Journal Description
Journal of Clinical Medicine
Journal of Clinical Medicine
is an international, peer-reviewed, open access journal of clinical medicine, published semimonthly online by MDPI. The International Bone Research Association (IBRA), Italian Resuscitation Council (IRC), Spanish Society of Hematology and Hemotherapy (SEHH), Japan Association for Clinical Engineers (JACE), European Independent Foundation in Angiology/ Vascular Medicine (VAS) and others are all affiliated with JCM, and their members receive a discount on article processing charges.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within Scopus, SCIE (Web of Science), PubMed, PMC, Embase, CAPlus / SciFinder, and other databases.
- Journal Rank: JCR - Q2 (Medicine, General & Internal) / CiteScore - Q1 (General Medicine)
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 17.9 days after submission; acceptance to publication is undertaken in 2.6 days (median values for papers published in this journal in the second half of 2023).
- Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
- Companion journals for JCM include: Epidemiologia, Transplantology, Uro, Sinusitis, Rheumato, Journal of Clinical & Translational Ophthalmology, Journal of Vascular Diseases, Osteology, Complications, Therapeutics, and Sclerosis.
Impact Factor:
3.9 (2022);
5-Year Impact Factor:
4.1 (2022)
Latest Articles
High-Density Dermal Matrix for Soft Tissue Augmentation Using a Matrix Tissue Graph Technique—A Comprehensive Multicenter Analysis of 20 Implants: A 1-Year Follow-Up Retrospective Study
J. Clin. Med. 2024, 13(10), 2954; https://doi.org/10.3390/jcm13102954 (registering DOI) - 17 May 2024
Abstract
Background: In this multicenter case series analysis, the authors present successful instances of 20 single-screw-retained and implant-supported prosthetic rehabilitation samples. Methods: A high-density heterologous dermal matrix (Derma® Osteobiol by Tecnoss, Torino, Italy) was employed with a specific technique named the
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Background: In this multicenter case series analysis, the authors present successful instances of 20 single-screw-retained and implant-supported prosthetic rehabilitation samples. Methods: A high-density heterologous dermal matrix (Derma® Osteobiol by Tecnoss, Torino, Italy) was employed with a specific technique named the matrix tissue graft (MTG) in all these cases characterized by an inadequate initial supra-crestal tissue height (thin if 1 mm or medium if 2 mm) to enhance the peri-implant soft tissues both vertically and horizontally. Results: The implants were deemed successful in all cases, yielding a success proportion of 100% (one-sided 97.5% confidence interval = 83.2–100%). The buccal and lingual gains were, respectively, 2.2 ± 0.38 mm (range 1.7–3.22 mm) and 0.83 ± 0.33 mm (range 0.1–1.5 mm). These measurements were calculated as the maximum distance between two superimposed .stl file models (derived from two different IOS devices) scanned before implant placement and 1 year after dermal matrix healing. Conclusions: An outstanding vertical and horizontal gain was obtained using this heterologous derma matrix placed above the bone crest and surrounding the dental implants.
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(This article belongs to the Section Dentistry, Oral Surgery and Oral Medicine)
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Open AccessPerspective
Proposed Screening for Congenital Hyperinsulinism in Newborns: Perspective from a Neonatal–Perinatal Medicine Group
by
Jeffrey R. Kaiser, Shaili Amatya, Rebecca J. Burke, Tammy E. Corr, Nada Darwish, Chintan K. Gandhi, Adrienne Gasda, Kristen M. Glass, Mitchell J. Kresch, Sarah M. Mahdally, Maria T. McGarvey, Sara J. Mola, Yuanyi L. Murray, Katie Nissly, Nanyaly M. Santiago-Aponte, Jazmine C. Valencia and Timothy W. Palmer
J. Clin. Med. 2024, 13(10), 2953; https://doi.org/10.3390/jcm13102953 (registering DOI) - 17 May 2024
Abstract
This perspective work by academic neonatal providers is written specifically for the audience of newborn care providers and neonatologists involved in neonatal hypoglycemia screening. Herein, we propose adding a screen for congenital hyperinsulinism (CHI) by measuring glucose and ketone (i.e., β-hydroxybutyrate (BOHB)) concentrations
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This perspective work by academic neonatal providers is written specifically for the audience of newborn care providers and neonatologists involved in neonatal hypoglycemia screening. Herein, we propose adding a screen for congenital hyperinsulinism (CHI) by measuring glucose and ketone (i.e., β-hydroxybutyrate (BOHB)) concentrations just prior to newborn hospital discharge and as close to 48 h after birth as possible, at the same time that the mandated state Newborn Dried Blood Spot Screen is obtained. In the proposed protocol, we do not recommend specific metabolite cutoffs, as our primary objective is to simply highlight the concept of screening for CHI in newborns to newborn caregivers. The premise for our proposed screen is based on the known effect of hyperinsulinism in suppressing ketogenesis, thereby limiting ketone production. We will briefly discuss genetic CHI, other forms of neonatal hypoglycemia, and their shared mechanisms; the mechanism of insulin regulation by functional pancreatic islet cell membrane KATP channels; adverse neurodevelopmental sequelae and brain injury due to missing or delaying the CHI diagnosis; the principles of a good screening test; how current neonatal hypoglycemia screening programs do not fulfill the criteria for being effective screening tests; and our proposed algorithm for screening for CHI in newborns.
