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The Role of Immune Checkpoint Inhibitors in Cancer Therapy
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The Importance of Psychometric and Physical Scales for the Evaluation of the Consequences of Scars—A Literature Review
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Telemedicine, E-Health, and Multi-Agent Systems for Chronic Pain Management
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Carcinogenic Effects of Areca Nut and Its Metabolites: A Review of the Experimental Evidence
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What Quality of Care Means? Exploring Clinical Nurses’ Perceptions on the Concept of Quality Care
Journal Description
Clinics and Practice
Clinics and Practice
is an international, scientific, peer-reviewed, open access journal on clinical medicine, published bimonthly online by MDPI (from Volume 11, Issue 1 - 2021).
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within Scopus, ESCI (Web of Science), PubMed, PMC, Embase, and other databases.
- Journal Rank: JCR - Q2 (Medicine, General and Internal) / CiteScore - Q2 (General Medicine)
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 26.4 days after submission; acceptance to publication is undertaken in 3.8 days (median values for papers published in this journal in the second half of 2023).
- Recognition of Reviewers: APC discount vouchers, optional signed peer review, and reviewer names published annually in the journal.
Impact Factor:
1.7 (2023);
5-Year Impact Factor:
1.6 (2023)
Latest Articles
Nuck Canal Endometriosis Following IVF Attempts in a Young Patient—Report of a Case
Clin. Pract. 2024, 14(4), 1245-1250; https://doi.org/10.3390/clinpract14040100 - 28 Jun 2024
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Introduction: Endometriosis is a common benign condition affecting 10–15% of women of reproductive age. An unusual site of endometriosis is the canal of Nuck, which is a physiologically obliterated space in women spanning the area from the deep inguinal ring to the labia
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Introduction: Endometriosis is a common benign condition affecting 10–15% of women of reproductive age. An unusual site of endometriosis is the canal of Nuck, which is a physiologically obliterated space in women spanning the area from the deep inguinal ring to the labia majora. Case presentation: A 37-year-old woman, with a past medical history of several in vitro fertilization attempts, presented with a right-sided painful inguinal mass. She was subsequently offered surgical exploration and excision of the lesion, which revealed the presence of endometrial glands and stroma. Discussion: Despite being a relatively common and benign pelvic condition, endometriosis can rarely manifest in the inguinal region, within the canal of Nuck. The treating physician should be cognizant of Nuck canal endometriosis, especially in young female patients presenting with an irreducible mass in the inguinal region and associated cyclic pain or infertility. Conclusion: When clinically and radiologically suspected, surgical excision is indicated to establish the diagnosis, provide symptomatic relief and guide further decision making.
Full article
Open AccessArticle
Predictors of Readmission in Young Adults with First-Episode Psychosis: A Multicentric Retrospective Study with a 12-Month Follow-Up
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Filippo Besana, Serena Chiara Civardi, Filippo Mazzoni, Giovanni Carnevale Miacca, Vincenzo Arienti, Matteo Rocchetti, Pierluigi Politi, Vassilis Martiadis, Natascia Brondino and Miriam Olivola
Clin. Pract. 2024, 14(4), 1234-1244; https://doi.org/10.3390/clinpract14040099 - 24 Jun 2024
Abstract
Background: A significant number of young individuals are readmitted one or more times shortly after their first episode of psychosis. Readmission may represent a marker of psychopathological vulnerability. Our primary aim was to evaluate the impact of clinical and socio-demographic variables on readmission
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Background: A significant number of young individuals are readmitted one or more times shortly after their first episode of psychosis. Readmission may represent a marker of psychopathological vulnerability. Our primary aim was to evaluate the impact of clinical and socio-demographic variables on readmission at 12-month follow-up. Secondly, our goal was to determine whether the use of Long-Acting Injection (LAI) antipsychotics provides notable benefits compared to oral medications in preventing subsequent readmissions. Subjects and methods: 80 patients hospitalised for the first time with a diagnosis of psychotic disorder (ICD-10 criteria) were retrospectively assessed through clinical records. The mean age was 21.7 years. Patients were predominantly male (n = 62, 77.5%), and 55 subjects had at least 8 years of education. 50% of the sample was “NEET” (not in education, employment, or training). Results: 35 patients (43.8%) were discharged with a LAI antipsychotic, while 45 (56.2%) recieved oral antipsychotic therapy. Substance use (p = 0.04) and oral antipsychotics at discharge (p = 0.003) were significantly associated with readmission at 1 year. We did not find any significant predictors of being discharged with LAI therapy. Conclusion: Our findings underlined the importance of identifying patients at risk of readmission in order to prevent future rehospitalization and promote appropriate prevention strategies. LAIs should be considered as a first-choice treatment for patients hospitalised for FEP since they proved to be effective in preventing relapse.
