Journal Description
Clinics and Practice
Clinics and Practice
is an international, scientific, peer-reviewed, open access journal on clinical medicine, published monthly online by MDPI (from Volume 11, Issue 1 - 2021).
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within Scopus, ESCI (Web of Science), PubMed, PMC, Embase, and other databases.
- Journal Rank: JCR - Q2 (Medicine, General and Internal) / CiteScore - Q2 (General Medicine)
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 22.7 days after submission; acceptance to publication is undertaken in 3.8 days (median values for papers published in this journal in the first half of 2025).
- Recognition of Reviewers: APC discount vouchers, optional signed peer review, and reviewer names published annually in the journal.
Impact Factor:
2.2 (2024);
5-Year Impact Factor:
1.9 (2024)
Latest Articles
Beneficial Effect of Platelet-Rich Fibrin as an Adjunct to Nonsurgical Therapy After Subgingival Professional Mechanical Plaque Removal for Periodontitis: A Systematic Review and Meta-Analysis
Clin. Pract. 2025, 15(7), 127; https://doi.org/10.3390/clinpract15070127 - 2 Jul 2025
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Background and Objectives: Periodontitis is an inflammatory disease that compromises the supporting structures of the teeth, leading to irreversible tissue damage and tooth loss. While subgingival professional mechanical plaque removal (PMPR) remains the gold standard treatment, there is increasing interest in adjunctive therapies.
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Background and Objectives: Periodontitis is an inflammatory disease that compromises the supporting structures of the teeth, leading to irreversible tissue damage and tooth loss. While subgingival professional mechanical plaque removal (PMPR) remains the gold standard treatment, there is increasing interest in adjunctive therapies. Platelet-rich fibrin (PRF) has gained attention as a promising biomaterial to enhance periodontal healing and regeneration. This study aimed to evaluate the clinical and immunological effectiveness of PRF as an adjunct to PMPR. Materials and Methods: Clinical studies published between January 2019 and August 2024 were included from the ProQuest, PubMed, PMC, ScienceDirect, Scopus, and EBSCO databases. Seven studies met the inclusion criteria, focusing on adults with periodontitis treated with PRF + PMPR compared to PMPR alone. Primary outcomes included changes in clinical and immunological parameters. Risk of bias was assessed using the Cochrane ROB2 tool. Meta-analysis was conducted using both fixed-effect and random-effects models, depending on heterogeneity. Results: The meta-analysis demonstrated significant improvements in clinical outcomes in the PRF + PMPR group, with reductions in probing pocket depth (SMD: −1.43 mm; 95% CI: −2.05 to −0.81; p < 0.00001), clinical attachment level (SMD: −1.34 mm; 95% CI: −1.95 to −0.73; p < 0.0001), bleeding on probing (SMD: −0.75 mm; 95% CI: −1.11 to −0.39; p < 0.00001), gingival recession (SMD: −0.79 mm; 95% CI: −1.33 to −0.25; p = 0.004), and gingival index (SMD: −0.82 mm; 95% CI: −1.37 to −0.28; p = 0.003). Favorable trends were also observed in IL-10, TGF-β, VEGF, PDGF-BB, periostin, and type I collagen levels. Conclusions: PRF enhances clinical and immunological outcomes and supports periodontal tissue stability when used as an adjunct to non-surgical therapy.
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Open AccessArticle
Preeclampsia as a Risk Factor of Postmenopausal Cardiovascular Disease: A Cross-Sectional Study
by
Pasquale Palmiero, Pierpaolo Caretto, Francesca Amati, Marco Matteo Ciccone and Maria Maiello
Clin. Pract. 2025, 15(7), 126; https://doi.org/10.3390/clinpract15070126 - 2 Jul 2025
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Introduction: Preeclampsia (PE) is a pregnancy-specific disorder characterized by hypertension and organ dysfunction, affecting 5–8% of pregnancies globally and increasing women’s long-term risk of cardiovascular disease (CVD). This study investigates the association between prior PE and cardiovascular health in postmenopausal women. Methods: A
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Introduction: Preeclampsia (PE) is a pregnancy-specific disorder characterized by hypertension and organ dysfunction, affecting 5–8% of pregnancies globally and increasing women’s long-term risk of cardiovascular disease (CVD). This study investigates the association between prior PE and cardiovascular health in postmenopausal women. Methods: A total of 108 postmenopausal women with a history of PE and 100 controls without PE were enrolled. Clinical data, blood pressure readings, and echocardiographic assessments were obtained. Statistical analysis was conducted using SPSS version 20.0. Results: Women with prior PE showed a higher prevalence of eccentric left ventricular hypertrophy (37% vs. 23%, p < 0.02) and diastolic dysfunction (51% vs. 39%, p < 0.003). Maternal history of hypertension was also more common in the PE group (55% vs. 26%, p < 0.003). Obesity was more frequent in the PE group, but did not reach statistical significance (p < 0.09). Conclusions: Prior PE was linked to an increased risk of postmenopausal cardiac abnormalities, including left ventricular hypertrophy and diastolic dysfunction. A maternal history of hypertension was also more common among women with prior PE, suggesting a familial connection; PE should be acknowledged as a significant predictor of long-term cardiovascular risk, requiring lifelong monitoring and preventive measures.
