Clinics and Practice

9 pages, 587 KiB

Open AccessCase Report

A Newborn with Cleft Palate Associated with PTEN Hamartoma Tumor Syndrome

by Ulf Nestler, Daniel Gräfe, Vincent Strehlow, Robin-Tobias Jauss, Andreas Merkenschlager, Annika Schönfeld and Florian Wilhelmy

Clin. Pract. 2025, 15(1), 22; https://doi.org/10.3390/clinpract15010022 - 20 Jan 2025

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Abstract

Background: PTEN hamartoma tumor syndrome (PHTS) has evolved into an umbrella term for a range of syndromes, characterized by loss-of-function variants in the phosphatase and tensin homolog (PTEN) tumor suppressor gene on chromosome 10q23.31. This can result in a lifelong tumor predisposition [...] Read more.

Background: PTEN hamartoma tumor syndrome (PHTS) has evolved into an umbrella term for a range of syndromes, characterized by loss-of-function variants in the phosphatase and tensin homolog (PTEN) tumor suppressor gene on chromosome 10q23.31. This can result in a lifelong tumor predisposition in patients. Often, the syndrome is diagnosed in early childhood because of macrocephaly, dermatological findings, or development delay. Since the correlation between phenotype and genotype is weak, and the penetrance is age-dependent, this poses the question of the appropriate timing of potentially invasive and burdensome examinations for early cancer detection. Case: The present report describes an infant with cleft palate associated with PHTS, a rare occurrence, though the initial report of Cowden syndrome already pointed to oromaxillofacial abnormalities. The recent pediatric literature is reviewed to assess which clinical symptoms should raise suspicion of PHTS and may then lead to early genetic counseling. Conclusion: Since the amount of prospective data remains limited, and the estimation of tumor risk during infancy and adulthood is very difficult, we advocate for early and broad genetic testing in suspected cases, to gain more insights into this rare disease and allow for better counseling for patients and their families. Full article

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15 pages, 1103 KiB

Open AccessArticle

Immunosuppression and Outcomes in Patients with Cutaneous Squamous Cell Carcinoma of the Head and Neck

by Doriana Iancu, Ana Fulga, Doina Vesa, Iuliu Fulga, Dana Tutunaru, Andrei Zenovia, Alin Ionut Piraianu, Elena Stamate, Corina Sterian, Florentin Dimofte, Mihail Alexandru Badea and Alin Laurentiu Tatu

Clin. Pract. 2025, 15(1), 21; https://doi.org/10.3390/clinpract15010021 - 17 Jan 2025

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Abstract

Cutaneous squamous scell carcinoma (cSCC) is a frequent non-melanoma skin cancer that originates from keratinocytes with increased prevalence. cSCC can be either in situ, as in Bowen’s disease, or extended. Advanced age, accumulated sun exposure, light pigmentation, and prior skin cancer diagnosis are [...] Read more.

Cutaneous squamous scell carcinoma (cSCC) is a frequent non-melanoma skin cancer that originates from keratinocytes with increased prevalence. cSCC can be either in situ, as in Bowen’s disease, or extended. Advanced age, accumulated sun exposure, light pigmentation, and prior skin cancer diagnosis are all significant risk factors for cSCC. Although most cSCCs can be treated surgically, some recur and metastasize, resulting in death. The role of immune status is not yet determined in the prognosis of these patients. Objective. Immunosuppressed patients are more likely to develop cSCC, which is often characterized by more aggressive, multifocal lesions. This study aimed to determine the risks of mortality in patients with cSCC and immunosuppression versus non immunosuppression and to compare variations in overall survival based on different clinical features. Method. We evaluated clinical cases of patients at “Sfantul Apostol Andrei” Emergency Hospital of Galati, Romania, from 1 March 2018 to 1 April 2024. Subjects in the trial had to be at least 18 years old and have a pathologically confirmed diagnosis of cutaneous head and neck squamous cell carcinoma (cHNSCC). We divided the patients into two different categories based on whether they had immunosuppression. Results. In this cohort of 68 subjects with cSCC, patients with immunosuppression had significantly lower overall survival, as well as lower three- and five-year survival rates compared with those without immunosuppression, even after adjustment for age, sex, stage, and previous surgical treatment. The median survival time for immunosuppressed individuals ranged from 11 to 21 months, varying based on their particular characteristics, and most critically, on the presence of other malignancies, while that of immunocompetent patients ranged from 18 to 51 months. In addition, immune-deficient patients with early-stage disease had a 21-month median survival rate that changed to11 months for advanced-stage cases. In a similar manner, immunocompetent patients with early-stage cancer had a significantly better median survival than those withadvancedstages,43 versus 18months. Our results indicate that immunosuppression is a distinct risk factors associated with a less favorable outcome in patients with cHNSCC. Full article

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8 pages, 228 KiB

Open AccessArticle

Evaluating the Efficacy of Combined Intravaginal Estriol Therapy and Kegel Exercises in Managing Menopausal Atrophic Vulvovaginitis

by Lucian Șerbănescu, Vadym Rotar, Dragoș Brezeanu, Sebastian Mirea, Elena-Valentina Ionescu and Paris Ionescu

Clin. Pract. 2025, 15(1), 20; https://doi.org/10.3390/clinpract15010020 - 15 Jan 2025

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Abstract

Background: This is a prospective study. Atrophic vulvovaginitis (VVA), a prevalent condition resulting from estrogen deficiency after the menopause, is characterized by symptoms such as vaginal dryness, itching, burning, dyspareunia, and urinary discomfort. Standard treatment involves systemic estrogen replacement therapy (HRT) and [...] Read more.

