Clinics and Practice

23 pages, 1422 KB

Open AccessEditor’s ChoiceReview

Serotonin–Norepinephrine Reuptake Inhibitors in Fibromyalgia Management: An Integrative Literature Review of Clinical Evidence

by Isabella Oliveira do Lago, Bruna Moura Medina Diniz, Daniela Vieira Buchaim and Rogerio Leone Buchaim

Clin. Pract. 2026, 16(4), 68; https://doi.org/10.3390/clinpract16040068 - 28 Mar 2026

Cited by 1 | Viewed by 1368

Abstract

Fibromyalgia (FM) is a chronic pain syndrome characterized by central sensitization and impaired pain modulation, involving dysfunctional descending inhibitory pathways and altered nociceptive processing. These processes contribute to persistent musculoskeletal pain, difficulties with sleep, feelings of depression, and ongoing fatigue. Serotonin and norepinephrine [...] Read more.

Fibromyalgia (FM) is a chronic pain syndrome characterized by central sensitization and impaired pain modulation, involving dysfunctional descending inhibitory pathways and altered nociceptive processing. These processes contribute to persistent musculoskeletal pain, difficulties with sleep, feelings of depression, and ongoing fatigue. Serotonin and norepinephrine are key mediators of pain control, and evidence indicates that dual reuptake inhibition provides superior analgesia compared to single-pathway approaches. Accordingly, serotonin–norepinephrine reuptake inhibitors (SNRIs), including milnacipran and duloxetine, approved for FM treatment, show favorable efficacy and tolerability compared with tricyclic antidepressants. This integrative literature review aimed to evaluate the impact of SNRIs on musculoskeletal pain, fatigue, depression, and quality of life in patients with FM by analyzing randomized clinical trials (RCTs), identified via PubMed/MEDLINE searches (2015–2025) in English/Portuguese using descriptors: “Fibromyalgia”, “Serotonin and Norepinephrine Reuptake Inhibitors”, “Duloxetine” and “Milnacipran”. From 195 records screened, 18 studies met inclusion criteria (9.2% inclusion rate); duloxetine evaluated in 16 studies (88.9%), milnacipran in 2 (11.1%); SNRIs demonstrated superior efficacy vs. placebo: pain reduction 30–40%, fatigue improvement 25%, quality of life enhancement 20%. SNRIs were overall more effective than placebo but did not achieve high levels of analgesia, underscoring the need for further research on long-term efficacy and comparisons with combination pharmacological and non-pharmacological therapies. SNRIs significantly alleviate musculoskeletal pain (30–50% of patients), fatigue, depression symptoms, and improve quality of life in FM versus placebo. Duloxetine showed superior efficacy for pain/depression; milnacipran excelled in sleep quality. Long-term studies and combination therapies warrant further investigation. Full article

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20 pages, 2455 KB

Open AccessEditor’s ChoiceArticle

Pre-Injury Adversity, Functional Recovery, and Salivary microRNA Changes After a Dual-Task Exercise in Asians and Pacific Islanders with Mild Traumatic Brain Injury: A Feasibility Study

by Hyunhwa Lee, Haehyun Lee, Jinyoung Park and Jessica Gill

Clin. Pract. 2026, 16(4), 65; https://doi.org/10.3390/clinpract16040065 - 25 Mar 2026

Viewed by 408

Abstract

Background: Mild traumatic brain injury (mTBI) is frequently associated with persistent cognitive and psychosocial symptoms, yet biological correlates of recovery remain poorly understood, particularly among Asian and Pacific Islander (API) populations. Pre-injury psychosocial adversity may further shape post-injury recovery trajectories. This pilot study [...] Read more.

Background: Mild traumatic brain injury (mTBI) is frequently associated with persistent cognitive and psychosocial symptoms, yet biological correlates of recovery remain poorly understood, particularly among Asian and Pacific Islander (API) populations. Pre-injury psychosocial adversity may further shape post-injury recovery trajectories. This pilot study examined associations between participation in a 2-week, home-based, dual-task cognitive–walking intervention (Daily Brain Exercise; DBE) and changes in cognitive, psychological, and salivary microRNA (miRNAs) measures among APIs with and without a self-reported history of mTBI. Methods: API participants completed remote cognitive testing (CNS Vital Signs), psychosocial assessments (Neuro-QoL), and saliva collection before and after DBE participation. Salivary RNA was purified, and miRNA expression was profiled using nCounter^® Human v3 miRNA Expression Panels (NanoString). Differential expression analyses were conducted using ROSALIND^® platform (OnRamp Bioinformatics, San Diego, CA, USA), a cloud-based bioinformatics analysis system, to calculate fold changes and p-values. Pre-injury psychosocial adversity was assessed via the Trauma History Screen and examined descriptively as a contextual modifier of functional outcomes. Results: Twenty-one APIs (mean age 22.9 years; 76.7% female) were enrolled, including 14 individuals with a self-reported history of mTBI (mean 4.64 years post-injury; 50% with multiple injuries). Following DBE participation, increases in cognitive flexibility and executive function scores were observed in both mTBI and control groups. Additional increases in psychomotor speed, processing speed, sleep disturbance, and depressive symptoms were observed descriptively within the mTBI group. Subgroup analyses suggested variability in pre–post patterns across combinations of mTBI history and pre-injury psychosocial adversity. Exploratory miRNA analyses identified seven miRNAs that were differentially expressed in the mTBI group following DBE (unadjusted p < 0.005), including hsa-miR-7-5p, previously reported in association with neurodevelopmental and neurological pathways. Conclusions: In this pilot, feasibility-focused study, participation in a brief, home-based, dual-task intervention was associated with descriptive changes in selected cognitive and psychosocial measures among APIs, particularly those with a history of mTBI and pre-injury adversity. The observed subgroup patterns warrant confirmation in adequately powered, controlled studies. Exploratory changes in salivary miRNAs co-occurred with functional improvements, thus generating a hypothesis for a future investigation. Full article

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23 pages, 2513 KB

Open AccessEditor’s ChoiceReview

Triple Latency as a Driver of Chronic Inflammation: An Integrative View of HSV, EBV, and CMV Persistence in Immunocompetent Hosts

by Maria E. Ramos-Nino

Clin. Pract. 2026, 16(4), 64; https://doi.org/10.3390/clinpract16040064 - 24 Mar 2026

Viewed by 710

Abstract

Background: Herpes simplex virus (HSV), Epstein–Barr virus (EBV), and cytomegalovirus (CMV) establish lifelong latency in sensory neurons, lymphoid tissue, and myeloid–endothelial cells, respectively. A substantial proportion of adults worldwide are infected with all three viruses and may experience concurrent herpesvirus latency, yet they [...] Read more.

Background: Herpes simplex virus (HSV), Epstein–Barr virus (EBV), and cytomegalovirus (CMV) establish lifelong latency in sensory neurons, lymphoid tissue, and myeloid–endothelial cells, respectively. A substantial proportion of adults worldwide are infected with all three viruses and may experience concurrent herpesvirus latency, yet they have largely been studied independently. This review examined whether latent and intermittently reactivating herpesviruses share overlapping inflammatory signatures and whether their combined presence contributes to chronic inflammatory burden. Methods: A narrative integrative review was conducted using MEDLINE, Embase, and Google Scholar (inception–October 2025). Evidence from thirty-one cohort studies and mechanistic investigations spanning virology, immunology, neurology, and clinical medicine was synthesized. Results: Herpesvirus reactivation rates ranged from 23% in general Intensive Care Unit (ICU) populations to 85% in severe COVID-19. Concurrent reactivation of multiple viruses occurred in 34–63% of critically ill patients and was associated with worse clinical outcomes. Notably, simultaneous CMV and EBV reactivation independently predicted mortality (adjusted hazard ratio, 3.17; 95% CI, 1.41–7.13). Across infections, overlapping inflammatory biomarkers, including IL-6, TNF-α, CRP, and PGE₂, were consistently elevated, reflecting convergent activation of IFN and NF-κB signaling pathways. Mechanistic studies suggest cross-compartment immune priming, where CMV-driven T-cell exhaustion facilitates EBV reactivation, and viral cytokine signaling enhances HSV-associated neuroinflammation. Conclusions: HSV, EBV, and CMV triple latency may represent an underrecognized contributor to chronic inflammation in immunocompetent hosts. Understanding this multi-virus inflammatory network may inform mechanistic research, biomarker-guided risk stratification, and therapeutic strategies targeting convergent inflammatory pathways. Prospective interventional studies incorporating concurrent multi-virus monitoring are needed to clarify causal relationships. Full article

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21 pages, 1501 KB

Open AccessEditor’s ChoiceReview

Case-Based Perspectives on the Management of Genitourinary Syndrome of Menopause

by Jissy Cyriac and Richa Sood

Clin. Pract. 2026, 16(3), 60; https://doi.org/10.3390/clinpract16030060 - 12 Mar 2026

Viewed by 1626

Abstract

Background and Objectives: Genitourinary syndrome of menopause (GSM), previously known as vulvovaginal atrophy, is a chronic, progressive hypoestrogenic condition affecting vulvovaginal, urinary and sexual health in women. Common symptoms include vaginal dryness, itching, dyspareunia, urinary urgency and recurrent urinary tract infections (UTIs). Despite [...] Read more.

Background and Objectives: Genitourinary syndrome of menopause (GSM), previously known as vulvovaginal atrophy, is a chronic, progressive hypoestrogenic condition affecting vulvovaginal, urinary and sexual health in women. Common symptoms include vaginal dryness, itching, dyspareunia, urinary urgency and recurrent urinary tract infections (UTIs). Despite the high prevalence, GSM is underdiagnosed and undertreated, thereby negatively impacting women’s quality of life. To illustrate the practical aspects of GSM diagnosis and provide evidence-based management, we present a case-based narrative review synthesizing recently published, high-quality evidence. Materials and Methods: Evidence was drawn from multiple sources through targeted searches of databases, and included the 2025 AUA/SUFU/AUGS guideline (AUA), the 2024 NICE network meta-analyses (NICE), a 2025 systematic review/meta-analysis in breast-cancer survivors, the 2020 Menopause Society GSM Position Statement, the 2018 NAMS/ISSWSH breast cancer consensus, several primary source citations and other high quality peer-reviewed publications. Results: Five illustrative composite case vignettes of GSM are presented to highlight the evaluation strategy and evidence-supported treatment choices. Nonhormonal options are the first line treatments for mild GSM symptoms, either with or without the addition of vaginal estrogen therapy. For moderate to severe GSM, low-dose vaginal estrogen, vaginal DHEA, and ospemifene are all effective FDA-approved options. In breast cancer survivors, individualized decisions with oncology input are warranted. Maximal caution and a shared decision-making approach is required for women using Aromatase Inhibitors (AIs) for breast cancer risk reduction when choosing treatments for GSM. Conclusions: Treating GSM improves vaginal, sexual and urinary outcomes and quality of life of women. Clinicians need to proactively screen for GSM and offer evidence-based treatment options. The treatment decisions in breast cancer survivors are nuanced, requiring a shared-decision approach. Full article

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19 pages, 1774 KB

Open AccessEditor’s ChoiceSystematic Review

Assessment of Cognitive Emotion Regulation in Gambling Disorder: A Systematic Review of the Literature

by Ioana Ioniță, Mădălina Iuliana Mușat, Bogdan Cătălin and Adela Magdalena Ciobanu

Clin. Pract. 2026, 16(3), 56; https://doi.org/10.3390/clinpract16030056 - 5 Mar 2026

Viewed by 738

Abstract

Background/Objectives: Gambling disorder (GD) is a behavioral addiction characterized by persistent and repetitive gambling behaviors that cause significant psychological distress and functional impairment. Increasing evidence indicates that difficulties in emotion regulation are a key factor in the development and persistence of GD. This [...] Read more.

Background/Objectives: Gambling disorder (GD) is a behavioral addiction characterized by persistent and repetitive gambling behaviors that cause significant psychological distress and functional impairment. Increasing evidence indicates that difficulties in emotion regulation are a key factor in the development and persistence of GD. This systematic review aimed to summarize and critically evaluate the existing literature on the relationship between emotion regulation strategies and gambling disorder, with a specific focus on studies using the Emotion Regulation Questionnaire (ERQ) and the Cognitive Emotion Regulation Questionnaire (CERQ). Methods: The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Systematic searches were performed in PubMed and Scopus databases for studies published between 25 October 2015 and 25 October 2025. The methodological quality and risk of bias of the included studies were evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist and JBI Checklist for Randomized Controlled Trials. Data extraction and synthesis were performed manually by two independent reviewers. Eligible studies included adult participants (≥18 years) diagnosed with gambling disorder or pathological gambling and using the ERQ or CERQ to assess emotion regulation. Results: Nine studies met the inclusion criteria, comprising a total of 607 patients with GD. Across studies, individuals with GD consistently showed reduced cognitive reappraisal, greater expressive suppression, and higher use of maladaptive cognitive strategies such as rumination, catastrophizing, and self-blame. All studies identified impulsivity, emotion dysregulation, alexithymia, or gambling-related cognitive distortions as significant predictors of gambling severity. Neuroimaging evidence from one study further revealed altered activation of frontal regions during negative emotion regulation. Conclusions: This review highlights the central role of emotion regulation in GD. However, the limited available ERQ/CERQ studies in GD were mostly cross-sectional, limiting causal inferences. Second, samples were predominantly male, reducing generalizability to women. Finally, only one study used neurobiological measures, hindering integration of self-report and neural data. These findings emphasize the importance of integrating emotion regulation-based interventions within therapeutic programs for gambling disorder, with ERQ and CERQ being useful tools to assess the pathology. Full article

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18 pages, 405 KB

Open AccessEditor’s ChoiceArticle

Factors Associated with Quality of Life Among Patients with Cardiac Pacemakers Assessed by Two Scales

by Eirini Stavrou, Georgios Vasilopoulos, Dionyssios Leftheriotis, Panagiota Flevari and Maria Polikandrioti

Clin. Pract. 2026, 16(3), 53; https://doi.org/10.3390/clinpract16030053 - 28 Feb 2026

Viewed by 574

Abstract

Background/Objectives: Permanent cardiac pacemakers (PPMs) are small electronic implanted devices that regulate cardiac rhythm. Measurement of quality of life (QoL) serves as a powerful tool for gaining in-depth insights into pacing therapy and ultimately guiding patient-centered management strategies. The aim of the [...] Read more.

