Clinics and Practice

21 pages, 1691 KiB

Open AccessEditor’s ChoiceArticle

The Connection Between Depression and Ischemic Heart Disease: Analyzing Demographic Characteristics, Risk Factors, Symptoms, and Treatment Approaches to Identify Their Relationship

by Laura Ioana Bondar, Brigitte Osser, Gyongyi Osser, Mariana Adelina Mariș, Ligia Elisaveta Piroș, Robert Almășan, Csongor Toth, Caius Calin Miuta, Gabriel Roberto Marconi, Ana-Liana Bouroș-Tataru, Victor Măduța, Dana Tăședan and Mircea Ioachim Popescu

Clin. Pract. 2024, 14(5), 2166-2186; https://doi.org/10.3390/clinpract14050171 - 17 Oct 2024

Cited by 6 | Viewed by 2062

Abstract

Background: This study investigates the association between depression and ischemic heart disease (IHD), conditions that often coexist and complicate patient management. Understanding the impact of demographic factors, risk factors, symptoms, and medical approaches in these patients is essential to develop effective clinical strategies. [...] Read more.

Background: This study investigates the association between depression and ischemic heart disease (IHD), conditions that often coexist and complicate patient management. Understanding the impact of demographic factors, risk factors, symptoms, and medical approaches in these patients is essential to develop effective clinical strategies. Objectives: The aim of this study is to investigate how demographic characteristics, risk factors, symptoms, and treatment methods differ between patients with depression alone and those with both depression and IHD. It seeks to identify how these factors influence patient outcomes, providing insights to improve management and treatment approaches for this complex patient group. Materials and Methods: This cross-sectional study included a sample of 332 patients diagnosed with depression, with a specific subgroup consisting of individuals who also had comorbid IHD. Statistical analyses were performed to compare the patients with depression, focusing on those with IHD. Data on demographic characteristics (e.g., gender, environment, social status), risk factors (e.g., hypertension, diabetes), symptom severity, and treatments (e.g., antidepressants, antipsychotics, anxiolytics, hypnotics) were analyzed. The study also evaluated the frequency of cardiac examinations and emergency hospitalizations. Results: Significant demographic differences were found between the two groups. Patients with both depression and IHD had higher rates of hypertension and diabetes mellitus and experienced more severe depressive symptoms, including reduced mood, energy, and activity levels. The treatment patterns were similar in terms of antidepressant use, but the IHD group had a higher use of antipsychotics, anxiolytics, and hypnotics. Additionally, these patients required more cardiac examinations and emergency hospitalizations. Conclusions: Comorbidity between depression and IHD presents complex clinical challenges, and it is crucial to implement an integrated management approach that addresses both mental and physical health. This study highlights the need for comprehensive therapeutic strategies to improve the quality of life and outcomes for patients with these coexisting conditions. Full article

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12 pages, 258 KiB

Open AccessEditor’s ChoiceArticle

Effect of Treatment of Neuropathic and Ischemic Diabetic Foot Ulcers with the Use of Local Ozone Therapy Procedures—An Observational Single Center Study

by Jarosław Pasek, Sebastian Szajkowski and Grzegorz Cieślar

Clin. Pract. 2024, 14(5), 2139-2150; https://doi.org/10.3390/clinpract14050169 - 16 Oct 2024

Cited by 2 | Viewed by 1619

Abstract

Background: Diabetes ranks high among worldwide global health problems, and diabetic foot ulcer syndrome (DFU) is considered as one of its most serious complications. The purpose of this study was to evaluate the impact of local ozone therapy procedures on the wound healing [...] Read more.

Background: Diabetes ranks high among worldwide global health problems, and diabetic foot ulcer syndrome (DFU) is considered as one of its most serious complications. The purpose of this study was to evaluate the impact of local ozone therapy procedures on the wound healing process in patients with two DFU types: neuropathic and ischemic. Material and Methods: In the retrospective study reported here, the treatment outcomes of 90 patients were analyzed: 44 males (48.8%) and 46 females (51.2%), in the age range between 38 and 87 years of age, with neuropathic (group 1) and ischemic (group 2) diabetic foot ulcers treated by means of local ozone therapy. The assessment of therapeutic effects in both groups of patients included an analysis of the rate of ulcer healing using planimetry and an analysis of the intensity of pain associated with ulcers performed using the VAS scale. Results: After the application of ozone therapy procedures, a statistically significant decrease in the surface area of the ulcers was obtained in both groups of patients, respectively: in group 1 from 7 (6–7.5) cm² to 3 (2–3.5) cm² and in group 2 from 7.5 (6.5–8) cm² to 5 (4.5–5.5) cm² (p < 0.001), with a complete healing of ulcers not observed in any patients from groups 1 and 2. After treatment, the surface area of the assessed ulcers was smaller in the neuropathic group. The intensity of pain experienced after treatment also decreased with statistical significance in both groups (p < 0.001). Conclusions: Short-term local ozone therapy was effective in promoting wound healing and alleviating pain in patients with DFUs of both neuropathic and ischemic etiology. The effectiveness of therapy in the neuropathic type of DFUs was significantly higher than in the ischemic type, in which patients had a higher incidence of risk factors and more advanced lesions, characterized by a larger initial ulcer area and greater intensity of pain. Full article

15 pages, 1893 KiB

Open AccessEditor’s ChoiceArticle

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

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

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

Viewed by 3970

Abstract

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

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

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

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9 pages, 15974 KiB

Open AccessEditor’s ChoiceCase Report

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

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

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

Cited by 1 | Viewed by 2115

Abstract

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

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

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

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13 pages, 287 KiB

Open AccessEditor’s ChoiceArticle

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

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

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

Cited by 2 | Viewed by 1551

Abstract

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

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

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

17 pages, 282 KiB

Open AccessEditor’s ChoiceReview

Thoracic Trauma: Current Approach in Emergency Medicine

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

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

Cited by 3 | Viewed by 4805

Abstract

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

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

9 pages, 2967 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 3 | Viewed by 1388

Abstract

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

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

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14 pages, 917 KiB

Open AccessEditor’s ChoiceArticle

An Increase in Aspartate Aminotransferase Can Predict Worsening Disease Severity in Japanese Patients with COVID-19

by Kengo Matsumoto, Tsutomu Nishida, Dai Nakamatsu, Masashi Yamamoto, Koji Fukui, Osamu Morimura, Kinya Abe, Yukiyoshi Okauchi, Hiromi Iwahashi and Masami Inada

Clin. Pract. 2024, 14(4), 1601-1614; https://doi.org/10.3390/clinpract14040129 - 20 Aug 2024

Cited by 1 | Viewed by 1367

Abstract

Background: The prognostic significance of liver dysfunction in COVID-19 patients remains unclear. In this study, we investigated the association between liver function test results and severe disease progression in COVID-19 patients. Methods: This retrospective study included consecutive Japanese COVID-19 patients admitted between February [...] Read more.

Background: The prognostic significance of liver dysfunction in COVID-19 patients remains unclear. In this study, we investigated the association between liver function test results and severe disease progression in COVID-19 patients. Methods: This retrospective study included consecutive Japanese COVID-19 patients admitted between February 2020 and July 2021. Predictive variables for severe disease progression were identified by multivariate logistic regression analysis. Severe disease-free survival was estimated with the Kaplan–Meier method and Cox regression analysis. Aspartate aminotransferase (AST) was divided into three grades: grade 1, AST < 30 U/L; grade 2, 30 U/L ≤ AST < 60 U/L; and grade 3, AST > 60 U/L. Results: Among 604 symptomatic patients, 141 (23.3%) developed severe disease at a median of 2 days postadmission. The median hospital stay was 10 days, and 43 patients (7.1%) died during hospitalization. Multivariate regression analysis revealed that hypertension, decreased lymphocyte count, and elevated LDH, CRP, and AST levels (grade 2 and grade 3 relative to grade 1) were the significant predictive variables. Severe disease-free survival time was significantly different between the different AST grades (hazard ratio (HR): grade 2 vs. grade 1, 4.07 (95% confidential interval (CI): 2.06–8.03); grade 3 vs. grade 1, 7.66 (95% CI: 3.89–15.1)). Conclusions: The AST level at admission was an independent risk factor for severe disease in hospitalized Japanese patients with COVID-19. Full article

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8 pages, 456 KiB

Open AccessEditor’s ChoiceArticle

Leveraging Generative Artificial Intelligence Models in Patient Education on Inferior Vena Cava Filters

by Som P. Singh, Aleena Jamal, Farah Qureshi, Rohma Zaidi and Fawad Qureshi

Clin. Pract. 2024, 14(4), 1507-1514; https://doi.org/10.3390/clinpract14040121 - 30 Jul 2024

Cited by 3 | Viewed by 1208

Abstract

Background: Inferior Vena Cava (IVC) filters have become an advantageous treatment modality for patients with venous thromboembolism. As the use of these filters continues to grow, it is imperative for providers to appropriately educate patients in a comprehensive yet understandable manner. Likewise, [...] Read more.

Background: Inferior Vena Cava (IVC) filters have become an advantageous treatment modality for patients with venous thromboembolism. As the use of these filters continues to grow, it is imperative for providers to appropriately educate patients in a comprehensive yet understandable manner. Likewise, generative artificial intelligence models are a growing tool in patient education, but there is little understanding of the readability of these tools on IVC filters. Methods: This study aimed to determine the Flesch Reading Ease (FRE), Flesch–Kincaid, and Gunning Fog readability of IVC Filter patient educational materials generated by these artificial intelligence models. Results: The ChatGPT cohort had the highest mean Gunning Fog score at 17.76 ± 1.62 and the lowest at 11.58 ± 1.55 among the Copilot cohort. The difference between groups for Flesch Reading Ease scores (p = 8.70408 × 10⁻⁸) was found to be statistically significant albeit with priori power found to be low at 0.392. Conclusions: The results of this study indicate that the answers generated by the Microsoft Copilot cohort offers a greater degree of readability compared to ChatGPT cohort regarding IVC filters. Nevertheless, the mean Flesch–Kincaid readability for both cohorts does not meet the recommended U.S. grade reading levels. Full article

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18 pages, 530 KiB

Open AccessEditor’s ChoiceReview

How to Evaluate the Efficacy of Manipulations in Spine Disorders—A Comprehensive Review of New and Traditional Outcome Measures

by Giacomo Farì, Carlo Mariconda, Laura Dell’Anna, Francesco Quarta, Danilo Donati, Cristiano Sconza, Vincenzo Ricci, Giustino Varrassi, Valeria Coco, Alessandro Manelli, Ennio Spadini, Maria Teresa Giglio and Andrea Bernetti

Clin. Pract. 2024, 14(4), 1478-1495; https://doi.org/10.3390/clinpract14040119 - 29 Jul 2024

Cited by 1 | Viewed by 1381

Abstract

Spine pain (SP) is the most common musculoskeletal disorder that causes transitional forms of motor disability. Considering its affordability and safety, manipulative therapy (MT) stands as one of the primary therapeutic approaches for SP and the related dysfunctional consequences. However, it is still [...] Read more.

Spine pain (SP) is the most common musculoskeletal disorder that causes transitional forms of motor disability. Considering its affordability and safety, manipulative therapy (MT) stands as one of the primary therapeutic approaches for SP and the related dysfunctional consequences. However, it is still difficult to assess and quantify the results of this treatment since there is a lack of objective evaluation tools in the available scientific literature. Thus, the purpose of this comprehensive review is to summarize the main outcomes used to evaluate the effectiveness of spine manipulations, focusing on their strengths and weaknesses. An extensive review of the PubMed, Cochrane, and Embase databases was performed to identify the literature of the last ten years regarding MT and the related assessment tools. A total of 12 studies met the inclusion criteria. The analyzed literature indicates that a wide range of outcome measures have been used to assess the effectiveness of spine MT. Pain is the main aspect to be investigated but it remains difficult to elucidate since it is strongly linked to various dimensions such as self-perception and psychological aspects. Therefore, it seems necessary to include new tools for evaluating the effects of spine MT, with the aim of exploiting new technologies and taking into consideration the SP biomechanical and biopsychosocial aspects. Full article

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

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17 pages, 1090 KiB

Open AccessEditor’s ChoiceReview

Dietary Protein and Physical Exercise for the Treatment of Sarcopenia

by Rosarita Nasso, Antonio D’Errico, Maria Letizia Motti, Mariorosario Masullo and Rosaria Arcone

Clin. Pract. 2024, 14(4), 1451-1467; https://doi.org/10.3390/clinpract14040117 - 25 Jul 2024

Cited by 6 | Viewed by 4868

Abstract

Sarcopenia is a multifactorial age-related disorder that causes a decrease in muscle mass, strength, and function, leading to alteration of movement, risk of falls, and hospitalization. This article aims to review recent findings on the factors underlying sarcopenia and the strategies required to [...] Read more.

