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Clinics and Practice
Volume 14
Issue 6
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Clin. Pract., Volume 14, Issue 6 (December 2024) – 45 articles

Cover Story (view full-size image): Metabolic dysfunction-associated steatotic liver disease (MASLD) affects 38% of the global population and is closely associated with obesity and cardiometabolic risk factors. MASLD can progress from simple steatosis to fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). Chronic hepatitis C virus (HCV) infection exacerbates liver damage through inflammation and metabolic disruption. The convergence of MASLD and HCV infection significantly accelerates the progression to severe liver damage. Despite high curing rates of direct-acting antivirals, post-treatment weight gain and an obesogenic diet increase the risk of liver cancer. Effective clinical and nutritional treatment before and after HCV eradication is essential to prevent progression to HCC. This review explores MASLD and HCV interactions and their clinical and nutritional management. View this paper
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8 pages, 832 KiB  
Article
No Significant Association Between Herpes Zoster and Breast Cancer: A German Outpatient Study with over 120,000 Participants
by Vedanth D. Krishnan, Niklas Gremke, André Hajek, Karel Kostev and Matthias Kalder
Clin. Pract. 2024, 14(6), 2770-2777; https://doi.org/10.3390/clinpract14060218 (registering DOI) - 23 Dec 2024
Abstract
Purpose: The purpose of this study was to investigate a possible association between Herpes Zoster (HZ) and the subsequent diagnosis of breast cancer (BC). Methods: Utilizing the Disease Analyzer database, anonymized medical records from German office-based practices were accessed. Longitudinal data of female [...] Read more.
Purpose: The purpose of this study was to investigate a possible association between Herpes Zoster (HZ) and the subsequent diagnosis of breast cancer (BC). Methods: Utilizing the Disease Analyzer database, anonymized medical records from German office-based practices were accessed. Longitudinal data of female patients aged 18 years and above diagnosed with HZ between 2005 and 2021 were included. Individuals without HZ diagnoses were matched to HZ patients using a nearest neighbor propensity score matching (1:1) based on age, sex, index year, average yearly consultation frequency during the follow-up, and predefined co-diagnoses. The incidence of BC in the cohort with and without HZ was evaluated using Kaplan–Meier curves and compared using the log-rank test. Finally, a univariable Cox regression analysis was conducted to assess the association between HZ and BC. Results: This study included 64,255 women with HZ and an equal number without HZ, with comparable characteristics in terms of age, visit frequency, and comorbidities. Analysis revealed no significant association between HZ and subsequent BC incidence, with similar rates observed in both HZ and non-HZ cohorts across different age groups. Conclusions: In this retrospective cohort study consisting of well-matched patients, the results indicate no significant association between an HZ infection and the development of BC over a 10-year follow-up period. This is the largest study of its kind to date. Full article
11 pages, 235 KiB  
Article
Satisfaction of Patients with Multiple Sclerosis Towards the Provision of Healthcare Services at a Tertiary Care Setting in Saudi Arabia
by Dalal Salem Al-Dossari, Ibrahim Abdulaziz Al-Zaagi, Mashael Abdulrahman Bin Salamma, Faisal Abdulaziz Alghamdi, Ahmed Hasan Althobaiti, Abdullah Bin Dakhil Allah bin Awad Al-Harbi, Abdullah Rashed Alshelali, Anham Nabil Hassan, Baleegh Mohammed Ali and Sheraz Ali
Clin. Pract. 2024, 14(6), 2759-2769; https://doi.org/10.3390/clinpract14060217 - 20 Dec 2024
Viewed by 251
Abstract
Background: Multiple sclerosis (MS) is an autoimmune-mediated neurological disorder and the most frequent neurological disability in young adults. Assessing MS patient satisfaction with care is necessary to evaluate healthcare service quality and factors impacting it. Objectives: We aimed to determine the satisfaction of [...] Read more.
Background: Multiple sclerosis (MS) is an autoimmune-mediated neurological disorder and the most frequent neurological disability in young adults. Assessing MS patient satisfaction with care is necessary to evaluate healthcare service quality and factors impacting it. Objectives: We aimed to determine the satisfaction of patients with MS towards the provision of healthcare services, and the factors affecting their satisfaction. Methods: We conducted a cross-sectional survey from November 2022 to December 2022 at King Saud Medical City, Saudi Arabia. The study participants completed the CANHELP Lite27 questionnaire, which consists of 21 items. Results: A total of 300 patients with MS participated in this study. The majority were female (80%), with an average age of 31.6 years and a mean disease duration of 5.22 years. Overall, satisfaction was moderate (63.59 ± 14.54). Patients were most satisfied with general aspects of care (72.00 ± 16.46), doctor relationships (68.58 ± 14.88), and communication (67.72 ± 17.60), but less so with decision-making (64.98 ± 18.37) and illness management (59.60 ± 16.31). Correlation analysis revealed a negative association between disease duration and satisfaction across all domains (correlation coefficient ranged from −0.290 to −0.206, p < 0.01), while age showed no significant correlation (p > 0.05). Multiple linear regression identified age as positively influencing satisfaction, while longer disease duration had a negative impact. Higher education and marital status were associated with increased satisfaction, while employment status and having children showed mixed results. Conclusions: This research uncovered significant insights regarding MS patient satisfaction within healthcare services. Despite moderate satisfaction levels overall, specific interventions are necessary to address shortcomings in decision-making and illness management. The negative correlation between disease duration and satisfaction across all domains underscores the evolving needs of MS patients over time. Future research could examine the effectiveness of illness management programs in improving MS patient satisfaction. Full article
22 pages, 2219 KiB  
Systematic Review
Biochemical Mechanisms and Rehabilitation Strategies in Osteoporosis-Related Pain: A Systematic Review
by Giorgia Natalia Iaconisi, Rachele Mancini, Vincenzo Ricci, Danilo Donati, Cristiano Sconza, Riccardo Marvulli, Maurizio Ranieri, Marisa Megna, Giustino Varrassi, Simone Della Tommasa, Andrea Bernetti, Loredana Capobianco and Giacomo Farì
Clin. Pract. 2024, 14(6), 2737-2758; https://doi.org/10.3390/clinpract14060216 - 19 Dec 2024
Viewed by 291
Abstract
Background/Objectives: Osteoporosis causes a bone mass reduction and often determines acute and chronic pain. Understanding the biochemical and neurophysiological mechanisms behind this pain is crucial for developing new, effective rehabilitative and therapeutic approaches. This systematic review synthesizes recent advances in muscle–bone interactions and [...] Read more.
