Clinics and Practice

17 pages, 464 KiB

Open AccessEditor’s ChoiceArticle

The Impact of the Test Dissociation on the Binocular Balance of Children

by Danjela Ibrahimi, Marcos Aviles and Juvenal Rodríguez-Reséndiz

Clin. Pract. 2023, 13(4), 977-993; https://doi.org/10.3390/clinpract13040088 - 18 Aug 2023

Viewed by 1940

Purpose: this research compared the dissociated phoria at near and distance fixation in free space using the Howell test, alternate Cover test, and Thorington test. Methods: 220 healthy Mexican children (mean age

8.3 \pm 2.5

years) participated in this study. Phorias were quantified [...] Read more.

Purpose: this research compared the dissociated phoria at near and distance fixation in free space using the Howell test, alternate Cover test, and Thorington test. Methods: 220 healthy Mexican children (mean age

8.3 \pm 2.5

years) participated in this study. Phorias were quantified at both distances using each test, from the least to the most disruptive. The stereopsis degree and near point of convergence (break/recovery) were analyzed to understand their role in the visual system’s sensorimotor balance. Results: statistically significant differences were found among techniques, with a higher congruence for the EF. However, only the Howell and Thorington tests can be interchanged. The break value and near exophoria relate to each other and affect the stereopsis degree, whereas age is associated with the stereopsis degree and break value. Conclusions: the three techniques cannot be interchanged except for the Howell and Thorington test for the EF at far. The differences in the mode of dissociation could relate to the results. Full article

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15 pages, 2800 KiB

Open AccessEditor’s ChoiceReview

Past, Current, and Future Perspectives on Transplanting Acute Kidney Injury Kidneys

by Rachana Punukollu, Margaret Ryan, Suman Misra, Pooja Budhiraja, Stephanie Ohara, Kayla Kumm, Giselle Guerra, Kunam S. Reddy, Raymond Heilman and Caroline C. Jadlowiec

Clin. Pract. 2023, 13(4), 944-958; https://doi.org/10.3390/clinpract13040086 - 14 Aug 2023

Cited by 2 | Viewed by 2004

Abstract

(1) Background: Acute kidney injury (AKI) kidneys have high non-utilization rates due to concerns regarding unfavorable outcomes. In this paper, we aimed to review the past, present, and future opinions on AKI kidneys. (2) Methods: A PubMed search was conducted for topics relevant [...] Read more.

(1) Background: Acute kidney injury (AKI) kidneys have high non-utilization rates due to concerns regarding unfavorable outcomes. In this paper, we aimed to review the past, present, and future opinions on AKI kidneys. (2) Methods: A PubMed search was conducted for topics relevant to AKI kidney transplantation. (3) Results: Current short- and long-term data on AKI kidneys have demonstrated good outcomes including favorable graft function and survival. The role of procurement biopsies is controversial, but they have been shown to be beneficial in AKI kidneys by allowing clinicians to differentiate between reversible tubular injury and irreversible cortical necrosis. Machine perfusion has also been applied to AKI kidneys and has been shown to reduce delayed graft function (DGF). The incidence of DGF increases with AKI severity and its management can be challenging. Strategies employed to counteract this have included early initiation of dialysis after kidney transplantation, early targeting of adequate immunosuppression levels to minimize rejection risk, and establishment of outpatient dialysis. (4) Conclusions: Despite good outcomes, there continue to be barriers that impact AKI kidney utilization. Successful strategies have included use of procurement biopsies or machine perfusion and expectant management of DGF. With increasing experience, better use of AKI kidneys can result in additional opportunities to expand the donor pool. Full article

(This article belongs to the Special Issue Clinical Treatment of End-Stage Renal Diseases: Hemodialysis, Peritoneal Dialysis, and Kidney Transplantation)

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16 pages, 2237 KiB

Open AccessEditor’s ChoiceArticle

Pulpectomy vs. Pulpotomy as Alternative Emergency Treatments for Symptomatic Irreversible Pulpitis—A Multicenter Comparative Randomised Clinical Trial on Patient Perceptions

by Guillem Esteve-Pardo, Pedro Barreiro-Gabeiras and Lino Esteve-Colomina

Clin. Pract. 2023, 13(4), 898-913; https://doi.org/10.3390/clinpract13040082 - 2 Aug 2023

Cited by 1 | Viewed by 2748

Abstract

Aim: There needs to be more general agreement on the most effective treatment for the emergency patient with Symptomatic Irreversible Pulpitis (SIP). This equivalence randomised clinical study compared the clinical efficiency, as an urgent treatment, of pulpotomy (POT) and pulpectomy (PEC) in the [...] Read more.

Aim: There needs to be more general agreement on the most effective treatment for the emergency patient with Symptomatic Irreversible Pulpitis (SIP). This equivalence randomised clinical study compared the clinical efficiency, as an urgent treatment, of pulpotomy (POT) and pulpectomy (PEC) in the permanent teeth with SIP. The primary outcome was pain management, and the secondary outcome was the patient’s perception of duration, comfort, and satisfaction. Material & Methods: 80 patients were blindly and randomly allocated into two equal parallel groups, the control group treated by PEC and the test group by POT. Data were collected through numerical rating scales (NRS) during the intervention and 6, 24, and 72 h post-op. Non-parametric tests were used to analyse the data. The Brunner-Longer models were adopted for longitudinal data and the analysis of variance (ANOVA)-type statistical was used. Results: The mean preoperative pain levels for the whole sample scored 5.8 ± 2.8 and significantly decreased to 2.1 ± 2.4 at 6 h, 1.5 ± 2.1 at 24 h, and 1.3 ± 2 at 72 h, without any differences between the groups. No significant differences were found in the patient’s perception of treatment discomfort or duration between the groups. Three days after the intervention, patient satisfaction was high, with 9.2 ± 1.7 and 9.1 ± 2 in the PEC and POT groups, respectively. Self-reported pain was the only variable penalising the patient’s final satisfaction. Conclusions: The current randomised control trial (RCT) showed that both pulpectomy and pulpotomy effectively eliminate pain and achieve high levels of patient satisfaction. Furthermore, the patient’s perceptions of the duration and discomfort of the two treatments were similar. Given that pulpotomy is a faster and more straightforward technique, it may be recommended as a viable and pragmatic option for treating emergency patients with symptomatic irreversible pulpitis. Full article

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

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10 pages, 707 KiB

Open AccessEditor’s ChoiceSystematic Review

Mobile Health Solutions for Prostate Cancer Diagnostics—A Systematic Review

by Masood Moghul, Walter Cazzaniga, Fionnuala Croft, Netty Kinsella, Declan Cahill and Nicholas David James

Clin. Pract. 2023, 13(4), 863-872; https://doi.org/10.3390/clinpract13040078 - 28 Jul 2023

Cited by 2 | Viewed by 1791

Abstract

Prostate cancer, the most common cause of cancer in men in the UK and one of the most common around the world to date, has no consensus on screening. Multiple large-scale trials from around the world have produced conflicting outcomes in cancer-specific and [...] Read more.

Prostate cancer, the most common cause of cancer in men in the UK and one of the most common around the world to date, has no consensus on screening. Multiple large-scale trials from around the world have produced conflicting outcomes in cancer-specific and overall mortality. A main part of the issue is the PSA test, which has a high degree of variability, making it challenging to set PSA thresholds, as well as limited specificity. Prostate cancer has a predisposition in men from black backgrounds, and outcomes are worse in men of lower socioeconomic groups. Mobile targeted case finding, focusing on high-risk groups, may be a solution to help those that most need it. The aim of this systematic review was to review the evidence for mobile testing for prostate cancer. A review of all mobile screening studies for prostate cancer was performed in accordance with the Cochrane guidelines and the PRISMA statement. Of the 629 unique studies screened, 6 were found to be eligible for the review. The studies dated from 1973 to 2017 and came from four different continents, with around 30,275 men being screened for prostate cancer. Detection rates varied from 0.6% in the earliest study to 8.2% in the latest study. The challenge of early diagnosis of potentially lethal prostate cancer remains an issue for developed and low- and middle-income countries alike. Although further studies are needed, mobile screening of a targeted population with streamlined investigation and referral pathways combined with raising awareness in those communities may help make the case for screening for prostate cancer. Full article

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10 pages, 286 KiB

Open AccessEditor’s ChoiceArticle

Screening, Genetic Variants, and Bipolar Disorders: Can Useful Hypotheses Arise from the Sum of Partial Failures?

by Mauro Giovanni Carta, Goce Kalcev, Alessandra Scano, Samantha Pinna, Cesar Ivan Aviles Gonzalez, Antonio Egidio Nardi, Germano Orrù and Diego Primavera

Clin. Pract. 2023, 13(4), 853-862; https://doi.org/10.3390/clinpract13040077 - 27 Jul 2023

Cited by 21 | Viewed by 1863

Abstract

Bipolar disorder (BD) is a relevant public health issue, therefore accurate screening tools could be useful. The objective of this study is to verify the accuracy of the Mood Disorder Questionnaire (MDQ) and genetic risk as screeners, and their comparison in terms of [...] Read more.

