Clin. Pract., Volume 14, Issue 6 (December 2024) – 26 articles

Background: The existing literature predominantly examines post and core assessments post-cementation, neglecting the critical pre-cementation phase. Research on the clinical acceptance of dental posts received from dental laboratories before cementation is notably lacking. This study investigates the percentage of zirconia and metal dental posts that are deemed suitable for cementation by clinicians, among the total received from the dental laboratory. Additionally, it aims to examine whether this percentage varies based on the type of impression made by the clinician: digital impression versus conventional impression. Methods: This article introduces the application of computer-aided design-computer-aided manufacturing (CAD-CAM) technology for manufacturing customized zirconia and Cobalt–Chromium (Co-Cr) post and cores. Intraoral scanning is employed to capture the canal anatomy. In contrast to the traditional casting process, a three-dimensional (3D) metal printer machine is utilized to 3D print the metal post and core from Co-Cr, resulting in enhanced toughness and superior adaptability to the canal. Two null hypotheses were formulated, investigating the clinical acceptance of zirconia and metal posts obtained through traditional versus digital impressions. Results: Among 577 post and cores, 95% of metal posts from both impression methods received clinical approval. However, for zirconia posts, a significantly higher acceptance rate (95% versus 88%) was observed for those from traditional impressions. The Chi-squared test yielded a p-value < 0.05, underscoring the clinical superiority of conventionally obtained zirconia posts and supporting the null hypothesis for metal posts. Conclusions: A significantly higher acceptance rate is apparent among zirconia post and cores manufactured through conventional impressions, in contrast to zirconia post and cores produced via digital impressions. No statistically significant difference was identified between metal post and cores obtained through digital impressions and those acquired through conventional impressions. Full article

Background: Children’s eye disorders are a major cause of irreversible vision loss. Delays in diagnosing eye problems in children are recurring problems that require quick attention. This study assesses parents’ knowledge, attitudes, and practices regarding the early ophthalmological screening of preschool-aged children in Jazan, KSA. Methods: An observational cross-sectional study was conducted among 522 parents of preschool-aged children in the Jazan region. A self-administered web-based questionnaire was randomly distributed to the parents via WhatsApp. The survey tool consisted of four main sections: socio-demographic data, knowledge about eye care, attitudes toward eye screening, and eye care practices. Results: Parents’ level of knowledge regarding children’s eye care was distributed as follows: low (21.5%), medium (40.2%), and high (38.4%). Parent gender, age, occupation, level of income, and nationality showed no statistically significant association with the knowledge level (p > 0.05 for all). However, parent education played a significant role (p = 0.013). Further, parents expressed a positive attitude toward the early screening of eye problems, as more than 90% agreed that early eye examinations for children reduce complications from visual problems and that the increased use of electronic devices requires early eye examinations. Almost 47.0% of the parents had examined their children’s eyes when they were between 1 and 5 years of age, compared with only 10.3% of parents of children less than 1 year of age. The multiple linear regression model for factors that predict knowledge level among the study participants showed that having a child undergo early screening is positively associated with an increased knowledge score (p < 0.05). Conclusions: Jazan parents showed a positive attitude toward the early screening of eye problems, and one-third had a high level of knowledge regarding children’s eye care. However, the proportion of those who practiced early eye screening was low. More health education is necessary to increase parents’ awareness regarding early eye care practices. Full article

Background: Artificial intelligence has become a valuable tool for diagnosing and detecting postoperative complications early. Through imaging and biochemical markers, clinicians can anticipate the clinical progression of patients and the risk of long-term complications that could impact the quality of life or even be life-threatening. In this context, artificial intelligence is crucial for identifying early signs of complications and enabling clinicians to take preventive measures before problems worsen. Materials and methods: This observational study analyzed medical charts from the electronic archive of the Clinical Emergency Hospital in Galați, Romania, covering a four-year period from 2018 to 2022. A neural network model was developed to analyze various socio-demographic and paraclinical data. Key features included patient demographics, laboratory investigations, and clinical outcomes. Statistical analyses were performed to identify significant risk factors associated with deep venous thrombosis (DVT). Results: The analysis revealed a higher prevalence of female patients (60.78%) compared to male patients, indicating a potential gender-related risk factor for DVT. The incidence of DVT was highest among patients aged 71 to 90 years, affecting 56.86% of individuals in this age group, suggesting that advanced age significantly contributes to the risk of developing DVT. Additionally, among the DVT patients, 15.69% had a body mass index (BMI) greater than 30, categorizing them as obese, which is known to increase the risk of thrombotic events. Furthermore, this study highlighted that the highest frequency of DVT was associated with femur fractures, occurring in 52% of patients with this type of injury. The neural network analysis indicated that elevated levels of direct bilirubin (≥1.5 mg/dL) and prothrombin activity (≤60%) were strong predictors of fracture-related complications, with sensitivity and specificity rates of 78% and 82%, respectively. These findings underscore the importance of monitoring these laboratory markers in at-risk populations for early intervention. Conclusions: This study identified critical risk factors for developing DVT, including advanced age, high BMI, and femur fractures, which necessitate longer recovery periods. Additionally, the findings indicate that elevated direct bilirubin and prothrombin activity play a significant role in predicting DVT development. These results suggest that AI can effectively enhance the anticipation of clinical evolution in patients, aiding in early intervention and management strategies. Full article