Background: This is a prospective study. Atrophic vulvovaginitis (VVA), a prevalent condition resulting from estrogen deficiency after the menopause, is characterized by symptoms such as vaginal dryness, itching, burning, dyspareunia, and urinary discomfort. Standard treatment involves systemic estrogen replacement therapy (HRT) and localized estrogen treatments, such as estriol. However, many women with moderate-to-severe VVA may not fully benefit from estrogen therapy alone. Non-hormonal adjunctive treatments, such as pelvic floor exercises (e.g., Kegel exercises), are being explored to enhance clinical outcomes. Objectives: This study investigates the combined effect of local estriol therapy and Kegel exercises in improving VVA symptoms in postmenopausal women. Methods: Fifty postmenopausal women diagnosed with VVA were enrolled and divided into three severity groups: mild, moderate, and severe. All participants received estriol therapy (0.5 mg vaginal tablets daily for 10 days each month) for the first three months. Following this, Kegel exercises were introduced for an additional three-month period, alongside continued estriol therapy. Symptom improvement was evaluated after six months, with outcomes categorized as complete remission, partial remission, or no remission. Results: Significant improvements in symptom remission were observed, particularly in the moderate and severe groups. In the mild VVA group, 81.82% achieved complete remission with combined therapy compared to 68.18% with estriol alone. In the severe group, complete remission was observed in 40% of patients receiving combined therapy compared to 20% with estriol therapy alone. These findings suggest that Kegel exercises enhance the effectiveness of estriol by improving local blood circulation, which facilitates better estrogen absorption and distribution. Conclusions: The addition of Kegel exercises to local estriol therapy significantly improves symptom remission rates, especially in moderate and severe VVA cases. This approach offers a promising strategy for managing postmenopausal VVA, particularly in cases that do not fully respond to estrogen therapy alone. Full article

17 pages, 211 KiB

Open AccessArticle

Barriers and Factors Affecting Nursing Communication When Providing Patient Care in Jeddah

by Ruba M. Alharazi, Rahaf J. Abdulrahim, Alhanouf H. Mazuzah, Reem M. Almutairi, Hayfa Almutary and Aisha Alhofaian

Clin. Pract. 2025, 15(1), 19; https://doi.org/10.3390/clinpract15010019 - 14 Jan 2025

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Abstract

Background/Objectives: Effective communication between nurses and patients plays a crucial role in the delivery of quality healthcare services, especially when caring for patients from diverse cultural backgrounds. It fosters trust, understanding, and collaboration and contributes to better health outcomes and satisfactory nurse–patient relationships. [...] Read more.

Background/Objectives: Effective communication between nurses and patients plays a crucial role in the delivery of quality healthcare services, especially when caring for patients from diverse cultural backgrounds. It fosters trust, understanding, and collaboration and contributes to better health outcomes and satisfactory nurse–patient relationships. The aim of the study is to assess the factors and barriers affecting nurses’ communication when providing care for patients from diverse cultural backgrounds in Jeddah, Saudi Arabia. Methods: A cross-sectional quantitative descriptive design is used with an online survey instrument. The study involved registered nurses employed in Jeddah’s hospitals. The study utilized a convenience sample for data collection and used the latest version of the statistical package for the social sciences (SPSS version 21) for data entry and analysis. Results: A study of 367 participants found significant barriers to nurse–patient communication, with a mean score of 2.84 on a three-point scale. Key challenges included language differences between nurses and patients with a mean score of 2.87, and cultural and religious differences with a mean score of 2.83 and 2.81, as well as nurses’ communication skills, attitudes, and self-confidence and patients’ awareness, attitudes, and resistance to communication. The multifaceted nature of these barriers emphasizes the need for targeted interventions to improve nurse–patient interactions and enhance care quality. Conclusions: The study highlights the impact of various factors on effective communication between nurses and patients, emphasizing the need for nurses to develop their communication skills and to receive adequate training from nursing officials. Full article

18 pages, 8173 KiB

Open AccessReview

The Relevance of the Virchow Node and Virchow Triad in Renal Cancer Diagnosis

by Luiza-Roxana Dorobantu-Lungu, Viviana Dinca, Andrei Gegiu, Dan Spataru, Andreea Toma, Luminita Welt, Mihaela Florentina Badea, Constantin Caruntu, Cristian Scheau and Ilinca Savulescu-Fiedler

Clin. Pract. 2025, 15(1), 18; https://doi.org/10.3390/clinpract15010018 - 14 Jan 2025

Viewed by 420

Abstract

Background: The purpose of this article is to overview the clinical significance of left supraclavicular adenopathy and review the etiology of inferior vena cava (IVC) thrombosis, starting from a presentation of a rare case of renal cell carcinoma (RCCs) with Xp11.2 translocation involving [...] Read more.

Background: The purpose of this article is to overview the clinical significance of left supraclavicular adenopathy and review the etiology of inferior vena cava (IVC) thrombosis, starting from a presentation of a rare case of renal cell carcinoma (RCCs) with Xp11.2 translocation involving TFE3 gene fusion. This article also aims to review the literature to understand the characteristics of this rare type of renal tumor. Renal cell carcinoma (RCC) associated with Xp11.2 translocation/gene fusion TFE3 is a rare subtype of kidney cancer that was classified in 2016 as belonging to the family of renal carcinomas with MiT gene translocation (microphthalmia-associated transcription factor). The prognosis for these kidney cancers is poorer compared to other types. Methods: We present a case of a 66-year-old man with Virchow–Troisier adenopathy during physical examination, which raises the suspicion of infra-diaphragmatic tumor. The echocardiography highlighted a heterogeneous mass in the right cardiac cavities, and the abdominal ultrasound exam revealed a solid mass at the upper pole of the left kidney. Results: Following computed tomography, magnetic resonance imaging, PET-CT, and histopathological and immunohistochemical examinations, the patient was diagnosed with renal carcinoma with Xp11.2 translocation and TFE3 gene fusion. Conclusions: IVC thrombosis is often associated with neoplastic disease due to the procoagulant state of these patients, the most common malignancies related to IVC thrombosis being represented by RCCs (38%), genitourinary cancers (25%), bronchus and lung cancers, retroperitoneal leiomyosarcoma, and adrenal cortical carcinoma. Imaging methods play a crucial role in differential diagnosis, allowing for the localization of the primary tumor and assessment of its characteristics. Full article

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25 pages, 1047 KiB

Open AccessReview

Artificial Intelligence in Cardiac Surgery: Transforming Outcomes and Shaping the Future

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

Clin. Pract. 2025, 15(1), 17; https://doi.org/10.3390/clinpract15010017 - 14 Jan 2025

Viewed by 562

Abstract

Background: Artificial intelligence (AI) has emerged as a transformative technology in healthcare, with its integration into cardiac surgery offering significant advancements in precision, efficiency, and patient outcomes. However, a comprehensive understanding of AI’s applications, benefits, challenges, and future directions in cardiac surgery is [...] Read more.