Full article
(This article belongs to the Special Issue Current Trends in Pediatric Endocrinology)
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Open AccessArticle
Time of Birth and the Risk of Adverse Maternal and Neonatal Outcomes—A Retrospective Cohort Study
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Anat Schwartz, Shiri Shinar, Amit Iton-Schwartz, Ronella Marom, Dror Mandel, Ayelet Dangot and Ariel Many
J. Clin. Med. 2024, 13(10), 2952; https://doi.org/10.3390/jcm13102952 (registering DOI) - 17 May 2024
Abstract
Objectives: To determine whether in a labor floor housed continuously by senior physicians the risk of adverse maternal and neonatal outcome is affected by time of delivery. Methods: This retrospective cohort study, conducted at a tertiary medical center, assessed singleton term deliveries from
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Objectives: To determine whether in a labor floor housed continuously by senior physicians the risk of adverse maternal and neonatal outcome is affected by time of delivery. Methods: This retrospective cohort study, conducted at a tertiary medical center, assessed singleton term deliveries from 1 January 2011 to 30 January 2020. Participants were categorized based on delivery timing, correlating with nursing shifts, to evaluate perinatal outcomes. The primary endpoint included adverse maternal outcomes such as emergency Cesarean section, anal sphincter injuries, blood product transfusions, and postpartum surgeries (laparotomy/laparoscopy). Secondary outcomes focused on neonatal health indicators, including low Apgar scores, ICU admissions, respiratory issues, extended hospital stays, and neurological complications. Results: 87,863 deliveries were available for analysis with equal distribution during the day. The risk of adverse composite maternal outcome was highest during the evening (aOR 1.25, 95% CI 1.18–1.32) and lowest during the night (aOR 0.94, 95% CI 0.88–0.99) compared to daytime deliveries. This difference was primarily driven by the highest rate of emergency CD in the evening. Neonatal outcomes were comparable, except for length of stay > 5 days, which was more frequent among newborns delivered during the evening and night shifts compared to the morning shift (aOR 1.19, 95% CI 1.07–1.33 and aOR 1.17, 95% CI 1.05–1.31, respectively). Conclusions: In term pregnancies, the evening shift is associated with the highest risk of adverse maternal and neonatal outcomes despite physician seniority.
Full article
(This article belongs to the Special Issue Management of Pregnancy Complications)
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Open AccessSystematic Review
Landiolol for Treatment of New-Onset Atrial Fibrillation in Critical Care: A Systematic Review
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Bruno Levy, Michel Slama, Ines Lakbar, Julien Maizel, Hiromi Kato, Marc Leone and Motoi Okada
J. Clin. Med. 2024, 13(10), 2951; https://doi.org/10.3390/jcm13102951 (registering DOI) - 17 May 2024
Abstract
Background: new-onset atrial fibrillation remains a common complication in critical care settings, often necessitating treatment when the correction of triggers is insufficient to restore hemodynamics. The treatment strategy includes electric cardioversion in cases of hemodynamic instability and either rhythm control or rate
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Background: new-onset atrial fibrillation remains a common complication in critical care settings, often necessitating treatment when the correction of triggers is insufficient to restore hemodynamics. The treatment strategy includes electric cardioversion in cases of hemodynamic instability and either rhythm control or rate control in the absence of instability. Landiolol, an ultrashort beta-blocker, effectively controls heart rate with the potential to regulate rhythm. Objectives This review aims to compare the efficacy of landiolol in controlling heart rate and converting to sinus rhythm in the critical care setting. Methods: We conducted a comprehensive review of the published literature from 2000 to 2022 describing the use of landiolol to treat atrial fibrillation in critical care settings, excluding both cardiac surgery and medical cardiac care settings. The primary outcome assessed was sinus conversion following landiolol treatment. Results: Our analysis identified 17 publications detailing the use of landiolol for the treatment of 324 critical care patients. While the quality of the data was generally low, primarily comprising non-comparative studies, landiolol consistently demonstrated similar efficacy in controlling heart rate and facilitating conversion to sinus rhythm in both non-surgical (75.7%) and surgical (70.1%) settings. The incidence of hypotension associated with landiolol use was 13%. Conclusions: The use of landiolol in critical care patients with new-onset atrial fibrillation exhibited comparable efficacy and tolerance in both non-surgical and surgical settings. Despite these promising results, further validation through randomized controlled trials is necessary.
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(This article belongs to the Section Intensive Care)
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Open AccessReview
Artificial Intelligence in the Management of Women with Endometriosis and Adenomyosis: Can Machines Ever Be Worse Than Humans?
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Giulia Emily Cetera, Alberto Eugenio Tozzi, Valentina Chiappa, Isabella Castiglioni, Camilla Erminia Maria Merli and Paolo Vercellini
J. Clin. Med. 2024, 13(10), 2950; https://doi.org/10.3390/jcm13102950 (registering DOI) - 16 May 2024
Abstract
Artificial intelligence (AI) is experiencing advances and integration in all medical specializations, and this creates excitement but also concerns. This narrative review aims to critically assess the state of the art of AI in the field of endometriosis and adenomyosis. By enabling automation,
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Artificial intelligence (AI) is experiencing advances and integration in all medical specializations, and this creates excitement but also concerns. This narrative review aims to critically assess the state of the art of AI in the field of endometriosis and adenomyosis. By enabling automation, AI may speed up some routine tasks, decreasing gynecologists’ risk of burnout, as well as enabling them to spend more time interacting with their patients, increasing their efficiency and patients’ perception of being taken care of. Surgery may also benefit from AI, especially through its integration with robotic surgery systems. This may improve the detection of anatomical structures and enhance surgical outcomes by combining intra-operative findings with pre-operative imaging. Not only that, but AI promises to improve the quality of care by facilitating clinical research. Through the introduction of decision-support tools, it can enhance diagnostic assessment; it can also predict treatment effectiveness and side effects, as well as reproductive prognosis and cancer risk. However, concerns exist regarding the fact that good quality data used in tool development and compliance with data sharing guidelines are crucial. Also, professionals are worried AI may render certain specialists obsolete. This said, AI is more likely to become a well-liked team member rather than a usurper.