Full article
(This article belongs to the Special Issue Pediatric and Adolescent Psychiatry and Psychology: Current Treatments and Future Options)
Open AccessStudy Protocol
Individualized Cognitive Functional Therapy Compared with Conservative Treatment for Patients with Chronic Neck Pain—Study Protocol for A Single Blind Pragmatic Randomized Controlled Trial
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George Ploutarchou, Vasileios Korakakis, Evi Lazoura, Christos Savva, Kyriakos Pavlou, Iacovos Christofi, Katerina Sotiriou, Chara Savvidou, Andreas Panteli, Christos Karagiannis and Ioannis Mamais
Clin. Pract. 2024, 14(4), 1225-1233; https://doi.org/10.3390/clinpract14040098 - 21 Jun 2024
Abstract
Chronic neck pain (CNP) is one of the most common musculoskeletal conditions, is considered the second leading cause of pain, and is among the leading causes of disability. Cognitive Functional Therapy (CFT) is a novel behavioral therapy for individualizing the management of spinal
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Chronic neck pain (CNP) is one of the most common musculoskeletal conditions, is considered the second leading cause of pain, and is among the leading causes of disability. Cognitive Functional Therapy (CFT) is a novel behavioral therapy for individualizing the management of spinal pain targeting the multidimensional aspect of musculoskeletal pain. This study outlines the protocol for an assessor-blind randomized controlled trial (RCT) designed to compare an individualized Cognitive Functional Therapy (CFT) intervention with usual care in terms of pain and disability. Aiming for a pragmatic intervention, the CFT group will receive 16 sessions based on patient’s condition characteristics, and clinical presentation and progression. The control group will receive 16 sessions of standardized usual care (electrotherapy, massage, posture exercise, and educations). Both groups will have the same intervention duration. Patients will be randomly allocated into groups and will be assessed at baseline, at the 8th session, at the 16th session, and 3 months after randomization. Primary outcomes will be pain, disability, cervical range of motion, and neck muscle isometric strength. To our knowledge, this study will be the first RCT to compare the clinical effectiveness of CFT compared to UC for adults with CNP. The study results will provide information about the use of CFT in clinical practice.
Full article
(This article belongs to the Special Issue Clinical Outcome Research in the Head and Neck)
Open AccessArticle
A Higher Neutrophil Count Is Associated with Favorable Achievement of Treatment-Free Remission in Patients with Chronic Myeloid Leukemia Who Received Second Generation Tyrosine Kinase Inhibitor as Frontline Treatment
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Hiroshi Ureshino, Yusuke Takeda, Kazuharu Kamachi, Takaaki Ono, Noriyoshi Iriyama, Eiichi Ohtsuka, Emiko Sakaida and Shinya Kimura
Clin. Pract. 2024, 14(4), 1216-1224; https://doi.org/10.3390/clinpract14040097 - 21 Jun 2024
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Background: ABL1 tyrosine kinase inhibitor discontinuation securely became among the therapeutic goal for chronic myeloid leukemia chronic phase patients (CML-CP). To establish successful prognostic factors for treatment-free remission (TFR), it is necessary to diagnose the patients with high-risk molecular relapse, however, a biomarker
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Background: ABL1 tyrosine kinase inhibitor discontinuation securely became among the therapeutic goal for chronic myeloid leukemia chronic phase patients (CML-CP). To establish successful prognostic factors for treatment-free remission (TFR), it is necessary to diagnose the patients with high-risk molecular relapse, however, a biomarker for the achievement of TFR has not been completely elucidated. Recent investigations have determined that neutrophils function crucially in cancer immunology. Patients and Methods: The research was a multicenter retrospective observational study to examine the correlation between TFR and neutrophil counts before TKI discontinuation. The investigation included patients having Philadelphia chromosome-positive CML-CP who attempted the discontinuation of TKIs after a durable deep molecular response between January 2012 and July 2021 at four institutions in Japan. Results: 118 CML-CP patients in total discontinued TKIs and an estimated 36-month TFR rate was 65.1%. 52 patients received second-generation TKIs as frontline. Higher neutrophil count (>3210/μL) at TKIs discontinuation was determined as an independent prognostic variable for TFR in patients who received second-generation TKIs as frontline [(HR, 0.235 (95%, confidence interval (CI) 0.078–0.711); p = 0.010]. Conclusions: The neutrophil-mediated immunomodulation can be a significant component for the effective achievement of TFR in CML supported by our clinical observation.
Full article
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Open AccessEditorial
Quality in Contemporary Surgical Nursing
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Georgios Vasilopoulos
Clin. Pract. 2024, 14(4), 1214-1215; https://doi.org/10.3390/clinpract14040096 - 21 Jun 2024
Abstract
Quality in healthcare is a multidimensional issue involving various features that depend on service performance and personal assessment (Stavropoulou et al [...]