Background/Objectives: Osteoporosis causes a bone mass reduction and often determines acute and chronic pain. Understanding the biochemical and neurophysiological mechanisms behind this pain is crucial for developing new, effective rehabilitative and therapeutic approaches. This systematic review synthesizes recent advances in muscle–bone interactions and molecular pathways related to osteoporosis-associated pain. Methods: We carried out a systematic review including studies published from 2018 to 2024 using PubMed, Scopus, clinicaltrials.gov and Cochrane Library. The Cochrane Collaboration tool was used to assess bias risk. The review adhered to PRISMA guidelines and is registered with PROSPERO (CRD42024574456); Results: Thirteen studies were included. It emerged that osteoporosis causes progressive bone loss due to disruptions in biochemical processes and muscle–bone interactions. This condition is also closely associated with the development of pain, both acute and chronic. Key findings include the role of the miR-92a-3p/PTEN/AKT pathway and the impact of muscle–bone disconnection on bone health. Mechanotransduction is critical for bone maintenance. Effective pain management and rehabilitation strategies include physical therapy and physical exercise, yoga, Pilates, and cognitive behavioral therapy (CBT); they all improve pain relief and functional outcomes by enhancing muscle strength, flexibility, and balance. Pharmacological options such as NSAIDs, opioids, and new agents like SHR-1222, along with surgical interventions like percutaneous vertebroplasty, offer additional pain reduction, especially when included in individualized rehabilitation projects; Conclusions: This review highlights advancements in understanding osteoporotic pain mechanisms and identifies promising treatments. Integrating targeted therapies and rehabilitation strategies can enhance patients’ pain relief. Full article
(This article belongs to the Special Issue Musculoskeletal Pain and Rehabilitation)
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12 pages, 4623 KiB  
Article
Microbial Spectrum, Intraoperative Findings, and Postoperative Outcomes in Native Knee Joint Infections: A Retrospective Analysis
by Jonas Roos, Britta Mangels, Max Jaenisch, Matthias Dominik Wimmer, Thomas Martin Randau, Christian Prangenberg, Kristian Welle and Martin Gathen
Clin. Pract. 2024, 14(6), 2725-2736; https://doi.org/10.3390/clinpract14060215 - 16 Dec 2024
Viewed by 292
Abstract
Background: Native knee joint infections, while uncommon, present a serious condition predominantly instigated by bacteria such as Staphylococcus aureus. Without timely intervention, they can result in joint destruction or sepsis, with risk factors encompassing preexisting medical conditions and iatrogenic procedures. The diagnostic [...] Read more.
Background: Native knee joint infections, while uncommon, present a serious condition predominantly instigated by bacteria such as Staphylococcus aureus. Without timely intervention, they can result in joint destruction or sepsis, with risk factors encompassing preexisting medical conditions and iatrogenic procedures. The diagnostic process includes a comprehensive patient history, clinical evaluation, laboratory testing, imaging studies, and microbiological investigations. Treatment typically involves joint aspiration and arthroscopy. This study aims to examine and establish correlations between diagnostic criteria and treatment modalities, enhancing the speed and specificity of future therapeutic strategies. Materials and methods: The present study is a retrospective cohort study conducted at a 1200-bed university clinic between 2007 and 2017, with an in-depth examination of patient details, symptoms, treatments, and outcomes. A scoring system was developed to classify the severity of knee joint impairment, categorizing patients on the basis of hospital stay duration, surgeries, and postoperative factors such as recurring symptoms, pain, and range of motion. Results: This study of 116 patients with knee joint infections revealed that clinical symptoms such as pain, swelling, and effusion are common but not definitive for diagnosis. Laboratory analysis revealed no significant differences in CRP or leukocyte counts between cultures positive or negative for pathogens. Hospital stay and disease severity are influenced by factors such as age, sex, presence of polyarthritis, neutrophil count, and type of pathogen, with higher weight and cortisone treatment associated with poorer outcomes. Conclusions: This study highlights the diagnostic challenges in native knee joint infections, revealing the need for comprehensive approaches given the nonspecificity of clinical symptoms and laboratory findings. This underscores the importance of advancing research through standardized methodologies and prospective studies to increase the accuracy of diagnosis and the effectiveness of treatment in this field. Full article
(This article belongs to the Special Issue Musculoskeletal Pain and Rehabilitation)
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12 pages, 235 KiB  
Protocol
Methodology for a Series of Rapid Reviews on Virtual Care in Rehabilitation, Reviewing Its Advantages and Challenges to Inform Best Practices
by Jennifer Sigouin, Anne Hudon, Mirella Veras, Simon Beaulieu-Bonneau, Sabrina Cavallo and Dahlia Kairy
Clin. Pract. 2024, 14(6), 2713-2724; https://doi.org/10.3390/clinpract14060214 (registering DOI) - 13 Dec 2024
Viewed by 735
Abstract
Background/Objective: Over the past two decades, the utilization of virtual care in rehabilitation has witnessed a significant surge; this is owing to the widespread availability of technological tools and the global impact of the COVID-19 pandemic. As a result, discussions surrounding the [...] Read more.
Background/Objective: Over the past two decades, the utilization of virtual care in rehabilitation has witnessed a significant surge; this is owing to the widespread availability of technological tools and the global impact of the COVID-19 pandemic. As a result, discussions surrounding the relevance and benefits of telerehabilitation have gained prominence among practitioners, who continually seek to enhance patient care while maintaining high standards of quality. Associated with these discussions are concerns over being able to provide care in an ethical way, as well as addressing equity issues that might be hindered or improved via telerehabilitation. To address the ethical and equity concerns around telerehabilitation, a series of five parallel rapid reviews of the scientific literature were conducted, focusing on different rehabilitation fields: physiotherapy and occupational therapy (1); speech therapy and audiology (2); psychology and neuropsychology (3); and in two age groups: older adults (4); and pediatrics and young adults (5). The objective of this series of rapid reviews is to evaluate the evidence presented regarding telerehabilitation; identifying and recommending best practices especially in the realm of ethics and equity. Methods: Medline; CINAHL; and EMBASE were searched between 2010 and 2023 for English or French-language reviews (2010–2020) and individual studies (2020–2023) pertaining to telerehabilitation and these fields of interest. Data were extracted following a standardized form focusing on: outcomes; findings; quality assessment/biases; limitations; and discussion of ethical and equity concerns. Results: The results are presented according to the most relevant themes, which include: findings; strengths; limitations; and ethical/equity considerations. Conclusions: This research presents a methodology rarely published before, on how to conduct multiple parallel rapid reviews on the theme of telerehabilitation, based on different rehabilitation fields and age groups. This research will shape future guidelines and standards in applying ethical and equity standards in telerehabilitation. Full article
8 pages, 7037 KiB  
Case Report
An Unusual Cause of Inguinal Mass in a Patient with Urolithiasis: A Case Report of Deep (Aggressive) Angiomyxoma in a Male Patient
by Christodoulos Chatzigrigoriadis, Vasileios Tatanis, Theodoros Spinos, Angelis Peteinaris, Angelos Samaras, Anastasios Thanos, Evangelos Liatsikos and Panagiotis Kallidonis
Clin. Pract. 2024, 14(6), 2705-2712; https://doi.org/10.3390/clinpract14060213 - 13 Dec 2024
Viewed by 400
Abstract
Background: Deep or aggressive angiomyxoma is an uncommon neoplasm of the pelvis. Although deep angiomyxoma is a benign tumor, its tendency to infiltrate soft tissues and reach a large size (typically > 10 cm) indicates aggressive biological behavior. It is usually present in [...] Read more.
