Clinics and Practice

15 pages, 531 KB

Open AccessReview

Impact of Tongue Piercings on Oral Health: A Narrative Literature Review

by Silvia Rojas-Rueda, Nechama S. Citrin, Mark Adam Antal, Rene Garcia-Contreras, Carlos A. Jurado and Francisco X. Azpiazu-Flores

Clin. Pract. 2025, 15(9), 171; https://doi.org/10.3390/clinpract15090171 - 18 Sep 2025

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Abstract

Background: Tongue piercing has gained popularity among teenagers and young adults as a form of self-expression, cultural identity, and fashion. However, patients are often unaware of the harmful effects tongue piercings can have on their oral health. Despite its popularity, this form of [...] Read more.

Background: Tongue piercing has gained popularity among teenagers and young adults as a form of self-expression, cultural identity, and fashion. However, patients are often unaware of the harmful effects tongue piercings can have on their oral health. Despite its popularity, this form of body modification carries considerable risk, particularly when performed or maintained without proper care. This review summarizes findings from clinical case reports, observational studies, and previous literature reviews, with a focus on the clinical outcomes of tongue piercings and their appropriate management. Methods: An internet-based literature review was conducted to evaluate the short- and long-term oral health implications of tongue piercings. Only articles published between January 1990 and April 2025 were included. The databases searched were PubMed, Google Scholar, Scopus, and Web of Science, using keywords such as “tongue piercing,” “oral piercing,” “oral complications,” and “dental trauma.” Results: The literature revealed that tongue piercings can lead to numerous adverse effects on oral health, including dental fractures, gingival recession, enamel wear, and localized tissue overgrowth, in addition to localized and systemic infections. The presence of foreign objects in the oral cavity, combined with poor oral hygiene, habitual trauma, and long-term contact with oral tissues, often worsens these complications. Conclusions: The results of this literature review suggest that tongue piercings pose significant and often underestimated risks to oral health. Clinicians should remain vigilant, educate patients on potential complications, and be well-equipped to prevent, monitor, and manage associated dental problems effectively in clinical practice. 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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11 pages, 1231 KB

Open AccessArticle

Harnessing Visual Neuroplasticity Through Auditory Biofeedback—Functional and Electrophysiological Gains Across Retinal, Optic-Nerve, and Cortical Visual Impairment: A Prospective Pilot Study

by Marco Zeppieri, Roberta Amato, Daniela Catania, Mutali Musa, Alessandro Avitabile, Fabiana D’Esposito, Caterina Gagliano, Matteo Capobianco and Simonetta Gaia Nicolosi

Clin. Pract. 2025, 15(9), 170; https://doi.org/10.3390/clinpract15090170 - 17 Sep 2025

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Abstract

Background: This prospective pilot study included four participants with chronic visual impairment and assessed functional and electrophysiological recovery following visual evoked potential (VEP)-guided auditory biofeedback across diverse etiologies. Low vision affects more than two billion people worldwide and imposes a sustained personal and [...] Read more.

Background: This prospective pilot study included four participants with chronic visual impairment and assessed functional and electrophysiological recovery following visual evoked potential (VEP)-guided auditory biofeedback across diverse etiologies. Low vision affects more than two billion people worldwide and imposes a sustained personal and socioeconomic burden. Conventional rehabilitation emphasizes optical aids and environmental modification without directly stimulating the visual pathway. Emerging evidence indicates that auditory biofeedback based on real-time cortical activity can leverage adult neuroplasticity. Methods: Four men (mean age 58 ± 12 years) with chronic visual impairment attributable to occipital stroke, stage IV macular hole, end-stage open-angle glaucoma, or diabetic maculopathy completed ten 10-min monocular sessions with the Retimax Vision Trainer over three weeks (15 Hz pattern reversal, 90% contrast). Primary end points were best corrected visual acuity (BCVA, ETDRS letters) and P100 amplitude/latency. Fixation stability was recorded with MAIA microperimetry when feasible. A focused PubMed review (2010–2025) mapped current evidence and research gaps. Results: Median BCVA improved by seven letters (IQR 0–15); three of eight eyes gained ≥ 10 letters and none lost vision. Mean P100 amplitude increased from 1.0 ± 1.2 µV to 3.0 ± 1.1 µV, while latency shortened by 3.9 ms. Electrophysiological improvement paralleled behavioural gain irrespective of lesion site. No adverse events occurred. Conclusions: A concise course of VEP-guided auditory biofeedback produced concordant functional and neurophysiological gains across retinal, optic nerve, and cortical pathologies. These pilot data support integration of closed-loop biofeedback into routine low vision care and justify larger sham-controlled trials. Full article

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20 pages, 847 KB

Open AccessReview

Artificial Intelligence in Clinical Medicine: Challenges Across Diagnostic Imaging, Clinical Decision Support, Surgery, Pathology, and Drug Discovery

by Eren Ogut

Clin. Pract. 2025, 15(9), 169; https://doi.org/10.3390/clinpract15090169 - 16 Sep 2025

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Abstract

Aims/Background: The growing integration of artificial intelligence (AI) into clinical medicine has opened new possibilities for enhancing diagnostic accuracy, therapeutic decision-making, and biomedical innovation across several domains. This review is aimed to evaluate the clinical applications of AI across five key domains of [...] Read more.