Background/Objectives: Health management in workers in the taxi industry is particularly challenging due to irregular working hours and the need to prevent fatal accidents. In addition, drivers in Japan are aging, and the early prevention of age-related deterioration in oral health is an increasingly important issue. The aim of this cross-sectional study was to investigate the relationships between oral diadochokinesis (OD), tongue pressure, and lip-seal strength in Japanese male taxi workers. Methods: Measurements of tongue pressure and lip-seal strength were performed by dentists using specialized equipment. OD was measured using the number of consecutive “Pa”, “Ta”, and “Ka” vocalizations that could be produced in 5 s. We performed multiple regression analysis to examine the effects of lip-seal strength and tongue pressure on OD. Results: The study included 437 participants, excluding 17 who could not complete all oral cavity measurements. Tongue pressure showed a significant positive correlation with “Pa”, “Ta”, and “Ka” (correlation coefficients: 0.527–0.680). Lip-seal strength was not significantly correlated with OD. Tongue pressure showed a significant positive correlation with “Pa”, “Ta”, and “Ka”. In the results of multiple regression analyses without the elderly participants, tongue pressure was associated with “Pa” (β[95% confidence interval]: 0.574[0.304, 0.843]), “Ta” (0.436[0.231, 0.640]), and “Ka” (0.424[0.210, 0.639]), and lip-seal strength was associated with “Pa” (0.128[0.032, 0.224]) and “Ka” (0.083[0.006, 0.160]). Conclusions: OD may be associated with lip-seal strength and tongue pressure even without including elderly workers. Regardless of age, maintaining good OD may help maintain lip-seal strength and tongue pressure, which may play a role in reducing the risk of age-related oral disorders. Full article

Background: Patellofemoral pain is one of the most common injuries in recreational runners, with significant implications for dynamic knee valgus. The knee valgus angle can be corrected surgically or with a more conservative non-operative approach. Increasing running cadence may be an effective biomechanical gait retraining intervention to reduce knee valgus and thus patellofemoral pain. The primary purpose of this study was to examine if an increase in cadence could change the knee valgus angle. Methods: Ten asymptomatic recreational runners were recorded running on a treadmill during control and experimental intervals. Each interval lasted five minutes, and participants ran at 100% and 110% of their baseline cadence. Peak angles of knee valgus were compared between both intervals using the video analysis software application Dartfish Express. A paired sample, a two-tailed t-test, was used to determine the significant difference between bilateral frontal plane knee angle measurements during both intervals. Results: The average decrease in knee valgus measured in control versus experimental intervals was 2.23° for the right leg and 2.05° for the left leg, with a significance of p < 0.001 and p < 0.001, respectively. Conclusion: The results indicated a statistically significant decrease in angles of dynamic knee valgus, attributable to increased cadence. These changes in knee valgus angle are likely to have a positive impact on preventing and reducing pain associated with PFP. Full article

Background: Central serous chorioretinopathy (CSCR) is a retinal condition characterized by the accumulation of subretinal fluid, often linked to elevated levels of endogenous corticosteroids and stress-related hormones, which can lead to visual disturbances. This connection may explain the association of CSCR with high stress levels and the use of corticosteroid medications. Although many cases resolve spontaneously, persistent or severe instances may require intervention. Case Description: Our report presents a case of acute CSCR in a 33-year-old male who developed the condition following corticosteroid treatment for acute parotiditis and left submandibular lymphadenopathy. Initial presentation was 6 weeks after corticosteroid treatment was initiated. Diagnostic evaluation with optical coherence tomography (OCT) and fluorescein angiography confirmed the presence of subretinal fluid at the retinal pigment epithelium–Bruch’s membrane complex. Micropulse laser therapy (MPLT) was applied to address the leakage points, leading to significant fluid reduction at a two-week follow-up. By six weeks, the complete resolution of subretinal fluid was documented, with substantial visual recovery. Conclusions: This case confirms MPLT as an effective treatment for CSCR, particularly when conservative management is insufficient. Unlike traditional photocoagulation, MPLT offers a safer alternative, minimizing the risk of retinal damage, such as permanent scotomas. Clinical Significance: This case underscores the importance of carefully monitoring patients undergoing corticosteroid therapy for potential ocular complications and highlights the role of MPLT as a safe and effective option for managing persistent CSCR, protecting the surrounding retinal tissue from damage while achieving significant therapeutic outcomes. Full article