Background: Artificial intelligence (AI) has emerged as a transformative technology in healthcare, with its integration into cardiac surgery offering significant advancements in precision, efficiency, and patient outcomes. However, a comprehensive understanding of AI’s applications, benefits, challenges, and future directions in cardiac surgery is needed to inform its safe and effective implementation. Methods: A systematic review was conducted following PRISMA guidelines. Literature searches were performed in PubMed, Scopus, Cochrane Library, Google Scholar, and Web of Science, covering publications from January 2000 to November 2024. Studies focusing on AI applications in cardiac surgery, including risk stratification, surgical planning, intraoperative guidance, and postoperative management, were included. Data extraction and quality assessment were conducted using standardized tools, and findings were synthesized narratively. Results: A total of 121 studies were included in this review. AI demonstrated superior predictive capabilities in risk stratification, with machine learning models outperforming traditional scoring systems in mortality and complication prediction. Robotic-assisted systems enhanced surgical precision and minimized trauma, while computer vision and augmented cognition improved intraoperative guidance. Postoperative AI applications showed potential in predicting complications, supporting patient monitoring, and reducing healthcare costs. However, challenges such as data quality, validation, ethical considerations, and integration into clinical workflows remain significant barriers to widespread adoption. Conclusions: AI has the potential to revolutionize cardiac surgery by enhancing decision making, surgical accuracy, and patient outcomes. Addressing limitations related to data quality, bias, validation, and regulatory frameworks is essential for its safe and effective implementation. Future research should focus on interdisciplinary collaboration, robust testing, and the development of ethical and transparent AI systems to ensure equitable and sustainable advancements in cardiac surgery. Full article

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

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16 pages, 702 KiB

Open AccessReview

Role of Cannabis in the Management of Chronic Non-Cancer Pain: A Narrative Review

by Lou’i Al-Husinat, Shrouq Obeidat, Saif Azzam, Yara Al-Gwairy, Fatima Obeidat, Sarah Al Sharie, Deema Haddad, Fadi Haddad, Martina Rekatsina, Matteo Luigi Giuseppe Leoni and Giustino Varrassi

Clin. Pract. 2025, 15(1), 16; https://doi.org/10.3390/clinpract15010016 - 13 Jan 2025

Viewed by 587

Abstract

Chronic non-cancer pain, defined by the Center for Disease Control and Prevention (CDC) as lasting beyond three months, significantly affects individuals’ quality of life and is often linked to various medical conditions or injuries. Its management is complex. Cannabis, containing the key compounds [...] Read more.

Chronic non-cancer pain, defined by the Center for Disease Control and Prevention (CDC) as lasting beyond three months, significantly affects individuals’ quality of life and is often linked to various medical conditions or injuries. Its management is complex. Cannabis, containing the key compounds Delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), has garnered interest for its potential in pain management, though it remains controversial due to its psychoactive effects and illegal status in many countries. THC provides pain relief by blocking nociceptive stimuli but has psychoactive effects and may potentially induce dependency. CBD has calming and antipsychotic properties. The inhalation of cannabis offers quick relief but poses respiratory risks, while its oral administrations are safer but act more slowly. Short-term cannabis use can impair cognition and motor skills, while long-term use may lead to dependency and cognitive decline, especially if used from an early age. Adverse effects vary by gender and prior use, with addiction mainly linked to THC and influenced by genetics. Despite these risks, patients often report more benefits, such as improved quality of life and reduced opioid use, although the evidence remains inconclusive. The legal landscape for medical cannabis varies globally, with some positive public health outcomes like reduced opioid-related issues in areas where it is legalized. Cannabis shows promise in managing chronic pain, but its psychoactive effects and dependency risks necessitate cautious use. Future research should prioritize long-term clinical trials to establish optimal dosing, efficacy, and safety, aiding in the development of informed guidelines for safe cannabis use in chronic pain management. This review examines the use of cannabis in managing chronic non-cancer pain, focusing on its benefits, drawbacks, mechanisms, delivery methods, and impact on quality of life. Full article

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

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16 pages, 2648 KiB

Open AccessArticle

Impact of Comorbidities on Prognosis and Treatment Outcomes in Elderly Patients with Hodgkin Lymphoma

by Dávid Tóthfalusi, Boglárka Dobó, Fanni Borics, László Imre Pinczés, Árpád Illés and Zsófia Miltényi

Clin. Pract. 2025, 15(1), 15; https://doi.org/10.3390/clinpract15010015 - 13 Jan 2025

Viewed by 452

Abstract

Background/Objectives: Hodgkin lymphoma (HL) primarily affects young adults, but about 20% of cases occur in patients over the age of 60 years. Older individuals often have comorbidities and poorer functional status, which can affect treatment choices. Methods: We retrospectively analyzed data [...] Read more.

Background/Objectives: Hodgkin lymphoma (HL) primarily affects young adults, but about 20% of cases occur in patients over the age of 60 years. Older individuals often have comorbidities and poorer functional status, which can affect treatment choices. Methods: We retrospectively analyzed data from HL patients over 60 years old who were treated at our institution between January 2010 and December 2023. We examined various factors, such as blood parameters (e.g., platelet count, lactate dehydrogenase (LDH), C-reactive protein (CRP)), PET/CT results and comorbidities (e.g., hypertension, diabetes, cardiovascular diseases), to assess their impact on overall survival (OS) and progression-free survival (PFS). Diagnostic efficiency was determined via receiver operating characteristic analysis, while the survival outcomes were evaluated using the Cox proportional hazards model. Results: A total of 35 patients with a median age of 68 were treated. The most common subtype was nodular sclerosis, and 72% of patients were in advanced stages at diagnosis. Treatment varied by age, with younger patients receiving ABVD and older patients (80–89) receiving brentuximab vedotin with dacarbazine. The survival of older patients, when analyzed by age groups, did not show a significant difference in the OS (p = 0.16) and PFS (p = 0.11). Comorbidities significantly worsened survival, with patients who scored > 7 on the Charlson Comorbidity Index (CCI) showing a 5-year PFS of 41.3%, compared to 91.3% for those who scored ≤ 7. Among the tested laboratory parameters, a platelet count over 310.5 G/L and an absolute lymphocyte count below 0.47 G/L were found to be independent risk factors for OS. Patients with neither or only one of these risk factors demonstrated a 5-year OS of 81.7%, whereas those presenting with both risk factors experienced a reduced 5-year OS of 70%. For PFS, a white blood cell count > 8.48 G/L, a platelet count > 310.5 G/L, and advanced age (>73.5 years) were identified as significant adverse prognostic factors. Patients with none of these risk factors had a 5-year PFS of 100%, whereas those with ≥ 1 risk factor had a 5-year PFS of 35.6%. Conclusions: Comorbidities play a greater role in prognosis than chronological age, emphasizing the need for personalized treatment approaches. Full article

