Clinics and Practice

15 pages, 1893 KiB

Open AccessArticle

A Single-Centre Analysis of Surgical Techniques for Myelomeningocele Closure: Methods, Outcomes, and Complications

by Alina Roxana Cehan, Dorin Constantin Dorobanțu, Corina Ionela Tamas, Vlad Dimitrie Cehan, Flaviu Tamas and Adrian Balasa

Clin. Pract. 2024, 14(5), 2056-2070; https://doi.org/10.3390/clinpract14050162 - 29 Sep 2024

Abstract

(1) Background: Neural tube defects are a prevalent cause of congenital malformations, myelomeningocele (MMC) being the most severe form. This study evaluates the clinical outcome and postoperative-associated complications following MMC surgical closures, focusing on the following three techniques: direct suture (DS); VY advancement [...] Read more.

(1) Background: Neural tube defects are a prevalent cause of congenital malformations, myelomeningocele (MMC) being the most severe form. This study evaluates the clinical outcome and postoperative-associated complications following MMC surgical closures, focusing on the following three techniques: direct suture (DS); VY advancement flap (VYF); and Limberg flap (LF). (2) Methods: A retrospective observational study was conducted from March 2015 to February 2023, and the inclusion criteria were newborns who underwent lumbosacral MMC within 24 h of birth. (3) Results: Out of 20 cases, 45% underwent DS closure; 25% underwent VY-F closure; 15% underwent LF closure, and 15% (n = 3) underwent combined flap closure. A significant statistical correlation was observed between intracranial hypertension (IH), the need for external ventricular drainage (EVD), and DS closure type. In the DS group, 60% of patients required EVD (p = 0.041), and 90% had IH (p = 0.027). CSF fistula was present in 40% of LF cases and 30% of DS cases, while wound dehiscence was observed in 60% of LF cases and 30% of DS cases. (4) Conclusions: Our study demonstrated that DS was linked to higher rates of complications. The VY-F is the safest method for closing MMC defects. Full article

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

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12 pages, 308 KiB

Open AccessArticle

Balance, Gait, Functionality and Fall Occurrence in Adults and Older Adults with Type 2 Diabetes Mellitus and Associated Peripheral Neuropathy

by Natália Maria Bezerra Tavares, Jonathânya Marques Silva, Mayra Darlene Morato da Silva, Letícia Danielly Tenório Silva, Jackson Nascimento de Souza, Lucas Ithamar, Maria Cristina Falcão Raposo and Renato S. Melo

Clin. Pract. 2024, 14(5), 2044-2055; https://doi.org/10.3390/clinpract14050161 - 28 Sep 2024

Abstract

Background: Body balance is regulated by sensory information from the vestibular, visual and somatosensory systems, and changes in one or more of these sensory systems can trigger balance disorders. Individuals with type 2 Diabetes Mellitus (DM2) often present peripheral neuropathy, a condition that [...] Read more.

Background: Body balance is regulated by sensory information from the vestibular, visual and somatosensory systems, and changes in one or more of these sensory systems can trigger balance disorders. Individuals with type 2 Diabetes Mellitus (DM2) often present peripheral neuropathy, a condition that alters foot sensory information and can negatively influence balance and gait performance of these subjects. Objective: To evaluate and compare balance, gait, functionality and the occurrence of falls between individuals with and without a clinical diagnosis of DM2 with associated peripheral neuropathy. Methods: Cross-sectional study, which evaluated seventy individuals, thirty-five with and thirty-five without a clinical diagnosis of DM2, of both sexes and age range between 50 and 85 years, who were recruited from Basic Health Units of Serra Talhada, Pernambuco state, Brazil. The volunteers’ balance was analyzed using the Berg Balance Scale, gait-related functional tasks were measured using the Dynamic Gait Index, functional mobility was assessed using the Timed Up and Go test and functionality was assessed using the Katz Index. The occurrence of falls was recorded by the volunteers’ self-report. Results: Individuals with DM2 demonstrated the worst performance in balance (p = 0.000) and in gait-related functional tasks (p = 0.000), slower functional mobility (p = 0.000) and worse functionality (p = 0.016) compared to the group without DM2, demonstrating significant differences for all analyzed outcomes. A greater occurrence of falls was observed in individuals with DM2, compared to those without the disease (p = 0.019). Conclusion: Individuals with DM2 demonstrated worse performance on balance, gait-related functional tasks, slower functional mobility and worse functionality compared to those without the disease. Individuals with DM2 had the highest occurrence of falls in this study. Full article

17 pages, 4666 KiB

Open AccessCase Report

Twisted Troubles: A Rare Case of Intestinal Obstruction Due to Endometriosis and a Review of the Literature

by Ionut Eduard Iordache, Luana Alexandrescu, Alina Doina Nicoara, Razvan Popescu, Nicoleta Leopa, Gabriela Baltatescu, Andreea Nelson Twakor, Ionut Tiberiu Tofolean and Liliana Steriu

Clin. Pract. 2024, 14(5), 2027-2043; https://doi.org/10.3390/clinpract14050160 - 27 Sep 2024

Abstract

Background and Objectives: Intestinal endometriosis is an exceptionally rare cause of intestinal obstruction. This case report and literature review aim to highlight the clinical presentation, diagnostic challenges, and surgical management of this condition. Materials and methods: We report the case of a 50-year-old [...] Read more.