Aims/Background: The growing integration of artificial intelligence (AI) into clinical medicine has opened new possibilities for enhancing diagnostic accuracy, therapeutic decision-making, and biomedical innovation across several domains. This review is aimed to evaluate the clinical applications of AI across five key domains of medicine: diagnostic imaging, clinical decision support systems (CDSS), surgery, pathology, and drug discovery, highlighting achievements, limitations, and future directions. Methods: A comprehensive PubMed search was performed without language or publication date restrictions, combining Medical Subject Headings (MeSH) and free-text keywords for AI with domain-specific terms. The search yielded 2047 records, of which 243 duplicates were removed, leaving 1804 unique studies. After screening titles and abstracts, 1482 records were excluded due to irrelevance, preclinical scope, or lack of patient-level outcomes. Full-text review of 322 articles led to the exclusion of 172 studies (no clinical validation or outcomes, n = 64; methodological studies, n = 43; preclinical and in vitro-only, n = 39; conference abstracts without peer-reviewed full text, n = 26). Ultimately, 150 studies met inclusion criteria and were analyzed qualitatively. Data extraction focused on study context, AI technique, dataset characteristics, comparator benchmarks, and reported outcomes, such as diagnostic accuracy, area under the curve (AUC), efficiency, and clinical improvements. Results: AI demonstrated strong performance in diagnostic imaging, achieving expert-level accuracy in tasks such as cancer detection (AUC up to 0.94). CDSS showed promise in predicting adverse events (sepsis, atrial fibrillation), though real-world outcome evidence was mixed. In surgery, AI enhanced intraoperative guidance and risk stratification. Pathology benefited from AI-assisted diagnosis and molecular inference from histology. AI also accelerated drug discovery through protein structure prediction and virtual screening. However, challenges included limited explainability, data bias, lack of prospective trials, and regulatory hurdles. Conclusions: AI is transforming clinical medicine, offering improved accuracy, efficiency, and discovery. Yet, its integration into routine care demands rigorous validation, ethical oversight, and human-AI collaboration. Continued interdisciplinary efforts will be essential to translate these innovations into safe and effective patient-centered care. Full article

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16 pages, 1770 KB

Open AccessArticle

Calcium and Vitamin D Supplementation with and Without Collagen on Bone Density and Skin Elasticity in Menopausal Women—A Randomized Controlled Study

by Acharaporn Duangjai, Jukkarin Srivilai, Sawitree Nangola and Doungporn Amornlerdpison

Clin. Pract. 2025, 15(9), 168; https://doi.org/10.3390/clinpract15090168 - 15 Sep 2025

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Abstract

Background/Objectives: Menopause leads to estrogen deficiency, which negatively affects bone density, skin integrity, and hair health in women. This study aimed to evaluate the effects of fish-derived collagen peptides, calcium, and vitamin D3 supplementation on body composition, bone turnover markers, skin condition, and [...] Read more.

Background/Objectives: Menopause leads to estrogen deficiency, which negatively affects bone density, skin integrity, and hair health in women. This study aimed to evaluate the effects of fish-derived collagen peptides, calcium, and vitamin D3 supplementation on body composition, bone turnover markers, skin condition, and hair loss in menopausal women. Methods: Participants were randomized into four groups: placebo (G01), 1000 mg calcium + 400 IU vitamin D3 (G02), 5 g collagen (G03), and 1000 mg calcium + 400 IU vitamin D3 + 5 g collagen (G04). Participants received daily supplementation for six months. Body composition, biochemical bone markers (P1NP, BAP, osteocalcin), skin hydration, elasticity, transepidermal water loss (TEWL), and hair loss were assessed at baseline and follow-ups. Results: No significant changes were observed in body composition or bone biomarkers including P1NP, BAP, and osteocalcin across groups. Serum creatinine, ALT, and AST levels remained within normal ranges. Serum calcium levels remained stable, and urinary calcium excretion slightly increased in calcium-supplemented groups, indicating no adverse effects on kidney or liver function. G02 and G04 exhibited slightly decreased serum calcium levels compared to G01 and G03. However, G04 showed significantly improved skin hydration by 23% and skin elasticity by 8.52% compared to baseline after six months, whereas the placebo group showed negligible changes. G03 also showed notable improvement in elasticity by 12.23%, indicating collagen’s dominant role. The G02, G03, and G04 also significantly retarded hair shedding compared to the placebo (G01) group. TEWL did not significantly change in any group. Conclusions: These findings suggest that six-month supplementation with collagen peptides, particularly when combined with calcium and vitamin D, improves skin hydration and elasticity in menopausal women. Full article

