Clinics and Practice

22 pages, 2219 KiB

Open AccessSystematic Review

Biochemical Mechanisms and Rehabilitation Strategies in Osteoporosis-Related Pain: A Systematic Review

by Giorgia Natalia Iaconisi, Rachele Mancini, Vincenzo Ricci, Danilo Donati, Cristiano Sconza, Riccardo Marvulli, Maurizio Ranieri, Marisa Megna, Giustino Varrassi, Simone Della Tommasa, Andrea Bernetti, Loredana Capobianco and Giacomo Farì

Clin. Pract. 2024, 14(6), 2737-2758; https://doi.org/10.3390/clinpract14060216 - 19 Dec 2024

Abstract

Background/Objectives: Osteoporosis causes a bone mass reduction and often determines acute and chronic pain. Understanding the biochemical and neurophysiological mechanisms behind this pain is crucial for developing new, effective rehabilitative and therapeutic approaches. This systematic review synthesizes recent advances in muscle–bone interactions and [...] Read more.

Background/Objectives: Osteoporosis causes a bone mass reduction and often determines acute and chronic pain. Understanding the biochemical and neurophysiological mechanisms behind this pain is crucial for developing new, effective rehabilitative and therapeutic approaches. This systematic review synthesizes recent advances in muscle–bone interactions and molecular pathways related to osteoporosis-associated pain. Methods: We carried out a systematic review including studies published from 2018 to 2024 using PubMed, Scopus, clinicaltrials.gov and Cochrane Library. The Cochrane Collaboration tool was used to assess bias risk. The review adhered to PRISMA guidelines and is registered with PROSPERO (CRD42024574456); Results: Thirteen studies were included. It emerged that osteoporosis causes progressive bone loss due to disruptions in biochemical processes and muscle–bone interactions. This condition is also closely associated with the development of pain, both acute and chronic. Key findings include the role of the miR-92a-3p/PTEN/AKT pathway and the impact of muscle–bone disconnection on bone health. Mechanotransduction is critical for bone maintenance. Effective pain management and rehabilitation strategies include physical therapy and physical exercise, yoga, Pilates, and cognitive behavioral therapy (CBT); they all improve pain relief and functional outcomes by enhancing muscle strength, flexibility, and balance. Pharmacological options such as NSAIDs, opioids, and new agents like SHR-1222, along with surgical interventions like percutaneous vertebroplasty, offer additional pain reduction, especially when included in individualized rehabilitation projects; Conclusions: This review highlights advancements in understanding osteoporotic pain mechanisms and identifies promising treatments. Integrating targeted therapies and rehabilitation strategies can enhance patients’ pain relief. Full article

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

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12 pages, 4623 KiB

Open AccessArticle

Microbial Spectrum, Intraoperative Findings, and Postoperative Outcomes in Native Knee Joint Infections: A Retrospective Analysis

by Jonas Roos, Britta Mangels, Max Jaenisch, Matthias Dominik Wimmer, Thomas Martin Randau, Christian Prangenberg, Kristian Welle and Martin Gathen

Clin. Pract. 2024, 14(6), 2725-2736; https://doi.org/10.3390/clinpract14060215 - 16 Dec 2024

Abstract

Background: Native knee joint infections, while uncommon, present a serious condition predominantly instigated by bacteria such as Staphylococcus aureus. Without timely intervention, they can result in joint destruction or sepsis, with risk factors encompassing preexisting medical conditions and iatrogenic procedures. The diagnostic [...] Read more.

Background: Native knee joint infections, while uncommon, present a serious condition predominantly instigated by bacteria such as Staphylococcus aureus. Without timely intervention, they can result in joint destruction or sepsis, with risk factors encompassing preexisting medical conditions and iatrogenic procedures. The diagnostic process includes a comprehensive patient history, clinical evaluation, laboratory testing, imaging studies, and microbiological investigations. Treatment typically involves joint aspiration and arthroscopy. This study aims to examine and establish correlations between diagnostic criteria and treatment modalities, enhancing the speed and specificity of future therapeutic strategies. Materials and methods: The present study is a retrospective cohort study conducted at a 1200-bed university clinic between 2007 and 2017, with an in-depth examination of patient details, symptoms, treatments, and outcomes. A scoring system was developed to classify the severity of knee joint impairment, categorizing patients on the basis of hospital stay duration, surgeries, and postoperative factors such as recurring symptoms, pain, and range of motion. Results: This study of 116 patients with knee joint infections revealed that clinical symptoms such as pain, swelling, and effusion are common but not definitive for diagnosis. Laboratory analysis revealed no significant differences in CRP or leukocyte counts between cultures positive or negative for pathogens. Hospital stay and disease severity are influenced by factors such as age, sex, presence of polyarthritis, neutrophil count, and type of pathogen, with higher weight and cortisone treatment associated with poorer outcomes. Conclusions: This study highlights the diagnostic challenges in native knee joint infections, revealing the need for comprehensive approaches given the nonspecificity of clinical symptoms and laboratory findings. This underscores the importance of advancing research through standardized methodologies and prospective studies to increase the accuracy of diagnosis and the effectiveness of treatment in this field. Full article

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

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12 pages, 235 KiB

Open AccessProtocol

Methodology for a Series of Rapid Reviews on Virtual Care in Rehabilitation, Reviewing Its Advantages and Challenges to Inform Best Practices

by Jennifer Sigouin, Anne Hudon, Mirella Veras, Simon Beaulieu-Bonneau, Sabrina Cavallo and Dahlia Kairy

Clin. Pract. 2024, 14(6), 2713-2724; https://doi.org/10.3390/clinpract14060214 - 13 Dec 2024

Abstract

Background/Objective: Over the past two decades, the utilization of virtual care in rehabilitation has witnessed a significant surge; this is owing to the widespread availability of technological tools and the global impact of the COVID-19 pandemic. As a result, discussions surrounding the [...] Read more.