Background and Objectives: Intestinal endometriosis is an exceptionally rare cause of intestinal obstruction. This case report and literature review aim to highlight the clinical presentation, diagnostic challenges, and surgical management of this condition. Materials and methods: We report the case of a 50-year-old female patient who presented diffuse abdominal pain, nausea, vomiting, a distended abdomen, and an absence of intestinal transit for gas and faeces. Initial symptoms included flatulence and constipation, which gradually worsened for two months prior to the patient’s hospital admission, leading to acute intestinal obstruction. Diagnostic investigations, including blood tests, ultrasound (USG), X-ray, and a contrast-enhanced computer tomography (CT) scan, revealed significant small bowel dilatation and an ileal volvulus. The patient underwent urgent hydro-electrolytic and metabolic rebalancing followed by a median laparotomy surgical procedure. Intraoperative findings included a distended small intestine and an obstructive ileal volvulus, and required an 8 cm segmental enterectomy and terminal ileostomy. Results: Postoperative recovery was slow but favourable, with a gradual digestive tolerance. Histopathological examination of the resected ileum revealed intestinal endometriosis characterized by a fibro-conjunctive reaction and nonspecific chronic active inflammation. Five months later, the patient underwent a successful reversal of the ileostomy with a mechanical lateral anastomosis of the cecum and ileum, resulting in a favourable postoperative course. Conclusions: This case underscores the importance of considering intestinal endometriosis in women presenting with unexplained gastrointestinal symptoms and highlights the need for timely surgical intervention and careful postoperative management. Further research is required to better understand the pathophysiology and optimal treatment strategies for intestinal endometriosis. Full article

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14 pages, 9838 KiB

Open AccessCase Report

Aesthetical and Functional Rehabilitation for an Ankylosed Maxillary Canine—A Case Report

by Tatiana Roman, Maxime Delarue, Matthieu Esquenet, Frédéric Rafflenbeul, Catherine Petit, Naji Kharouf and Olivier Etienne

Clin. Pract. 2024, 14(5), 2013-2026; https://doi.org/10.3390/clinpract14050159 - 27 Sep 2024

Abstract

Background: As the functional and aesthetical importance of the canine cannot be overstated, the management of a missing canine is challenging. This case report describes the treatment of an infra-occluded ankylosed maxillary canine in a patient with previously failed orthodontic treatment. Case description: [...] Read more.

Background: As the functional and aesthetical importance of the canine cannot be overstated, the management of a missing canine is challenging. This case report describes the treatment of an infra-occluded ankylosed maxillary canine in a patient with previously failed orthodontic treatment. Case description: A 20-year-old patient sought a second opinion for orthodontic treatment failure. The patient presented with an impacted, ankylosed, and severely infra-occluded right maxillary canine, as well as an iatrogenic clockwise cant of the maxillary occlusal plane and several root resorptions. The treatment corrected the cant of the occlusal plane while avoiding further root resorption, partially extracted the upper right canine, improved the quality and quantity of the soft tissue in the newly edentulous area, and provided a prosthetic rehabilitation using a lithium disilicate ceramic resin-bonded cantilever bridge. Conclusions: The use of a cantilevered bridge resulted in an aesthetically pleasing and minimally invasive rehabilitation. This technique is reversible, does not affect pulp vitality, and is a viable solution for rehabilitating the smiles of young patients. Clinical significance: The smile rehabilitation for an ankylosed maxillary canine, especially in the case of a previously failed orthodontic treatment, is an important clinical challenge. A minimally invasive long-term restoration with a cantilever bridge is a viable solution. Functional and aesthetically pleasant results can be achieved with a multidisciplinary approach. Full article

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

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16 pages, 1635 KiB

Open AccessSystematic Review

Current Evidence on and Clinical Implications of Vitamin D Levels in Pain and Functional Management of Knee Osteoarthritis: A Systematic Review

by Bianca Georgescu, Adelina Elena Cristea, Doinița Oprea, Andreea Alexandra Lupu, Liliana-Elena Stanciu, Erdin Borgazi, Bogdan Marian Caraban, Viorela Mihaela Ciortea, Laszlo Irsay and Mădălina Gabriela Iliescu

Clin. Pract. 2024, 14(5), 1997-2012; https://doi.org/10.3390/clinpract14050158 - 26 Sep 2024

Abstract

Background: Osteoarthritis is a common chronic disease that affects quality of life and increases public health costs. Knee osteoarthritis is a frequent form, marked by joint degeneration, pain, stiffness, and functional restrictions. Factors such as age, genetics, joint injuries, obesity, and vitamin D [...] Read more.