Background/Objectives: Permanent cardiac pacemakers (PPMs) are small electronic implanted devices that regulate cardiac rhythm. Measurement of quality of life (QoL) serves as a powerful tool for gaining in-depth insights into pacing therapy and ultimately guiding patient-centered management strategies. The aim of the present study was to evaluate factors affecting QoL among PPM patients by applying the two generic questionnaires: SF-36 and EQ-5D-5L. Materials and Methods: A total of 120 patients with PPM were enrolled. QoL data were collected through interviews using the 36-Item Short Form Health Survey (SF-36) and the Euro QoL 5-Dimensions 5-Levels Health Questionnaire (EQ-5D-5L). Patients’ characteristics were also recorded. Results: The majority of participants were male (54.2%), retired (83.3%) residents in urban areas (75.5%), had a DDD pacemaker (82.5%), had rate response programmed on (77.5%), and had comorbidities (83.3%). Regarding QoL measured by SF-36, the Physical Component Summary Score (PCS) was significantly associated with programming rate response in their pacemaker (p = 0.046), comorbidities (p = 0.047), and the NYHA functional class (p = 0.047). The Mental Component Summary Score (MCS) was significantly associated with sex (p = 0.034), place of residence (p = 0.003), NYHA functional class (p = 0.001), and patients’ level of information about the device (p = 0.039). Patients’ QoL, as measured by the EQ-5D-5L, was significantly associated with sex (p = 0.001), age (p = 0.019), occupation (p = 0.040), pacing mode (p = 0.034), comorbidities (p = 0.019), NYHA functional class (p = 0.047), and level of information about the device (p = 0.005). Conclusions: NYHA functional class, comorbidities, and level of information as reported by patients were the factors associated with QoL, as shown by the two scales. All three factors guide a personalized care plan since NYHA class shows the burden of disease, comorbidities add to the complexity, and patient information determines the effectiveness of management. Full article

23 pages, 934 KB

Open AccessEditor’s ChoiceSystematic Review

Fall Prevention Interventions and Fracture Risk in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

by Yazan Jumah Alalwani, Munira Abdullah Aldossari, Layan Adeeb Alzahrani, Nouf Ibrahim Alhatlani, Sarah Musaad Albarrak, Waleed Khalid Moosa, Raghad Ali Aloufi, Ibtisam Heji AlBader, Sadeem Khalid Almulhim, Nurah Jamel Alnbi, Leen Awad Alkahtani, Fatimah Mohammed Alsayoud, Ahmed Y. Azzam and Ghada Fouad Al Yousif

Clin. Pract. 2026, 16(3), 52; https://doi.org/10.3390/clinpract16030052 - 28 Feb 2026

Viewed by 1078

Abstract

Introduction: Falls and subsequent fractures represent a major public health concern among older adults. While fall prevention interventions have demonstrated efficacy in reducing falls, their impact on fracture outcomes remains unclear. Methods: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. [...] Read more.

Introduction: Falls and subsequent fractures represent a major public health concern among older adults. While fall prevention interventions have demonstrated efficacy in reducing falls, their impact on fracture outcomes remains unclear. Methods: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. We searched multiple databases up to 7 June 2025 for studies investigating fall prevention interventions and fracture outcomes in community-dwelling older adults. A primary outcome was hip fractures; secondary outcomes included any fractures, falls, and serious fall injuries. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated, using random-effects meta-analysis where appropriate. Results: Seventeen studies were included, spanning over 25,000 participants. Interventions included exercise programs, multifactorial approaches, medication optimization, and vitamin D supplementation. For hip fractures, only two randomized controlled trials (RCTs) reported extractable outcome data (12,489 participants; 132 events); both showed non-significant reductions favoring intervention (RR 0.80–0.87), precluding pooled meta-analysis. For any fractures, five studies (18,519 participants; 1343 events) demonstrated no significant effect (RR 0.91, 95% CI 0.72–1.14; p-value = 0.40) with significant heterogeneity (I² = 65%). Fall prevention interventions significantly reduced falls across 14 studies. GRADE assessment indicated very low certainty for both hip fractures and any fractures due to limited studies, inconsistency, and imprecision. Conclusions: Current evidence suggests fall prevention interventions may reduce hip fractures but do not significantly prevent fractures overall. Despite consistent fall reduction, the translation to fracture prevention remains uncertain, highlighting the need for integrated interventions targeting both fall risk and bone health. Full article

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17 pages, 266 KB

Open AccessEditor’s ChoiceArticle

Redefining Beauty: Knowledge, Attitudes, and Behaviours Toward Aesthetic Medicine and Cosmetic Surgery in Urban Adults

by Fabiana Di Duca, Giancarlo Biondi, Elvira De Rosa, Alessandro Venuta, Salvatore Di Sarno, Alfonso Nardo, Bartolomeo Ferrante, Giovanni Mazzei, Stefano Scippa, Immacolata Russo, Maria Triassi and Paolo Montuori

Clin. Pract. 2026, 16(3), 47; https://doi.org/10.3390/clinpract16030047 - 26 Feb 2026

Viewed by 989

Abstract

Background: In recent years, aesthetic medicine and cosmetic surgery have seen significant growth, reflecting changing sociocultural views on beauty and self-care; however, public knowledge and awareness of associated risks remain inconsistent. This study aimed to assess knowledge, attitudes, and behaviours toward aesthetic medicine [...] Read more.

Background: In recent years, aesthetic medicine and cosmetic surgery have seen significant growth, reflecting changing sociocultural views on beauty and self-care; however, public knowledge and awareness of associated risks remain inconsistent. This study aimed to assess knowledge, attitudes, and behaviours toward aesthetic medicine and cosmetic surgery in a large metropolitan population in Southern Italy using the Knowledge–Attitude–Practice (KAP) framework. Methods: A cross-sectional survey was conducted between June 2021 and January 2022 among 1079 adults aged 18–72 years residing in the metropolitan area of Naples. A structured questionnaire collected socio-demographic data and assessed knowledge, attitudes, and behaviours related to surgical and non-surgical aesthetic procedures. Descriptive statistics and multiple linear regression analyses were performed to identify predictors of knowledge, attitudes, and behaviours. Results: Overall, 66.8% of participants reported having undergone general beauty treatments, while 9.8% declared the use of cosmetic medicine procedures. A total of 5.1% had undergone botulinum toxin treatments, 11% reported filler injections, and 9.8% had experienced plastic surgery. A majority had strong knowledge, especially on non-surgical procedures, but there were gaps in their knowledge on side effects, regulations, age limits, and qualifications. Most viewed appearance as important, though with critical views of excessive aesthetic treatments and claimed limited social media influence. Female sex and parental status were positively associated with aesthetic behaviours, while attitudes emerged as the strongest predictor of engagement. Conclusions: Aesthetic practices are widely accepted within this urban population, yet important informational deficiencies persist. Targeted educational interventions based on the KAP framework are warranted to enhance health literacy, promote safe decision-making, and foster realistic expectations regarding aesthetic medicine and cosmetic surgery. Full article

19 pages, 6201 KB

Open AccessEditor’s ChoiceArticle

Transcranial Doppler Pulsatility Index and MRI Findings in Meningoencephalitis: A Pilot Observational Retrospective Cohort Study in Critically Ill Patients

by Maria Grazia Bocci, Giulia Capecchi, Antonio Lesci, Dorotea Rubino, Ilaria Caravella, Giorgia Taloni, Valerio Sabatini, Candido Porcelli, Giulia Valeria Stazi, Gabriele Garotto, Elena Mattiucci, Emanuele Nicastri, Tommaso Ascoli Bartoli, Gaetano Maffongelli, Emiliano Cingolani, Fabrizio Albarello, Giulia Anello, Paolo Campioni, Stefania Ianniello and Daniele Guerino Biasucci

Clin. Pract. 2026, 16(2), 41; https://doi.org/10.3390/clinpract16020041 - 14 Feb 2026

Viewed by 513

Abstract

Background: Meningoencephalitis is a complex inflammatory condition of the CNS that can result in significant morbidity and mortality in critically ill adults. Accurate and timely neuromonitoring is essential for guiding management and improving outcomes. This study aimed to descriptively evaluate the prognostic value [...] Read more.

Background: Meningoencephalitis is a complex inflammatory condition of the CNS that can result in significant morbidity and mortality in critically ill adults. Accurate and timely neuromonitoring is essential for guiding management and improving outcomes. This study aimed to descriptively evaluate the prognostic value of early TCCD monitoring, particularly the pulsatility index, and its integration with conventional and perfusion MRI in patients with meningoencephalitis. Methods: We present an observational, retrospective, cohort study involving ten adult patients (median age 56 years, IQR 45.5–68.5; mean 55.9, range 35–76) with neurological syndromes caused by suspected or confirmed infectious meningoencephalitis. Etiologies included bacterial meningitis/meningoencephalitis (50%), viral meningoencephalitis (10%), neurotoxoplasmosis (10%), progressive multifocal leukoencephalopathy (10%), and undetermined origin (20%). Patients underwent TCCD and MRI within 24 h. In five cases, standard MRI sequences were acquired, while in the remaining five, perfusion imaging was performed using Arterial Spin Labelling (ASL). A favorable outcome was defined as survival with neurological recovery (Glasgow Outcome Scale > 5) at ICU discharge. Results: TCCD-derived PI provided valuable information on cerebral hemodynamics. PI values ≤ 1.25 were associated with favorable clinical outcomes and symmetrical MRI findings. Conversely, PI > 1.25 correlated with poor prognosis and often preceded MRI-detectable structural damage. When combined with ASL, PI mirrored the detected perfusion asymmetries and was associated with poor prognosis in fatal cases. Conclusions: Bedside TCCD can offer real-time assessment of cerebrovascular dynamics and, when integrated with conventional and ASL MRI, could enhance the understanding of pathophysiological processes in meningoencephalitis, supporting timely and informed decisions in neurocritical care. Full article

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19 pages, 1515 KB

Open AccessEditor’s ChoiceArticle

Longitudinal Changes in Depression, Anxiety and Stress Symptoms Among Hemodialysis Patients

by Adriana-Luciana Luca, Felicia Militaru, Mădălina Iuliana Mușat, Ion Udriștoiu and Eugen Moța

Clin. Pract. 2026, 16(2), 37; https://doi.org/10.3390/clinpract16020037 - 8 Feb 2026

Cited by 2 | Viewed by 687

Abstract

Background/Objectives: Chronic kidney disease (CKD) progresses with the gradual and irreversible loss of renal function. In Romania, given the increasing number of patients undergoing hemodialysis (HD), the prevalence of psychiatric symptoms and disorders in this population has become particularly significant. Although important [...] Read more.

Background/Objectives: Chronic kidney disease (CKD) progresses with the gradual and irreversible loss of renal function. In Romania, given the increasing number of patients undergoing hemodialysis (HD), the prevalence of psychiatric symptoms and disorders in this population has become particularly significant. Although important advances have been made in the management of psychiatric conditions in HD patients, their mental health remains relatively poor. The aim of this study was to observe the severity temporal trends of depression, anxiety and stress symptoms and correlations among HD patients. Methods: A total of 173 patients, underwent a detailed anamnesis, with emphasis dialysis duration, comorbidities and a complex psychiatric evaluation, followed by the application of the Socio-economic Scale (SES-3); Mini Mental State Examination (MMSE); and the Depression, Anxiety and Stress Scale 21R (DASS-21R). The dialysis performance (spKt/V) and Charlson Comorbidity (CCI) indices were provided by DIAVERUM Nephrology and Dialysis Center in Craiova. Results: The severity of depression and anxiety symptoms significantly increased over six months, 0.248 ± 1.432 vs. 0.453 ± 1.488 (p < 0.0001; r_rb = 0.296) for depression, and −0.090 ± 1.004 vs. 0.089 ± 1.047 (p < 0.0001; r_rb = 0.252) for anxiety; while stress-like symptoms remained stable 0.080 ± 1.318 vs. 0.164 ± 1.357 (p = 0.0661; r_rb = 0.123), despite improvements in dialysis adequacy (spKt/V). Depression scores were moderately correlated with anxiety and weakly correlated with stress and spKt/V. Anxiety results were moderately correlated with stress, while both anxiety and stress showed negligible correlations with spKt/V. Clinical variables assessed showed moderate predictive value for psychological outcomes in this cohort. Conclusions: Our study confirms the temporal trend of severity of mental symptoms and their persistence among HD patients, highlighting the urge to integrate mental health screening and intervention programs and a multidisciplinary team adapted for each case. Full article

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17 pages, 830 KB

Open AccessEditor’s ChoiceArticle

Age at Menarche and Risk of Hypertensive Disorders of Pregnancy: A Retrospective Cohort Study

by Erick Ordoñez-Villordo, Monica Alethia Cureño-Díaz, Erika Gómez-Zamora, Miguel Trujillo-Martínez, Ricardo Castrejón-Salgado, Fani Villa-Rivas, Rocío Castillo-Díaz, Nadia Velázquez-Hernández, Juan Carlos Fernando Sánchez-Velázquez, Ximena Solis-Gómez and José Ángel Hernández-Mariano

Clin. Pract. 2026, 16(2), 32; https://doi.org/10.3390/clinpract16020032 - 29 Jan 2026

Viewed by 988

Abstract

Background/Objectives: Hypertensive disorders of pregnancy (HDP) remain a major contributor to maternal morbidity and mortality worldwide, yet early-life reproductive factors such as age at menarche have been insufficiently explored in relation to HDP. Therefore, we aimed to evaluate the association between age [...] Read more.

Background/Objectives: Hypertensive disorders of pregnancy (HDP) remain a major contributor to maternal morbidity and mortality worldwide, yet early-life reproductive factors such as age at menarche have been insufficiently explored in relation to HDP. Therefore, we aimed to evaluate the association between age at menarche and the risk of HDP in a cohort of Mexican pregnant women. Methods: We conducted a retrospective cohort study among 1344 women with singleton pregnancies receiving care at a tertiary hospital in Mexico City in 2024. Age at menarche was categorized as <12, 12–14, and >14 years. HDP diagnoses were extracted from clinical records. Poisson regression with robust variance was used to estimate adjusted risk ratios (RRs). Sensitivity analyses included alternative menarche categorizations and restricted cubic spline models. Counterfactual mediation analyses assessed indirect effects through reconstructed prepregnancy BMI and gestational diabetes. Results: Both early (<12 years) and late (>14 years) menarche were associated with higher HDP risk than the 12–14-year reference (adjusted RR = 1.81; 95% CI 1.42–2.30, and 1.74; 95% CI 1.27–2.38, respectively). Spline models confirmed a U-shaped association. Mediation analyses indicated that prepregnancy BMI did not meaningfully mediate the association for either early or late menarche (<5% mediated). Gestational diabetes explained a modest proportion of the association for early menarche (≈14%), but not for late menarche. Conclusions: Age at menarche showed a robust U-shaped association with HDP, mostly independent of adiposity and gestational diabetes, within the limits of the available measurements. Incorporating pubertal timing into routine reproductive history taking may enhance contextual risk assessment for HDP. Full article

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16 pages, 1096 KB

Open AccessEditor’s ChoiceArticle

Elevated Serum LPS in Newly Diagnosed Hashimoto’s Thyroiditis: A Case–Control Study in Bulgaria

by Desislav Tomov, Boryana Levterova, Valentina Mihailova, Dimitar Troev, Zlatina Tomova, Yordanka Uzunova and Maria Orbetzova

Clin. Pract. 2026, 16(2), 26; https://doi.org/10.3390/clinpract16020026 - 26 Jan 2026

Viewed by 955

Abstract

Background: Hashimoto’s thyroiditis (HT) is a prevalent autoimmune disorder, often diagnosed late due to its asymptomatic or nonspecific presentation. Emerging evidence suggests that gut-derived lipopolysaccharides (LPS) may contribute to autoimmune activation. Objective: The primary objective of this study was to assess circulating [...] Read more.