Full article
(This article belongs to the Special Issue Endometriosis and Adenomyosis: Modern Concepts on Clinical Outcomes, Treatment and Management)
Open AccessSystematic Review
Postpartum Depression in Fathers: A Systematic Review
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Pablo Álvarez-García, Rubén García-Fernández, Cristian Martín-Vázquez, Natalia Calvo-Ayuso and Enedina Quiroga-Sánchez
J. Clin. Med. 2024, 13(10), 2949; https://doi.org/10.3390/jcm13102949 (registering DOI) - 16 May 2024
Abstract
Background/Objectives: Postpartum depression is usually defined as a major depressive episode that occurs shortly after childbirth. This condition is most commonly found in females; however, paternal postpartum depression has begun to attract more research attention. This study aims to identify different instruments for
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Background/Objectives: Postpartum depression is usually defined as a major depressive episode that occurs shortly after childbirth. This condition is most commonly found in females; however, paternal postpartum depression has begun to attract more research attention. This study aims to identify different instruments for measuring this mental health problem and to detect risk factors as well as the main sources of resilience in paternal postpartum depression. Methods: A literature review was conducted following the PRISMA method. Results: After analyzing 10 articles, it was determined that the Edinburgh Postpartum Depression Scale is the most widely used instrument for the diagnosis of postpartum depression in the female population, and after several studies, it has already been validated for the male sex. After several studies were analyzed to highlight the main risk factors for paternal postpartum depression, it was established that the most influential factor is male gender role stress. These findings highlight the traditional role of fathers today. Most health professionals see the mother as the priority. Conclusions: Paternal depression is a major problem for mothers and fathers today, as well as for the newborn. As time goes on, there is a growing need to incorporate fathers into current and future mental health programs to be able to provide the necessary support.
Full article
(This article belongs to the Section Mental Health)
Open AccessArticle
Dietary Intake and Oral Glucose Tolerance Test Results in Women with Gestational Diabetes
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Lucas Almeida das Chagas, Maria Regina Torloni, Luiz Gonzaga Ribeiro Silva-Neto, Patricia Medici Dualib, Rosângela Maria Lopes de Sousa, Jalila Andréa Sampaio Bittencourt, Edward Araujo Júnior, Roberta Granese and Rosiane Mattar
J. Clin. Med. 2024, 13(10), 2948; https://doi.org/10.3390/jcm13102948 - 16 May 2024
Abstract
Background/Objective: Diet is a risk factor for gestational diabetes mellitus (GDM). There are few studies on women’s diet and glucose tolerance test (GTT) results during pregnancy. The objective of this study was to evaluate the relationship between one’s previous diet and the
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Background/Objective: Diet is a risk factor for gestational diabetes mellitus (GDM). There are few studies on women’s diet and glucose tolerance test (GTT) results during pregnancy. The objective of this study was to evaluate the relationship between one’s previous diet and the number of abnormal values on the diagnostic GTT in women with GDM. We hypothesized that there would be an inverse relation between antioxidant micronutrient consumption and the number of abnormal GTT values. Methods: This cross-sectional study included 60 women diagnosed with GDM (2-h, 75 g-GTT), divided in two groups as follows: 1 abnormal glucose value and 2-3 abnormal values. Shortly after the diagnosis, participants answered a validated food frequency questionnaire to assess their food consumption in the last 6 months. The Mann–Whitney test was used to compare the dietary intake of the participants in the two groups. Results: The participant characteristics were similar. The median intake of total calories, carbohydrates, lipids, and proteins did not differ significantly between groups. Participants with 1 abnormal GTT value had significantly higher intakes of fiber (11.9 vs. 11.0 g/day p = 0.049), vitamin D (40.6 vs. 40.4 mcg/day p = 0.049), and vitamin C (180.0 vs. 151.0 mg/day p = 0.008) than those with 2-3 abnormal values. Conclusions: Our results suggest a possible association between the consumption of fiber and antioxidant micronutrients and the number of abnormal GTT values.
Full article
(This article belongs to the Section Obstetrics & Gynecology)
Open AccessArticle
Performance of Risk Scores in Predicting Infective Endocarditis in Patients with Staphylococcus aureus Bacteraemia in a Prospective Asian Cohort
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Jinghao Nicholas Ngiam, Matthew Chung Yi Koh, Sophia Archuleta, Dale Fisher, Louis Yi-Ann Chai, Ching-Hui Sia, William K. F. Kong and Paul Anantharajah Tambyah
J. Clin. Med. 2024, 13(10), 2947; https://doi.org/10.3390/jcm13102947 - 16 May 2024
Abstract
Background: Several risk scores have been derived to predict the risk of infective endocarditis (IE) amongst patients with Staphylococcus aureus bacteraemia (SAB), which helps to guide clinical management. Methods: We prospectively studied 634 patients admitted with SAB. The cohort was stratified into
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Background: Several risk scores have been derived to predict the risk of infective endocarditis (IE) amongst patients with Staphylococcus aureus bacteraemia (SAB), which helps to guide clinical management. Methods: We prospectively studied 634 patients admitted with SAB. The cohort was stratified into those with or without IE, and the PREDICT Day 1, Day 5 and VIRSTA scores were tabulated. Area under the receiver operating characteristic (AUC) curves were constructed to compare the performance of each score. Results: Of the 634 patients examined, 36 (5.7%) had IE. These patients were younger (51.6 ± 20.1 vs. 59.2 ± 18.0 years, p = 0.015), tended to have community acquisition of bacteraemia (41.7% vs. 17.9%, p < 0.001), and had persistent bacteraemia beyond 72 h (19.4% vs. 6.0%, p = 0.002). The VIRSTA score had the best performance in predicting IE (AUC 0.76, 95%CI 0.66–0.86) compared with PREDICT Day 1 and Day 5. A VIRSTA score of <3 had the best negative predictive value (97.5%), compared with PREDICT Day 1 (<4) and Day 5 (<2) (94.3% and 96.6%, respectively). Conclusions: Overall, the risk scores performed well in our Asian cohort. If applied, 23.5% of the cohort with a VIRSTA ≥ 3 would require TEE, and a score of <3 had an excellent negative predictive value.