Background: Deep or aggressive angiomyxoma is an uncommon neoplasm of the pelvis. Although deep angiomyxoma is a benign tumor, its tendency to infiltrate soft tissues and reach a large size (typically > 10 cm) indicates aggressive biological behavior. It is usually present in female patients, but there have been recent reports of male-aggressive angiomyxoma. While rare, it is an important consideration in patients with a pelvic mass. The clinical presentation is non-specific; patients are either asymptomatic or present with non-specific complaints, such as dull pain, constipation, and dysuria. It is commonly mistaken for an inguinal hernia, hydrocele, testicular cancer, lipoma, and epididymal cyst in male patients, thus misguiding the management of these cases. Hence, preoperative evaluation with imaging studies (ultrasound, computed tomography, magnetic resonance imaging) and biopsy allows for an accurate diagnosis and treatment. Currently, the standard of treatment is surgical resection of the tumor with free margins. The role of hormone therapy is under investigation for patients with deep angiomyxoma positive for estrogen/progesterone receptors. Regular follow-up is necessary given the high recurrence rate of deep angiomyxoma (9–72%). Methods: We present a case of an elderly man who presented with hematuria due to urolithiasis and an asymptomatic inguinal mass mimicking an inguinal hernia. A computed scan (CT) of the abdomen confirmed the presence of the mass, which was removed surgically. Results: The pathologic examination of the tumor was consistent with deep angiomyxoma. Conclusions: The diagnosis of deep angiomyxoma should always be considered in patients with an inguinal mass to avoid delayed treatment and incomplete surgical excision. Full article
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12 pages, 270 KiB  
Article
Developmental Psychology and Healthcare Professions: Autism Knowledge Among Nurses: An Observational Study
by Rosaria Ferrara, Giuseppe Campagna, Pasquale Ricci, Felice Damato, Lidia Ricci, Leonardo Iovino, Flavio Marti, Roberto Latina and Roberta Simeoli
Clin. Pract. 2024, 14(6), 2693-2704; https://doi.org/10.3390/clinpract14060212 - 12 Dec 2024
Viewed by 398
Abstract
Background: One of the biggest limitations faced by autistic people is the lack of knowledge of their condition. Our study aims to evaluate and discuss the knowledge of autism among nurses, which is a social and health category often in close contact with [...] Read more.
Background: One of the biggest limitations faced by autistic people is the lack of knowledge of their condition. Our study aims to evaluate and discuss the knowledge of autism among nurses, which is a social and health category often in close contact with autistic people. Objective: Given the limited exploration of awareness levels about autism among healthcare professionals, this study aims to investigate general and specific knowledge of autism within a group of nursing students enrolled in a master’s degree. Methods: A total of 66 nurses completed the questionnaire. Descriptive analyses were conducted on the results for the four subcomponents of the questionnaire: (i) general knowledge, (ii) symptomatology, (iii) screening and diagnosis, and (iv) intervention and treatment. A correlation analysis was performed between the participants’ demographic variables and questionnaire scores. Additionally, a multivariable logistic regression was conducted to analyze the association between the participants’ basic demographic characteristics and questionnaire scores. Results: Results showed a good percentage of correct answers in the “general knowledge” category. Furthermore, a good level of knowledge regarding the fact that ASD is a developmental disorder and a congenital disease also emerged. Conclusions: Regarding the knowledge of typical autism symptoms, participants answered most of the questions correctly. Correct answers decreased for questions related to screening and diagnosis. In particular, participants had limited knowledge of the DSM-5 and the timing of ASD diagnosis. Similar levels of knowledge were observed for the fourth category, “intervention and treatment”. Full article
12 pages, 484 KiB  
Article
Exploring Awareness Levels of Diabetic Ketoacidosis Risk Among Patients with Diabetes: A Cross-Sectional Study
by Elhassan Hussein Eltom, Abdulrahman Omar A. Alali, Rakan Khalid Marzouq Alanazi, Ali Ahmad M. Alanazi, Meshal Ahmed Abdullah Albalawi, Saud Alraydh N. Alanazi, Mansour Sarhan G. Alanazi, Abdelnaser A. Badawy, Naglaa Mokhtar and Manal S. Fawzy
Clin. Pract. 2024, 14(6), 2681-2692; https://doi.org/10.3390/clinpract14060211 - 12 Dec 2024
Viewed by 313
Abstract
Background/Objectives: Diabetic ketoacidosis (DKA) is a critical complication of diabetes mellitus, posing significant health. While global studies have indicated a concerning lack of awareness regarding DKA among patients with diabetes, research specific to the northern area of Saudi Arabia remains limited. This [...] Read more.