Bipolar disorder (BD) is a relevant public health issue, therefore accurate screening tools could be useful. The objective of this study is to verify the accuracy of the Mood Disorder Questionnaire (MDQ) and genetic risk as screeners, and their comparison in terms of reliability. Older adults (N = 61, ≥60 years) received a clinical psychiatric evaluation, the MDQ, and were evaluated according to the presence of the genetic variant RS1006737 of CACNA1C. MDQ+ versus the diagnosis of BD as a gold standard shows a sensitivity of 0.286 (Cl 95% 0.14–0.39); a specificity of 0.925 (Cl 95% 0.85–0.08); a predictive positive value (PPV) of 0.667 (Cl 95% 0.33–0.91); and a predictive negative value (PNV) of 0.702 (Cl 95% 0.65–0.75). The positivity for the variant RS1006737 of the CACNA1C against the diagnosis of BD as a gold standard shows a sensitivity of 0.750 (Cl 95% 0.55–0.90); a specificity of 0.375 (Cl 95% 0.28–0.45); a PPV of 0.375 (Cl 95% 0.28–0.45); and a PNV of 0.750 (Cl 95% 0.55–0.90). The reliability between the MDQ+ and positivity for the variant RS1006737 of the CACNA1C was very low (K = −0.048, Cl 95% −0.20–0.09). The study found that both the genetic and the paper and pencil test were quite accurate, but were not reliable in case finding. In fact, despite some validity, albeit specular (in the case of a positive genetic test, the probability of having the disorder is very high, whereas in the case of a negative score on the paper and pencil test, the probability of not having the disorder is very high), the unreliability of the two tests (i.e., they certainly do not measure the same underlying dimension) opens the door to the need for an interpretation and the possibility of a synergistic use for screening. From a heuristic perspective, which obviously requires all of the necessary verifications, this study seems to suggest the hypothesis that a condition of hyperactivation common to disorders and stress conditions, and identified by a positive score on the MDQ (which is common to BD, post-traumatic stress disorder (PTSD), and anxiety disorders and whose genetic basis has not yet been clarified) can trigger BD in people with a predisposition to hyperactivity (i.e., in people with the condition identified by the analyzed genetic variant). Full article

(This article belongs to the Special Issue 2023 Feature Papers in Clinics and Practice)

11 pages, 2861 KiB

Open AccessEditor’s ChoiceReview

External Ventricular Drainage: A Practical Guide for Neuro-Anesthesiologists

by Alessandro Bertuccio, Stefano Marasco, Yaroslava Longhitano, Tatsiana Romenskaya, Angela Elia, Gianluca Mezzini, Matteo Vitali, Christian Zanza and Andrea Barbanera

Clin. Pract. 2023, 13(1), 219-229; https://doi.org/10.3390/clinpract13010020 - 31 Jan 2023

Cited by 10 | Viewed by 14943

Abstract

External ventricular drainage is often considered a life-saving treatment in acute hydrocephalus. Given the large number of discussion points, the ideal management of EVD has not been completely clarified. The objective of this study was to review the most relevant scientific evidence about [...] Read more.

External ventricular drainage is often considered a life-saving treatment in acute hydrocephalus. Given the large number of discussion points, the ideal management of EVD has not been completely clarified. The objective of this study was to review the most relevant scientific evidence about the management of EVD in its main clinical scenarios. We reviewed the most recent and relevant articles about indications, timing, management, and complications of EVD in neurocritical care, with particular interest in patients with subarachnoid hemorrhage (SAH), severe traumatic brain injury (TBI), and intraventricular hemorrhage (IVH) using the following keywords alone or matching with one another: intracranial pressure, subarachnoid hemorrhage, traumatic brain injury, intraventricular hemorrhage, external ventricular drainage, cerebrospinal shunt, intracranial pressure monitoring, and ventriculoperitoneal shunt. In the management of EVD in SAH, the intermittent drainage strategy is burdened with an elevated risk of complications (e.g., clogged catheter, hemorrhage, and need for replacement). There seems to be more ventriculoperitoneal shunt dependency in rapid weaning approach-managed patients than in those treated with the gradual weaning approach. Although there is no evidence in favor of either strategy, it is conventionally accepted to adopt a continuous drainage approach in TBI patients. Less scientific evidence is available in the literature regarding the management of EVD in patients with severe TBI and intraparenchymal/intraventricular hemorrhage. EVD placement is a necessary treatment in several clinical scenarios. However, further randomized clinical trials are needed to clarify precisely how EVD should be managed in different clinical scenarios. Full article

(This article belongs to the Special Issue 2022 Feature Papers in Clinics and Practice)

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11 pages, 1523 KiB

Open AccessEditor’s ChoiceReview

Pathogenesis, Diagnostic Challenges, and Risk Factors of Pott’s Disease

by Ira Glassman, Kevin H. Nguyen, Jane Giess, Cheldon Alcantara, Michelle Booth and Vishwanath Venketaraman

Clin. Pract. 2023, 13(1), 155-165; https://doi.org/10.3390/clinpract13010014 - 25 Jan 2023

Cited by 8 | Viewed by 17507

Abstract

Tuberculosis (TB) prevalence is increasing in developed nations and continuing to cause significant mortality in low- and middle-income countries. As a result of the uptick in cases, there also exists an increased prevalence of extrapulmonary TB. TB is caused by Mycobacterium tuberculosis ( [...] Read more.

Tuberculosis (TB) prevalence is increasing in developed nations and continuing to cause significant mortality in low- and middle-income countries. As a result of the uptick in cases, there also exists an increased prevalence of extrapulmonary TB. TB is caused by Mycobacterium tuberculosis (M. tb). When M. tb disseminates to the vertebral column, it is called Pott’s disease or spinal TB. The frequency, symptoms, and severity of the disease range by the location of the spine and the region of the affected vertebrae. While the current literature shows that timely diagnosis is crucial to reduce the morbidity and mortality from Pott’s disease, there is a lack of specific clinical diagnostic criteria for Pott’s disease, and the symptoms may be very non-specific. Studies have shown that novel molecular diagnostic methods are effective and timely choices. Research has implicated the risk factors for the susceptibility and severity of Pott’s disease, such as HIV and immunosuppression, poverty, and malnutrition. Based on the current literature available, our group aims to summarize the pathogenesis, clinical features, diagnostic challenges, as well as the known risk factors for Pott’s disease within this literature review. Full article

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14 pages, 12474 KiB

Open AccessEditor’s ChoiceCase Report

Disappearance of Plaque Following Treatment with Antioxidants in Peyronie’s Disease Patients—A Report of 3 Cases

by Gianni Paulis and Giovanni De Giorgio

Clin. Pract. 2022, 12(6), 1020-1033; https://doi.org/10.3390/clinpract12060105 - 9 Dec 2022

Cited by 2 | Viewed by 11287

Abstract

Peyronie’s disease (PD) is a fibrotic disorder of the penile tunica albuginea. To date, only a few cases of recovery from PD following medical treatment have been reported in the literature. In this article, we describe three new cases of PD where patients [...] Read more.

Peyronie’s disease (PD) is a fibrotic disorder of the penile tunica albuginea. To date, only a few cases of recovery from PD following medical treatment have been reported in the literature. In this article, we describe three new cases of PD where patients achieved complete resorption of plaque following multimodal antioxidant treatment. In all three cases, treatment included the following antioxidants: bilberry, propolis, ginkgo biloba, silymarin, and vitamin E. Only in case nos. 1 and 2 did we also use the following antioxidant substances: L-carnitine, coenzyme Q10, and Boswellia. In all three cases, we also used a local therapy with diclofenac gel. Only in case no. 2 did we also use periodic perilesional injections with pentoxifylline. Although the sample of cases presented here was small, these patients incontrovertibly experienced complete plaque disappearance and recovery (in one case, only after a short course of treatment). Therefore, it is our conviction that urologists may find our experiences of considerable interest in their clinical practices. Full article

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9 pages, 1154 KiB

Open AccessEditor’s ChoiceReview

Role of Interferons in Mycobacterium tuberculosis Infection

by Gaithrri Shanmuganathan, Davit Orujyan, William Narinyan, Nicole Poladian, Sanya Dhama, Arpitha Parthasarathy, Alexandra Ha, Daniel Tran, Prathosh Velpuri, Kevin H. Nguyen and Vishwanath Venketaraman

Clin. Pract. 2022, 12(5), 788-796; https://doi.org/10.3390/clinpract12050082 - 26 Sep 2022

Cited by 12 | Viewed by 3515

Abstract

Considerable measures have been implemented in healthcare institutions to screen for and treat tuberculosis (TB) in developed countries; however, in low- and middle-income countries, many individuals still suffer from TB’s deleterious effects. TB is caused by an infection from the Mycobacterium tuberculosis ( [...] Read more.