Sarcopenia is a multifactorial age-related disorder that causes a decrease in muscle mass, strength, and function, leading to alteration of movement, risk of falls, and hospitalization. This article aims to review recent findings on the factors underlying sarcopenia and the strategies required to delay and counteract its symptoms. We focus on molecular factors linked to ageing, on the role of low-grade chronic and acute inflammatory conditions such as cancer, which contributes to the onset of sarcopenia, and on the clinical criteria for its diagnosis. The use of drugs against sarcopenia is still subject to debate, and the suggested approaches to restore muscle health are based on adequate dietary protein intake and physical exercise. We also highlight the difference in the amount and quality of amino acids within animal- and plant-based diets, as studies have often shown varying results regarding their effect on sarcopenia in elderly people. In addition, many studies have reported that non-pharmacological approaches, such as an optimization of dietary protein intake and training programs based on resistance exercise, can be effective in preventing and delaying sarcopenia. These approaches not only improve the maintenance of skeletal muscle function, but also reduce health care costs and improve life expectancy and quality in elderly people. Full article

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13 pages, 397 KiB

Open AccessEditor’s ChoiceReview

Integrating Artificial Intelligence into Biomedical Science Curricula: Advancing Healthcare Education

by Aarti Sharma, Amal Al-Haidose, Maha Al-Asmakh and Atiyeh M. Abdallah

Clin. Pract. 2024, 14(4), 1391-1403; https://doi.org/10.3390/clinpract14040112 - 11 Jul 2024

Cited by 3 | Viewed by 3076

Abstract

The integration of artificial intelligence (AI) into healthcare practice has improved patient management and care. Many clinical laboratory specialties have already integrated AI in diagnostic specialties such as radiology and pathology, where it can assist in image analysis, diagnosis, and clinical reporting. As [...] Read more.

The integration of artificial intelligence (AI) into healthcare practice has improved patient management and care. Many clinical laboratory specialties have already integrated AI in diagnostic specialties such as radiology and pathology, where it can assist in image analysis, diagnosis, and clinical reporting. As AI technologies continue to advance, it is crucial for biomedical science students to receive comprehensive education and training in AI concepts and applications and to understand the ethical consequences for such development. This review focus on the importance of integrating AI into biomedical science curricula and proposes strategies to enhance curricula for different specialties to prepare future healthcare workers. Improving the curriculum can be achieved by introducing specific subjects related to AI such as informatics, data sciences, and digital health. However, there are many challenges to enhancing the curriculum with AI. In this narrative review, we discuss these challenges and suggest mitigation strategies. Full article

(This article belongs to the Special Issue Clinical Practice of Artificial Intelligence in Diagnostic and Treatment Assistance)

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8 pages, 240 KiB

Open AccessEditor’s ChoiceArticle

Comparisons of Audiologic Characteristics in Patients with Continuous and Intermittent Tinnitus

by Seok Hwan Chung, Sung Soo Kim, Sang Hoon Kim and Seung Geun Yeo

Clin. Pract. 2024, 14(4), 1383-1390; https://doi.org/10.3390/clinpract14040111 - 11 Jul 2024

Cited by 1 | Viewed by 1130

Abstract

Background: No studies to date have compared audiologic characteristics in patients with continuous and intermittent tinnitus. The present study classified tinnitus patients into continuous and intermittent groups based on tinnitus duration and compared their audiologic characteristics. Methods: This study enrolled 604 patients with [...] Read more.

Background: No studies to date have compared audiologic characteristics in patients with continuous and intermittent tinnitus. The present study classified tinnitus patients into continuous and intermittent groups based on tinnitus duration and compared their audiologic characteristics. Methods: This study enrolled 604 patients with tinnitus from January 2019 to December 2022. Clinical manifestations, PTA results, the frequency and loudness of tinnitus, ABR, DPOAE, and TEOAE tests were compared in patients with continuous and intermittent tinnitus. Results: Of the 604 patients, 231 (38.2%) had continuous and 373 (61.8%) had intermittent tinnitus. There were no significant between-group differences in otologic symptoms, tinnitus onomatopoeia. PTA showed that hearing thresholds, except at 125 Hz, were significantly higher in patients with continuous rather than intermittent tinnitus. The loudness of tinnitus was significantly greater in patients with continuous rather than intermittent tinnitus. ABR tests showed that the absolute latency of wave V was significantly longer in continuous than in intermittent tinnitus. Signal-to-noise ratios on TEOAE tests were significantly lower in patients with continuous rather than intermittent tinnitus at all frequencies tested (1, 1.5, 2, 3, and 4 kHz). Response rates to sound stimuli at all frequencies, except for 1 kHz, were significantly lower on DPOAE tests in patients with continuous rather than intermittent tinnitus. Conclusions: Continuous tinnitus is more common in males, more persistent over time, and is associated with a higher rate of hearing loss. In contrast, intermittent tinnitus is more common in women, appears acutely, and is associated with a relatively lower rate of hearing loss. Based on the findings of the current paper, it seems that audiologic characteristics may differ between patients with continuous and intermittent tinnitus. Full article

9 pages, 250 KiB

Open AccessEditor’s ChoiceArticle

Assessment of 2′-Fucosyllactose and Lacto-N-Neotetraose Solution as an Irrigant in E. faecalis-Infected Root Canals: An In Vitro Study

by Francesco Puleio, Rosario Pirri, Vincenzo Tosco, Angelo Sergio Lizio, Paola Tripodi, Isabella La Spina, Vincenza La Fauci and Raffaele Squeri

Clin. Pract. 2024, 14(4), 1348-1356; https://doi.org/10.3390/clinpract14040108 - 10 Jul 2024

Cited by 2 | Viewed by 1800

Abstract

Background: Given the lack of an ideal endodontic irrigant on the market, this study evaluates the antimicrobial potential of a formulated solution of 2′-fucosyllactose and lacto-N-neotetraose against E. faecalis within infected root canals, and explores any associated impacts related to the duration of [...] Read more.

Background: Given the lack of an ideal endodontic irrigant on the market, this study evaluates the antimicrobial potential of a formulated solution of 2′-fucosyllactose and lacto-N-neotetraose against E. faecalis within infected root canals, and explores any associated impacts related to the duration of irrigation. Methods: 32 single-rooted teeth extracted for periodontal reasons were infected with Enterococcus faecalis, and subsequently subjected to endodontic treatment with two different irrigation systems: sodium hypochlorite or a solution of 2′-fucosyllactose and lacto-N-neotetraose. These samples were then incubated in sterile culture media at 37 °C to observe microbial activity through turbidity. The culture broth of each individual sample was assessed as positive or negative by observing the turbidity or lack of turbidity in the culture at the time of evaluation. Results: the analysis of the results obtained from the comparison of groups irrigated with sodium hypochlorite or a solution of 2′-fucosyllactose and lacto-N-neotetraose demonstrates that the case solution has no bactericidal effect against E. faecalis inoculated in the endodontic system. Conclusions: the HMOs used in this study do not have a bactericidal effect on E. faecalis inoculated in an endodontic system. Full article

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

11 pages, 238 KiB

Open AccessEditor’s ChoiceArticle

Predictors of Readmission in Young Adults with First-Episode Psychosis: A Multicentric Retrospective Study with a 12-Month Follow-Up

by Filippo Besana, Serena Chiara Civardi, Filippo Mazzoni, Giovanni Carnevale Miacca, Vincenzo Arienti, Matteo Rocchetti, Pierluigi Politi, Vassilis Martiadis, Natascia Brondino and Miriam Olivola

Clin. Pract. 2024, 14(4), 1234-1244; https://doi.org/10.3390/clinpract14040099 - 24 Jun 2024

Cited by 7 | Viewed by 1902

Abstract

Background: A significant number of young individuals are readmitted one or more times shortly after their first episode of psychosis. Readmission may represent a marker of psychopathological vulnerability. Our primary aim was to evaluate the impact of clinical and socio-demographic variables on readmission [...] Read more.

Background: A significant number of young individuals are readmitted one or more times shortly after their first episode of psychosis. Readmission may represent a marker of psychopathological vulnerability. Our primary aim was to evaluate the impact of clinical and socio-demographic variables on readmission at 12-month follow-up. Secondly, our goal was to determine whether the use of Long-Acting Injection (LAI) antipsychotics provides notable benefits compared to oral medications in preventing subsequent readmissions. Subjects and methods: 80 patients hospitalised for the first time with a diagnosis of psychotic disorder (ICD-10 criteria) were retrospectively assessed through clinical records. The mean age was 21.7 years. Patients were predominantly male (n = 62, 77.5%), and 55 subjects had at least 8 years of education. 50% of the sample was “NEET” (not in education, employment, or training). Results: 35 patients (43.8%) were discharged with a LAI antipsychotic, while 45 (56.2%) recieved oral antipsychotic therapy. Substance use (p = 0.04) and oral antipsychotics at discharge (p = 0.003) were significantly associated with readmission at 1 year. We did not find any significant predictors of being discharged with LAI therapy. Conclusion: Our findings underlined the importance of identifying patients at risk of readmission in order to prevent future rehospitalization and promote appropriate prevention strategies. LAIs should be considered as a first-choice treatment for patients hospitalised for FEP since they proved to be effective in preventing relapse. Full article

(This article belongs to the Special Issue Pediatric and Adolescent Psychiatry and Psychology: Current Treatments and Future Options)

12 pages, 267 KiB

Open AccessEditor’s ChoiceArticle

Perceived Orthodontic Needs and Attitudes towards Early Evaluation and Interventions: A Survey-Based Study among Parents of Italian School-Aged Children

by Federica Di Spirito, Davide Cannatà, Valentina Schettino, Marzio Galdi, Rosaria Bucci and Stefano Martina

Clin. Pract. 2024, 14(3), 1159-1170; https://doi.org/10.3390/clinpract14030092 - 18 Jun 2024

Cited by 2 | Viewed by 1513

Abstract

(1) Background: Parents’ awareness of malocclusion and their attitude towards early evaluation and interventions influence children’s orthodontic management. This cross-sectional study investigates factors that affect the perceived orthodontic needs and the attitude towards interceptive orthodontics among a sample of one-thousand eight-hundred and six [...] Read more.

(1) Background: Parents’ awareness of malocclusion and their attitude towards early evaluation and interventions influence children’s orthodontic management. This cross-sectional study investigates factors that affect the perceived orthodontic needs and the attitude towards interceptive orthodontics among a sample of one-thousand eight-hundred and six (1806) parents of children aged between 6 and 11 years. (2) Methods: The investigation was carried out thought a 18-items online questionnaire divided as follows: characteristics of respondents; perceived child’s orthodontic needs; attitude toward early orthodontic evaluation and interventions. The associations between responses were assessed with a Chi-square test. (3) Results: Two-thirds of the respondents referred to having consulted an orthodontist for their child, and more than half of them initiated the required orthodontic treatment. In 44% of cases, the orthodontic consultation occurred after the age of 7 years. Parents’ higher education and history of orthodontic treatment were associated with a greater awareness of orthodontic needs. Parents’ perception of the impact of teeth on their child’s personality was significantly associated with the decision to start the orthodontic treatment (p < 0.001). (4) Conclusions: Although the parents’ level of awareness of their child’s orthodontic needs was generally satisfactory, the results of the present study pointed out the need for a better education regarding the importance of an early orthodontic assessment. Full article

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

10 pages, 1383 KiB

Open AccessEditor’s ChoiceArticle

Smoking and Hypertriglyceridemia Predict ST-Segment Elevation Myocardial Infarction in Kosovo Patients with Acute Myocardial Infarction

by Afrim Poniku, Arlind Batalli, Dua Shita, Zarife Rexhaj, Arlind Ferati, Rita Leka, Artan Bajraktari, Genc Abdyli, Edmond Haliti, Pranvera Ibrahimi, Rona Karahoda, Shpend Elezi, Faik Shatri, Ibadete Bytyçi, Michael Henein and Gani Bajraktari

Clin. Pract. 2024, 14(3), 1149-1158; https://doi.org/10.3390/clinpract14030091 - 17 Jun 2024

Cited by 1 | Viewed by 2016

Abstract

Background: Myocardial infarction (MI), presented as ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI), is influenced by atherosclerosis risk factors. Aim: The aim of this study was to assess the patterns of presentation of patients with acute MI in Kosovo. Methods: This [...] Read more.