Background/Objectives: Diabetic ketoacidosis (DKA) is a critical complication of diabetes mellitus, posing significant health. While global studies have indicated a concerning lack of awareness regarding DKA among patients with diabetes, research specific to the northern area of Saudi Arabia remains limited. This study aims to explore the level of knowledge and awareness of DKA among patients with diabetes residing in the local region. Methods: A cross-sectional analysis was conducted utilizing a non-probability convenient sampling technique, with 339 participants recruited from March to August 2024. Data were gathered through a self-administered pre-validated questionnaire distributed via different social media platforms to assess demographic characteristics and awareness levels relating to DKA, including knowledge of its symptoms, causes, and treatment options. Results: Although there was moderate awareness of DKA, with 68.4% having heard of the condition, two-thirds of the participants exhibited significant gaps in overall knowledge. Among those aware, 76.3% recognized DKA as an emergency requiring immediate medical intervention. At the same time, 64.6% understood the causes of DKA, and only 25.6% identified insulin deficiency as a major contributing factor. Although 62.5% felt knowledgeable about treatment, 66.0% incorrectly identified oral sugar as a DKA treatment. Notably, 30.1% cited social media as their main information source. Age emerged as an essential factor impacting knowledge, with younger participants (ages 18–30) demonstrating higher awareness than older individuals. Additionally, single participants displayed a higher percentage of good knowledge than married participants (p = 0.000). Non-working individuals showed better overall knowledge about DKA (p = 0.002). The duration of diabetes did not show a significant association with knowledge levels about DKA across the various duration categories. Conclusions: The present findings underscore a substantial knowledge gap concerning DKA among the local community, highlighting a critical need for targeted public health educational interventions. Full article
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20 pages, 1160 KiB  
Article
Metabolic Syndrome as a Risk Factor Among Lebanese Patients with Substance Use Disorder Undergoing Treatment for Recovery Through Rehabilitation or Opioid Substitution Treatment
by Nadine Mahboub, Elissa Ayoub, Carine Mounzer, Tatiana Kate Baltagi, Dimitrios Papandreou, Nanne de Vries and Rana Rizk
Clin. Pract. 2024, 14(6), 2661-2680; https://doi.org/10.3390/clinpract14060210 - 10 Dec 2024
Viewed by 669
Abstract
Background/Objectives: Data about metabolic syndrome (MS) in people who use drugs (PWUD) undergoing treatment for recovery are limited. We aimed to explore the extent of the MS and its predominant components and determinants in a sample of PWUD undergoing treatment for recovery through [...] Read more.
Background/Objectives: Data about metabolic syndrome (MS) in people who use drugs (PWUD) undergoing treatment for recovery are limited. We aimed to explore the extent of the MS and its predominant components and determinants in a sample of PWUD undergoing treatment for recovery through rehabilitation or opioid substitution treatment (OST) in Lebanon. Furthermore, we investigated the effect of each treatment modality on the MS; Methods: This was a cross-sectional study, in which demographics and treatment-related, nutritional, and biochemical data of the participants were collected. MS was defined according to the American Heart Association and the National Heart, Lung, and Blood Institute (AHA/NHLBI) criteria. Descriptive statistics were presented, and bivariate and multivariate analyses were conducted; Results: A total of 155 male subjects with the following characteristics were included: OST: n = 80; rehabilitation: n = 75; mean age: 32.53 ± 8.39 years; mean body mass index (BMI): 27.41 ± 4.99 Kg/m2; mean duration of treatment: 18 months. More than half of the sample had low HDL-C (56.8%) and/or elevated blood pressure (51.6%), 42.9% had elevated WC, 21.9% had elevated TG, and 12.3% had elevated FBS. Furthermore, 7.2% of the sample had no components of the MS, 29.2% had one component, 40.9% had two components, 16.9% had three components, and 5.8% had four components. MS was identified in 22.7% of the sample. Higher age was associated with higher odds of being diagnosed with MS (OR = 1.072; 95% CI: 1.021–1.126), whereas higher duration of current treatment was associated with lower odds (OR = 0.969; 95% CI: 0.944–0.995); Conclusions: MS and its components are prevalent in PWUD undergoing treatment for recovery. Routine screening and preventive measures are essential to prevent metabolic syndrome, particularly among older people and treatment newcomers. Full article
(This article belongs to the Special Issue Clinical Nutrition in Metabolic Disorders)
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11 pages, 271 KiB  
Review
Relationship Between Sleep Disturbances and Chronic Pain: A Narrative Review
by Sejal V. Jain, Geoffrey D. Panjeton and Yuri Chaves Martins
Clin. Pract. 2024, 14(6), 2650-2660; https://doi.org/10.3390/clinpract14060209 - 9 Dec 2024
Viewed by 885
Abstract
Sleep disturbances and chronic pain are prevalent and interrelated conditions that have significant impact on individuals’ quality of life. Understanding the intricate dynamics between sleep and pain is crucial for developing effective treatments that enhance the well-being of affected individuals and reduce the [...] Read more.
Sleep disturbances and chronic pain are prevalent and interrelated conditions that have significant impact on individuals’ quality of life. Understanding the intricate dynamics between sleep and pain is crucial for developing effective treatments that enhance the well-being of affected individuals and reduce the economic burden of these debilitating conditions. This narrative review examines the complex relationship between sleep disturbances and chronic pain. We describe the prevalence and types of sleep disturbances and sleep disorders in chronic pain patients. Posteriorly, we critically review the clinical and experimental evidence, investigating the relationship between sleep disturbances and chronic pain, aiming to clarify the impact of chronic pain on sleep and, conversely, the impact of sleep disturbances on pain perception. In conclusion, the literature largely agrees on the existence of a bidirectional relationship between chronic pain and sleep disturbances, though the strength of each direction in this association remains uncertain. Current evidence suggests that sleep impairment more strongly predicts pain than pain does sleep impairment. Additionally, addressing sleep disturbances in chronic pain patients is crucial, as poor sleep has been linked to higher levels of disability, depression, and pain-related catastrophizing. Full article
(This article belongs to the Special Issue 2024 Feature Papers in Clinics and Practice)
13 pages, 540 KiB  
Article
Effect of Self-Measuring Blood Pressure Program on Hypertension Control: Analysis by Diabetes Status, Age, Gender, and Race in Rural Arizona
by Joy Luzingu, Aminata Kilungo, Randall Flores, Zoe Baccam, Tenneh Turner-Warren, Thelma Reis, Babasola Okusanya and John Ehiri
Clin. Pract. 2024, 14(6), 2637-2649; https://doi.org/10.3390/clinpract14060208 - 5 Dec 2024
Viewed by 537
Abstract
Background: Rural areas face numerous health challenges, including workforce shortages, limited training opportunities, and delayed care. These disparities can be mitigated by self-management interventions for diseases such as hypertension. This study assessed the implementation of a Self-Measuring Blood Pressure (SMBP) program in rural [...] Read more.
