Clinics and Practice

20 pages, 1644 KiB

Open AccessReview

Clinical Research in Prehospital Care: Current and Future Challenges

by Jonathan Cimino and Claude Braun

Clin. Pract. 2023, 13(5), 1266-1285; https://doi.org/10.3390/clinpract13050114 - 23 Oct 2023

Cited by 5 | Viewed by 8315

Prehospital care plays a critical role in improving patient outcomes, particularly in cases of time-sensitive emergencies such as trauma, cardiac failure, stroke, bleeding, breathing difficulties, systemic infections, etc. In recent years, there has been a growing interest in clinical research in prehospital care, [...] Read more.

Prehospital care plays a critical role in improving patient outcomes, particularly in cases of time-sensitive emergencies such as trauma, cardiac failure, stroke, bleeding, breathing difficulties, systemic infections, etc. In recent years, there has been a growing interest in clinical research in prehospital care, and several challenges and opportunities have emerged. There is an urgent need to adapt clinical research methodology to a context of prehospital care. At the same time, there are many barriers in prehospital research due to the complex context, posing unique challenges for research, development, and evaluation. Among these, this review allows the highlighting of limited resources and infrastructure, ethical and regulatory considerations, time constraints, privacy, safety concerns, data collection and analysis, selection of a homogeneous study group, etc. The analysis of the literature also highlights solutions such as strong collaboration between emergency medical services (EMS) and hospital care, use of (mobile) health technologies and artificial intelligence, use of standardized protocols and guidelines, etc. Overall, the purpose of this narrative review is to examine the current state of clinical research in prehospital care and identify gaps in knowledge, including the challenges and opportunities for future research. Full article

(This article belongs to the Special Issue Clinical Nursing and Quality of Healthcare)

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13 pages, 897 KiB

Open AccessArticle

Serum Markers of Brain Injury in Pediatric Patients with Congenital Heart Defects Undergoing Cardiac Surgery: Diagnostic and Prognostic Role

by Lacramioara Eliza Chiperi, Adina Huţanu, Cristina Tecar and Iolanda Muntean

Clin. Pract. 2023, 13(5), 1253-1265; https://doi.org/10.3390/clinpract13050113 - 23 Oct 2023

Cited by 1 | Viewed by 1732

Abstract

Introduction: The objectives of this study were to assess the role of neuromarkers like glial fibrillary acidic protein (GFAP), brain-derived neurotrophic factor (BDNF), protein S100 (pS100), and neuron-specific enolase (NSE) as diagnostic markers of acute brain injury and also as prognostic markers [...] Read more.

Introduction: The objectives of this study were to assess the role of neuromarkers like glial fibrillary acidic protein (GFAP), brain-derived neurotrophic factor (BDNF), protein S100 (pS100), and neuron-specific enolase (NSE) as diagnostic markers of acute brain injury and also as prognostic markers for short-term neurodevelopmental impairment. Methods: Pediatric patients with congenital heart defects (CHDs) undergoing elective cardiac surgery were included. Neurodevelopmental functioning was assessed preoperatively and 4–6 months postoperatively using the Denver Developmental Screening Test II. Blood samples were collected preoperatively and postoperatively. During surgery, regional cerebral tissue oxygen saturation was monitored using near-infrared spectroscopy (NIRS). Results: Forty-two patients were enrolled and dichotomized into cyanotic and non-cyanotic groups based on peripheric oxygen saturation. Nineteen patients (65.5%) had abnormal developmental scores in the non-cyanotic group and eleven (84.6%) in the cyanotic group. A good diagnostic model was observed between NIRS values and GFAP in the cyanotic CHD group (AUC = 0.7). A good predicting model was observed with GFAP and developmental scores in the cyanotic CHD group (AUC = 0.667). A correlation was found between NSE and developmental quotient scores (r = 0.09, p = 0.046). Conclusions: From all four neuromarkers studied, only GFAP was demonstrated to be a good diagnostic and prognostic factor in cyanotic CHD patients. NSE had only prognostic value. Full article

(This article belongs to the Special Issue Pediatric and Adolescent Psychiatry and Psychology: Current Treatments and Future Options)