Background: Myocardial infarction (MI), presented as ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI), is influenced by atherosclerosis risk factors. Aim: The aim of this study was to assess the patterns of presentation of patients with acute MI in Kosovo. Methods: This was a cross-sectional study conducted at the University Clinical Center of Kosovo, which included all patients hospitalized with acute MI over a period of 7 years. Results: Among the 7353 patients admitted with acute MI (age 63 ± 12 years, 29% female), 59.4% had STEMI and 40.6% had NSTEMI. The patients with NSTEMI patients less (48.3% vs. 54%, p < 0.001), but more of them had diabetes (37.8% vs. 33.6%, p < 0.001), hypertension (69.6% vs. 63%, p < 0.001), frequently had a family history of coronary artery disease (CAD) (40% vs. 38%, p = 0.009), and had more females compared to the patients with STEMI (32% vs. 27%, p < 0.001). The patients with NSTEMI underwent less primary percutaneous interventions compared with the patients with STEMI (43.6% vs. 55.2%, p < 0.001). Smoking [1.277 (1.117–1.459), p ˂ 0.001] and high triglycerides [0.791 (0.714–0.878), p = 0.02] were independent predictors of STEMI. Conclusions: In Kosovo, patients with STEMI are more common than those with NSTEMI, and they were mostly males and more likely to have diabetes, hypertension, and a family history of CAD compared to those with NSTEMI. Smoking and high triglycerides proved to be the strongest predictors of acute STEMI in Kosovo, thus highlighting the urgent need for optimum atherosclerosis risk control and education strategies. Full article

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12 pages, 916 KiB

Open AccessEditor’s ChoiceArticle

A Modern Diagnostic Procedure—The Introduction of Point-of-Care Ultrasound in Romanian Emergency Physicians’ Daily Routine

by George-Catalin Bouros, Tudor Ovidiu Popa, Paul Lucian Nedelea, Emilian Manolescu, Anca Haisan, Iulia Roca, Petruta Morosanu, Alexandra Hauta, Gabriela Grigorasi, Mihaela Corlade-Andrei and Diana Cimpoesu

Clin. Pract. 2024, 14(3), 1137-1148; https://doi.org/10.3390/clinpract14030090 - 14 Jun 2024

Cited by 2 | Viewed by 1361

Abstract

Background: Emergency medicine in Romania has developed fast since inception. The need for faster diagnostic capabilities due to the high workload pre- and in-hospital made point-of-care ultrasound (POCUS) a logical next step. The advantages of POCUS are well known, but implementation presents challenges. [...] Read more.

Background: Emergency medicine in Romania has developed fast since inception. The need for faster diagnostic capabilities due to the high workload pre- and in-hospital made point-of-care ultrasound (POCUS) a logical next step. The advantages of POCUS are well known, but implementation presents challenges. Our goal was to study how a straightforward method of implementation would work locally. Methods: Two prospective observational studies were conducted at 6 months (prehospital) and 4 months (in-hospital). The protocol used was extended focused assessment sonography in trauma (eFAST), and the shock index (SI) was used to stratify patients. Voluntary sampling was conducted by emergency physicians. The primary outcomes were patient numbers, type of case use, results, and accuracy. Results: The prehospital study registered 34 patients: 41% traumas, 35% cardiac arrest, 18% shock, and 6% acute respiratory distress. The in-hospital study patients were 78: 36% traumas, 6% cardiac arrests, 41% shock, and 17% acute respiratory distress. A total of 88.5% of the cases were confirmed with definitive imagistic findings. Conclusion: The studies mark an increase in POCUS usage and use in complicated cases. Providing supervision and feedback into clinical practice resulted in a further increase in POCUS usage, the second study having an 88.5% accuracy when compared to the final diagnostic proving the increased efficiency of a longitudinal training approach. Full article

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15 pages, 1249 KiB

Open AccessEditor’s ChoiceArticle

Unravelling Quality of Life for Head and Neck Cancer Patients after VMAT Radiation Therapy: Insights from Toxicity, Dosimetry and Symptoms Correlation

by Panagiota Kiafi, Maria Anthi Kouri, Georgios Patatoukas, Andromachi Kougioumtzopoulou, Marina Chalkia, Ourania Nicolatou-Galitis, Vassilis Kouloulias, Efthimios Kyrodimos and Kalliopi Platoni

Clin. Pract. 2024, 14(3), 1085-1099; https://doi.org/10.3390/clinpract14030086 - 6 Jun 2024

Cited by 2 | Viewed by 2440

Abstract

(1) Background: Head and neck cancer treatment, including advanced techniques like Volumetric Modulated Arc Therapy (VMAT), presents challenges for maintaining patient quality of life (QoL). Thus, thoroughly investigating how radiation therapy (RT) affects patients has been proved essential. Derived by that, this study [...] Read more.

(1) Background: Head and neck cancer treatment, including advanced techniques like Volumetric Modulated Arc Therapy (VMAT), presents challenges for maintaining patient quality of life (QoL). Thus, thoroughly investigating how radiation therapy (RT) affects patients has been proved essential. Derived by that, this study aims to understand the complex interactions between not only RT and QoL but also symptom severity, and treatment-related toxicities in three distinct time points of patient’s treatment; (2) Methods: To achieve that, EORTC-QLQ-C30 and EORTC QLQ-H&N35 questionnaires were used in combination with EORTC_RTOG scoring criteria and Spearman’s rho statistical analysis for 74 patients with cancer undergoing VMAT radiation therapy; (3) Results: The results revealed a significant improvement in the Overall Health Index post-treatment, indicating a temporary decline during therapy followed by subsequent recovery, often surpassing pre-treatment QoL levels. Concurrently a reduction in symptomatology was observed, notably in pain, swallowing difficulties, and dry mouth, aligning with prior research indicating decreased symptom burden post-treatment. However, Spearman’s correlation coefficient analysis at two distinct time points during therapy uncovered varying degrees of correlation between dosimetric data at Organs at Risk (OARs) and reported symptoms, highlighting potential limitations in using QoL questionnaires as sole indicators of treatment efficacy. Our investigation into the correlation between dosimetric data, toxicity, and symptoms focused on the relationship between radiation doses and oral mucositis levels, a common toxicity in head and neck cancer patients. Significant associations were identified between toxicity levels and dosimetric parameters, particularly with OARs such as the parotid glands, oral cavity, and swallowing muscles, underlining the utility of the EORTC method as a reliable toxicity assessment tool; (4) Conclusions: To summarize, current research attempts to underscore the importance of refining QoL assessments for enhanced patient care. The integration of dosimetric data, symptom severity, and treatment-related toxicities in the QoL outcomes of head and neck cancer patients undergoing VMAT radiation therapy, can lead towards the optimization of treatment strategies and the improvement of patient outcomes in future patient-centered radiation therapy practices. Full article

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

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9 pages, 1180 KiB

Open AccessEditor’s ChoiceCase Report

Case Report: The Rehabilitation of a Patient with Acute Transverse Myelitis after COVID-19 Vaccination

by Piotr Niebrzydowski, Małgorzata Kusiak-Kaczmarek, Jarosław Tomaszewski, Maciej Gmiński and Dominika Szalewska

Clin. Pract. 2024, 14(3), 1076-1084; https://doi.org/10.3390/clinpract14030085 - 6 Jun 2024

Cited by 1 | Viewed by 3054

Abstract

We report the case of a 55-year-old man with multi-symptomatic transverse myelitis after vaccination against coronavirus disease 2019 (COVID-19). The patient was diagnosed based on the course of the disease and the results of imaging and laboratory tests. We excluded other most probable [...] Read more.

We report the case of a 55-year-old man with multi-symptomatic transverse myelitis after vaccination against coronavirus disease 2019 (COVID-19). The patient was diagnosed based on the course of the disease and the results of imaging and laboratory tests. We excluded other most probable causes of the disease. The quick start of diagnosis allowed for early treatment with intravenous steroids and then plasmapheresis and the implementation of modern rehabilitation methods using biofeedback platforms, among others, and an exoskeleton. The patient returned to work, but the rehabilitation process continues to this day due to persistent symptoms that impair the patient’s quality of life. Full article

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15 pages, 1301 KiB

Open AccessEditor’s ChoiceArticle

Lactate Profile Assessment—A Good Predictor of Prognosis in Patients with COVID-19 and Septic Shock Requiring Continuous Renal Therapy

by Cosmin Iosif Trebuian, Adina Maria Marza, Raul Chioibaş, Dumitru Şutoi, Alina Petrica, Iulia Crintea-Najette, Daian Popa, Florin Borcan, Daniela Flondor and Ovidiu Alexandru Mederle

Clin. Pract. 2024, 14(3), 980-994; https://doi.org/10.3390/clinpract14030078 - 27 May 2024

Cited by 1 | Viewed by 1493

Abstract

Introduction: Lactate is a useful prognostic marker, as its level increases in hypoxic tissue and/or during accelerated aerobic glycolysis due to excessive beta-adrenergic stimulation and decreased lactate clearance. The Surviving Sepsis Campaign Bundle 2018 Update suggests premeasurement of lactate within 2–4 h so [...] Read more.

Introduction: Lactate is a useful prognostic marker, as its level increases in hypoxic tissue and/or during accelerated aerobic glycolysis due to excessive beta-adrenergic stimulation and decreased lactate clearance. The Surviving Sepsis Campaign Bundle 2018 Update suggests premeasurement of lactate within 2–4 h so that physicians perform, assist, administer, and introduce lactate-guided resuscitation to reduce mortality due to sepsis. Methods: A total of 108 patients with septic shock who underwent continuous renal replacement therapy (CRRT) for acute kidney injury were enrolled in this observational study. Demographic, clinical, and laboratory data were collected, and patients were divided into two groups: survivors and non-survivors. Results: Multivariate analysis demonstrated that lactate levels at 24 h after initiation of CRRT treatment, but not lactate levels at intensive care unit (ICU) admission, were associated with mortality. Lactate clearance was associated with lower mortality among the survivors (OR = 0.140) at 6 h after ICU admission and late mortality (OR = 0.260) after 24 h. The area under the ROC curves for mortality was 0.682 for initial lactate; 0.797 for lactate at 24 h; and 0.816 for lactate clearance at 24 h. Conclusions: Our result reinforces that the determination of lactate dynamics represents a good predictor for mortality, and serial lactate measurements may be more useful prognostic markers than initial lactate in patients with septic shock. Full article

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8 pages, 7266 KiB

Open AccessEditor’s ChoiceCase Report

Zero-Fluoroscopy Catheter Ablation of Right Appendage Focal Atrial Tachycardia in a Pregnant Woman

by Federica Troisi, Noemi Valenti, Federico Quadrini, Nicola Vitulano, Antonio Di Monaco, Imma Romanazzi, Rosa Caruso, Rocco Orfino and Massimo Grimaldi

Clin. Pract. 2024, 14(3), 946-953; https://doi.org/10.3390/clinpract14030075 - 21 May 2024

Cited by 1 | Viewed by 1184

Abstract

Background: Arrhythmias in pregnancy are complex to manage due to the teratogenic effects of many antiarrhythmic drugs and the common use of ionizing radiation during catheter ablation procedures. Furthermore, pregnant women are extremely vulnerable and difficult to treat because of the progressive physical [...] Read more.