Considerable measures have been implemented in healthcare institutions to screen for and treat tuberculosis (TB) in developed countries; however, in low- and middle-income countries, many individuals still suffer from TB’s deleterious effects. TB is caused by an infection from the Mycobacterium tuberculosis (M. tb) bacteria. Symptoms of TB may range from an asymptomatic latent-phase affecting the pulmonary tract to a devastating active and disseminated stage that can cause central nervous system demise, musculoskeletal impairments, and genitourinary compromise. Following M. tb infection, cytokines such as interferons (IFNs) are released as part of the host immune response. Three main classes of IFNs prevalent during the immune defense include: type I IFN (α and β), type II IFN (IFN-γ), and type III IFN (IFN-λ). The current literature reports that type I IFN plays a role in diminishing the host defense against M. tb by attenuating T-cell activation. In opposition, T-cell activation drives type II IFN release, which is the primary cytokine mediating protection from M. tb by stimulating macrophages and their oxidative defense mechanisms. Type III IFN has a subsidiary part in improving the Th1 response for host cell protection against M. tb. Based on the current evidence available, our group aims to summarize the role that each IFN serves in TB within this literature review. Full article

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16 pages, 903 KiB

Open AccessEditor’s ChoiceReview

Approach to Thromboprophylaxis for Prevention of Venous Thromboembolism in COVID-19: Global Updates and Clinical Insights from India

by Nagarajan Ramakrishnan, Suresh Ramasubban, Ashit Hegde and Deepak Govil

Clin. Pract. 2022, 12(5), 766-781; https://doi.org/10.3390/clinpract12050080 - 23 Sep 2022

Cited by 3 | Viewed by 3169

Abstract

Venous thromboembolism (VTE) frequently occurs in patients with coronavirus disease-19 (COVID-19) and is associated with increased mortality. Several global guidelines recommended prophylactic-intensity anticoagulation rather than intermediate-intensity or therapeutic-intensity anticoagulation for patients with COVID-19-related acute or critical illness without suspected or confirmed VTE. Even [...] Read more.

Venous thromboembolism (VTE) frequently occurs in patients with coronavirus disease-19 (COVID-19) and is associated with increased mortality. Several global guidelines recommended prophylactic-intensity anticoagulation rather than intermediate-intensity or therapeutic-intensity anticoagulation for patients with COVID-19-related acute or critical illness without suspected or confirmed VTE. Even though standard doses of thromboprophylaxis are received, many cases of thrombotic complications are reported; hence, appropriate and adequate thromboprophylaxis is critical for the prevention of VTE in COVID-19. In spite of an increased prevalence of VTE in Indian patients, sufficient data on patient characteristics, diagnosis, and therapeutic approach for VTE in COVID is lacking. In this article, we review the available global literature (search conducted up to 31 May 2021) and provide clinical insights into our approach towards managing VTE in patients with COVID-19. Furthermore, in this review, we summarize the incidence and risk factors for VTE with emphasis on the thromboprophylaxis approach in hospitalized patients and special populations with COVID-19 and assess clinical implications in the Indian context. Full article

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17 pages, 1057 KiB

Open AccessEditor’s ChoiceReview

Review of Pediatric Tuberculosis in the Aftermath of COVID-19

by Patrida Rangchaikul, Phillip Ahn, Michelle Nguyen, Vivian Zhong and Vishwanath Venketaraman

Clin. Pract. 2022, 12(5), 738-754; https://doi.org/10.3390/clinpract12050077 - 11 Sep 2022

Cited by 1 | Viewed by 2978

Abstract

In 2014, the World Health Organization developed the End Tuberculosis Strategy with the goal of a 95% reduction in deaths from tuberculosis (TB) by 2035. The start of the COVID-19 pandemic and global lockdown has had a major impact on TB awareness, screening, [...] Read more.

In 2014, the World Health Organization developed the End Tuberculosis Strategy with the goal of a 95% reduction in deaths from tuberculosis (TB) by 2035. The start of the COVID-19 pandemic and global lockdown has had a major impact on TB awareness, screening, diagnosis, and prompt initiation of treatment, inevitably leading to a significant setback. We explore pediatric tuberculosis through the lens of the COVID-19 era, investigating how COVID-19 has impacted pediatric TB cases in different regions of the world and what the implications are for management moving forward to mitigate these effects. Furthermore, in light of recent findings showing how exposed infants and children are at higher risk than we thought of contracting the disease, greater attention and resources are needed to prevent further downward trends. Full article

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19 pages, 3092 KiB

Open AccessEditor’s ChoiceReview

PD-L1 Over-Expression Varies in Different Subtypes of Lung Cancer: Will This Affect Future Therapies?

by Asad Ullah, Steven Pulliam, Nabin Raj Karki, Jaffar Khan, Sana Jogezai, Sandresh Sultan, Lal Muhammad, Marjan Khan, Nimra Jamil, Abdul Waheed, Sami Belakhlef, Intisar Ghleilib, Eric Vail, Saleh Heneidi and Nagla Abdel Karim

Clin. Pract. 2022, 12(5), 653-671; https://doi.org/10.3390/clinpract12050068 - 24 Aug 2022

Cited by 10 | Viewed by 4796

Abstract

Programmed death-ligand (PD-L) 1 and 2 are ligands of programmed cell death 1 (PD-1) receptor. They are members of the B7/CD28 ligand-receptor family and the most investigated inhibitory immune checkpoints at present. PD-L1 is the main effector in PD-1-reliant immunosuppression, as the PD-1/PD-L [...] Read more.

Programmed death-ligand (PD-L) 1 and 2 are ligands of programmed cell death 1 (PD-1) receptor. They are members of the B7/CD28 ligand-receptor family and the most investigated inhibitory immune checkpoints at present. PD-L1 is the main effector in PD-1-reliant immunosuppression, as the PD-1/PD-L pathway is a key regulator for T-cell activation. Activation of T-cells warrants the upregulation of PD-1 and production of cytokines which also upregulate PD-L1 expression, creating a positive feedback mechanism that has an important role in the prevention of tissue destruction and development of autoimmunity. In the context of inadequate immune response, the prolonged antigen stimulation leads to chronic PD-1 upregulation and T-cell exhaustion. In lung cancer patients, PD-L1 expression levels have been of special interest since patients with non-small cell lung cancer (NSCLC) demonstrate higher levels of expression and tend to respond more favorably to the evolving PD-1 and PD-L1 inhibitors. The Food and Drug Administration (FDA) has approved the PD-1 inhibitor, pembrolizumab, alone as front-line single-agent therapy instead of chemotherapy in patients with NSCLC and PD-L1 ≥1% expression and chemoimmunotherapy regimens are available for lower stage disease. The National Comprehensive Cancer Network (NCCN) guidelines also delineate treatment by low and high expression of PD-L1 in NSCLC. Thus, studying PD-L1 overexpression levels in the different histological subtypes of lung cancer can affect our approach to treating these patients. There is an evolving role of immunotherapy in the other sub-types of lung cancer, especially small cell lung cancer (SCLC). In addition, within the NSCLC category, squamous cell carcinomas and non-G12C KRAS mutant NSCLC have no specific targetable therapies to date. Therefore, assessment of the PD-L1 expression level among these subtypes of lung cancer is required, since lung cancer is one of the few malignances wherein PD-L1 expression levels is so crucial in determining the role of immunotherapy. In this study, we compared PD-L1 expression in lung cancer according to the histological subtype of the tumor. Full article

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9 pages, 253 KiB

Open AccessEditor’s ChoiceArticle

Extracellular Oxidative Stress Markers in COVID-19 Patients with Diabetes as Co-Morbidity

by Devika Sanil Kumar, Gowtham Hanumanram, Prasanna Karthik Suthakaran, Jagadeesan Mohanan, Lal Devayani Vasudevan Nair and Kannan Rajendran

Clin. Pract. 2022, 12(2), 168-176; https://doi.org/10.3390/clinpract12020021 - 28 Feb 2022

Cited by 13 | Viewed by 3195

Abstract

COVID-19 patients have a higher risk of developing inflammatory responses associated with serious and even fatal respiratory diseases. The role of oxidative stress in exacerbating manifestations in COVID-19 pathogenesis is under-reported.This study aimed touseserum levels of superoxide dismutase (SOD3) and glutathione-S-transferase (GSTp1) by [...] Read more.

COVID-19 patients have a higher risk of developing inflammatory responses associated with serious and even fatal respiratory diseases. The role of oxidative stress in exacerbating manifestations in COVID-19 pathogenesis is under-reported.This study aimed touseserum levels of superoxide dismutase (SOD3) and glutathione-S-transferase (GSTp1) by ELISA, zinc (ErbaChem5), ferritin and free iron (VitrosChemistry, Ortho Clinical Diagnosis, Raritan, NJ, USA) at the first encounter of randomly selected RT-PCR-positive COVID-19 patients, for assessing disease severity. The parameters which helped in identifying the severity, leading to poor prognosis, were neutrophil:lymphocyte higher than 4, high CRP, low SOD3 values and high GSTp1 values, and diabetes mellitus as a co-morbidity. Higher zinc levels correlated with high GSTp1 and low SOD3, indicating the protective effect of zinc on ROS. The increased high GSTp1 shows an anticipated protective biochemical response, to mitigate the low SOD3 values due to ROS consumption. Decreased SOD3 levels indicate a state of high oxidative stress at cellular levels, and an anticipated increase in GSTp1 levels points to the pathophysiological bases of increasing severity with age, sex, and co-morbidities, such asdiabetes. High levels of initial GSTp1 and zinc levels possibly offer protection to redox reactions at the cellular level in severe COVID-19 infection, preventing deterioration. Full article

15 pages, 544 KiB

Open AccessEditor’s ChoiceReview

A Proposal for a National Cancer Control Plan for the UAE: 2022–2026

by Humaid O. Al-Shamsi, Amin M. Abyad and Saeed Rafii

Clin. Pract. 2022, 12(1), 118-132; https://doi.org/10.3390/clinpract12010016 - 17 Feb 2022

Cited by 7 | Viewed by 4960

Abstract

The United Arab Emirates (UAE) is one of the fastest growing economies with consequent increase in non-communicable diseases including cancer. The number of reported cases and mortality have been increasing in the UAE over the years, despite screening and early detection efforts which [...] Read more.