Background/Objectives: Rheumatoid arthritis (RA) is a chronic inflammatory disorder characterized by joint damage. However, no incidence analyses have been conducted on a Korean population since 2013. We aimed to calculate the incidence of RA and examine trends using complete Korean National Health Insurance Service claims data from 2007. Methods: We used 16 years of Korean NHIS claims data from 1 January 2002 to 31 December 2017. Patients were defined as having RA when diagnosed with ICD-10 codes M05 and M06. We set the 5-year period prior to 2006 as disease-free. Results: From 2007 to 2017, the incidence rate of RA was 35 to 43 per 100,000 individuals. The female-to-male ratio was approximately 3–3.5 to 1. The sex-standardized incidence rate was highest in the 60–69 age group but gradually declined, resulting in a reversal in 2017, with the highest incidence rate observed in the 50–59 age group. The incidence of elderly onset RA (EORA) in individuals aged >60 years exhibited a decreasing trend during the study period (age 60–69, −6.45, 95% CI = −8.27 to −4.62, p < 0.001; age ≥70, −6.09, 95% CI = −7.66 to −4.53, p < 0.001). Conclusions: This study is the first to analyze the incidence trend of RA over an 11-year period. In South Korea, the incidence of RA has shown a decreasing trend since 2011; the same trend was observed in the EORA group. Young-onset RA showed the opposite trend, suggesting that RA is diagnosed earlier, due to the new RA classification criteria. Full article

Background: Atrial fibrillation (AF) is prevalent among obese patients, and cryoballoon ablation (CBA) is an effective strategy for the rhythm control of AF. The impact of body mass index (BMI) on the clinical outcomes of CBA for AF is not fully explored. Methods: 85 consecutive patients with paroxysmal AF were enrolled and were categorized into three groups as per their BMI: normal weight (BMI 18.5–25 kg/m²), overweight (BMI 25–30 kg/m²), and obese patients (BMI > 30 kg/m²). The primary study endpoint was a late (12 month) recurrence of AF. Early recurrence of AF, symptom improvement, and procedural outcomes were some key secondary outcomes. Results: 20 patients had normal weight, 35 were overweight, and 30 were obese. Obese patients featured a higher prevalence of diabetes mellitus, heavier exposure to smoking, and worse baseline symptoms (as assessed through EHRA class at admission and 12 months before CBA) compared to overweight and normal weight patients. Both late and early (<3 months) AF recurrence rates were comparable across the three groups. Of note, obese patients showed greater improvement in their symptoms post-CBA, defined as improvement by at least one EHRA class, compared to normal weight patients; this might be explained by improved diastolic function. Total procedure time and dose area product were significantly increased in obese patients. The multivariate logistic regression analysis indicated that early AF recurrence and the duration of hypertension are independent predictors of late AF recurrence. Conclusion: CBA is effective in overweight and obese patients with paroxysmal AF. Procedure time and radiation exposure are increased in obese patients undergoing CBA. Full article

Congenital cytomegalovirus (CMV) infection is the most common intrauterine viral infection with a significant impact on the foetus and newborn. Current diagnostic practice includes serological testing for specific antibodies, but there are no global screening protocols. Maternal CMV screening is often performed in conjunction with antenatal ultrasound. While most infections are asymptomatic, severe cases can lead to long-term disability or death. Antiviral therapies, mainly ganciclovir and valganciclovir, are reserved for symptomatic patients, especially those with central nervous system involvement. Although effective, these treatments are associated with significant side effects such as neutropenia and hepatotoxicity. Foscarnet and cidofovir are used as alternatives, but their efficacy and safety require further study in paediatric patient populations. The effectiveness of passive prophylaxis is still uncertain. The lack of universally accepted guidelines for diagnosis, treatment, and prevention and the risk of serious side effects highlight the need for continued research. This review evaluates current therapeutic strategies, discusses their efficacy and associated risks, and highlights the need for innovative approaches to improve outcomes for affected neonates. Full article

Background: Epidermal cysts are common benign lesions encountered in primary care, especially in minor surgery clinics. The management of large epidermal cysts (>5 cm in diameter) poses significant challenges, including surgical intervention requirements, potential for complications, and impacts on patient care and clinic workflow. The prevalence of these cysts underlines the need for optimised management strategies that are essential for enhancing patient outcomes and clinic efficiency. This quality improvement initiative sought to better manage large epidermal cysts in primary care settings. Patients and methods: The initiative utilised the Plan-Do-Study-Act (PDSA) cycle over three distinct phases, with an emphasis on improving surgical techniques and postoperative care, optimising clinic workflow, and enhancing patient education and involvement. Over the course of this eighteen-month study, 100 patients who required surgical excision of large epidermal cysts were included. The interventions focused on standardising surgical protocols, implementing a new scheduling system, and developing comprehensive educational materials for patients. Results: The programme contributed to major efficiency gains for surgeries: the average operative time was reduced from 45 min to 30. The postoperative complication rate decreased dramatically while patient and clinician satisfaction went up, as did clinic throughput. With patient education enhancements, follow-up adherence rose to 92% while the postoperative complication rate declined from 18% to 9% with the overall approach to patient engagement. Conclusions: The successful application of the PDSA cycles in this work demonstrates that quality improvement methodologies have a potential role in optimising management for large epidermal cysts in primary care settings. Developed interventions can therefore be put into routine care that will indeed improve patient outcome, clinician experience, and operational efficiency in minor surgery clinics. Full article