Background: Rural areas face numerous health challenges, including workforce shortages, limited training opportunities, and delayed care. These disparities can be mitigated by self-management interventions for diseases such as hypertension. This study assessed the implementation of a Self-Measuring Blood Pressure (SMBP) program in rural Arizona, documenting its barriers and patient experiences. Methods: In this before-after study, participants were loaned a digital device which they used to self-measure and record blood pressure (BP) over 1 week or more for hypertension diagnosis or 4 weeks or more for monitoring. Blood pressure (BP) control was assessed per the guidelines of the American Heart Association and American Diabetes Association. BP changes between baseline and post-program were assessed using paired-Student t tests. Effect modification by diabetes was analyzed using stratification. Results: Among 740 participants, significant associations were found with gender, age, and controlled BP among non-diabetic patients. Post-intervention, 63.4% of diabetic patients showed controlled BP, and 25.7% of non-diabetic patients had controlled BP, with higher control rates among females and older age groups (60–79 years). Baseline mean SBP was 148.3 ± 19.6 mmHg, improving to 133.9 ± 14.6 mmHg; baseline DBP was 88.5 ± 33.6 mmHg, improving to 83.4 ± 9.6 mmHg. Conclusions: The SMBP program effectively controlled BP, highlighting the value of combining clinical care with telemonitoring. Full article
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14 pages, 1115 KiB  
Article
Artificial Intelligence and Modern Technology in Dentistry: Attitudes, Knowledge, Use, and Barriers Among Dentists in Croatia—A Survey-Based Study
by Ana Ivanišević and Antonija Tadin
Clin. Pract. 2024, 14(6), 2623-2636; https://doi.org/10.3390/clinpract14060207 - 5 Dec 2024
Viewed by 506
Abstract
Aim: This study aims to assess Croatian dentists’ knowledge, attitudes, and use of artificial intelligence (AI) and modern technology, while also identifying perceived barriers to AI and modern technology adoption and evaluating the need for further education and training. Materials and Methods: A [...] Read more.
Aim: This study aims to assess Croatian dentists’ knowledge, attitudes, and use of artificial intelligence (AI) and modern technology, while also identifying perceived barriers to AI and modern technology adoption and evaluating the need for further education and training. Materials and Methods: A cross-sectional survey was conducted in February 2024 among general dentists in Croatia using a self-structured questionnaire. A total of 200 respondents filled out the questionnaire. It included five sections: socio-demographic and professional information, self-assessment of AI and modern technology use, knowledge of AI in dentistry, current innovations and devices used in practice, and barriers to AI and modern technology integration in practice. Data were analyzed using descriptive statistics and a regression analysis to explore relationships between socio-demographic factors and AI knowledge. Results: The mean knowledge of AI systems was 3.62 ± 2.56 out of a possible score of 7, indicating relatively poor knowledge, with 47.5% demonstrating knowledge below the median. Most respondents (76.0%) did not use AI systems and modern technology in practice; however, prosthodontics (13.0%) and oral surgery (10.0%) were identified as the primary fields utilizing these technologies. Respondents rated their knowledge of modern technologies and AI as weak or moderate, with 60.5% engaged in continuous education. Despite 76.0% not using AI daily, 71.0% believed that these technologies could enhance patient care. Participants interested in further training showed significantly better knowledge of AI applications (p = 0.030). Major barriers included acquisition and maintenance costs (59.0%) and financial constraints (58.0%). Conclusions: The study revealed that most respondents had poor knowledge of AI systems. Despite this, there is a recognition of AI’s and modern technology potential in dentistry, emphasizing the need for enhanced education and training in this field. Full article
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15 pages, 1205 KiB  
Article
Body Composition Changes and Factors Influencing the Total Weight Loss Rate After Laparoscopic Sleeve Gastrectomy
by Hironobu Nakaguchi, Bunzo Matsuura, Teruki Miyake, Hidenori Senba, Shinya Furukawa, Motohira Yoshida, Shigehiro Koga, Yuji Watanabe, Taro Oshikiri, Kumiko Toshimitsu and Yoichi Hiasa
Clin. Pract. 2024, 14(6), 2608-2622; https://doi.org/10.3390/clinpract14060206 - 5 Dec 2024
Viewed by 750
Abstract
Objectives: While the effectiveness of metabolic/bariatric surgery has been confirmed, understanding the factors associated with weight loss is paramount for providing guidance in postoperative treatment strategies. Here, we aimed to examine the factors associated with long-term maintenance of weight loss after laparoscopic sleeve [...] Read more.
Objectives: While the effectiveness of metabolic/bariatric surgery has been confirmed, understanding the factors associated with weight loss is paramount for providing guidance in postoperative treatment strategies. Here, we aimed to examine the factors associated with long-term maintenance of weight loss after laparoscopic sleeve gastrectomy (LSG). Methods: This prospective observational cohort included patients who underwent LSG at a single academic health center between January 2017 and June 2022. We examined their body composition using InBody 720 or 770 and analyzed the factors associated with the percentage of total weight loss (%TWL) for 24 months. Results: The median body mass index (BMI) was 38.8 (interquartile range [IQR]: 35.6–46.7) preoperatively, 32.7 kg/m2 (IQR: 28.2–38.7) at 12 months postoperatively, and 33.9 kg/m2 (IQR: 29.1–40.1) at 24 months postoperatively. The lowest BMI was observed at 12 months (p < 0.001 vs. preoperative), followed by a significant increase at 24 months (p = 0.003). However, BMI remained significantly lower at 24 months than preoperatively (p < 0.001). The skeletal muscle mass to fat mass ratio (SMM/FM) was 0.59 (IQR: 0.50–0.71) preoperatively, 0.79 (IQR: 0.58–1.26) at 12 months, and 0.70 (IQR: 0.54–1.05) at 24 months, peaking at 12 months (p < 0.001 vs. preoperative) and decreasing significantly by 24 months (p < 0.001). Nevertheless, the SMM/FM ratio at 24 months remained higher than preoperative values (p < 0.001). Median body weight and %TWL were 86.0 kg and 15.6%, respectively, at 24 months after LSG. The SMM/FM ratio at 12 months was positively correlated with %TWL at 24 months after adjusting for age and sex. Conclusions: The effects of LSG persisted for up to 24 months postoperatively. The SMM/FM ratio 12 months after LSG was associated with the rate of weight loss at 24 months. Full article
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7 pages, 620 KiB  
Article
The Use of Acetazolamide to Prevent Acute Kidney Injury in Patients with Cancer on High-Dose Methotrexate Treatment: A Retrospective Pilot Analysis
by Lindon Lin, Tracey Batt and Gregory M. Peterson
Clin. Pract. 2024, 14(6), 2601-2607; https://doi.org/10.3390/clinpract14060205 - 28 Nov 2024
Viewed by 503
Abstract
Background: High-dose methotrexate (HDMTX) chemotherapy is associated with a significant risk of acute kidney injury (AKI). Acetazolamide is thought to increase methotrexate solubility via urinary alkalinisation, potentially reducing the risk of crystalline nephropathy. A tertiary hospital has included acetazolamide in its HDMTX protocols, [...] Read more.