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Open AccessArticle
Immediate Effects of Multiple Ischemic Compression Applications on Pain Sensitivity and Biomechanical Properties of Myofascial Trigger Points
by
Sebastian Szajkowski, Jarosław Pasek and Grzegorz Cieślar
Clin. Pract. 2025, 15(7), 125; https://doi.org/10.3390/clinpract15070125 - 1 Jul 2025
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Background: Myofascial trigger points (MTrPs) are hyperirritable spots within taut bands of skeletal muscle fibers, often developing in overloaded muscles. Ischemic compression (IC) is a frequently used therapeutic technique for MTrP treatment. Material and Methods: Seventy-nine participants with MTrPs in the upper trapezius
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Background: Myofascial trigger points (MTrPs) are hyperirritable spots within taut bands of skeletal muscle fibers, often developing in overloaded muscles. Ischemic compression (IC) is a frequently used therapeutic technique for MTrP treatment. Material and Methods: Seventy-nine participants with MTrPs in the upper trapezius muscle were included. Three IC protocols were used. In group 1, the compression force was increased once; in group 2, twice; and in group 3, three times—each time up to the pain threshold, then held constant until the pain subsided. Evaluations included pressure pain threshold (PPT), pressure pain perception (PPP), and myotonometric measurements. Results: PPT values increased significantly in group 2 (p = 0.009) and group 3 (p = 0.009), while PPP values decreased significantly in both groups (group 2: p = 0.016; group 3: p = 0.041) post-intervention. Group 1 showed a significant reduction in muscle tone (p < 0.001), and group 2 in muscle stiffness (p = 0.036). Muscle elasticity significantly improved in all groups: group 1 (p = 0.022), group 2 (p = 0.001), and group 3 (p = 0.042). Conclusions: IC applied with a constant force at the individual’s pain perception threshold effectively elevates the pain threshold and enhances the biomechanical parameters of muscle fibers in the trigger point area.
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Open AccessCase Report
Beyond Passive Immunity: Three Neonatal Influenza Cases Highlighting Impact of Missed Maternal Vaccination
by
Irina Profir, Cristina-Mihaela Popescu, Gabriel Valeriu Popa and Aurel Nechita
Clin. Pract. 2025, 15(7), 124; https://doi.org/10.3390/clinpract15070124 - 30 Jun 2025
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Background: Neonatal influenza is a rare condition. Young infants have immature immune defenses and are unable to receive direct vaccination; this can result in significant illness. Maternal anti-influenza immunization during pregnancy provides passive antibodies to the newborn via transplacental transfer, significantly decreasing
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Background: Neonatal influenza is a rare condition. Young infants have immature immune defenses and are unable to receive direct vaccination; this can result in significant illness. Maternal anti-influenza immunization during pregnancy provides passive antibodies to the newborn via transplacental transfer, significantly decreasing the incidence and severity of influenza in early infancy. Nevertheless, the vaccination coverage during pregnancy remains low in many regions, leaving certain neonates without adequate protection. Methods: We present three cases of laboratory-confirmed influenza infection in neonates admitted to the “Sf. Ioan” Clinical Emergency Pediatric Hospital in Galați and conduct a literature review. The clinical presentation, co-infections, timing of antiviral therapy, laboratory findings, maternal vaccination status, and outcomes (including the hospitalization duration and recovery) were systematically analyzed for each case. Results: All three neonates were full-term and previously healthy, born to mothers who had not received influenza vaccinations during their pregnancies. They presented at ages ranging from 2 to 4 weeks with fever, respiratory symptoms including a cough, nasal congestion, and respiratory distress, as well as feeding difficulties. One case involved a co-infection with Bordetella pertussis, which manifested as a severe paroxysmal cough, cyanosis, and apnea. Laboratory findings in the cases with influenza alone indicated leukopenia accompanied by normal C-reactive protein levels. In the co-infection case, leukocytosis, lymphocytosis, and thrombocytosis were observed. All the infants received oseltamivir treatment within 48 h of the symptom onset; the case with pertussis co-infection also received azithromycin. Each infant required supplemental oxygen, but none necessitated mechanical ventilation. Clinical improvement was observed in all cases, with hospitalization ranging from 6 to 7 days and complete recovery without complications. Conclusions: Neonatal influenza may result in considerable morbidity, particularly in infants born to unvaccinated mothers. Positive outcomes, however, have been correlated with early diagnosis and antiviral treatment. Pertussis co-infection may exacerbate clinical progression, underscoring the importance of maternal immunization against both influenza and pertussis. In this case series, we aim to present three cases of laboratory-confirmed influenza in neonates born to mothers who were not immunized against influenza during pregnancy. These cases highlight the clinical presentations of neonatal influenza, underscore the risks associated with pertussis co-infection, and reinforce the importance of maternal influenza and Tdap vaccination for preventing severe outcomes in newborns.
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Open AccessReview
Rethinking the Subjective Units of Distress Scale: Validity and Clinical Utility of the SUDS
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Elizabeth Mattera and Brian Zaboski
Clin. Pract. 2025, 15(7), 123; https://doi.org/10.3390/clinpract15070123 - 29 Jun 2025
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The Subjective Units of Distress Scale (SUDS) is a widely used self-report measure clinicians rely on during exposure and response prevention (ERP) to monitor progress, guide exposure pacing, and assess intervention efficacy. However, despite its ubiquity in clinical and research settings, foundational investigations
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The Subjective Units of Distress Scale (SUDS) is a widely used self-report measure clinicians rely on during exposure and response prevention (ERP) to monitor progress, guide exposure pacing, and assess intervention efficacy. However, despite its ubiquity in clinical and research settings, foundational investigations of its psychometrics are often atheoretical, fail to evaluate its longitudinal properties, and lack a rigorous construct validation framework. This paper addresses these shortcomings by evaluating the SUDS as a measure of state negative affective intensity using the Strong Program of Construct Validation. Our evaluation demonstrates that the SUDS suffers from significant psychometric weaknesses, including construct underrepresentation, construct irrelevance, poorly defined measurement occasions, and structural limitations, challenging its validity as a precise measure of subjective distress. These limitations have crucial implications for clinical practice, potentially leading to misinterpretations of patient distress and compromising treatment decisions. We discuss these clinical implications, highlight them with a brief clinical vignette, outline a research roadmap for potential improvement using modern psychometric methods, and provide practical recommendations for clinicians currently using the SUDS. Given these validity concerns, caution is warranted when interpreting SUDS scores in both clinical and research contexts until its psychometric properties are more robustly established and understood.