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9 pages, 491 KiB

Open AccessArticle

The Use of Vacuum Devices as Adjuvant Therapy before and after Penile Curvature Surgery in Patients Affected by La Peyronie’s Disease: Results from a Comparative Study

by Tommaso Cai, Marco Capece, Carlo Ceruti, Daniele Tiscione, Marco Puglisi, Paolo Verze, Paolo Gontero and Alessandro Palmieri

Clin. Pract. 2023, 13(5), 1244-1252; https://doi.org/10.3390/clinpract13050112 - 17 Oct 2023

Cited by 1 | Viewed by 1929

Abstract

Background: Peyronie’s disease (PD) represents a challenging urological disease, due to not optimal post-operative surgical outcomes. We aim to retrospectively evaluate if vacuum erection device (VED) treatment before penile curvature surgery is able to improve post-operative surgical outcomes. Methods: All enrolled patients were [...] Read more.

Background: Peyronie’s disease (PD) represents a challenging urological disease, due to not optimal post-operative surgical outcomes. We aim to retrospectively evaluate if vacuum erection device (VED) treatment before penile curvature surgery is able to improve post-operative surgical outcomes. Methods: All enrolled patients were assigned to the following groups: (a) the treatment group: VED treatment (three times per week) starting 3 months before surgery and (three times per week) one month after surgery; and (b) the control group: VED treatment (three times per week) one month after surgery. Follow-up urologic visits were scheduled for 3 and 6 months after surgery, and the two groups were compared. Results: A total of 38 patients were enrolled (median age 67 years, 57–74, IQR): 20 in the treatment group and 18 in the control group. At the follow-up visits, the two groups were different in terms of IIEF-5 (26 vs. 24; p = 0.02), “yes” to SEP2 and 3 (85% vs. 55%; p < 0.001, 85% vs. 50%; p < 0.001, respectively), and PDQ (−16 vs. −11; p = 0.03). Complete correction of penile curvature was achieved in 36 patients (94.7%). In the treatment group, no hourglass deformity was reported, whereas one patient reported a mild hourglass deformity in the control group. In the treatment group, we obtained a longer total penile length (median +1.5 cm). The overall satisfaction rate was 98% in the treatment group and 96% in the control group. Conclusions: The VED treatment before penile curvature surgery in patients affected by PD was able to improve surgical outcomes. Full article

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8 pages, 1804 KiB

Open AccessCase Report

Giant Pancreatic Pseudocyst after Coronary Artery Bypass Graft in a Hemodialysis Patient: A Case Report

by Ming-Jen Chan, Chun-Yih Hsieh, Yi-Jiun Su, Chien-Chang Huang, Wen-Hung Huang, Cheng-Hao Weng, Tzung-Hai Yen and Ching-Wei Hsu

Clin. Pract. 2023, 13(5), 1236-1243; https://doi.org/10.3390/clinpract13050111 - 8 Oct 2023

Viewed by 1196

Abstract

End-stage renal disease (ESRD) patients have a high prevalence of coronary artery disease, and coronary artery bypass graft (CABG) is one of the essential treatments. ESRD patients undergoing CABG surgery have an increased risk of postoperative complications, including acute pancreatitis. Here, we present [...] Read more.

End-stage renal disease (ESRD) patients have a high prevalence of coronary artery disease, and coronary artery bypass graft (CABG) is one of the essential treatments. ESRD patients undergoing CABG surgery have an increased risk of postoperative complications, including acute pancreatitis. Here, we present the unique case of an exceptionally large pancreatic pseudocyst caused by pancreatitis in an ESRD patient after CABG surgery. A 45-year-old male with ESRD under maintenance hemodialysis received CABG surgery for significant coronary artery disease. Two weeks later, he experienced worsening abdominal pain and a palpable mass was noticed in the epigastric region. Computer tomography revealed an unusually large pseudocyst measuring 21 × 17 cm in the retroperitoneum due to necrotizing pancreatitis. The patient underwent percutaneous cystic drainage, and the symptoms were significantly improved without surgical intervention. Factors such as prolonged cardiopulmonary bypass time, postoperative hypotension, and intradialytic hypotension appeared to have contributed to the development of severe pancreatitis in this case. This report highlights the rarity of a giant pancreatic pseudocyst in an ESRD patient after CABG surgery and emphasizes the importance of vigilant postoperative care. Full article

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9 pages, 1381 KiB

Open AccessArticle

The Impact of a Single Supervised Exercise Session in the Third Trimester of Pregnancy on the Physical Activity Levels of Pregnant Women—A Pilot Study

by Christos Chatzakis, George Mastorakos, Eleftheria Demertzidou, Anatoli Theodoridou, Konstantinos Dinas and Alexandros Sotiriadis

Clin. Pract. 2023, 13(5), 1227-1235; https://doi.org/10.3390/clinpract13050110 - 3 Oct 2023

Cited by 1 | Viewed by 1429

Abstract

Background: Despite the numerous beneficial effects of physical exercise during pregnancy, the levels of physical activity remain low. The aim of the study is to investigate the impact of a single supervised physical exercise session on the overall physical activity levels of pregnant [...] Read more.