Background/Objective: Over the past two decades, the utilization of virtual care in rehabilitation has witnessed a significant surge; this is owing to the widespread availability of technological tools and the global impact of the COVID-19 pandemic. As a result, discussions surrounding the relevance and benefits of telerehabilitation have gained prominence among practitioners, who continually seek to enhance patient care while maintaining high standards of quality. Associated with these discussions are concerns over being able to provide care in an ethical way, as well as addressing equity issues that might be hindered or improved via telerehabilitation. To address the ethical and equity concerns around telerehabilitation, a series of five parallel rapid reviews of the scientific literature were conducted, focusing on different rehabilitation fields: physiotherapy and occupational therapy (1); speech therapy and audiology (2); psychology and neuropsychology (3); and in two age groups: older adults (4); and pediatrics and young adults (5). The objective of this series of rapid reviews is to evaluate the evidence presented regarding telerehabilitation; identifying and recommending best practices especially in the realm of ethics and equity. Methods: Medline; CINAHL; and EMBASE were searched between 2010 and 2023 for English or French-language reviews (2010–2020) and individual studies (2020–2023) pertaining to telerehabilitation and these fields of interest. Data were extracted following a standardized form focusing on: outcomes; findings; quality assessment/biases; limitations; and discussion of ethical and equity concerns. Results: The results are presented according to the most relevant themes, which include: findings; strengths; limitations; and ethical/equity considerations. Conclusions: This research presents a methodology rarely published before, on how to conduct multiple parallel rapid reviews on the theme of telerehabilitation, based on different rehabilitation fields and age groups. This research will shape future guidelines and standards in applying ethical and equity standards in telerehabilitation Full article

8 pages, 7037 KiB

Open AccessCase Report

An Unusual Cause of Inguinal Mass in a Patient with Urolithiasis: A Case Report of Deep (Aggressive) Angiomyxoma in a Male Patient

by Christodoulos Chatzigrigoriadis, Vasileios Tatanis, Theodoros Spinos, Angelis Peteinaris, Angelos Samaras, Anastasios Thanos, Evangelos Liatsikos and Panagiotis Kallidonis

Clin. Pract. 2024, 14(6), 2705-2712; https://doi.org/10.3390/clinpract14060213 - 13 Dec 2024

Abstract

Background: Deep or aggressive angiomyxoma is an uncommon neoplasm of the pelvis. Although deep angiomyxoma is a benign tumor, its tendency to infiltrate soft tissues and reach a large size (typically > 10 cm) indicates aggressive biological behavior. It is usually present in [...] Read more.

Background: Deep or aggressive angiomyxoma is an uncommon neoplasm of the pelvis. Although deep angiomyxoma is a benign tumor, its tendency to infiltrate soft tissues and reach a large size (typically > 10 cm) indicates aggressive biological behavior. It is usually present in female patients, but there have been recent reports of male-aggressive angiomyxoma. While rare, it is an important consideration in patients with a pelvic mass. The clinical presentation is non-specific; patients are either asymptomatic or present with non-specific complaints, such as dull pain, constipation, and dysuria. It is commonly mistaken for an inguinal hernia, hydrocele, testicular cancer, lipoma, and epididymal cyst in male patients, thus misguiding the management of these cases. Hence, preoperative evaluation with imaging studies (ultrasound, computed tomography, magnetic resonance imaging) and biopsy allows for an accurate diagnosis and treatment. Currently, the standard of treatment is surgical resection of the tumor with free margins. The role of hormone therapy is under investigation for patients with deep angiomyxoma positive for estrogen/progesterone receptors. Regular follow-up is necessary given the high recurrence rate of deep angiomyxoma (9–72%). Methods: We present a case of an elderly man who presented with hematuria due to urolithiasis and an asymptomatic inguinal mass mimicking an inguinal hernia. A computed scan (CT) of the abdomen confirmed the presence of the mass, which was removed surgically. Results: The pathologic examination of the tumor was consistent with deep angiomyxoma. Conclusions: The diagnosis of deep angiomyxoma should always be considered in patients with an inguinal mass to avoid delayed treatment and incomplete surgical excision. Full article

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12 pages, 270 KiB

Open AccessArticle

Developmental Psychology and Healthcare Professions: Autism Knowledge Among Nurses: An Observational Study

by Rosaria Ferrara, Giuseppe Campagna, Pasquale Ricci, Felice Damato, Lidia Ricci, Leonardo Iovino, Flavio Marti, Roberto Latina and Roberta Simeoli

Clin. Pract. 2024, 14(6), 2693-2704; https://doi.org/10.3390/clinpract14060212 - 12 Dec 2024

Abstract

Background: One of the biggest limitations faced by autistic people is the lack of knowledge of their condition. Our study aims to evaluate and discuss the knowledge of autism among nurses, which is a social and health category often in close contact with [...] Read more.