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12 pages, 1617 KiB

Open AccessArticle

Decoding Urinary Tract Infection Trends: A 5-Year Snapshot from Central Portugal

by Francisco Rodrigues, Patrícia Coelho, Sónia Mateus, Armando Caseiro, Hatem Eideh, Teresa Gonçalves and Miguel Castelo Branco

Clin. Pract. 2025, 15(1), 14; https://doi.org/10.3390/clinpract15010014 - 6 Jan 2025

Viewed by 607

Abstract

Introduction: This study analyzes urinary tract infections (UTIs) in a hospital in Central Portugal over a five-year period, focusing on bacterial prevalence, patient demographics, and antibiotic resistance patterns. This investigation aims to provide insights that can guide improved infection control and treatment strategies. [...] Read more.

Introduction: This study analyzes urinary tract infections (UTIs) in a hospital in Central Portugal over a five-year period, focusing on bacterial prevalence, patient demographics, and antibiotic resistance patterns. This investigation aims to provide insights that can guide improved infection control and treatment strategies. Methods: A total of 6161 positive urine cultures collected over five years were examined, with particular emphasis on 2019 due to a peak in infection rates. The analysis explored bacterial prevalence, demographic factors such as sex and clinical service origin, and antibiotic resistance. Special attention was given to hospitalized patients, especially those undergoing invasive procedures, due to their increased vulnerability to infection. Results: This study found that UTIs were more prevalent in female patients, reflecting anatomical susceptibilities. Hospitalized individuals, particularly those requiring invasive procedures, were at greater risk. The predominant bacteria were Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis, with differences in prevalence by patient sex and service origin. Resistance to Imipenem in E. coli increased, raising concerns about last-resort treatments. However, resistance to other antibiotics declined, suggesting improvements due to recent stewardship measures. During the COVID-19 pandemic, overall antibiotic consumption decreased due to changes in clinical practices. Conclusion: The findings highlight the importance of strict infection control, targeted prevention measures, and rational antibiotic use to combat resistance. Ongoing surveillance and personalized treatment approaches are essential to improve UTI management and outcomes. Full article

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15 pages, 1069 KiB

Open AccessReview

Emergency Airway Management: A Systematic Review on the Effectiveness of Cognitive Aids in Improving Outcomes and Provider Performance

by Raisa Chowdhury, Ostap Orishchak, Marco A. Mascarella, Bshair Aldriweesh, Mohammed K. Alnoury, Guillaume Bousquet-Dion, Jeffrey Yeung and Lily Ha-Nam P. Nguyen

Clin. Pract. 2025, 15(1), 13; https://doi.org/10.3390/clinpract15010013 - 6 Jan 2025

Viewed by 535

Abstract

Background/Objectives: Emergency airway management is a critical skill for healthcare professionals, particularly in life-threatening situations like “cannot intubate, cannot oxygenate” (CICO) scenarios. Errors and delays in airway management can lead to adverse outcomes, including hypoxia and death. Cognitive aids, such as checklists and [...] Read more.

Background/Objectives: Emergency airway management is a critical skill for healthcare professionals, particularly in life-threatening situations like “cannot intubate, cannot oxygenate” (CICO) scenarios. Errors and delays in airway management can lead to adverse outcomes, including hypoxia and death. Cognitive aids, such as checklists and algorithms, have been proposed as tools to improve decision-making, procedural competency, and non-technical skills in these high-stakes environments. This systematic review aims to evaluate the effectiveness of cognitive aids in enhancing emergency airway management skills among health professionals and trainees. Methods: A systematic search of MEDLINE, Embase, CINAHL, Cochrane Library, Scopus, Web of Science, and ClinicalTrials.gov was conducted from February to March 2024. Studies examining the use of cognitive aids, such as the Vortex method, the ASA difficult airway algorithm, and visual airway aids, in emergency airway scenarios were included. Outcomes assessed included decision-making speed, procedural success rates, and non-technical skills. Data were extracted using standardized protocols, and the quality of included studies was appraised. Results: Five studies met inclusion criteria, encompassing randomized controlled trials, controlled studies, and mixed-methods research. Cognitive aids improved decision-making times (reduced by 44.6 s), increased procedural success rates, and enhanced non-technical skills such as teamwork and crisis management. Participants reported reduced anxiety and improved confidence levels (self-efficacy scores increased by 1.9 points). The Vortex method and visual cognitive aids demonstrated particular effectiveness in simulated scenarios. Conclusions: Cognitive aids significantly enhance emergency airway management skills, improving performance, reducing errors, and increasing provider confidence. Integrating cognitive aids into training programs has the potential to improve patient safety and outcomes. Further research is needed to validate these findings in clinical settings and optimize cognitive aid design and implementation. Full article

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13 pages, 239 KiB

Open AccessArticle

Clinical Characteristics and Mortality-Associated Factors in Trauma Patients Undergoing Permanent Versus Temporary Tracheostomy

by Ahmad K. Alnemare

Clin. Pract. 2025, 15(1), 12; https://doi.org/10.3390/clinpract15010012 - 4 Jan 2025

Viewed by 478

Abstract

Objective: This study evaluated the characteristics, outcomes, and mortality-associated factors in patients who underwent tracheostomy after traumatic injury to optimize clinical decision-making and patient care in critical trauma settings. Materials and Methods: A retrospective cohort analysis was conducted using the National Trauma Data [...] Read more.