The United Arab Emirates (UAE) is one of the fastest growing economies with consequent increase in non-communicable diseases including cancer. The number of reported cases and mortality have been increasing in the UAE over the years, despite screening and early detection efforts which appear to be far from target coverage of the intended population. In this work, we highlight key elements of a proposed national cancer control plan for the UAE. The plan is still a work in progress and has not yet been officially adopted. A comprehensive and effective control plan requires accurate data, a reliable cancer registry, and periodic monitoring and evaluation. The UAE cancer control plan is being prepared in line with the WHO and EMRO framework, with defined objectives and goals. The objectives are to combat cancer, reduce incidence, control mortality, and improve outcomes and quality of life for cancer patients. There is also a focus on improving public health education, prevention, early detection, prompt diagnosis, treatment facilitation, continuity of care, performance evaluation, training of workforce, and research. Full article

7 pages, 496 KiB

Open AccessEditor’s ChoiceArticle

Can Intentional Weight Loss Ameliorate Sarcopenia in Individuals with Obesity? A Longitudinal Interventional Study

by Hana Tannir, Leila Itani, Dima Kreidieh, Dana El Masri and Marwan El Ghoch

Clin. Pract. 2022, 12(1), 106-112; https://doi.org/10.3390/clinpract12010014 - 17 Feb 2022

Cited by 5 | Viewed by 2844

Abstract

Little remains known regarding the impact of weight loss on sarcopenic obesity (SO), and for this reason we aimed to assess the relationship between the two during a weight management program. Body composition was measured at baseline and six-month follow-up using the Tanita [...] Read more.

Little remains known regarding the impact of weight loss on sarcopenic obesity (SO), and for this reason we aimed to assess the relationship between the two during a weight management program. Body composition was measured at baseline and six-month follow-up using the Tanita BC-418, and step measurements were obtained daily over a period of six months using an Omron HJ-320 pedometer, in 41 adults of both genders with obesity. The participants were then categorized according to the presence or absence of SO. After a significant weight loss, an improvement in the appendicular skeletal mass (ASM) to weight ratio (24.5 ± 3.5 vs. 26.2 ± 3.6, p < 0.01), indicated a decrease in the prevalence of SO by 12.2%. Moreover, these findings were confirmed by logistic regression analysis revealing a significant WL% ≥ 5% combined with an active lifestyle (i.e., ≥8000 steps/day), decreased the risk of SO by 91% (OR = 0.09; 95% CI: 0.02–0.56), after adjusting for age and gender. In conclusion, in a weight management setting, a personalized program for individuals with SO that incorporates new strategies in terms of weight loss and physical activity targets may be adopted to improve the sarcopenia-related index and reduce the prevalence of SO in this population. Full article

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23 pages, 6419 KiB

Open AccessEditor’s ChoiceReview

New Aspects of Sarcomas of Uterine Corpus—A Brief Narrative Review

by Stoyan Kostov, Yavor Kornovski, Vesela Ivanova, Deyan Dzhenkov, Dimitar Metodiev, Rafał Watrowski, Yonka Ivanova, Stanislav Slavchev, Dimitar Mitev and Angel Yordanov

Clin. Pract. 2021, 11(4), 878-900; https://doi.org/10.3390/clinpract11040103 - 22 Nov 2021

Cited by 17 | Viewed by 7792

Abstract

Sarcomas of the uterine corpus are rare malignant neoplasms, which are further classified into mesenchymal tumors, and mixed (epithelial plus mesenchymal) tumors. The main issues concerning these neoplasms are the small number of clinical trials, insufficient data from evidence-based medicine, insignificant interest from [...] Read more.

Sarcomas of the uterine corpus are rare malignant neoplasms, which are further classified into mesenchymal tumors, and mixed (epithelial plus mesenchymal) tumors. The main issues concerning these neoplasms are the small number of clinical trials, insufficient data from evidence-based medicine, insignificant interest from the pharmaceutical industry, all of which close a vicious circle. The low frequency of these malignancies implies insufficient experience in the diagnosis, hence incomplete surgical and complex treatment. Additionally, the rarity of these sarcomas makes it very difficult to develop clinical practice guidelines. Preoperative diagnosis, neoadjuvant and adjuvant chemoradiation, target and hormone therapies still raise many controversies. Disagreements about the role and type of surgical treatment are also often observed in medical literature. There are still insufficient data about the role of pelvic lymph node dissection and fertility-sparing surgery. Pathologists’ experience is of paramount importance for an accurate diagnosis. Additionally, genetics examinations become part of diagnosis in some sarcomas of the uterine corpus. Some gene mutations observed in uterine sarcomas are associated with different outcomes. Therefore, a development of molecular classification of uterine sarcomas should be considered in the future. In this review, we focus on the epidemiology, pathogenesis, pathology, diagnosis and treatment of the following sarcomas of the uterine corpus: leiomyosarcoma, low- and high-grade endometrial stromal sarcomas, undifferentiated sarcoma and adenosarcoma. Uterine carcinosarcomas are excluded as they represent an epithelial tumor rather than a true sarcoma. Full article

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10 pages, 270 KiB

Open AccessEditor’s ChoiceReview

Quantifying Remission Probability in Type 2 Diabetes Mellitus

by Sanjay Kalra, Ganapathi Bantwal, Nitin Kapoor, Rakesh Sahay, Saptarshi Bhattacharya, Beatrice Anne, Raju A Gopal, Sunil Kota, Ashok Kumar, Ameya Joshi, Debmalya Sanyal, Mangesh Tiwaskar and Ashok Kumar Das

Clin. Pract. 2021, 11(4), 850-859; https://doi.org/10.3390/clinpract11040100 - 9 Nov 2021

Cited by 4 | Viewed by 3827

Abstract

Type 2 diabetes mellitus (T2DM) is a chronic progressive disorder and is associated with significant morbidity and mortality. The concept of T2DM remission and the reversal of diabetic parameters to normal levels has been gaining momentum over the past years. T2DM remission is [...] Read more.

Type 2 diabetes mellitus (T2DM) is a chronic progressive disorder and is associated with significant morbidity and mortality. The concept of T2DM remission and the reversal of diabetic parameters to normal levels has been gaining momentum over the past years. T2DM remission is increasingly being recognized by various global guidelines. Multiple models have been developed and validated for quantifying the extent of remission achieved. Based on favorable clinical evidence, T2DM remission can be considered as the therapeutic goal in diabetes management and, in select cases, as an alternative to expensive treatment options, which can be burdensome as T2DM progresses. This narrative review discusses the available strategies, such as lifestyle interventions, physical activity, bariatric surgery, medical nutrition therapy, and non-insulin glucose-lowering medications, for achieving T2DM remission. Although the concept of T2DM remission has emerged as a real-world option, effective implementation in routine clinical practice may not be feasible until long-term studies prove the efficacy of different approaches in this regard. Full article

10 pages, 633 KiB

Open AccessEditor’s ChoiceArticle

Plasmatic Magnesium Deficiency in 101 Outpatients Living with Type 2 Diabetes Mellitus

by Hajer Zahra, Olfa Berriche, Ramla Mizouri, Fatma Boukhayatia, Marwa Khiari, Amel Gamoudi, Ines Lahmar, Nadia Ben Amor, Faten Mahjoub, Souheil Zayet and Henda Jamoussi

Clin. Pract. 2021, 11(4), 791-800; https://doi.org/10.3390/clinpract11040095 - 27 Oct 2021

Cited by 8 | Viewed by 3150

Abstract

(1) Background: Magnesium deficiency is usually associated with type 2 diabetes mellitus (T2DM). Individuals living with T2DM with hypomagnesemia show a more rapid disease progression and have an increased risk for diabetes complications. (2) Methods: This is a cross-sectional and descriptive study in [...] Read more.