Background: Hashimoto’s thyroiditis (HT) is a prevalent autoimmune disorder, often diagnosed late due to its asymptomatic or nonspecific presentation. Emerging evidence suggests that gut-derived lipopolysaccharides (LPS) may contribute to autoimmune activation. Objective: The primary objective of this study was to assess circulating LPS concentrations and dietary patterns in patients with Hashimoto’s thyroiditis compared to healthy controls. Methods: A hospital-based case–control study was conducted involving 105 HT patients and 25 healthy controls. Serum LPS concentrations, thyroid hormone profiles, and autoantibody levels were assessed. Dietary patterns were evaluated using the validated KomPAN questionnaire. Results: HT patients exhibited significantly higher serum LPS levels, particularly those with elevated anti-TPO and TRAB antibodies. A positive correlation was found between LPS and the fT3/fT4 ratio (r = 0.247, p = 0.006), and a negative correlation with fT4 (r = −0.314, p < 0.001). Dietary analysis revealed lower Pro-Healthy Diet Index scores in HT patients (3.94 vs. 5.34, p = 0.001), with increased consumption of processed foods and reduced intake of whole grains and oats. Conclusions: Elevated levels of lipopolysaccharides (LPS) and unhealthy dietary patterns may play a role in the development of thyroid autoimmunity. Taken together, these observations are consistent with a multifactorial model that potentially involves gut barrier dysfunction, endotoxemia, and nutritional factors in HT pathogenesis. Full article

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17 pages, 1794 KB

Open AccessEditor’s ChoiceArticle

Sedation Strategies for Awake Carotid Endarterectomy: An Exploratory Retrospective Study Comparing Dexmedetomidine and Remifentanil

by Rosanna Carmela De Rosa and Antonio Romanelli

Clin. Pract. 2026, 16(2), 23; https://doi.org/10.3390/clinpract16020023 - 23 Jan 2026

Viewed by 1115

Abstract

Background: Awake carotid endarterectomy (CEA) under local anesthesia demands an optimal sedation strategy that ensures patient comfort while preserving the ability for real-time neurological assessment. Dexmedetomidine (DEX) and remifentanil (REMI) are widely used agents, but direct comparisons in this setting remain scarce. Methods: [...] Read more.

Background: Awake carotid endarterectomy (CEA) under local anesthesia demands an optimal sedation strategy that ensures patient comfort while preserving the ability for real-time neurological assessment. Dexmedetomidine (DEX) and remifentanil (REMI) are widely used agents, but direct comparisons in this setting remain scarce. Methods: Exploratory, retrospective, single-center study of awake CEA (March–July 2019). DEX or REMI infusions were titrated to a Richmond Agitation–Sedation Scale (RASS) of −1 to −2. Outcomes were sedation failure (RASS ≥ +2 despite maximum infusion rate), bradycardia, hypotension, and neurologic events. Statistical analyses used χ² test (categorical variables) and Student’s t-test or Mann–Whitney test (continuous variables). Associations were assessed with Firth’s logistic regression (univariable and bivariate models), reporting odds ratios (OR) with 95% confidence intervals (CI_95%). Trends in the Bispectral Index (BIS), hemodynamic, and respiratory parameters were assessed using two-way repeated-measures Analysis of Variance (ANOVA). A p-value < 0.05 was considered significant. Results: Fifty-two patients were included (DEX = 25; REMI = 27). DEX group showed more frequent sedation failure (32.0% vs. 3.7%; p = 0.020), bradycardia (36.0% vs. 3.7%; p = 0.009), and hypotension (28.0% vs. 0%; p = 0.011). DEX was associated with increased risk in sedation failure (OR 8.58, CI_95% 1.70–85.81), bradycardia (OR 10.17, CI_95% 2.05–101.21), and hypotension (OR 22.30, CI_95% 2.46–2959.60); the direction of associations remained consistent in bivariate models adjusted for baseline confounders. ANOVA showed group-by-time interactions for BIS, heart rate, mean arterial pressure, and end-tidal CO₂. No intraoperative complications or adverse outcomes were observed. Conclusions: In this retrospective cohort of awake CEA, DEX was associated with higher rates of sedation failure and hemodynamic adverse events compared with REMI, without an apparent impact on procedural success. Given non-random allocation and baseline imbalances, these findings are hypothesis-generating and warrant confirmation in larger, robust, and prospective studies. Full article

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16 pages, 259 KB

Open AccessEditor’s ChoiceArticle

Fatigue Among Caregivers of Hospitalized Patients

by Eleni Maria Mitrou, Lamprini Avramopoulou, Dimitrios Alefragkis, Athanasia Tsami and Maria Polikandrioti

Clin. Pract. 2026, 16(1), 22; https://doi.org/10.3390/clinpract16010022 - 22 Jan 2026

Viewed by 539

Abstract

Introduction: Caregiving has been an emerging public health priority mainly due to the rapid pace of population aging, increase in chronic diseases and shortages of health professionals. In clinical settings, caregivers have a crucial role by providing support to patients. Consequently, they [...] Read more.

Introduction: Caregiving has been an emerging public health priority mainly due to the rapid pace of population aging, increase in chronic diseases and shortages of health professionals. In clinical settings, caregivers have a crucial role by providing support to patients. Consequently, they may experience physical and emotional burden mainly attributed to environmental, personal or family stressors. The aim of this study was to evaluate fatigue and the associated factors among caregivers of hospitalized patients in medical-surgical wards. Methods and Material: In the present study caregivers of hospitalized patients in medical and surgical wards were enrolled. Collection of data was performed with the following: a. Fatigue Assessment Scale (FAS), b. Zung Self-Rating Anxiety Scale (SAS) and c. Athens Insomnia Scale (AIS), which included patients’ characteristics. In this cross-sectional study, participants were selected using the method of convenience sampling. Results: Of the 142 participants, the majority were spouses (64.8%), female (64.8%) and over 60 years old (53.6%). The mean FAS score was 25.9 ± 9.3, the mean SAS was 38.1 ± 9.0, and the mean AIS score was 7.6 ± 4.7, indicating moderate, moderate to low and moderate levels of fatigue, anxiety and insomnia, respectively. Moreover, fatigue showed a positive linear correlation with both anxiety (Spearman’s rho = 0.713) and insomnia (Spearman’s rho = 0.671). The factors found to be statistically significantly associated with caregivers’ fatigue were the following: gender (p = 0.001), length of hospitalization (p = 0.013), experience of environmental stressors (p = 0.045), experience of financial stressors (p = 0.001), and unfamiliarity with the provision of care (p = 0.001). Conclusions: Provided that caregivers’ involvement in care not only enhances patient well-being but also supports clinical teams, it is widely comprehended that addressing their needs should be emphasized. Full article

(This article belongs to the Special Issue Advances in Clinical Nursing: Integrating Advanced Surgical and Medical Nursing for Enhanced Patient Outcomes)

10 pages, 193 KB

Open AccessEditor’s ChoiceReview

Attention to Elderspeak: A Call for Dignity-Affirming Communication in Advanced Nursing Care

by Takahiko Nagamine

Clin. Pract. 2026, 16(1), 21; https://doi.org/10.3390/clinpract16010021 - 22 Jan 2026

Cited by 1 | Viewed by 1021

Abstract

Elderspeak is a form of communication overaccommodation directed toward older adults, characterized by simplified language and an elevated pitch. While typically well-intentioned, it is rooted in ageist stereotypes and linked to negative health outcomes. A literature search was conducted in PubMed, CINAHL, and [...] Read more.

Elderspeak is a form of communication overaccommodation directed toward older adults, characterized by simplified language and an elevated pitch. While typically well-intentioned, it is rooted in ageist stereotypes and linked to negative health outcomes. A literature search was conducted in PubMed, CINAHL, and PsycINFO (2018–2025), yielding 24 key articles focusing on acute and surgical settings. The purpose of this narrative review is to synthesize current evidence on Elderspeak within acute care hospitals and propose a research framework and intervention strategies. Elderspeak is a key determinant of resistiveness to care (RTC), particularly in acute settings where it is triggered by functional impairment. Exposure increases patient distress and negatively impacts vital signs and cooperation with medical interventions. Inconsistent measurement is being addressed through standardized schemes like the Iowa Coding Scheme for Elderspeak (ICodE). This paper proposes that future research must employ mixed-methods, longitudinal designs to capture the impact of Elderspeak on long-term outcomes. Drawing on the ICodE, we propose a qualitative self-reflection tool for clinicians to enhance awareness in high-stakes acute settings. Eliminating Elderspeak is a foundational necessity for patient safety and dignity-affirming care in advanced nursing. Full article

(This article belongs to the Special Issue Advances in Clinical Nursing: Integrating Advanced Surgical and Medical Nursing for Enhanced Patient Outcomes)

7 pages, 227 KB

Open AccessEditor’s ChoiceCase Report

A Hypersexuality Subset Behavior Induced by Aripiprazole Overdose in an Antipsychotic Naïve Patient: A Case Report and Review of the Literature

by Tiziano Serfilippi, Silvia Piccirillo, Alessandra Preziuso, Valentina Terenzi, Francesca Romagnoli, Marella Tarini, Vincenzo Lariccia, Agnese Secondo and Simona Magi

Clin. Pract. 2026, 16(1), 19; https://doi.org/10.3390/clinpract16010019 - 20 Jan 2026

Cited by 1 | Viewed by 2473

Abstract

Background: Aripiprazole is an atypical antipsychotic that acts as a partial agonist on the dopamine receptor D2 while also displaying agonistic activity on the 5-HT1A and antagonistic activity on the 5-HT2A receptors. As a partial agonist, aripiprazole stabilizes the activity of the [...] Read more.

Background: Aripiprazole is an atypical antipsychotic that acts as a partial agonist on the dopamine receptor D2 while also displaying agonistic activity on the 5-HT1A and antagonistic activity on the 5-HT2A receptors. As a partial agonist, aripiprazole stabilizes the activity of the D2 receptor, preventing overactivation. Case presentation: Within our deprescribing activity, we came across the case of a 30-year-old antipsychotic-naïve patient treated with the depot formulation of aripiprazole for bipolar disorder and acute mania, possibly developing hypersexuality due to an overdose that impacted negatively and heavily on his personal life. Results: The patient developed a peculiar subset of hypersexuality, changing his sexual orientation. Of interest, one month after discontinuing aripiprazole and switching to paliperidone, all the sexual-related symptoms and impulse control disorders resolved. Conclusions: We suggest stronger communication among the clinical teams involved in the patient’s care and screening patients for impulse control disorder prior to the administration of aripiprazole and monitoring them during treatment. Full article

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16 pages, 3571 KB

Open AccessEditor’s ChoiceSystematic Review

A Systematic Review of Personality Disorders in Patients with Gambling Disorder

by Ioana Ioniță, Mădălina Iuliana Mușat, Bogdan Cătălin, Constantin Alexandru Ciobanu and Adela Magdalena Ciobanu

Clin. Pract. 2026, 16(1), 15; https://doi.org/10.3390/clinpract16010015 - 9 Jan 2026

Viewed by 1532

Abstract

Background/Objectives: Gambling disorder (GD) is characterized by a high prevalence of co-occurring psychiatric disorders, including personality disorders (PDs), which may negatively influence clinical presentation, treatment outcomes, and relapse rates. The aim of this systematic review was to synthesize recent evidence regarding the association [...] Read more.

Background/Objectives: Gambling disorder (GD) is characterized by a high prevalence of co-occurring psychiatric disorders, including personality disorders (PDs), which may negatively influence clinical presentation, treatment outcomes, and relapse rates. The aim of this systematic review was to synthesize recent evidence regarding the association between GD and formally diagnosed PD and/or diagnostically anchored PD symptomatology, and to describe the main personality dimension most frequently reported in affected individuals. Methods: A systematic search was conducted in the PubMed and Dialnet databases for articles published between 30 November 2015 and 30 November 2025, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. PubMed was selected as the primary database because it is the most comprehensive source for peer-reviewed biomedical and psychiatric research, while Dialnet was included to complement PubMed by ensuring coverage of peer-reviewed psychiatric and psychological research published in other Romance-language journals, which are often underrepresented in international databases. The methodological quality and risk of bias of the included studies were evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for cross-sectional studies and the Newcastle–Ottawa Scale (NOS) for observational studies. Data extraction and synthesis were performed manually by two independent reviewers. Eight studies, predominantly cross-sectional in nature, assessing exclusively formally diagnosed personality disorders in adult individuals (≥18 years) diagnosed with GD were included. Results: Eight studies met the inclusion criteria, including a total of 4607 patients with GD. Across studies, personality pathology was highly prevalent among individuals with GD, with antisocial and borderline personality disorders most consistently reported. Elevated levels of impulsivity, emotional dysregulation, and narcissistic traits were frequently observed and were additionally associated with greater gambling severity, earlier onset, and poorer clinical outcomes. Antisocial personality symptoms were strongly linked to high-risk gambling subtypes, while obsessive–compulsive personality traits showed a more heterogeneous relationship with gambling severity. Conclusions: These results underscore the importance of personality assessment in individuals with GD and highlight the need for longitudinal studies using standardized diagnostic frameworks to inform tailored prevention and treatment strategies. Full article

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30 pages, 1851 KB

Open AccessEditor’s ChoiceReview

Telehealth for Sexual and Reproductive Healthcare: Evidence Map of Effectiveness, Patient and Provider Experiences and Preferences, and Patient Engagement Strategies

by Romil R. Parikh, Nishka U. Shetty, Chinar Singhal, Prachi Patel, Priyanka Manghani, Ashwin A. Pillai, Luz Angela Chocontá-Piraquive and Mary E. Butler

Clin. Pract. 2026, 16(1), 14; https://doi.org/10.3390/clinpract16010014 - 9 Jan 2026

Viewed by 1992

Abstract

Objective: The aim of this study was to systematically map evidence to inform best practices for sexual and reproductive healthcare delivered via telehealth (TeleSRH) in United States-based Title X-funded clinics. Methods: We searched three databases (2017–2025) for studies evaluating effectiveness, harms, patient and [...] Read more.