Objective: This study evaluated the characteristics, outcomes, and mortality-associated factors in patients who underwent tracheostomy after traumatic injury to optimize clinical decision-making and patient care in critical trauma settings. Materials and Methods: A retrospective cohort analysis was conducted using the National Trauma Data Bank (NTDB) records from 2013 to 2016. This study included 41,630 adult trauma patients who underwent tracheostomy procedures. Data analysis included descriptive statistics, univariate comparisons, and multivariate logistic regression analyses. The study protocol adhered to STROBE guidelines for observational studies. Results: Analysis of the total cohort revealed that patients with tracheostomy demonstrated high rates of severe injuries (75.2%) and a notable comorbidity burden, including cardiovascular disorders (4.0%) and blood disorders (5.8%). Multivariate analysis revealed that mortality risk was independently associated with advanced age (OR 1.018, 95% CI 1.016–1.021), higher injury severity scores (OR 1.004, CI 1.002–1.007), female sex (OR 1.187, CI 1.078–1.308), and cardiovascular surgical intervention (OR 1.487, CI 1.350–1.638). Among the study population, 7.6% underwent permanent tracheostomy procedures, with these patients showing some distinct clinical characteristics in terms of injury severity and comorbidity profiles. Conclusions: This comprehensive analysis demonstrates the complex clinical characteristics and mortality-associated factors in trauma patients requiring tracheostomy. Key factors influencing survival outcomes include age, injury severity, sex, and cardiovascular surgical intervention. These findings provide valuable insights for clinical decision-making and risk assessment in trauma patients requiring tracheostomy. The observed differences between permanent and temporary tracheostomy patients warrant further investigation with more detailed timing and indication data. Full article

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

13 pages, 1433 KiB

Open AccessArticle

Comparing International Guidelines for the Remission of Hypertension After Bariatric Surgery

by Carina Vieira Dias, Ana Lúcia Silva, Joana Dias, Paulo Cardoso, Rute Castanheira, Andreia Fernandes, Filipa Nunes, Tina Sanai, Mercedes Sanchez, João Maia-Teixeira and Ana Luísa De Sousa-Coelho

Clin. Pract. 2025, 15(1), 11; https://doi.org/10.3390/clinpract15010011 - 2 Jan 2025

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Abstract

Background/Objectives: Obesity remains a global health concern and is associated with increased risk of type 2 diabetes, hypertension, and cardiovascular disease overall. Dissimilar hypertension guidelines are available for clinicians, namely those prepared by the American Heart Association (AHA) and the European Society of [...] Read more.

Background/Objectives: Obesity remains a global health concern and is associated with increased risk of type 2 diabetes, hypertension, and cardiovascular disease overall. Dissimilar hypertension guidelines are available for clinicians, namely those prepared by the American Heart Association (AHA) and the European Society of Cardiology (ESC), which may lead to distinctive appreciation of health outcomes of patients with obesity after bariatric and metabolic surgery, such as hypertension remission. The main goal of this study was to compare the effects of applying stricter (AHA) versus looser (ESC) blood pressure criteria on hypertension diagnosis pre-bariatric surgery and remission assessment one year post-op. Methods: A retrospective analysis of clinical data from patients who underwent surgical treatment for obesity at a single university hospital was performed. To evaluate the hypertension improvement or remission, two different types of blood pressure (BP) categorization were considered (based on AHA and ESC guidelines), in which each patient would fit according to their BP values pre- (m0) and 12 months postoperative (m12). Results: From a sample of 153 patients submitted for surgical treatment of obesity, more patients were considered with hypertension based on the AHA guideline (130 vs. 102; p < 0.001), while a higher rate of hypertension remission at 12 months after bariatric surgery was observed when following the ESC guideline (58.82 vs. 53.08%). Baseline patients’ clinical characteristics based on each hypertension outcome were mostly independent of the guideline used (p > 0.05), where only age and systolic blood pressure were relatively higher in “ESC groups”. Conclusions: We conclude that only minor differences exist between the two guidelines used. If evaluated based on ESC guidelines, it is expected that less patients are considered with hypertension, and the remission rate may be, at least numerically, higher. Full article

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

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11 pages, 228 KiB

Open AccessArticle

Distribution of Major HLA-A, -B, -DR, and -DQ Loci Potentially Associated with Multiple Sclerosis in a Healthy Population from Southern Morocco

by Abir Fguirouche, Fatimazahra Ouahmani, Ikram Brahim, Raja Hazime, Nissrine Louhab, Najib Kissani, Mohamed Chraa and Brahim Admou

Clin. Pract. 2025, 15(1), 10; https://doi.org/10.3390/clinpract15010010 - 2 Jan 2025

Viewed by 532

Abstract

Background: Many factors contribute to the development and the progression of Multiple Sclerosis (MS), including Human Leukocyte Antigen (HLA) molecules. Some of them are considered as predisposing, like DRB1*15, DRB1*13, DRB1*03, DRB1*04, DQB1*06, DQB1*02, while HLA A2, HLA B44, DRB1*11, and DRB1*12 are [...] Read more.