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Open AccessArticle
Like a Complete Unknown: An Audit of the Quality of the Referrals to the Cancer of Unknown Primary Clinic at a Tertiary Care Centre
by
Ian Hirsch, Jonah Teich, Khaled Abdulalem and Samuel D. Saibil
Clin. Pract. 2025, 15(7), 122; https://doi.org/10.3390/clinpract15070122 - 26 Jun 2025
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Background: Carcinoma of Unknown Primary (CUP) constitutes approximately 3% of all advanced cancer cases globally, posing a distinct and complex medical challenge due to its metastatic nature, with no identifiable primary tumour site despite comprehensive investigations. Aim: This study aimed to assess the
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Background: Carcinoma of Unknown Primary (CUP) constitutes approximately 3% of all advanced cancer cases globally, posing a distinct and complex medical challenge due to its metastatic nature, with no identifiable primary tumour site despite comprehensive investigations. Aim: This study aimed to assess the quality of referrals to the Cancer of Unknown Primary Clinic at the Princess Margaret Cancer Centre (PMCC) by conducting a retrospective audit of initial referrals between January 2022 and March 2023. Methods: The adequacy of referrals was evaluated based on adherence to NICE guidelines, focusing on essential diagnostic investigations such as comprehensive history, physical examination, CT scans, and pathological assessment with immunohistochemistry. Our cohort consisted of 97 patients with a median age of 66 years. Results: The results indicated that only 55% of referrals met the criteria for adequacy, with significant deficiencies in computed tomography (CT) scans and immunohistochemistry (IHC). Notably, the adequacy of referrals varied by specialty, with the lowest rates in emergency medicine and family medicine, and the highest rates in medical oncology, gastroenterology, and neurosurgery. Conclusions: These findings underscore the need for improved standardization and education to enhance referral quality, ensuring that patients with CUP receive appropriate and timely care. This study marks the initial phase of the Knowledge-to-Action cycle, highlighting areas for quality improvement in the referral process to the CUP clinic.
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Open AccessArticle
Determinants of Survival and Prognostic Factors in Patients Undergoing Liver Resection for Primary Hepatic Carcinoma—A Follow-Up Study
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Unenbat Gurbadam, Gantuya Dorj, Aryabilig Otgongerel, Munkhtsetseg Janlav, Serod Khuyagaa, Tsenguun Ganbat, Tserendorj Demchig, Amgalantuul Batdelger, Batsaikhan Bayartugs, Munkhdelger Byambaragchaa, Yerbolat Amankeldi, Munkhzaya Chogsom, Chinburen Jigjidsuren, Bayart-Uils Bayar and Lkham Nyam-Osor
Clin. Pract. 2025, 15(7), 121; https://doi.org/10.3390/clinpract15070121 - 26 Jun 2025
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Background: Mongolia has a high incidence of hepatocellular carcinoma (HCC), with 85.6 cases per 100,000 population and 70% diagnosed at an advanced stage. HCC accounts for 35% of all cancer-related deaths in the country. The primary treatment for HCC remains hepatotectomy. This study
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Background: Mongolia has a high incidence of hepatocellular carcinoma (HCC), with 85.6 cases per 100,000 population and 70% diagnosed at an advanced stage. HCC accounts for 35% of all cancer-related deaths in the country. The primary treatment for HCC remains hepatotectomy. This study aims to investigate the factors affecting the prognosis of patients undergoing liver resection for HCC in Mongolia. Materials and Methods: A retrospective cohort study was conducted using data from the National Cancer Centre’s eHealth program and cancer registry. The study enrolled 1100 patients who underwent liver resection from 2015 to 2018, with a follow-up period of 5.25–9.25 years to determine survival rates. Results: The study included 980 patients, with a male-to-female ratio of 1.2:1 and an average age of 60 years. Tumour stage II patients had the highest survival rate (46.55%), and those with stage IIIb had the lowest (1.51%) (p = 0.0001). Smaller tumours (≤5 cm) were associated with better survival (p = 0.0006). Histologically, 19.4% had liver cirrhosis, and 80.7% had liver fibrosis. The preoperative median AFP level was 23.9 ng/mL (range 0–121,000 ng/mL). The average survival time post-liver resection was 6.675 years (p = 0.0006). Factors such as blood loss (p = 0.0004), vascular invasion (MaVI-p < 0.0001, MVI p = 0.0011), tumour size ≤ 5 cm (p = 0.0007), and elevated AST and ALT levels significantly influenced long-term survival (p = 0.0004, respectively). Conclusions: The study identified key prognostic factors influencing survival rates in HCC patients post-liver resection. Minimising blood loss, early detection, and managing vascular invasion, along with early-stage detection and treatment, are crucial for improving patient outcomes.
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Open AccessArticle
Endothelial Damage in Sepsis: The Interplay of Coagulopathy, Capillary Leak, and Vasoplegia—A Physiopathological Study
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Gianni Turcato, Arian Zaboli, Lucia Filippi, Alessandro Cipriano, Paolo Ferretto, Michael Maggi, Fabrizio Lucente, Massimo Marchetti, Lorenzo Ghiadoni and Christian J. Wiedermann
Clin. Pract. 2025, 15(7), 120; https://doi.org/10.3390/clinpract15070120 - 25 Jun 2025
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Background: Sepsis remains a leading cause of mortality worldwide, and understanding endothelial damage is crucial for improving patient outcomes. Endothelial dysfunction in sepsis contributes to coagulopathy, increased capillary permeability, and vasoplegia, but the interplay between these processes remains underexplored. The study aims to
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Background: Sepsis remains a leading cause of mortality worldwide, and understanding endothelial damage is crucial for improving patient outcomes. Endothelial dysfunction in sepsis contributes to coagulopathy, increased capillary permeability, and vasoplegia, but the interplay between these processes remains underexplored. The study aims to evaluate the clinical relationship between those factors due to sepsis-induced endothelial damage. Methods: A prospective single-center study on 75 community-acquired septic patients admitted to an Intermediate Care Unit. The Sepsis-Induced Coagulopathy (SIC) score, serum albumin (as a surrogate for capillary leak), and Total Peripheral Resistance Index (TPRI) (as a surrogate for vasoplegia) were assessed. Structural Equation Modeling (SEM) explored the relationship between variables, hypothesizing a common latent factor (endothelial damage). Principal Component Analysis assessed the shared variance among variables. Results: The mean SIC score was 3.4 (SD 1.3), with 44% of patients affected. TPRI and albumin had mean values of 1954 (SD 738) and 2.58 (SD 0.59), respectively, both negatively correlated with SIC: TPRI −0.263 (p = 0.023) and albumin −0.454 (p < 0.001). SEM showed SIC, albumin, and TPRI are associated with a latent factor (endothelial damage), explaining 68% of the variance (CFI = 1.000, RMSEA = 0.000). Albumin was inversely correlated (p = 0.004), and TPRI was significantly associated (p = 0.003). Conclusions: This pilot study suggests that coagulopathy, increased vascular permeability, and vasoplegia may be clinically interrelated manifestations of endothelial injury in sepsis. These findings support the feasibility of modeling a unified pathophysiological construct using accessible bedside data, potentially guiding future individualized approaches in sepsis management.