Objective: The aim of this study was to systematically map evidence to inform best practices for sexual and reproductive healthcare delivered via telehealth (TeleSRH) in United States-based Title X-funded clinics. Methods: We searched three databases (2017–2025) for studies evaluating effectiveness, harms, patient and provider experiences, barriers/facilitators, and engagement strategies encompassing TeleSRH for sexually transmitted infections (STIs), contraceptive care/family planning (CC/FP), and sexual wellness, in countries with a human development index of ≥0.8. Results: From 5963 references and 436 articles, we included 142 eligible publications. TeleSRH use declined since the COVID-19 pandemic’s peak but remains higher than pre-pandemic. Evidence comes mostly from poor-quality studies. TeleSRH increases access and adherence to STI prevention (e.g., pre-exposure prophylaxis for HIV). Tele-follow-up may safely facilitate HIV care continuity. For CC/FP, TeleSRH is comparable to in-person care for patient satisfaction and uptake; patients are less likely to select long-acting reversible contraception but post-initiation tele-follow-up may increase its continuation rates. Vasectomy completion rates may be similar between pre-procedural counseling via telehealth versus in-person. TeleSRH’s potential benefits might include reduced travel time, wait times, no-show rates, and clinic human resource burden (via tele-triaging) and increased preventative screening rates for STIs and non-communicable diseases, prescription refill rates, ability to receive confidential care in preferred settings, and rural/marginalized community outreach. Implementation challenges span technological and capital constraints, provider availability, staff capability building, restrictive policies, language incompatibility, and patient mistrust. Supplementing synchronous TeleSRH with asynchronous communication (e.g., mobile application) may improve continued patient engagement. Conclusions: Preventive, diagnostic, and therapeutic TeleSRH can be effective, with high patient acceptability; however, effectiveness and adoption hinge on contextual factors outlined in this review. Full article

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25 pages, 1413 KB

Open AccessEditor’s ChoiceArticle

Early Trajectories of Suicidality in Adolescents and Young Adults: A Retrospective Study from a Community Mental Health Facility in Northern Italy

by Miriam Olivola, Serena Chiara Civardi, Silvia Carnevali, Roberta Anniverno, Federico Durbano and Bernardo Maria Dell’Osso

Clin. Pract. 2026, 16(1), 12; https://doi.org/10.3390/clinpract16010012 - 4 Jan 2026

Viewed by 1028

Abstract

Background/Objectives: Suicide is the second leading cause of death among adolescents and young adults. Those suffering from psychiatric illnesses are at particular risk. Our study, conducted at an outpatient mental health facility in Northern Italy, aimed at delineating demographic and psychopathological features [...] Read more.

Background/Objectives: Suicide is the second leading cause of death among adolescents and young adults. Those suffering from psychiatric illnesses are at particular risk. Our study, conducted at an outpatient mental health facility in Northern Italy, aimed at delineating demographic and psychopathological features of youths aged 16–29 who attempted suicide and were referred to our community-based outpatient service. Methods: We identified 63 subjects, most of whom suffered from personality disorders, mood disorders, and schizophrenia spectrum disorders. Analysis of variance and post hoc pairwise comparisons were performed. Results: Inferential analysis yielded significant results in terms of age at index suicide attempt across diagnostic groups. Patients with personality disorders attempted suicide at a younger age (M = 18.70) compared to those with schizophrenia spectrum disorders (M = 23.64; η² = 0.32). Conclusions: Our findings highlighted the period of transition from adolescence to adulthood as a stress on the need of preventive approaches towards suicidality in young people in both clinical and non-clinical settings. Moreover, the difference of age at index suicide attempt across different diagnostic groups stresses the need for tailored clinical interventions based on the specific psychopathological trajectories and natural histories of the diseases. Full article

(This article belongs to the Special Issue Innovations in Youth Psychiatry and Psychology: Challenges and Advances)

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27 pages, 865 KB

Open AccessEditor’s ChoiceArticle

by George M. Pamboris, Spyridon Plakias, Charalambos Papacharalambous, Kyriakos Pavlou, Andrew Smythe, Anna Christakou and Eleftherios Paraskevopoulos

Clin. Pract. 2026, 16(1), 11; https://doi.org/10.3390/clinpract16010011 - 4 Jan 2026

Viewed by 1468

Abstract

Background: Rotator cuff-related shoulder pain (RCRSP) is a prevalent musculoskeletal disorder treated by physiotherapists. Although international guidelines support active, exercise-based management, little is known about current physiotherapy practices in Cyprus. Aim: To investigate physiotherapy management practices for RCRSP in Cyprus, assess adherence to [...] Read more.

Background: Rotator cuff-related shoulder pain (RCRSP) is a prevalent musculoskeletal disorder treated by physiotherapists. Although international guidelines support active, exercise-based management, little is known about current physiotherapy practices in Cyprus. Aim: To investigate physiotherapy management practices for RCRSP in Cyprus, assess adherence to recommended clinical guidelines, and compare findings with practices in other countries. Methods: A cross-sectional online survey was conducted among Cypriot physiotherapists between June and July 2024. An English case vignette-based questionnaire, adapted from validated international surveys, examined demographics, clinical reasoning, treatment preferences, and guideline adherence. Descriptive statistics summarised responses; chi-square tests and logistic regression identified associations between demographics and clinical decisions. Content analysis was performed on open-ended responses. Results: A total of 143 physiotherapists completed the survey. Most adhered to guideline-recommended care, with 99.3% (n = 142/143) prescribing exercise and 100% (n = 143/143) providing patient education. Conservative management was preferred, with 64.3% (n = 91/143) not recommending imaging, 72.0% (n = 103/143) not recommending injections, and 73.4% (n = 104/143) not recommending surgical referrals. Significant associations were found between special interest in shoulder conditions and recommendations for surgery (χ² = 4.937, p = 0.026) and injections (χ² = 9.143, p = 0.002). Physiotherapists recommending surgery were nearly seven times more likely to suggest MRI (Exp(B) = 6.944, p < 0.001). Conclusions: Cypriot physiotherapists predominantly use exercise and education for the management of RCRSP, aligning closely with international recommendations. Conservative strategies were favoured, with limited use of imaging, injections, and surgical referrals. However, variation in clinical decision-making, particularly regarding referrals and imaging, indicates partial adherence to best practice and highlights opportunities for enhanced guideline implementation and targeted clinical training. Full article

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16 pages, 1636 KB

Open AccessEditor’s ChoiceArticle

A Digital Twin Strategy Combined with a Monte Carlo Simulation Framework to Predict Outcomes in Patients with Unusual-Site Venous Thrombosis Treated with Direct Oral Anticoagulants Versus Vitamin K Antagonists Using Data from Real-World Populations

by Anabel Franco-Moreno, Luis Escobar-Curbelo, Juan Torres-Macho, Nuria Muñoz-Rivas, Cristina Lucía Ancos-Aracil, Ana Martínez de la Casa-Muñoz, Ana Bustamante-Fermosel, Paz Arranz-García and Miguel Ángel Casado-Suela

Clin. Pract. 2025, 15(12), 237; https://doi.org/10.3390/clinpract15120237 - 17 Dec 2025

Viewed by 830

Abstract

Background/Objectives: Unusual-site venous thrombosis (USVT) lacks robust evidence guiding anticoagulant selection between vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs). This study aimed to evaluate recanalization, recurrence, and major bleeding outcomes in real-world USVT patients and to replicate these findings through a [...] Read more.

Background/Objectives: Unusual-site venous thrombosis (USVT) lacks robust evidence guiding anticoagulant selection between vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs). This study aimed to evaluate recanalization, recurrence, and major bleeding outcomes in real-world USVT patients and to replicate these findings through a validated digital twin model with Monte Carlo simulation. Methods: We conducted a retrospective study of 90 USVT patients (72% VKAs, 28% DOACs). A conditional generative adversarial network was used to generate digital twins matched on age, sex, thrombosis site, and malignancy. Logistic regression was applied to estimate treatment-specific outcome probabilities for recanalization, recurrence, and major bleeding. A nested stochastic simulation framework simulated 500 iterations across clinical scenarios, including increased DOAC use, cancer prevalence, cerebral vein thrombosis proportion, and optimized VKA control. Results: The mean age was 67.5 years, and 54.4% were female. 61.1% of splanchnic vein thrombosis, 36.7% of upper extremity deep vein thrombosis, and 2.2% of cerebral vein thrombosis were included. In the real cohort, complete recanalization occurred in 40.0% of patients with DOACs and 36.0% with VKAs. Recurrence was 8.0% with DOACs and 7.7% with VKAs, and major bleeding occurred in 8.0% and 10.8% of cases, respectively. All-cause mortality was 20% in DOAC-treated patients and 60% in those receiving VKAs. Digital Twin-based predictions replicated these results (recanalization 40.3% versus 38.0%; recurrence 10.9% versus 8.6%; bleeding 7.6% versus 9.1%). Simulated scenarios preserved the directionality effect, with the most significant differences observed in high-cerebral vein thrombosis and cancer-enriched patients. Conclusions: DOACs showed comparable efficacy and slightly lower bleeding risk than VKAs in USVT. Digital twin and Monte Carlo modeling provided robust, reproducible simulations of treatment effects under varying clinical conditions. Separating empirical and simulation-based findings, the digital twin supported the internal consistency of real-world observations and demonstrated the potential of in silico modeling as a complementary tool in rare thrombotic diseases. Full article

(This article belongs to the Special Issue Advances in Thromboembolism: Precision Prevention and Clinical Management)

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17 pages, 524 KB

Open AccessEditor’s ChoiceReview

Hyponatraemia After Hip and Knee Replacement: Incidence, Risk Factors, Clinical Consequences and Management in the Era of Enhanced Recovery

by Lauren Thornley, James Craig, Thomas W. Wainwright and Robert G. Middleton

Clin. Pract. 2025, 15(12), 236; https://doi.org/10.3390/clinpract15120236 - 16 Dec 2025

Viewed by 1120

Abstract

Introduction: Total hip replacements and total knee replacements are among the most frequently performed operations worldwide, and the demand for such procedures is ever-growing. It is essential to focus on preventable medical complications that can arise from these procedures, specifically postoperative hyponatraemia. Postoperative [...] Read more.

Introduction: Total hip replacements and total knee replacements are among the most frequently performed operations worldwide, and the demand for such procedures is ever-growing. It is essential to focus on preventable medical complications that can arise from these procedures, specifically postoperative hyponatraemia. Postoperative hyponatraemia has an incidence of 20–40% in total hip and knee replacement patient cohorts. Even mild postoperative hyponatraemia is clinically relevant, as it is associated with cognitive impairment and gait disturbance and may undermine the aims of enhanced recovery protocols. Severe postoperative hyponatraemia can lead to seizures, coma, intensive care admission, and death. Although uncommon, the high volume of patients treated in busy orthopaedic centres means such cases will inevitably be encountered. This narrative review summarises the current evidence on incidence, risk factors and consequences of postoperative hyponatraemia in total hip and knee replacement populations. Methods: A literature review was performed through the EBSCO and PubMed databases to identify relevant studies. Key search terms included were “hyponatraemia”, “total hip replacement”, and “total knee replacement”. Results: The incidence of postoperative hyponatraemia is largely between 20% and 40%; however, there are some outliers to this. Multiple risk factors have been identified through observational studies, including age, preoperative hyponatraemia, female sex and certain medications, which signal a need for a risk stratification strategy that can assist in preoperative assessment and the early identification of patients at higher risk of developing postoperative hyponatraemia. Evidence is scarce regarding interventional studies for the prevention and management of postoperative hyponatraemia, despite multiple studies highlighting the issue. Conclusion: Future work should focus on testable, quality improvement interventions, such as automatic sodium checks on postoperative day one, weight-based oral fluid protocols, oral salt supplementation, and escalation pathways for high-risk patients. Incorporating these into enhanced recovery frameworks has the potential not only to optimise safe early discharge for the majority but also to prevent rare but significant complications. Full article

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11 pages, 2172 KB

Open AccessEditor’s ChoiceArticle

Urine Cytological Diagnostics: Possibilities and Limitations—A 25-Year Review and Overview at Hannover Medical School

by Soudah Bisharah, Mieke Raap and Mahmoud Abbas

Clin. Pract. 2025, 15(12), 234; https://doi.org/10.3390/clinpract15120234 - 12 Dec 2025

Cited by 1 | Viewed by 1105

Abstract

Background: Urine cytology is a highly effective, straightforward, and cost-efficient diagnostic tool for identifying neoplastic and non-neoplastic changes in the bladder, ureter, and renal pelvis. The aim of this study is to demonstrate the high sensitivity and specificity of urine cytology in detecting [...] Read more.

Background: Urine cytology is a highly effective, straightforward, and cost-efficient diagnostic tool for identifying neoplastic and non-neoplastic changes in the bladder, ureter, and renal pelvis. The aim of this study is to demonstrate the high sensitivity and specificity of urine cytology in detecting a wide range of urothelial lesions, including metastatic involvement. Material and Methods: Urine cytology was performed on 9639 cases between 2000 and 2025. The samples, collected from patients, were processed at the Institute of Pathology. Cytological slides were prepared using cytocentrifugation and stained with May–Grünwald–Giemsa (MGG) and Papanicolaou stains. The cytological findings were classified according to WHO, 2004 compared with histological specimens. Additionally, selected cases underwent immunohistochemical and molecular analyses. All samples were anonymized and retrospectively analyzed following the guidelines and regulations of the local ethics committee. Results: Of the total cases, 7051 were classified as benign, 1269 as malignant, and 88 as normal findings. Insufficient material was obtained in 336 cases. No complications were reported during sample collection or processing. The concordance with histological findings for neoplastic lesions was over 96%, with a false-negative rate of 1.84%. The diagnostic methods demonstrated a sensitivity of 90.7% and a specificity of 96.64%. Among the 6956 cases analyzed, 3139 were women (45.13%) and 3817 were men (54.87%). Conclusions: The diagnostic value of urine cytology in representative material is relatively high in assessing both the presence or absence of malignancy and, when applicable, the tumor grade. This large 25-year single-center review demonstrates that urine cytology retains high sensitivity and specificity for the detection of urothelial malignancy, particularly high-grade disease. However, the atypical category remains a major diagnostic challenge and contributes substantially to false-positive results. Full article

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11 pages, 203 KB

Open AccessEditor’s ChoiceArticle

Teaching Prescribing in the PharmD Curriculum: A Qualitative Analysis

by Rachel E. Barenie, Devin Scott, David Rhys Axon and Alina Cernasev

Clin. Pract. 2025, 15(12), 232; https://doi.org/10.3390/clinpract15120232 - 9 Dec 2025

Viewed by 519

Abstract

Background: The scope of practice for pharmacists in the United States (US) is expanding rapidly, with the majority of states allowing pharmacists to prescribe to some degree. Doctor of Pharmacy (PharmD) programs are required to include medication prescribing effective 1 July 2025, ensuring [...] Read more.