Background and Objective: In this study, we aimed to identify the factors that could impact the Stress-Related Growth Scale (SRGS) questionnaire administered to patients. Materials and Methods: Participants were asked to complete a written SRGS questionnaire (a translated and approved version in Romania) at varying time intervals relative to the traumatic event. The questionnaire was developed in accordance with legal regulations of the World Health Organization and the European Union for research involving human subjects for medical purposes. It took approximately 15 min to complete. The questionnaire was filled out by the patient or their legal guardian/parent for minors between January 2021 and January 2022. Results: The findings revealed the individual dimensions in the context of the traumatic impact, and the subsequent conclusions could be applied to a larger group with similar traumatic experiences. It is recognized that psychosomatic pathologies can hinder posttraumatic rehabilitation, leading to slower and more challenging recovery. Conclusions: Posttraumatic stress disorder often manifests as chronic development of symptoms characterized by reexperiencing traumatic scenes, avoidance behaviors, negative alterations in cognition, and heightened arousal. Posttraumatic stress disorder (PTSD) is a prevalent, persistent, and psychologically debilitating syndrome that can significantly impair an individual’s ability to cope with life. The etiology and manifestation of this disorder present numerous challenges due to the complexity of defining and diagnosing these conditions. The distribution of men and women affected by posttraumatic stress disorder varies across different sources and cannot be simplified into one explanation. While sex distribution is an important factor, it is not the sole determinant for understanding the various aspects of these disorders. The diversity of stressors has been shown to correlate with changes in SRGS scores, including subtle emotions like shame and guilt, which contribute to the moral injury resulting from trauma. Full article

Hemifacial microsomia is the second most common congenital anomaly of the craniofacial region. Hemifacial microsomia is characterised by unilateral hypoplasia of the ear. Treatment of this condition depends on the severity of the lesion. The treatment of hemifacial microsomia must be carried out by a multidisciplinary group of professionals familiar with this pathology, including plastic surgeons, parapsychologists, orthodontists, and paediatricians. In hemifacial microsomia, microtia is usually accompanied by alterations of the middle ear. Since the ear develops embryonically from the first and second branchial arches, the facial areas that also develop from these embryonic origins are usually affected to a greater or lesser degree, including through hypoplasia of the jaw, maxilla, zygomatic bones, and temporal bone, among others. Although jaw hypoplasia is the most evident deformity in craniofacial microsomia, microtia is the alteration that often has the greatest aesthetic impact on patients. Alterations in dentition are also common, typically presenting as a cephalad inclination of the anterior occlusal plane of the maxilla and mandible on the affected side. This study aims to review the surgical approach and evaluate the results of a paediatric case of hemifacial microsomia. Hemifacial microsomia is present at birth, and successful reconstruction is essential for the correct integration of such infantile patients into society. Multiple facial asymmetries as well as neonatal onset are a challenge for reconstructive surgery, and the importance of multidisciplinary treatment in these patients must be emphasised. Full article

Background: Tuberculosis remains a major global public health problem, affecting millions of people every year, including children. At the same time, depressive disorders are among the most common mental disorders in children and adolescents, significantly influencing their quality of life and development. The intersection between these two pathologies—tuberculosis and depressive disorders—in pediatric patients raises complex clinical challenges that require effective identification and intervention strategies. Materials and Methods: A total sample of 190 patients aged between 7 and 18 years who presented to Galati “St. Spiridon” Pneumophthisiology Hospital between January 2019 and December 2021 was used. Objective: The main objective of this paper is to achieve a predictive score of depressive disorders in pediatric patients diagnosed with a form of tuberculosis. This score is particularly important because it helps to identify and treat early depressive disorders in children previously diagnosed with tuberculosis, resulting in increased compliance with anti-tuberculosis treatment, decreased dropout rate, and an optimal duration of hospitalization and surveillance, which positively influences the incidence of tuberculosis. Results: The final score is determined by a rating of a total of 9 points: if the value is below 4 points, there is a minor risk of affective disorders; if the value is between 4 and 6 points, there is a medium risk of affective disorders; if the value is above 6 points, there is a severe risk of affective disorders. Conclusions: A detailed clinical assessment, the usage of screening tools, long-term monitoring, multidisciplinary interventions, and family support are essential to ensure an effective management and to improve the life quality of these children. Full article