Full article
(This article belongs to the Special Issue Clinical Challenges in Endocarditis—2nd Edition)
Open AccessArticle
Risk Factor Analysis for Growth Arrest in Paediatric Physeal Fractures—A Prospective Study
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Nikki Hooper, Liam Johnson, Nicole Banting, Rubini Pathy, Emily K. Schaeffer, Jeffrey N. Bone, Bryn O. Zomar, Ash Sandhu, Caitlyn Siu, Anthony P. Cooper, Christopher Reilly and Kishore Mulpuri
J. Clin. Med. 2024, 13(10), 2946; https://doi.org/10.3390/jcm13102946 - 16 May 2024
Abstract
Fractures through the physis account for 18–30% of all paediatric fractures, leading to growth arrest in up to 5.5% of cases. We have limited knowledge to predict which physeal fractures result in growth arrest and subsequent deformity or limb length discrepancy. The purpose
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Fractures through the physis account for 18–30% of all paediatric fractures, leading to growth arrest in up to 5.5% of cases. We have limited knowledge to predict which physeal fractures result in growth arrest and subsequent deformity or limb length discrepancy. The purpose of this study is to identify factors associated with physeal growth arrest to improve patient outcomes. Methods: This prospective cohort study was designed to develop a clinical prediction model for growth arrest after physeal injury. Patients ≤ 18 years old presenting within four weeks of injury were enrolled if they had open physes and sustained a physeal fracture of the humerus, radius, ulna, femur, tibia or fibula. Patients with prior history of same-site fracture or a condition known to alter bone growth or healing were excluded. Demographic data, potential prognostic indicators, and radiographic data were collected at baseline, during healing, and at one- and two-years post-injury. Results: A total of 332 patients had at least six months of follow-up or a diagnosis of growth arrest within six months of injury. In a comparison analysis, patients who developed growth arrest were more likely to be older (12.8 years vs. 9.4 years) and injured on the right side (53.0% vs. 45.7%). Initial displacement and angulation rates were higher in the growth arrest group (59.0% vs. 47.8% and 47.0% vs. 38.8%, respectively), but the amount of angulation was similar (27.0° vs. 28.4°). Rates of growth arrest were highest in distal femoral fractures (86%). Conclusion: The incidence of growth arrest in this patient population appears higher than the past literature reports at 30.1%. However, there may be variances in diagnostic criteria for growth arrest, and the true incidence may be lower. A number of patients were approaching skeletal maturity, and any growth arrest is likely to have less clinical significance in these cases. Further prospective long-term follow-up is required to determine risk factors, incidence, and true clinical impact of growth arrest when it does occur.
Full article
(This article belongs to the Special Issue Evidence-Based Medicine in the Practice of Orthopedics and Trauma Care: Current Status and Future Challenges)
Open AccessSystematic Review
The Clinical Role of CXCR4-Targeted PET on Lymphoproliferative Disorders: A Systematic Review
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Maryam Zamanian, Domenico Albano, Giorgio Treglia, Alessio Rizzo and Iraj Abedi
J. Clin. Med. 2024, 13(10), 2945; https://doi.org/10.3390/jcm13102945 - 16 May 2024
Abstract
Background/Objectives: We conducted a comprehensive investigation to explore the pathological expression of the CXCR4 receptor in lymphoproliferative disorders (LPDs) using [68Ga]Ga-Pentixafor PET/CT or PET/MRI technology. The PICO question was as follows: What is the diagnostic role (outcome) of [68Ga]Ga-Pentixafor
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Background/Objectives: We conducted a comprehensive investigation to explore the pathological expression of the CXCR4 receptor in lymphoproliferative disorders (LPDs) using [68Ga]Ga-Pentixafor PET/CT or PET/MRI technology. The PICO question was as follows: What is the diagnostic role (outcome) of [68Ga]Ga-Pentixafor PET (intervention) in patients with LPDs (problem/population)? Methods: The study was written based on the reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines, and it was registered on the prospective register of systematic reviews (PROSPERO) website (CRD42024506866). A comprehensive computer literature search of Scopus, MEDLINE, Scholar, and Embase databases was conducted, including articles indexed up to February 2024. To the methodological evaluation of the studies used the quality assessment of diagnosis accuracy studies-2 (QUADAS-2) tool. Results: Of the 8380 records discovered, 23 were suitable for systematic review. Fifteen studies (on 571 LPD patients) focused on diagnosis and staging, and eight trials (194 LPD patients) assessed treatment response. Conclusions: The main conclusions that can be inferred from the published studies are as follows: (a) [68Ga]Ga-Pentixafor PET may have excellent diagnostic performance in the study of several LPDs; (b) [68Ga]Ga-Pentixafor PET may be superior to [18F]FDG or complementary in some LPDs variants and settings; (c) multiple myeloma seems to have a high uptake of [68Ga]Ga-Pentixafor. Overall, this technique is probably suitable for imaging, staging, and follow-up on patients with LPD. Due to limited data, further studies are warranted to confirm the promising role of [68Ga]Ga-Pantixafor in this context.