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Open AccessArticle
The Association Between COVID-19-Related Persistent Symptoms, Psychological Flexibility, and General Mental Health Among People With and Without Persistent Pain in the UK
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Lin Yu and Lance M. McCracken
Clin. Pract. 2025, 15(7), 119; https://doi.org/10.3390/clinpract15070119 - 25 Jun 2025
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Objectives: Persistent symptoms following COVID-19 may adversely impact the general mental health of people with chronic pain, and psychological flexibility may buffer these impacts. However, it remains unclear whether such lasting implications of COVID-19 differ between people with and without chronic pain. This
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Objectives: Persistent symptoms following COVID-19 may adversely impact the general mental health of people with chronic pain, and psychological flexibility may buffer these impacts. However, it remains unclear whether such lasting implications of COVID-19 differ between people with and without chronic pain. This study investigated the relationships between persistent symptoms post-COVID-19, psychological flexibility, and general mental health among people with and without persistent pain during the COVID-19 pandemic in the UK. Methods: A total of 204 adults living in the UK were recruited via social media and completed an online survey, including measures of persistent symptoms, depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder-7), insomnia (the Insomnia Severity Index), and psychological flexibility (the Multidimensional Psychological Flexibility Inventory), and were included in the analyses. Results: Participants with persistent pain (n = 70) experienced more-persistent symptoms, poorer general mental health, and a higher level of psychological inflexibility compared with participants without persistent pain (n = 133). Overall, the relationships between persistent physical symptoms, general mental health, and psychological (in)flexibility showed similar patterns in the two groups. Participants with more-persistent physical symptoms experienced significantly poorer general mental health. Furthermore, people with higher levels of psychological inflexibility reported worse general mental health. There was little evidence that psychological (in)flexibility could “buffer” the association between persistent physical symptoms and general mental health. Conclusions: People with chronic pain appear more vulnerable to persistent symptoms and reduced general mental health compared with people without pain. Treatments that reduce psychological inflexibility, such as ACT, may improve outcomes for people with persistent symptoms post-COVID-19.
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Open AccessCase Report
First Case of Infective Endocarditis Caused by Vibrio metschnikovii: Clinico-Diagnostic Complexities and a Systematic Literature Review
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Alessandro Carrozzo, Vittorio Bolcato, Luigi Martinelli, Ferdinando Dodi, Antonella Vulcano, Giuseppe Basile and Livio P. Tronconi
Clin. Pract. 2025, 15(7), 118; https://doi.org/10.3390/clinpract15070118 - 25 Jun 2025
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Background: Non-cholera Vibrio species are rare waterborne pathogens that can cause severe infections. Among these, few cases of Vibrio metschnikovii infections have been reported, especially in the gastrointestinal tract, with no cardiac tissue involvement as a result. Following the PRISMA checklist, we conducted
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Background: Non-cholera Vibrio species are rare waterborne pathogens that can cause severe infections. Among these, few cases of Vibrio metschnikovii infections have been reported, especially in the gastrointestinal tract, with no cardiac tissue involvement as a result. Following the PRISMA checklist, we conducted a literature review, and thirteen articles for twenty-two cases overall were included: seven cases of sepsis (in three cases, the echocardiographic results were negative), seven cases of pneumonia, two skin infections, eleven cases of diarrhoea, and a gastroenteritis outbreak. This report documents the expanding clinical spectrum and the role played by V. metschnikovii in infective endocarditis. Case report: A 28-year-old male patient was referred to the cardiac surgery unit for urgent mitral valve replacement due to suspicion of infective endocarditis. Microbiological tests yielded negative results. Following recovery and discharge with antimicrobial therapy for 6 weeks, the patient experienced prosthesis detachment, necessitating re-hospitalisation for an emergency valve replacement. Vibrio metschnikovii was identified on the prosthesis valve through PCR and successfully treated with ciprofloxacin. However, a spontaneous rupture of the ascending thoracic aorta led to a neurological injury. Discussion: This case represents the first case of valve infection caused by Vibrio metschnikovii, characterised by diagnostic and therapeutic challenges and the involvement of the great vessels. Also considered in this case, for a disease with a median age of 58 years (11–83) and a male-to-female ratio of 2.2, were one male neonate and six cases for whom neither sex nor age was indicated. Excluding gastrointestinal cases, the septic forms are associated with high morbidity, although the single case described involved a young and healthy subject. Risk factors for the pathogen or predisposing/pathological conditions for endocarditis did not emerge. The routes and the time of infection could not be determined, deepening the possibility of occupational exposure via the patient’s position as a boat worker. Poor sensitivity to third-generation cephalosporins has been reported in the literature: the absence of an antibiogram does not allow for a comparison, although resolution was achieved with ciprofloxacin. Conclusion: The rising global incidence of non-cholera Vibrio infections, driven by environmental changes, calls for urgent research into the factors behind their pathogenicity and infection routes. Diagnostic complexities have emerged together with clinical severity.