Background: Many factors contribute to the development and the progression of Multiple Sclerosis (MS), including Human Leukocyte Antigen (HLA) molecules. Some of them are considered as predisposing, like DRB1*15, DRB1*13, DRB1*03, DRB1*04, DQB1*06, DQB1*02, while HLA A2, HLA B44, DRB1*11, and DRB1*12 are rather considered as protective. Data about such associations in the Moroccan population remain unknown. The aim of this study was to determine the frequency of HLA class I (A and B) and II (DR and DQ) linked to Multiple Sclerosis (MS) in a healthy population from the South of Morocco. Materials and Methods: A cross-sectional study was carried out over the 2016–2023 period on 685 Moroccan healthy individuals, including 355 males and 330 females. Of the total sample tested, 685 underwent HLA class I typing, of which 305 also benefited from HLA class II typing. HLA class I typing was executed using the CDC (complement dependent cytotoxicity) technique (OneLambda™, Los Angeles CA, USA), and HLA class II typing was performed by either PCR-SSP (sequence-specific primer, OneLambda) or PCR-SSO (sequence-specific oligonucleotides) using the Luminex Xmap (Lifecodes, Immucor, Peachtree, Corners, GA, USA) system. Results: From different HLA molecules potentially predisposing to MS, our investigations showed that DRB1*03, DRB1*13, DRB1*15, DRB1*04, and DQB1*02 were observed in 19.2%, 15.8%, 13.31%, 12.7% and 31% respectively, while the frequency of those considered as protective, namely HLA-A2, HLA-B44, and HLA-DRB1*11 was 23.31%, 9.21% and 10.1% respectively. Conclusions: The findings of our study give evidence that among predisposing HLA class II molecules, DR allele groups were more prevalent, mostly DRB1*03, with also a high frequency of DQB1*06, while HLA-A2 marked the supposed protective specificities. These results need to be supported by complementary studies particularly in MS patients. Full article

13 pages, 1988 KiB

Open AccessArticle

Guidelines for the Management of Complications of Diabetes in Saudi Arabia Using Delphi Technique for Consensus Among National Experts

by Raed Aldahash, Mohammed A. Batais, Ashraf El-Metwally, Saja Alhosan, Mohammed Alharbi, Mohammed Almutairi, Abdulghani Alsaeed, Mohammed Alsofiani, Mohammed AlMehthel, Mohammed Aldubayee, Khaled Aldossari and Sulieman Alshehri

Clin. Pract. 2025, 15(1), 9; https://doi.org/10.3390/clinpract15010009 - 31 Dec 2024

Viewed by 472

Abstract

(1) Background: Saudi Arabia has one of the leading cases of diabetes globally, with approximately 27.8% of adults suffering from the disease. Given the negative consequences of diabetes mellitus (DM), it is critical to develop guidelines for its management. (2) Methods: After a [...] Read more.

(1) Background: Saudi Arabia has one of the leading cases of diabetes globally, with approximately 27.8% of adults suffering from the disease. Given the negative consequences of diabetes mellitus (DM), it is critical to develop guidelines for its management. (2) Methods: After a thorough review of the literature around diabetes management, a diverse panel of 14 clinical experts was identified to participate in the Delphi process. The Delphi process included three rounds to ensure all available evidence was accounted for. (3) Results: The Delphi method concluded with a total of 37 guidelines reviewed and approved by the panelists, followed by verification from a third party in Saudi Arabia. The Delphi and external evaluation confirmed that authentic, relevant, and applicable evidence for diabetes management in Saudi Arabia was accounted for. The process concluded with a list of 37 statements about the management of acute and chronic complications of diabetes in Saudi Arabia. (4) Conclusions: The preparation of contextual evidence for the management of diabetes in Saudi Arabia will be instrumental in addressing the burden of disease in the region. The guidelines offer useful insights into diabetes care, especially by prioritizing early detection and proactive management of complications. They highlight the importance of lifestyle changes and medical therapy. However, due to the ever-changing nature of diabetes, the document must be monitored and updated on a regular basis to ensure its continued relevance and effectiveness. Full article

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11 pages, 1374 KiB

Open AccessArticle

ChatGPT, Google, or PINK? Who Provides the Most Reliable Information on Side Effects of Systemic Therapy for Early Breast Cancer?

by Stefan Lukac, Sebastian Griewing, Elena Leinert, Davut Dayan, Benedikt Heitmeir, Markus Wallwiener, Wolfgang Janni, Visnja Fink and Florian Ebner

Clin. Pract. 2025, 15(1), 8; https://doi.org/10.3390/clinpract15010008 - 31 Dec 2024

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Abstract

Introduction: The survival in early breast cancer (BC) has been significantly improved thanks to numerous new drugs. Nevertheless, the information about the need for systemic therapy, especially chemotherapy, represents an additional stress factor for patients. A common coping strategy is searching for further [...] Read more.

Introduction: The survival in early breast cancer (BC) has been significantly improved thanks to numerous new drugs. Nevertheless, the information about the need for systemic therapy, especially chemotherapy, represents an additional stress factor for patients. A common coping strategy is searching for further information, traditionally via search engines or websites, but artificial intelligence (AI) is also increasingly being used. Who provides the most reliable information is now unclear. Material and Methods: AI in the form of ChatGPT 3.5 and 4.0, Google, and the website of PINK, a provider of a prescription-based mobile health app for patients with BC, were compared to determine the validity of the statements on the five most common side effects of nineteen approved drugs and one drug with pending approval (Ribociclib) for the systemic treatment of BC. For this purpose, the drugs were divided into three groups: chemotherapy, targeted therapy, and endocrine therapy. The reference for the comparison was the prescribing information of the respective drug. A congruence score was calculated for the information on side effects: correct information (2 points), generally appropriate information (1 point), and otherwise no point. The information sources were then compared using a Friedmann test and a Bonferroni-corrected post-hoc test. Results: In the overall comparison, ChatGPT 3.5 received the best score with a congruence of 67.5%, followed by ChatGPT 4.0 with 67.0%, PINK with 59.5%, and with Google 40.0% (p < 0.001). There were also significant differences when comparing the individual subcategories, with the best congruence achieved by PINK (73.3%, p = 0.059) in the chemotherapy category, ChatGPT 4.0 (77.5%; p < 0.001) in the targeted therapy category, and ChatGPT 3.5 (p = 0.002) in the endocrine therapy category. Conclusions: Artificial intelligence and professional online information websites provide the most reliable information on the possible side effects of the systemic treatment of early breast cancer, but congruence with prescribing information is limited. The medical consultation should still be considered the best source of information. Full article

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

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10 pages, 1026 KiB

Open AccessArticle

Chronic Microvascular Complications in Sulfonylureas-Treated Diabetic Patients: Correlations with Glycemic Control, Risk Factors and Duration of the Disease

by Luminita-Georgeta Confederat, Roxana Stefan, Mihaela-Iustina Condurache and Oana-Maria Dragostin

Clin. Pract. 2025, 15(1), 7; https://doi.org/10.3390/clinpract15010007 - 30 Dec 2024

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Abstract

Background: Diabetes has become one of the most challenging public health problems due to the alarming increase in prevalence and the morbidity and mortality attributed to its acute and chronic complications. Objective: This study aimed to investigate the development of chronic microvascular [...] Read more.