(1) Background: Magnesium deficiency is usually associated with type 2 diabetes mellitus (T2DM). Individuals living with T2DM with hypomagnesemia show a more rapid disease progression and have an increased risk for diabetes complications. (2) Methods: This is a cross-sectional and descriptive study in the National Institute of Nutrition and Food Technology of Tunis in Tunisia, including all adult outpatients (≥18 years old) with a diagnosis of T2DM from 1 September 2018 to 31 August 2019. The aim of this study was to evaluate the prevalence of plasmatic magnesium deficiency in a Tunisian population of T2DM and to study the relationship between magnesium status and intake, glycemic control and long-term diabetes-related complications. (3) Results: Among the 101 T2DM outpatients, 13 (12.9%) presented with a plasmatic magnesium deficiency. The mean age was 56 ± 7.9 years with a female predominance (62%, n = 63). The mean of the plasmatic magnesium level was 0.79 ± 0.11 mmol/L (0.5–1.1), and the mean of 24 h urinary magnesium excretion was 87.8 ± 53.8 mg/24 h [4.8–486.2]. HbA1c was significantly higher in the plasmatic magnesium deficiency group than the normal magnesium status group (10% ± 1.3 vs. 8.3% ± 1.9; p = 0.04), with a significant difference in participants with a poor glycemic control (HbA1c > 7%) (100%, n = 13/13 vs. 53%, n = 47/88; p = 0.001). A weak negative relationship was also found between plasmatic magnesium and HbA1c (r = −0.2, p = 0.03). Peripheral artery disease was more commonly described in individuals with low plasmatic magnesium levels than in individuals with normal levels (39%, n = 5 vs. 0%, n = 0; p < 0.001). The mean plasmatic magnesium level in participants without diabetic nephropathy and also peripheral artery disease was significantly higher compared to individuals with each long-term diabetes-related complication (0.8 mmol/L ± 0.1 vs. 0.71 mmol/L ± 0.07; p = 0.006) and (0.8 mmol/L ± 0.1 vs. 0.6 mmol/L ± 0.08; p < 0.001), respectively. (4) Conclusions: Hypomagnesemia was identified in individuals with T2DM, causing poor glycemic control and contributing to the development and progression of diabetes-related microvascular and macrovascular complications. Full article

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7 pages, 1032 KiB

Open AccessEditor’s ChoiceReview

Analysis of the Delta Variant B.1.617.2 COVID-19

by Shayan Shiehzadegan, Nazanin Alaghemand, Michael Fox and Vishwanath Venketaraman

Clin. Pract. 2021, 11(4), 778-784; https://doi.org/10.3390/clinpract11040093 - 21 Oct 2021

Cited by 209 | Viewed by 13200

Abstract

With the delta variant of COVID-19, known as B.1.617.2, quickly ramping up infections around the world, we need to understand what makes this variant more contagious. One study has reported that the delta variant is 60% more transmissible than the alpha variant. As [...] Read more.

With the delta variant of COVID-19, known as B.1.617.2, quickly ramping up infections around the world, we need to understand what makes this variant more contagious. One study has reported that the delta variant is 60% more transmissible than the alpha variant. As of August 2021, the delta variant has quickly become the dominant strain. Despite countries like the US, where most of the population is vaccinated, COVID-19 has made a resurgence in infections. Collectively, as a country, we ask: is it more deadly? What makes it more “contagious” or “transmissible”? This review article delves into the information we already know about the delta variant and how it compares with the other SARS-CoV-2 variants. The current vaccine companies like AstraZeneca, Pfizer/BioNTech, and Moderna have reported that their vaccines can provide protection against this variant but with a slightly reduced efficacy. In this article, we do a comprehensive review and summary of the delta B.1.617.2 variant and what makes it more contagious. Full article

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10 pages, 649 KiB

Open AccessEditor’s ChoiceArticle

Antimicrobial Resistance Patterns and ESBL of Uropathogens Isolated from Adult Females in Najran Region of Saudi Arabia

by Mohammed Yahia Alasmary

Clin. Pract. 2021, 11(3), 650-658; https://doi.org/10.3390/clinpract11030080 - 14 Sep 2021

Cited by 12 | Viewed by 3197

Abstract

Background: To explore the prevalence of urinary tract infections (UTIs) among female patients in the Najran region of Saudi Arabia and determine their antimicrobial resistance pattern. Methods: This study was conducted on 136 urine samples collected from outpatient departments (OPDs) of the different [...] Read more.

Background: To explore the prevalence of urinary tract infections (UTIs) among female patients in the Najran region of Saudi Arabia and determine their antimicrobial resistance pattern. Methods: This study was conducted on 136 urine samples collected from outpatient departments (OPDs) of the different government hospitals in the Najran region of Saudi Arabia. Over one year, the results of susceptibility testing reports of outpatient midstream urine samples from three government hospitals were prospectively evaluated. Results: Of 136 urine samples, only 123 (90.45%) were found to show significant growth for UTIs, from which 23 different uropathogens were identified. Escherichia coli (58.5%) was the most commonly isolated organism, followed by Klebsiella pneumoniae (8.1%). The isolated microorganism showed increased resistance patterns from 3.3% to 62.6%, with an overall resistance of 27.19%. Meropenem was the most effective antimicrobial, followed by amikacin and ertapenem (0.47%, 0.91%, and 1.5% resistance, respectively). At the same time, ampicillin and cephazolin were the least (62.6% and 59.5% resistance, respectively) effective. Overall, eleven (8.94%) uropathogens isolates were ESBLs, among which there were eight (6.5%) Escherichia coli, one (0.81%) Klebsiella pneumoniae, one (0.81%) Klebsiella oxytoca, and one (0.81%) Citrobacter amalonaticus. Conclusions: E. coli remains the most commonly isolated causative uropathogens, followed by Klebsiella species. The prevalence of pathogenic E. coli and Klebsiella species underscores the importance of developing cost-effective, precise, and rapid identification systems to minimize public exposure to uropathogens. Antibiotic susceptibility data revealed that most of the isolates were resistant to the majority of the antibiotics. The patients with UTIs in the Najran region of Saudi Arabia are at a high risk of antibiotic resistance, leading to significant problems in outpatient department (OPD) treatment outcomes and raising the alarm for the physician to change their empiric treatment. Full article

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10 pages, 1162 KiB

Open AccessEditor’s ChoiceCase Report

Diagnostic and Therapeutic Challenges of Cerebral Venous Thrombosis in SARS-CoV-2 Infection: A Case Report and Review of Literature

by Faisal Khan, Neha Sharma, Moin Ud Din and Ryan Chetram

Clin. Pract. 2021, 11(3), 598-606; https://doi.org/10.3390/clinpract11030075 - 7 Sep 2021

Cited by 4 | Viewed by 4225

Abstract

Headache, a common prodromal symptom of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, can also be a manifestation of cerebral venous thrombosis (CVT), secondary to COVID-19. CVT management continues to evolve, with direct oral anticoagulants (DOACs) emerging as an alternative to [...] Read more.

Headache, a common prodromal symptom of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, can also be a manifestation of cerebral venous thrombosis (CVT), secondary to COVID-19. CVT management continues to evolve, with direct oral anticoagulants (DOACs) emerging as an alternative to warfarin. A 44-year-old Asian female, with no past medical history, presented to the emergency room (ER) with complaints of nonproductive cough and left-sided headache. She denied a history of COVID-19 vaccination, and SARS-CoV-2 testing (with reverse transcriptase-polymerase chain reaction) was positive. Non-contrast computed tomography (CT) of the head revealed left transverse sinus hyperdensity, consistent with dense vein sign, and magnetic resonance venography (MRV) confirmed the presence of thrombus. The initial treatment included subcutaneous enoxaparin with headache resolution, and she was discharged on apixaban. Five weeks later, a non-contrast head CT showed resolution of the dense vein sign and recanalisation of left transverse sinus was seen on MRV. This report has highlighted the need for increased awareness of coagulopathy and thrombotic events, including cerebral venous thrombosis, in patients infected with SARS-CoV-2. Unremitting headache, in context of SARS-CoV-2 infection, should be evaluated with appropriate neurovascular imaging. Controlled studies are required to compare the safety and efficacy of DOACs with warfarin for management of cerebral venous thrombosis. Full article

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11 pages, 1015 KiB

Open AccessEditor’s ChoiceArticle

Postoperative Neutrophil to Lymphocyte Ratio as an Overall Mortality Midterm Prognostic Factor following OPCAB Procedures

by Tomasz Urbanowicz, Michał Michalak, Aleksandra Gąsecka, Bartłomiej Perek, Michał Rodzki, Michał Bociański, Ewa Straburzyńska-Migaj and Marek Jemielity

Clin. Pract. 2021, 11(3), 587-597; https://doi.org/10.3390/clinpract11030074 - 3 Sep 2021

Cited by 15 | Viewed by 2578

Abstract

Background: Off-pump coronary artery bypass grafting (OPCAB) is believed to limit inflammatory reaction. Neutrophil to lymphocyte ratio (NLR) is one of the more common and easily accessible markers of inflammatory response. The aim of the study was to compare postoperative results of NLR [...] Read more.