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13 pages, 386 KB

Open AccessArticle

Self-Reported Parosmia, Phantosmia, and Gustatory Dysfunction Among Adults with Mild-to-Moderate COVID-19: A Cross-Sectional Study in Saudi Arabia

by Reem A. Alsaqer, Ghazal Y. Dhaher, Rewa L. Alsharif, Razan Y. Almleaky, Khalid S. Menshawi, Turki M. Alqurashi and Abdullah Almaqhawi

Clin. Pract. 2025, 15(9), 167; https://doi.org/10.3390/clinpract15090167 - 15 Sep 2025

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Abstract

Background/Objectives: COVID-19 frequently causes olfactory and gustatory dysfunction, including qualitative disorders like parosmia and phantosmia. These distortions affect quality of life and may result from both peripheral and central neural damage. Despite increasing reports, their prevalence, mechanisms, and risk factors remain unclear. [...] Read more.

Background/Objectives: COVID-19 frequently causes olfactory and gustatory dysfunction, including qualitative disorders like parosmia and phantosmia. These distortions affect quality of life and may result from both peripheral and central neural damage. Despite increasing reports, their prevalence, mechanisms, and risk factors remain unclear. The purpose of this study is to evaluate the clinical characteristics and possible predictors of parosmia and phantosmia associated with COVID-19 in Saudi Arabia. Methods: This cross-sectional study utilized an online questionnaire targeting adults in Saudi Arabia with self-reported new-onset olfactory or gustatory dysfunction after COVID-19. Results: Out of 539 participants, 377 were included for analysis. Females slightly outnumbered males (195, 51.7% vs. 182, 48.3%) with a mean age of 34.5 years (SD = 12.7). Comorbidities were present in 86 (23.3%) participants, predominantly including hypertension (39.5%) and diabetes (30.2%). Sudden smell and taste loss were reported by 277 (73.5%) and 267 (70.8%) participants, respectively. Regional residence was significantly associated with both smell (p < 0.001) and taste loss (p < 0.001). Academic qualification exhibited borderline significance in relation to taste loss (p = 0.049). Logistic regression analysis indicated no significant predictors of dysfunction, with male gender exhibiting an odds ratio of 1.276 for smell (p = 0.301) and an odds ratio of 1.401 for taste (p = 0.144). Over 60% of participants experienced a negative impact on their quality of life. Conclusions: This study demonstrates the prevalence of parosmia and phantosmia in COVID-19 patients in Saudi Arabia, with a significant impact on quality of life. While regional differences and education level exhibited certain associations, no demographic or clinical factors independently predicted dysfunction, highlighting the necessity for additional research into underlying mechanisms and long-term effects. Full article

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13 pages, 918 KB

Open AccessArticle

A Retrospective Observational Study of Ephedrine Use in Hip Arthroplasty: Routine Practice at a Secondary Care Hospital in Romania

by Erika Bimbo-Szuhai, Mihai Octavian Botea, Harrie Toms John, Adela Bostan Danciu, Pirvan Titus Razvan, Mihaela Gabriela Bontea, Mihai Pavel, Caius Salajan, Maria Viviana Rusu, Adrian Gheorghe Osiceanu and Iulia Codruta Macovei

Clin. Pract. 2025, 15(9), 166; https://doi.org/10.3390/clinpract15090166 - 15 Sep 2025

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Abstract

Background and Objectives: The primary goal of the study is to analyze factors associated with spinal anesthesia-induced hypotension (SAIH), with a focus on ephedrine requirements in relation to patient characteristics and the type of intrathecal opioid used, reflecting real-world clinical practice in a [...] Read more.

Background and Objectives: The primary goal of the study is to analyze factors associated with spinal anesthesia-induced hypotension (SAIH), with a focus on ephedrine requirements in relation to patient characteristics and the type of intrathecal opioid used, reflecting real-world clinical practice in a Romanian secondary care hospital. Bolus ephedrine is often required during spinal anesthesia to maintain hemodynamic stability. We conducted a retrospective observational study of patients undergoing total hip arthroplasty. We analyzed the hemodynamic effects of spinal anesthesia to optimize management of spinal anesthesia-induced hypotension (SAIH). Materials and Methods: A total of 329 patients were included in the study, out of which 113 patients were without high blood pressure (60 cases needed Ephedrine) and 216 patients with high blood pressure were drug controlled (106 cases needed Ephedrine). Each group of patients was divided into two groups based on the type of spinal anesthesia: bupivacaine with morphine (Group M) and bupivacaine with fentanyl (Group F). The study explored perioperative factors associated with spinal anesthesia-induced hypotension and the ephedrine dose required to maintain hemodynamic stability. Results: We found that ephedrine dosage correlated with hypertension in 19% of cases and with patient age in 44.1% of cases. The type of anesthetic mixture did not significantly affect the need for intraoperative ephedrine administration. Conclusions: Ephedrine remains essential for ensuring hemodynamic stability and optimizing perioperative outcomes. Full article