Background: One of the biggest limitations faced by autistic people is the lack of knowledge of their condition. Our study aims to evaluate and discuss the knowledge of autism among nurses, which is a social and health category often in close contact with autistic people. Objective: Given the limited exploration of awareness levels about autism among healthcare professionals, this study aims to investigate general and specific knowledge of autism within a group of nursing students enrolled in a master’s degree. Methods: A total of 66 nurses completed the questionnaire. Descriptive analyses were conducted on the results for the four subcomponents of the questionnaire: (i) general knowledge, (ii) symptomatology, (iii) screening and diagnosis, and (iv) intervention and treatment. A correlation analysis was performed between the participants’ demographic variables and questionnaire scores. Additionally, a multivariable logistic regression was conducted to analyze the association between the participants’ basic demographic characteristics and questionnaire scores. Results: Results showed a good percentage of correct answers in the “general knowledge” category. Furthermore, a good level of knowledge regarding the fact that ASD is a developmental disorder and a congenital disease also emerged. Conclusions: Regarding the knowledge of typical autism symptoms, participants answered most of the questions correctly. Correct answers decreased for questions related to screening and diagnosis. In particular, participants had limited knowledge of the DSM-5 and the timing of ASD diagnosis. Similar levels of knowledge were observed for the fourth category, “intervention and treatment”. Full article

12 pages, 484 KiB

Open AccessArticle

Exploring Awareness Levels of Diabetic Ketoacidosis Risk Among Patients with Diabetes: A Cross-Sectional Study

by Elhassan Hussein Eltom, Abdulrahman Omar A. Alali, Rakan Khalid Marzouq Alanazi, Ali Ahmad M. Alanazi, Meshal Ahmed Abdullah Albalawi, Saud Alraydh N. Alanazi, Mansour Sarhan G. Alanazi, Abdelnaser A. Badawy, Naglaa Mokhtar and Manal S. Fawzy

Clin. Pract. 2024, 14(6), 2681-2692; https://doi.org/10.3390/clinpract14060211 - 12 Dec 2024

Abstract

Background/Objectives: Diabetic ketoacidosis (DKA) is a critical complication of diabetes mellitus, posing significant health. While global studies have indicated a concerning lack of awareness regarding DKA among patients with diabetes, research specific to the northern area of Saudi Arabia remains limited. This [...] Read more.

Background/Objectives: Diabetic ketoacidosis (DKA) is a critical complication of diabetes mellitus, posing significant health. While global studies have indicated a concerning lack of awareness regarding DKA among patients with diabetes, research specific to the northern area of Saudi Arabia remains limited. This study aims to explore the level of knowledge and awareness of DKA among patients with diabetes residing in the local region. Methods: A cross-sectional analysis was conducted utilizing a non-probability convenient sampling technique, with 339 participants recruited from March to August 2024. Data were gathered through a self-administered pre-validated questionnaire distributed via different social media platforms to assess demographic characteristics and awareness levels relating to DKA, including knowledge of its symptoms, causes, and treatment options. Results: Although there was moderate awareness of DKA, with 68.4% having heard of the condition, two-thirds of the participants exhibited significant gaps in overall knowledge. Among those aware, 76.3% recognized DKA as an emergency requiring immediate medical intervention. At the same time, 64.6% understood the causes of DKA, and only 25.6% identified insulin deficiency as a major contributing factor. Although 62.5% felt knowledgeable about treatment, 66.0% incorrectly identified oral sugar as a DKA treatment. Notably, 30.1% cited social media as their main information source. Age emerged as an essential factor impacting knowledge, with younger participants (ages 18–30) demonstrating higher awareness than older individuals. Additionally, single participants displayed a higher percentage of good knowledge than married participants (p = 0.000). Non-working individuals showed better overall knowledge about DKA (p = 0.002). The duration of diabetes did not show a significant association with knowledge levels about DKA across the various duration categories. Conclusions: The present findings underscore a substantial knowledge gap concerning DKA among the local community, highlighting a critical need for targeted public health educational interventions. Full article

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20 pages, 1160 KiB

Open AccessArticle

Metabolic Syndrome as a Risk Factor Among Lebanese Patients with Substance Use Disorder Undergoing Treatment for Recovery Through Rehabilitation or Opioid Substitution Treatment

by Nadine Mahboub, Elissa Ayoub, Carine Mounzer, Tatiana Kate Baltagi, Dimitrios Papandreou, Nanne de Vries and Rana Rizk

Clin. Pract. 2024, 14(6), 2661-2680; https://doi.org/10.3390/clinpract14060210 - 10 Dec 2024

Abstract

Background/Objectives: Data about metabolic syndrome (MS) in people who use drugs (PWUD) undergoing treatment for recovery are limited. We aimed to explore the extent of the MS and its predominant components and determinants in a sample of PWUD undergoing treatment for recovery through [...] Read more.

Background/Objectives: Data about metabolic syndrome (MS) in people who use drugs (PWUD) undergoing treatment for recovery are limited. We aimed to explore the extent of the MS and its predominant components and determinants in a sample of PWUD undergoing treatment for recovery through rehabilitation or opioid substitution treatment (OST) in Lebanon. Furthermore, we investigated the effect of each treatment modality on the MS; Methods: This was a cross-sectional study, in which demographics and treatment-related, nutritional, and biochemical data of the participants were collected. MS was defined according to the American Heart Association and the National Heart, Lung, and Blood Institute (AHA/NHLBI) criteria. Descriptive statistics were presented, and bivariate and multivariate analyses were conducted; Results: A total of 155 male subjects with the following characteristics were included: OST: n = 80; rehabilitation: n = 75; mean age: 32.53 ± 8.39 years; mean body mass index (BMI): 27.41 ± 4.99 Kg/m²; mean duration of treatment: 18 months. More than half of the sample had low HDL-C (56.8%) and/or elevated blood pressure (51.6%), 42.9% had elevated WC, 21.9% had elevated TG, and 12.3% had elevated FBS. Furthermore, 7.2% of the sample had no components of the MS, 29.2% had one component, 40.9% had two components, 16.9% had three components, and 5.8% had four components. MS was identified in 22.7% of the sample. Higher age was associated with higher odds of being diagnosed with MS (OR = 1.072; 95% CI: 1.021–1.126), whereas higher duration of current treatment was associated with lower odds (OR = 0.969; 95% CI: 0.944–0.995); Conclusions: MS and its components are prevalent in PWUD undergoing treatment for recovery. Routine screening and preventive measures are essential to prevent metabolic syndrome, particularly among older people and treatment newcomers. Full article