Full article
(This article belongs to the Special Issue Clinical Nursing and Quality of Healthcare)
Open AccessReview
Preserving Patient Stories: Bioethical and Legal Implications Related to the Shift from Traditional to Digital Anamnesis
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Filippo Gibelli, Paolo Bailo, Giuliano Pesel and Giovanna Ricci
Clin. Pract. 2024, 14(4), 1196-1213; https://doi.org/10.3390/clinpract14040095 - 21 Jun 2024
Abstract
It is since the beginning of the so-called ‘digital revolution’ in the 1950s that technological tools have been developed to simplify and optimise traditional, time-consuming, and laborious anamnestic collection for many physicians. In recent years, more and more sophisticated ‘automated’ anamnestic collection systems
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It is since the beginning of the so-called ‘digital revolution’ in the 1950s that technological tools have been developed to simplify and optimise traditional, time-consuming, and laborious anamnestic collection for many physicians. In recent years, more and more sophisticated ‘automated’ anamnestic collection systems have been developed, to the extent that they can actually enter daily clinical practice. This article not only provides a historical overview of the evolution of such tools, but also explores the ethical and medico-legal implications of the transition from traditional to digital anamnesis, including the protection of data confidentiality, the preservation of the communicative effectiveness of the doctor–patient dialogue and the safety of care in patients with poor digital and health literacy.
Full article
Open AccessArticle
Computer-Guided Evaluation of the Use of Two Different Devices in the Reduction of Inferior Tooth Crowding
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Sara Di Nicolantonio, Maria Ausilia D’Angelo, Davide Pietropaoli, Annalisa Monaco and Eleonora Ortu
Clin. Pract. 2024, 14(3), 1185-1195; https://doi.org/10.3390/clinpract14030094 - 20 Jun 2024
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Objective: Lower tooth crowding is considered one of the most common malocclusions in growing patients and due to the potential complications associated with it, it is recommended to intercept this condition as soon as possible. The purpose of this paper is to examine
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Objective: Lower tooth crowding is considered one of the most common malocclusions in growing patients and due to the potential complications associated with it, it is recommended to intercept this condition as soon as possible. The purpose of this paper is to examine and compare the effectiveness of two different orthodontic devices (elastodontic device and clear aligners) in the treatment of anterior tooth crowding in the jaws of young patients. Materials and methods: Seventy patients aged between 10 and 16 years with anterior inferior tooth crowding were recruited into this study and divided into case and control groups. The former group comprised 35 patients (15 males and 20 females, average age 10.2 years) who were treated with elastodontic devices (EQ CP series, Eptamed), while the control group consisted of 35 patients (15 males and 20 females, average age 10.5 years) who received aligners (Invisalign). All patients underwent periodic visits after 6 months from the start of treatment (T1) and after 1 year (T2) in which the progress of therapy was evaluated by measuring the inferior intercanine distance using a digital caliper. A parametric ANOVA test was conducted for statistical analysis. Results: There is no statistically significant difference between the two groups at either T1 or T2 (p < 0.05), thus making the two treatment modalities comparable. Conclusions: Both elastodontic devices and aligners can be considered as effective tools to successfully conduct inferior expansive treatment for the resolution of tooth crowding; however, the elastodontic devices are considered more comfortable to wear and they are required to be worn for less time during the day.
Full article
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Open AccessArticle
Anesthesia Medication’s Impacts on Inflammatory and Neuroendocrine Immune Response in Patients Undergoing Digestive Endoscopy
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Denisa-Ancuța Popa-Ion, Lidia Boldeanu, Dan-Ionuț Gheonea, Madalina Maria Denicu, Mihail Virgil Boldeanu and Luminița Cristina Chiuțu
Clin. Pract. 2024, 14(3), 1171-1184; https://doi.org/10.3390/clinpract14030093 - 18 Jun 2024
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The aim of this study was to explore the impact of anesthetic drugs currently used to perform lower digestive endoscopy on serum concentrations of inflammation markers and catecholamines. We selected 120 patients and divided them into three lots of 40 patients each: L1,
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The aim of this study was to explore the impact of anesthetic drugs currently used to perform lower digestive endoscopy on serum concentrations of inflammation markers and catecholamines. We selected 120 patients and divided them into three lots of 40 patients each: L1, in which no anesthetics were used; L2, in which propofol was used; and L3, in which propofol combined with fentanyl was used. All patients had serum concentrations of adrenaline/epinephrine (EPI), noradrenaline/norepinephrine (NE), tumor necrosis factor alpha (TNF-α), interleukin-4 (IL-4), IL-6, IL-8, and IL-10, taken at three time points: at the beginning of the endoscopic procedure (T0), 15 min after (T1), and 2 h after the end of the endoscopic procedure (T2). The results of the research showed changes in the levels of catecholamines and interleukins (ILs) at T0, with an increased response in L1 above the mean recorded in L2 and L3 (p < 0.001). At T1, increased values were recorded in all lots; values were significantly higher in L1. At T2, the values recorded in L3 were significantly lower than the values in L2 (student T, p < 0.001) and L1, in which the level of these markers continued to increase, reaching double values compared to T0 (student T, p < 0.001). In L2 at T1, the dose of propofol correlated much better with NE, EPI, and well-known cytokines. Our results show that propofol combined with fentanyl can significantly inhibit the activation of systemic immune and neuroendocrine response during painless lower digestive endoscopy.