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10 pages, 2218 KB

Open AccessCase Report

Mustardé Cheek Rotation-Advancement Flap: A Case-Based Experience in Reconstruction of a Large Defect of the Lower Eyelid Due to Squamous Cell Carcinoma

by Kostadin Gigov, Ivan Ginev and Petra Kavradzhieva

Clin. Pract. 2025, 15(9), 165; https://doi.org/10.3390/clinpract15090165 - 15 Sep 2025

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Abstract

Background: Restoring the integrity of the lower eyelid presents a complex surgical challenge due to its lamellar structure and the high risk of complications. Among these, ectropion is the most frequent and troublesome outcome. Objective: This study aims to present a [...] Read more.

Background: Restoring the integrity of the lower eyelid presents a complex surgical challenge due to its lamellar structure and the high risk of complications. Among these, ectropion is the most frequent and troublesome outcome. Objective: This study aims to present a case of lower eyelid reconstruction following the excision of squamous cell carcinoma using Mohs micrographic surgery combined with the Mustardé cheek rotation flap technique, highlighting its advantages, limitations, and applicability in elderly patients. Case presentation: A 93-year-old female patient with right lower eyelid squamous cell carcinoma underwent Mohs micrographic surgery. The resulting defect was reconstructed using a Mustardé cheek rotation flap, chosen for its suitability in patients with adequate skin laxity. Patient-specific risk factors, including advanced age, a history of ischemic stroke, and class II heart failure (NYHA classification), were considered in the surgical planning stage. Results: The Mustardé cheek rotation flap provided a reliable closure with a favorable esthetic outcome and inconspicuous scarring, aligned with natural anatomical margins. The technique was technically straightforward in this patient owing to age-related skin laxity. No major postoperative complications were observed. Conclusions: The Mustardé cheek rotation flap represents a safe and effective reconstructive option for elderly patients with lower eyelid defects following tumor excision. This case illustrates the esthetic and functional benefits of the technique while emphasizing the need to tailor reconstruction strategies to patient comorbidities and defect characteristics. Full article

(This article belongs to the Special Issue Clinical Outcome Research in the Head and Neck: 2nd Edition)

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15 pages, 1115 KB

Open AccessArticle

Low Vitamin D and High Psychological Distress: Are They Associated with Poor Differentiation in Head and Neck Cancer?

by Bogdan Hirtie, Ana-Maria Stanoiu, Kristine Guran, Norberth-Istvan Varga, Claudia Raluca Balasa Virzob, Delia Hutanu, Adrian Cote, Rodica Anamaria Negrean, Delia Ioana Horhat and Cristian Ion Mot

Clin. Pract. 2025, 15(9), 164; https://doi.org/10.3390/clinpract15090164 - 12 Sep 2025

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Abstract

Background and Objectives: Vitamin D deficiency and psychological distress have been linked to cancer biology, but their relevance to tumor differentiation in head-and-neck squamous cell carcinoma (HNSCC) is uncertain. Materials and Methods: In this cross-sectional study at the Department of Otolaryngology, County Hospital [...] Read more.

Background and Objectives: Vitamin D deficiency and psychological distress have been linked to cancer biology, but their relevance to tumor differentiation in head-and-neck squamous cell carcinoma (HNSCC) is uncertain. Materials and Methods: In this cross-sectional study at the Department of Otolaryngology, County Hospital of Timișoara, Romania, we enrolled newly diagnosed HNC patients from October 2023 to December 2024, analyzing 199 SCC patients after exclusions. Vitamin D status was assessed using serum 25-OH-vitamin D levels, and distress was measured with the validated Romanian version of the Hospital Anxiety and Depression Scale (HADS). Tumor aggressiveness was defined by histological grade (G3 vs. G1–G2). Univariate, multivariate, and subgroup analyses were conducted, adjusting for confounders like smoking. Results: Vitamin D deficiency (<20 ng/mL) was prevalent (80.40%), with median 25-OH-vitamin D levels of 15.1 ng/mL. Univariate analysis revealed a modest association between vitamin D deficiency and poorly differentiated tumors (G3 vs. G1–G2; OR = 1.79, p = 0.055) and between clinically significant anxiety (HADS-A ≥ 8) and G3 tumors (OR = 1.71, p = 0.059). A weak negative correlation was observed between 25-OH-vitamin D levels and HADS-A scores (rho = −0.17, p = 0.052). In multivariate analysis adjusted for age, smoking, and tumor location, these associations weakened (vitamin D deficiency: OR = 1.55, p = 0.082; HADS-A ≥8: OR = 1.56, p = 0.113). Subgroup analysis suggested a trend toward higher odds of G3 tumors in patients with both vitamin D deficiency and high anxiety (OR = 1.72, p = 0.075). Conclusions: Univariate analyses indicated potential links between vitamin D deficiency, psychological distress, and tumor aggressiveness in HNSCC, but these did not reach statistical significance after adjustment for confounders. The observed trends, particularly in subgroups with combined deficiency and distress, suggest a possible interplay worth exploring further. To conclude, neither vitamin-D deficiency nor clinically significant distress independently predicted poor histological differentiation after adjustment; observed trends, including a possible distress–vitamin-D interaction, are hypothesis-generating and warrant testing in larger, longitudinal cohorts. Full article