(This article belongs to the Special Issue Clinical Nutrition in Metabolic Disorders)

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11 pages, 271 KiB

Open AccessReview

Relationship Between Sleep Disturbances and Chronic Pain: A Narrative Review

by Sejal V. Jain, Geoffrey D. Panjeton and Yuri Chaves Martins

Clin. Pract. 2024, 14(6), 2650-2660; https://doi.org/10.3390/clinpract14060209 - 9 Dec 2024

Abstract

Sleep disturbances and chronic pain are prevalent and interrelated conditions that have significant impact on individuals’ quality of life. Understanding the intricate dynamics between sleep and pain is crucial for developing effective treatments that enhance the well-being of affected individuals and reduce the [...] Read more.

Sleep disturbances and chronic pain are prevalent and interrelated conditions that have significant impact on individuals’ quality of life. Understanding the intricate dynamics between sleep and pain is crucial for developing effective treatments that enhance the well-being of affected individuals and reduce the economic burden of these debilitating conditions. This narrative review examines the complex relationship between sleep disturbances and chronic pain. We describe the prevalence and types of sleep disturbances and sleep disorders in chronic pain patients. Posteriorly, we critically review the clinical and experimental evidence, investigating the relationship between sleep disturbances and chronic pain, aiming to clarify the impact of chronic pain on sleep and, conversely, the impact of sleep disturbances on pain perception. In conclusion, the literature largely agrees on the existence of a bidirectional relationship between chronic pain and sleep disturbances, though the strength of each direction in this association remains uncertain. Current evidence suggests that sleep impairment more strongly predicts pain than pain does sleep impairment. Additionally, addressing sleep disturbances in chronic pain patients is crucial, as poor sleep has been linked to higher levels of disability, depression, and pain-related catastrophizing. Full article

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

13 pages, 540 KiB

Open AccessArticle

Effect of Self-Measuring Blood Pressure Program on Hypertension Control: Analysis by Diabetes Status, Age, Gender, and Race in Rural Arizona

by Joy Luzingu, Aminata Kilungo, Randall Flores, Zoe Baccam, Tenneh Turner-Warren, Thelma Reis, Babasola Okusanya and John Ehiri

Clin. Pract. 2024, 14(6), 2637-2649; https://doi.org/10.3390/clinpract14060208 - 5 Dec 2024

Abstract

Background: Rural areas face numerous health challenges, including workforce shortages, limited training opportunities, and delayed care. These disparities can be mitigated by self-management interventions for diseases such as hypertension. This study assessed the implementation of a Self-Measuring Blood Pressure (SMBP) program in rural [...] Read more.

Background: Rural areas face numerous health challenges, including workforce shortages, limited training opportunities, and delayed care. These disparities can be mitigated by self-management interventions for diseases such as hypertension. This study assessed the implementation of a Self-Measuring Blood Pressure (SMBP) program in rural Arizona, documenting its barriers and patient experiences. Methods: In this before-after study, participants were loaned a digital device which they used to self-measure and record blood pressure (BP) over 1 week or more for hypertension diagnosis or 4 weeks or more for monitoring. Blood pressure (BP) control was assessed per the guidelines of the American Heart Association and American Diabetes Association. BP changes between baseline and post-program were assessed using paired-Student t tests. Effect modification by diabetes was analyzed using stratification. Results: Among 740 participants, significant associations were found with gender, age, and controlled BP among non-diabetic patients. Post-intervention, 63.4% of diabetic patients showed controlled BP, and 25.7% of non-diabetic patients had controlled BP, with higher control rates among females and older age groups (60–79 years). Baseline mean SBP was 148.3 ± 19.6 mmHg, improving to 133.9 ± 14.6 mmHg; baseline DBP was 88.5 ± 33.6 mmHg, improving to 83.4 ± 9.6 mmHg. Conclusions: The SMBP program effectively controlled BP, highlighting the value of combining clinical care with telemonitoring. Full article

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14 pages, 1115 KiB

Open AccessArticle

Artificial Intelligence and Modern Technology in Dentistry: Attitudes, Knowledge, Use, and Barriers Among Dentists in Croatia—A Survey-Based Study

by Ana Ivanišević and Antonija Tadin

Clin. Pract. 2024, 14(6), 2623-2636; https://doi.org/10.3390/clinpract14060207 - 5 Dec 2024

Abstract

Aim: This study aims to assess Croatian dentists’ knowledge, attitudes, and use of artificial intelligence (AI) and modern technology, while also identifying perceived barriers to AI and modern technology adoption and evaluating the need for further education and training. Materials and Methods: A [...] Read more.

Aim: This study aims to assess Croatian dentists’ knowledge, attitudes, and use of artificial intelligence (AI) and modern technology, while also identifying perceived barriers to AI and modern technology adoption and evaluating the need for further education and training. Materials and Methods: A cross-sectional survey was conducted in February 2024 among general dentists in Croatia using a self-structured questionnaire. A total of 200 respondents filled out the questionnaire. It included five sections: socio-demographic and professional information, self-assessment of AI and modern technology use, knowledge of AI in dentistry, current innovations and devices used in practice, and barriers to AI and modern technology integration in practice. Data were analyzed using descriptive statistics and a regression analysis to explore relationships between socio-demographic factors and AI knowledge. Results: The mean knowledge of AI systems was 3.62 ± 2.56 out of a possible score of 7, indicating relatively poor knowledge, with 47.5% demonstrating knowledge below the median. Most respondents (76.0%) did not use AI systems and modern technology in practice; however, prosthodontics (13.0%) and oral surgery (10.0%) were identified as the primary fields utilizing these technologies. Respondents rated their knowledge of modern technologies and AI as weak or moderate, with 60.5% engaged in continuous education. Despite 76.0% not using AI daily, 71.0% believed that these technologies could enhance patient care. Participants interested in further training showed significantly better knowledge of AI applications (p = 0.030). Major barriers included acquisition and maintenance costs (59.0%) and financial constraints (58.0%). Conclusions: The study revealed that most respondents had poor knowledge of AI systems. Despite this, there is a recognition of AI’s and modern technology potential in dentistry, emphasizing the need for enhanced education and training in this field. Full article