Background: Despite the numerous beneficial effects of physical exercise during pregnancy, the levels of physical activity remain low. The aim of the study is to investigate the impact of a single supervised physical exercise session on the overall physical activity levels of pregnant women. Methods: During the third trimester, pregnant women attending our outpatient clinic were requested to assess their physical activity levels using the International Physical Activity Questionnaire (IPAQ). Additionally, they were invited to participate in a supervised 30 min mild–moderate-intensity aerobic exercise session (stationary bike ergometer) under the guidance of medical personnel. Subsequently, physical activity levels were reevaluated at the time of delivery. Results: Prior to the intervention, 3 out of 50 (6%) women engaged in mild–moderate physical activity for 150 min per week, while 20 out of 50 (40%) women participated in mild–moderate activity for 15–30 min, twice a week. Following the intervention, these percentages increased to 10 out of 50 (20%) and 31 out of 50 (62%), respectively (p < 0.05). Conclusions: This pilot study suggests that a single exercise session supervised by medical personnel may significantly improve the low physical activity levels observed in pregnant women. Full article

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12 pages, 256 KiB

Open AccessArticle

Quality of Life among Peritoneal and Hemodialysis Patients: A Cross-Sectional Study

by Fadel AlRowaie, Abdullah Alaryni, Abdullah AlGhamdi, Renad Alajlan, Razan Alabdullah, Raed Alnutaifi, Raneem Alnutaifi, Amani Aldakheelallah, Alanoud Alshabanat, Abdullah Bin Shulhub, Othillah Moazin, Rayan Qutob, Enad Alsolami and Osamah Hakami

Clin. Pract. 2023, 13(5), 1215-1226; https://doi.org/10.3390/clinpract13050109 - 30 Sep 2023

Cited by 3 | Viewed by 2461

Abstract

Background: The quality of life (QoL) of patients with end-stage kidney disease (ESKD) who undergo dialysis is a reliable predictor of their long-term survival. Hemodialysis is the most common form of kidney replacement therapy for ESKD, followed by peritoneal dialysis. This study aimed [...] Read more.

Background: The quality of life (QoL) of patients with end-stage kidney disease (ESKD) who undergo dialysis is a reliable predictor of their long-term survival. Hemodialysis is the most common form of kidney replacement therapy for ESKD, followed by peritoneal dialysis. This study aimed to identify the factors affecting QoL in ESKD patients treated with peritoneal dialysis (PD) or hemodialysis (HD) in Riyadh, Saudi Arabia. Methods: A cross-sectional study was conducted between June and July 2021 to assess the QoL of patients with ESKD who underwent peritoneal dialysis and hemodialysis. Patients who had been on dialysis for at least one year were included. The Arabic version of the Quality of Life Index–Dialysis (QLI-D) version III was used to measure the QoL. Results: A total of 210 patients completed the questionnaire. The overall QLI score was 21.73 ± 4.2, with subscales for health and functioning (20.35 ± 5.2), social and economic (20.20 ± 4.8), psychological/spiritual (23.94 ± 4.9), and family (24.95 ± 4.5). The QLI scores for PD and HD patients were 21.80 ± 4.4 and 21.72 ± 4.1, respectively. SOCSUB (p = 0.031) was significantly associated with group and income, whereas QLI (p = 0.003), HFSUB (p = 0.013), SOCSUB (p = 0.002), and PSPSUB (p = 0.003) were significantly correlated with group and years of dialysis. Conclusion: The study found that patients were most satisfied with their family, health and functioning, and social/economic subscales. Income and years of dialysis were found to be predictive factors of QoL. Overall, peritoneal patients in this study demonstrated a better QoL than HD patients. Full article