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12 pages, 240 KB

Open AccessReview

Neurogenic Dysphagia: Peripheral and Central Neuromodulation

by Mario Stampanoni Bassi, Diego Centonze, Bledar Gjikolaj, Angelo Alito, Adriana Tisano, Rosario Marchese-Ragona and Domenico Antonio Restivo

Clin. Pract. 2025, 15(9), 163; https://doi.org/10.3390/clinpract15090163 - 4 Sep 2025

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Abstract

Dysphagia is a frequent and potentially life-threatening complication in patients with neurological disorders. Swallowing is a complex neurophysiological mechanism regulated by a widespread network of central nervous system regions. The control of swallowing functions requires the integrity of the central pattern generator located [...] Read more.

Dysphagia is a frequent and potentially life-threatening complication in patients with neurological disorders. Swallowing is a complex neurophysiological mechanism regulated by a widespread network of central nervous system regions. The control of swallowing functions requires the integrity of the central pattern generator located in the brainstem, the sensorimotor cortex, the basal ganglia, and the cerebellum, but also peripheral nerves and swallowing muscles. Neurological diseases affecting either central or peripheral components of this system commonly result in dysphagia. Despite its clinical relevance, the management of neurogenic dysphagia remains challenging. While rehabilitative strategies such as swallowing therapy currently represent the main treatment option, emerging evidence suggests that non-invasive central and peripheral neuromodulation techniques may provide adjunctive beneficial effects. Further research is warranted to better define their efficacy, optimal protocols, and long-term outcomes. Full article

11 pages, 1307 KB

Open AccessArticle

Prospective Comparison of Short-Term Outcomes in Kinematic and Mechanical Alignment Total Knee Arthroplasty

by Ofir Vinograd, Ahmad Essa, Netanel Steinberg, Ilan Y. Mitchnik, Dana Avraham, Inon Rotem, Adi Vinograd, Yiftah Beer, Noam Shohat and Yaron Bar-Ziv

Clin. Pract. 2025, 15(9), 162; https://doi.org/10.3390/clinpract15090162 - 31 Aug 2025

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Abstract

Background: While mechanical alignment total knee arthroplasty (TKA) has long been the conventional surgical technique in patients with advanced osteoarthritis, kinematic alignment TKA has emerged as a promising alternative, designed to restore the knee’s native pre-arthritic anatomy. Since superiority of either technique remains [...] Read more.

Background: While mechanical alignment total knee arthroplasty (TKA) has long been the conventional surgical technique in patients with advanced osteoarthritis, kinematic alignment TKA has emerged as a promising alternative, designed to restore the knee’s native pre-arthritic anatomy. Since superiority of either technique remains inconclusive, we aimed to compare immediate and short-term postoperative outcomes of kinematic versus mechanical alignment TKA. Methods: This prospective cohort study was conducted at a tertiary care centre between January 2020 and August 2022, enrolling kinematic and mechanical alignment TKA patients. Outcomes were assessed during hospitalization and at 14 days postoperatively. Data collected included patient-reported outcome measures (PROMs), functional performance evaluations, pain scores, discharge disposition and hospital length of stay. Both univariate and multivariate regression analyses were conducted, adjusting for potential confounders. Results: The study included 103 patients, with 77 who underwent kinematic alignment and 26 mechanical alignment TKA. Patients in the kinematic alignment group demonstrated statistically significant better postoperative outcomes compared to those in the mechanical alignment group. Kinematic alignment TKA patients demonstrated superior functional performance on the Timed Up and Go test immediately postoperatively and were more frequently discharged home rather than to a rehabilitation facility. Hospital stay length and short-term PROMs also favoured the Kinematic alignment TKA group, showing statistically significant higher scores in the Oxford Knee Score, short form-12 Mental Component Summary, and the Knee Injury and Osteoarthritis Outcome Score Symptoms subscale. Conclusions: Kinematic alignment TKA offers superior immediate and short-term outcomes compared to mechanical alignment TKA, with benefits in functional recovery, hospitalization duration, and discharge disposition. This evidence supports kinematic alignment TKA as a viable alternative, aiding in patient and surgeon decision-making. Full article