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15 pages, 1205 KiB

Open AccessArticle

Body Composition Changes and Factors Influencing the Total Weight Loss Rate After Laparoscopic Sleeve Gastrectomy

by Hironobu Nakaguchi, Bunzo Matsuura, Teruki Miyake, Hidenori Senba, Shinya Furukawa, Motohira Yoshida, Shigehiro Koga, Yuji Watanabe, Taro Oshikiri, Kumiko Toshimitsu and Yoichi Hiasa

Clin. Pract. 2024, 14(6), 2608-2622; https://doi.org/10.3390/clinpract14060206 - 5 Dec 2024

Abstract

Objectives: While the effectiveness of metabolic/bariatric surgery has been confirmed, understanding the factors associated with weight loss is paramount for providing guidance in postoperative treatment strategies. Here, we aimed to examine the factors associated with long-term maintenance of weight loss after laparoscopic sleeve [...] Read more.

Objectives: While the effectiveness of metabolic/bariatric surgery has been confirmed, understanding the factors associated with weight loss is paramount for providing guidance in postoperative treatment strategies. Here, we aimed to examine the factors associated with long-term maintenance of weight loss after laparoscopic sleeve gastrectomy (LSG). Methods: This prospective observational cohort included patients who underwent LSG at a single academic health center between January 2017 and June 2022. We examined their body composition using InBody 720 or 770 and analyzed the factors associated with the percentage of total weight loss (%TWL) for 24 months. Results: The median body mass index (BMI) was 38.8 (interquartile range [IQR]: 35.6–46.7) preoperatively, 32.7 kg/m² (IQR: 28.2–38.7) at 12 months postoperatively, and 33.9 kg/m² (IQR: 29.1–40.1) at 24 months postoperatively. The lowest BMI was observed at 12 months (p < 0.001 vs. preoperative), followed by a significant increase at 24 months (p = 0.003). However, BMI remained significantly lower at 24 months than preoperatively (p < 0.001). The skeletal muscle mass to fat mass ratio (SMM/FM) was 0.59 (IQR: 0.50–0.71) preoperatively, 0.79 (IQR: 0.58–1.26) at 12 months, and 0.70 (IQR: 0.54–1.05) at 24 months, peaking at 12 months (p < 0.001 vs. preoperative) and decreasing significantly by 24 months (p < 0.001). Nevertheless, the SMM/FM ratio at 24 months remained higher than preoperative values (p < 0.001). Median body weight and %TWL were 86.0 kg and 15.6%, respectively, at 24 months after LSG. The SMM/FM ratio at 12 months was positively correlated with %TWL at 24 months after adjusting for age and sex. Conclusions: The effects of LSG persisted for up to 24 months postoperatively. The SMM/FM ratio 12 months after LSG was associated with the rate of weight loss at 24 months. Full article

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7 pages, 620 KiB

Open AccessArticle

The Use of Acetazolamide to Prevent Acute Kidney Injury in Patients with Cancer on High-Dose Methotrexate Treatment: A Retrospective Pilot Analysis

by Lindon Lin, Tracey Batt and Gregory M. Peterson

Clin. Pract. 2024, 14(6), 2601-2607; https://doi.org/10.3390/clinpract14060205 - 28 Nov 2024

Abstract

Background: High-dose methotrexate (HDMTX) chemotherapy is associated with a significant risk of acute kidney injury (AKI). Acetazolamide is thought to increase methotrexate solubility via urinary alkalinisation, potentially reducing the risk of crystalline nephropathy. A tertiary hospital has included acetazolamide in its HDMTX protocols, [...] Read more.

Background: High-dose methotrexate (HDMTX) chemotherapy is associated with a significant risk of acute kidney injury (AKI). Acetazolamide is thought to increase methotrexate solubility via urinary alkalinisation, potentially reducing the risk of crystalline nephropathy. A tertiary hospital has included acetazolamide in its HDMTX protocols, although data on the risks and benefits are limited. This study evaluated the role of acetazolamide in managing patients receiving HDMTX and identified risk factors for AKI. Methods: The retrospective cohort pilot study included consecutive hospital patients who received HDMTX (≥500 mg/m²). Data collected from digital medical records included demographics, comorbidities, methotrexate dosages and serum concentrations, and pathology results. The development of AKI was defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Relationships between variables and AKI were initially assessed using Mann–Whitney U-tests and chi-square tests, and significant variables were further analysed using logistic regression to identify independent predictors of AKI. Results: Among 66 HDMTX treatment cycles in 31 patients, AKI occurred in 0/7 cycles with acetazolamide versus 14/59 cycles without (p = 0.33). Increasing age, the presence of hypertension, and concurrent use of beta-lactam antibiotics were associated with the development of AKI. Age was identified as the strongest independent risk factor for AKI (odds ratio 1.12, p = 0.034). Conclusions: Optimising management protocols, especially for older patients, is essential to reduce AKI risk during HDMTX therapy. While acetazolamide did not appear to reduce the risk of AKI, this pilot study was limited by a small sample size. Large randomised controlled trials are needed to assess efficacy and patient outcomes. Full article