Full article
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Open AccessArticle
Perceived Orthodontic Needs and Attitudes towards Early Evaluation and Interventions: A Survey-Based Study among Parents of Italian School-Aged Children
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Federica Di Spirito, Davide Cannatà, Valentina Schettino, Marzio Galdi, Rosaria Bucci and Stefano Martina
Clin. Pract. 2024, 14(3), 1159-1170; https://doi.org/10.3390/clinpract14030092 - 18 Jun 2024
Abstract
(1) Background: Parents’ awareness of malocclusion and their attitude towards early evaluation and interventions influence children’s orthodontic management. This cross-sectional study investigates factors that affect the perceived orthodontic needs and the attitude towards interceptive orthodontics among a sample of one-thousand eight-hundred and six
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(1) Background: Parents’ awareness of malocclusion and their attitude towards early evaluation and interventions influence children’s orthodontic management. This cross-sectional study investigates factors that affect the perceived orthodontic needs and the attitude towards interceptive orthodontics among a sample of one-thousand eight-hundred and six (1806) parents of children aged between 6 and 11 years. (2) Methods: The investigation was carried out thought a 18-items online questionnaire divided as follows: characteristics of respondents; perceived child’s orthodontic needs; attitude toward early orthodontic evaluation and interventions. The associations between responses were assessed with a Chi-square test. (3) Results: Two-thirds of the respondents referred to having consulted an orthodontist for their child, and more than half of them initiated the required orthodontic treatment. In 44% of cases, the orthodontic consultation occurred after the age of 7 years. Parents’ higher education and history of orthodontic treatment were associated with a greater awareness of orthodontic needs. Parents’ perception of the impact of teeth on their child’s personality was significantly associated with the decision to start the orthodontic treatment (p < 0.001). (4) Conclusions: Although the parents’ level of awareness of their child’s orthodontic needs was generally satisfactory, the results of the present study pointed out the need for a better education regarding the importance of an early orthodontic assessment.
Full article
(This article belongs to the Special Issue New Trends, Materials, and Technologies and Consolidating Best Practices in Dentistry)
Open AccessArticle
Smoking and Hypertriglyceridemia Predict ST-Segment Elevation Myocardial Infarction in Kosovo Patients with Acute Myocardial Infarction
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Afrim Poniku, Arlind Batalli, Dua Shita, Zarife Rexhaj, Arlind Ferati, Rita Leka, Artan Bajraktari, Genc Abdyli, Edmond Haliti, Pranvera Ibrahimi, Rona Karahoda, Shpend Elezi, Faik Shatri, Ibadete Bytyçi, Michael Henein and Gani Bajraktari
Clin. Pract. 2024, 14(3), 1149-1158; https://doi.org/10.3390/clinpract14030091 - 17 Jun 2024
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Background: Myocardial infarction (MI), presented as ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI), is influenced by atherosclerosis risk factors. Aim: The aim of this study was to assess the patterns of presentation of patients with acute MI in Kosovo. Methods: This
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Background: Myocardial infarction (MI), presented as ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI), is influenced by atherosclerosis risk factors. Aim: The aim of this study was to assess the patterns of presentation of patients with acute MI in Kosovo. Methods: This was a cross-sectional study conducted at the University Clinical Center of Kosovo, which included all patients hospitalized with acute MI over a period of 7 years. Results: Among the 7353 patients admitted with acute MI (age 63 ± 12 years, 29% female), 59.4% had STEMI and 40.6% had NSTEMI. The patients with NSTEMI patients less (48.3% vs. 54%, p < 0.001), but more of them had diabetes (37.8% vs. 33.6%, p < 0.001), hypertension (69.6% vs. 63%, p < 0.001), frequently had a family history of coronary artery disease (CAD) (40% vs. 38%, p = 0.009), and had more females compared to the patients with STEMI (32% vs. 27%, p < 0.001). The patients with NSTEMI underwent less primary percutaneous interventions compared with the patients with STEMI (43.6% vs. 55.2%, p < 0.001). Smoking [1.277 (1.117–1.459), p ˂ 0.001] and high triglycerides [0.791 (0.714–0.878), p = 0.02] were independent predictors of STEMI. Conclusions: In Kosovo, patients with STEMI are more common than those with NSTEMI, and they were mostly males and more likely to have diabetes, hypertension, and a family history of CAD compared to those with NSTEMI. Smoking and high triglycerides proved to be the strongest predictors of acute STEMI in Kosovo, thus highlighting the urgent need for optimum atherosclerosis risk control and education strategies.
Full article
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Open AccessArticle
A Modern Diagnostic Procedure—The Introduction of Point-of-Care Ultrasound in Romanian Emergency Physicians’ Daily Routine
by
George-Catalin Bouros, Tudor Ovidiu Popa, Paul Lucian Nedelea, Emilian Manolescu, Anca Haisan, Iulia Roca, Petruta Morosanu, Alexandra Hauta, Gabriela Grigorasi, Mihaela Corlade-Andrei and Diana Cimpoesu
Clin. Pract. 2024, 14(3), 1137-1148; https://doi.org/10.3390/clinpract14030090 - 14 Jun 2024
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Background: Emergency medicine in Romania has developed fast since inception. The need for faster diagnostic capabilities due to the high workload pre- and in-hospital made point-of-care ultrasound (POCUS) a logical next step. The advantages of POCUS are well known, but implementation presents challenges.
