistency, and Exploratory Factor Analysis (EFA) using Principal Component Analysis (PCA) with Varimax rotation. The final sample included 39 respondents. Data was analyzed using SPSS v26.0. Results: The questionnaire demonstrated excellent internal consistency (Cronbach’s alpha = 0.900; standardized alpha = 0.917). Most items had corrected item-total correlations > 0.40. EFA revealed eight coherent factors explaining 81.68% of total variance, with high communalities (0.549–0.966), strong Kaiser–Meyer–Olkin test (KMO) values, and significant Bartlett’s test values, confirming construct validity. Descriptive statistics showed predominantly positive attitudes among dentists regarding the periodontal considerations in prosthetic treatment. The highest-rated items emphasized oral hygiene, periodontal stability, and biological adaptation of restorations. Lower scores were associated with routine use of periodontal indices and recognition of failures due to insufficient evaluation. Conclusions: The validated instrument proved reliable and demonstrated strong psychometric properties in this exploratory validation, supporting its use in research and education. Romanian dentists demonstrated a favorable perception of the role of periodontal health in prosthetic success. This tool can inform curriculum development and interdisciplinary clinical protocols in prosthodontics and periodontology. 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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