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11 pages, 272 KiB

Open AccessArticle

Evaluating the Impact of Maternal Lipid Profiles on Fetal Cardiac Function at Mid-Gestation: An Observational Study

by Biliana Belovan, Zoran Laurentiu Popa, Cosmin Citu, Ioana Mihaela Citu, Ioan Sas and Adrian Ratiu

Clin. Pract. 2024, 14(6), 2590-2600; https://doi.org/10.3390/clinpract14060204 - 27 Nov 2024

Abstract

Background: Maternal dyslipidemia during pregnancy may influence fetal cardiac development and function, potentially predisposing offspring to cardiovascular diseases later in life. This study aims to evaluate the relationship between maternal lipid profiles and fetal cardiac function at mid-gestation, utilizing detailed echocardiographic assessments. Methods: [...] Read more.

Background: Maternal dyslipidemia during pregnancy may influence fetal cardiac development and function, potentially predisposing offspring to cardiovascular diseases later in life. This study aims to evaluate the relationship between maternal lipid profiles and fetal cardiac function at mid-gestation, utilizing detailed echocardiographic assessments. Methods: In this prospective cohort study conducted at the Obstetrics and Gynecology Clinic of the Timișoara Municipal Emergency Hospital, 19 pregnant women aged 27–40 years were recruited and divided into two groups based on their triglyceride levels: Group A (triglycerides ≤ 150 mg/dL, n = 48) and Group B (triglycerides > 150 mg/dL, n = 28). Maternal demographic data and lipid profiles were recorded. Fetal echocardiographic measurements, including global longitudinal strain and ventricular function parameters, were obtained between 20 and 24 weeks of gestation. Statistical analyses, including subgroup comparisons, correlations, and regression analyses, were performed. Results: Maternal BMI was significantly higher in Group B compared to Group A (31.94 ± 2.80 vs. 27.01 ± 2.40 kg/m², p < 0.001). Group B showed higher mean triglyceride levels (163.43 ± 11.34 mg/dL) compared to Group A (131.42 ± 10.57 mg/dL, p < 0.001). Fetal echocardiographic measurements indicated reduced global longitudinal strain in fetuses of Group B mothers (LV strain: −19.86% ± 6.83% vs. −26.14% ± 5.92%, p = 0.017). Significant correlations were found between maternal triglyceride levels and fetal LV strain (r = 0.536, p = 0.019). Regression analysis identified maternal triglyceride levels and BMI as significant predictors of reduced fetal LV strain (β = 0.45, p = 0.021 and β = 0.39, p = 0.038, respectively). Conclusions: Elevated maternal triglyceride levels, LDL cholesterol, and BMI are associated with altered fetal cardiac function parameters at mid-gestation, suggesting that maternal lipid profiles may impact fetal cardiac development. These findings underscore the importance of monitoring lipid levels during pregnancy and suggest potential benefits of managing dyslipidemia to improve fetal cardiac outcomes. However, the study included only a small sample; therefore, the study needs to be continued with a larger group. Full article

10 pages, 270 KiB

Open AccessArticle

Clinical Success of Pulpotomies Using Intermediate Restorations and Preformed Metal Crowns in the Context of a Developing Country: A Retrospective Questionnaire-Based Investigation

by Ana Luisa Montero-Copoya, Norma Leticia Robles-Bermeo, Salvador Eduardo Lucas-Rincón, María de Lourdes Márquez-Corona, Saraí Carmina Guadarrama-Reyes, Nayeli Lovera-Rojas, Juan Fernando Casanova-Rosado, Juan José Villalobos-Rodelo, Mauricio Escoffié-Ramírez and Carlo Eduardo Medina-Solís

Clin. Pract. 2024, 14(6), 2580-2589; https://doi.org/10.3390/clinpract14060203 - 27 Nov 2024

Abstract

Background: Dental caries is one of the most prevalent dental illnesses in children. Untreated severe caries can damage teeth, requiring pulpotomy to save them. Objective: To evaluate the clinical success rate of treatments involving pulpotomies + IRM (Intermediate Restorative Material, composed of reinforced [...] Read more.

Background: Dental caries is one of the most prevalent dental illnesses in children. Untreated severe caries can damage teeth, requiring pulpotomy to save them. Objective: To evaluate the clinical success rate of treatments involving pulpotomies + IRM (Intermediate Restorative Material, composed of reinforced zinc oxide–eugenol polymers) + preformed metal crowns (PMCs) in primary teeth of children treated at a public university in Mexico. Materials and Methods: A cross-sectional ambispective study was conducted on children aged 10 years or younger, treated at a public university in Mexico. A total of 1281 medical records from February 2018 to June 2023 were reviewed, yielding a sample of 199 children treated with pulpotomy + IRM + PMC. Information was collected via telephone interviews with parents/caregivers to inquire about any symptoms following the pulpotomy and metal crown treatments. Success was defined as the absence of pain, inflammation, or infection. Results: During the study period, the number of teeth treated with pulpotomy + IRM + PMC was 414, with follow-ups ranging from 6 to 69 months. Most participants were girls (54.3%), while 45.7% were boys. Out of the 167 pulpotomy + IRM + PMC treatments included in the study, the clinical success rate was 98.2%. Conclusions: The clinical success rate of primary teeth treated with pulpotomy + IRM + PMCs was high, close to 100%, based on evidence and symptom reports from parents/caregivers. It would be beneficial to implement its use in public health institutions in countries such as Mexico. Full article

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

12 pages, 1331 KiB

Open AccessArticle

Immediate Effects of the Mandibular Muscle Energy Technique in Adults with Chronic Temporomandibular Disorder

by Antonio Márquez-Vera, Luis Polo-Ferrero, Ana Silvia Puente-González, Roberto Méndez-Sánchez and José Antonio Blanco-Rueda

Clin. Pract. 2024, 14(6), 2568-2579; https://doi.org/10.3390/clinpract14060202 - 25 Nov 2024

Abstract

Background/Objectives: Temporomandibular disorders affect the muscles used for chewing, the temporomandibular joint, and other related tissues, resulting in pain, limited mobility, and dysfunction of the masticatory muscles. Physical therapy plays a critical role in treatment. Manual therapy can trigger neurophysiological mechanisms that contribute [...] Read more.