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Background: Emergency medicine in Romania has developed fast since inception. The need for faster diagnostic capabilities due to the high workload pre- and in-hospital made point-of-care ultrasound (POCUS) a logical next step. The advantages of POCUS are well known, but implementation presents challenges. Our goal was to study how a straightforward method of implementation would work locally. Methods: Two prospective observational studies were conducted at 6 months (prehospital) and 4 months (in-hospital). The protocol used was extended focused assessment sonography in trauma (eFAST), and the shock index (SI) was used to stratify patients. Voluntary sampling was conducted by emergency physicians. The primary outcomes were patient numbers, type of case use, results, and accuracy. Results: The prehospital study registered 34 patients: 41% traumas, 35% cardiac arrest, 18% shock, and 6% acute respiratory distress. The in-hospital study patients were 78: 36% traumas, 6% cardiac arrests, 41% shock, and 17% acute respiratory distress. A total of 88.5% of the cases were confirmed with definitive imagistic findings. Conclusion: The studies mark an increase in POCUS usage and use in complicated cases. Providing supervision and feedback into clinical practice resulted in a further increase in POCUS usage, the second study having an 88.5% accuracy when compared to the final diagnostic proving the increased efficiency of a longitudinal training approach.
Full article
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Open AccessArticle
Development of the Home Environmental Scale of Accessibility Instrument for Spain
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Estíbaliz Jiménez-Arberas, Gemma Ruíz Varela, Feliciano Francisco Ordoñez Fernández and María Isabel Fernández Méndez
Clin. Pract. 2024, 14(3), 1123-1136; https://doi.org/10.3390/clinpract14030089 - 12 Jun 2024
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Background: Universal accessibility is one of the most active lines of intervention for people with disabilities and older adults. This accessibility has become a topic of growing interest regarding home access and use. Therefore, the main objective of this study was to create
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Background: Universal accessibility is one of the most active lines of intervention for people with disabilities and older adults. This accessibility has become a topic of growing interest regarding home access and use. Therefore, the main objective of this study was to create and validate a home assessment tool: the HESA II. Methods: The study was conducted in four phases: (1) agreement on variables by an expert panel; (2) development of 90 items according to the AOTA framework; (3) pilot test with n = 20; and (4) final study with 156 subjects where confirmatory factor analysis was performed. Results: The tool consisted of 85 items divided into five subscales related to each of the main spaces of Spanish homes: living room; kitchen; bedroom; and bathroom. Conclusions: The tool demonstrates good psychometric properties of reliability. The HESA II assesses home accessibility based on limitations in activity and participation restriction of the evaluated person as per the International Classification of Functioning, Disability, and Health rather than on a diagnosis, making it applicable to a wide range of groups.
Full article
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Open AccessCase Report
Renal Vein Thrombosis Secondary to Pyelonephritis: Targeting a Thrombo-Inflammatory Entity
by
Dimitris Kounatidis, Vasileios Papadimitropoulos, Natalia Vallianou, Aikaterini Poulaki, Krystalia Dimitriou, Ioanna Tsiara, Konstantinos Avramidis, Alexandra Alexopoulou and Dimitrios Vassilopoulos
Clin. Pract. 2024, 14(3), 1110-1122; https://doi.org/10.3390/clinpract14030088 - 9 Jun 2024
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Renal vein thrombosis (RVT) is a relatively uncommon condition that is most frequently observed in individuals with nephrotic syndrome. While rare, pyelonephritis (PN) may serve as a predisposing factor for secondary RVT. In such cases, one should consider the possibility of RVT when
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Renal vein thrombosis (RVT) is a relatively uncommon condition that is most frequently observed in individuals with nephrotic syndrome. While rare, pyelonephritis (PN) may serve as a predisposing factor for secondary RVT. In such cases, one should consider the possibility of RVT when patients fail to respond to appropriate antibiotic treatment. Typically, these patients require additional anticoagulation therapy for a duration of 3 to 6 months, with a generally favorable prognosis. In this report, we present the case of a 74-year-old female who developed RVT due to Klebsiella pneumoniae PN. Additionally, we reviewed 11 cases of PN complicated by RVT, which were documented in the PubMed database over a span of 40 years, emphasizing key elements in diagnostic and therapeutic approaches. Lastly, we elaborated upon the role of thrombo-inflammation, especially in the context of sepsis.