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Open AccessArticle
Trends and Predictors of Venous Thromboembolism and Major Hemorrhagic Events in Hospitalized Leukemia Patients: A Cross-Sectional Analysis of the NIS (2016–2020)
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Daniel Antwi-Amoabeng, Bryce D. Beutler, Vijay Neelam and Mark Ulanja
Clin. Pract. 2025, 15(7), 117; https://doi.org/10.3390/clinpract15070117 - 25 Jun 2025
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Background/Objectives: Venous thromboembolism (VTE) and major hemorrhagic events are significant complications in hospitalized leukemia patients, but contemporary analyses of their epidemiology, predictors, and impact on clinical outcomes remain limited. Methods: We conducted a cross-sectional study using the National Inpatient Sample (NIS) database from
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Background/Objectives: Venous thromboembolism (VTE) and major hemorrhagic events are significant complications in hospitalized leukemia patients, but contemporary analyses of their epidemiology, predictors, and impact on clinical outcomes remain limited. Methods: We conducted a cross-sectional study using the National Inpatient Sample (NIS) database from 2016 to 2020. Hospitalized leukemia patients were identified using ICD-10 codes. Trends in the incidence of venous thromboembolism (VTE) and bleeding were assessed across the years, and multivariable logistic regression models were used to evaluate the predictors of VTE and bleeding. We assessed the influence thromboembolic and hemorrhagic complications on length of stay, cost, and mortality outcomes. Results: Among 430,780 leukemia hospitalizations, the overall incidence of VTE was 5.4% and remained stable throughout the study period (p = 0.09), while hemorrhagic events = 5.6%) showed a significant upward trend (p = 0.01). Cerebrovascular accidents, central venous catheter insertion, and protein calorie malnutrition (PCM) were significant predictors of both VTE and hemorrhage. PCM demonstrated a dose-dependent relationship with both complications. VTE was associated with a 33.5% increase in length of stay (LOS) and a 35% increase in cost of care (COC). Hemorrhage was associated with 23.2% increase in LOS and 32.6% increase in COC. Only hemorrhagic events were independently associated with increased mortality (adjusted OR 2.88, p < 0.001). Conclusions: The incidence of VTE in hospitalized leukemia patients has remained stable while hemorrhagic complications have increased significantly. Nutritional status represents a potentially modifiable risk factor for both VTE and bleeding complications. The competing risk between thrombosis and hemorrhage varies with age and nutritional status, suggesting the need for nuanced thromboprophylaxis strategies in this vulnerable population.
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Open AccessArticle
The Impact of the Quality of Care for Adults with Acute Asthma in the Emergency Department of a Tertiary Hospital: A 1-Year Follow-Up Study
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Carlos Martinez Rivera, Agnes Hernandez Biette, Anna Núñez Condominas, Ignasi Garcia Olive, María Basagaña Torrentó, Clara Padró Casas, Leandro Tapia Barredo and Antoni Rosell Gratacós
Clin. Pract. 2025, 15(7), 116; https://doi.org/10.3390/clinpract15070116 - 24 Jun 2025
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Background/Objectives: This study evaluates the adherence to guidelines for the management of asthma exacerbations in the ED, recommendations at discharge, and impact at a 1-year of follow-up. Methods: An observational study of 87 asthma patients who attended the ED during 2022
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Background/Objectives: This study evaluates the adherence to guidelines for the management of asthma exacerbations in the ED, recommendations at discharge, and impact at a 1-year of follow-up. Methods: An observational study of 87 asthma patients who attended the ED during 2022 and were discharged within 24 h was carried out. Data before the ED admission, care in the ED, and discharge reports, as well as the clinical characteristics at follow-up, were recorded. The relationship between complete ED discharge reports and outcome at 1 year, and factors associated with new exacerbations were analyzed. Results: The mean age was 51 years, 80% of the patients were women, and 50% had severe asthma. Prior to ED admission, 58.8% of patients used ICS-LABA, 26.2% triple therapy, 31.8% had not been treated, and 51.2% had presented at least one exacerbation. On ED admission, PEF was measured in 21% of patients only, decreasing to 6.8% at 3 h. In the ED discharge reports, the use of systemic corticosteroids was recommended in 76.5% of the cases and ICS-LABA in 46.9%. However, complete ED discharge reports were recorded for only 18.2% of patients. A total of 6.7% of patients were referred to a primary care physician and 29.9% to a pneumologist. Complete ED discharge forms did not improve asthma control at follow-up or reduce new exacerbations. Exacerbations before ED admission (OR 2.49, 95% CI 1.47–4.22, p = 0.001) and the use of any asthma controller treatment (OR 1.84, 95% CI 1.84–507, p = 0.017) were associated with ≥2 exacerbations at follow-up. Conclusions: Contact with ED did not improve disease control or reduce exacerbations. It is necessary to optimize care before, during, and after exacerbations by developing integrated programs with primary care to improve asthma management.
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Open AccessArticle
Incidence of Gallstones in Patients with Obesity After Bariatric Surgery in Northern Saudi Arabia: A Cross-Sectional Study
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Abdulrahman Omar A. Alali, Abdualaziz Fayez Alhumidi Alanazi, Mohammed Abdulaziz M. Albarghash, Rakan Nasser Abdullah Alruweli, Mohammed Bader H. Alanazi, Ibrahim Farhan B. Alanazi, Turkey Saleh H. Alrowaily, Rakan Khalid Marzouq Alanazi, Baraah AbuAlsel, Fadih Nada M. Alenezi, Rashad Qasem Ali Othman and Manal S. Fawzy
Clin. Pract. 2025, 15(7), 115; https://doi.org/10.3390/clinpract15070115 - 23 Jun 2025
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Background/Objectives: Gallstone formation (cholelithiasis) is a common and important consequence following bariatric surgery, though regional data from the Northern Border Region are limited. This study aimed to investigate the incidence and risk factors of gallstones in this population, with the goal of optimizing
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Background/Objectives: Gallstone formation (cholelithiasis) is a common and important consequence following bariatric surgery, though regional data from the Northern Border Region are limited. This study aimed to investigate the incidence and risk factors of gallstones in this population, with the goal of optimizing postoperative treatment and reducing morbidity. Methods: We conducted a cross-sectional study using a non-probability convenience sampling technique to recruit 509 participants with varying degrees of obesity. Four hundred and ten study participants underwent bariatric surgery, of whom 73 were excluded for preoperative cholelithiasis and/or cholecystectomy. Data were collected through a self-administered, pre-validated questionnaire distributed via various social media platforms. These data included demographics, type/timing of surgery, pre/postoperative BMI, medical history, use of gallstone prophylaxis, and gallstone outcomes. Logistic regression analysis was used to identify independent predictors of gallstone formation. Results: Postoperative cholelithiasis developed in 60.8% of patients, most commonly within the first postoperative year, with risk peaking between 7 and 12 months after surgery. Rapid and substantial postoperative weight loss, as reflected in a lower current BMI and a transition to normal or overweight status within one year, was significantly associated with an increased incidence of gallstones. Female sex (OR: 2.62, 95% CI: 1.38–4.98, p = 0.003) and non-use of gallstone prevention medication (OR: 4.12, 95% CI: 1.34–12.64, p = 0.013) were independent predictors of gallstone formation. A longer time since surgery (OR: 0.76, 95% CI: 0.63–0.91, p = 0.004) and a lower current BMI (OR: 0.48, 95% CI: 0.28–0.83, p = 0.008) were associated with a reduced risk. Smoking status and comorbidities were not significantly related to the risk of gallstones. Conclusions: Gallstone formation after bariatric surgery in this population is influenced by female sex, rapid postoperative weight loss, and lack of prophylactic medication, while the type of surgical procedure does not significantly affect risk. Focused monitoring and preventive strategies, particularly in high-risk groups, are recommended to reduce gallstone-related complications following bariatric surgery.