Full article
(This article belongs to the Special Issue PET/CT Imaging in Oncology: Innovations, Challenges, and Opportunities)
Open AccessArticle
Assessing Disparities about Overweight and Obesity in Pakistani Youth Using Local and International Standards for Body Mass Index
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Muhammad Asif, Hafiz Ahmad Iqrash Qureshi, Saba Mazhar Seyal, Muhammad Aslam, Muhammad Tauseef Sultan, Maysaa Elmahi Abd Elwahab, Piotr Matłosz and Justyna Wyszyńska
J. Clin. Med. 2024, 13(10), 2944; https://doi.org/10.3390/jcm13102944 - 16 May 2024
Abstract
Background/Objectives: Obesity is currently considered a public health problem in both developed and developing countries. Gender- and age-specific body mass index (BMI) growth standards or references are particularly effective in monitoring the global obesity pandemic. This study aimed to report disparities in age-,
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Background/Objectives: Obesity is currently considered a public health problem in both developed and developing countries. Gender- and age-specific body mass index (BMI) growth standards or references are particularly effective in monitoring the global obesity pandemic. This study aimed to report disparities in age-, gender- and ethnic-specific statistical estimates of overweight and obesity for 2–18 years aged Pakistani children and adolescents using the World Health Organization (WHO), the Center for Disease Control (CDC) 2000 references, the International Obesity Task Force (IOTF) and Pakistani references for BMI. Methods: The study used secondary data of 10,668 pediatric population, aged 2–18 years. Demographic information like age (years), gender, city and anthropometric examinations, i.e., height (cm) and weight (kg) were used in this study. The recommended age- and gender-specific BMI cut-offs of the WHO, CDC 2000 and the IOTF references were used to classify the children sampled as overweight and obese. For the Pakistani reference, overweight and obesity were defined as BMI-for-age ≥ 85th percentile and BMI-for-age ≥ 95th percentile, respectively. Cohen’s κ statistic was used to assess the agreement between the international references and local study population references in the classification of overweight/obesity. Results: The statistical estimates (%) of the participants for overweight and obesity varied according to the reference used: WHO (7.4% and 2.2%), CDC (4.9% and 2.1%), IOTF (5.2% and 2.0%) and Pakistan (8.8% and 6.0%), respectively; suggesting higher levels of overweight and obesity prevalence when local study references are used. The Kappa statistic shows a moderate to excellent agreement (κ ≥ 0.6) among three international references when classifying child overweight and obesity and poor agreement between local references and the WHO (0.45, 0.52), CDC (0.25, 0.50) and IOTF references (0.16, 0.31), for overweight and obesity, respectively. Conclusions: The results of the study showed a visible difference in the estimates of excess body weight after applying the WHO, CDC, IOTF and local BMI references to the study population. Based on the disparity results and poor agreement between international references and the local study reference, this study recommends using local BMI references in identifying children with overweight and obesity.
Full article
(This article belongs to the Special Issue Prevalence and Risk Factors of Obesity and Hypertension)
Open AccessArticle
Selenoprotein P-1 (SEPP1) as an Early Biomarker of Myocardial Injury in Patients Undergoing Cardiopulmonary Bypass
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Giuseppe Filiberto Serraino, Davide Bolignano, Federica Jiritano, Giuseppe Coppolino, Désirée Napolitano, Mariateresa Zicarelli, Patrizia Pizzini, Sebastiano Cutrupi, Alessandra Testa, Belinda Spoto, Michele Andreucci, Pasquale Mastroroberto and Raffaele Serra
J. Clin. Med. 2024, 13(10), 2943; https://doi.org/10.3390/jcm13102943 - 16 May 2024
Abstract
Background: Biomarkers development for prognostication or prediction of perioperative myocardial disease is critical for the evolution of treatment options in patients undergoing cardiac surgery. The aim of our prospective monocentric study was to investigate the role of selenoprotein 1 (SEEP 1) as
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Background: Biomarkers development for prognostication or prediction of perioperative myocardial disease is critical for the evolution of treatment options in patients undergoing cardiac surgery. The aim of our prospective monocentric study was to investigate the role of selenoprotein 1 (SEEP 1) as a potential biomarker for assessing the risk of myocardial injury after cardiac surgery. Methods: Circulating SEPP1 was measured in the blood of 45 patients before surgery and at 4 h, 8 h and 12 h after CPB by enzyme-linked immunosorbent assay (ELISA); (3) Results: circulating SEPP-1 levels measured 4 h after surgery were strongly correlated with CK-MB levels measured at 48 h (R = 0.598, p < 0.0001) and at 72 h (R = 0.308, p = 0.05). Close correlations were also found between 4 h SEPP-1 and Hs-c troponin values measured at 24 h (R = 0.532, p < 0.0001), 48 h (R = 0.348, p = 0.01) and 72 h (R = 0.377, p = 0.02), as well as with cardiopulmonary bypass (CPB) (R = 0.389, p = 0.008) and cross-clamp time (R = 0.374, p = 0.001); (4) Conclusions: Early SEPP1 measurement after CPB may hold great potential for identifying cardiac surgery patients at risk of developing perioperative myocardial injury.
Full article
(This article belongs to the Section Cardiology)
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Open AccessArticle
Periodontal Health and Its Relationship with Psychological Stress: A Cross-Sectional Study
by
Monica Macrì, Giuseppe D’Albis, Vincenzo D’Albis, Anna Antonacci, Antonia Abbinante, Riccardo Stefanelli, Francesco Pegreffi and Felice Festa
J. Clin. Med. 2024, 13(10), 2942; https://doi.org/10.3390/jcm13102942 - 16 May 2024
Abstract
Background: Studies suggest that chronic psychological stress can lead to oral health deterioration, alter the immune response, and possibly contribute to increased inflammation, which can impact the physiological healing of periodontal tissues. This cross-sectional study seeks to assess and improve clinical understanding
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Background: Studies suggest that chronic psychological stress can lead to oral health deterioration, alter the immune response, and possibly contribute to increased inflammation, which can impact the physiological healing of periodontal tissues. This cross-sectional study seeks to assess and improve clinical understanding regarding the relationship between perceived stress, mindfulness, and periodontal health. Methods: A total of 203 people were analyzed from December 2022 to June 2023. The Periodontal Screening and Recording (PSR) score and Gingival Bleeding Index (GBI), and Plaque Control Record (PCR) of every patient were registered. Subsequently, participants completed the Sheldon Cohen Perceived Stress Scale (PSS) and the Mindfulness Awareness Attention Scale (MAAS) questionnaires. The collected data underwent statistical analysis, encompassing the evaluation of correlations and dependencies. Applying Welch’s t-test to assess the relationship between MAAS and the variable indicating the presence or absence of periodontitis, a noteworthy p-value of 0.004265 was obtained. Results: This underscores a significant distinction in MAAS scores between patients affected by periodontitis and those unaffected by the condition. Additionally, Pearson correlations were computed for GBI and perceived stress, PCR and perceived stress, PCR and MAAS. The resulting p-values of 2.2–16, 3.925–8, and 2.468–8, respectively, indicate a statistically significant correlation in each instance. Conclusions: These findings contribute valuable insights into the interconnectedness of these variables, emphasizing the significance of their associations in the study context. Despite the limitations, the findings of this study suggest a significant relationship between psychological stress, mindfulness, and periodontal tissue health. Clinical trials are necessary to incorporate the assessment of a patient’s psychological status as a new valuable tool in the management of periodontal health.