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

8 pages, 1060 KiB

Open AccessBrief Report

Digital Patient Education on Xanthelasma Palpebrarum: A Content Analysis

by Kevin J. Varghese, Som P. Singh, Fahad M. Qureshi, Shreevarsha Shreekumar, Aarya Ramprasad and Fawad Qureshi

Clin. Pract. 2023, 13(5), 1207-1214; https://doi.org/10.3390/clinpract13050108 - 29 Sep 2023

Cited by 2 | Viewed by 1461

Abstract

Patient education has been transformed using digital media and online repositories which disseminate information with greater efficiency. In dermatology, this transformation has allowed for patients to gain education on common cutaneous conditions and improve health literacy. Xanthelasma palpebrarum is one of the most [...] Read more.

Patient education has been transformed using digital media and online repositories which disseminate information with greater efficiency. In dermatology, this transformation has allowed for patients to gain education on common cutaneous conditions and improve health literacy. Xanthelasma palpebrarum is one of the most common cutaneous conditions, yet there is a poor understanding of how digital materials affect health literacy on this condition. Our study aimed to address this paucity of literature utilizing Brief DISCERN, Rothwell’s Classification of Questions, and six readability calculations. The findings of this study indicate a poor-quality profile (Brief DISCERN < 16) regarding digital materials and readability scores which do not meet grade-level recommendations in the United States. This indicates a need to improve the current body of educational materials used by clinicians for diagnosing and managing xanthelasma palpebrarum. Full article

(This article belongs to the Special Issue Teaching Pathology Towards Clinics and Practice)

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11 pages, 2233 KiB

Open AccessBrief Report

Individual Differences in Auditory Training Benefits for Hearing Aid Users

by Ayelet Barda, Yair Shapira and Leah Fostick

Clin. Pract. 2023, 13(5), 1196-1206; https://doi.org/10.3390/clinpract13050107 - 29 Sep 2023

Cited by 2 | Viewed by 1465

Abstract

The present study aimed to examine whether individual differences in baseline speech perception could serve as predictors for the effectiveness and generalization of auditory training (AT) to non-trained tasks. Twelve adults, aged 60–75 years with bilateral hearing loss, completed a two-month, home-based, computerized [...] Read more.

The present study aimed to examine whether individual differences in baseline speech perception could serve as predictors for the effectiveness and generalization of auditory training (AT) to non-trained tasks. Twelve adults, aged 60–75 years with bilateral hearing loss, completed a two-month, home-based, computerized AT program, involving sessions four times per week. Training tasks included the identification of vowel frontal, height, manner of articulation, point of articulation, voicing, and open-set consonant-vowel-consonant (CVC) words. Non-trained speech perception tests were conducted one month before AT, prior to training, after one and two months of training, and during a two-month follow-up. The results showed that one month of AT improved performance in most trained tasks, with generalization observed in the CVC words test and HeBio sentences with speech-shaped noise (SSN). No evidence of spontaneous learning or added benefit from an extra month of training was found. Most importantly, baseline speech perception predicted improvements in both training and post-training generalization tasks. This emphasizes the significance of adopting an individualized approach when determining the potential effectiveness of AT, applicable in both clinical and research contexts. Full article

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14 pages, 1555 KiB

Open AccessReview

Ledderhose’s Disease: An Up-to-Date Review of a Rare Non-Malignant Disorder

by Alexandru Tomac, Alexandru Petru Ion, Diana Roxana Opriș, Eliza Mihaela Arbănași, Claudiu Constantin Ciucanu, Bogdan Corneliu Bandici, Cătălin Mircea Coșarcă, Diana Carina Covalcic and Adrian Vasile Mureșan

Clin. Pract. 2023, 13(5), 1182-1195; https://doi.org/10.3390/clinpract13050106 - 28 Sep 2023

Cited by 1 | Viewed by 5995

Abstract

Plantar fibromatosis (or Ledderhose’s disease) is a rare benign condition, difficult to treat, defined by gradual-growing nodules in the central medial part of the plantar fascia, with the possibility of sclerosis and shrinkage of the entire fascia or, rarely, contractures of the toes. [...] Read more.