Background: High-dose methotrexate (HDMTX) chemotherapy is associated with a significant risk of acute kidney injury (AKI). Acetazolamide is thought to increase methotrexate solubility via urinary alkalinisation, potentially reducing the risk of crystalline nephropathy. A tertiary hospital has included acetazolamide in its HDMTX protocols, although data on the risks and benefits are limited. This study evaluated the role of acetazolamide in managing patients receiving HDMTX and identified risk factors for AKI. Methods: The retrospective cohort pilot study included consecutive hospital patients who received HDMTX (≥500 mg/m2). Data collected from digital medical records included demographics, comorbidities, methotrexate dosages and serum concentrations, and pathology results. The development of AKI was defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Relationships between variables and AKI were initially assessed using Mann–Whitney U-tests and chi-square tests, and significant variables were further analysed using logistic regression to identify independent predictors of AKI. Results: Among 66 HDMTX treatment cycles in 31 patients, AKI occurred in 0/7 cycles with acetazolamide versus 14/59 cycles without (p = 0.33). Increasing age, the presence of hypertension, and concurrent use of beta-lactam antibiotics were associated with the development of AKI. Age was identified as the strongest independent risk factor for AKI (odds ratio 1.12, p = 0.034). Conclusions: Optimising management protocols, especially for older patients, is essential to reduce AKI risk during HDMTX therapy. While acetazolamide did not appear to reduce the risk of AKI, this pilot study was limited by a small sample size. Large randomised controlled trials are needed to assess efficacy and patient outcomes. Full article
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11 pages, 272 KiB  
Article
Evaluating the Impact of Maternal Lipid Profiles on Fetal Cardiac Function at Mid-Gestation: An Observational Study
by Biliana Belovan, Zoran Laurentiu Popa, Cosmin Citu, Ioana Mihaela Citu, Ioan Sas and Adrian Ratiu
Clin. Pract. 2024, 14(6), 2590-2600; https://doi.org/10.3390/clinpract14060204 - 27 Nov 2024
Viewed by 597
Abstract
Background: Maternal dyslipidemia during pregnancy may influence fetal cardiac development and function, potentially predisposing offspring to cardiovascular diseases later in life. This study aims to evaluate the relationship between maternal lipid profiles and fetal cardiac function at mid-gestation, utilizing detailed echocardiographic assessments. Methods: [...] Read more.
Background: Maternal dyslipidemia during pregnancy may influence fetal cardiac development and function, potentially predisposing offspring to cardiovascular diseases later in life. This study aims to evaluate the relationship between maternal lipid profiles and fetal cardiac function at mid-gestation, utilizing detailed echocardiographic assessments. Methods: In this prospective cohort study conducted at the Obstetrics and Gynecology Clinic of the Timișoara Municipal Emergency Hospital, 19 pregnant women aged 27–40 years were recruited and divided into two groups based on their triglyceride levels: Group A (triglycerides ≤ 150 mg/dL, n = 48) and Group B (triglycerides > 150 mg/dL, n = 28). Maternal demographic data and lipid profiles were recorded. Fetal echocardiographic measurements, including global longitudinal strain and ventricular function parameters, were obtained between 20 and 24 weeks of gestation. Statistical analyses, including subgroup comparisons, correlations, and regression analyses, were performed. Results: Maternal BMI was significantly higher in Group B compared to Group A (31.94 ± 2.80 vs. 27.01 ± 2.40 kg/m2, p < 0.001). Group B showed higher mean triglyceride levels (163.43 ± 11.34 mg/dL) compared to Group A (131.42 ± 10.57 mg/dL, p < 0.001). Fetal echocardiographic measurements indicated reduced global longitudinal strain in fetuses of Group B mothers (LV strain: −19.86% ± 6.83% vs. −26.14% ± 5.92%, p = 0.017). Significant correlations were found between maternal triglyceride levels and fetal LV strain (r = 0.536, p = 0.019). Regression analysis identified maternal triglyceride levels and BMI as significant predictors of reduced fetal LV strain (β = 0.45, p = 0.021 and β = 0.39, p = 0.038, respectively). Conclusions: Elevated maternal triglyceride levels, LDL cholesterol, and BMI are associated with altered fetal cardiac function parameters at mid-gestation, suggesting that maternal lipid profiles may impact fetal cardiac development. These findings underscore the importance of monitoring lipid levels during pregnancy and suggest potential benefits of managing dyslipidemia to improve fetal cardiac outcomes. However, the study included only a small sample; therefore, the study needs to be continued with a larger group. Full article
10 pages, 270 KiB  
Article
Clinical Success of Pulpotomies Using Intermediate Restorations and Preformed Metal Crowns in the Context of a Developing Country: A Retrospective Questionnaire-Based Investigation
by Ana Luisa Montero-Copoya, Norma Leticia Robles-Bermeo, Salvador Eduardo Lucas-Rincón, María de Lourdes Márquez-Corona, Saraí Carmina Guadarrama-Reyes, Nayeli Lovera-Rojas, Juan Fernando Casanova-Rosado, Juan José Villalobos-Rodelo, Mauricio Escoffié-Ramírez and Carlo Eduardo Medina-Solís
Clin. Pract. 2024, 14(6), 2580-2589; https://doi.org/10.3390/clinpract14060203 - 27 Nov 2024
Viewed by 622
Abstract
Background: Dental caries is one of the most prevalent dental illnesses in children. Untreated severe caries can damage teeth, requiring pulpotomy to save them. Objective: To evaluate the clinical success rate of treatments involving pulpotomies + IRM (Intermediate Restorative Material, composed of reinforced [...] Read more.