Background: Osteoarthritis is a common chronic disease that affects quality of life and increases public health costs. Knee osteoarthritis is a frequent form, marked by joint degeneration, pain, stiffness, and functional restrictions. Factors such as age, genetics, joint injuries, obesity, and vitamin D deficiency can affect knee osteoarthritis progression. While the exact link between vitamin D and osteoarthritis is still being studied, recent research indicates that low vitamin D levels might influence the articular cartilage’s structure and function, potentially accelerating osteoarthritis. This review aims to analyze the last decade of research on vitamin D’s role in osteoarthritis. Methods: A systematic review of the literature was conducted in accordance with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Relevant studies from the last ten years were included to evaluate the association between vitamin D levels and knee osteoarthritis. The inclusion criteria were studies examining the role of vitamin D in cartilage health and osteoarthritis progression and the potential clinical implications for disease management. Results: This review identified a variety of studies exploring the connection between vitamin D and osteoarthritis, with mixed findings. Conclusions: The relationship between vitamin D and knee osteoarthritis remains inconclusive, highlighting the need for further research. An updated evaluation of the literature is crucial for osteoarthritis management strategies and to potentially include vitamin D supplementation in therapeutic protocols. Full article

(This article belongs to the Special Issue Musculoskeletal Pain and Rehabilitation)

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27 pages, 3052 KiB

Open AccessSystematic Review

The Potential of Intra-Articular Therapies in Managing Knee Osteoarthritis: A Systematic Review

by Ciprian Vasile Pojala, Sebastian Toma, Cristea Costache, Tunde Peter, Cristiana Elena Pojala, Nadinne Alexandra Roman and Lorena Dima

Clin. Pract. 2024, 14(5), 1970-1996; https://doi.org/10.3390/clinpract14050157 - 25 Sep 2024

Abstract

Background: Knee osteoarthritis (KOA) is a common degenerative and progressive joint disorder that negatively influences patients’ quality of life. Intra-articular therapies, such as hyaluronic acid (HA) and platelet-rich plasma (PRP), have garnered attention for their potential to manage osteoarthritis OA symptoms effectively. This [...] Read more.

Background: Knee osteoarthritis (KOA) is a common degenerative and progressive joint disorder that negatively influences patients’ quality of life. Intra-articular therapies, such as hyaluronic acid (HA) and platelet-rich plasma (PRP), have garnered attention for their potential to manage osteoarthritis OA symptoms effectively. This systematic review aims to identify the effectiveness and safety of HA and PRP treatment modalities in treating KOA. Methods: A literature search was conducted across MEDLINE (PubMed), Web of Science Core Collection, and Science Direct Collection Elsevier. Twenty-three randomized controlled trials, cohort studies, and observational studies were included in the review. The selection criteria focused on studies published in English within the last 10 years, involving subjects with KOA treated with intra-articular injections of HA or PRP and reporting on pain, function, or overall treatment efficacy outcomes. Results: The analysis showed that both HA and PRP significantly improve functionality and reduce pain in KOA patients. High molecular weight HA consistently reduced pain and improved joint mobility in various studies. PRP had better long-term outcomes when combined with HA, leading to greater pain reduction and functional improvement. Both therapies had generally favorable safety profiles, with only minor adverse events reported. However, there were potential biases identified across the studies, such as selection, performance, detection, and reporting biases, which impacted the reliability of the results. Conclusions: Intra-articular treatments with HA and PRP show promise in managing knee osteoarthritis, with personalized treatment plans and further research needed to confirm these findings. Full article

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10 pages, 1013 KiB

Open AccessArticle

Management of Early Post-Transplant Hyperglycemia by Dedicated Endocrine Care Improves Glycemic Outcomes

by Alon Kaplan, Tslil Manela, Tammy Hod, Ronen Ghinea, Eytan Mor, Amit Tirosh, Amir Tirosh and Gadi Shlomai

Clin. Pract. 2024, 14(5), 1960-1969; https://doi.org/10.3390/clinpract14050156 - 25 Sep 2024

Abstract

Introduction: Early post-transplant hyperglycemia (EPTH) is an independent risk factor for hospital readmissions, acute rejection, infections and developing post-transplant diabetes mellitus (PTDM). Close glycemic control is prudent in the early post-transplant period. The management of EPTH was evaluated among a cohort of kidney [...] Read more.