Background: Arrhythmias in pregnancy are complex to manage due to the teratogenic effects of many antiarrhythmic drugs and the common use of ionizing radiation during catheter ablation procedures. Furthermore, pregnant women are extremely vulnerable and difficult to treat because of the progressive physical and hormonal changes that occur during the nine months of pregnancy. Case Presentation: In this case report, we describe a complex clinical case of a 34-year-old pregnant woman who was affected by an incessant right atrial tachycardia, with signs and symptoms of initial hemodynamic instability. This tachycardia was refractory to antiarrhythmic drugs, so a zero-fluoroscopy ablation was performed. The first procedure was complicated by cardiac tamponade, quickly resolved without further complications for the mother or the fetus. In the following days, a deep venous thrombosis occurred at the femoral venous access. After a few days, the patient underwent a second procedure that was successful and resulted in the restoration of a sinus rhythm. Conclusions: The management of this clinical case was complex both from a procedural and a clinical (cardiological and gynecological) point of view. Finally, the integration of the various skills led to an excellent result. Full article

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13 pages, 1231 KiB

Open AccessEditor’s ChoiceArticle

Global Trends in Kidney Stone Awareness: A Time Series Analysis from 2004–2023

by Noppawit Aiumtrakul, Charat Thongprayoon, Supawadee Suppadungsuk, Pajaree Krisanapan, Preyarat Pinthusopon, Michael A. Mao, Chinnawat Arayangkool, Kristine B. Vo, Chalothorn Wannaphut, Jing Miao and Wisit Cheungpasitporn

Clin. Pract. 2024, 14(3), 915-927; https://doi.org/10.3390/clinpract14030072 - 20 May 2024

Cited by 9 | Viewed by 4151

Abstract

Background: Despite the prevalence and incidence of kidney stones progressively increasing worldwide, public awareness of this condition remains unclear. Understanding trends of awareness can assist healthcare professionals and policymakers in planning and implementing targeted health interventions. This study investigated online search interest in [...] Read more.

Background: Despite the prevalence and incidence of kidney stones progressively increasing worldwide, public awareness of this condition remains unclear. Understanding trends of awareness can assist healthcare professionals and policymakers in planning and implementing targeted health interventions. This study investigated online search interest in “kidney stone” by analyzing Google Trends, focusing on stationarity of the trends and predicting future trends. Methods: We performed time series analysis on worldwide Google monthly search data from January 2004 to November 2023. The Augmented Dickey–Fuller (ADF) test was used to assess the stationarity of the data, with a p-value below 0.05 indicating stationarity. Time series forecasting was performed using the autoregressive integrated moving average to predict future trends. Results: The highest search interest for “kidney stone” (score 100) was in August 2022, while the lowest was in December 2007 (score 36). As of November 2023, search interest remained high, at 92. The ADF test was significant (p = 0.023), confirming data stationarity. The time series forecasting projected continued high public interest, likely reflecting ongoing concern and awareness. Notably, diverse regions such as Iran, the Philippines, Ecuador, the United States, and Nepal showed significant interest, suggesting widespread awareness of nephrolithiasis. Conclusion: This study highlighted that “kidney stone” is a consistently relevant health issue globally. The increase and stationarity of search trends, the forecasted sustained interest, and diverse regional interest emphasize the need for collaborative research and educational initiatives. This study’s analysis serves as a valuable tool for shaping future healthcare policies and research directions in addressing nephrolithiasis related health challenges. Full article

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

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14 pages, 1783 KiB

Open AccessEditor’s ChoiceArticle

Pre-Infection Nutritional Status, Oxidative Stress, and One-Year-Long COVID Persistence in Patients Undergoing Hemodialysis: A Prospective Cohort Study

by Natalia Stepanova, Lesya Korol, Tetyana Ostapenko, Valeriia Marchenko, Olga Belousova, Lyudmyla Snisar, Iryna Shifris and Mykola Kolesnyk

Clin. Pract. 2024, 14(3), 892-905; https://doi.org/10.3390/clinpract14030070 - 17 May 2024

Cited by 3 | Viewed by 1398

Abstract

Background: Nutritional status’s role in long COVID is evident in the general population, yet unexplored in patients undergoing hemodialysis (HD), posing a research gap. We hypothesized that pre-infection undernutrition in HD patients might impact long COVID persistence by accelerating oxidative stress. The present [...] Read more.

Background: Nutritional status’s role in long COVID is evident in the general population, yet unexplored in patients undergoing hemodialysis (HD), posing a research gap. We hypothesized that pre-infection undernutrition in HD patients might impact long COVID persistence by accelerating oxidative stress. The present study aimed to investigate the association between pre-infection nutritional status, oxidative stress, and one-year-long COVID persistence in HD patients. Methods: This prospective observational cohort study enrolled 115 HD patients with confirmed COVID-19. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score twice: before infection and three months post-infection. Oxidative markers included malondialdehyde (MDAs), ceruloplasmin, transferrin, and sulfhydryl groups. The endpoint was one-year-long COVID persistence. Results: Moderate pre-infection CONUT scores were associated with heightened severe undernutrition risk (p < 0.0001), elevated MDAs (p < 0.0001), and reduced ceruloplasmin levels (p = 0.0009) at three months post-COVID-19 compared to light CONUT scores. Pre-infection CONUT score independently predicted post-COVID oxidative damage [OR 2.3 (95% CI 1.2; 4.6), p < 0.0001] and one-year-long COVID persistence [HR 4.6 (95% CI 1.4; 9.9), p < 0.0001], even after adjusting for potential confounders. Conclusion: Moderate pre-infection undernutrition heightens post-COVID oxidative stress and increases the risk of one-year-long COVID persistence in HD patients. Full article

(This article belongs to the Topic Multifaceted Efforts from Basic Research to Clinical Practice in Controlling COVID-19 Disease)

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10 pages, 1754 KiB

Open AccessEditor’s ChoiceCase Report

Safety and Efficacy of Very Early Conversion to Belatacept in Pediatric Kidney Transplantation with Transplant-Associated Thrombotic Microangiopathy: Case Study and Review of Literature

by Ratna Acharya, William Clapp and Kiran Upadhyay

Clin. Pract. 2024, 14(3), 882-891; https://doi.org/10.3390/clinpract14030069 - 16 May 2024

Cited by 1 | Viewed by 1936

Abstract

The inhibition of co-stimulation during T-cell activation has been shown to provide effective immunosuppression in kidney transplantation (KT). Hence, the conversion from calcineurin inhibitor (CNI) to belatacept is emerging as a potential alternate maintenance immunosuppressive therapy in those with transplant-associated thrombotic microangiopathy (TA-TMA) [...] Read more.

The inhibition of co-stimulation during T-cell activation has been shown to provide effective immunosuppression in kidney transplantation (KT). Hence, the conversion from calcineurin inhibitor (CNI) to belatacept is emerging as a potential alternate maintenance immunosuppressive therapy in those with transplant-associated thrombotic microangiopathy (TA-TMA) or in the prevention of TA-TMA. We present a 17-year-old male who presented with biopsy-proven CNI-associated TA-TMA immediately post-KT. The administration of eculizumab led to the reversal of TMA. Tacrolimus was converted to belatacept with excellent efficacy and safety during a short-term follow-up of one year. Further larger controlled studies are required to demonstrate the efficacy of this approach in children who present with early-onset TMA post-KT. Full article

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12 pages, 547 KiB

Open AccessEditor’s ChoiceReview

Infective Pleural Effusions—A Comprehensive Narrative Review Article

by Mohammad Abdulelah and Mohammad Abu Hishmeh

Clin. Pract. 2024, 14(3), 870-881; https://doi.org/10.3390/clinpract14030068 - 16 May 2024

Cited by 4 | Viewed by 5469

Abstract

Infective pleural effusions are mainly represented by parapneumonic effusions and empyema. These conditions are a spectrum of pleural diseases that are commonly encountered and carry significant mortality and morbidity rates reaching upwards of 50%. The causative etiology is usually an underlying bacterial pneumonia [...] Read more.

Infective pleural effusions are mainly represented by parapneumonic effusions and empyema. These conditions are a spectrum of pleural diseases that are commonly encountered and carry significant mortality and morbidity rates reaching upwards of 50%. The causative etiology is usually an underlying bacterial pneumonia with the subsequent seeding of the infectious culprit and inflammatory agents to the pleural space leading to an inflammatory response and fibrin deposition. Radiographical evaluation through a CT scan or ultrasound yields high specificity and sensitivity, with features such as septations or pleural thickening indicating worse outcomes. Although microbiological yields from pleural studies are around 56% only, fluid analysis assists in both diagnosis and prognosis by evaluating pH, glucose, and other biomarkers such as lactate dehydrogenase. Management centers around antibiotic therapy for 2–6 weeks and the drainage of the infected pleural space when the effusion is complicated through tube thoracostomies or surgical intervention. Intrapleural enzymatic therapy, used to increase drainage, significantly decreases treatment failure rates, length of hospital stay, and surgical referrals but carries a risk of pleural hemorrhage. This comprehensive review article aims to define and delineate the progression of parapneumonic effusions and empyema as well as discuss pathophysiology, diagnostic, and treatment modalities with aims of broadening the generalist’s understanding of such complex disease by reviewing the most recent and relevant high-quality evidence. Full article

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16 pages, 701 KiB

Open AccessEditor’s ChoiceSystematic Review

Alterations in the Gut Microbiome Composition of People Living with HIV in the Asia–Pacific Region: A Systematic Review

by Paul Benedic U. Salvador, Patrick Josemaria d. R. Altavas, Mark Angelo S. del Rosario, Eric David B. Ornos and Leslie Michelle M. Dalmacio

Clin. Pract. 2024, 14(3), 846-861; https://doi.org/10.3390/clinpract14030066 - 15 May 2024

Cited by 2 | Viewed by 1852

Abstract

Human immunodeficiency virus (HIV) infection continues to present a global health issue. Recent studies have explored the potential role of the gut microbiome in HIV infection for novel therapeutic approaches. We investigated the gut microbiome composition of people living with HIV (PLHIV) in [...] Read more.

Human immunodeficiency virus (HIV) infection continues to present a global health issue. Recent studies have explored the potential role of the gut microbiome in HIV infection for novel therapeutic approaches. We investigated the gut microbiome composition of people living with HIV (PLHIV) in the Asia–Pacific region. This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. An electronic search was conducted in the PubMed/MEDLINE, Scopus, and ScienceDirect databases using keywords such as “HIV”, “PLHIV”, “AIDS”, “gut microbiome”, “gut dysbiosis”, and “metagenomics”. Only peer-reviewed and full-text studies published in English were included. A total of 15 studies from the Asia–Pacific region were included for analysis. Compared to healthy controls, PLHIV showed an increased abundance of Proteobacteria and its genera, which may be considered pathobionts, and decreased abundances of Bacteroidetes and several genera under Firmicutes with known short-chain fatty acid and immunoregulatory activities. Predominant taxa such as Ruminococcaceae and Prevotellaceae were also associated with clinical factors such as CD4 count, the CD4/CD8 ratio, and inflammatory cytokines. This review highlights gut microbiome changes among PLHIV in the Asia–Pacific region, indicating potential bacterial signatures for prognostication. The partial restoration of the microbiome toward beneficial taxa may ensure the long-term success of treatment, promoting immune recovery while maintaining viral load suppression. Full article

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12 pages, 1175 KiB

Open AccessEditor’s ChoiceArticle

Lactate Levels and Clearance: Key Predictors of Prognosis for COVID-19 and Non-COVID-19 Septic Shock Patients in the Emergency Department

by Cosmin Iosif Trebuian, Octavia Maria Brici, Dumitru Sutoi, Daian Ionel Popa, Daniel Raul Chioibas and Ovidiu Alexandru Mederle

Clin. Pract. 2024, 14(3), 834-845; https://doi.org/10.3390/clinpract14030065 - 9 May 2024

Cited by 4 | Viewed by 2229

Abstract

Background: This investigation assesses the prognostic value of lactate levels and their clearance in septic shock patients, particularly emphasizing the comparative analysis between COVID-19 and non-COVID-19 patients in the emergency department. This study aims to elucidate the unique prognostic implications of lactate dynamics [...] Read more.