Full article
(This article belongs to the Section Dentistry, Oral Surgery and Oral Medicine)
Open AccessArticle
QMAC-DST for Rapid Detection of Drug Resistance in Pulmonary Tuberculosis Patients: A Multicenter Pre–Post Comparative Study
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Nakwon Kwak, Sangyeop Lee, Suyeoun Kim, Eunbee Song, Jae-Joon Yim, Tae Sun Shim, Doosoo Jeon, Byung Woo Jhun, Kwang-Hyuk Seok, Saerom Kim, Sunghoon Kwon and Jeongha Mok
J. Clin. Med. 2024, 13(10), 2941; https://doi.org/10.3390/jcm13102941 - 16 May 2024
Abstract
Background/Objectives: This study explores the impact of QMAC-DST, a rapid, fully automated phenotypic drug susceptibility test (pDST), on the treatment of tuberculosis (TB) patients. Methods: This pre–post comparative study, respectively, included pulmonary TB patients who began TB treatment between 1 December 2020 and
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Background/Objectives: This study explores the impact of QMAC-DST, a rapid, fully automated phenotypic drug susceptibility test (pDST), on the treatment of tuberculosis (TB) patients. Methods: This pre–post comparative study, respectively, included pulmonary TB patients who began TB treatment between 1 December 2020 and 31 October 2021 (pre-period; pDST using the Löwenstein–Jensen (LJ) DST (M-kit DST)) and between 1 November 2021 and 30 September 2022 (post-period; pDST using the QMAC-DST) in five university-affiliated tertiary care hospitals in South Korea. We compared the turnaround times (TATs) of pDSTs and the time to appropriate treatment for patients whose anti-TB drugs were changed based on these tests between the groups. All patients were permitted to use molecular DSTs (mDSTs). Results: A total of 182 patients (135 in the M-kit DST group and 47 in the QMAC-DST group) were included. The median TAT was 36 days for M-kit DST (interquartile range (IQR), 30–39) and 12 days for QMAC-DST (IQR, 9–15), with the latter being significantly shorter (p < 0.001). Of the total patients, 10 (5.5%) changed their anti-TB drugs based on the mDST or pDST results after initiating TB treatment (8 in the M-kit DST group and 2 in the QMAC-DST group). In the M-kit DST group, three (37.5%) patients changed anti-TB drugs based on the pDST results. In the QMAC-DST group, all changes were due to mDST results; therefore, calculating the time to appropriate treatment for patients whose anti-TB drugs were changed based on pDST results was not feasible. In the QMAC-DST group, 46.8% of patients underwent the first-line line probe assay compared to 100.0% in the M-kit DST group (p < 0.001), indicating that rapid QMAC-DST results provide quicker assurance of the ongoing treatment by confirming susceptibility to the current anti-TB drugs. Conclusions: QMAC-DST delivers pDST results more rapidly than LJ-DST, ensuring faster confirmation for the current treatment regimen.
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(This article belongs to the Section Pulmonology)
Open AccessReview
Carbon vs. Titanium Nails in the Treatment of Impending and Pathological Fractures: A Literature Review
by
Elisa Pesare, Cesare Meschini, Matteo Caredda, Federica Messina, Giuseppe Rovere, Giuseppe Solarino and Antonio Ziranu
J. Clin. Med. 2024, 13(10), 2940; https://doi.org/10.3390/jcm13102940 - 16 May 2024
Abstract
Background: Long bones are commonly affected by musculoskeletal tumors, but they also represent one of the most frequent locations for metastases. The treatment is based on pain management and the prevention or stabilization of pathological fractures by intramedullary nailing. While titanium nails
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Background: Long bones are commonly affected by musculoskeletal tumors, but they also represent one of the most frequent locations for metastases. The treatment is based on pain management and the prevention or stabilization of pathological fractures by intramedullary nailing. While titanium nails are probably the most used, carbon-fiber-reinforced (CFR) nails have emerged as a new option for oncological patients. The aim of this review is to compare titanium and CFR nails according to current findings. Methods: Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards were followed: a total of 1004 articles were identified and 10 were included. Results: Traditionally, titanium implants are highly valued for their optimal biomechanical properties and ease of insertion, facilitated by their radiopacity. However, the use of titanium poses challenges in radiotherapy due to interference with radiation dosage and the creation of ferromagnetic artifacts. Conversely, CFR implants have emerged as a recommended option for intramedullary fixation, due to their biomechanical and structural properties and their benefits during radiotherapy and follow-up monitoring X-ray. Conclusions: CFR nailing represents a promising advancement in the surgical management of oncological patients with long bone metastases. However, further studies are needed to increase surgeons’ confidence in their use.