Plantar fibromatosis (or Ledderhose’s disease) is a rare benign condition, difficult to treat, defined by gradual-growing nodules in the central medial part of the plantar fascia, with the possibility of sclerosis and shrinkage of the entire fascia or, rarely, contractures of the toes. From a histopathological point of view, it is linked to Dupuytren’s contracture of the hand and Peyronie’s disease of the penis, being part of a large group of fibromatoses, based on a proliferation of collagen and fibroblasts. Its etiology is still not fully understood, even though it has been associated with trauma, diabetes mellitus, use of anticonvulsants, frozen shoulder, alcohol consumption, and liver disease. Typically, ultrasound confirms the diagnosis, and magnetic resonance imaging is used for more aggressive and advanced types. Several conservative treatment techniques, such as steroid injections, verapamil, imatinib, radiation therapy, extracorporeal shock wave therapy, tamoxifen, sorafenib, mitomycin C, and collagenase, have been documented. When non-operative care fails, surgical measures may be considered, even though recurrence is expected. We attempted to provide a better understanding of this disease by covering all of the important aspects: its history, clinical and radiologic findings, diagnosis, pathophysiology features, conservative and surgical treatment, recurrence rate, and prognosis. Full article

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9 pages, 1154 KiB

Open AccessBrief Report

Use of Oral Anticoagulants in Patients with Atrial Fibrillation: Preliminary Data from the Italian Atrial Fibrillation (ITALY-AF) Registry

by Fabio Angeli, Gianpaolo Reboldi, Giancarlo Agnelli, Giuseppe Ambrosio, Alessandro Capucci, Giovanni Carreras, Claudio Cavallini, Adriano Murrone, Gaetano Vaudo, Gianluca Zingarini and Paolo Verdecchia

Clin. Pract. 2023, 13(5), 1173-1181; https://doi.org/10.3390/clinpract13050105 - 27 Sep 2023

Viewed by 1384

Abstract

Background: Atrial fibrillation (AFIB), the most frequent cardiac arrhythmia, is a major risk factor for stroke, heart failure, and death. Because of the recent advances in AFIB management and the availability of new oral anticoagulants (OACs), there is a need for a systematic [...] Read more.

Background: Atrial fibrillation (AFIB), the most frequent cardiac arrhythmia, is a major risk factor for stroke, heart failure, and death. Because of the recent advances in AFIB management and the availability of new oral anticoagulants (OACs), there is a need for a systematic and predefined collection of contemporary data regarding its management and treatment. Methods: The objective of the ongoing ITALY-AFIB registry is to evaluate the long-term morbidity and mortality in patients with AFIB and to verify the implementation of the current guidelines for stroke prevention in these patients. The registry includes consecutive in- and out-patients with first diagnosed, paroxysmal, persistent, or permanent AFIB. In patients in sinus rhythm at entry, the qualifying episode of AFIB, confirmed by ECG diagnosis, had to have occurred within 1 year before entry. The clinical record form is web-based and accessible by personal keyword. Results: Enrolment into the registry started in the year 2013. In a current cohort of 2470 patients (mean age 75 ± 11 years, males 56%), the mean CHA₂DS₂-VASc score was 3.7 ± 1.8, and the mean HAS-BLED was 1.6 ± 0.9. There were no significant sex differences in the AFIB subtypes. At the end of the inclusion visit and after receiving knowledge of the web-based electronic estimate of risk for stroke and bleeding, the proportion of patients discharged with OACs was 80%. After exclusion of patients with first diagnosed AFIB (n = 397), the proportion of patients with prescription of OACs rose from 66% before the visit to 82% on discharge (p < 0.0001). Prescription of aspirin or other antiplatelet drugs fell from 18% before the visit to 10% on discharge (p < 0.0001). Conclusions: A web-based management of AFIB with automated estimation of risk profiles appears to favorably affect adherence to AFIB guidelines, based on a high proportion of patients treated with OACs and a substantial decline in the use of antiplatelet drugs. Full article

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

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13 pages, 1332 KiB

Open AccessArticle

AI-Powered Renal Diet Support: Performance of ChatGPT, Bard AI, and Bing Chat

by Ahmad Qarajeh, Supawit Tangpanithandee, Charat Thongprayoon, Supawadee Suppadungsuk, Pajaree Krisanapan, Noppawit Aiumtrakul, Oscar A. Garcia Valencia, Jing Miao, Fawad Qureshi and Wisit Cheungpasitporn

Clin. Pract. 2023, 13(5), 1160-1172; https://doi.org/10.3390/clinpract13050104 - 26 Sep 2023

Cited by 22 | Viewed by 4923

Abstract

Patients with chronic kidney disease (CKD) necessitate specialized renal diets to prevent complications such as hyperkalemia and hyperphosphatemia. A comprehensive assessment of food components is pivotal, yet burdensome for healthcare providers. With evolving artificial intelligence (AI) technology, models such as ChatGPT, Bard AI, [...] Read more.