Background: This investigation assesses the prognostic value of lactate levels and their clearance in septic shock patients, particularly emphasizing the comparative analysis between COVID-19 and non-COVID-19 patients in the emergency department. This study aims to elucidate the unique prognostic implications of lactate dynamics in these distinct patient groups, thereby enhancing the management of septic shock. Methods: An observational prospective study was conducted, enrolling 114 septic shock patients from the Emergency County Hospital Resita, Romania, categorizing them into COVID-19 and non-COVID-19 groups to examine their initial lactate levels, clearance rates, and their correlation with patient outcomes. Results: This study identified significant differences in the initial lactate levels and clearance rates between the two groups, indicating higher initial lactate levels and slower clearance rates in COVID-19 patients. Survivors demonstrated significantly lower initial lactate levels (1.5 ± 0.4 mmol/L) and higher lactate clearance rates (33 ± 15%) compared to non-survivors (2.5 ± 0.5 mmol/L and 24 ± 9%, respectively; lactate levels p = 0.001, clearance rates p = 0.002). Conclusions: Lactate monitoring, particularly clearance rates, is crucial in the prognostic assessment of septic shock patients. These findings highlight the need for targeted interventions in COVID-19 patients to improve outcomes, underscoring lactate dynamics as a vital component of septic shock management in differing patient populations. Full article

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33 pages, 1162 KiB

Open AccessEditor’s ChoiceSystematic Review

Prevalence of the Gingival Phenotype in Adults and Associated Risk Factors: A Systematic Review of the Literature

by Sophie-Myriam Dridi, Clément Ameline, Jean Michel Heurtebise, Séverine Vincent-Bugnas and Carole Charavet

Clin. Pract. 2024, 14(3), 801-833; https://doi.org/10.3390/clinpract14030064 - 8 May 2024

Cited by 2 | Viewed by 2521

Abstract

The relevance of assessing the gingival phenotype prior to the initiation of periodontal, orthodontic, or prosthetic therapy has been clearly demonstrated. However, publications on this subject are either old or concerned with the means of assessing the gingival phenotype or the main factors [...] Read more.

The relevance of assessing the gingival phenotype prior to the initiation of periodontal, orthodontic, or prosthetic therapy has been clearly demonstrated. However, publications on this subject are either old or concerned with the means of assessing the gingival phenotype or the main factors likely to modify it. The main objective of this systematic review of the literature was therefore to investigate the prevalence of different gingival phenotypes in adults in good general health and with a healthy periodontium. A systematic review of the literature was performed following the guidelines of PRISMA recommendations using an electronic search strategy on four databases (PubMed, Scopus, Cochrane Library, and Embase) complemented by a manual search. Three independent authors were involved in study selection, data extraction, and bias assessment. Results: Of 807 articles, 17 of them, published between 2012 and 2023, involving 3277 subjects from 11 countries and 9766 dental sites, fulfilled the inclusion criteria. The prevalence of the gingival phenotype could not be determined at the level of an individual or a dental arch because all the publications assessed this phenotype only at the level of certain dental sectors, and were not chosen at random. The maxillary central incisors and maxillary or mandibular first molar sectors were associated with a high and thick gingival phenotype, independently of the dental morphology, gender, and age of adult subjects. Furthermore, in these regions, this gingival phenotype tended to be associated with a thick vestibular bone table. In contrast, maxillary and mandibular incisors and premolars more often had a thin gingival phenotype. For other teeth, the results were less conclusive. It is important not to rely solely on the overall appearance of the dentition but to independently assess the thickness and height of the gingiva at each dental site requiring intervention. Finally, this study highlights a key point, namely the need for further longitudinal studies to determine the prevalence in healthy adults. For practicality and feasibility reasons, these studies should be designed according to therapeutic needs, dental sector by dental sector, and within homogeneous source populations. PROSPERO registration: CRD 42023392602. Full article

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14 pages, 1051 KiB

Open AccessEditor’s ChoiceArticle

Evaluating Weight Loss Efficacy in Obesity Treatment with Allurion’s Ingestible Gastric Balloon: A Retrospective Study Utilizing the Scale App Health Tracker

by Danut Dejeu, Paula Dejeu, Paula Bradea, Anita Muresan and Viorel Dejeu

Clin. Pract. 2024, 14(3), 765-778; https://doi.org/10.3390/clinpract14030061 - 6 May 2024

Cited by 1 | Viewed by 2936

Abstract

Obesity represents a growing public health concern, affecting more than 15% of the global adult population and involving a multi-billion market that comprises nutritional, surgical, psychological, and multidisciplinary interventions. The objective of this retrospective study was to evaluate the short-term efficacy and body [...] Read more.

Obesity represents a growing public health concern, affecting more than 15% of the global adult population and involving a multi-billion market that comprises nutritional, surgical, psychological, and multidisciplinary interventions. The objective of this retrospective study was to evaluate the short-term efficacy and body weight measurements associated with differing levels of physical activity following the use of Allurion’s ingestible gastric balloon that was designed to increase feelings of fullness and decrease food consumption, being naturally eliminated after approximately 16 weeks. This study involved 571 individuals who qualified for the intervention for being older than 20 years with a body mass index (BMI) of 27 kg/m² or more. Utilizing the Scale App Health Tracker and Allurion’s smartwatch, this study was able to track vital signs and physical activity in real time. The participants had an average initial BMI of 34.1 kg/m² and a median age of 41 years. Notable outcomes were observed in both study groups, “Less Active” and “More Active”, which were classified by achieving less or more than a median number of 8000 daily steps. Specifically, body fat percentage saw a reduction from 33.1 ± 9.4 to 28.3 ± 10.2 in the less active group and from 32.2 to 27.5 in the more active group, with both groups achieving statistical significance (p < 0.001). Additionally, there was a significant reduction in average weight, dropping from 98.2 ± 22.8 kg to 84.6 ± 19.3 kg in the less active group and from 97.7 ± 21.0 kg to 82.1 ± 22.9 kg in the more active group (both p < 0.001). Interestingly, those in the more active group also experienced a significant increase in lean mass compared to their less active counterparts (p = 0.045), although no substantial differences in weight loss, BMI reduction, and total body fat decrease were observed between the two groups. This investigation confirms the hypothesis that Allurion’s ingestible gastric balloon significantly reduces weight in the short term and enhances several physical health metrics, demonstrating effectiveness as an autonomous method for challenging weight management, regardless of the level of daily physical activity. Full article

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

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11 pages, 1186 KiB

Open AccessEditor’s ChoiceArticle

Oral Habits in Childhood and Occlusal Pathologies: A Cohort Study

by Mario Santos Barrera, David Ribas-Perez, Carolina Caleza Jimenez, Olga Cortes Lillo and Asunción Mendoza-Mendoza

Clin. Pract. 2024, 14(3), 718-728; https://doi.org/10.3390/clinpract14030057 - 24 Apr 2024

Cited by 4 | Viewed by 2891

Abstract

Purpose: To analyse the relationship between the different habits that occur in childhood and the different malocclusions in the three planes of space. Material and methods: A clinical examination of 106 children between 5 and 12 years of age was carried out and [...] Read more.

Purpose: To analyse the relationship between the different habits that occur in childhood and the different malocclusions in the three planes of space. Material and methods: A clinical examination of 106 children between 5 and 12 years of age was carried out and a survey validated by professors of the Faculty of Dentistry of the University of Seville was made for the parents in order to identify the habits and relate them to the possible malocclusions detected in the child’s mouth. Results: 72.64% of the sample presented a malocclusion in at least one of the three planes of space, with a similar distribution. When correlating the variables, statistically significant relationships were observed in the vertical plane with atypical swallowing (p = 0 < 0.05; V > 0.3) and lip sucking (p = 0 < 0.05; V > 0.3) and in the horizontal plane with oral breathing (p = 0 < 0.05; V > 0.3), atypical swallowing (p = 0 < 0.05; V < 0.3) and digital sucking (p = 0 < 0.05; V < 0.3). Conclusions: It has been observed that the prevalence and prolongation of habits in childhood is increasing, so it is essential to detect pernicious habits at an early age to prevent the establishment of malocclusions and to favour the correct craniofacial growth of the child. Full article

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13 pages, 8122 KiB

Open AccessEditor’s ChoiceArticle

A Worldwide Bibliometric Analysis of Published Literature Assessing Fear of COVID-19

by Jesús Cebrino and Silvia Portero de la Cruz

Clin. Pract. 2024, 14(3), 672-684; https://doi.org/10.3390/clinpract14030054 - 23 Apr 2024

Cited by 1 | Viewed by 1496

Abstract

Many people experience intense fear of COVID-19. The purpose of this study was to provide a comprehensive visual overview of the published literature from 2020 to 2022 assessing fear of COVID-19. From 2020 to 2022, we employed the Scopus database to conduct a [...] Read more.

Many people experience intense fear of COVID-19. The purpose of this study was to provide a comprehensive visual overview of the published literature from 2020 to 2022 assessing fear of COVID-19. From 2020 to 2022, we employed the Scopus database to conduct a bibliometric analysis. We used the VOSviewer program to perform the author co-citation analysis, Mapchart to produce a worldwide map, and Wordart to make a word cloud image. From the 1769 records examined, 1654 (93.50%) were articles, with English being the most common language (96.31%). From 2020 to 2022, annual citations experienced significant growth (R² = 99.91%; p = 0.0195). The Institut National de la Santé et de la Recherche Médicale (INSERM, France) and China led in terms of publication output (n = 36; n = 255). M. D. Griffiths authored the highest number of articles (n = 21). The most active journal was the International Journal of Environmental Research and Public Health (n = 146), and the most prevalent keyword was “human/s” (11.51%). This bibliometric analysis evaluates the quality of the research on fear of the pandemic and the crisis management of COVID-19, which can provide managers and researchers with crucial insights for future decision making. Full article

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

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12 pages, 1643 KiB

Open AccessEditor’s ChoiceArticle

Do MRI Results Represent Functional Outcomes Following Arthroscopic Repair of an Isolated Meniscus Tear in Young Patients?—A Prospective Comparative Cohort Study

by Viktorija Brogaitė Martinkėnienė, Donatas Austys, Andrius Šaikus, Andrius Brazaitis, Giedrius Bernotavičius, Aleksas Makulavičius, Tomas Sveikata and Gilvydas Verkauskas

Clin. Pract. 2024, 14(2), 602-613; https://doi.org/10.3390/clinpract14020047 - 1 Apr 2024

Cited by 2 | Viewed by 2414

Abstract

Background: The use of postoperative MRI to assess the healing status of repaired menisci is a long-standing issue. This study evaluates and compares functional and MRI outcomes following an arthroscopic meniscus repair procedure with the aim of postoperative MRI diagnostic accuracy clarification in [...] Read more.

Background: The use of postoperative MRI to assess the healing status of repaired menisci is a long-standing issue. This study evaluates and compares functional and MRI outcomes following an arthroscopic meniscus repair procedure with the aim of postoperative MRI diagnostic accuracy clarification in young patients. Methods: A total of 35 patients under 18 years old who underwent isolated meniscus repair were included. The Pedi-IKDC score, Lysholm score, and Tegner activity index (TAS) were compared between the groups formed according to the Stroller and Crues three-grade classification of postoperative MRI-based evaluations. Grade 3 MRI views were classified as unhealed, grade 2 as partially healed, and grade 1 as fully healed within the repaired meniscus, whereas grade 3 cases were considered unsuccessful due to MRI evaluation. Results: MRI assessment revealed 4 cases of grade 1 (11.4%), 14 cases of grade 2 (40.8%), and 17 cases of grade 3 (48.0%) lesions. Pedi-IKDC and TAS scores were significantly higher among MRI grade 2 patients than among MRI grade 3 patients (p < 0.05). Weak negative correlations between MRI grades and all functional scales were found (p < 0.05). ROC analysis showed that Pedi-IKDC and TAS scores could correctly classify 77% and 71% of MRI grade 3 patients, respectively. The optimal cut-off values to detect grade 3 patients were 88.74 for the Pedi-IKDC score and 4.5 for the TAS score. Conclusions: To conclude, established functional score cut-off values may help identify unhealed meniscus repair patients. Full article

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12 pages, 1956 KiB

Open AccessEditor’s ChoiceArticle

Evaluating Global and Temporal Trends in Pancreas and Islet Cell Transplantation: Public Awareness and Engagement

by Oscar A. Garcia Valencia, Charat Thongprayoon, Caroline C. Jadlowiec, Shennen A. Mao, Napat Leeaphorn, Pooja Budhiraja, Nadeen Khoury, Pradeep Vaitla, Supawadee Suppadungsuk and Wisit Cheungpasitporn

Clin. Pract. 2024, 14(2), 590-601; https://doi.org/10.3390/clinpract14020046 - 29 Mar 2024

Cited by 3 | Viewed by 1527

Abstract

Background: Pancreas transplantation is a crucial surgical intervention for managing diabetes, but it faces challenges such as its invasive nature, stringent patient selection criteria, organ scarcity, and centralized expertise. Despite the steadily increasing number of pancreas transplants in the United States, there is [...] Read more.