Background/Objectives: Temporomandibular disorders affect the muscles used for chewing, the temporomandibular joint, and other related tissues, resulting in pain, limited mobility, and dysfunction of the masticatory muscles. Physical therapy plays a critical role in treatment. Manual therapy can trigger neurophysiological mechanisms that contribute to pain relief and a reduction in muscle activation. Evaluations of different manual therapy techniques are needed on this topic. The main objective of this study was to evaluate the effects of a specific manual therapy technique (the mandibular muscle energy technique) in adults with temporomandibular disorders. Methods: A randomized, parallel clinical trial was conducted, and 31 participants were recruited into an experimental group and 30 were recruited into a control group in order to analyze its effects on outcomes such as pain, pain threshold to pressure, mandibular mobility, and kinesiophobia. Pre- and post-intervention assessments were performed, followed by statistical analyses to verify the intra- and intergroup changes. Results: The results showed that the mandibular muscle energy technique produced positive effects with significant differences in the intra- and intergroup comparisons for pain threshold to pressure, mandibular mobility, and kinesiophobia, demonstrating its efficacy and safety as a treatment option for adults with temporomandibular disorders, with proven effects in the short term. Conclusions: The effects obtained and the absence of side effects showed that this technique can be integrated into multimodal treatment along with other types of interventions in patients with temporomandibular disorders. Full article

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

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9 pages, 215 KiB

Open AccessArticle

Extraperitoneal Open Radical Cystectomy: A New Standard in Frail Patients with Muscle-Invasive Bladder Cancer?

by Daniel Porav-Hodade, Silvestru-Alexandru Big, Vlad-Ilie Barbos, Bogdan Gherle, Ernő Jerzicska, Victor Ona and Bogdan-Ovidiu Feciche

Clin. Pract. 2024, 14(6), 2559-2567; https://doi.org/10.3390/clinpract14060201 - 24 Nov 2024

Abstract

Background/Objectives: Radical cystectomy (RC) represents one of the most complex and morbid surgical procedures in the field of Urology. Extraperitoneal open RC has emerged as an alternative to the traditional transperitoneal approach for the treatment of muscle-invasive bladder cancer. Frailty is one [...] Read more.

Background/Objectives: Radical cystectomy (RC) represents one of the most complex and morbid surgical procedures in the field of Urology. Extraperitoneal open RC has emerged as an alternative to the traditional transperitoneal approach for the treatment of muscle-invasive bladder cancer. Frailty is one of the most important risk factors for perioperative morbidity and mortality, and this category of patients can benefit the most from the extraperitoneal approach. The purpose of this study was to evaluate the feasibility and the safety of extraperitoneal open RC in our experience; Methods: We retrospectively collected the data of 75 frail patients who underwent an extraperitoneal open RC, performed by a single experienced surgeon. We assessed their frailty status using the simplified frailty index (sFI). We recorded data regarding general characteristics, intraoperative, pathological, and postoperative complications, and mortality (within 90 days); Results: We analyzed 61 males and 14 females with an sFI equal to or higher than 3. The median age was 77 years. Fifty-one patients had an ASA score of 3 or more. Sixty procedures were with radical intention, while fifteen were palliative. Cutaneous ureterostomy was performed in 70 cases and extraperitonized ileal conduit in five cases. The median operative time was 150 min. The median blood loss was 400 mL. The median time to flatus was 2 days. The median postoperative stay was 7 days. Thirteen patients had Clavien–Dindo III or IV complications. Two patients died in first 90 days postoperatively; Conclusions: The extraperitoneal open RC in frail patients was demonstrated to be a feasible and safe alternative approach in definitive treatment or a palliative setting in our experience. Full article

17 pages, 8205 KiB

Open AccessReview

Metabolic Dysfunction-Associated Steatotic Liver Disease in Chronic Hepatitis C Virus Infection: From Basics to Clinical and Nutritional Management

by Karina Gonzalez-Aldaco, Luis A. Torres-Reyes, Claudia Ojeda-Granados, Leonardo Leal-Mercado, Sonia Roman and Arturo Panduro

Clin. Pract. 2024, 14(6), 2542-2558; https://doi.org/10.3390/clinpract14060200 - 24 Nov 2024

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely associated with obesity and other cardiometabolic risk factors. MASLD has rapidly become the most common cause of liver disease worldwide, currently affecting 38% of the global population. Excess weight causes chronic inflammation and the activation [...] Read more.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely associated with obesity and other cardiometabolic risk factors. MASLD has rapidly become the most common cause of liver disease worldwide, currently affecting 38% of the global population. Excess weight causes chronic inflammation and the activation of different pathways involved in liver damage. MASLD can progress from simple steatosis to steatohepatitis, giving way to its inflammatory component, metabolic dysfunction-associated steatohepatitis (MASH), previously recognized as non-alcoholic steatosis hepatitis (NASH). Chronic hepatitis C virus (HCV) infection remains a significant challenge to liver health as it triggers hepatic inflammation, metabolic disruption, and hepatic steatosis. The convergence of MASLD and chronic HCV infection can significantly alter the course of liver disease and accelerate the progression to severe liver damage. Currently, HCV treatment has a high cure rate. However, in patients who achieve a sustained virological response after treatment with direct-acting antivirals, weight gain, and excessive calorie intake may contribute to increased liver steatosis and a higher risk of liver disease progression. Therefore, the effective clinical and nutritional management of HCV patients, both before and after viral eradication, is crucial to reducing the risk of death from hepatocellular carcinoma. Understanding the complex interactions between MASLD and HCV infection is crucial for managing these patients appropriately. Herein, host and viral mechanisms inducing liver damage during the coexistence of MASLD and HCV infection are described, and their therapeutic and dietary management are discussed. Full article