Full article
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Open AccessArticle
Association of Postoperative Serum Lactate Levels with Acute Kidney Injury in Mexican Patients Undergoing Cardiac Surgery
by
Héctor-Enrique Flores-Salinas, Anahí de Jesús Zambada-Gamboa, Texali-Candelaria Garcia-Garduño, Guillermo Rodríguez-Zavala, Yeminia Valle, Juan-Carlos Chávez-Herrera, Porfirio-Eduardo Martinez-Gutierrez, Arturo Godinez-Flores, Salvador Jiménez-Limón and Jorge-Ramón Padilla-Gutiérrez
Clin. Pract. 2024, 14(3), 1100-1109; https://doi.org/10.3390/clinpract14030087 - 7 Jun 2024
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Acute kidney injury (AKI) is a highly prevalent and a critical complication of cardiac surgery (CS). Serum lactate (sLac) levels have consistently shown an association with morbimortality after CS. We performed a cross-sectional study including 264 adult patients that had a cardiac surgery
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Acute kidney injury (AKI) is a highly prevalent and a critical complication of cardiac surgery (CS). Serum lactate (sLac) levels have consistently shown an association with morbimortality after CS. We performed a cross-sectional study including 264 adult patients that had a cardiac surgery between January and December 2020. Logistic regression analysis was performed to determine factors associated with AKI development. We measured the postoperative levels of sLac for all participants immediately after CS (T0) and at 4 h (T4) after the surgical intervention. A linear regression model was used to identify the factors influencing both sLac metrics. We identified four risk predictors of AKI; one was preoperative (atrial fibrillation), one intraoperative (cardiopulmonary bypass time), and two were postoperative (length of hospital stay and postoperative sLac). T0 and T4 sLac levels were higher among CS-AKI patients than in Non-CS-AKI patients. Postoperative sLac levels were significant independent predictors of CSA-AKI, and sLac levels are influenced by length of hospital stay, the number of transfused packed red blood cells, and the use of furosemide in CS-AKI patients. These findings may facilitate the earlier identification of patients susceptible to AKI after CS.
Full article
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Open AccessArticle
Unravelling Quality of Life for Head and Neck Cancer Patients after VMAT Radiation Therapy: Insights from Toxicity, Dosimetry and Symptoms Correlation
by
Panagiota Kiafi, Maria Anthi Kouri, Georgios Patatoukas, Andromachi Kougioumtzopoulou, Marina Chalkia, Ourania Nicolatou-Galitis, Vassilis Kouloulias, Efthimios Kyrodimos and Kalliopi Platoni
Clin. Pract. 2024, 14(3), 1085-1099; https://doi.org/10.3390/clinpract14030086 - 6 Jun 2024
Abstract
(1) Background: Head and neck cancer treatment, including advanced techniques like Volumetric Modulated Arc Therapy (VMAT), presents challenges for maintaining patient quality of life (QoL). Thus, thoroughly investigating how radiation therapy (RT) affects patients has been proved essential. Derived by that, this study
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(1) Background: Head and neck cancer treatment, including advanced techniques like Volumetric Modulated Arc Therapy (VMAT), presents challenges for maintaining patient quality of life (QoL). Thus, thoroughly investigating how radiation therapy (RT) affects patients has been proved essential. Derived by that, this study aims to understand the complex interactions between not only RT and QoL but also symptom severity, and treatment-related toxicities in three distinct time points of patient’s treatment; (2) Methods: To achieve that, EORTC-QLQ-C30 and EORTC QLQ-H&N35 questionnaires were used in combination with EORTC_RTOG scoring criteria and Spearman’s rho statistical analysis for 74 patients with cancer undergoing VMAT radiation therapy; (3) Results: The results revealed a significant improvement in the Overall Health Index post-treatment, indicating a temporary decline during therapy followed by subsequent recovery, often surpassing pre-treatment QoL levels. Concurrently a reduction in symptomatology was observed, notably in pain, swallowing difficulties, and dry mouth, aligning with prior research indicating decreased symptom burden post-treatment. However, Spearman’s correlation coefficient analysis at two distinct time points during therapy uncovered varying degrees of correlation between dosimetric data at Organs at Risk (OARs) and reported symptoms, highlighting potential limitations in using QoL questionnaires as sole indicators of treatment efficacy. Our investigation into the correlation between dosimetric data, toxicity, and symptoms focused on the relationship between radiation doses and oral mucositis levels, a common toxicity in head and neck cancer patients. Significant associations were identified between toxicity levels and dosimetric parameters, particularly with OARs such as the parotid glands, oral cavity, and swallowing muscles, underlining the utility of the EORTC method as a reliable toxicity assessment tool; (4) Conclusions: To summarize, current research attempts to underscore the importance of refining QoL assessments for enhanced patient care. The integration of dosimetric data, symptom severity, and treatment-related toxicities in the QoL outcomes of head and neck cancer patients undergoing VMAT radiation therapy, can lead towards the optimization of treatment strategies and the improvement of patient outcomes in future patient-centered radiation therapy practices.
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(This article belongs to the Special Issue Clinical Outcome Research in the Head and Neck)
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Open AccessCase Report
Case Report: The Rehabilitation of a Patient with Acute Transverse Myelitis after COVID-19 Vaccination
by
Piotr Niebrzydowski, Małgorzata Kusiak-Kaczmarek, Jarosław Tomaszewski, Maciej Gmiński and Dominika Szalewska
Clin. Pract. 2024, 14(3), 1076-1084; https://doi.org/10.3390/clinpract14030085 - 6 Jun 2024
Abstract
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We report the case of a 55-year-old man with multi-symptomatic transverse myelitis after vaccination against coronavirus disease 2019 (COVID-19). The patient was diagnosed based on the course of the disease and the results of imaging and laboratory tests. We excluded other most probable
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We report the case of a 55-year-old man with multi-symptomatic transverse myelitis after vaccination against coronavirus disease 2019 (COVID-19). The patient was diagnosed based on the course of the disease and the results of imaging and laboratory tests. We excluded other most probable causes of the disease. The quick start of diagnosis allowed for early treatment with intravenous steroids and then plasmapheresis and the implementation of modern rehabilitation methods using biofeedback platforms, among others, and an exoskeleton. The patient returned to work, but the rehabilitation process continues to this day due to persistent symptoms that impair the patient’s quality of life.