Introduction: Early post-transplant hyperglycemia (EPTH) is an independent risk factor for hospital readmissions, acute rejection, infections and developing post-transplant diabetes mellitus (PTDM). Close glycemic control is prudent in the early post-transplant period. The management of EPTH was evaluated among a cohort of kidney transplant recipients, who either received routine care (RC) or dedicated endocrine care (DEC). Methods: A retrospective analysis was conducted on kidney transplant recipients from 2019 to 2023. The impact of DEC on post-transplant glycemic control was investigated. Hospitalized patients receiving post-transplant insulin therapy were included. DEC involved at least twice-daily blood glucose (BG) assessment by an endocrinologist, while the RC received usual care. A mixed-model analysis was employed to assess differences in BG trajectories between DEC and RC over an eight-day period. Additionally, various glycemic control metrics were compared, including glucose variability, time-in-range for target BG, rates of hypoglycemia and response to hyperglycemia. Results: The cohort comprised 113 patients. In the DEC group, 91% had pre-transplant DM compared to 15% in the RC group (p < 0.001). Patients under DEC had higher baseline BG and glycated hemoglobin compared to those under RC (p < 0.001, for both). The DEC group displayed a lower trajectory of BG over time compared to the RC group (p = 0.002). Patients under DEC were more likely to receive insulin if BG measured above 200 mg/dL (66% vs. 46%) and displayed less below-range BG (<110 mg/dL) compared to those under RC (12.9% vs. 23.6%, p < 0.001). Conclusions: Management of EPTH by DEC improves glycemic outcomes in renal transplant recipients. Full article

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7 pages, 1651 KiB

Open AccessCase Report

Acute Heart Failure in a Young Patient Treated in ICU—Diagnostic Pitfalls

by Łukasz Surówka, Paweł Andruszkiewicz, Monika Budnik, Robert Kowalik, Agnieszka Milner and Mateusz Zawadka

Clin. Pract. 2024, 14(5), 1953-1959; https://doi.org/10.3390/clinpract14050155 - 24 Sep 2024

Abstract

Background: Chlamydia pneumoniae and human herpesvirus 6 (HHV-6) are uncommon aetiological agents in respiratory tract infections and are rarely associated with cardiogenic shock. This case report presents a rare instance of severe cardiomyopathy linked to these infections in a 19-year-old Asian female. [...] Read more.

Background: Chlamydia pneumoniae and human herpesvirus 6 (HHV-6) are uncommon aetiological agents in respiratory tract infections and are rarely associated with cardiogenic shock. This case report presents a rare instance of severe cardiomyopathy linked to these infections in a 19-year-old Asian female. The case highlights the importance of considering a broad differential diagnosis in acute heart failure, especially in young adults. Case report: The patient was admitted with chest pain and diagnosed with ST-elevation myocardial infarction (STEMI) based on electrocardiography. She subsequently developed heart failure, with a marked reduction in myocardial contractility and a left ventricular ejection fraction (LVEF) of 20%. Treatment included broad-spectrum antibiotics and inotropic support guided by hemodynamic monitoring, leading to clinical improvement. The patient was discharged in a significantly improved condition following a stay in the intensive care unit (ICU). Conclusions: This case emphasizes the importance of considering Takotsubo syndrome in differential diagnoses, especially in ICU patients presenting with cardiogenic shock, to improve outcomes and reduce mortality through timely and appropriate management. Inotropic support, often used in the ICU to treat hypoperfusion, may worsen outcomes in patients with Takotsubo syndrome by exacerbating basal hypercontractility and prolonging the acute phase through catecholamine receptor activation. Full article

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13 pages, 1570 KiB

Open AccessArticle

Comparative Strength Study of Indirect Permanent Restorations: 3D-Printed, Milled, and Conventional Dental Composites

by João Paulo Mendes Tribst, Adelheid Veerman, Gabriel Kalil Rocha Pereira, Cornelis Johannes Kleverlaan and Amanda Maria de Oliveira Dal Piva

Clin. Pract. 2024, 14(5), 1940-1952; https://doi.org/10.3390/clinpract14050154 - 20 Sep 2024

Abstract

Background/Objectives: Limited research has been performed to assess the strength of resin-bonded 3D-printed restorations. Based on that, this study investigates the impact of different manufacturing methods on the fracture load of indirect composite restorations (ICRs) following an aging process. Methods: Three [...] Read more.

Background/Objectives: Limited research has been performed to assess the strength of resin-bonded 3D-printed restorations. Based on that, this study investigates the impact of different manufacturing methods on the fracture load of indirect composite restorations (ICRs) following an aging process. Methods: Three manufacturing techniques—conventional (CRC), milled (MRC), and printed (PRC)—were evaluated using 60 specimens, each with a diameter of 10 mm and a thickness of 1.0 mm. Sandblasting with Al₂O₃ particles was employed to optimize the bonding process, significantly influencing surface roughness parameters (Ra, Rz, RSm). All specimens were bonded to the dentin analog using composite resin cement and subjected to either 10,000 thermocycles (TC) or storage (ST) at 37 °C in distilled water. Fracture load assessments were performed using a universal testing machine. A finite element analysis was conducted to assess stress distribution. Results: Two-way ANOVA results indicated that the manufacturing method significantly affected mean fracture load values (p < 0.001), with PRC showing the highest mean fracture load (4185 ± 914 N), followed by MRC (2495 ± 941 N) and CRC (599 ± 292 N). The aging protocol did not have a significant impact on fracture load. Conclusions: This study revealed that 3D-printed resin composite exhibited comparable strength to milled resin composite when adhesively cemented, suggesting it is a promising option for indirect composite restorations based on its mechanical performance. However, further research is needed to evaluate its bond strength and optimal surface treatment methods to prevent early debonding. Full article