Background: The scope of practice for pharmacists in the United States (US) is expanding rapidly, with the majority of states allowing pharmacists to prescribe to some degree. Doctor of Pharmacy (PharmD) programs are required to include medication prescribing effective 1 July 2025, ensuring program alignment with modern pharmacy practice. Objective: This study aimed to characterize student pharmacists’ beliefs about education on prescribing in the US PharmD program. Methods: Focus group discussions (FGDs) were conducted with student pharmacists enrolled in the PharmD curriculum at two different universities in the US. The conceptualization and data collection, guided by Self-Determination Theory, occurred over three months during the 2024 Fall semester. Data analysis was performed using thematic analysis, and themes were identified through inductive and deductive coding. Results: Twenty-two student pharmacists participated in three FGDs. Thematic analysis revealed two major themes: (1) essential role of didactic education in the prescribing process and (2) enhancing student preparedness to prescribe through experiential training. These themes uncover student pharmacists’ beliefs that prescribing education is vitally important to the didactic and experiential curriculum, highlighting the need to take a comprehensive approach to incorporate these topics into the PharmD program. Conclusions: Teaching medication prescribing in the PharmD didactic curriculum using a state’s scope of practice as a framework for its delivery, with reinforcement in their experiential training, to ensure pharmacy students are practice-ready, may be a preferred approach for delivery. This area remains ripe for further study to determine an evidence-based approach to teaching medication prescribing to pharmacy students. Full article

12 pages, 253 KB

Open AccessEditor’s ChoiceArticle

Cultural Biases and Clinical Variation

by Óscar Gasulla, Antonio Sarría-Santamera, Ferran A. Mazaira-Font, Cielo García-Montero, Oscar Fraile-Martinez, Diego Cantalapiedra, Manuel F. Carrillo-Rodríguez, Belen Gómez-Valcárcel, Miguel Á. Ortega, Melchor Álvarez-Mon and Angel Asúnsolo

Clin. Pract. 2025, 15(12), 229; https://doi.org/10.3390/clinpract15120229 - 5 Dec 2025

Viewed by 671

Abstract

Background: This study investigates the possible role of cultural biases in clinical variation. Methods: An observational, analytical, and retrospective cohort design, using a Spanish primary care database, was used, on which a cross-sectional analysis was performed. Diseases were classified into the [...] Read more.

Background: This study investigates the possible role of cultural biases in clinical variation. Methods: An observational, analytical, and retrospective cohort design, using a Spanish primary care database, was used, on which a cross-sectional analysis was performed. Diseases were classified into the following: generic conditions with established protocols (control group), specialist-diagnosed diseases, women’s diseases, and psychiatric diseases. Diagnostic incidence was calculated across 25 geographical clusters, and variability was measured using the coefficient of variation (CV). To test systematic differences, multivariate linear regression models were adjusted for socio-demographics and healthcare system proxies. Results: The final sample for analysis consisted of 617,222 women aged 15 to 65, with a mean age of 43. The results did not reveal significant variability between generic and specialized diseases, but women’s and psychiatric diseases showed consistently higher CVs in all models (p < 0.05), indicating that approximately 20% to 30% of the clinical variation observed in these groups was unexplained. Conclusions: Although we cannot establish causality, these findings may suggest that cultural taboos and gender biases likely contribute to unjustified clinical variation, highlighting cultural bias as a plausible explanatory factor. Full article

15 pages, 2624 KB

Open AccessEditor’s ChoiceArticle

Ultrasound Assessment of the Tibial Nerve at the Retromalleolar Level: Influence of Anthropometric Characteristics and Clinical Implications

by María Benimeli-Fenollar, Cecili Macián-Romero, Lucía Carbonell-José, María José Chiva-Miralles, José Maria Montiel-Company, José Manuel Almerich-Silla, Rosa Cibrian and Vicent Tomás-Martínez

Clin. Pract. 2025, 15(12), 227; https://doi.org/10.3390/clinpract15120227 - 3 Dec 2025

Viewed by 569

Abstract

Background: Clinical procedures involving the tibial nerve (TN) are complex procedures due to its deep anatomical position and the variability of its course in the retromalleolar region. Few studies have described the ultrasound characteristics of the TN in vivo. This study aims to [...] Read more.

Background: Clinical procedures involving the tibial nerve (TN) are complex procedures due to its deep anatomical position and the variability of its course in the retromalleolar region. Few studies have described the ultrasound characteristics of the TN in vivo. This study aims to describe the ultrasound position of the TN and its relationship with the posterior tibial artery (PTA) at the retromalleolar level, evaluating the influence of sex, weight, height, and body mass index (BMI). Methods: A cross-sectional ultrasound study was performed on 100 volunteers. Anthropometric variables were recorded. Ultrasound measurements included the TN perimeter, distance from the medial malleolus to the TN center, depth, and spatial relationship with the PTA. Statistical analyses included Student’s t-test, ANOVA, Chi-square test, and Pearson’s correlation coefficient, with a significance level of p < 0.05. Results: The mean distance from the TN to the medial malleolus was 2.17 cm, and its mean depth was 0.91 cm. The most common anatomical pattern was Type I (TN posterior to the PTA) (60%). Sex influenced TN position, with men showing greater distances from the medial malleolus to the TN center (2.42 vs. 1.99 cm) and women showing greater depth from the skin surface to the upper edge of the tibial nerve perimeter (0.94 vs. 0.86 cm). Weight (p = 0.004), height (p < 0.001), and ankle circumference (p = 0.006) correlated significantly with TN location, whereas BMI did not (p = 0.253). Conclusion: These findings provide clinically relevant reference data that may improve the precision and safety of different tibial nerve procedures. Full article

(This article belongs to the Topic The Use of New Technologies, Artificial Intelligence and Digital Twin in Health and Clinical Practice)

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17 pages, 502 KB

Open AccessEditor’s ChoiceArticle

Systemic and Oral Factors Relating to Stress in Later Life: A Study Using the Japanese National Statistics Database

by Kanako Seino, Akira Komatsuzaki, Kanako Mitomi, Mio Susuga, Sachie Ono, Yukika Enoki, Asami Iguchi, Hiromi Fujita and Naru Komatsuzaki

Clin. Pract. 2025, 15(12), 226; https://doi.org/10.3390/clinpract15120226 - 1 Dec 2025

Cited by 1 | Viewed by 704

Abstract

Background: The psychosomatic effects of stress are risk factors for a range of dental and systemic diseases. This study used the massive Japanese national statistics database to clarify the association of psychological stress with subjective symptoms and conditions requiring hospital visits. Methods [...] Read more.

Background: The psychosomatic effects of stress are risk factors for a range of dental and systemic diseases. This study used the massive Japanese national statistics database to clarify the association of psychological stress with subjective symptoms and conditions requiring hospital visits. Methods: Anonymized data from 93,690 respondents of the 2019 Japanese survey were provided for this study. From these data, those of 29,777 respondents aged 40–89 years were classified into stress groups based on their responses to the Kessler Psychological Distress Scale (K6). The response rates for symptoms and diseases were compared and analyzed using contingency tables and binomial logistic regression. Results: The items with the largest odds ratios in the univariate analysis were depression/other mental disease (7.60), followed by irritability (6.86) and health perception QOL (6.31). Among those with subjective symptoms, the proportion in the high-stress group was higher (15.1%), with a univariate odds ratio of 3.17. The results of the binomial logistic regression analysis, with subjective QOL as the dependent variable, were as follows: The explanatory variables with the highest adjusted odds ratios were stress group classification (3.14), followed by feeling physically tired (2.44) and sleep satisfaction (2.22). The stress group was associated with subjective symptoms, such as irritability and depression/other mental diseases, as well as with social factors, such as household structure and work hours. These results suggest the existence of specific symptoms, diseases, and environmental factors associated with high stress. Conclusions: The results suggest that stress may have a substantial impact on quality of life in later life. Therefore, healthcare measures for older adults should focus on the symptoms and diseases that tend to be associated with stress to mitigate their effects. Full article

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9 pages, 214 KB

Open AccessEditor’s ChoiceBrief Report

Sjogren Disease and Nephrolithiasis: A Case Series and Review of the Literature

by Ben Schroeder, Chokkalingam Siva and Chen-Chung Steven Liu

Clin. Pract. 2025, 15(12), 225; https://doi.org/10.3390/clinpract15120225 - 28 Nov 2025

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Abstract

Background: Primary Sjogren Disease (pSD) is a chronic autoimmune disease characterized by a classic triad of keratoconjunctivitis sicca, xerostomia, and polyarthritis. The primary pathological feature of pSD is lymphoplasmacytic infiltration in glandular epithelial tissue, often affecting the salivary and lacrimal glands, leading to [...] Read more.

Background: Primary Sjogren Disease (pSD) is a chronic autoimmune disease characterized by a classic triad of keratoconjunctivitis sicca, xerostomia, and polyarthritis. The primary pathological feature of pSD is lymphoplasmacytic infiltration in glandular epithelial tissue, often affecting the salivary and lacrimal glands, leading to classic sicca symptoms (ocular and oral dryness). Sjogren Disease (SD) can be categorized as “primary” when occurring independently or “secondary” when accompanying another autoimmune connective tissue disorder such as rheumatoid arthritis, systemic lupus erythematosus, or systemic sclerosis. Additionally, systemic disease is common in pSD and can manifest with kidney dysfunction resulting in nephrolithiasis and distal renal tubular acidosis (dRTA). Methods: This report details a case series drawing patients from the literature as well as patients from our institution which serves to demonstrate key points in clinical hallmarks. We utilize a literature search with key words Sjogren Disease, nephrolithiasis, renal tubular acidosis, and nephrocalcinosis in addition to pSD patients with concomitant nephrolithiasis at our institution to characterize clinical and serologic findings as well as treatment modalities. Results: We find well demonstrated clinical hallmarks such as female predominance and presence of dRTA amongst the cohort of pSD patients. We also find that further research on pSD serologies could prove beneficial in risk stratifying those most likely to develop renal disease and nephrolithiasis. Furthermore, we review signs, symptoms, pathophysiology, and management of SD with added emphasis on associated renal disease including nephrolithiasis and dRTA. Conclusion: Overall, pSD associated renal disease remains an area of ongoing research and further study on patient serologies may aid clinicians in better serving and surveilling patients at risk of systemic involvement. Full article

9 pages, 1390 KB

Open AccessEditor’s ChoiceCase Report

A Case of Extensive Airway Necrosis Following Esophagectomy Successfully Treated with Airway Stenting

by Tatsuki Tsuruga, Hajime Fujimoto, Esteban C. Gabazza, Masaki Ohi, Masahide Oki and Tetsu Kobayashi

Clin. Pract. 2025, 15(12), 223; https://doi.org/10.3390/clinpract15120223 - 27 Nov 2025

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Abstract

Background: Airway stenting is an alternative therapy for patients with complicated esophagectomy. Case presentation: A 60-year-old man with clinical stage IIIA esophageal cancer underwent neoadjuvant chemotherapy followed by robot-assisted subtotal esophagectomy with cervical esophagogastrostomy and jejunostomy. During surgery, both bronchial arteries were ligated [...] Read more.

Background: Airway stenting is an alternative therapy for patients with complicated esophagectomy. Case presentation: A 60-year-old man with clinical stage IIIA esophageal cancer underwent neoadjuvant chemotherapy followed by robot-assisted subtotal esophagectomy with cervical esophagogastrostomy and jejunostomy. During surgery, both bronchial arteries were ligated to facilitate esophageal mobilization. Bronchoscopy on the first postoperative day showed no abnormalities; however, by the second postoperative day, the patient developed pneumonia and septic shock, requiring mechanical ventilation. On the fifth postoperative day, bronchoscopy revealed extensive epithelial injury extending from the trachea to both main bronchi, indicating ischemic airway damage. He was diagnosed with airway necrosis and referred to our respiratory department. Serial bronchoscopic examinations and suctioning of the sloughed epithelium were performed, and a tracheostomy enabled weaning from mechanical ventilation. By the twenty-fourth postoperative day, bronchoscopy revealed the accumulation of large, hardened secretions within the trachea, carina, and both main bronchi, resulting in airway narrowing and a high risk of asphyxiation. A silicone Y-shaped airway stent was inserted to maintain patency. Following stent placement, airway secretions progressively decreased, and the patient was discharged on the sixty-third postoperative day. The stent was removed six months later, with no recurrence of airway or respiratory complications. Conclusion: This case illustrates a rare but severe complication of extensive airway necrosis, likely caused by intraoperative bronchial artery ligation and dissection of the tracheal membranous portion. Although preservation of the bronchial arteries and meticulous surgical technique are essential preventive strategies, such complications may be unavoidable. In cases of extensive airway necrosis, airway stenting can serve as an effective therapeutic option to prevent obstruction and support recovery. Full article

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23 pages, 648 KB

Open AccessEditor’s ChoiceSystematic Review

The Effectiveness and Safety of Stem Cell-Based Tissue Engineering in the Regeneration of Periodontal Bone Lesions: A Systematic Review

by Marouan Fanid, Ana Sofia Vinhas, Cátia Reis, Marta Relvas, Rosana Costa and Cristina Cabral

Clin. Pract. 2025, 15(12), 222; https://doi.org/10.3390/clinpract15120222 - 26 Nov 2025

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Abstract

Background/Objectives: Periodontal diseases are highly prevalent worldwide, causing progressive destruction of the alveolar bone and eventual tooth loss when not treated. Despite advances in conventional periodontal therapies, complete tissue regeneration remains limited. This review aims to evaluate the efficacy, safety, and clinical relevance [...] Read more.