Background: Dental caries is one of the most prevalent dental illnesses in children. Untreated severe caries can damage teeth, requiring pulpotomy to save them. Objective: To evaluate the clinical success rate of treatments involving pulpotomies + IRM (Intermediate Restorative Material, composed of reinforced zinc oxide–eugenol polymers) + preformed metal crowns (PMCs) in primary teeth of children treated at a public university in Mexico. Materials and Methods: A cross-sectional ambispective study was conducted on children aged 10 years or younger, treated at a public university in Mexico. A total of 1281 medical records from February 2018 to June 2023 were reviewed, yielding a sample of 199 children treated with pulpotomy + IRM + PMC. Information was collected via telephone interviews with parents/caregivers to inquire about any symptoms following the pulpotomy and metal crown treatments. Success was defined as the absence of pain, inflammation, or infection. Results: During the study period, the number of teeth treated with pulpotomy + IRM + PMC was 414, with follow-ups ranging from 6 to 69 months. Most participants were girls (54.3%), while 45.7% were boys. Out of the 167 pulpotomy + IRM + PMC treatments included in the study, the clinical success rate was 98.2%. Conclusions: The clinical success rate of primary teeth treated with pulpotomy + IRM + PMCs was high, close to 100%, based on evidence and symptom reports from parents/caregivers. It would be beneficial to implement its use in public health institutions in countries such as Mexico. Full article
(This article belongs to the Special Issue New Trends, Materials, and Technologies and Consolidating Best Practices in Dentistry, 2nd Edition)
12 pages, 1331 KiB  
Article
Immediate Effects of the Mandibular Muscle Energy Technique in Adults with Chronic Temporomandibular Disorder
by Antonio Márquez-Vera, Luis Polo-Ferrero, Ana Silvia Puente-González, Roberto Méndez-Sánchez and José Antonio Blanco-Rueda
Clin. Pract. 2024, 14(6), 2568-2579; https://doi.org/10.3390/clinpract14060202 - 25 Nov 2024
Viewed by 418
Abstract
Background/Objectives: Temporomandibular disorders affect the muscles used for chewing, the temporomandibular joint, and other related tissues, resulting in pain, limited mobility, and dysfunction of the masticatory muscles. Physical therapy plays a critical role in treatment. Manual therapy can trigger neurophysiological mechanisms that contribute [...] Read more.
Background/Objectives: Temporomandibular disorders affect the muscles used for chewing, the temporomandibular joint, and other related tissues, resulting in pain, limited mobility, and dysfunction of the masticatory muscles. Physical therapy plays a critical role in treatment. Manual therapy can trigger neurophysiological mechanisms that contribute to pain relief and a reduction in muscle activation. Evaluations of different manual therapy techniques are needed on this topic. The main objective of this study was to evaluate the effects of a specific manual therapy technique (the mandibular muscle energy technique) in adults with temporomandibular disorders. Methods: A randomized, parallel clinical trial was conducted, and 31 participants were recruited into an experimental group and 30 were recruited into a control group in order to analyze its effects on outcomes such as pain, pain threshold to pressure, mandibular mobility, and kinesiophobia. Pre- and post-intervention assessments were performed, followed by statistical analyses to verify the intra- and intergroup changes. Results: The results showed that the mandibular muscle energy technique produced positive effects with significant differences in the intra- and intergroup comparisons for pain threshold to pressure, mandibular mobility, and kinesiophobia, demonstrating its efficacy and safety as a treatment option for adults with temporomandibular disorders, with proven effects in the short term. Conclusions: The effects obtained and the absence of side effects showed that this technique can be integrated into multimodal treatment along with other types of interventions in patients with temporomandibular disorders. Full article
(This article belongs to the Special Issue Clinical Outcome Research in the Head and Neck)
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9 pages, 215 KiB  
Article
Extraperitoneal Open Radical Cystectomy: A New Standard in Frail Patients with Muscle-Invasive Bladder Cancer?
by Daniel Porav-Hodade, Silvestru-Alexandru Big, Vlad-Ilie Barbos, Bogdan Gherle, Ernő Jerzicska, Victor Ona and Bogdan-Ovidiu Feciche
Clin. Pract. 2024, 14(6), 2559-2567; https://doi.org/10.3390/clinpract14060201 - 24 Nov 2024
Viewed by 706
Abstract
Background/Objectives: Radical cystectomy (RC) represents one of the most complex and morbid surgical procedures in the field of Urology. Extraperitoneal open RC has emerged as an alternative to the traditional transperitoneal approach for the treatment of muscle-invasive bladder cancer. Frailty is one [...] Read more.
Background/Objectives: Radical cystectomy (RC) represents one of the most complex and morbid surgical procedures in the field of Urology. Extraperitoneal open RC has emerged as an alternative to the traditional transperitoneal approach for the treatment of muscle-invasive bladder cancer. Frailty is one of the most important risk factors for perioperative morbidity and mortality, and this category of patients can benefit the most from the extraperitoneal approach. The purpose of this study was to evaluate the feasibility and the safety of extraperitoneal open RC in our experience; Methods: We retrospectively collected the data of 75 frail patients who underwent an extraperitoneal open RC, performed by a single experienced surgeon. We assessed their frailty status using the simplified frailty index (sFI). We recorded data regarding general characteristics, intraoperative, pathological, and postoperative complications, and mortality (within 90 days); Results: We analyzed 61 males and 14 females with an sFI equal to or higher than 3. The median age was 77 years. Fifty-one patients had an ASA score of 3 or more. Sixty procedures were with radical intention, while fifteen were palliative. Cutaneous ureterostomy was performed in 70 cases and extraperitonized ileal conduit in five cases. The median operative time was 150 min. The median blood loss was 400 mL. The median time to flatus was 2 days. The median postoperative stay was 7 days. Thirteen patients had Clavien–Dindo III or IV complications. Two patients died in first 90 days postoperatively; Conclusions: The extraperitoneal open RC in frail patients was demonstrated to be a feasible and safe alternative approach in definitive treatment or a palliative setting in our experience. Full article
17 pages, 8205 KiB  
Review
Metabolic Dysfunction-Associated Steatotic Liver Disease in Chronic Hepatitis C Virus Infection: From Basics to Clinical and Nutritional Management
by Karina Gonzalez-Aldaco, Luis A. Torres-Reyes, Claudia Ojeda-Granados, Leonardo Leal-Mercado, Sonia Roman and Arturo Panduro
Clin. Pract. 2024, 14(6), 2542-2558; https://doi.org/10.3390/clinpract14060200 - 24 Nov 2024
Viewed by 1175
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely associated with obesity and other cardiometabolic risk factors. MASLD has rapidly become the most common cause of liver disease worldwide, currently affecting 38% of the global population. Excess weight causes chronic inflammation and the activation [...] Read more.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely associated with obesity and other cardiometabolic risk factors. MASLD has rapidly become the most common cause of liver disease worldwide, currently affecting 38% of the global population. Excess weight causes chronic inflammation and the activation of different pathways involved in liver damage. MASLD can progress from simple steatosis to steatohepatitis, giving way to its inflammatory component, metabolic dysfunction-associated steatohepatitis (MASH), previously recognized as non-alcoholic steatosis hepatitis (NASH). Chronic hepatitis C virus (HCV) infection remains a significant challenge to liver health as it triggers hepatic inflammation, metabolic disruption, and hepatic steatosis. The convergence of MASLD and chronic HCV infection can significantly alter the course of liver disease and accelerate the progression to severe liver damage. Currently, HCV treatment has a high cure rate. However, in patients who achieve a sustained virological response after treatment with direct-acting antivirals, weight gain, and excessive calorie intake may contribute to increased liver steatosis and a higher risk of liver disease progression. Therefore, the effective clinical and nutritional management of HCV patients, both before and after viral eradication, is crucial to reducing the risk of death from hepatocellular carcinoma. Understanding the complex interactions between MASLD and HCV infection is crucial for managing these patients appropriately. Herein, host and viral mechanisms inducing liver damage during the coexistence of MASLD and HCV infection are described, and their therapeutic and dietary management are discussed. Full article
(This article belongs to the Special Issue Clinical Nutrition in Metabolic Disorders)
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9 pages, 525 KiB  
Article
Clinical Acceptance of Digitally Produced Zirconia and Metal Post and Cores, Based on the Impression Method
by Paula Perlea, Cosmin Stefanescu and Alexandru Eugen Petre
Clin. Pract. 2024, 14(6), 2533-2541; https://doi.org/10.3390/clinpract14060199 - 20 Nov 2024
Viewed by 721
Abstract
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 [...] Read more.