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

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9 pages, 15974 KiB

Open AccessCase Report

Guided Biofilm Therapy for Management of “Desquamative Gingivitis”—Clinical Cases

by Blagovesta Yaneva, Maria Mutafchieva, Petar Shentov and Georgi Tomov

Clin. Pract. 2024, 14(5), 1931-1939; https://doi.org/10.3390/clinpract14050153 - 20 Sep 2024

Abstract

Background: Desquamative gingivitis is a clinical manifestation often associated with various mucocutaneous disorders, characterized by red, painful, and friable gingiva. It is predominantly seen in middle-aged to elderly females and is typically linked to autoimmune conditions such as lichen planus, pemphigoid, and pemphigus, [...] Read more.

Background: Desquamative gingivitis is a clinical manifestation often associated with various mucocutaneous disorders, characterized by red, painful, and friable gingiva. It is predominantly seen in middle-aged to elderly females and is typically linked to autoimmune conditions such as lichen planus, pemphigoid, and pemphigus, among others. Due to the chronic pain and difficulty in maintaining personal oral hygiene, professional care becomes crucial. Methods: This article explores the application of guided biofilm therapy as a novel, gentle approach for managing desquamative gingivitis, focusing on three clinical cases. This therapy employs erythritol-based powders for biofilm removal, offering a less abrasive and more comfortable alternative to traditional mechanical plaque removal techniques. Results: The cases demonstrate the effectiveness of guided biofilm therapy in reducing discomfort and improving clinical outcomes in desquamative gingivitis patients, particularly those suffering from mucous membrane pemphigoid, pemphigus vulgaris, and oral lichen planus. Conclusions: The guided biofilm approach underscores the importance of tailored periodontal therapy in managing nonplaque-induced gingival lesions, improving patient compliance and oral health outcomes. Full article

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

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10 pages, 221 KiB

Open AccessArticle

Urinary Incontinence and Quality of Life in Women of Central Jordan: A Cross-Sectional Study

by Rana Abu-Huwaij, Rolla Al-Shalabi, Enas Alkhader and Farah N. Almasri

Clin. Pract. 2024, 14(5), 1921-1930; https://doi.org/10.3390/clinpract14050152 - 20 Sep 2024

Abstract

Background: Considering the high prevalence of UI in the rural areas of Jordan and the limited clinical data on its occurrence in central Jordan, this study aims to investigate the prevalence, risk factors, and impact of urinary incontinence (UI) on the quality of [...] Read more.

Background: Considering the high prevalence of UI in the rural areas of Jordan and the limited clinical data on its occurrence in central Jordan, this study aims to investigate the prevalence, risk factors, and impact of urinary incontinence (UI) on the quality of life (QoL) of women in central Jordan. Method: This cross-sectional study was conducted from September to December 2022, using online the Incontinence Impact Questionnaire short form (IIQ-7) and Urogenital Distress Inventory short form (UDI-6). Participation was voluntary, and anonymous. Internal consistency was assessed using Cronbach’s α. Results: A total of 128 women participated in the study. More than half of the participants (54.33%, N = 69) experienced UI symptoms. Body mass index was the sole statistically significant factor linked to UI. Obese patients had the highest risk (OR 35, CI 95% 2.577–475.308, p < 0.05) compared to those with a healthy weight. Multivariate regression indicated significant associations of severe UI with smoking and vaginal births with a moderate impact of UI on QoL. Conclusions: The study’s findings emphasize the need for women’s health centers in the center of Jordan to develop comprehensive UI prevention and management programs to improve women’s health and well-being. Full article

(This article belongs to the Special Issue 2024 Feature Papers in Clinics and Practice)

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Graphical abstract

10 pages, 1172 KiB

Open AccessReview

Practice-Based Management Data of Consecutive Subjects Assessed for the Median Arcuate Ligament Syndrome at a Single Tertiary Institution

by Stephanie Zbinden, Gabor Forgo, Nils Kucher and Stefano Barco

Clin. Pract. 2024, 14(5), 1911-1920; https://doi.org/10.3390/clinpract14050151 - 18 Sep 2024

Abstract

Background: The pathophysiology of median arcuate ligament syndrome (MALS) is poorly understood. The diagnostic process remains inadequately standardized, with an absence of precise criteria to guide therapeutic management. Methods: We studied consecutive subjects referred to the Department of Angiology at the University Hospital [...] Read more.