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17 pages, 251 KB

Open AccessArticle

Addressing Healthcare Disparities Among the Homeless: Insights from a Student-Run Clinic in Houston, TX

by Damien Kelly, Umer Khan, Elizabeth Bixler, Gabriella Becerra and Chakema Carmack

Clin. Pract. 2025, 15(9), 161; https://doi.org/10.3390/clinpract15090161 - 31 Aug 2025

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Abstract

Background: Unhoused individuals face significant health disparities and encounter numerous barriers to accessing adequate healthcare, resulting in high rates of chronic disease, mental illness, and untreated conditions in Houston, TX. The purpose of this study was to identify prevalent health conditions within a [...] Read more.

Background: Unhoused individuals face significant health disparities and encounter numerous barriers to accessing adequate healthcare, resulting in high rates of chronic disease, mental illness, and untreated conditions in Houston, TX. The purpose of this study was to identify prevalent health conditions within a sample of unhoused adults and to identify patterns in patient characteristics and clinical health outcomes. Methods: This study utilized clinical and demographic data from n = 191 patients who received care at a student-run clinic embedded within a homeless drop-in center in Houston, TX. Data included patient demographics, chief complaints, social determinants of health (SDOHs), past medical history, on-site diagnoses, and provider actions. Results: The most prevalent issues were housing insecurity (36.1%), cardiovascular conditions (38.7%), and substance use (17.8%). Nearly half of all patients (46.6%) declined treatment or left before receiving care. Significant associations were found between patient demographics and provider responses, including differences by gender and age in treatment type and diagnostic categorization. Conclusions: These findings underscore critical challenges in treatment adherence, diagnostic bias, and retention among unhoused populations. The study provides actionable recommendations for improving care coordination and continuity in low-barrier, student-run clinics serving medically underserved communities. Full article

13 pages, 920 KB

Open AccessArticle

Implantable Cardioverter–Defibrillator Therapies Following Generator Replacements—Long-Term Remote Monitoring Data

by Maciej Dyrbuś, Łukasz Pyka, Anna Kurek, Jacek Niedziela, Elżbieta Adamowicz-Czoch, Katarzyna Sokoła, Joanna Machowicz, Mateusz Ostręga, Damian Pres, Michał Skrzypek, Mariusz Gąsior and Mateusz Tajstra

Clin. Pract. 2025, 15(9), 160; https://doi.org/10.3390/clinpract15090160 - 30 Aug 2025

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Abstract

Background: The rate of long-term outcomes, including arrhythmic episodes following implantable cardioverter–defibrillator (ICD) device replacements, is often unknown. Thus, the aim of this manuscript was to evaluate the risk of ICD or cardiac resynchronization therapy–defibrillator (CRT-D) therapies in remotely monitored patients following [...] Read more.

Background: The rate of long-term outcomes, including arrhythmic episodes following implantable cardioverter–defibrillator (ICD) device replacements, is often unknown. Thus, the aim of this manuscript was to evaluate the risk of ICD or cardiac resynchronization therapy–defibrillator (CRT-D) therapies in remotely monitored patients following device replacement. Methods: Data from 134 patients who underwent ICD/CRT-D replacement or upgrade were analyzed. Kaplan–Meier estimates, as well as Cox proportional hazards regression, were used to present long-term outcomes and predictors of study endpoints, these being all-cause mortality, and appropriate and inappropriate ICD/CRT-D therapies. Results: Among the cohort, 51.5% of patients received ICDs and 48.5% received CRT-Ds; the median (quartile 1–quartile 3) LVEF at replacement was 23.0% (18.0–28.0%). In 11 (8.2%) patients, the LVEF at replacement was higher than 35%. During the median (Q1–Q3) follow-up of 3.0 (1.4–5.0) years, 32.1% experienced appropriate and 6.0% experienced inappropriate therapies. The all-cause mortality rate was 38.0%, and appropriate antitachycardia pacing (ATP), a reduced baseline LVEF, and no history of myocardial infarction were independent predictors of death (odds ratios of 1.87 for appropriate ATP, 0.88 per 1% of the LVEF and 0.54 for a history of MI, respectively). The rate of appropriate device therapies was numerically lower in patients whose LVEF improved (19.8% vs. 33.3% and 0% vs. 6.5%, for appropriate and inappropriate therapies). An LVEF of >35% at replacement did not influence the analyzed outcomes. Conclusions: In patients who underwent ICD/CRT-D replacement, an improvement in LVEF was not identified as either a predictor of improved survival or of a lower risk of needing device therapies. Further stratification models are needed to evaluate the arrhythmic risk in patients after generator replacements. Full article