Background/Objectives: Periodontal diseases are highly prevalent worldwide, causing progressive destruction of the alveolar bone and eventual tooth loss when not treated. Despite advances in conventional periodontal therapies, complete tissue regeneration remains limited. This review aims to evaluate the efficacy, safety, and clinical relevance of stem cell-based tissue engineering approaches for regeneration of periodontal bone lesions. Methods: Following PRISMA guidelines, a systematic search was conducted across multiple databases, resulting in the inclusion of 17 studies in humans that met predefined PICO criteria. The study protocol was registered on PROSPERO (CRD420251229271). These studies assessed various stem cell sources, including dental and bone marrow-derived cells among others, both on their own and in combination with scaffolds or growth factors. Results: Most studies reported favorable outcomes in terms of clinical attachment gain, radiographic bone fill, probing depth reduction, and implant stability. No major adverse effects were noted, indicating good safety. However, results varied based on cell type, culture protocols, and defect characteristics. Conclusions: Stem cell therapy shows strong potential for periodontal regeneration, with outcomes that may potentially surpass those of conventional methods in selected cases. Further standardization, cost reduction, and long-term clinical trials are essential to confirm these findings and support their integration into daily dental practice. 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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28 pages, 1331 KB

Open AccessEditor’s ChoiceReview

ECM Remodeling in Direct Inguinal Hernia: The Role of Aging, Oxidative Stress, and Antioxidants Defenses

by John Dawi, Yura Misakyan, Edgar Gonzalez, Kevin Kafaja, Scarlet Affa, Kevin Tumanyan, Kyla Qumsieh and Vishwanath Venketaraman

Clin. Pract. 2025, 15(12), 219; https://doi.org/10.3390/clinpract15120219 - 24 Nov 2025

Cited by 1 | Viewed by 2169

Abstract

Inguinal hernia represents a multifactorial condition driven by extracellular matrix (ECM) dysregulation, collagen imbalance, and oxidative stress. Across studies, a consistent reduction in the collagen I:III ratio, coupled with altered expression of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs), underpins weakened [...] Read more.

Inguinal hernia represents a multifactorial condition driven by extracellular matrix (ECM) dysregulation, collagen imbalance, and oxidative stress. Across studies, a consistent reduction in the collagen I:III ratio, coupled with altered expression of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs), underpins weakened fascia and hernia susceptibility. Aging further impairs ECM remodeling through fibroblast senescence, cross-linking deficits, and elastic fiber attrition, while oxidative stress and inflammation amplify tissue degradation and impair repair mechanisms. Evidence from clinical and experimental studies underscores the interplay between surgical technique, mesh choice, redox balance, and recurrence risk. Understanding the combined impact of aging and oxidative stress provides a mechanistic framework for targeted therapeutic and surgical strategies aimed at preventing hernia development and recurrence. Full article

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9 pages, 4869 KB

Open AccessEditor’s ChoiceCase Report

Urinary Bladder Hamartoma: Narrative Literature Review of an Exotic Pathology and Rare Cause of LUTS

by Mohammed Rafea Kanaan, Meryem Akkoyun, Marcel Lafos, Markus Antonius Kuczyk and Hossein Tezval

Clin. Pract. 2025, 15(12), 218; https://doi.org/10.3390/clinpract15120218 - 24 Nov 2025

Viewed by 648

Abstract

Urinary bladder hamartoma is an exceptionally rare benign lesion composed of disorganized yet mature tissue elements native to the bladder, including urothelium, fibrous stroma, smooth muscle, and occasionally adipose tissue. Unlike malignant tumors, it lacks cytological atypia, mitotic activity, or necrosis. Patients most [...] Read more.

Urinary bladder hamartoma is an exceptionally rare benign lesion composed of disorganized yet mature tissue elements native to the bladder, including urothelium, fibrous stroma, smooth muscle, and occasionally adipose tissue. Unlike malignant tumors, it lacks cytological atypia, mitotic activity, or necrosis. Patients most often present with lower urinary tract symptoms (LUTS) or hematuria, though some cases are incidental findings. Associations with syndromic conditions such as Peutz–Jeghers, Beckwith–Wiedemann, Goldenhar, and Loeys–Dietz have been reported. Transurethral resection is the preferred treatment and has generally been curative. We report the first case in Germany—and the 16th worldwide—of urinary bladder hamartoma, occurring in a young adult male with bothersome LUTS. Because of its proximity to both ureteral orifices, only partial transurethral resection was performed, which provided durable symptom relief at 14 months of follow-up. This case highlights partial TUR as a pragmatic, organ-preserving alternative when complete resection is anatomically unsafe, while emphasizing that TURBT remains the standard of care. We provide a detailed discussion of the histopathological features, differential diagnosis, treatment considerations, and an updated narrative review of all reported cases. Full article

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14 pages, 1368 KB

Open AccessEditor’s ChoiceArticle

Biomarker-Based Diagnosis of Contact Dermatitis: A Step Towards More Accurate and Patient-Friendly Testing

by Nique Grob, Thomas Rustemeyer and Florentine de Boer

Clin. Pract. 2025, 15(12), 217; https://doi.org/10.3390/clinpract15120217 - 21 Nov 2025

Viewed by 1161

Abstract

Background: Contact dermatitis (CD) is a prevalent inflammatory skin condition, with diagnostic challenges in distinguishing allergic (ACD) from irritant contact dermatitis (ICD). This study aimed to explore cholesterol-derived biomarkers as potential diagnostic tools. As cholesterol derivatives play key roles in skin barrier integrity [...] Read more.

Background: Contact dermatitis (CD) is a prevalent inflammatory skin condition, with diagnostic challenges in distinguishing allergic (ACD) from irritant contact dermatitis (ICD). This study aimed to explore cholesterol-derived biomarkers as potential diagnostic tools. As cholesterol derivatives play key roles in skin barrier integrity and inflammation, they are promising candidates for assessing skin barrier disruption in CD. Methods: Stratum corneum samples were collected by tape stripping from experimentally induced and chronic lesions, as well as healthy non-lesional skin. Biomarkers Cholesterol Sulfate (Chol-Sulf), Cholesterol Glucosyl (Chol-Glc) and their ratio were quantified. Data were analyzed using ANOVA, Pearson’s correlation, logistic regression and ROC curves. Results: Chol-Glc and the Chol-Glc/Chol-Sulf ratio differed significantly across the diagnostic groups, while Chol-Sulf did not. Logistic regression and ROC analyses revealed a limited standalone diagnostic accuracy for the individual biomarkers (all AUC < 0.6). Conclusions: Chol-Glc and the ratio exhibit disease-specific patterns relevant for subtype discrimination. Although insufficient as independent diagnostic tools, these markers may contribute to future multivariate diagnostic models for CD diagnosis. Full article

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16 pages, 1243 KB

Open AccessEditor’s ChoiceArticle

Urinary Tract Infections and Bacterial Multidrug Resistance in Kidney Transplant Impact on Function and Graft Survival

by Hernán Javier Pájaro Huertas, María Viviana Pantoja Echeverri, Gustavo Aroca Martínez, Carlos Guido Musso, Alex Dominguez Vargaz and Henry J. González-Torres

Clin. Pract. 2025, 15(11), 215; https://doi.org/10.3390/clinpract15110215 - 19 Nov 2025

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Abstract

Objective: This study aimed to evaluate the sociodemographic, clinical, paraclinical, and microbiological characteristics of kidney transplant recipients with and without urinary tract infection (UTI) and determine their impact on renal function and graft survival in a referral center in Atlántico, Colombia. Methods [...] Read more.

Objective: This study aimed to evaluate the sociodemographic, clinical, paraclinical, and microbiological characteristics of kidney transplant recipients with and without urinary tract infection (UTI) and determine their impact on renal function and graft survival in a referral center in Atlántico, Colombia. Methods: We conducted a retrospective, observational, analytical study including 163 kidney transplant recipients between 2015 and 2020. Clinical and microbiological variables were compared according to UTI status. Renal function was assessed using estimated glomerular filtration rate (eGFR). Graft survival was analyzed with Kaplan–Meier curves, and predictors of graft loss were identified using Cox regression models. Results: UTI prevalence was 17.8% (29/163), with a higher proportion of women in the UTI (+) group compared to the UTI (−) group (62% vs. 34%, p = 0.004). Escherichia coli (59%) and Klebsiella spp. (31%) were the predominant pathogens, with MDR in 66% of isolates and carbapenem resistance in 28%. Patients with UTIs had significantly lower baseline and follow-up eGFR (p ≤ 0.002), yet five-year graft survival was comparable (93% vs. 91%, p = 0.54). Baseline eGFR (HR: 0.95, p < 0.001) and institutional referral (HR: 9.7, p = 0.010) were independent predictors of graft loss, whereas UTIs were not associated with increased risk. Conclusions: Post-transplant UTIs in Atlántico were characterized by high antimicrobial resistance and reduced renal function, but did not affect graft survival. Antimicrobial stewardship and institutional optimization strategies are essential to improve outcomes in this vulnerable population. Full article

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7 pages, 205 KB

Open AccessEditor’s ChoiceCase Report

Asparaginase Hypersensitivity Reactions in NK/T-Cell Lymphomas

by Javier Varela Gonzalez-Aller, Pablo Nadal, Salome Cañizares, Carmen Muñoz, Anna Valer, Eva Gonzalez-Barca, Eva Domingo, Ana Sureda and Silvana Novelli

Clin. Pract. 2025, 15(11), 211; https://doi.org/10.3390/clinpract15110211 - 17 Nov 2025

Cited by 1 | Viewed by 1081

Abstract

Background/Objectives: Asparaginase (ASP)-based chemotherapy has substantially improved clinical outcomes in Epstein–Barr virus (EBV)-positive NK/T-cell lymphomas (NKTCL). However, as a bacterial-derived enzyme, ASP is frequently associated with immune-mediated adverse events, particularly hypersensitivity reactions (HSRs), which may compromise both treatment efficacy and patient safety. [...] Read more.

Background/Objectives: Asparaginase (ASP)-based chemotherapy has substantially improved clinical outcomes in Epstein–Barr virus (EBV)-positive NK/T-cell lymphomas (NKTCL). However, as a bacterial-derived enzyme, ASP is frequently associated with immune-mediated adverse events, particularly hypersensitivity reactions (HSRs), which may compromise both treatment efficacy and patient safety. This report presents a case of an ASP-related HSR and reviews the incidence within our institutional cohort. Detailed Case Description: A 60-year-old female presented an immediate Grade 2 HSR during her second PEG-asparaginase infusion, with pruritus, vomiting, and presyncope. The infusion was discontinued, and she was subsequently transitioned to crisantaspase—an alternative formulation—which was well tolerated without further adverse events. She remains disease-free to date. A retrospective review of institutional records (2015–2025) identified six patients with NKTCL treated with ASP-containing chemotherapy. The incidence of HSRs in this cohort was 1 of 6 (16.7%). Conclusions: As in acute lymphoblastic leukemia, HSRs to asparaginase remains a major challenge in the management of NKTCL with potential implications for treatment safety and efficacy. The establishment of standardized, consensus-based criteria for the diagnosis, classification, and management of ASP-related HSRs is urgently needed to optimize patient outcomes. Full article

9 pages, 1050 KB

Open AccessEditor’s ChoiceArticle

Impact of an Artificial Intelligence-Guided Pulmonary Embolism Response Team (AIPERT) on Patient Transfers, Diagnosis, and Management: A Healthcare System Experience

by Akhil Khosla, Inderjit Singh, Jeffrey Pollak and Hamid Mojibian

Clin. Pract. 2025, 15(11), 207; https://doi.org/10.3390/clinpract15110207 - 13 Nov 2025

Cited by 1 | Viewed by 1011

Abstract

Background: Pulmonary embolism (PE) is a time-sensitive condition with variable clinical presentations and outcomes. Rapid risk stratification and appropriate triage are essential for optimizing treatment and patient outcomes. Artificial intelligence (AI) offers an opportunity to enhance clinical decision-making, yet its real-world applications remain [...] Read more.

Background: Pulmonary embolism (PE) is a time-sensitive condition with variable clinical presentations and outcomes. Rapid risk stratification and appropriate triage are essential for optimizing treatment and patient outcomes. Artificial intelligence (AI) offers an opportunity to enhance clinical decision-making, yet its real-world applications remain limited. Objective: The objective of this study was to describe a single healthcare system’s implementation and early experience with an AI-enabled triage tool for pulmonary embolism patients across a multi-hospital network. Methods: This retrospective observational study evaluated the deployment of an AI-based clinical decision support system within a healthcare network. The AI tool detected PE and right ventricular (RV) strain and alerted the PE response team (PERT) to facilitate timely transfer and intervention. Three cohorts were evaluated: pre-AI, Year 1 post-AI, and Year 2 post-AI. Outcomes included transfer volumes, advanced therapy rates, and hospital length of stay (LOS). Results: A total of 183 PE transfer patients were analyzed: 36 pre-AI, 72 in Year 1 post-AI, and 75 in Year 2 post-AI. Transfers increased by 100% in Year 1 (p = 0.0005) and 108% in Year 2 (p = 0.011) compared to pre-AI. Catheter-based thrombectomy increased from 10 pre-AI to 18 in Year 1 (+80%, p < 0.0001) and 28 in Year 2 (+180%, p = 0.0006). After-hours diagnosis rose from 69.4% pre-AI to 70.8% in Year 1 (p = 0.027) and 77.3% in Year 2 (p = 0.088). Surgical embolectomy showed a borderline increase in Year 2 (p = 0.04), though case numbers were small. Conclusions: Implementation of an AI-assisted triage platform for PE was associated with sustained increases in interhospital transfers and advanced interventions, and a reduction in hospital length of stay. These findings support the potential for AI to standardize and expedite acute PE care in a multi-hospital health system. Full article

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14 pages, 426 KB

Open AccessEditor’s ChoiceArticle

Determinants of Patient Satisfaction with Vascular Access in Hemodialysis: Insights from a Multicenter Study in Italy

by Vincenzo Andretta, Marco Cascella, Alexia Cerrone, Angela Prendin, Antonio Mastrangelo and Valentina Cerrone

Clin. Pract. 2025, 15(11), 203; https://doi.org/10.3390/clinpract15110203 - 31 Oct 2025

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Abstract

Background: Vascular access is a very important element for patients on chronic hemodialysis treatment, but it is also a major source of complications, often compromising patients’ quality of life. Arteriovenous fistulas (AVFs) are preferred for their durability, but complications such as edema, bruising, [...] Read more.