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Open AccessCase Report
Bone Marrow Aplasia and Neutropenic Fever Following Azathioprine Dose Escalation in a TPMT-Deficient Patient with Crohn’s Disease and Psoriatic Arthritis—A CARE–Compliant Case
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Krzysztof Wroński, Michał Tadeusz Holecki, Natalia Boguszewska, Marzena Skrzypczak-Zielińska and Jerzy Tadeusz Chudek
Clin. Pract. 2025, 15(6), 114; https://doi.org/10.3390/clinpract15060114 - 19 Jun 2025
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Background: Myelotoxicity, usually manifested by moderate leukopenia (particularly neutropenia), is a well-known adverse drug reaction to azathioprine (AZA) therapy. Thiopurine methyltransferase (TMPT) and nucleoside diphosphate-linked moiety X-type motif 15 (NUDT15) genotyping are not routinely performed in patients starting AZA therapy
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Background: Myelotoxicity, usually manifested by moderate leukopenia (particularly neutropenia), is a well-known adverse drug reaction to azathioprine (AZA) therapy. Thiopurine methyltransferase (TMPT) and nucleoside diphosphate-linked moiety X-type motif 15 (NUDT15) genotyping are not routinely performed in patients starting AZA therapy due to their low cost-effectiveness. Additionally, the concomitant use of xanthine oxidase inhibitors and 5-aminosalicylates may slow the metabolism of 6-mercaptopurine. Case Description: We describe a case of a 26-year-old Caucasian man with Crohn’s disease and psoriatic arthritis treated with mesalazine and AZA (100 mg daily) who developed prolonged bone marrow aplasia and neutropenic fever after increasing the daily dose of AZA from 100 to 150 mg (from 44 to 66 mg/m2), without frequent total blood count monitoring. Discontinuation of AZA, multiple transfusions of red blood cells and platelet concentrate, filgrastim, empirical antibiotic therapy, and antiviral and antifungal prophylaxis were obtained after 11 days complete recovery of bone marrow aplasia. Methods: Genomic DNA genotyping of coding regions of TPMT (exons 2–9) and NUDT15 (exons 1–3). Results: Heterozygous alleles in the untranslated region (c.460G>A and c.719A>G) associated with TPMT deficiency and a benign variant (c.*7G>A) in the 3′-UTR of NUDT15 with no effect on enzyme activity were found. Conclusions: This case highlights the importance of monitoring the total blood count frequently during the first weeks of treatment with moderate-to-high doses of AZA. Furthermore, the interaction between AZA and mesalazine may play a significant role in the development of prolonged bone marrow aplasia.
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Open AccessSystematic Review
Comparing Stenting with Medical Therapy Versus Medical Therapy Alone in Patients with Intracranial Atherosclerotic Stenosis: A Current Systematic Review and Meta-Analysis
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Khalid Bin Aziz, Hussam Alhathlol, Fahad Bin Aziz, Mohammed Alshammari, Mohammed Ali Alhefdhi, Abdulrahman M. Alrasheed, Nawwaf Alfayez and Thamer S. Alhowaish
Clin. Pract. 2025, 15(6), 113; https://doi.org/10.3390/clinpract15060113 - 19 Jun 2025
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Background: Intracranial atherosclerotic stenosis (ICAS) is a significant cause of ischemic stroke worldwide, with high recurrence rates despite optimal medical therapy. While endovascular stenting has been proposed as an adjunctive treatment, its clinical benefit remains controversial as a first line therapy. Objective: To
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Background: Intracranial atherosclerotic stenosis (ICAS) is a significant cause of ischemic stroke worldwide, with high recurrence rates despite optimal medical therapy. While endovascular stenting has been proposed as an adjunctive treatment, its clinical benefit remains controversial as a first line therapy. Objective: To evaluate the efficacy and safety of stenting plus medical therapy (STN+MT) compared to medical therapy alone (MT) in patients with symptomatic ICAS through a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: We systematically searched PubMed, Web of Science, the Cochrane Library, Embase, Scopus, and EBSCO for RCTs comparing STN+MT with MT in adult patients with symptomatic ICAS. Primary outcomes included transient ischemic attack (TIA), stroke, intracerebral hemorrhage (ICH), and death at 30 days and 1 year. Pooled risk ratios with 95% confidence intervals were calculated using random-effects or fixed-effects models as appropriate. Meta-regression was conducted to assess effect modification by study-level characteristics. Results: Four trials comprising 990 patients were included. STN+MT was associated with significantly higher 30-day risk of stroke and ICH compared to MT alone. No significant differences in TIA, stroke, ICH, or death were found at 1 year. Meta-regression revealed no significant effect modifiers, suggesting consistent findings across subgroups. Conclusions: Our meta-analysis consolidates the evidence that intracranial stenting as a first line therapy offers no significant advantage over medical therapy in preventing stroke in symptomatic ICAS, while it does pose added early risks. This holds true across different trials, patient demographics, and clinical scenarios examined. The consistency of this message across multiple RCTs provides a high level of evidence to guide practice. At present, aggressive medical therapy alone should be the default management for most patients. Endovascular intervention should be reserved for clinical trial settings or carefully selected salvage cases, until and unless new evidence emerges to change the risk–benefit calculus such as the promising use of balloon angioplasty in the BASIS trial.