Background: Diabetes has become one of the most challenging public health problems due to the alarming increase in prevalence and the morbidity and mortality attributed to its acute and chronic complications. Objective: This study aimed to investigate the development of chronic microvascular complications in sulfonylureas-treated diabetic patients and their correlations with glycemic control, risk factors and duration of the disease. Methods: This study included 200 patients that presented to “Providența” Medical Center, Iași. The information was obtained in a retrospective manner based on the observation sheets of the patients. A database was created, analyzed and statistically processed using the Microsoft Excel software (Version 15) and the chi-square test of independence. Results: The prevalence of diabetic polyneuropathy was 33.5%, while diabetic retinopathy was found in 27% of cases. For diabetic polyneuropathy, the results of the statistical analysis demonstrated a statistically significant dependence of the risk factors hyperlipidemia (significance level = 0.01) and overweight/obesity (significance level = 0.05). For diabetic retinopathy, the results demonstrated a statistically significant dependence of the risk factors hypertension (significance level = 0.05) and hyperlipidemia (significance level = 0.01). Conclusions: The present study reveals a strong correlation between the presence of risk factors and the development of microvascular complications of diabetes. Full article

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7 pages, 1834 KiB

Open AccessCase Report

Pedicled Radial Forearm “Free” Flap for Intraoral Reconstruction Based on an Unexpectedly High Origin of the Radial Artery—Case Report

by Marino Lupi-Ferandin, Dinko Martinovic, Ante Pojatina, Ante Mihovilovic, Ema Puizina, Sasa Ercegovic, Ivana Stula, Josko Bozic and Slaven Lupi-Ferandin

Clin. Pract. 2025, 15(1), 6; https://doi.org/10.3390/clinpract15010006 - 30 Dec 2024

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Abstract

Background: Radial forearm free flap (RFFF) is considered one of the workhorses in modern head and neck reconstruction surgery due to its technical simplicity, versatility and less time-consuming harvest. Methods: In this report, we present the case of a 56-year-old woman with sublingual [...] Read more.

Background: Radial forearm free flap (RFFF) is considered one of the workhorses in modern head and neck reconstruction surgery due to its technical simplicity, versatility and less time-consuming harvest. Methods: In this report, we present the case of a 56-year-old woman with sublingual squamous cell carcinoma (SCC) who underwent surgical resection and reconstruction of the defect with a RFFF. Results: The preoperative Allen test showed normal blood flow, and the ultrasound did not recognize any blood vessel abnormalities in the left arm. However, during the RFFF harvest, when the dissection of the pedicle came to the cubital fossa, there was no brachial artery bifurcation. While trying to find the bifurcation, the dissection almost came to the axillary region. Hence, the RFFF was converted to a pedicle flap and was pulled through to the intraoral defect where it was used for reconstruction. Conclusions: Hence, during the preoperative radiological ultrasound, besides the usual characteristics such as the radial artery diameter, flow and possible obstructions, it is also important to explore if there are any other anatomical abnormalities that could influence the operation. Full article

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12 pages, 1471 KiB

Open AccessCase Report

Cerebrovascular Accidents After Orthotopic Liver Transplantation in Patients with Hepatopulmonary Syndrome: A Case Series

by Steffi K. Chan, Manuel M. Buitrago Blanco, Nicholas J. Feduska, Vatche G. Agopian, Samer S. Ebaid, Tisha Wang, Ami Tamhaney and Igor Barjaktarevic

Clin. Pract. 2025, 15(1), 5; https://doi.org/10.3390/clinpract15010005 - 29 Dec 2024

Viewed by 412

Abstract

Background: Hepatopulmonary syndrome (HPS), defined by the presence of pulmonary vascular dilatations that cause right-to-left transpulmonary shunting of venous blood with a consequential increase in the alveolar–arterial oxygen gradient, is a relatively frequent complication of chronic liver disease. While orthotopic liver transplantation (OLT) [...] Read more.

Background: Hepatopulmonary syndrome (HPS), defined by the presence of pulmonary vascular dilatations that cause right-to-left transpulmonary shunting of venous blood with a consequential increase in the alveolar–arterial oxygen gradient, is a relatively frequent complication of chronic liver disease. While orthotopic liver transplantation (OLT) is indicated and often curative in HPS patients with end-stage liver disease (ESLD), little is known about the peri- and post-operative-period risks of CVA in OLT recipients with HPS. Case Presentation: We report a case series of five non-consecutive OLT recipients with HPS who developed ischemic and/or hemorrhagic CVAs during or shortly after OLT, raising concern that the risks of neurological complications remain increased even after OLT. Conclusions: Our case series hopes to highlight the importance of close vigilance in this subset of patients, at a time when there may be multiple issues to be addressed in facilitating post-operative recovery. Full article

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13 pages, 1965 KiB

Open AccessReview

Magnetic Resonance Imaging Techniques for Post-Treatment Evaluation After External Beam Radiation Therapy of Prostate Cancer: Narrative Review

by Eleni Bekou, Admir Mulita, Ioannis Seimenis, Athanasia Kotini, Nikolaos Courcoutsakis, Michael I. Koukourakis, Francesk Mulita and Efstratios Karavasilis

Clin. Pract. 2025, 15(1), 4; https://doi.org/10.3390/clinpract15010004 - 27 Dec 2024

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Abstract

Background/Objectives: This study aimed to investigate the prognostic value of advanced techniques of magnetic resonance imaging (MRI) biochemical recurrence (BCR) after radiotherapy in patients with prostate cancer (PCa). Methods: A comprehensive literature review was conducted to evaluate the role of MRI [...] Read more.