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(This article belongs to the Special Issue Recent Advances in the Management of Pathological Fractures)
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Open AccessArticle
A Machine Learning-Based Mortality Prediction Model for Patients with Chronic Hepatitis C Infection: An Exploratory Study
by
Abdullah M. Al Alawi, Halima H. Al Shuaili, Khalid Al-Naamani, Zakariya Al Naamani and Said A. Al-Busafi
J. Clin. Med. 2024, 13(10), 2939; https://doi.org/10.3390/jcm13102939 - 16 May 2024
Abstract
Background: Chronic hepatitis C (HCV) infection presents global health challenges with significant morbidity and mortality implications. Successfully treating patients with cirrhosis may lead to mortality rates comparable to the general population. This study aims to utilize machine learning techniques to create predictive mortality
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Background: Chronic hepatitis C (HCV) infection presents global health challenges with significant morbidity and mortality implications. Successfully treating patients with cirrhosis may lead to mortality rates comparable to the general population. This study aims to utilize machine learning techniques to create predictive mortality models for individuals with chronic HCV infections. Methods: Data from chronic HCV patients at Sultan Qaboos University Hospital (2009–2017) underwent analysis. Data pre-processing handled missing values and scaled features using Python via Anaconda. Model training involved SelectKBest feature selection and algorithms such as logistic regression, random forest, gradient boosting, and SVM. The evaluation included diverse metrics, with 5-fold cross-validation, ensuring consistent performance assessment. Results: A cohort of 702 patients meeting the eligibility criteria, predominantly male, with a median age of 47, was analyzed across a follow-up period of 97.4 months. Survival probabilities at 12, 36, and 120 months were 90.0%, 84.0%, and 73.0%, respectively. Ten key features selected for mortality prediction included hemoglobin levels, alanine aminotransferase, comorbidities, HCV genotype, coinfections, follow-up duration, and treatment response. Machine learning models, including the logistic regression, random forest, gradient boosting, and support vector machine models, showed high discriminatory power, with logistic regression consistently achieving an AUC value of 0.929. Factors associated with increased mortality risk included cardiovascular diseases, coinfections, and failure to achieve a SVR, while lower ALT levels and specific HCV genotypes were linked to better survival outcomes. Conclusions: This study presents the use of machine learning models to predict mortality in chronic HCV patients, providing crucial insights for risk assessment and tailored treatments. Further validation and refinement of these models are essential to enhance their clinical utility, optimize patient care, and improve outcomes for individuals with chronic HCV infections.
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(This article belongs to the Section Gastroenterology & Hepatopancreatobiliary Medicine)
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Open AccessArticle
Direct Intraocular Lens Extraction Using a Newly Developed Lens-Grabbing Forceps
by
Santaro Noguchi, Shunsuke Nakakura, Hitoshi Tabuchi and Asuka Noguchi
J. Clin. Med. 2024, 13(10), 2938; https://doi.org/10.3390/jcm13102938 - 16 May 2024
Abstract
Background: Due to lower age thresholds for cataract surgery and increased longevity, cases with intraocular lens (IOL) dislocation requiring removal have increased. Traditional methods, such as cutting or folding the IOL within the eye, pose a high risk of complications, including corneal endothelial
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Background: Due to lower age thresholds for cataract surgery and increased longevity, cases with intraocular lens (IOL) dislocation requiring removal have increased. Traditional methods, such as cutting or folding the IOL within the eye, pose a high risk of complications, including corneal endothelial and iris damage. Methods: We developed a new minimally invasive technique for direct IOL removal using specially designed lens-grabbing forceps. These forceps can grasp and remove the IOL through a small incision in a single motion, significantly reducing intraocular manipulations compared to conventional methods. Results: In our test cases, IOL removal through a 2.2 mm corneal incision was completed in approximately 95 s, with minimal incision enlargement (about 0.16 mm) and a slight decrease in corneal endothelial cells. Conclusions: Our findings suggest that this technique is minimally invasive and safe for IOL removal, offering a promising alternative to existing methods.
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(This article belongs to the Special Issue Advances in Anterior Segment Surgery)
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Open AccessArticle
Systemic Manifestations of COPD and the Impact of Dual Bronchodilation with Tiotropium/Olodaterol on Cardiac Function and Autonomic Integrity
by
Ieva Dimiene, Deimante Hoppenot, Donatas Vajauskas, Lina Padervinskiene, Airidas Rimkunas, Marius Zemaitis, Diana Barkauskiene, Tomas Lapinskas, Egle Ereminiene and Skaidrius Miliauskas
J. Clin. Med. 2024, 13(10), 2937; https://doi.org/10.3390/jcm13102937 - 16 May 2024
Abstract
Background: Chronic obstructive pulmonary disease (COPD) has significant systemic manifestations, including cardiovascular morbidity. The main aim of our study was to evaluate the effect of short-term COPD treatment with tiotropium/olodaterol (TIO/OLO) 5/5 μg on cardiac function and autonomic integrity. Methods: Twenty-nine
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Background: Chronic obstructive pulmonary disease (COPD) has significant systemic manifestations, including cardiovascular morbidity. The main aim of our study was to evaluate the effect of short-term COPD treatment with tiotropium/olodaterol (TIO/OLO) 5/5 μg on cardiac function and autonomic integrity. Methods: Twenty-nine patients with newly diagnosed moderate-to-severe COPD were enrolled. We performed pulmonary function tests, cardiac magnetic resonance, cardiac 123I-metaiodobenzylguanidine (123I-MIBG) imaging and analysis of blood biomarkers on our study subjects. The correlations between the tests’ results were evaluated at baseline. The changes in pulmonary and cardiac parameters from baseline through 12 weeks were assessed. Results: Significant associations between pulmonary function tests’ results and high-sensitivity C-reactive protein (hs-CRP), as well as interleukin-22 (IL-22), were observed at baseline. Treatment with TIO/OLO significantly improved lung function as measured by spirometry and body plethysmography. Moreover, we found that the cardiac index increased from 2.89 (interquartile range (IQR) 1.09) to 3.21 L/min/m2 (IQR 0.78) (p = 0.013; N = 18) and the late heart-to-mediastinum ratio improved from 1.88 (IQR 0.37) to 2 (IQR 0.41) (p = 0.026; N = 16) after 12 weeks of treatment. Conclusions: Treatment with TIO/OLO improves lung function and positively impacts cardiac function and autonomic integrity, suggesting that dual bronchodilation might have a potential in decreasing the risk for cardiac events in COPD. Hs-CRP and IL-22 might be beneficial in determining the intensity of systemic inflammation in COPD. Further research with a larger cohort is needed to enhance the initial results of this study.