Introduction: In November 2022, OpenAI launched ChatGPT for public use through a free online platform. ChatGPT is an artificial intelligence (AI) chatbot trained on a broad dataset encompassing a wide range of topics, including medical literature. The usability in the medical field and the quality of AI-generated responses are widely discussed and are the subject of current investigations. Patellofemoral pain is one of the most common conditions among young adults, often prompting patients to seek advice. This study examines the quality of ChatGPT as a source of information regarding patellofemoral conditions and surgery, hypothesizing that there will be differences in the evaluation of responses generated by ChatGPT between populations with different levels of expertise in patellofemoral disorders. Methods: A comparison was conducted between laymen, doctors (non-orthopedic), and experts in patellofemoral disorders based on a list of 12 questions. These questions were divided into descriptive and recommendatory categories, with each category further split into basic and advanced content. Questions were used to prompt ChatGPT in April 2024 using the ChatGPT 4.0 engine, and answers were evaluated using a custom tool inspired by the Ensuring Quality Information for Patients (EQIP) instrument. Evaluations were performed independently by laymen, non-orthopedic doctors, and experts, with the results statistically analyzed using a Mann–Whitney U Test. A p-value of less than 0.05 was considered statistically significant. Results: The study included data from seventeen participants: four experts in patellofemoral disorders, seven non-orthopedic doctors, and six laymen. Experts rated the answers lower on average compared to non-experts. Significant differences were observed in the ratings of descriptive answers with increasing complexity. The average score for experts was 29.3 ± 5.8, whereas non-experts averaged 35.3 ± 5.7. For recommendatory answers, experts also gave lower ratings, particularly for more complex questions. Conclusion: ChatGPT provides good quality answers to questions concerning patellofemoral disorders, although questions with higher complexity were rated lower by patellofemoral experts compared to non-experts. This study emphasizes the potential of ChatGPT as a complementary tool for patient information on patellofemoral disorders, although the quality of the answers fluctuates with the complexity of the questions, which might not be recognized by non-experts. The lack of personalized recommendations and the problem of “AI hallucinations” remain a challenge. Human expertise and judgement, especially from trained healthcare experts, remain irreplaceable. Full article

Background: Exclusive breastfeeding is vital for the optimal development of infants, yet the practice of using infant formula has become increasingly prevalent. While many studies globally investigate factors affecting breastfeeding, there is a scarcity of research focusing on marginalized groups, particularly the Roma community. This study seeks to compare the breastfeeding rates of Roma and non-Roma mothers upon discharge from a maternity hospital in Greece. It also examines factors contributing to the decline in breastfeeding among Roma women, with particular emphasis on the role of midwifery support. The aim of this study is to promote the development of supportive policies and programs for breastfeeding among Roma mothers. Methods: A cross-sectional study was conducted from September 2019 to January 2022, involving 248 infants born at ≥37 weeks of gestation and their mothers, who were of Greek nationality. Both Roma and non-Roma participants received consistent, high-quality care from the same midwife researcher, who personally attended to them. All participants initiated breastfeeding immediately after their newborns’ births and practiced rooming-in by keeping their babies in the room with them during their hospital stay. Data were collected through questionnaires to determine the rates of exclusive breastfeeding among the two groups. Results: The study found that a smaller proportion of Roma mothers exclusively breastfed their infants compared to non-Roma mothers, despite receiving similar levels of support from healthcare professionals. Conclusions: The provision of midwifery support did not significantly enhance exclusive breastfeeding rates among Roma mothers. This suggests the need for more comprehensive and multi-faceted interventions. Further research is required to confirm these findings and to design effective programs aimed at increasing exclusive breastfeeding rates, thereby improving health outcomes for Roma children and mothers. Full article

Background and Objectives: A randomized, double-blind clinical trial was conducted based on the CONSORT study protocol for randomized clinical trials (NCT06531720) to compare the effectiveness of oral mucosa healing properties of 0.2% chlorhexidine digluconate (CHX) and 8.7% choline salicylate (CHS), as well as a control group (CON) with no intervention, in patients with delivered partial removable dentures (PRDs). Materials and Methods: Patients (n = 27) who were enrolled in the study were healthy subjects according to the inclusion/exclusion criteria, and they received new PRDs to complement Kennedy’s class III and IV deficiencies. During the process of adaptation to new prosthetic restorations, OMLs were formed and treated with one of two selected preparations, either CHX = 0.2% or CHS = 8.7%, in relation to the control group (CON). The wound surface area (WSA) (mm²) was measured on repeatable intraoral images taken in accordance with the examination protocol on the first control visit on day 1, day 3, day 7, day 10, and day 14 with the assistance of computer software. Results: There were no statistically significant differences between groups. The fastest effect of WSA complete reduction was observed in the CHX group after 7 days (WAS = 0.78, SD = 1.18) in comparison to CHS = 10 days (WAS = 0.44, SD = 0.90) and CON = 14 days (WAS = 0.22, SD = 0.67). The decrease in the WSA after 7 days of observation was 85.1% in the CHX group, 70.1% in the CHS group, and 59.2% in the CON group. Conclusions: The WSA decreased most rapidly after 7 days of treatment with 0.2% chlorhexidine digluconate (CHX), slightly more slowly after 10 days of treatment with 8.7% choline salicylate (CHS), and relatively most slowly in the CON group, who were not treated with any topical medication after 14 days. Oral mucosa lesions (OMLs) therapy during the process of adaptation to new removable prosthetic restorations is a very important element supporting the whole process. Topical medications containing 0.2% chlorhexidine digluconate are indicated as adjunctive therapy in the process of the supportive treatment and disinfection of oral mucosa lesions. However, this does not release the dentist from liability for the careful adjustment of the removable prosthetic restoration. Full article