Background: Off-pump coronary artery bypass grafting (OPCAB) is believed to limit inflammatory reaction. Neutrophil to lymphocyte ratio (NLR) is one of the more common and easily accessible markers of inflammatory response. The aim of the study was to compare postoperative results of NLR with mid-term OPCAB results. Methods: In total, 224 patients (198 (88%) men and 26 (12%) women) with mean age 65 +/− 9 years who underwent OPCAB though median full sternotomy in our department in 2018 enrolled into the study. We scrupulously collected the postoperative mid-term results, including survival rate, clinical status and risk for major adverse events, and compared them with perioperative laboratory results. Results: A three-year follow-up was completed by 198 individuals (90% survival rate) with 12 (5%) showing major adverse cardiovascular (MACE) events risk. In the multivariable analysis, the laboratory parameters noticed on the 1st postoperative day were statistically significantly predictive of survival, including neutrophils (HR 1.59, 1.33–1.89 95%CI, p < 0.0001), platelets (HR 1.01, 1.01–1.01 95%CI, p = 0.0065), NLR (HR 1.47, 1.3–1.65 95%CI, p < 0.0001) and postoperative ejection fraction (HR 0.9, 0.87–0.95 95%CI, p < 0.0001). Conclusions: Postoperative NLR above 4.6, as an inflammatory reaction marker, is related to mid-term mortality in OPCAB patients. Full article

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18 pages, 300 KiB

Open AccessEditor’s ChoiceReview

An Expert Opinion on “Glycemic Happiness”: Delineating the Concept and Determinant Factors for Persons with Type 2 Diabetes Mellitus

by Sanjay Kalra, Ashok Kumar Das, Gagan Priya, Ameya Joshi, Hitesh Punyani, Nareen Krishna and Kumar Gaurav

Clin. Pract. 2021, 11(3), 543-560; https://doi.org/10.3390/clinpract11030071 - 20 Aug 2021

Cited by 4 | Viewed by 3137

Abstract

The importance of the psychological impact of diabetes is globally well-documented. Evidence suggests that there is a high level of psychosocial burden of diabetes in India. Moreover, there is a lack of relevant knowledge among the patients and caregivers regarding the psychological impact [...] Read more.

The importance of the psychological impact of diabetes is globally well-documented. Evidence suggests that there is a high level of psychosocial burden of diabetes in India. Moreover, there is a lack of relevant knowledge among the patients and caregivers regarding the psychological impact of diabetes and how to cope with it, as compared to the majority of other countries. “Happiness of the patient” is an essential component of diabetes management, which potentially affects the treatment outcome, treatment adherence, self-care, and lifelong management of diabetes. Although several validated tools and scales exist for measuring psychological outcomes both in patients and physicians, tools to assess “happiness in diabetes care” are still lacking. With this background, an expert group meeting was held in India in September 2019, involving nine expert diabetologists and endocrinologists across the country to discuss the concept of “glycemic happiness”. This article summarizes the expert opinion on the factors affecting psychological outcomes in diabetes, introduces the concept of glycemic happiness, describes available scales and tools to measure general happiness, and delineates the five sets of questionnaires developed with questions that may help correlate with “glycemic happiness”. The questionnaires are based on a five-point Likert method. The experts also discussed and decided upon the study design for a proposed observational survey to assess glycemic happiness of persons with type 2 diabetes mellitus (T2DM) based on the developed five sets of questionnaires. Given the huge burden of diabetes in India, the introduction of the concept of glycemic happiness will help in the optimization of diabetes care in the country. Full article

7 pages, 484 KiB

Open AccessEditor’s ChoiceArticle

The Relationship between Sarcopenic Obesity, Weight-Loss and Maintenance Outcomes during Obesity Management: Are Additional Strategies Required?

by Dana El Masri, Leila Itani, Hana Tannir, Dima Kreidieh and Marwan El Ghoch

Clin. Pract. 2021, 11(3), 525-531; https://doi.org/10.3390/clinpract11030069 - 18 Aug 2021

Cited by 7 | Viewed by 3158

Abstract

The lack of long-term maintenance of the weight loss achieved during weight-management programs is the major cause of failure in obesity treatments. The identification of factors related to this outcome has clinical implications. Therefore, we aimed to assess the relationship between sarcopenic obesity [...] Read more.

The lack of long-term maintenance of the weight loss achieved during weight-management programs is the major cause of failure in obesity treatments. The identification of factors related to this outcome has clinical implications. Therefore, we aimed to assess the relationship between sarcopenic obesity (SO) and the weight-loss percentage (WL%). The WL% was measured at the six-month follow-up and after more than 12 months, in 46 adult participants with obesity, during an individualized weight-management program where participants were categorized as having or not having SO at the baseline. At the six-month follow-up, participants with SO did not display a significant difference in terms of WL%, when compared to those without SO (−10.49 ± 5.75% vs. −12.73 ± 4.30%; p = 0.148). However, after a longer term (i.e., >12 months), the WL% appeared to be significantly lower in the former (SO vs. non-SO) (−7.34 ± 6.29% vs. −11.43 ± 4.31%; p = 0.024). In fact, partial correlation analysis revealed a relationship between SO at the baseline and a lower WL% after more than 12 months (ρ = −0.425, p = 0.009), after controlling for age, sex, and body mass index (BMI). Participants with SO appeared to face more difficulties in maintaining the achieved WL over a longer term (>12 months follow-up) by comparison with their counterparts (i.e., non-SO). Should this finding be replicated in larger-sample studies, new strategies should be adopted for these patients in order to improve this clinical outcome, especially during the weight-maintenance phase. Full article

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11 pages, 783 KiB

Open AccessEditor’s ChoiceArticle

Prevalence and Characteristics of Thyroid Abnormalities and Its Association with Anemia in ASIR Region of Saudi Arabia: A Cross-Sectional Study

by Saif Aboud M. Alqahtani

Clin. Pract. 2021, 11(3), 494-504; https://doi.org/10.3390/clinpract11030065 - 6 Aug 2021

Cited by 17 | Viewed by 4086

Abstract

The thyroid gland plays a significant role in the metabolism and proliferation of blood cells; hematological disorders are frequently observed in patients with thyroid disorders, and the most frequent problem is anemia. The main objective of this research work is to evaluate the [...] Read more.

The thyroid gland plays a significant role in the metabolism and proliferation of blood cells; hematological disorders are frequently observed in patients with thyroid disorders, and the most frequent problem is anemia. The main objective of this research work is to evaluate the prevalence and types of thyroid dysfunction and their association with anemia in different gender stratified by age in the Asir region of Saudi Arabia. Four years of data from July 2016 to July 2020 for 9992 study subjects were collected. Statistical analysis was performed based on thyroid disorder and anemia stratified by gender and age subgroup. The mean age of the study subject was 43.4 ± 15.8 years, and females constituted 61.7% of cases. Thyroid dysfunction was observed in 49.76% (4973), and subclinical hypothyroidism was the most prevalent type (3922/9992), followed by primary hypothyroidism (530/9992). Females have a significantly higher overall prevalence of thyroid dysfunction than males (p < 0.05). Anemia was detected in 1344 females and 465 males with a thyroid disorder, and also, the prevalence was significantly higher (p < 0.05), compared to the normal thyroid group. Thyroid disorders are a common problem in our population, more prevalent in females than males, with the peak age of above 30 years, and are associated with an increased prevalence of anemia. Full article

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20 pages, 2819 KiB

Open AccessEditor’s ChoiceReview

Radiation-Induced Lung Injury—Current Perspectives and Management

by Mandeep Singh Rahi, Jay Parekh, Prachi Pednekar, Gaurav Parmar, Soniya Abraham, Samar Nasir, Rajamurugan Subramaniyam, Gini Priyadharshini Jeyashanmugaraja and Kulothungan Gunasekaran

Clin. Pract. 2021, 11(3), 410-429; https://doi.org/10.3390/clinpract11030056 - 1 Jul 2021

Cited by 30 | Viewed by 8769

Abstract

Radiotherapy plays an important role in the treatment of localized primary malignancies involving the chest wall or intrathoracic malignancies. Secondary effects of radiotherapy on the lung result in radiation-induced lung disease. The phases of lung injury from radiation range from acute pneumonitis to [...] Read more.

Radiotherapy plays an important role in the treatment of localized primary malignancies involving the chest wall or intrathoracic malignancies. Secondary effects of radiotherapy on the lung result in radiation-induced lung disease. The phases of lung injury from radiation range from acute pneumonitis to chronic pulmonary fibrosis. Radiation pneumonitis is a clinical diagnosis based on the history of radiation, imaging findings, and the presence of classic symptoms after exclusion of infection, pulmonary embolism, heart failure, drug-induced pneumonitis, and progression of the primary tumor. Computed tomography (CT) is the preferred imaging modality as it provides a better picture of parenchymal changes. Lung biopsy is rarely required for the diagnosis. Treatment is necessary only for symptomatic patients. Mild symptoms can be treated with inhaled steroids while subacute to moderate symptoms with impaired lung function require oral corticosteroids. Patients who do not tolerate or are refractory to steroids can be considered for treatment with immunosuppressive agents such as azathioprine and cyclosporine. Improvements in radiation technique, as well as early diagnosis and appropriate treatment with high-dose steroids, will lead to lower rates of pneumonitis and an overall good prognosis. Full article

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5 pages, 838 KiB

Open AccessEditor’s ChoiceCase Report

A Rare Cause of Drug-Induced Pancytopenia: Trimethoprim–Sulfamethoxazole-Induced Pancytopenia

by Khalid Sawalha, Philip T. Sobash and Gilbert-Roy Kamoga

Clin. Pract. 2021, 11(2), 358-362; https://doi.org/10.3390/clinpract11020050 - 3 Jun 2021

Cited by 4 | Viewed by 4662

Abstract

Pancytopenia is a decrease across cellular hematological lines. Many different etiologies can cause this clinical picture including viral and bacterial infections, chemicals, malignancy, and medications. Particular attention should be paid to the onset, timing, and severity as they can indicate the underlying cause. [...] Read more.