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
(This article belongs to the Special Issue Clinical Outcome Research in the Head and Neck)
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11 pages, 771 KiB  
Article
Knowledge, Attitudes, and Practices of Parents Regarding Ophthalmological Screening of Preschool-Aged Children in Jazan, Saudi Arabia
by Mohamed Salih Mahfouz, Samy Shaban Mahmoud, Saleha Qaseem Haroobi, Latifah Mohammed Bahkali, Shahad Ibrahim Numan, Areen Mohsen Taheri, Ohoud Ali Hakami, Orjuwan Adel Zunquti and Sarah Mohammed Khered
Clin. Pract. 2024, 14(6), 2522-2532; https://doi.org/10.3390/clinpract14060198 - 20 Nov 2024
Viewed by 610
Abstract
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 [...] Read more.
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
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15 pages, 2232 KiB  
Article
Artificial Intelligence Applied in Early Prediction of Lower Limb Fracture Complications
by Aurelian-Dumitrache Anghele, Virginia Marina, Liliana Dragomir, Cosmina Alina Moscu, Iuliu Fulga, Mihaela Anghele and Cristina-Mihaela Popescu
Clin. Pract. 2024, 14(6), 2507-2521; https://doi.org/10.3390/clinpract14060197 - 14 Nov 2024
Viewed by 777
Abstract
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 [...] Read more.
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
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8 pages, 213 KiB  
Article
Oral Diadochokinesis, Tongue Pressure, and Lip-Seal Strength Among Japanese Male Workers in the Taxi Industry: A Cross-Sectional Study
by Akira Minoura, Yoshiaki Ihara, Hirotaka Kato, Kouzou Murakami, Yoshio Watanabe, Kojiro Hirano, Yoshinori Ito and Akatsuki Kokaze
Clin. Pract. 2024, 14(6), 2499-2506; https://doi.org/10.3390/clinpract14060196 - 14 Nov 2024
Viewed by 571
Abstract
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 [...] Read more.
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
(This article belongs to the Special Issue Clinical Outcome Research in the Head and Neck)
8 pages, 436 KiB  
Article
Running Cadence and the Influence on Frontal Plane Knee Deviations
by Jacob R. Peterson, Collin R. Sanders, Nathan S. Reynolds, Conner A. Alford, Michael J. Platt, Jeffrey J. Parr, Felix Twum, James R. Burns and David R. Dolbow
Clin. Pract. 2024, 14(6), 2491-2498; https://doi.org/10.3390/clinpract14060195 - 14 Nov 2024
Viewed by 563
Abstract
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 [...] Read more.
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
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7 pages, 8271 KiB  
Case Report
Micropulse Laser Therapy in Central Serous Chorioretinopathy
by Flaviu Bodea, Andrei-Flavius Radu, Ruxandra-Florina Bodog, Teodora Maria Bodog and Cristina Ariadna Nicula
Clin. Pract. 2024, 14(6), 2484-2490; https://doi.org/10.3390/clinpract14060194 - 14 Nov 2024
Viewed by 560
Abstract
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 [...] Read more.
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
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9 pages, 823 KiB  
Article
Incidence Trends of Rheumatoid Arthritis in Korea for 11 Years (2006–2017)
by Hanna Lee, Sang-Il Lee, Hyunjin Lim, Hyun-Ok Kim, Rock Bum Kim and Yun-Hong Cheon
Clin. Pract. 2024, 14(6), 2475-2483; https://doi.org/10.3390/clinpract14060193 - 13 Nov 2024
Viewed by 705
Abstract
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 [...] Read more.
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
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12 pages, 514 KiB  
Article
Impact of Body Mass Index on the Outcomes of Cryoballoon Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation
by Konstantinos A. Papathanasiou, Dimitrios A. Vrachatis, Charalampos Kossyvakis, Sotiria G. Giotaki, Gerasimos Deftereos, Maria Kousta, Ioannis Anagnostopoulos, Dimitrios Avramides, George Giannopoulos, Vaia Lambadiari, Gerasimos Siasos and Spyridon Deftereos
Clin. Pract. 2024, 14(6), 2463-2474; https://doi.org/10.3390/clinpract14060192 - 12 Nov 2024
Viewed by 607
Abstract
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: [...] Read more.
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
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18 pages, 313 KiB  
Review
Progress and Challenges in the Management of Congenital Cytomegalovirus Infection
by Weronika Szulc, Natalia Szydłowska, Julia M. Smyk and Anna Majewska
Clin. Pract. 2024, 14(6), 2445-2462; https://doi.org/10.3390/clinpract14060191 - 12 Nov 2024
Viewed by 1047
Abstract
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 [...] Read more.
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
12 pages, 765 KiB  
Article
Enhancing Outcomes and Efficiency in Large Epidermal Cyst Management: Quality Improvement Approach in Primary Care
by Waseem Jerjes, Pratik Ramkumar and Yousuf Yaqub
Clin. Pract. 2024, 14(6), 2433-2444; https://doi.org/10.3390/clinpract14060190 - 12 Nov 2024
Viewed by 572
Abstract
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 [...] Read more.
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
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14 pages, 252 KiB  
Article
Psycho-Somatic Evolution of Patients with Multiple Traumatic Injuries
by Mihaela Anghele, Virginia Marina, Cosmina Alina Moscu, Aurelian-Dumitrache Anghele and Liliana Dragomir
Clin. Pract. 2024, 14(6), 2419-2432; https://doi.org/10.3390/clinpract14060189 - 11 Nov 2024
Viewed by 574
Abstract
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) [...] Read more.
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
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