The increasing use of digital applications in healthcare has led to a greater need for patient education materials. These materials, often in the form of pamphlets, booklets, and handouts, are designed to supplement physician–patient communication and aim to improve patient outcomes. However, the effectiveness of these materials can be hindered by variations in patient health literacy. Readability, a measure of text comprehension, is a key factor influencing how well patients understand these educational materials. While there has been growing interest in readability assessment in medicine, many studies have demonstrated that digital texts do not frequently meet the recommended sixth-to-eighth grade reading level. The purpose of this opinion article is to review readability from the perspective of studies in pediatric medicine, internal medicine, preventative medicine, and surgery. This article aims to communicate that while readability is important, it tends to not fully capture the complexity of health literacy or effective patient communication. Moreover, a promising avenue to improve readability may be in generative artificial intelligence, as there are currently limited tools with similar effectiveness. Full article

Purpose: The purpose of this study is to determine the magnitude of change that is clinically meaningful in the EORTC QLQ-C30 and EORTC QLQ-HN35 instruments in head and neck cancer patients. Methods: Two hundred and twenty-two patients completed the EORTC QLQ-C30 and EORTC QLQ-HN35 at baseline and follow-up one to two months later. Minimal clinically important differences (MCIDs) were calculated through anchor- and distribution-based methods for improvement and deterioration. Karnofsky Performance status (KPS) was used as the anchor to determine meaningful change. Results: In the group of patients who deteriorated, more scales and symptoms demonstrated statistically significant meaningful change. EORTC QLQ-C30 meaningful change values for deterioration with KPS anchor ranged from 7.2 (physical functioning) to 16.7 units (Global Health Status), and for improvement ranged from 10.0 (role functioning) to 16.7 units (Global Health Status). Conclusions: We report—for the first time, to the best of our knowledge—MCID for EORTC QLQ-C30 and QLQ-HN35 in head and neck cancer patients. Knowledge of meaningful change in these questionnaires allows physicians to assess patient change over time, along with evaluating the impact of treatment on quality of life. Full article

Background: To implement recovery-oriented practice, it is important to have instruments capable of evaluating such practice. A number of different questionnaires have been developed in recent years which measure recovery orientation in mental health services. Objective: To identify and analyze patient-reported experience measures (PREMs) reported in the literature that are related to recovery-oriented practice in mental health services. Methodology: This study followed the Joanna Briggs Institute methodology for scoping reviews. Searches were carried out in the Web of Science, CINAHL, Medline (via Pubmed), and SCOPUS databases and in grey literature repositories (Google Scholar, Opengrey, Dart-Europe, Teseo). Papers on recovery services for adults suffering from mental disorders (MDs) were included. Those focusing on addiction and intellectual disability care services were excluded. Results: Sixteen papers met the inclusion criteria. The selected PREMs mainly identified recovery-oriented systems, treatment, community integration and support as the dimensions addressed most frequently in questionnaires. The average number of items included in the questionnaires was found to be 54. With regard to psychometric properties, 62% of the papers evaluated reliability (internal consistency) and 56% provided some kind of evidence of validity. Conclusions: This review aims to give an overview of the existing instruments in the literature and to highlight the characteristics of each one of them. Several different PREMs exist which evaluate recovery-oriented practice. No instrument currently exists which could be described as a benchmark tool, but there are quite a few with good psychometric properties capable of producing data that are useful when evaluating clinical services. Full article