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21 pages, 1922 KB

Open AccessArticle

Effects of Dietary and Probiotic Interventions in Patients with Metabolic Syndrome and Obstructive Sleep Apnea

by Amina Venter, Amin-Florin El-kharoubi, Mousa El-kharoubi, Evelin Claudia Ghitea, Marc Cristian Ghitea, Timea Claudia Ghitea and Ciprian Florian Venter

Clin. Pract. 2025, 15(9), 159; https://doi.org/10.3390/clinpract15090159 - 29 Aug 2025

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Abstract

Background: Metabolic syndrome (MS) and obstructive sleep apnea (OSA) frequently coexist, exacerbating systemic inflammation, oxidative stress, and metabolic dysregulation. This study evaluates the effects of dietary and probiotic interventions, compared to a non-intervention control group, on metabolic, hemodynamic, and neurochemical parameters, with a [...] Read more.

Background: Metabolic syndrome (MS) and obstructive sleep apnea (OSA) frequently coexist, exacerbating systemic inflammation, oxidative stress, and metabolic dysregulation. This study evaluates the effects of dietary and probiotic interventions, compared to a non-intervention control group, on metabolic, hemodynamic, and neurochemical parameters, with a specific focus on the neurotransmitters GABA and glutamate. Methods: In a prospective randomized study (2020–2023), 120 patients with coexisting MS and OSA were assigned to three groups: control (n = 36), diet therapy (n = 42), and diet therapy combined with probiotics (n = 42). Interventions lasted six months and included personalized dietary plans and probiotic supplementation. Outcome measures included BMI, visceral fat, HOMA index, lipid profile, oxygen saturation, and urinary GABA and glutamate levels. Unsupervised K-means clustering and principal component analysis (PCA) were applied to identify phenotypic response patterns based on delta values. Results: Diet therapy led to significant reductions in BMI (−15.7%, p = 0.001), visceral fat (−17.3%, p = 0.001), triglycerides (−14.6%, p = 0.003), uric acid (−9.5%, p = 0.011), and C-reactive protein (CRP) (−21.4%, p = 0.007). The combined intervention group exhibited further improvements in visceral fat (−22.8%, p = 0.001), glutamate (−18.2%, p = 0.002), and GABA levels (+19.5%, p = 0.001). Oxygen saturation improved across all groups, with the greatest increase in the probiotics group (+2.3%). Clustering analysis revealed three distinct response phenotypes—strong, moderate, and non-responders—highlighting inter-individual variability in treatment efficacy. Conclusions: Personalized dietary interventions, especially when paired with probiotics, effectively improve metabolic, inflammatory, and neurochemical profiles in patients with MS and OSA. Integrating clustering algorithms enables phenotype-specific stratification, offering a step toward precision lifestyle medicine. Future studies should explore long-term outcomes and refine microbiota-targeted approaches to optimize intervention efficacy. Full article

(This article belongs to the Special Issue The Effect of Dietary Compounds on Inflammation-Mediated Diseases)

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9 pages, 5694 KB

Open AccessCase Report

Plasma Cell Gingivitis: Clinical Presentation, Histopathologic Correlation, and Therapeutic Challenges

by Davide Gerardi, Diana Torge, Sara Bernardi, Pierangelo Burdo, Maurizio Piattelli and Giuseppe Varvara

Clin. Pract. 2025, 15(9), 158; https://doi.org/10.3390/clinpract15090158 - 28 Aug 2025

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Abstract

Background/Objectives: Plasma cell gingivitis (PCG) is a rare, benign, non-dental-plaque-induced inflammatory condition characterized by dense subepithelial infiltration of polyclonal plasma cells. Due to its nonspecific clinical presentation, PCG represents a diagnostic challenge. This case report aims to describe a clinical case of PCG, [...] Read more.

Background/Objectives: Plasma cell gingivitis (PCG) is a rare, benign, non-dental-plaque-induced inflammatory condition characterized by dense subepithelial infiltration of polyclonal plasma cells. Due to its nonspecific clinical presentation, PCG represents a diagnostic challenge. This case report aims to describe a clinical case of PCG, highlighting the diagnostic process, histopathological correlation, and therapeutic approach. Methods: A 57-year-old male presented with a polypoid, erythematous, and edematous gingival lesion in the anterior maxillary region, with spontaneous bleeding on probing. Following clinic assessment, an incisional biopsy was performed, alongside complete hematological and inflammatory profiling. Histological and immunohistochemical analyses revealed the presence of an inflammatory infiltrate. Results: Histological evaluation revealed spongiotic squamous epithelium characterized by a dense plasma cell infiltrate with a liquenoid pattern of CD3-positive T and CD20-positive B lymphocytes. A polytypic expression of kappa and lambda light chains was also detected. The patient underwent topical corticosteroid therapy, showing progressive clinical improvement and resolution of symptoms, although minor mucosal involvement persisted. Conclusions: PCG remains a rare and underdiagnosed condition requiring integration of clinical, hematological, and histopathological data for accurate diagnosis. While corticosteroids remain the first-line therapy, emerging treatments, including photobiomodulation, may offer future adjunctive strategies to improve outcomes and reduce recurrence. Full article