Background: Vascular access is a very important element for patients on chronic hemodialysis treatment, but it is also a major source of complications, often compromising patients’ quality of life. Arteriovenous fistulas (AVFs) are preferred for their durability, but complications such as edema, bruising, cannulation pain, and hygiene concerns can affect patient satisfaction. Aim: We aimed to evaluate patient satisfaction with vascular access and to identify the clinical and sociodemographic factors influencing this satisfaction. Methods: We conducted a multicenter cross-sectional study on 235 hemodialysis patients in Italy. Satisfaction was assessed using the Short Form Vascular Access Questionnaire (SF-VAQ). Clinical and sociodemographic data were collected and analyzed with descriptive statistics, correlations, and multivariate regression models. Results: Satisfaction was significantly influenced by local complications, perceived hygiene, and access duration. Lower satisfaction was reported by patients with swelling, bruising, or negative hygiene perceptions. Longer use of the access was also associated with declining satisfaction. Conclusions: Patient satisfaction involves both clinical outcomes and patient perceptions. The integration of patient-reported outcomes (PROs) into vascular access management can help clinicians identify early dissatisfaction and implement interventions that can improve treatment adherence and quality of life. Full article

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14 pages, 993 KB

Open AccessEditor’s ChoiceArticle

Outcomes Following Surgery for Pancreatic Neuro-Endocrine Tumours: A Single-Centre Experience

by Mina Fouad, Sayed Ali Almahari, Abed Moeti Zaitoun, Prithvirao Sonoo, Sepand Malek, Karim Sourial and Dhanny Gomez

Clin. Pract. 2025, 15(11), 202; https://doi.org/10.3390/clinpract15110202 - 30 Oct 2025

Viewed by 978

Abstract

Aims: The purpose of this study was to evaluate survival outcomes and recurrence patterns following curative-intent resection of pancreatic neuroendocrine tumours (PNETs) at a UK tertiary centre. The secondary aims included identifying prognostic clinicopathological factors that influenced survival. Methods: Patients undergoing curative-intent surgical [...] Read more.

Aims: The purpose of this study was to evaluate survival outcomes and recurrence patterns following curative-intent resection of pancreatic neuroendocrine tumours (PNETs) at a UK tertiary centre. The secondary aims included identifying prognostic clinicopathological factors that influenced survival. Methods: Patients undergoing curative-intent surgical resection for PNETs between August 2010 and March 2024 were retrospectively reviewed. The data collated included demographics, histopathology, recurrence, and survival outcomes. Results: Eighty-six patients were included, with a median age of 61.5 years (IQR: 50–71) and an equal sex distribution. Most tumours were solitary (88.4%) and located in the pancreatic tail (57%), with distal pancreatectomy performed in 75% of cases. The median tumour size was 25 mm (IQR: 13–40). Lymph node metastases were observed in 23.3% of patients, and R0 resection was achieved in 67%. Most of the PNETs resected were WHO grade 1 tumours (65.1%), followed by grade 2 tumours (26.7%). Postoperative morbidity occurred in 37.2% of cases, while the 30-day postoperative mortality rate was 1.5%. Recurrence was observed in 13.95% of patients, with a median time to recurrence of 36.3 months. The 5-year overall survival (OS) was 83.0%, with a median OS and disease-free survival (DFS) of 143.3 months and 147.0 months, respectively. Multivariable analysis revealed that poorer DFS was associated with larger tumours (p = 0.009), higher tumour grade (p = 0.006), male sex (p = 0.039), vascular invasion (p = 0.003), perineural invasion (p = 0.042) and lymph node metastases (p = 0.015). OS was significantly influenced by the Charlson Comorbidity Index (p < 0.001) and tumour grade (p = 0.025). Conclusions: PNETs are associated with excellent long-term survival following curative-intent resection. However, adverse pathological features are linked to an increased risk of recurrence and a poorer prognosis. Full article

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17 pages, 1610 KB

Open AccessEditor’s ChoiceArticle

Advancing Toward P6 Medicine: Recommendations for Integrating Artificial Intelligence in Internal Medicine

by Ismael Said-Criado, Filomena Pietrantonio, Marco Montagna, Francesco Rosiello, Oleg Missikoff, Carlo Drago, Tiffany I. Leung, Antonio Vinci, Alessandro Signorini and Ricardo Gómez-Huelgas

Clin. Pract. 2025, 15(11), 200; https://doi.org/10.3390/clinpract15110200 - 29 Oct 2025

Cited by 1 | Viewed by 1663

Abstract

Background: Internists formulate diagnostic hypotheses and personalized treatment plans by integrating data from a comprehensive clinical interview, reviewing a patient’s medical history, physical examination and findings from complementary tests. The patient treatment life cycle generates a significant volume of data points that can [...] Read more.

Background: Internists formulate diagnostic hypotheses and personalized treatment plans by integrating data from a comprehensive clinical interview, reviewing a patient’s medical history, physical examination and findings from complementary tests. The patient treatment life cycle generates a significant volume of data points that can offer valuable insights to improve patient care by guiding clinical decision-making. Artificial Intelligence (AI) and, in particular, Generative AI (GAI), are promising tools in this regard, particularly after the introduction of Large Language Models. The European Federation of Internal Medicine (EFIM) recognizes the transformative impact of AI in leveraging clinical data and advancing the field of internal medicine. This position paper from the EFIM explores how AI can be applied to achieve the goals of P6 Medicine principles in internal medicine. P6 Medicine is an advanced healthcare model that extends the concept of Personalized Medicine toward a holistic, predictive, patient-centered approach that also integrates psycho-cognitive and socially responsible dimensions. An additional concept introduced is that of Digital Therapies (DTx), software applications designed to prevent and manage diseases and disorders through AI, which are used in the clinical setting if validated by rigorous research studies. Methods: The literature examining the relationship between AI and Internal Medicine was investigated through a bibliometric analysis. The themes identified in the literature review were further examined through the Delphi method. Thirty international AI and Internal Medicine experts constituted the Delphi panel. Results: Delphi results were summarized in a SWOT Analysis. The evidence is that through extensive data analysis, diagnostic capacity, drug development and patient tracking are increased. Conclusions: The panel unanimously considered AI in Internal Medicine as an opportunity, achieving a complete consensus on the matter. AI-driven solutions, including clinical applications of GAI and DTx, hold the potential to strongly change internal medicine by streamlining workflows, enhancing patient care and generating valuable data. Full article

(This article belongs to the Topic Artificial Intelligence in Public Health: Current Trends and Future Possibilities, 2nd Edition)

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11 pages, 1053 KB

Open AccessEditor’s ChoiceArticle

Changing Tides in the Treatment of Spondylodiscitis? A Retrospective, Monocentric Comparison of Mortality and Quality of Life After Surgical and Conservative Treatment

by Victoria Buschmann, Erik Wegner, Daniel Wagner, Alexander N. Wartensleben, Philipp Drees, Stefan Mattyasovszky and Tobias Nowak

Clin. Pract. 2025, 15(11), 198; https://doi.org/10.3390/clinpract15110198 - 29 Oct 2025

Viewed by 698

Abstract

Background: The increasing incidence of spondylodiscitis and its potentially severe consequences when not promptly diagnosed highlight the need for further research to improve treatment guidelines, reduce mortality and morbidity and improve the quality of life in patients who suffer from persistent physical limitations. [...] Read more.

Background: The increasing incidence of spondylodiscitis and its potentially severe consequences when not promptly diagnosed highlight the need for further research to improve treatment guidelines, reduce mortality and morbidity and improve the quality of life in patients who suffer from persistent physical limitations. Methods: We collected data from 103 patients, with 8 patients lost to follow-up, who were diagnosed with vertebral osteomyelitis, disk infection or discitis between 2009 and 2018. The primary outcome was the 1-year mortality rate in patients treated with either conservative or surgical intervention, with both groups receiving antibiotic treatment. A standardized questionnaire was used to assess health-related quality of life after treatment by evaluating the European Quality of Life 5 Dimension 5 Level version (EQ-5D-5L) and the European Quality of Life Visual Analog Scale (EQ-VAS). In addition, we used the Oswestry Disability Index (ODI) and the Parker Mobility Score to identify backpain-related limitations after treatment. Results: The group receiving surgical treatment had a significantly lower 1-year mortality rate (22%) than did those who were treated conservatively, who had a 4-fold greater risk for death after a year following first diagnosis of SD and treatment. With respect to quality of life, 39 patients answered the standardized questionnaires during follow-up, and the questionnaire results revealed no significant difference in limitations in daily life or in health-related quality of life, with a median Parker Mobility Score of 9 for the conservatively treated patients compared with 7.5 for the surgically treated patients. This difference between the groups was not statistically significant, with a p value of 0.216 > α. A similar result was obtained in the evaluation of the ODI, with a medial index of 30% in the conservatively treated group compared with 24% in the surgical group, which was not statistically significant as indicated by a p value of 0.360 > α. Conclusions: The early surgical approach when treating spondylodiscitis is advantageous for identifying the underlying infection and initiating appropriate antibiotic therapy, therefore reducing mortality and resulting in a greater likelihood of full recovery than the conservative treatment does. Full article

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2 pages, 146 KB

Open AccessEditor’s ChoiceReply

Reply to Haq et al. Comment on “Leivaditis et al. Artificial Intelligence in Cardiac Surgery: Transforming Outcomes and Shaping the Future. Clin. Pract. 2025, 15, 17”

by Vasileios Leivaditis, Eleftherios Beltsios, Athanasios Papatriantafyllou, Konstantinos Grapatsas, Francesk Mulita, Nikolaos Kontodimopoulos, Nikolaos G. Baikoussis, Levan Tchabashvili, Konstantinos Tasios, Ioannis Maroulis, Manfred Dahm and Efstratios Koletsis

Clin. Pract. 2025, 15(11), 196; https://doi.org/10.3390/clinpract15110196 - 27 Oct 2025

Cited by 1 | Viewed by 584

Abstract

We thank Haq and Khan for their thoughtful commentary [...] Full article

13 pages, 3122 KB

Open AccessEditor’s ChoiceArticle

Medical Professionals’ Opinions of and Attitudes Toward Uterus Transplantation in Hungary

by Kata Szilvia Papp, Peter Szakaly, Szilard Kolumban, Kálmán András Kovács, Jozsef Bodis, Nelli Farkas, Gabor Fazekas and Balint Farkas

Clin. Pract. 2025, 15(11), 194; https://doi.org/10.3390/clinpract15110194 - 25 Oct 2025

Viewed by 876

Abstract

Background: Uterus transplantation (UTx) is a proven treatment for individuals affected by absolute uterine factor infertility (AUFI) who desire biological motherhood. Despite the fact that over 130 procedures have been performed worldwide in the past decade, UTx remains relatively unfamiliar, even among [...] Read more.

Background: Uterus transplantation (UTx) is a proven treatment for individuals affected by absolute uterine factor infertility (AUFI) who desire biological motherhood. Despite the fact that over 130 procedures have been performed worldwide in the past decade, UTx remains relatively unfamiliar, even among healthcare professionals. This study aimed to identify knowledge gaps regarding and evaluate attitudes toward UTx among Hungarian obstetricians/gynecologists and transplantation providers, in anticipation of the first procedure to be performed in the country. Methods: A Microsoft Forms^® questionnaire was distributed electronically among Hungarian medical professionals via e-mail, including members of the Hungarian Society of Obstetrics and Gynaecology and the Hungarian Transplantation Society. Additionally, participants of the “Update 2024” OB/GYN conference (held 28–29 November 2024, in Visegrád, Hungary) were invited to complete the survey through a QR code displayed during the event. Results: A total of 290 medical professionals completed the survey (response rate: 27.6%, 290/1050). Most of the respondents specialized in obstetrics and gynecology (81.7%, n = 237), with the remainder representing transplantation fields (18.3%, n = 53). Over half (56.6%, n = 161) reported they would recommend UTx to patients with AUFI, and 64.1% (n = 186) agreed that UTx should be available as a treatment option. The medical risks associated with the procedure were deemed acceptable for both living donors (58.0%, n = 168) and recipients (54.8%, n = 159). Conclusions: This is the first study to explore perceptions of UTx among Hungarian medical professionals. The findings suggest there is a generally favorable professional attitude toward its future clinical implementation. Full article

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13 pages, 3076 KB

Open AccessEditor’s ChoiceArticle

Estimation of Kidney Volumes in Autosomal Dominant Polycystic Kidney Disease: A Comparison Between Manual Segmentation and Ellipsoid Formula

by Nicola Maggialetti, Claudia Dipalma, Eva Colucci, Ilaria Villanova, Giovanni Lorusso, Maria Grazia Arcidiacono, Giovanni Piscopo and Amato Antonio Stabile Ianora

Clin. Pract. 2025, 15(11), 191; https://doi.org/10.3390/clinpract15110191 - 23 Oct 2025

Viewed by 1418

Abstract

Objectives: Evaluate the agreement and interobserver variability between manual segmentation and the ellipsoid formula in estimating single kidney volume (SKV) in patients with autosomal dominant polycystic kidney disease (ADPKD). Methods: In this retrospective study, 130 unenhanced CT scans of ADPKD kidneys [...] Read more.

Objectives: Evaluate the agreement and interobserver variability between manual segmentation and the ellipsoid formula in estimating single kidney volume (SKV) in patients with autosomal dominant polycystic kidney disease (ADPKD). Methods: In this retrospective study, 130 unenhanced CT scans of ADPKD kidneys were analyzed. Three radiologists (one senior, two juniors) measured SKV using manual segmentation and the ellipsoid formula. Statistical analyses included intraclass correlation coefficient (ICC), Wilcoxon signed-rank test, Bland–Altman analysis, and paired t-tests to compare measurement values and computation times. Results: Both methods showed excellent interobserver agreement (ICC ≥ 0.977). No significant difference was observed in volume estimates between the two techniques (Wilcoxon p = 0.295). Bland–Altman analysis confirmed strong agreement between methods for the senior radiologist. The ellipsoid method was significantly faster for all readers (p < 0.05). Conclusions: The ellipsoid formula is a reliable, time-efficient alternative to manual segmentation for SKV estimation in ADPKD, offering comparable accuracy with reduced resource demands in clinical settings. Full article

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14 pages, 275 KB

Open AccessEditor’s ChoiceReview

Kidney and Pregnancy: A Comprehensive Review

by Luca Piscitani, Paolo Sipari, Lorenzo Ottavio Di Pietro, Sofia Bussolaro, Maurizio Guido and Ilaria Fantasia

Clin. Pract. 2025, 15(10), 189; https://doi.org/10.3390/clinpract15100189 - 20 Oct 2025

Viewed by 5467

Abstract

During pregnancy, a series of physiological changes occur in women, particularly affecting the cardiovascular system with significant hemodynamic alterations. Subsequently, this leads to renal adaptations manifesting through variations in glomerular filtration rate. This close interconnection between the heart and kidneys implies that issues [...] Read more.