Background: The pathophysiology of median arcuate ligament syndrome (MALS) is poorly understood. The diagnostic process remains inadequately standardized, with an absence of precise criteria to guide therapeutic management. Methods: We studied consecutive subjects referred to the Department of Angiology at the University Hospital of Zurich over the past 17 years due to suspected MALS. We focused on (1) the imaging criteria that led to diagnosis, notably the results of color duplex ultrasound and the consistency with different imaging tests; (2) the clinical consequences focusing on symptom resolution. Results: We included 33 subjects; in 8 subjects (24.2%), the diagnosis of MALS was retained. The median expiration peak systolic velocity (PSV) on ultrasound was 3.05 (Q1; 2.1–Q3; 3.3). To confirm the sonographic results, either a CT or MRI was performed on all patients, with consistent findings confirming a significant stenosis. Seven patients underwent surgery, all involving arcuate ligament release. Four procedures were laparoscopic, one was via laparotomy, and two were robot-assisted. Additionally, two patients required angioplasty with stenting as a secondary intervention. Only two (28.6%) of the seven operated patients experienced a relief of symptoms. None experienced a relief of symptoms following secondary angioplasty, despite stent patency. The prevalence of psychiatric disorders was comparable between patients with retained and rejected diagnoses, 38% and 36%, respectively. Conclusions: Our study confirmed sonography and CT/MRI consistency. However, most patients with MALS did not benefit from invasive treatment. The majority (83%) of patients without MALS were diagnosed with alternative conditions, mainly functional disorders. Full article

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13 pages, 287 KiB

Open AccessArticle

Musculoskeletal Disorders in the Clinical Practice of Dental Hygienists and Dentists, Prevention and Awareness among Italian Professionals: Focus on Enlarging Systems

by Andrea Butera, Carolina Maiorani, Giulia Fantozzi, Francesca Bergamante, Matteo Castaldi, Roberta Grassi, Cinzia Leuter, Andrea Scribante and Gianna Maria Nardi

Clin. Pract. 2024, 14(5), 1898-1910; https://doi.org/10.3390/clinpract14050150 - 12 Sep 2024

Abstract

(1) Background: Musculoskeletal disorders of the upper limbs are a common medical condition among dental hygienists and dentists, making them a common occupational risk for dental professionals. The purpose of the work was to collect information about the dental professions and their habits [...] Read more.

(1) Background: Musculoskeletal disorders of the upper limbs are a common medical condition among dental hygienists and dentists, making them a common occupational risk for dental professionals. The purpose of the work was to collect information about the dental professions and their habits to highlight what can be good practices to be carried out to prevent any musculoskeletal disorders. (2) Methods: To identify habits and problems inherent in the professional activity of dental hygienists and dentists, a questionnaire was formulated on the use of enlarging systems. (3) Results: The questionnaire was completed by 241 dental professionals. As for the use of magnifiers, 72.6% of participants use them: among dental hygienists, 67.8% use magnifiers, among dentists, 80.9% use magnifiers; there is a statistically significant difference. There is no statistically significant difference between professions regarding muscle disorders. (4) Conclusions: For a clearer assessment, it would be appropriate to submit the questionnaire to a wider sample of professionals, to define better the correlation between musculoskeletal disorders, work activity and the type of enlarging systems used. Full article

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

12 pages, 1131 KiB

Open AccessArticle

Characteristics, Management, and Outcomes of Acute Life-Threatening Asthma in Adult Intensive Care

by Adam J. R. Watson, Thomas Roe, Oliver Arscott, Charlotte Thomas, James Ward, Ryan Beecham, David Browning, Kordo Saeed and Ahilanandan Dushianthan

Clin. Pract. 2024, 14(5), 1886-1897; https://doi.org/10.3390/clinpract14050149 - 12 Sep 2024

Abstract

Background: There is limited evidence regarding the management of acute life-threatening asthma in intensive care units (ICUs), and few guidelines have details on this. We aimed to describe the characteristics, management, and outcomes of adults with life-threatening asthma requiring ICU admission. Methods: In [...] Read more.

Background: There is limited evidence regarding the management of acute life-threatening asthma in intensive care units (ICUs), and few guidelines have details on this. We aimed to describe the characteristics, management, and outcomes of adults with life-threatening asthma requiring ICU admission. Methods: In this single-centre retrospective observational study, we included consecutive adults with acute asthma requiring ICU admission between 1 January 2016 and 31 December 2023. Our primary outcome was requirement for invasive mechanical ventilation (IMV). Results: We included 100 patients (median age 42.5 years, 67% female). The median pH, PaCO₂, and white cell count (WCC) on ICU admission were 7.37, 39 mmHg, and 13.6 × 109/L. There were 30 patients (30%) who required IMV, and the best predictors of IMV requirement were pH (AUC 0.772) and PaCO₂ (AUC 0.809). In univariate analysis, IMV requirement was associated with both increasing WCC (OR 1.14) and proven bacterial infection (OR 8.50). A variety of respiratory support strategies were utilised, with 38 patients (38%) receiving only non-invasive respiratory support. Conclusions: Our data highlight key characteristics which may be risk factors for acute asthma requiring ICU admission and suggest that pH, PaCO₂, and WCC are prognostic markers for disease severity. Our overall outcomes were good, with an IMV requirement of 30% and a 28-day mortality of 1%. Full article

(This article belongs to the Special Issue 2024 Feature Papers in Clinics and Practice)