Pancytopenia is a decrease across cellular hematological lines. Many different etiologies can cause this clinical picture including viral and bacterial infections, chemicals, malignancy, and medications. Particular attention should be paid to the onset, timing, and severity as they can indicate the underlying cause. In cases of iatrogenic-induced pancytopenia, the offending agent should be stopped immediately and the patient should be monitored for recovery of cell lines. While not well reported in the literature, trimethoprim–sulfamethoxazole (TMP-SMX) is a cause of pancytopenia. We present a case of drug-induced pancytopenia secondary to TMP-SMX that resolved quickly with cessation of use. Full article

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13 pages, 838 KiB

Open AccessEditor’s ChoiceCase Report

Analysis of COVID-19 on Diagnosis, Vaccine, Treatment, and Pathogenesis with Clinical Scenarios

by Daniel Tellez, Sujay Dayal, Phong Phan, Ajinkya Mawley, Kush Shah, Gabriel Consunji, Cindy Tellez, Kimberly Ruiz, Rutuja Sabnis, Surbi Dayal and Vishwanath Venketaraman

Clin. Pract. 2021, 11(2), 309-321; https://doi.org/10.3390/clinpract11020044 - 19 May 2021

Cited by 7 | Viewed by 3254

Abstract

As the world continues to suffer from an ever-growing number of confirmed cases of the SARS-CoV-2 novel coronavirus, researchers are at the forefront of developing the best plan to overcome this pandemic through analyzing the pathogenesis, prevention, and treatment options pertaining to the [...] Read more.

As the world continues to suffer from an ever-growing number of confirmed cases of the SARS-CoV-2 novel coronavirus, researchers are at the forefront of developing the best plan to overcome this pandemic through analyzing the pathogenesis, prevention, and treatment options pertaining to the virus. In the midst of a pandemic, the main route for detection of the virus has been conducting antigen tests for rapid results, using qRT-PCR, and conducting more accurate molecular tests, using rRT-PCR, on samples from patients. Most common treatments for those infected with COVID-19 include Remdesivir, an antiviral, dexamethasone, a steroid, and rarely, monoclonal antibody treatments. Although these treatments exist and are used commonly in hospitals all around the globe, clinicians often challenge the efficacy and benefit of these remedies for the patient. Furthermore, targeted therapies largely focus on interfering with or reducing the binding of viral receptors and host cell receptors affected by the SARS-CoV-2 novel coronavirus. In addition to treatment, the most efficacious method of preventing the spread of COVID-19 is the development of multiple vaccines that have been distributed as well as the development of multiple vaccine candidates that are proving hopeful in preventing severe symptoms of the virus. The exaggerated immune response to the virus proves to be a worrying complication due to widespread inflammation and subsequent clinical sequela. The medical and scientific community as a whole will be expected to respond with the latest in technology and research, and further studies into the pathogenesis, clinical implications, identification, diagnosis, and treatment of COVID-19 will push society past this pandemic. Full article

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15 pages, 1081 KiB

Open AccessEditor’s ChoiceReview

Impact of Oral Lichen Planus on Oral Health-Related Quality of Life: A Systematic Review and Meta-Analysis

by Monal Yuwanati, Shailesh Gondivkar, Sachin C. Sarode, Amol Gadbail, Gargi S. Sarode, Shankargouda Patil and Shubhangi Mhaske

Clin. Pract. 2021, 11(2), 272-286; https://doi.org/10.3390/clinpract11020040 - 7 May 2021

Cited by 16 | Viewed by 3570

Abstract

Oral health-related quality of life (OR-QoL) measurement in patients with oral lichen planus (OLP) can provide valuable information for the optimal management of their clinical conditions. The main objective of the present study was to assess the OR-QoL of patients with OLP as [...] Read more.

Oral health-related quality of life (OR-QoL) measurement in patients with oral lichen planus (OLP) can provide valuable information for the optimal management of their clinical conditions. The main objective of the present study was to assess the OR-QoL of patients with OLP as measured by the short-form Oral Health Impact profile-14 (OHIP-14) questionnaire. PubMed/MEDLINE, ISI/Web of Science, clinical trial registry, Embase, Scopus, and grey literature (via Google Scholar and Scilit) were searched. Reviewers independently screened titles/abstracts, assessed full-text articles, extracted data, and appraised their quality. Random effect analysis along with subgroup analysis for age, gender, and clinical type was performed. Seventeen studies were included. Mean overall OH-QoL was 15.20, [95% CI 12.176, 18.231]; a higher OHIP-14 score was seen in OLP patients, resulting in poor OH-QoL. The impact of OLP on OH-QoL life was moderate as compared to healthy subjects. However, medical treatment of the disease improved the OH-QoL and thus reduced the impact of OLP on it. OH-QoL among patients with OLP is generally poor. Clinicians and physicians should consider the OH-QoL of these patients as part of patients’ evaluation and modulate the administered treatment based on the OH-QoL response. Full article

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5 pages, 2095 KiB

Open AccessEditor’s ChoiceCase Report

White Nail as a Static Physical Finding: Revitalization of Physical Examination

by Ryuichi Ohta and Chiaki Sano

Clin. Pract. 2021, 11(2), 241-245; https://doi.org/10.3390/clinpract11020036 - 1 May 2021

Cited by 4 | Viewed by 2346

Abstract

Physical examinations are critical for diagnosis and should be differentiated into static and dynamic categories. One of the static findings is white nail, such as Terry’s and Lindsay’s nails. Here, we report the cases of two older patients with acute diseases who had [...] Read more.

Physical examinations are critical for diagnosis and should be differentiated into static and dynamic categories. One of the static findings is white nail, such as Terry’s and Lindsay’s nails. Here, we report the cases of two older patients with acute diseases who had nail changes that aided evaluation of their clinical course. Two elderly women who presented with acute conditions were initially thought to have normal serum albumin levels. They were found to have white nail with differences in nail involvement of the first finger, which subsequently revealed their hypoalbuminemia. The clinical courses were different following the distribution of nail whitening. Our findings show that examination of a white nail could indicate the previous clinical status more clearly than laboratory data. It can be useful for evaluating preclinical conditions in patients with acute diseases. Further evaluation is needed to establish the relationship between clinical outcomes and the presence of white nail in acute conditions among older patients. Full article

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11 pages, 2475 KiB

Open AccessEditor’s ChoiceReview

Malignant Phyllodes Tumor of the Breast: A Practice Review

by Ângelo Bezerra de Souza Fede, Ronaldo Pereira Souza, Mauricio Doi, Marina De Brot, Cynthia Aparecida Bueno de Toledo Osorio, Guilherme Rocha Melo Gondim, Jose Claudio Casali-da-Rocha, Rima Jbili, Almir Galvao Vieira Bitencourt, Juliana Alves de Souza, Rafael Caparica Bitton, Fabiana Baroni Alves Makdissi and Solange Moraes Sanches

Clin. Pract. 2021, 11(2), 205-215; https://doi.org/10.3390/clinpract11020030 - 6 Apr 2021

Cited by 11 | Viewed by 7706

Abstract

Introduction: Phyllodes tumor (PT) of the breast, particularly malignant phyllodes tumor (mPT), is a rare fibroepithelial neoplasm. A complex diagnosis is based on pathologic, radiologic, and clinical findings, with controversies about what is the best therapeutic strategy. Objective: Our objective was to provide [...] Read more.

Introduction: Phyllodes tumor (PT) of the breast, particularly malignant phyllodes tumor (mPT), is a rare fibroepithelial neoplasm. A complex diagnosis is based on pathologic, radiologic, and clinical findings, with controversies about what is the best therapeutic strategy. Objective: Our objective was to provide an overview of the clinical, pathologic, and therapeutic aspects of this rare tumor. Conclusions: mPT is a rare presentation of breast cancer and a challenge in clinical practice. A multidisciplinary approach should take into account some aspects like pathogenic mutations and hereditary syndromes. Oncologic surgery is the fundamental approach, and the use of adjuvant therapies is still controversial due to the lack of clinical trials. Treatment recommendations should be individualized according to patient risk and preferences. Prospective studies are fundamental to clarifying the best treatment for these tumors. Full article

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11 pages, 253 KiB

Open AccessEditor’s ChoiceCase Report

COVID-19 Patient with Severe Comorbidity in Multimodal Acute Care Setting with Non-Invasive Medical Ventilation: A Clinical Outcome Report

by Tobias Romeyke, Elisabeth Noehammer and Harald Stummer

Clin. Pract. 2021, 11(1), 81-91; https://doi.org/10.3390/clinpract11010013 - 3 Feb 2021

Cited by 4 | Viewed by 2704

Abstract

The virus that causes COVID-19 is rapidly spreading across the globe. Elderly patients with multiple pre-existing conditions are at a higher risk. This case study describes acute inpatient treatment of a COVID-19 patient with uncontrolled diabetes mellitus, kidney complications, heart failure, chronic pain, [...] Read more.