During pregnancy, a series of physiological changes occur in women, particularly affecting the cardiovascular system with significant hemodynamic alterations. Subsequently, this leads to renal adaptations manifesting through variations in glomerular filtration rate. This close interconnection between the heart and kidneys implies that issues arising in one organ will disrupt this fundamental balance, inevitably involving all associated organs. The purpose of this review is to gather all possible nephrological conditions that may arise during pregnancy, as well as pre-existing conditions that may become apparent or worsen during this period. This review describes the natural history, treatment, and impact of these conditions on pregnancy itself. Among the most common conditions are preeclampsia and HELLP syndrome, severe complications characterized by hypertension, proteinuria, and multiorgan damage that require immediate clinical attention. Additionally, women with chronic kidney disease are at higher risk of developing maternal–fetal complications, such as preterm birth and intrauterine growth restriction. Common causes of acute renal failure are also analyzed, including thrombotic microangiopathy, acute fatty liver of pregnancy, acute onset or flare of systemic lupus erythematosus, and catastrophic antiphospholipid antibody syndrome. Given the importance of proper renal function during pregnancy, it is essential to have a thorough understanding of nephrological diseases that may affect this phase of women’s lives. This knowledge is crucial for managing these conditions effectively to avoid risks to the survival of both the mother and the newborn. Full article

23 pages, 464 KB

Open AccessEditor’s ChoiceArticle

Temporal Evolution of the Profile of Patients Hospitalized with Heart Failure (2000–2022)

by Teresa Seoane-Pillado, Roi Suárez-Gil, Sonia Pértega-Díaz, Juan Carlos Piñeiro-Fernández, Elena Rodriguez-Ameijeiras and Emilio Casariego-Vales

Clin. Pract. 2025, 15(10), 187; https://doi.org/10.3390/clinpract15100187 - 16 Oct 2025

Viewed by 689

Abstract

Background: The clinical characteristics of patients who have a first episode of congestive heart failure (CHF) may have changed in recent years. Methods: A retrospective cohort study was performed on 19,796 patients discharged from medical departments with a diagnosis of CHF between 1 [...] Read more.

Background: The clinical characteristics of patients who have a first episode of congestive heart failure (CHF) may have changed in recent years. Methods: A retrospective cohort study was performed on 19,796 patients discharged from medical departments with a diagnosis of CHF between 1 January 2000 and 31 December 2022. Data were drawn from two data sets of the Minimum Basic Data Set-Hospital Data Set (MBDS) of the Lucus Augusti University Hospital (Spain): hospitalizations and patients. Patient characteristics (including the period of their first admission) and the association rules between diseases determined using the Apriori algorithm were studied in five consecutive time periods. Results: The general characteristics of patients on first admission for CHF changed over time. There were increases in mean age (75.9 ± SD 11.2 vs. 81.6 ± SD 11.5 years; p < 0.0001), the proportion of women (48.3% vs. 51.4; p = 0.0001), the number of acute diseases (1.1 ± SD 1.4 to 2.7 ± SD 2.5; p < 0.0001), and the number of chronic diseases (3.6 ± SD 1.9 to 6.5 ± SD 2.6); p < 0.001). Accordingly, the median number of diagnoses (from 3 to 7) and itemsets per patient increased (mean number of items 1.75 vs. 3.4; p < 0.0001), and the associations of diseases leading to CHF became more complex. Conclusions: This single-center study shows that in the last two decades, the characteristics of patients with a first hospital admission for CHF have changed. Patients are older, there is a predominance of women, and they have a greater number of acute and chronic concomitant diseases, making their clinical management more difficult. Full article

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8 pages, 213 KB

Open AccessEditor’s ChoiceArticle

Impact of a Nutrition Protocol on Vitamin D Supplementation in a Pediatric Intensive Care Unit: A Retrospective Cohort Study

by Maria Pérez Marin, Vivianne Chanez, Guillaume Maitre, Laurence Boillat, Frida Rizzati, Pauline Lauwers and Maria-Helena Perez

Clin. Pract. 2025, 15(10), 186; https://doi.org/10.3390/clinpract15100186 - 13 Oct 2025

Viewed by 937

Abstract

Background: Vitamin D deficiency (VDD) is highly prevalent in pediatric critically ill patients and is a potentially modifiable risk factor during critical illness. There are no established national or international recommendations for vitamin D supplementation in Pediatric Intensive Care Unit (PICU) patients. Objectives: [...] Read more.

Background: Vitamin D deficiency (VDD) is highly prevalent in pediatric critically ill patients and is a potentially modifiable risk factor during critical illness. There are no established national or international recommendations for vitamin D supplementation in Pediatric Intensive Care Unit (PICU) patients. Objectives: This monocentric study aims to compare the practices regarding vitamin D supplementation before and after the introduction of a nutrition protocol (NP). Methods: We retrospectively analyzed vitamin D administration (time from PICU admission to initiation, amount of supplementation, accordance with existing guidelines) in children aged 0 to 16 who were admitted to the PICU of Lausanne University Hospital for more than 48 h the year before and the year after the introduction of a NP. Results: Vitamin D supplementation increased after NP introduction (95 IU per day more, p < 0.0001). More patients received vitamin D during their stay (95% after vs. 77% before, p < 0.0001). The dose adhered to NP recommendations for children under 12 and was higher for older children. According to Swiss guidelines for the general pediatric population, vitamin D supplementation was accurate in children under one year old before and after NP implementation. However, it was less than recommended for patients over one year old. Conclusions: The implementation of a NP significantly enhanced the scope of vitamin D supplementation. This study also highlights the practical limitations in meeting the recommended requirements with certain galenic formulations. Full article

15 pages, 514 KB

Open AccessEditor’s ChoiceReview

Treating Temporomandibular Disorders Through Orthodontics: A Scoping Review of Evidence, Gaps, and Clinical Guidance

by Man Hung, Jacob Daniel Gardner, Samantha Lee, Wendy C. Birmingham, Richard M. Stevens, Connor Schwartz, Nader Karimi and Amir Mohajeri

Clin. Pract. 2025, 15(10), 182; https://doi.org/10.3390/clinpract15100182 - 30 Sep 2025

Viewed by 3713

Abstract

Introduction: Evidence on orthodontic interventions for temporomandibular disorders (TMD) is fragmented and inconclusive, creating a gap in guidance for clinical decision-making. This study addresses that gap by evaluating current knowledge on these interventions. Methods: A PRISMA-ScR scoping review was conducted with a systematic [...] Read more.

Introduction: Evidence on orthodontic interventions for temporomandibular disorders (TMD) is fragmented and inconclusive, creating a gap in guidance for clinical decision-making. This study addresses that gap by evaluating current knowledge on these interventions. Methods: A PRISMA-ScR scoping review was conducted with a systematic search of PubMed, Scopus, and Web of Science (2018–2023). Eligible studies were peer-reviewed, English-language, human studies examining TMD treatment and/or etiology. Three independent reviewers screened records and extracted data and a fourth reviewer performed random audits. Results: Of 899 records, 10 studies met inclusion criteria (non-surgical, n = 7: 4 case reports, 2 prospective, 1 longitudinal; combined orthodontic–surgical, n = 3: 1 case report, 2 longitudinal; participant ages 15–71 years). Diagnostics included imaging, clinical examination, occlusal analysis, and questionnaires, although few used RDC/TMD or DC/TMD criteria. Non-surgical orthodontic modalities (fixed appliances, camouflage, TADs, stabilization splints) showed mixed results, with several studies reporting short-term symptom improvement, while others found no effect on TMD onset or progression. Combined orthodontic–surgical approaches (e.g., bilateral sagittal split osteotomy, Le Fort I) also showed variable outcomes. Conclusions: Low-to-moderate quality evidence suggests that orthodontic-surgical interventions may alleviate TMD symptoms in select patients; however, heterogeneity and limited use of standardized diagnostics constrain the certainty of these findings. Future research should prioritize DC/TMD-based diagnostics, core outcomes, comparative designs, and ≥12–24 months of follow-up to identify prognostic factors and responsive subgroups. Full article

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14 pages, 1188 KB

Open AccessEditor’s ChoiceSystematic Review

The Effects of Physical Exercise on Depression and Anxiety in Cancer Patients: A Systematic Review

by Giacomo Farì, Annatonia Fai, Francesco Quarta, Morena Pitruzzella, Cristiano Sconza, Matteo Luigi Giuseppe Leoni, Giustino Varrassi, Marco Filipponi, Giuseppe Rollo, Alessio Baricich and Andrea Bernetti

Clin. Pract. 2025, 15(10), 180; https://doi.org/10.3390/clinpract15100180 - 28 Sep 2025

Cited by 1 | Viewed by 2733

Abstract

Background: Depression affects around 280 million people globally and is one of the main causes of disability. Among people with cancer, depression and anxiety affect 20–25%, significantly reducing quality of life, adherence to treatments, and survival. Despite the availability of pharmacological and [...] Read more.

Background: Depression affects around 280 million people globally and is one of the main causes of disability. Among people with cancer, depression and anxiety affect 20–25%, significantly reducing quality of life, adherence to treatments, and survival. Despite the availability of pharmacological and psychological treatments, their application can be limited by side effects, accessibility, and costs—especially in low- and middle-income countries. Physical exercise is emerging as a valuable complementary strategy, improving both physical and mental well-being. Nevertheless, structured exercise programs are still rarely implemented in oncology. This review aims to provide evidence-based recommendations for integrating physical activity into mental health support for people with cancer. Methods: This review includes six randomized controlled trials (RCTs) evaluating physical exercise interventions for depression and anxiety in people with cancer aged over 18 years. Included studies compared exercise interventions to control or standard care and reported outcomes related to psychological well-being and adverse effects. Exclusion criteria included non-original studies, non-English articles, and works not focused on exercise. The search was conducted in PubMed, Scopus, Google Scholar, and the Cochrane Library using MeSH terms and Boolean operators. The review protocol was registered in PROSPERO (CRD42025637522). Results: Exercise interventions—such as aerobic, resistance, and mind–body practices—proved effective and feasible across cancer types. Benefits were seen in both psychological and physical outcomes. However, variations in protocols and outcome measures, as well as a lack of long-term data, limit generalizability. Conclusions: Personalized exercise programs can significantly reduce depression and anxiety in people with cancer. Standardized core methods, long-term research, and systemic support are needed to integrate exercise into routine oncology care. Full article

(This article belongs to the Special Issue Exercise and Sports for Chronic Diseases)

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36 pages, 2093 KB

Open AccessEditor’s ChoiceReview

Serum Sickness-Like Reaction: A Narrative Review of Epidemiology, Immunopathogenesis, Diagnostic Challenges, and Therapeutic Approaches

by Christodoulos Chatzigrigoriadis, Emmanouil Koufopoulos, Prodromos Avramidis, Ioannis Erginousakis, Vasiliki Karakoida, Theofanis Papadopoulos, Despoina Sperdouli, Myrsini-Eirini Tachliabouri, Kyriakos Vilanakis, Dimitrios Zampounidis, Vasiliki Michou, Panagiotis Eskitzis, Panagis Galiatsatos, Lazaros Lavasidis and Doxakis Anestakis

Clin. Pract. 2025, 15(10), 178; https://doi.org/10.3390/clinpract15100178 - 26 Sep 2025

Cited by 2 | Viewed by 7706

Abstract

Serum sickness-like reaction (SSLR) is a rare immune-mediated condition that typically affects the skin and joints after exposure to certain drugs, infections, or vaccines. Although it shares clinical similarities with serum sickness (SS), SSLR differs in its underlying mechanisms, histopathology, and causes. Despite [...] Read more.

Serum sickness-like reaction (SSLR) is a rare immune-mediated condition that typically affects the skin and joints after exposure to certain drugs, infections, or vaccines. Although it shares clinical similarities with serum sickness (SS), SSLR differs in its underlying mechanisms, histopathology, and causes. Despite its generally benign and self-limiting nature, SSLR is frequently misdiagnosed and may lead to unnecessary hospitalization. This narrative review summarizes current knowledge on epidemiology, pathophysiology, clinical features, diagnosis, treatment, and long-term considerations related to SSLR. The condition is most often associated with antibiotics, monoclonal antibodies, and vaccines, particularly in pediatric populations. Its pathogenesis remains incompletely understood, but proposed mechanisms include immune complex formation, altered drug metabolism, lymphocyte toxicity, and the development of anti-drug antibodies. Diagnosis is primarily clinical, although novel diagnostic tools are emerging. Management involves discontinuation of the offending agent and supportive care, such as antihistamines or nonsteroidal anti-inflammatory drugs (NSAIDs) in mild cases, and corticosteroids in more severe cases. Long-term management, especially in cases requiring potential re-exposure to the causative agent, remains challenging. Skin testing and graded oral challenges appear promising within a structured clinical framework. Increased awareness of SSLR is essential for timely recognition and appropriate care, and further research is needed to elucidate its mechanisms and inform evidence-based management strategies. Full article

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12 pages, 627 KB

Open AccessEditor’s ChoiceArticle

Gender-Pain Questionnaire: Internal Validation of a Scale for Assessing the Influence of Chronic Pain Experience on Gender Identity and Roles

by Ana M. Peiró, Noelia Serrano-Gadea, Daniel García-Torres, María Teresa Ruiz-Cantero and Virtudes Pérez-Jover

Clin. Pract. 2025, 15(10), 176; https://doi.org/10.3390/clinpract15100176 - 25 Sep 2025

Viewed by 1148

Abstract

Background/Objectives: Gender (roles as household load and job strain, and identity) represent an effect modifier of the interference between pain experience and sex because it is different between men and women. This study validates a new scale developed to assess how life functioning [...] Read more.

Background/Objectives: Gender (roles as household load and job strain, and identity) represent an effect modifier of the interference between pain experience and sex because it is different between men and women. This study validates a new scale developed to assess how life functioning is impacted by Chronic Non-Cancer Pain (CNCP) due to gender. Methods: A total of 193 Spanish ambulatory CNCP patients (60 [51–73] years old, 69.4% women, 31% retired) were interviewed. Exploratory Factor Analysis (EFA) yielded 3-factor structure: Gender Self-identity, Roles, and Chronic Pain Impact on Social, Familial, Work and Sexual Life. Results: The Gender-Pain Questionnaire, with the presented factor structure, is an evaluation instrument with enough reliability and internal validity for CNCP patients. Conclusions: This study presents the psychometric properties of a scale for assessing the interference of CNCP patients’ experience on gender and how it affects their daily life activities, relationships and self-identity. It represents the first original questionnaire known in Spanish language to date. This measure could potentially help researchers and clinicians to obtain gender key information to design appropriate and equity healthcare interventions. Full article

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