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Open AccessArticle
Administering Parenteral Medications in Managing Patients with Acute Arousal in the Behavioral Assessment Unit of the Emergency Department in Hospital Settings
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Harshini M. Liyanage, Katy Boyce, Yiting Gong, Theresa Koo, Soumitra Das and Naveen Thomas
Clin. Pract. 2025, 15(6), 112; https://doi.org/10.3390/clinpract15060112 - 16 Jun 2025
Abstract
Background/Objectives: The administration of parenteral medications is essential in managing acute arousal within the Behavioral Assessment Unit (BAU) of the emergency department (ED), where timely and effective intervention is critical. This study aims to evaluate current practices surrounding the use of parenteral
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Background/Objectives: The administration of parenteral medications is essential in managing acute arousal within the Behavioral Assessment Unit (BAU) of the emergency department (ED), where timely and effective intervention is critical. This study aims to evaluate current practices surrounding the use of parenteral medications for patients with acute agitation, focusing on adherence to protocols, medication safety, documentation accuracy, and patient outcomes. Methods: A retrospective analysis was conducted on 177 cases from December 2023 to February 2024. The study assessed the demographics, diagnoses, treatment protocols, and patient outcomes, with a particular emphasis on the use of parenteral medications such as benzodiazepines and antipsychotics. The relationship between medication administration and involuntary admission, mechanical restraint usage, and patient outcomes was also explored. Results: The majority of patients were aged between 21 and 30 years, and there was a predominance of male patients across both groups. Schizophrenia was the most common diagnosis, with a higher prevalence in the parenteral group (34%) compared to the oral-only group (24%), and personality disorders were more frequent in the parenteral group. Intramuscular (IM) medication administration was strongly associated with the use of mechanical restraint, with patients receiving IM medication being 35 times more likely to require restraint, emphasizing the link between more intensive treatment approaches and behavioral challenges. The most frequently administered medications were diazepam (40.6%) and olanzapine (36.5%), with olanzapine, droperidol, and diazepam most commonly used parenterally. Documentation of physical assessments prior to parenteral administration was present in most cases, though comprehensive evaluations such as ECGs were inconsistently performed. Conclusions: Parenteral medications, including benzodiazepines and antipsychotics, were effective in rapidly stabilizing patients, but the study emphasizes reducing dependency on mechanical restraints. Tailoring treatment to patient characteristics and employing alternative de-escalation strategies can improve safety and align with recovery-oriented care. This study highlights the need for evidence-based practices to optimize care and improve patient outcomes in ED settings. Further research is needed to explore long-term outcomes and refine non-coercive care approaches.
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Open AccessArticle
Validation, Content Validity, and Reliability of the Spanish SE-OAM Questionnaire: Assessing Nursing Self-Efficacy in Oral Anticoagulant Therapy Management
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Juan Ramón de-Moya-Romero, Raquel Valera-Lloris, Elena Chover-Sierra, Laura Fernández-Puerta, Alexis Caballero-Bonafé and Antonio Martínez-Sabater
Clin. Pract. 2025, 15(6), 111; https://doi.org/10.3390/clinpract15060111 - 16 Jun 2025
Abstract
Background/Objectives: Oral anticoagulant therapy (OAT) has been prescribed for over seventy years to prevent thromboembolic complications associated with various conditions. The emergence of direct-acting oral anticoagulants (DOACs) has reduced the use of vitamin K antagonists (VKAs), but specific clinical scenarios still necessitate VKAs.
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Background/Objectives: Oral anticoagulant therapy (OAT) has been prescribed for over seventy years to prevent thromboembolic complications associated with various conditions. The emergence of direct-acting oral anticoagulants (DOACs) has reduced the use of vitamin K antagonists (VKAs), but specific clinical scenarios still necessitate VKAs. Nurses play a crucial role in managing OAT, and their self-efficacy is essential for optimal patient outcomes. This study aims to validate and adapt the Nursing Self-Efficacy for Oral Anticoagulant Therapy Management (SE-OAM) questionnaire to Spanish (SE-OAM-SV) to assess nurses’ self-efficacy in managing OAT. Methods: A methodological design was employed to develop the validity and reliability of the SE-OAM-SV. The process included translation and back-translation, expert review, and a pilot study. Content validity was analyzed using the content validity index (CVI), modified kappa coefficient, and Aiken’s V. A descriptive cross-sectional study was conducted with 100 nurses across Spain to test the SE-OAM-SV and identify comprehension issues. Internal consistency was assessed via Cronbach’s alpha. Results: The translation process highlighted some items requiring clarification, which were resolved through expert consultation. The SE-OAM-SV demonstrated adequate content validity with a global CVI of 0.86. The pilot study revealed an average participant age of 41.3 years and 17.3 years of professional experience. The SE-OAM-SV showed high internal consistency with a Cronbach’s alpha of 0.96. The average score of participants on the SE-OAM-SV was 56.8 points, indicating room for improvement in all aspects of the scale. Conclusion: The SE-OAM-SV is a reliable and valid tool for measuring nurses’ self-efficacy in managing OAT in Spanish-speaking communities. This tool can facilitate the development of educational programs and public policies to enhance nurses’ self-efficacy and improve patient outcomes. The availability of the SE-OAM-SV supports larger-scale studies and validation in other Spanish-speaking countries.