Introduction: Chronic obstructive pulmonary disease (COPD) has a severe impact on patients’ health and can lead to multiple complications. Material and methods: We analyzed the co-occurrence of obstructive sleep apnea (OSA) in COPD patients hospitalized in the Pneumology Clinic of Târgu Mureș, Romania. Results: A total of 150 COPD patients were investigated by clinical examination, STOP-BANG and Epworth questionnaires, ventilatory polygraphy (PG), EKG, cardiac ultrasound, blood lipids, and sugar. Sixty-eight patients (45.3%) had OSA associated with COPD. A total of 61.7% were COPD gr. E, and 30.8% were gr. B. Frequently shown symptoms were snoring and nonrestorative sleep (100%), somnolence (73.5%), nocturnal awakenings (41.17%), morning headache (32.3%), and aggravated dyspnea. Types of OSA included obstructive (97.05%), central (2.5%), and associated obesity–hypoventilation (39.7%). A total of 76.4% were recently diagnosed with OSA. Men predominated at 70.5%, 76.4% were smokers, and 61.7% had experienced alcohol abuse. A total of 25% were overweight, and 71% had obesity. A total of 13.2% belonged to the category of 38–50-year-olds, 55.8% were in the 51–65-year-old category, 17.6% were in the 66–70-year-old category, and roughly 13.2% were in the 71-year-old category. Overlap syndrome (OS) comorbidities and complications were frequently present: 41% experienced respiratory failure, 66.1% experienced blood hypertension, 58.8% experienced ischemic cardiac disease, 32.35% experienced diabetes mellitus, 50% experienced dyslipidemia, and 29.4% experienced cor pulmonale. Conclusions: OS conferred gravity or directly contributed to cardiovascular, respiratory, and metabolic complications. OS was associated with more severe COPD and obesity. The prevalence of smoking in OS patients was higher than the national/European average. Full article

Background: Medullary thyroid carcinoma (MTC), the third most frequent histological type of thyroid malignancy, may be found isolated or as part of multiple endocrine neoplasia type 2 (MEN2). One particular subtype of this autosomal dominant-transmitted syndrome includes an association with cutaneous lichen amyloidosis, although, generally, a tide genotype–phenotype correlation is described in patients who carry RET proto-oncogene pathogenic variants. Methods: Our objective was to provide an endocrine perspective of a case series diagnosed with RET-positive familial MTC associated with cutaneous primary lichen amyloidosis amid the confirmation of MEN2. Six members of the same family had cutaneous lesion with different features (from hyperpigmented, velvety to red/pink appearance) and four of them harbored a RET pathogenic variant at 634 codon (exon 11): c.1900T>G, p.634G (TGC634CGC). Results: All six patients were females with the lesion at the interscapular region. Except for two women, four of these subjects were investigated and had MTC (three of them with postoperatory confirmation). The youngest affected individual was 6 years old. The three adult females were confirmed with RET pathogenic variant during their 30s, while the girl underwent the familial screening as a newborn. None of them had primary hyperparathyroidism until the present time, except for one subject, and two out of the three adults also had bilateral pheochromocytoma. Notably, all patients were rather asymptomatic from the endocrine perspective at the moment when endocrine tumor/cancer was confirmed, and the skin was progressively affected a few years before the actual MEN2 confirmation. Conclusions: This case series highlights the following key message: awareness of the dermatologic findings in MTC/MEN2 patients is essential since lesions such as cutaneous lichen amyloidosis might represent the skin signature of the endocrine condition even before the actual endocrine manifestations. These data add to the limited published reports with respect to this particular presentation, noting the fact that RET-C634 is the most frequent pathogenic variant in MEN2-associated lichen amyloidosis; females are more often affected; the interscapular region is the preferred site; the age of diagnosis might be within the third decade of life, while we reported one of the youngest patients with the lesion. The same RET pathogenic variant is not associated with the same dermatologic features as shown in the vignette. The same RET mutation does not mean that all family members will present the same skin anomaly. Full article

Background: Augmented reality (AR) enhances sensory perception by adding extra information, improving anatomical localization and simplifying treatment views. In dentistry, digital planning on bidimensional screens lacks real-time feedback, leading to potential errors. However, it is not clear if AR can improve the clinical treatment precision. The aim of this research is to evaluate if the use of AR-based instruments could improve dental procedure precision. Methods: This review covered studies from January 2018 to June 2023, focusing on AR in dentistry. The PICO question was “Does AR increase the precision of dental interventions compared to non-AR techniques?”. The systematic review was carried out on electronic databases, including Ovid MEDLINE, PubMed, and the Web of Science, with the following inclusion criteria: studies comparing the variation in the precision of interventions carried out with AR instruments and non-AR techniques. Results: Thirteen studies were included. Conclusions: The results of this systematic review demonstrate that AR enhances the precision of various dental procedures. The authors advise clinicians to use AR-based tools in order to improve the precision of their therapies. Full article

Improving preoperative care for elderly patients with hip fractures is crucial for achieving the best outcomes. A multidisciplinary team that can improve overall care quality by addressing patient’s medical conditions, analgesia, timely surgery, and early postoperative mobilization is required. This narrative review provides insights regarding the extent of preoperative optimization needed for hip fracture surgery. Full article