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Open AccessArticle
Predictive Role of NLR, dNLR, PLR, NLPR, and Other Laboratory Markers in Diagnosing SIRS in Premature Newborns
by
Manuela Pantea, Daniela Iacob, Claudia Ioana Bortea, Ileana Enatescu, Vlad Barbos, Mihaela Prodan, Raluca Tudor and Gabriel Veniamin Cozma
Clin. Pract. 2024, 14(3), 1065-1075; https://doi.org/10.3390/clinpract14030084 - 6 Jun 2024
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Background: Premature newborns are at a significant risk for Systemic Inflammatory Response Syndrome SIRS, a condition associated with high morbidity and mortality. This study aimed to evaluate the predictive and diagnostic capability of laboratory markers like Neutrophil to Lymphocyte Ratio (NLR), derived Neutrophil
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Background: Premature newborns are at a significant risk for Systemic Inflammatory Response Syndrome SIRS, a condition associated with high morbidity and mortality. This study aimed to evaluate the predictive and diagnostic capability of laboratory markers like Neutrophil to Lymphocyte Ratio (NLR), derived Neutrophil to Lymphocyte Ratio (dNLR), Platelet-to-Lymphocyte Ratio (PLR), and Neutrophil-to-Lymphocyte-to-Platelet Ratio (NLPR) in diagnosing SIRS in premature newborns. Methods: Premature newborns with and without SIRS were evaluated in a prospective design during a one-year period. Among 136 newborns, early and 72 h post-birth analyses were performed. Results: At 24 h, NLR’s cutoff value was 8.69, yielding sensitivity and specificity rates of 52.77% and 83.47% (p = 0.0429), respectively. The dNLR showed a cutoff of 5.61, with corresponding rates of 63.27% and 84.15% (p = 0.0011), PLR had a cutoff of 408.75, with rates of 51.89% and 80.22% (p = 0.1026), and NLPR displayed a cutoff of 0.24, with rates of 75.85% and 86.70% (p = 0.0002). At 72 h, notable sensitivity and specificity improvements were observed, particularly with NLPR having a cutoff of 0.17, showing sensitivity of 77.74% and specificity of 95.18% (p < 0.0001). NLR above the cutoff indicated a 33% increase in SIRS risk, with a hazard ratio (HR)of 1.33. The dNLR was associated with a twofold increase in risk (HR 2.04). NLPR demonstrated a significant, over threefold increase in SIRS risk (HR 3.56), underscoring its strong predictive and diagnostic value for SIRS development. Conclusion: Integrating these findings into clinical practice could enhance neonatal care by facilitating the early identification and management of SIRS, potentially improving outcomes for this vulnerable population.
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Open AccessReview
Safety of Progestogen Hormonal Contraceptive Methods during Lactation: An Overview
by
Karolina Chmaj-Wierzchowska, Katarzyna Wszołek, Katarzyna Tomczyk and Maciej Wilczak
Clin. Pract. 2024, 14(3), 1054-1064; https://doi.org/10.3390/clinpract14030083 - 4 Jun 2024
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Background: Breastfeeding is a process for not only nourishing infants but also for building a unique emotional bond between mother and child. Therefore, the ideal contraception during lactation should not affect lactation (milk composition, milk volume) and offspring development. Objectives: This study aims
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Background: Breastfeeding is a process for not only nourishing infants but also for building a unique emotional bond between mother and child. Therefore, the ideal contraception during lactation should not affect lactation (milk composition, milk volume) and offspring development. Objectives: This study aims to analyze the literature on the safety of progestogen hormonal contraceptive methods during lactation. Methods: We conducted a thorough search across various databases, including the National Library of Medicine (PubMed), and the Cochrane Database, Drugs and Lactation Database (LactMed). Our search utilized specific phrases such as: “lactation” and “breastfeeding” and “oral contraception” with “drospirenone” or “desogestrel”, with “subcutaneous etonogestrel implant” or “etonogestrel implant”, with “levonorgestrel-releasing intrauterine system”, and “emergency contraception”, with “levonorgestrel” or “ulipristal acetate”. Conclusions: Based on published scientific reports, progestogen hormonal contraceptives can be considered a relatively safe solution for women desiring to continue feeding their infant with their milk while using hormonal contraception. It is important to seek guidance on selecting the best contraception method based on the latest medical knowledge, tailored to the individual needs and clinical circumstances of each woman and place of residence. A woman should always be informed of the potential risks of such a treatment and then allowed to make her own decision based on the knowledge received from a specialist.