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17 pages, 282 KiB

Open AccessReview

Thoracic Trauma: Current Approach in Emergency Medicine

by Giorgia Caputo, Stefano Meda, Andrea Piccioni, Angela Saviano, Veronica Ojetti, Gabriele Savioli, Gaia Bavestrello Piccini, Chiara Ferrari, Antonio Voza, Lavinia Pellegrini, Miriam Ottaviani, Federica Spadazzi, Gianpietro Volonnino and Raffaele La Russa

Clin. Pract. 2024, 14(5), 1869-1885; https://doi.org/10.3390/clinpract14050148 - 10 Sep 2024

Abstract

Chest trauma is the leading cause of death in people under 40. It is estimated to cause around 140,000 deaths each year. The key aims are to reduce mortality and the impact of associated complications to expedite recovery and to restore patient’s conditions. [...] Read more.

Chest trauma is the leading cause of death in people under 40. It is estimated to cause around 140,000 deaths each year. The key aims are to reduce mortality and the impact of associated complications to expedite recovery and to restore patient’s conditions. The recognition of lesions through appropriate imaging and early treatment already in the emergency department are fundamental. The majority can be managed in a non-surgical way, but especially after traumatic cardiac arrest, a surgical approach is required. One of the most important surgical procedures is the Emergency Department Thoracotomy (EDT). The aim of this review is to provide a comprehensive synthesis about the management of thoracic trauma, the surgical procedures, accepted indications, and technical details adopted during the most important surgical procedures for different thoracic trauma injuries. Literature from 1990 to 2023 was retrieved from multiple databases and reviewed. It is also important to emphasize the medico-legal implications of this type of trauma, both from the point of view of collaboration with the judicial authority and in the prevention of any litigation. Full article

27 pages, 639 KiB

Open AccessSystematic Review

Comparing the Effectiveness of Open and Minimally Invasive Approaches in Coronary Artery Bypass Grafting: A Systematic Review

by Arwa Alsharif, Abdulaziz Alsharif, Ghadah Alshamrani, Abdulhameed Abu Alsoud, Rowaida Abdullah, Sarah Aljohani, Hawazen Alahmadi, Samratul Fuadah, Atheer Mohammed and Fatma E. Hassan

Clin. Pract. 2024, 14(5), 1842-1868; https://doi.org/10.3390/clinpract14050147 - 10 Sep 2024

Abstract

Coronary artery bypass grafting (CABG) is an essential operation for patients who have severe coronary artery disease (CAD). Both open and minimally invasive CABG methods are used to treat CAD. This in-depth review looks at the latest research on the effectiveness of open [...] Read more.

Coronary artery bypass grafting (CABG) is an essential operation for patients who have severe coronary artery disease (CAD). Both open and minimally invasive CABG methods are used to treat CAD. This in-depth review looks at the latest research on the effectiveness of open versus minimally invasive CABG. The goal is to develop evidence-based guidelines that will improve surgical outcomes. This systematic review used databases such as PubMed, MEDLINE, and Web of Science for a full electronic search. We adhered to the PRISMA guidelines and registered the results in the PROSPERO. The search method used MeSH phrases and many different study types to find papers. After removing duplicate publications and conducting a screening process, we collaboratively evaluated the full texts to determine their inclusion. We then extracted data, including diagnosis, the total number of patients in the study, clinical recommendations from the studies, surgical complications, angina recurrence, hospital stay duration, and mortality rates. Many studies that investigate open and minimally invasive CABG methods have shown that the type of surgery can have a large effect on how well the patient recovers and how well the surgery works overall. While there are limited data on the possible advantages of minimally invasive CABG, a conclusive comparison with open CABG is still dubious. Additional clinical trials are required to examine a wider spectrum of patient results. Full article

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15 pages, 982 KiB

Open AccessArticle

Comparative Perceptions of Fluoride Toxicity in Oral Hygiene Products: Insights from the General Population and Healthcare Professionals

by Marija Badrov, Lidia Gavic, Ana Seselja Perisin, Davor Zeljezic, Jasen Vladislavic, Ema Puizina Mladinic and Antonija Tadin

Clin. Pract. 2024, 14(5), 1827-1841; https://doi.org/10.3390/clinpract14050146 - 5 Sep 2024

Abstract

Background: The safety of oral hygiene products is a growing concern, particularly regarding the toxicity of specific ingredients used in their formulations. The purpose of this study was to evaluate the knowledge and attitudes of dentists, physicians, pharmacists, and the general public regarding [...] Read more.