Background: Pancreas transplantation is a crucial surgical intervention for managing diabetes, but it faces challenges such as its invasive nature, stringent patient selection criteria, organ scarcity, and centralized expertise. Despite the steadily increasing number of pancreas transplants in the United States, there is a need to understand global trends in interest to increase awareness of and participation in pancreas and islet cell transplantation. Methods: We analyzed Google Search trends for “Pancreas Transplantation” and “Islet Cell Transplantation” from 2004 to 14 November 2023, assessing variations in search interest over time and across geographical locations. The Augmented Dickey–Fuller (ADF) test was used to determine the stationarity of the trends (p < 0.05). Results: Search interest for “Pancreas Transplantation” varied from its 2004 baseline, with a general decline in peak interest over time. The lowest interest was in December 2010, with a slight increase by November 2023. Ecuador, Kuwait, and Saudi Arabia showed the highest search interest. “Islet Cell Transplantation” had its lowest interest in December 2016 and a more pronounced decline over time, with Poland, China, and South Korea having the highest search volumes. In the U.S., “Pancreas Transplantation” ranked 4th in interest, while “Islet Cell Transplantation” ranked 11th. The ADF test confirmed the stationarity of the search trends for both procedures. Conclusions: “Pancreas Transplantation” and “Islet Cell Transplantation” showed initial peaks in search interest followed by a general downtrend. The stationary search trends suggest a lack of significant fluctuations or cyclical variations. These findings highlight the need for enhanced educational initiatives to increase the understanding and awareness of these critical transplant procedures among the public and professionals. Full article

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11 pages, 1997 KiB

Open AccessEditor’s ChoiceArticle

Can Secondary Adhesive Capsulitis Complicate Calcific Tendinitis of the Rotator Cuff? An Ultrasound Imaging Analysis

by Giovanni Tuè, Oriana Masuzzo, Francesco Tucci, Marco Cavallo, Anna Parmeggiani, Fabio Vita, Alberto Patti, Danilo Donati, Alessandro Marinelli, Marco Miceli and Paolo Spinnato

Clin. Pract. 2024, 14(2), 579-589; https://doi.org/10.3390/clinpract14020045 - 28 Mar 2024

Cited by 5 | Viewed by 2093

Abstract

Background: Adhesive capsulitis (AC) of the glenohumeral joint is a recognized cause of pain associated with both active and passive restricted ranges of movement. AC can be subdivided into primary and secondary forms. Trauma, surgery, immobilization, and diabetes mellitus are the leading well-recognized [...] Read more.

Background: Adhesive capsulitis (AC) of the glenohumeral joint is a recognized cause of pain associated with both active and passive restricted ranges of movement. AC can be subdivided into primary and secondary forms. Trauma, surgery, immobilization, and diabetes mellitus are the leading well-recognized causes of secondary AC. Calcific tendinitis/tendinitis (CT) of the rotator cuff is considered a possible trigger for AC, as reported in a few previous articles. However, there are no original investigations that assess the frequency and characteristics of this association. The aim of our research was to evaluate the presence of AC in a cohort of patients with a known CT condition of the rotator cuff by an ultrasound (US) examination. Materials and methods: We prospectively enrolled all the patients admitted at our single institution (October 2022–June 2023) for the preoperative US evaluation of a known CT condition. In these patients, we searched for parameters related to secondary AC. An axillary pouch (AP) thickness equal to or greater than 4 mm (or greater than 60% of the contralateral AP) was considered diagnostic of AC. Moreover, rotator interval (RI) thickness and the presence of effusion within the long-head biceps tendon (LHBT) sheath was also assessed in all patients. Results: A total of 78 patients (54F, 24M—mean age = 50.0 and range = 31–71 y.o.) were enrolled in the study. In 26 of those patients (26/78—33.3%), US signs of AC were detected. Notably, the mean AP thickness in patients with AC and CT was 3.96 ± 1.37 mm (Group 1) and 2.08 ± 0.40 mm in patients with CT only (Group 2). RI thickness was significantly greater in patients with superimposed AC: 2.54 ± 0.38 mm in Group 1 and 1.81 ± 0.41 mm in Group 2 (p < 0.00001). Moreover, effusion within the LHBT was significantly more frequently detected in patients with AC: 84.61% in Group 1 versus 15.79% in Group 2—p < 0.00001. Conclusion: US signs of AC are found in one-third of patients with CT of the rotator cuff, demonstrating that AC represents a frequent complication that should be routinely evaluated during US investigation to provide more personalized treatment strategies. Full article

(This article belongs to the Special Issue Shoulder Disorders: Diagnosis and Treatment)

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9 pages, 1142 KiB

Open AccessEditor’s ChoiceArticle

Epidemiology of Hepatocellular Carcinoma in Taiwan

by Yu-Wei Lai and Ching-Hu Chung

Clin. Pract. 2024, 14(2), 570-578; https://doi.org/10.3390/clinpract14020044 - 28 Mar 2024

Cited by 5 | Viewed by 1982

Abstract

Background: Hepatocellular carcinoma (HCC) is a major contributor to the world’s cancer burden. Understanding the HCC incidence rate in Taiwan is thus an interesting avenue of research. Methods: From an NHI database, those patients who had been newly diagnosed with HCC and who [...] Read more.

Background: Hepatocellular carcinoma (HCC) is a major contributor to the world’s cancer burden. Understanding the HCC incidence rate in Taiwan is thus an interesting avenue of research. Methods: From an NHI database, those patients who had been newly diagnosed with HCC and who had been listed on a registry in a catastrophic illness dataset during the years 2013–2021 were enrolled in this study. Antineoplastic agent usage and comorbidities were also studied. Results: The incidence rate of HCC decreased from 57.77 to 44.95 in 100,000 from 2013 to 2021. The average age of patients with HCC increased from 65.54 years old with a CCI score of 4.98 in 2013 to 67.92 years old with a CCI score of 5.49 in 2021. Among these HCC patients, the patients under antineoplastic agent treatment decreased from 53.47% to 31.41% from 2013 to 2021. The presence of comorbidities in HCC patients was about 55.77–83.01% with mild liver disease and 29.93–37.30% with diabetes (without complications) in the period 2013–2021. Conclusions: The incidence rate of HCC slightly decreased in Taiwan. Due to antineoplastic agent usage decreasing over time, these results may indicate that more early-stage HCC patients detected in recent years were mainly treated with surgeries. Full article

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15 pages, 1562 KiB

Open AccessEditor’s ChoiceReview

Magnesium Is a Vital Ion in the Body—It Is Time to Consider Its Supplementation on a Routine Basis

by Ákos Géza Pethő, Tibor Fülöp, Petronella Orosz and Mihály Tapolyai

Clin. Pract. 2024, 14(2), 521-535; https://doi.org/10.3390/clinpract14020040 - 22 Mar 2024

Cited by 9 | Viewed by 7881

Abstract

The importance of maintaining proper magnesium intake and total body magnesium content in preserving human health remains underappreciated among medical professionals and laymen. This review aimed to show the importance of hypomagnesemia as a modifiable risk factor for developing disease processes. We searched [...] Read more.

The importance of maintaining proper magnesium intake and total body magnesium content in preserving human health remains underappreciated among medical professionals and laymen. This review aimed to show the importance of hypomagnesemia as a modifiable risk factor for developing disease processes. We searched the PubMed database and Google Scholar using the keywords ‘magnesium’, ‘diabetes’, ‘cardiovascular disease’, ‘respiratory disease’, ‘immune system’, ‘inflammation’, ‘autoimmune disease’, ‘neurology’, ‘psychiatry’, ‘cognitive function’, ‘cancer’, and ‘vascular calcification’. In multiple contexts of the search terms, all reviews, animal experiments, and human observational data indicated that magnesium deficiency can lead to or contribute to developing many disease states. The conclusions of several in-depth reviews support our working hypothesis that magnesium and its supplementation are often undervalued and underutilized. Although much research has confirmed the importance of proper magnesium supply and tissue levels, simple and inexpensive magnesium supplementation has not yet been sufficiently recognized or promoted. Full article

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13 pages, 875 KiB

Open AccessEditor’s ChoiceArticle

Tissue-Based Genomic Testing in Prostate Cancer: 10-Year Analysis of National Trends on the Use of Prolaris, Decipher, ProMark, and Oncotype DX

by Eugenio Bologna, Francesco Ditonno, Leslie Claire Licari, Antonio Franco, Celeste Manfredi, Spencer Mossack, Savio Domenico Pandolfo, Cosimo De Nunzio, Giuseppe Simone, Costantino Leonardo and Giorgio Franco

Clin. Pract. 2024, 14(2), 508-520; https://doi.org/10.3390/clinpract14020039 - 19 Mar 2024

Cited by 16 | Viewed by 3126

Abstract

Background: Prostate cancer (PCa) management is moving towards patient-tailored strategies. Advances in molecular and genetic profiling of tumor tissues, integrated with clinical risk assessments, provide deeper insights into disease aggressiveness. This study aims to offer a comprehensive overview of the pivotal genomic tests [...] Read more.

Background: Prostate cancer (PCa) management is moving towards patient-tailored strategies. Advances in molecular and genetic profiling of tumor tissues, integrated with clinical risk assessments, provide deeper insights into disease aggressiveness. This study aims to offer a comprehensive overview of the pivotal genomic tests supporting PCa treatment decisions, analyzing—through real-world data—trends in their use and the growth of supporting literature evidence. Methods: A retrospective analysis was conducted using the extensive PearlDiver™ Mariner database, which contains de-identified patient records, in compliance with the Health Insurance Portability and Accountability Act (HIPAA). The International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes were employed to identify patients diagnosed with PCa during the study period—2011 to 2021. We determined the utilization of primary tissue-based genetic tests (Oncocyte DX^®, Prolaris^®, Decipher^®, and ProMark^®) across all patients diagnosed with PCa. Subsequently, within the overall PCa cohort, patients who underwent radical prostatectomy (RP) and received genetic testing postoperatively were identified. The yearly distribution of these tests and the corresponding trends were illustrated with graphs. Results: During the study period, 1,561,203 patients with a PCa diagnosis were recorded. Of these, 20,748 underwent tissue-based genetic testing following diagnosis, representing 1.3% of the total cohort. An increasing trend was observed in the use of all genetic tests. Linear regression analysis showed a statistically significant increase over time in the use of individual tests (all p-values < 0.05). Among the patients who underwent RP, 3076 received genetic analysis following surgery, representing 1.27% of this group. Conclusions: Our analysis indicates a growing trend in the utilization of tissue-based genomic testing for PCa. Nevertheless, they are utilized in less than 2% of PCa patients, whether at initial diagnosis or after surgical treatment. Although it is anticipated that their use may increase as more scientific evidence becomes available, their role requires further elucidation. Full article

(This article belongs to the Special Issue Urologic Oncology: Recent Advances and Future Perspectives)

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13 pages, 1514 KiB

Open AccessEditor’s ChoiceArticle

Breast Cancer Risk Factors among Women with Solid Breast Lesions

by Ivana Eremici, Andreea Borlea, Catalin Dumitru and Dana Stoian

Clin. Pract. 2024, 14(2), 473-485; https://doi.org/10.3390/clinpract14020036 - 18 Mar 2024

Cited by 4 | Viewed by 3082

Abstract

Background: Breast cancer is the most frequent malignancy in women worldwide and one of the most curable cancers if diagnosed at an early stage. Female patients presenting solid breast lesions are greatly predisposed to breast cancer development, and as such, effective screening of [...] Read more.