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Graphical abstract
Open AccessArticle
Early Screening for Long QT Syndrome and Cardiac Anomalies in Infants: A Comprehensive Study
by
Luana Nosetti, Marco Zaffanello, Carolina Lombardi, Alessandra Gerosa, Giorgio Piacentini, Michele Abramo and Massimo Agosti
Clin. Pract. 2024, 14(3), 1038-1053; https://doi.org/10.3390/clinpract14030082 - 31 May 2024
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(1) Background: Sudden Infant Death Syndrome (SIDS) represents sudden and unexplained deaths during the sleep of infants under one year of age, despite thorough investigation. Screening for a prolonged QTc interval, a marker for Long QT Syndrome (LQTS), should be conducted on all
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(1) Background: Sudden Infant Death Syndrome (SIDS) represents sudden and unexplained deaths during the sleep of infants under one year of age, despite thorough investigation. Screening for a prolonged QTc interval, a marker for Long QT Syndrome (LQTS), should be conducted on all newborns to reduce the incidence of SIDS. Neonatal electrocardiograms (ECGs) could identify congenital heart defects (CHDs) early, especially those not detected at birth. Infants with prolonged QTc intervals typically undergo genetic analysis for Long QT Syndrome. (2) Methods: The study involved infants aged 20–40 days, born with no apparent clinical signs of heart disease, with initial ECG screening. Infants with prenatal diagnoses or signs/symptoms of CHDs identified immediately after birth, as well as infants who had previously had an ECG or echocardiogram for other medical reasons, were excluded from the study. We used statistical software (SPSS version 22.0) to analyze the data. (3) Results: Of the 42,200 infants involved, 2245 were enrolled, with 39.9% being males. Following this initial screening, 164 children (37.8% males) with prolonged QTc intervals underwent further evaluation. Out of these 164 children, 27 children were confirmed to have LQTS. However, only 18 children were finally investigated for genetic mutations, and mutations were identified in 11 tests. The most common mutations were LQT1 (54.5%), LQT2 (36.4%), and LQT3 (1 patient). Treatment options included propranolol (39.8%), nadolol (22.2%), inderal (11.1%), metoprolol (11.1%), and no treatment (16.7%). The most common abnormalities were focal right bundle branch block (54.5%), left axis deviation (9.2%), and nonspecific ventricular repolarization abnormalities (7.1%). Multiple anomalies were found in 0.47% of children with focal right bundle branch block. Structural abnormalities were associated with specific features in 267 patients (11.9%), primarily isolated patent foramen ovale (PFO) at 61.4%. (4) Conclusions: This screening approach has demonstrated effectiveness in the early identification of LQTS and other cardiac rhythm anomalies, with additional identification of mutations and/or prolonged QTc intervals in family members. Identifying other ECG abnormalities and congenital heart malformations further enhances the benefits of the screening.
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Open AccessReview
The Effect of Isotretinoin on Insulin Resistance and Serum Adiponectin Levels in Acne Vulgaris Patients: A Systematic Review and Meta-Analysis
by
Eleni Paschalidou, Georgios Katsaras, Thomas Papoulakis, Evangelia Kalloniati, Dimitrios Kavvadas, Sofia Karachrysafi, Dorothea Kapoukranidou, Georgios Tagarakis and Theodora Papamitsou
Clin. Pract. 2024, 14(3), 1021-1037; https://doi.org/10.3390/clinpract14030081 - 31 May 2024
Abstract
Background: Isotretinoin is the drug of choice for severe acne. We sought to examine the potential link between isotretinoin and insulin resistance. Methods: We conducted a systematic review and meta-analysis in accordance with the PRISMA statement. A comprehensive search of the PubMed/MEDLINE, SCOPUS,
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Background: Isotretinoin is the drug of choice for severe acne. We sought to examine the potential link between isotretinoin and insulin resistance. Methods: We conducted a systematic review and meta-analysis in accordance with the PRISMA statement. A comprehensive search of the PubMed/MEDLINE, SCOPUS, and Cochrane databases was performed until 12 January 2022 utilizing the PICO (Patient, Intervention, Comparison, Outcome) tool. Fifteen English-language studies focusing on isotretinoin-treated acne patients were included. Serum levels of insulin, glucose, and adiponectin were evaluated before and after treatment, and insulin sensitivity was assessed using the HOMA–IR. A meta-analysis was conducted using RevMan 5.4.1 software, and a quality assessment was undertaken using the ROBINS-I tool. Results: The meta-analysis unveiled a statistically significant rise in the post-treatment levels of adiponectin, an anti-inflammatory agent, which inhibits liver glucose production while enhancing insulin sensitivity (SMD = 0.86; 95% confidence interval (95% CI) = 0.48–1.25, p-value < 0.0001; I2 = 58%). Our subgroup analysis based on study type yielded consistent findings. However, no statistically significant outcomes were observed for insulin, glucose levels, and the HOMA-IR. Conclusions: There is not a clear association between isotretinoin and insulin resistance, but it appears to enhance the serum levels of adiponectin, which participates in glucose metabolism.
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(This article belongs to the Special Issue 2024 Feature Papers in Clinics and Practice)
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