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Open AccessArticle
Multicenter Study of Comorbidities in Patients with Periprosthetic Fractures After Total Hip Arthroplasty and Their Association with Immediate Postoperative Complications
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Victor Niculescu, Alexandru Lisias Dimitriu, Delia Carmen Nistor-Cseppento, Sebastian Tirla, Anamaria Gherle, Bogdan Uivaraseanu and Cristian Burnei
Clin. Pract. 2025, 15(6), 110; https://doi.org/10.3390/clinpract15060110 - 12 Jun 2025
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Background/Objectives: Periprosthetic fractures (PFs) can occur in both the upper and lower limbs, commonly resulting from falls at the same level. The frequency of PFs following total hip arthroplasty (THA) ranges from 0.045% to 4.1%, and this incidence is influenced by several factors,
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Background/Objectives: Periprosthetic fractures (PFs) can occur in both the upper and lower limbs, commonly resulting from falls at the same level. The frequency of PFs following total hip arthroplasty (THA) ranges from 0.045% to 4.1%, and this incidence is influenced by several factors, including age, gender, the type of prosthesis used, and existing comorbidities. Previous studies on this subject have been small in scale and did not adequately address the associated comorbidities, which pose a challenge for the aging population. This study aims to comparatively assess the incidence of THA-related PFs, immediate postoperative complications, and comorbidities in patients with PFs from three emergency hospitals. Methods: A retrospective observational study was conducted from 1 January to 31 December 2024, in which 54 patients with PFs hospitalized in three emergency hospitals (Bucharest, Oradea, and Ploiești) were evaluated, divided into Group B (n = 29), Group O (n = 14), and Group P (n = 11). Results: Of all patients with PFs, 81.48% had minor complications—grade 1, 9.26% had grade 2 complications (complications requiring medical treatment or other minor interventions), and 3.70% had complications requiring surgery or invasive procedures. Clavien–Dindo grade 5 (patient death) had an incidence of 3.70%. Cardiac pathology was the most common pathology; hypertension predominated in Group O (42.85%). Alzheimer’s disease was associated in 7 patients (12.96%). Without associated pathology, about 13% of patients were identified. Diabetes mellitus also occurred frequently in 31.50%. Data analysis indicates a very weak positive correlation between the Dindo Index and the Charlson Comorbidity Index (r = 0.046), which is not statistically significant (p = 0.628). The effect size, measured by Fisher’s z, is also reported as 0.046. Conclusions: No significant differences were found among the evaluated centers regarding therapeutic approaches, postoperative complications, and associated comorbidities. Furthermore, there is insufficient evidence to suggest a significant association between the Charlson Comorbidity Index and the Clavien–Dindo Index.
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Open AccessReview
Atypically Displaced Meniscal Tears: An Educational Review with Focus on MRI and Arthroscopy
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Paolo Spinnato, Paola Franceschi, Giuseppe Martinese, Anna Parmeggiani, Valerio D’Agostino, Silvia Ferraro, George R. Matcuk, Stefano Zaffagnini and Alberto Grassi
Clin. Pract. 2025, 15(6), 109; https://doi.org/10.3390/clinpract15060109 - 12 Jun 2025
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This review article on atypically displaced meniscal tears serves as a critical reminder for radiologists and orthopedic surgeons. It highlights and details uncommon lesions that may be overlooked during MRI evaluation and/or arthroscopic exploration. The knowledge of their existence can enable radiologists to
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This review article on atypically displaced meniscal tears serves as a critical reminder for radiologists and orthopedic surgeons. It highlights and details uncommon lesions that may be overlooked during MRI evaluation and/or arthroscopic exploration. The knowledge of their existence can enable radiologists to critically assess any meniscal abnormality, keeping in mind its possible arthroscopic presentation. This is essential for assisting the surgeon in making an accurate preoperative diagnosis. In fact, these atypical lesions pose great challenges to surgeons in terms of the technical aspects of their treatment. Often, they could require additional arthroscopic portals for their identification or the need for special devices or instrumentations for the repair. Knowing these challenges in advance is thus imperative for properly planning a proficient surgery. The correct diagnosis and description of tear patterns, including extent and location, allow optimal pre-operative planning with the choice of the indicated approach. Radiologists should know how to recognize menisci tears, even with atypical dislocation patterns. Particularly, in the case of ‘minus’ detection or thickness reduction in a meniscus, the possible displaced fragment should be carefully searched for, even in atypical sites.
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Open AccessArticle
Maternal Disorders Associated with Morbidity and Mortality in a Metropolis of Kazakhstan
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Aigerim Turekulova, Nurzhamal Dzhardemaliyeva, Alibek Mereke and Mukhtar Kulimbet
Clin. Pract. 2025, 15(6), 108; https://doi.org/10.3390/clinpract15060108 - 6 Jun 2025
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Background/Objectives: Hypertensive disorders of pregnancy, including pre-eclampsia and eclampsia, are leading causes of maternal morbidity and mortality worldwide and in Kazakhstan. This study aims to assess the burden of hypertensive disorders of pregnancy and main maternal disorders in Almaty, Kazakhstan, using the disability
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Background/Objectives: Hypertensive disorders of pregnancy, including pre-eclampsia and eclampsia, are leading causes of maternal morbidity and mortality worldwide and in Kazakhstan. This study aims to assess the burden of hypertensive disorders of pregnancy and main maternal disorders in Almaty, Kazakhstan, using the disability adjusted life years (DALY) methodology. Methods: We conducted a retrospective analysis of women aged 18 and above in Almaty, Kazakhstan, from 2018 to 2020. The medical claim data were retrieved from the Almaty city branch of the Republican Center for Electronic Health Care. Incidence-based DALY were calculated. Results: The total DALY increased for severe pre-eclampsia from 109.3 in 2018 to 187.2 in 2020 per 100,000 population and eclampsia from 3.1 in 2018 to 159.3 in 2020 per 100,000 population. Also, the 25–29 years age group had the largest increase in percent change (5.8) in the total DALY for hypertensive disorders of pregnancy. In addition, the 20–24 years age groups had the largest increase in percent change in the total DALY for severe pre-eclampsia (25.8) and eclampsia (80.5). Conclusions: Our findings highlight an increase in the burden of maternal disorders, especially for severe pre-eclampsia and eclampsia, in Almaty, Kazakhstan, from 2018 to 2020. Younger women bear a significant share of this burden, compounded by the pandemic’s impact on healthcare services.
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