(1) Background: Diet is significant for nutritional intake and serves as an essential element for improving quality of life (QOL). Poor dietary management skills increase the risk of onset or progression of lifestyle-related diseases, and, in particular, are a factor in reduced QOL during old age. This study aimed to clarify the physical and social background factors impeding dietary self-management. (2) Methods: The study participants were 3814 men (age range, 30–69 years) extracted from anonymous data comprising 15,294 persons provided from the Japanese national statistics database. The participants were classified into two groups (Concerned vs. Unconcerned) according to whether they were concerned about their diet. Adjusted odds ratios (ORs) for diet-conscious behaviors were then obtained by means of binomial logistic regression analysis performed following univariate analysis. (3) Results: The Concerned and Unconcerned groups comprised 2548 (66.8%) and 1266 subjects (33.2%), respectively. The diet-conscious behavior with the highest response rate was eating regularly (46.7%). The most frequent items in the Unconcerned group were the subjective symptom “irritable” (48.9%), high stress (46.3%), working more than 56 h/week (43.8%), and smoking (41.9%). The only item with a large significant OR in the binomial logistic regression analysis was smoking (OR: 2.2). (4) Conclusions: These results suggest that a smoking habit and stress are factors that impede diet management behaviors. Full article

Background: Ectopic organ-associated conditions belong to the larger panel of developmental ailments, and among this challenging medical and surgical chapter, ectopic endocrine glands-related picture is mostly focused on the presence of the ectopic parathyroid and thyroid. Ectopic thyroid tissue within mediastinum (ETTM) stands for a less common ETT site; while, globally, less than 1% of the mediastinum masses are ETTM. Objective: We aim to introduce a rare case of ETTM in a senior lady to whom one-time synchronous thyroidectomy with ETT removal was successfully performed via a minimally invasive modern procedure upon cervicotomy and intra-operatory use of the Cooper thymectomy retractor. Results: The panel of pros and cons with respect to providing endocrine thoracic surgery for ETTM resection in a 73-year-old subject is discussed amid a PubMed search of original English-language original reports from January 2000 until 15 August 2024 in order to identify similar distinct cases (individuals of 70 years or older who underwent surgery for ETTM). Conclusions: 1. We propose the term “three-leaf-clover thyroid” to capture the imaging essence of having an enlargement of both (eutopic) thyroid lobes and ETTM. 2. The modern surgical approach under these circumstances provided a rapid patient recovery with a low rate of complications and a minimum hospital stay. Hence, the procedure may be expanded to older patients after a careful consideration of their co-morbidities and of the need to releasing connected complaints (e.g., a 7-month history of intermittent dyspneea was found in this case with post-operatory remission). 3. The management remains a matter of individualised decision, and age may not be a limiting factor. 4. At the present time, this case adds to the very limited number of similar published cases in the mentioned age group that we could identify (seven patients, aged between 72 and 84; male-to-female ratio of 5 to 2; the rate of malignant ETTM was 3/7); of these cases, not all were reported to have a trans-cervical approach, and none reported the use of the Cooper thymectomy retractor to help the overall surgical procedure. This innovative surgical procedure offers the advantage of avoiding a sternotomy incision which has clear functional and aesthetic implications, while the video-assisted approach allows optimal visualization of the mediastinal anatomy and safe vascular sealing under visual control, without the risk of a major hemorrhage. Full article

Backgroud: The main function of the hamstring muscles is to bend the knee joint and support the function of the hip extensors. Their frequent injuries are the result of overload related to, among others, dynamic running or jumping, and inadequate preparation for athletics activities. The asymmetry of the work of individual flexor muscle groups is clearly marked in the case of valgus or varus of the knee joint, i.e., in different positions of the lower limb. The aim of the study was to determine the position and form of a rehabilitation exercise in which an isolated group of muscles flexing the knee joint will show the greatest bioelectrical activity. Methods: The study involved 25 students of the Jagiellonian University Medical College. The students were aged 20–26. The average age was 22.9 (±1.4). The study participants included 17 women with an average age of 23.0 (±1.1) and 8 men with an average age of 22.6 (±1.9). Women constituted 68% and men 32% of all respondents. All participants agreed to participate in the study. Surface electromyography measurements in both lower limbs provided an initial number of 50 cases. The activity of the knee flexor muscles during isometric contraction with resistance was measured in correlation with three foot and lower leg settings: internal rotation, neutral position, and external rotation. The bioelectrical activity of the semitendinosus muscle is significantly higher (p < 0.01) in the internal rotation position than in the neutral position of the lower leg, while the bioelectrical activity of the biceps femoris muscle is inversely higher (p < 0.01) in the external rotation position than in the neutral position. Results: The results are significant for both average and maximum values of muscle stimulation. During isometric contraction with resistance, the semitendinosus muscle shows the greatest bioelectrical activity in the internal rotation position of the lower leg and foot, and the biceps femoris muscle in the external rotation position of the lower leg and foot. Conclusions: The above information has important implicational applications when improving isolated groups of hamstrings. In the future, this may contribute to more effective rehabilitation of patients with injuries of the muscles described in the article. Full article