The virus that causes COVID-19 is rapidly spreading across the globe. Elderly patients with multiple pre-existing conditions are at a higher risk. This case study describes acute inpatient treatment of a COVID-19 patient with uncontrolled diabetes mellitus, kidney complications, heart failure, chronic pain, depression, and other comorbidities in an isolation ward without mechanical ventilation. Full article

10 pages, 707 KiB

Open AccessEditor’s ChoiceReview

A Structured Approach to Skin and Soft Tissue Infections (SSTIs) in an Ambulatory Setting

by Benjamin Silverberg

Clin. Pract. 2021, 11(1), 65-74; https://doi.org/10.3390/clinpract11010011 - 1 Feb 2021

Cited by 25 | Viewed by 10352

Abstract

The skin is the largest, and arguably, the most vulnerable organ in the human body. Scratches and scrapes, bites and puncture wounds, impetigo and erysipelas—all these disruptions can lead to pain, swelling, and/or systemic symptoms. In this article, which is based on the [...] Read more.

The skin is the largest, and arguably, the most vulnerable organ in the human body. Scratches and scrapes, bites and puncture wounds, impetigo and erysipelas—all these disruptions can lead to pain, swelling, and/or systemic symptoms. In this article, which is based on the Infectious Diseases Society of America’s 2014 guidelines and the World Society of Emergency Surgery and Surgical Infection Society of Europe’s 2018 consensus statement, a structured approach to skin and soft tissue infections (SSTIs) is reviewed, comparing treatment for suppurative and non-suppurative infections, and then discussing specific conditions commonly seen in Primary Care and Urgent Care facilities. Full article

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6 pages, 1861 KiB

Open AccessEditor’s ChoiceCase Report

Post-Operative Superior Mesenteric Artery Syndrome Following Retroperitoneal Sarcoma Resection

by Liam H. Wong, Thomas L. Sutton, Ryan G. Spurrier, Andrew F. Zigman and Skye C. Mayo

Clin. Pract. 2021, 11(1), 2-7; https://doi.org/10.3390/clinpract11010002 - 24 Dec 2020

Cited by 5 | Viewed by 4407

Abstract

Superior mesenteric artery (SMA) syndrome is an uncommon phenomenon caused by the compression of the third portion of the duodenum between the aorta and the SMA. Here, we present a previously healthy 15-year-old male who presented with early satiety and 20 kg weight [...] Read more.

Superior mesenteric artery (SMA) syndrome is an uncommon phenomenon caused by the compression of the third portion of the duodenum between the aorta and the SMA. Here, we present a previously healthy 15-year-old male who presented with early satiety and 20 kg weight loss. Computed tomography (CT) demonstrated a massive retroperitoneal liposarcoma displacing the entire small intestine into the right upper quadrant. Following resection of the large mass, the patient was intolerant of oral intake despite evidence of bowel function. Abdominal CT revealed a narrowing of the duodenum at the location of the SMA. A nasojejunal feeding tube was placed past this area, and enteral nutrition was initiated before slowly resuming oral intake. Post-operative SMA syndrome is an uncommon complication but should be considered in patients intolerant of oral intake following resection of large abdominal tumors associated with extensive retroperitoneal fat loss, even in the absence of concomitant major visceral resection. Full article

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333 KiB

Open AccessEditor’s ChoiceCase Report

Severe Immune Thrombocytopenia Induced by a Single Dose of Nivolumab in a Patient with Advanced Non-Small Cell Lung Cancer

by Adam Khorasanchi and Roger Keresztes

Clin. Pract. 2020, 10(2), 1249; https://doi.org/10.4081/cp.2020.1249 - 17 Jun 2020

Cited by 4 | Viewed by 1045

Abstract

Nivolumab-induced immune thrombocytopenia (ITP) is a rare process with few reported cases. We present a 67-year-old man with advanced non-small cell lung cancer who was hospitalized with severe thrombocytopenia. Physical exam was notable for petechiae across his chest and extremities as well as [...] Read more.

Nivolumab-induced immune thrombocytopenia (ITP) is a rare process with few reported cases. We present a 67-year-old man with advanced non-small cell lung cancer who was hospitalized with severe thrombocytopenia. Physical exam was notable for petechiae across his chest and extremities as well as bullae in his oral cavity. The patient initially received high-dose glucocorticoids and intravenous immuno - globulin, but did not respond to treatment. He was then started on weekly rituximab and after three doses, there was complete resolution of his thrombocytopenia. Altogether, his presentation was an extreme case and rare side effect of immune checkpoint therapy, known as nivolumab-induced ITP. Diagnosis of nivolumab-induced ITP is challenging given the lack of specific testing and a wide differential diagnosis. There are few cases reporting severe ITP following nivolumab treatment. We highlight the importance of recognizing and treating this rare complication of immunotherapy. Full article

392 KiB

Open AccessEditor’s ChoiceBrief Report

COVID-19: Hemoglobin, Iron, and Hypoxia beyond Inflammation. A Narrative Review

by Attilio Cavezzi, Emidio Troiani and Salvatore Corrao

Clin. Pract. 2020, 10(2), 1271; https://doi.org/10.4081/cp.2020.1271 - 28 May 2020

Cited by 297 | Viewed by 11452

Abstract

Coronavirus disease-19 (COVID-19) has been regarded as an infective-inflammatory disease, which affects mainly lungs. More recently, a multi-organ involvement has been highlighted, with different pathways of injury. A hemoglobinopathy, hypoxia and cell iron overload might have a possible additional role. Scientific literature has [...] Read more.

Coronavirus disease-19 (COVID-19) has been regarded as an infective-inflammatory disease, which affects mainly lungs. More recently, a multi-organ involvement has been highlighted, with different pathways of injury. A hemoglobinopathy, hypoxia and cell iron overload might have a possible additional role. Scientific literature has pointed out two potential pathophysiological mechanisms: i) severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) interaction with hemoglobin molecule, through CD147, CD26 and other receptors located on erythrocyte and/or blood cell precursors; ii) hepcidin-mimetic action of a viral spike protein, inducing ferroportin blockage. In this translational medicine-based narrative review, the following pathologic metabolic pathways, deriving from hemoglobin denaturation and iron metabolism dysregulation, are highlighted: i) decrease of functioning hemoglobin quote; ii) iron overload in cell/tissue (hyperferritinemia); iii) release of free toxic circulating heme; iv) hypoxemia and systemic hypoxia; v) reduction of nitric oxide; vi) coagulation activation; vii) ferroptosis with oxidative stress and lipoperoxidation; viii) mitochondrial degeneration and apoptosis. A few clinical syndromes may follow, such as pulmonary edema based on arterial vasoconstriction and altered alveolo-capillary barrier, sideroblastic-like anemia, endotheliitis, vasospastic acrosyndrome, and arterio- venous thromboembolism. We speculated that in COVID-19, beyond the classical pulmonary immune-inflammation view, the occurrence of an oxygen-deprived blood disease, with iron metabolism dysregulation, should be taken in consideration. A more comprehensive diagnostic/therapeutic approach to COVID-19 is proposed, including potential adjuvant interventions aimed at improving hemoglobin dysfunction, iron over-deposit and generalized hypoxic state. Full article

413 KiB

Open AccessEditor’s ChoiceBrief Report

Chiropractic Rehabilitation Plus Nighttime Bracing for Progressive Adolescent Idiopathic Scoliosis: A Case-Controlled Series

by Mark Morningstar and Dan Oslin

Clin. Pract. 2019, 9(4), 1191; https://doi.org/10.4081/cp.2019.1191 - 18 Mar 2020

Cited by 2 | Viewed by 1538

Abstract

Non-operative treatments for scoliosis include various types of scoliosis-specific exercise therapies, as well as dynamic and rigid spinal orthoses. Although there are many studies evaluating various types of bracing-only constructs for scoliosis treatment, few have evaluated bracing when combined with chiropractic care. The [...] Read more.

Non-operative treatments for scoliosis include various types of scoliosis-specific exercise therapies, as well as dynamic and rigid spinal orthoses. Although there are many studies evaluating various types of bracing-only constructs for scoliosis treatment, few have evaluated bracing when combined with chiropractic care. The present study analyzed the data of 18 patients from the initiation a chiropractic rehabilitation program combined with nighttime bracing. Patients were managed through the end of growth, and results were compared to baseline. Their collective results were compared to a similar group of previously published patients who participated in the same chiropractic rehabilitation program, but did not perform concurrent bracing treatment. Patients initiating the combined chiropractic and bracing treatment achieved a correction of 6° or more 81% of the time, while the remaining 19% remained within 5° of their baseline measurements. The average curve improvement was 9.4°. This was compared to a correction rate of 51.7%, a stabilization rate of 38.3%, and a progression rate of 10% in the group performing chiropractic rehabilitation only. Full article

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