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13 pages, 1060 KB

Open AccessArticle

Transcutaneous Electrical Nerve Stimulation for Muscle Recovery: Insights into Delayed Onset Muscle Soreness

by Sebastian Szajkowski, Jarosław Pasek and Grzegorz Cieślar

Clin. Pract. 2025, 15(9), 157; https://doi.org/10.3390/clinpract15090157 - 28 Aug 2025

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Abstract

Background: Delayed onset muscle soreness (DOMS) frequently occurs after engaging in strenuous physical activity. The manifestation of DOMS is often associated with changes in the biomechanical and viscoelastic characteristics of the affected muscles. Materials and Methods: Forty participants were enrolled and randomly assigned [...] Read more.

Background: Delayed onset muscle soreness (DOMS) frequently occurs after engaging in strenuous physical activity. The manifestation of DOMS is often associated with changes in the biomechanical and viscoelastic characteristics of the affected muscles. Materials and Methods: Forty participants were enrolled and randomly assigned to two groups: the intervention group receiving transcutaneous electrical nerve stimulation (TENS, n = 20) and a control group (n = 20). A fatigue-inducing protocol targeting the gastrocnemius muscle was implemented to elicit DOMS. The effectiveness of TENS was assessed by evaluating alterations in the biomechanical and viscoelastic properties of the muscle. Pain intensity was recorded using the Numeric Rating Scale (NRS) at five time points: before the study began, three times during the intervention, and once at the conclusion of the study. Results: No statistically significant changes have been found regarding muscle tone (p = 0.162) and stiffness (p = 0.212) in Group 1. However, a statistically significant lower level of stiffness in Group 1 after the end of therapy has been detected (p = 0.008). Decrement values decreased statistically significantly, both in Group 1 (p = 0.015) and in Group 2 (p = 0.014). There were no statistically significant differences in decrement level between Group 1 and 2. Relaxation and creep decreased statistically insignificantly in both groups. At the end of the observation period (Day 4), statistically significant (p = 0.027) lower pain intensity was observed in Group 1. Conclusions: It has been demonstrated that TENS has had limited effectiveness in restoring baseline biomechanical and viscoelastic parameters of muscles that undergo changes during DOMS. TENS significantly relieves pain symptoms occurring in DOMS. Full article

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Open AccessReview

Diagnostic Overshadowing and the Unseen Spectrum: A Narrative Review of Rare Complications in Sickle Cell Disease

by Abdulrahman Nasiri, Manal Alshammari, Reem Alkharras, Albaraa Madkhali, Mostafa F. Mohammed Saleh and Hazza Alzahrani

Clin. Pract. 2025, 15(9), 156; https://doi.org/10.3390/clinpract15090156 - 27 Aug 2025

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Abstract

Sickle cell disease (SCD) is a hereditary hemoglobin disorder characterized by chronic hemolysis and recurrent vaso-occlusive crises, leading to a wide spectrum of complications. While common SCD manifestations have well-established management protocols, rare and atypical complications pose significant diagnostic and therapeutic challenges. A [...] Read more.

Sickle cell disease (SCD) is a hereditary hemoglobin disorder characterized by chronic hemolysis and recurrent vaso-occlusive crises, leading to a wide spectrum of complications. While common SCD manifestations have well-established management protocols, rare and atypical complications pose significant diagnostic and therapeutic challenges. A critical barrier is diagnostic overshadowing, where common SCD symptoms (pain, fever, respiratory distress) mask infrequent but life-threatening conditions, resulting in delayed recognition and suboptimal outcomes. This narrative review synthesizes the literature from 2000–2025 on rare SCD complications, including atypical neurological events (e.g., spontaneous epidural or subdural hematoma, central retinal artery occlusion, cerebral arteriovenous malformations, posterior reversible encephalopathy syndrome), uncommon hematologic syndromes (acute leukemia, extramedullary hematopoiesis in unusual sites, hemophagocytic lymphohistiocytosis), severe cardiopulmonary emergencies (acute multiorgan failure and fat embolism syndromes), unusual hepatic crises (acute hepatic sequestration, intrahepatic cholestasis), and others (e.g., compartment syndrome). Key insights underscore the need for high clinical suspicion and prompt use of advanced diagnostics (e.g., MRI, specialized laboratory tests) when patients present with atypical or disproportionate symptoms. Clinical implications: Heightening clinician awareness of these rare complications and implementing structured diagnostic strategies can facilitate earlier intervention, improving outcomes and reducing the high morbidity and mortality associated with these infrequent but severe events. Full article

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Clin. Pract., Volume 15, Issue 9 (September 2025) – 16 articles

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