(This article belongs to the Special Issue Clinical Nutrition in Metabolic Disorders)

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9 pages, 525 KiB

Open AccessArticle

Clinical Acceptance of Digitally Produced Zirconia and Metal Post and Cores, Based on the Impression Method

by Paula Perlea, Cosmin Stefanescu and Alexandru Eugen Petre

Clin. Pract. 2024, 14(6), 2533-2541; https://doi.org/10.3390/clinpract14060199 - 20 Nov 2024

Abstract

Background: The existing literature predominantly examines post and core assessments post-cementation, neglecting the critical pre-cementation phase. Research on the clinical acceptance of dental posts received from dental laboratories before cementation is notably lacking. This study investigates the percentage of zirconia and metal dental [...] Read more.

Background: The existing literature predominantly examines post and core assessments post-cementation, neglecting the critical pre-cementation phase. Research on the clinical acceptance of dental posts received from dental laboratories before cementation is notably lacking. This study investigates the percentage of zirconia and metal dental posts that are deemed suitable for cementation by clinicians, among the total received from the dental laboratory. Additionally, it aims to examine whether this percentage varies based on the type of impression made by the clinician: digital impression versus conventional impression. Methods: This article introduces the application of computer-aided design-computer-aided manufacturing (CAD-CAM) technology for manufacturing customized zirconia and Cobalt–Chromium (Co-Cr) post and cores. Intraoral scanning is employed to capture the canal anatomy. In contrast to the traditional casting process, a three-dimensional (3D) metal printer machine is utilized to 3D print the metal post and core from Co-Cr, resulting in enhanced toughness and superior adaptability to the canal. Two null hypotheses were formulated, investigating the clinical acceptance of zirconia and metal posts obtained through traditional versus digital impressions. Results: Among 577 post and cores, 95% of metal posts from both impression methods received clinical approval. However, for zirconia posts, a significantly higher acceptance rate (95% versus 88%) was observed for those from traditional impressions. The Chi-squared test yielded a p-value < 0.05, underscoring the clinical superiority of conventionally obtained zirconia posts and supporting the null hypothesis for metal posts. Conclusions: A significantly higher acceptance rate is apparent among zirconia post and cores manufactured through conventional impressions, in contrast to zirconia post and cores produced via digital impressions. No statistically significant difference was identified between metal post and cores obtained through digital impressions and those acquired through conventional impressions. Full article

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

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11 pages, 771 KiB

Open AccessArticle

Knowledge, Attitudes, and Practices of Parents Regarding Ophthalmological Screening of Preschool-Aged Children in Jazan, Saudi Arabia

by Mohamed Salih Mahfouz, Samy Shaban Mahmoud, Saleha Qaseem Haroobi, Latifah Mohammed Bahkali, Shahad Ibrahim Numan, Areen Mohsen Taheri, Ohoud Ali Hakami, Orjuwan Adel Zunquti and Sarah Mohammed Khered

Clin. Pract. 2024, 14(6), 2522-2532; https://doi.org/10.3390/clinpract14060198 - 20 Nov 2024

Abstract

Background: Children’s eye disorders are a major cause of irreversible vision loss. Delays in diagnosing eye problems in children are recurring problems that require quick attention. This study assesses parents’ knowledge, attitudes, and practices regarding the early ophthalmological screening of preschool-aged children in [...] Read more.

Background: Children’s eye disorders are a major cause of irreversible vision loss. Delays in diagnosing eye problems in children are recurring problems that require quick attention. This study assesses parents’ knowledge, attitudes, and practices regarding the early ophthalmological screening of preschool-aged children in Jazan, KSA. Methods: An observational cross-sectional study was conducted among 522 parents of preschool-aged children in the Jazan region. A self-administered web-based questionnaire was randomly distributed to the parents via WhatsApp. The survey tool consisted of four main sections: socio-demographic data, knowledge about eye care, attitudes toward eye screening, and eye care practices. Results: Parents’ level of knowledge regarding children’s eye care was distributed as follows: low (21.5%), medium (40.2%), and high (38.4%). Parent gender, age, occupation, level of income, and nationality showed no statistically significant association with the knowledge level (p > 0.05 for all). However, parent education played a significant role (p = 0.013). Further, parents expressed a positive attitude toward the early screening of eye problems, as more than 90% agreed that early eye examinations for children reduce complications from visual problems and that the increased use of electronic devices requires early eye examinations. Almost 47.0% of the parents had examined their children’s eyes when they were between 1 and 5 years of age, compared with only 10.3% of parents of children less than 1 year of age. The multiple linear regression model for factors that predict knowledge level among the study participants showed that having a child undergo early screening is positively associated with an increased knowledge score (p < 0.05). Conclusions: Jazan parents showed a positive attitude toward the early screening of eye problems, and one-third had a high level of knowledge regarding children’s eye care. However, the proportion of those who practiced early eye screening was low. More health education is necessary to increase parents’ awareness regarding early eye care practices. Full article

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