Background: Breast cancer is the most frequent malignancy in women worldwide and one of the most curable cancers if diagnosed at an early stage. Female patients presenting solid breast lesions are greatly predisposed to breast cancer development, and as such, effective screening of high-risk patients is valuable in early-stage breast cancer detection. Objectives: The aim of our study was to identify the most relevant demographic, reproductive and lifestyle risk factors for breast cancer among women with solid breast lesions living in western Romania, namely the urban region consisting of Timisoara and the rural surrounding regions. Methods: From January 2017 to December 2021, 1161 patients with solid breast lesions, as detected by sonoelastography, were divided into two groups: patients with benign lesions (1019, 87.77%) and patients with malignant nodules (142, 12.23%). The malignancy group was confirmed by a histopathological result. Variables including age, BMI, menarche, menopause, years of exposure to estrogen, number of births, breastfeeding period, use of oral combined contraceptives, smoker status, family medical history and living area (rural-urban) were recorded. Results: It was evidenced by our study that the main risk factors for malignancy were elevated age (OR = 1.07, 95% CI 1.05–1.08), BMI (OR = 1.06, 95% CI 1.02–1.10), living area (rural) (OR = 1.86, 95% CI 1.13–2.85) and family medical history (negative) (OR 3.13, 95% CI 1.43–8.29). The other proposed risk factors were not found to be statistically significant. Conclusions: Age and BMI were observed to be the most significant factors for breast cancer risk increase, followed by living in a rural area. A family history of breast cancer was shown to be inversely correlated with cancer risk increase. Full article

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7 pages, 841 KiB

Open AccessEditor’s ChoiceCase Report

Diagnostic and Therapeutic Challenges of Oligosymptomatic Vesicovaginal Fistula in the Complex Case of Endometriosis

by Agnieszka A. Strojny, Arkadiusz Baran, Katarzyna Wiejak, Anna Scholz and Radosław B. Maksym

Clin. Pract. 2024, 14(2), 436-442; https://doi.org/10.3390/clinpract14020033 - 12 Mar 2024

Cited by 1 | Viewed by 1982

Abstract

Endometriosis is a complex condition causing surgical challenges, sometimes leading to urogynecological complications, the diagnosis and treatment of which are not always obvious. We present a case of a 46-year-old woman with a history of severe endometriosis and adenomyosis who developed an oligosymptomatic [...] Read more.

Endometriosis is a complex condition causing surgical challenges, sometimes leading to urogynecological complications, the diagnosis and treatment of which are not always obvious. We present a case of a 46-year-old woman with a history of severe endometriosis and adenomyosis who developed an oligosymptomatic vesicovaginal fistula (VVF) as a complication of surgery. The patient’s medical history included multiple surgeries for endometriosis, a cesarean section, and a laparoscopic hysterectomy. After the excision of the full-thickness infiltration of the urinary bladder, she experienced postoperative bowel obstruction treated by laparotomy. Subsequent urinary complications of bladder healing were eventually recognized as oligosymptomatic VVF. Symptoms of VVFs may vary, making a diagnosis challenging, especially when the lesion is narrow. Imaging techniques such as cystoscopy and cystography are helpful for diagnosis. The treatment options for VVFs range from surgical repair to conservative methods, like bladder catheterization, hormonal therapy, and platelet-rich plasma (PRP) injections, depending on the lesions’ size and location. In this case, the patient’s VVF was treated with PRP injections, a low-invasive method in urogynecology. PRP, known for its pleiotropic role, is increasingly used in medicine, including gynecology. The patient’s fistula closed after 6 weeks from the PRP session, highlighting the potential of this conservative treatment modality. Full article

(This article belongs to the Topic Pathology and Current State of Treatment of Chronic Pain)

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10 pages, 247 KiB

Open AccessEditor’s ChoiceArticle

The Relationship between Vitamin D Levels and Blood Glucose and Cholesterol Levels

by Eman Elsheikh, Abdulhakim Ibrahim Alabdullah, Sarah Saleh Al-Harbi, Amal Omar Alagha, Dhiyaa Hassan AlAhmed and Mazen Moraya Ali Alalmaee

Clin. Pract. 2024, 14(2), 426-435; https://doi.org/10.3390/clinpract14020032 - 29 Feb 2024

Cited by 3 | Viewed by 3910

Abstract

Background: Vitamin D deficiency has reached epidemic proportions globally. Observational data link low vitamin D status to diabetes, dyslipidemia, and metabolic syndrome, but interventional trials on the effects of supplementation are limited. Objective: We investigated associations between serum 25-hydroxyvitamin D (25(OH)D) levels and [...] Read more.

Background: Vitamin D deficiency has reached epidemic proportions globally. Observational data link low vitamin D status to diabetes, dyslipidemia, and metabolic syndrome, but interventional trials on the effects of supplementation are limited. Objective: We investigated associations between serum 25-hydroxyvitamin D (25(OH)D) levels and metabolic markers in Saudi adults. Methods: This retrospective cross-sectional study analyzed the clinical records of 476 patients from Saudi Arabia, aged 15–78 years. According to 25(OH)D levels, participants were stratified as vitamin D-sufficient (≥30 ng/mL), -insufficient (21–29 ng/mL), or -deficient (≤20 ng/mL). The outcomes were diabetic status (fasting glucose, HbA1c) and lipid panel results. Results: Higher diabetes prevalence was significantly associated with lower 25(OH)D levels (10.1% in the sufficient group, 11.6% in the insufficient group, and 18.3% in the deficient group). Similarly, worse lipid profiles were associated with more severe hypovitaminosis D, including a total cholesterol level of ≥240 mg/dL (5.3% in participants with normal vitamin D levels vs. 18.9% in those with deficient levels) and LDL ≥ 160 mg/dL (6.9% in participants with normal vitamin D levels vs. 13.2% in those with deficient levels). Vitamin D deficiency disproportionately affected women and adults > 45 years old. Conclusions: Vitamin D deficiency is endemic in Saudi Arabia and strongly linked to worsened metabolic markers. Optimizing vitamin D status through screening and correcting the deficiency may provide a cost-effective approach to confronting the regional diabetes epidemic and reducing cardiovascular disease risk. Full article

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

9 pages, 816 KiB

Open AccessEditor’s ChoiceArticle

Candida Variety in the Oral Cavity of Mexican Subjects with Type 2 Diabetes Mellitus and TLR2 Gene Expression

by Nadia Mabel Pérez-Vielma, Modesto Gómez-López, María de los Ángeles Martínez-Godínez, Ana Laura Luna-Torres, Aarón Domínguez López and Ángel Miliar-García

Clin. Pract. 2024, 14(2), 417-425; https://doi.org/10.3390/clinpract14020031 - 27 Feb 2024

Cited by 2 | Viewed by 1585

Abstract

Background: The aim was to diagnose Candida in the oral cavity of subjects with type 2 diabetes mellitus (T2DM) using a genotyping technique and compare the results with those from conventional diagnosis by Papanicolaou (Pap) staining. Methods: Palatal mucosa smears were performed on [...] Read more.

Background: The aim was to diagnose Candida in the oral cavity of subjects with type 2 diabetes mellitus (T2DM) using a genotyping technique and compare the results with those from conventional diagnosis by Papanicolaou (Pap) staining. Methods: Palatal mucosa smears were performed on 18 dental care patients diagnosed with T2DM and grade I, II, and III prosthetic stomatitis who met the inclusion criteria; 18 healthy control subjects were also included in the study. Hemoglobin A1c (HbA1c) levels were determined from total blood. Using exfoliative cytology, the Pap staining technique was used to diagnose candidiasis. Exfoliative cytology was also used for molecular diagnosis; DNA was obtained for Candida genotyping, and RNA was used for gene expression studies. Results: Clinical patterns indicated that all subjects were positive for Candida; however, Pap analysis revealed only three positive subjects, whereas end-point polymerase chain reaction (PCR) analysis revealed 15 subjects with some type of Candida. The most common Candida species found were Candida guilliermondii (38.8%), Candida krusei (33.3%), Candida tropicalis, and Candida lusitaniae (22.2%). Interestingly, the coexpression of different species of Candida was found in various patients. In all patients, HbA1c levels were increased. Gene expression analysis showed a significant decrease (p ≤ 0.05) in TLR2 expression in positive subjects, whereas TLR4 expression did not differ significantly among patients. Conclusions: The end-point PCR technique showed better sensitivity for the diagnosis of Candida when compared with the diagnosis by Pap staining. T2DM subjects showed an increased presence of C. guilliermondii that was correlated with decreased TLR2 expression. Full article

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29 pages, 3397 KiB

Open AccessEditor’s ChoiceReview

Evolution of Laboratory Diagnosis of Tuberculosis

by Natalia Zaporojan, Rodica Anamaria Negrean, Ramona Hodișan, Claudiu Zaporojan, Andrei Csep and Dana Carmen Zaha

Clin. Pract. 2024, 14(2), 388-416; https://doi.org/10.3390/clinpract14020030 - 23 Feb 2024

Cited by 24 | Viewed by 15280

Abstract

Tuberculosis (TB) is an infectious disease of global public health importance caused by the Mycobacterium tuberculosis complex. Despite advances in diagnosis and treatment, this disease has worsened with the emergence of multidrug-resistant strains of tuberculosis. We aim to present and review the history, [...] Read more.

Tuberculosis (TB) is an infectious disease of global public health importance caused by the Mycobacterium tuberculosis complex. Despite advances in diagnosis and treatment, this disease has worsened with the emergence of multidrug-resistant strains of tuberculosis. We aim to present and review the history, progress, and future directions in the diagnosis of tuberculosis by evaluating the current methods of laboratory diagnosis of tuberculosis, with a special emphasis on microscopic examination and cultivation on solid and liquid media, as well as an approach to molecular assays. The microscopic method, although widely used, has its limitations, and the use and evaluation of other techniques are essential for a complete and accurate diagnosis. Bacterial cultures, both in solid and liquid media, are essential methods in the diagnosis of TB. Culture on a solid medium provides specificity and accuracy, while culture on a liquid medium brings rapidity and increased sensitivity. Molecular tests such as LPA and Xpert MTB/RIF have been found to offer significant benefits in the rapid and accurate diagnosis of TB, including drug-resistant forms. These tests allow the identification of resistance mutations and provide essential information for choosing the right treatment. We conclude that combined diagnostic methods, using several techniques and approaches, provide the best result in the laboratory diagnosis of TB. Improving the quality and accessibility of tests, as well as the implementation of advanced technologies, is essential to help improve the sensitivity, efficiency, and accuracy of TB diagnosis. Full article

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16 pages, 3679 KiB

Open AccessEditor’s ChoiceReview

Phimosis in Adults: Narrative Review of the New Available Devices and the Standard Treatments

by Eleonora Rosato, Roberto Miano, Stefano Germani and Anastasios D. Asimakopoulos

Clin. Pract. 2024, 14(1), 361-376; https://doi.org/10.3390/clinpract14010028 - 18 Feb 2024

Cited by 2 | Viewed by 9767

Abstract

Background: Phimosis is the inability to completely retract the foreskin and expose the glans. The treatment of phimosis varies depending on the age of the patient and the severity of the disease; a great number of conservative or surgical treatments are currently available. [...] Read more.

Background: Phimosis is the inability to completely retract the foreskin and expose the glans. The treatment of phimosis varies depending on the age of the patient and the severity of the disease; a great number of conservative or surgical treatments are currently available. Aim: To provide the first review summarizing the available options for the treatment of adult phimosis. Methods: A PubMed, Cochrane and Embase search for peer-reviewed studies, published between January 2001 and December 2022 was performed using the search terms “phimosis AND treatment”. Results: A total of 288 publications were initially identified through database searching. Thirty manuscripts were ultimately eligible for inclusion in this review. Conservative treatment is an option. and it includes topical steroid application and the new medical silicon tubes (Phimostop™) application for gentle prepuce dilation. Concerning the surgical approach, the gold-standard treatment is represented by circumcision in which tissue synthesis after prepuce removal can be also obtained with barbed sutures, fibrin glues or staples. Laser circumcision seems to be providing superior outcomes in terms of operative time and postoperative complication rate when compared to the traditional one. Several techniques of preputioplasty and use of in situ devices (which crush the foreskin and simultaneously create haemostasis) have been also described. These in situ devices seem feasible, safe and effective in treating phimosis while they also reduce the operative time when compared to traditional circumcision. Patient satisfaction rates, complications and impact on sexual function of the main surgical treatments are presented. Conclusion: Many conservative and surgical treatments are available for the treatment of adult phimosis. The choice of the right treatment depends on the grade of phimosis, results, complications, and cost-effectiveness. Full article

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17 pages, 1761 KiB

Open AccessEditor’s ChoiceArticle

Optimizing Atrial Fibrillation Care: Comparative Assessment of Anticoagulant Therapies and Risk Factors

by Marius Rus, Adriana Ioana Ardelean, Simina Crisan, Paula Marian, Oana Lilliana Pobirci, Veronica Huplea, Claudia Judea Pusta, Gheorghe Adrian Osiceanu, Claudia Elena Stanis and Felicia Liana Andronie-Cioara

Clin. Pract. 2024, 14(1), 344-360; https://doi.org/10.3390/clinpract14010027 - 12 Feb 2024

Cited by 3 | Viewed by 2779

Abstract

Background and objectives: Atrial fibrillation (AF) is a common arrhythmia associated with various risk factors and significant morbidity and mortality. Materials and methods: This article presents findings from a study involving 345 patients with permanent AF. This study examined demographics, risk factors, associated [...] Read more.