Background/Objectives: This study aimed to investigate the prognostic value of advanced techniques of magnetic resonance imaging (MRI) biochemical recurrence (BCR) after radiotherapy in patients with prostate cancer (PCa). Methods: A comprehensive literature review was conducted to evaluate the role of MRI in detecting BCR of PCa patients after external beam radiation therapy. Results: National guidelines do not recommend imaging techniques in clinical follow-up PCa. However, in 2021, the European Association of Urogenital Radiology (ESUR), the European Association of Urological Imaging (ESUI), and the PI-RADS Steering Committee introduced the Prostate Imaging for Recurrence Reporting (PI-RR) system. PI-RR incorporates the MRI biomarkers in the post-treatment process. In the last decade, a growing number of clinical researchers have investigated the role of various MRI techniques in BCR. Conclusions: The integration of advanced MRI technologies into clinical routine marks the beginning of a new era of BCR with accuracy. Full article

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17 pages, 11162 KiB

Open AccessArticle

Innovative Damage Assessment of Endodontic Instruments Based on Digital Image Stacking

by Raúl Argüello-Sánchez, Ivette Alejandra Calderón-Alday, Antonio Hernández-Morales, Benjamín Gonzalo Rodríguez-Méndez, Diego Medina-Castro, Régulo López-Callejas and Carlo Eduardo Medina-Solís

Clin. Pract. 2025, 15(1), 3; https://doi.org/10.3390/clinpract15010003 - 26 Dec 2024

Viewed by 2401

Abstract

Background/Objectives: The damage assessment of dental instruments, such as endodontic files, is crucial to ensure patient safety and treatment quality. Conventional scanning electron microscopy (SEM) has been the gold standard for this purpose; however, its limited accessibility and complex sample preparation protocols hinder [...] Read more.

Background/Objectives: The damage assessment of dental instruments, such as endodontic files, is crucial to ensure patient safety and treatment quality. Conventional scanning electron microscopy (SEM) has been the gold standard for this purpose; however, its limited accessibility and complex sample preparation protocols hinder its routine use in clinical settings. This study proposes a novel system that leverages digital photography and advanced image processing techniques as a viable alternative to SEM. Methods: Our system accurately detects early instrument damage by capitalizing on the high resolution of digital images. Its exceptionally user-friendly interface, portability, and key features make it highly suitable for daily clinical practice. Results: Our findings suggest that the proposed system provides image quality comparable to SEM. Conclusions: Image stacking provides a practical, efficient, and objective method for assessing endodontic instruments’ morphology. By detecting early damage, this system significantly improves the safety and quality of endodontic procedures, especially for reusable NiTi files, instilling confidence and security in its use. It offers a cost-effective and user-friendly alternative to traditional methods such as visual inspection and SEM, making it a comfortable and confident choice for both research and clinical settings. Full article

(This article belongs to the Special Issue New Trends, Materials, and Technologies and Consolidating Best Practices in Dentistry, 2nd Edition)

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12 pages, 568 KiB

Open AccessReview

The Critical Management of Spinal Cord Injury: A Narrative Review

by Emilio Moreno-González and Antonio Ibarra

Clin. Pract. 2025, 15(1), 2; https://doi.org/10.3390/clinpract15010002 - 26 Dec 2024

Viewed by 457

Abstract

Spinal cord injury (SCI) is defined as physical damage that alters the function and structure of the spinal cord. Traumatic causes, such as vehicle accidents, falls, and violence, account for 90% of SCI cases. Recent evidence suggests that early intensive care unit (ICU) [...] Read more.

Spinal cord injury (SCI) is defined as physical damage that alters the function and structure of the spinal cord. Traumatic causes, such as vehicle accidents, falls, and violence, account for 90% of SCI cases. Recent evidence suggests that early intensive care unit (ICU) monitoring improves patient prognosis, highlighting the importance of prompt ICU admission and early decompression surgery. This review includes 50 publications selected based on specific criteria to gather evidence on the current management of SCI in acute settings. Pharmacological agents have been studied for their neuroprotective properties, offering hope for improved neurological outcomes. Several clinical trials are evaluating new pharmacological alternatives for SCI. In conclusion, the current management of acute SCI should focus on standardized treatments addressing ventilatory, cardiopulmonary, and hematologic complications, all of which directly impact long-term neurological and functional prognosis. New neuroprotective agents currently in clinical trials show promising results and should be further studied to determine their role in acute SCI management. Full article

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12 pages, 3694 KiB

Open AccessCase Report

Multi-Ligament Reconstruction in an Adolescent Female Affected by Congenital Femoral Deficiency and Complete Anterior and Posterior Cruciate Ligament agenesis: A Case Report

by Simone Giusti, Maria Beatrice Bocchi, Edoardo De Fenu, Osvaldo Palmacci and Ezio Adriani

Clin. Pract. 2025, 15(1), 1; https://doi.org/10.3390/clinpract15010001 - 24 Dec 2024

Viewed by 516

Abstract

Purpose: Multi-ligament reconstruction in adolescent patients affected by congenital femoral deficiency is an extremely rare and delicate surgical procedure. There are very few reported cases of complete anterior and posterior cruciate ligament agenesis in these patients. Methods: We present a complex case of [...] Read more.

Purpose: Multi-ligament reconstruction in adolescent patients affected by congenital femoral deficiency is an extremely rare and delicate surgical procedure. There are very few reported cases of complete anterior and posterior cruciate ligament agenesis in these patients. Methods: We present a complex case of a 16-year-old girl affected by congenital femoral deficiency and ipsilateral tibial hypoplasia who was treated successfully for a complete agenesis of the anterior (ACL) and posterior (PCL) cruciate ligament with single-sitting ACL and PCL reconstruction. Results: The adolescent patient was successfully reconstructed with excellent clinical results. Conclusions: Knee MRI (Magnetic Resonance Imaging) should be requested in all patients affected by congenital femoral deficiency to exclude ligamentous agenesis. Where present, these should be reconstructed at an early stage as soon as limb-lengthening procedures are completed. If still skeletally immature, physeal-sparing surgical techniques should be implemented. Full article

(This article belongs to the Special Issue Musculoskeletal Pain and Rehabilitation)

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Clin. Pract., Volume 15, Issue 1 (January 2025) – 22 articles

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