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(This article belongs to the Special Issue Chronic Obstructive Pulmonary Disease (COPD): Treatment and Management)
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Open AccessReview
Acute Myocardial Infarction in COVID-19 Patients—A Review of Literature Data and Two-Case Report Series
by
Luiza Nechita, Elena Niculet, Liliana Baroiu, Alexia Anastasia Stefania Balta, Aurel Nechita, Doina Carina Voinescu, Corina Manole, Camelia Busila, Mihaela Debita and Alin Laurentiu Tatu
J. Clin. Med. 2024, 13(10), 2936; https://doi.org/10.3390/jcm13102936 - 16 May 2024
Abstract
Background/Objectives: The newly emergent COVID-19 pandemic involved primarily the respiratory system and had also major cardiovascular system (CVS) implications, revealed by acute myocardial infarction (AMI), arrhythmias, myocardial injury, and thromboembolism. CVS involvement is done through main mechanisms—direct and indirect heart muscle injury,
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Background/Objectives: The newly emergent COVID-19 pandemic involved primarily the respiratory system and had also major cardiovascular system (CVS) implications, revealed by acute myocardial infarction (AMI), arrhythmias, myocardial injury, and thromboembolism. CVS involvement is done through main mechanisms—direct and indirect heart muscle injury, with high mortality rates, worse short-term outcomes, and severe complications. AMI is the echo of myocardial injury (revealed by increases in CK, CK-MB, and troponin serum markers—which are taken into consideration as possible COVID-19 risk stratification markers). When studying myocardial injury, physicians can make use of imaging studies, such as cardiac MRI, transthoracic (or transesophageal) echocardiography, coronary angiography, cardiac computed tomography, and nuclear imaging (which have been used in cases where angiography was not possible), or even endomyocardial biopsy (which is not always available or feasible). Two-case-series presentations: We present the cases of two COVID-19 positive male patients who were admitted into the Clinical Department of Cardiology in “Sfântul Apostol Andrei” Emergency Clinical Hospital of Galați (Romania), who presented with acute cardiac distress symptoms and have been diagnosed with ST elevation AMI. The patients were 82 and 57 years old, respectively, with moderate and severe forms of COVID-19, and were diagnosed with anteroseptal left ventricular AMI and extensive anterior transmural left ventricular AMI (with ventricular fibrillation at presentation), respectively. The first patient was a non-smoker and non-drinker with no associated comorbidities, and was later discharged, while the second one died due to AMI complications. Conclusions: From this two-case series, we extract the following: old age alone is not a significant risk factor for adverse outcomes in COVID-19-related CVS events, and that the cumulative effects of several patient-associated risk factors (be it either for severe forms of COVID-19 and/or acute cardiac injury) will most probably lead to poor patient prognosis (death). At the same time, serum cardiac enzymes, dynamic ECG changes, along with newly developed echocardiographic modifications are indicators for poor prognosis in acute cardiac injury in COVID-19 patients with acute myocardial injury, regardless of the presence of right ventricular dysfunction (due to pulmonary hypertension).
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(This article belongs to the Section Cardiovascular Medicine)
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Open AccessFeature PaperArticle
Eosinophilic Dermatosis of Hematologic Malignancy: Emerging Evidence for the Role of Insect Bites—A Retrospective Clinico-Pathological Study of 35 Cases
by
Andrea Michelerio, Marco Rubatto, Gabriele Roccuzzo, Marta Coscia, Pietro Quaglino and Carlo Tomasini
J. Clin. Med. 2024, 13(10), 2935; https://doi.org/10.3390/jcm13102935 - 16 May 2024
Abstract
Background/Objectives: Eosinophilic dermatosis of hematologic malignancy (EDHM) is a rare cutaneous disorder associated with various hematologic malignancies, most commonly chronic lymphocytic leukemia. Detailed clinicopathologic studies of EDHM are lacking and the pathogenesis remains enigmatic. Initially thought to be a hypersensitivity reaction to insect
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Background/Objectives: Eosinophilic dermatosis of hematologic malignancy (EDHM) is a rare cutaneous disorder associated with various hematologic malignancies, most commonly chronic lymphocytic leukemia. Detailed clinicopathologic studies of EDHM are lacking and the pathogenesis remains enigmatic. Initially thought to be a hypersensitivity reaction to insect stings, subsequent reports have challenged this understanding. The prognostic implications of EDHM remain unclear. Methods: A retrospective clinicopathologic study was performed on patients diagnosed with EDHM. Hematologic and dermatologic data were reviewed. Histologic specimens were re-evaluated and lesions were classified into acute/subacute, fully developed, and chronic/regressing. Results: The study included 35 patients. In 80% of these patients, EDHM was diagnosed after the hematologic disorder. Approximately 45% of the cohort experienced hematologic disease progression or relapse, while 65% required therapeutic intervention during the course of their hematologic disease. In total, 15/19 CLL patients had non-mutated IgHV, a marker of a more aggressive hematologic disease course. Dermatologic lesion morphology was heterogeneous, with most lesions occurring on exposed areas, and a significant 94% of patients demonstrated lesion seasonality. Histopathologic findings were consistent with features typically associated with insect bites. In addition, examination of lesions at different chronological stages revealed substantial similarities with Wells syndrome. Conclusions: Our findings support the potential role of insect bites in triggering EDHM in the context of adaptive immune dysfunction. EDHM may be associated with a more aggressive disease course or may be a marker of disease progression. The observed co-occurrence of features typical of Wells syndrome in EDHM patients suggests that these conditions are part of a spectrum of disorders that vary in clinical expression.
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(This article belongs to the Special Issue Recent Advances in Inflammatory and Infectious Skin Diseases)
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