Background and objectives: Atrial fibrillation (AF) is a common arrhythmia associated with various risk factors and significant morbidity and mortality. Materials and methods: This article presents findings from a study involving 345 patients with permanent AF. This study examined demographics, risk factors, associated pathologies, complications, and anticoagulant therapy over the course of a year. Results: The results showed a slight predominance of AF in males (55%), with the highest incidence in individuals aged 75 and older (49%). Common risk factors included arterial hypertension (54%), dyslipidemia, diabetes mellitus type 2 (19.13%), and obesity (15.65%). Comorbidities such as congestive heart failure (35.6%), mitral valve regurgitation (60%), and dilated cardiomyopathy (32%) were prevalent among the patients. Major complications included congestive heart failure (32%), stroke (17%), and myocardial infarction (5%). Thromboembolic and bleeding risk assessment using CHA2DS2-VASc and HAS-BLED scores demonstrated a high thromboembolic risk in all patients. The majority of patients were receiving novel oral anticoagulants (NOACs) before admission (73%), while NOACs were also the most prescribed antithrombotic therapy at discharge (61%). Conclusions: This study highlights the importance of risk factor management and appropriate anticoagulant therapy in patients with AF, to reduce complications and improve outcomes. The results support the importance of tailored therapeutic schemes, for optimal care of patients with AF. Full article

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22 pages, 1140 KiB

Open AccessEditor’s ChoiceArticle

Reference Values of Physical Performance in Handball Players Aged 13–19 Years: Taking into Account Their Biological Maturity

by Chirine Aouichaoui, Samir Krichen, Mohamed Tounsi, Achraf Ammar, Oussama Tabka, Salem Chatti, Monia Zaouali, Mohamed Zouch and Yassine Trabelsi

Clin. Pract. 2024, 14(1), 305-326; https://doi.org/10.3390/clinpract14010024 - 6 Feb 2024

Cited by 5 | Viewed by 2453

Abstract

Biological maturity status significantly influences success in handball, impacting an athlete’s performance and overall development. This study aimed to examine the anthropometric and physical performance variables concerning age and maturity status, establishing reference values for physical performance among Tunisian players. A total of [...] Read more.

Biological maturity status significantly influences success in handball, impacting an athlete’s performance and overall development. This study aimed to examine the anthropometric and physical performance variables concerning age and maturity status, establishing reference values for physical performance among Tunisian players. A total of 560 handball players (309 males and 251 females aged 13–19 years) were categorized based on maturity status: early (n = 98), average (n = 262), and late (n = 200), determined through Mirwald and colleagues’ equations. Anthropometric, physical fitness, and physiological data were collected for reference value creation. Our findings revealed significantly higher anthropometric parameters (p = 0.003) in late-maturing athletes compared to their early-maturing counterparts. Post-pubertal athletes showed significantly superior (p = 0.002) jumping ability, change of direction, and aerobic performance compared to their pre-pubertal peers. Additionally, male athletes outperformed females in both fitness (p = 0.001) and aerobic (p = 0.001) performance. A notable age-by-maturity interaction emerged for most performance outcomes (η² ranging from 0.011 to 0.084), highlighting increased sex-specific differences as athletes progressed in age. Percentile values are provided for males and females, offering valuable insights for coaches and sports scientists to design personalized training programs. Understanding a player’s performance relative to these percentiles allows trainers to tailor workouts, addressing specific strengths and weaknesses for enhanced development and competitiveness. Full article

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28 pages, 2255 KiB

Open AccessEditor’s ChoiceReview

A Narrative Review of Current Knowledge on Cutaneous Melanoma

by Bogdan Marian Caraban, Mariana Aschie, Mariana Deacu, Georgeta Camelia Cozaru, Mihaela Butcaru Pundiche, Cristian Ionut Orasanu and Raluca Ioana Voda

Clin. Pract. 2024, 14(1), 214-241; https://doi.org/10.3390/clinpract14010018 - 26 Jan 2024

Cited by 9 | Viewed by 2569

Abstract

Cutaneous melanoma is a public health problem. Efforts to reduce its incidence have failed, as it continues to increase. In recent years, many risk factors have been identified. Numerous diagnostic systems exist that greatly assist in early clinical diagnosis. The histopathological aspect illustrates [...] Read more.

Cutaneous melanoma is a public health problem. Efforts to reduce its incidence have failed, as it continues to increase. In recent years, many risk factors have been identified. Numerous diagnostic systems exist that greatly assist in early clinical diagnosis. The histopathological aspect illustrates the grim nature of these cancers. Currently, pathogenic pathways and the tumor microclimate are key to the development of therapeutic methods. Revolutionary therapies like targeted therapy and immune checkpoint inhibitors are starting to replace traditional therapeutic methods. Targeted therapy aims at a specific molecule in the pathogenic chain to block it, stopping cell growth and dissemination. The main function of immune checkpoint inhibitors is to boost cellular immunity in order to combat cancer cells. Unfortunately, these therapies have different rates of effectiveness and side effects, and cannot be applied to all patients. These shortcomings are the basis of increased incidence and mortality rates. This study covers all stages of the evolutionary sequence of melanoma. With all these data in front of us, we see the need for new research efforts directed at therapies that will bring greater benefits in terms of patient survival and prognosis, with fewer adverse effects. Full article

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16 pages, 1396 KiB

Open AccessEditor’s ChoiceReview

The Interplay between Mycobacterium tuberculosis and Human Microbiome

by Michelle Nguyen, Phillip Ahn, John Dawi, Areg Gargaloyan, Anthony Kiriaki, Tiffany Shou, Kevin Wu, Kian Yazdan and Vishwanath Venketaraman

Clin. Pract. 2024, 14(1), 198-213; https://doi.org/10.3390/clinpract14010017 - 24 Jan 2024

Cited by 1 | Viewed by 5166

Abstract

Tuberculosis (TB), a respiratory disease caused by Mycobacterium tuberculosis (Mtb), is a significant cause of mortality worldwide. The lung, a breeding ground for Mtb, was once thought to be a sterile environment, but has now been found to host its own profile of [...] Read more.

Tuberculosis (TB), a respiratory disease caused by Mycobacterium tuberculosis (Mtb), is a significant cause of mortality worldwide. The lung, a breeding ground for Mtb, was once thought to be a sterile environment, but has now been found to host its own profile of microbes. These microbes are critical in the development of the host immune system and can produce metabolites that aid in host defense against various pathogens. Mtb infection as well as antibiotics can shift the microbial profile, causing dysbiosis and dampening the host immune response. Additionally, increasing cases of drug resistant TB have impacted the success rates of the traditional therapies of isoniazid, rifampin, pyrazinamide, and ethambutol. Recent years have produced tremendous research into the human microbiome and its role in contributing to or attenuating disease processes. Potential treatments aimed at altering the gut-lung bacterial axis may offer promising results against drug resistant TB and help mitigate the effects of TB. Full article

(This article belongs to the Special Issue 2023 Feature Papers in Clinics and Practice)

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9 pages, 2599 KiB

Open AccessEditor’s ChoiceCase Report

Hypercalcemic Crisis Due to a Giant Intrathyroidal Parathyroid Adenoma, with Postsurgical Severe Hypocalcemia and Hungry Bone Syndrome: A Case Report

by Vasileios Papanikos, Elli Papadodima, Dimitra Bantouna, Rodis D. Paparodis, Sarantis Livadas, Nicholaos Angelopoulos and Evangelos Karvounis

Clin. Pract. 2024, 14(1), 179-187; https://doi.org/10.3390/clinpract14010015 - 22 Jan 2024

Cited by 3 | Viewed by 1587

Abstract

Background: Parathyroid adenoma is the most common cause of hypercalcemia and rarely leads to a hypercalcemic crisis, which is an unusual endocrine emergency that requires timely surgical excision. Case presentation: A 67-year-old male was admitted to the ER of the Euroclinic Hospital, Athens, [...] Read more.

Background: Parathyroid adenoma is the most common cause of hypercalcemia and rarely leads to a hypercalcemic crisis, which is an unusual endocrine emergency that requires timely surgical excision. Case presentation: A 67-year-old male was admitted to the ER of the Euroclinic Hospital, Athens, Greece, because of elevated calcium levels and a palpable right-sided neck mass, which were accompanied by symptoms of nausea, drowsiness, and weakness for six months that increased prior to our evaluation. A gradual creatinine elevation and decreasing mental state were observed as well. The initial laboratory investigation identified severely elevated serum calcium (3.6 mmol/L) levels consistent with a hypercalcemic crisis (HC) and parathyroid hormone PTH (47.6 pmol/L) due to primary hyperparathyroidism. Neck ultrasonography (USG) identified a large, well-shaped cystic mass in the right thyroid lobe. With a serum calcium concentration of 19.5 mg/dL and a PTH of 225.3 pmol/L, the patient underwent partial parathyroidectomy and total thyroidectomy, which decreased serum calcium and PTH to 2.5 mmol/L and 1.93 pmol/L, respectively. Histology revealed a giant intrathyroidal cystic parathyroid adenoma, which was responsible for the hypercalcemic crisis. Postoperatively, the patient developed severe biochemical and clinical hypocalcemia, with calcium concentrations as low as 1.65 mmol/L, consistent with hungry bone syndrome (HBS), which was treated with high doses of intravenous calcium gluconate and oral alfacalcidol, and a slow recovery of serum calcium. After discharge, parathyroid function recovered, and symptomatology resolved entirely in more than one month. Discussion/conclusions: We present a case involving an exceptionally large intrathyroidal parathyroid adenoma that is characterized by clinical manifestations that mimic malignancy. The identification and treatment of such tumors is challenging and requires careful preoperative evaluation and postoperative care for the risk of hungry bone syndrome. Full article

(This article belongs to the Special Issue Management of Thyroid Diseases: Current Strategies and Future Directions)

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16 pages, 5561 KiB

Open AccessEditor’s ChoiceReview

Radiological Insights into Sacroiliitis: A Narrative Review

by Asma’a Al-Mnayyis, Shrouq Obeidat, Ammar Badr, Basil Jouryyeh, Saif Azzam, Hayat Al Bibi, Yara Al-Gwairy, Sarah Al Sharie and Giustino Varrassi

Clin. Pract. 2024, 14(1), 106-121; https://doi.org/10.3390/clinpract14010009 - 3 Jan 2024

Cited by 5 | Viewed by 6743

Abstract

Sacroiliitis is the inflammation of the sacroiliac joint, the largest axial joint in the human body, contributing to 25% of lower back pain cases. It can be detected using various imaging techniques like radiography, MRI, and CT scans. Treatments range from conservative methods [...] Read more.

Sacroiliitis is the inflammation of the sacroiliac joint, the largest axial joint in the human body, contributing to 25% of lower back pain cases. It can be detected using various imaging techniques like radiography, MRI, and CT scans. Treatments range from conservative methods to invasive procedures. Recent advancements in artificial intelligence offer precise detection of this condition through imaging. Treatment options range from physical therapy and medications to invasive methods like joint injections and surgery. Future management looks promising with advanced imaging, regenerative medicine, and biologic therapies, especially for conditions like ankylosing spondylitis. We conducted a review on sacroiliitis using imaging data from sources like PubMed and Scopus. Only English studies focusing on sacroiliitis’s radiological aspects were included. The findings were organized and presented narratively. Full article

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