Background: The safety of oral hygiene products is a growing concern, particularly regarding the toxicity of specific ingredients used in their formulations. The purpose of this study was to evaluate the knowledge and attitudes of dentists, physicians, pharmacists, and the general public regarding ingredients in oral hygiene products, especially fluoride. Additionally, this study aimed to identify which ingredients may exhibit potential toxicity based on historical records of any adverse effects being induced by a material/component. Methods: A self-administered questionnaire was used in an online cross-sectional observational study to collect data on sociodemographic characteristics, knowledge of fluoride in dental medicine, fluoride usage practices in oral hygiene products, opinions on ingredient toxicity in oral hygiene products, and personal experiences of adverse reactions to products and their components. The collected data underwent descriptive and regression analyses to reveal patterns and relationships within the dataset. Results: The study found a moderate overall knowledge level regarding fluoride usage in dentistry among participants (Md = 5.00, IQR 2.50–7.00). Healthcare professionals exhibited significantly higher knowledge scores compared to the general population (p ≤ 0.001), with dental professionals displaying the highest scores. Regarding concerns about the usage of fluoride, the majority of respondents (77.0%) did not express any concerns. Minor concerns included the risk of ingestion (6.0%) and dental fluorosis (4.6%). Among the other ingredients in oral hygiene products, respondents named alcohol as the most toxic ingredient (70.3%), followed by artificial colors (53.1%), artificial sweeteners (50.4%), and parabens (50.1%). It is noteworthy that the majority of participants (61.6%) stated that they had never experienced any side effects associated with the use of oral hygiene products. Conclusion: This study underscores disparities in fluoride knowledge between healthcare professionals and the general population in Croatia, with dental experts exhibiting a superior understanding. Despite lingering misconceptions about fluoride content and potential toxicity, the majority of participants acknowledge its oral health benefits and use fluoride products regularly. Full article

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9 pages, 2967 KiB

Open AccessReview

Electric Scooter Falls: The 2023–2024 Experience in the Clinical Emergency Children’s Hospital in Galați

by Cristina-Mihaela Popescu, Virginia Marina, Floriana Popescu and Andreea Oprea

Clin. Pract. 2024, 14(5), 1818-1826; https://doi.org/10.3390/clinpract14050145 - 4 Sep 2024

Abstract

(1) Introduction: Since electric scooters were launched in 2017, they have become increasingly popular worldwide and a cause of childhood trauma. (2) Case reports: This paper has a double-fold purpose: it reports two cases of epidural hematomas and compares them with electric scooter-related [...] Read more.

(1) Introduction: Since electric scooters were launched in 2017, they have become increasingly popular worldwide and a cause of childhood trauma. (2) Case reports: This paper has a double-fold purpose: it reports two cases of epidural hematomas and compares them with electric scooter-related head trauma in the literature. An overview of the literature on this topic was performed to make such a comparison. Our cases are one of almost 52 cm³ and one of 129 cm^3, both in two eight-year-olds. (3) Discussion: Although usually mild, traumatic brain injuries following e-scooter falls can also be moderate and severe. Reduced helmet use, high speed, and a lack of experience are the perfect set-up for potential severe injuries. Intracranial bleeds are not frequent, and epidural hematomas are rare in such cases, but they can significantly impact the individual, community, and healthcare system. No other medium- or large-sized epidural hematomas were reported in children sustaining electric scooter-related head trauma. (4) Conclusions: Our review parallels the literature and our hospital’s experience. Although there are both similarities and discrepancies between our cases and the literature, mild trauma should not be disregarded, for it may hide serious complications requiring immediate surgery. Full article

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17 pages, 1295 KiB

Open AccessArticle

Is It Possible to Prevent the Thanatogenetic Processes in Premature Babies?

by Sinziana Andra Ghitoi, Mariana Deacu, Mariana Aschie, Manuela Enciu, Anca Florentina Mitroi, Georgeta Camelia Cozaru, Antonela Anca Nicolau, Cristian Ionut Orasanu, Oana Andreea Ursica and Raluca Ioana Voda

Clin. Pract. 2024, 14(5), 1801-1817; https://doi.org/10.3390/clinpract14050144 - 2 Sep 2024

Abstract

Preterm births comprise all pregnancies coming to an end before the gestational age of 37 weeks and remain the leading cause of death in children under 5 years old despite efforts to reduce their occurrence. We aim to analyze all morbidity and mortality [...] Read more.

Preterm births comprise all pregnancies coming to an end before the gestational age of 37 weeks and remain the leading cause of death in children under 5 years old despite efforts to reduce their occurrence. We aim to analyze all morbidity and mortality data to understand causes and risk factors, helping in prevention efforts. This study includes 140 cases collected during 2018–2022. Demographic, maternal, and thanatogenetic data were statistically analyzed. We observed an upward slope of stillborn babies. In the case of live-born premature, the average survival was 301.76 h. The multivariate analysis noted that extremely low birth weight (HR = 5.141) and very low birth weight (HR = 4.177) are risk factors involved in mortality. Increased parity was associated with premature births with low and very low birth weight (p = 0.019). We observed that a mother’s age of over 30 years is predictable for the development of pregnancy-induced hypertension. Cerebral and pulmonary hemorrhages were the most common intermediate morbid conditions, with prematurity and plurivisceral hemorrhages serving as their root causes. We have identified that anthropometric measurements have a high predictability on malformed babies. The identified associations indicate a shared mechanism for certain lesion processes, which can help optimize resources for predicting and preventing preterm neonatal issues. Full article

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