Patients with chronic kidney disease (CKD) necessitate specialized renal diets to prevent complications such as hyperkalemia and hyperphosphatemia. A comprehensive assessment of food components is pivotal, yet burdensome for healthcare providers. With evolving artificial intelligence (AI) technology, models such as ChatGPT, Bard AI, and Bing Chat can be instrumental in educating patients and assisting professionals. To gauge the efficacy of different AI models in discerning potassium and phosphorus content in foods, four AI models—ChatGPT 3.5, ChatGPT 4, Bard AI, and Bing Chat—were evaluated. A total of 240 food items, curated from the Mayo Clinic Renal Diet Handbook for CKD patients, were input into each model. These items were characterized by their potassium (149 items) and phosphorus (91 items) content. Each model was tasked to categorize the items into high or low potassium and high phosphorus content. The results were juxtaposed with the Mayo Clinic Renal Diet Handbook’s recommendations. The concordance between repeated sessions was also evaluated to assess model consistency. Among the models tested, ChatGPT 4 displayed superior performance in identifying potassium content, correctly classifying 81% of the foods. It accurately discerned 60% of low potassium and 99% of high potassium foods. In comparison, ChatGPT 3.5 exhibited a 66% accuracy rate. Bard AI and Bing Chat models had an accuracy rate of 79% and 81%, respectively. Regarding phosphorus content, Bard AI stood out with a flawless 100% accuracy rate. ChatGPT 3.5 and Bing Chat recognized 85% and 89% of the high phosphorus foods correctly, while ChatGPT 4 registered a 77% accuracy rate. Emerging AI models manifest a diverse range of accuracy in discerning potassium and phosphorus content in foods suitable for CKD patients. ChatGPT 4, in particular, showed a marked improvement over its predecessor, especially in detecting potassium content. The Bard AI model exhibited exceptional precision for phosphorus identification. This study underscores the potential of AI models as efficient tools in renal dietary planning, though refinements are warranted for optimal utility. Full article

(This article belongs to the Special Issue Clinical Practice of Artificial Intelligence in Diagnostic and Treatment Assistance)

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Graphical abstract

14 pages, 1116 KiB

Open AccessArticle

Two Pregnancy Care Models in Poland—A Descriptive–Comparative Study

by Marta Gallas, Aleksandra Gaworska-Krzemińska and Katarzyna Pogorzelczyk

Clin. Pract. 2023, 13(5), 1146-1159; https://doi.org/10.3390/clinpract13050103 - 20 Sep 2023

Viewed by 1380

Abstract

Care for a pregnant woman can take various organizational forms. The World Health Organization (WHO) recommends leaders increase research into health systems. The aim of this is to manage the healthcare system in such a way as to provide beneficiaries with access to [...] Read more.

Care for a pregnant woman can take various organizational forms. The World Health Organization (WHO) recommends leaders increase research into health systems. The aim of this is to manage the healthcare system in such a way as to provide beneficiaries with access to high-quality services with limited financial resources. The study presented in this paper was conducted using a diagnostic survey on a group of 1642 Polish women in the traditional model of care (TM) and 3216 women in the Coordinated Care for Pregnant Women Program (CCP). Two research tools were used in this study. The first is a survey prepared by the National Health Fund, the second is an author’s survey. The results indicate that most women (85%) receiving care under the CCP received effective pain management, compared to 67% under the traditional care model (p < 0.001). In the CCP, women were significantly more likely to receive midwife assistance in infant care (90%) than women in the traditional care model (60%) (p < 0.001). Significantly more CCP patients want to return to the same hospital for their subsequent childbirth (74%) than women in the traditional model of care (43%) (p < 0.001). In patients’ opinion, the new CCP model is superior in meeting their needs and providing higher-quality services. However, educating women that an obstetrician-gynecologist and a midwife can manage their pregnancy is still necessary. In addition to the CCP program, special attention should be paid to available pain management during childbirth since the use of analgesia is still insufficient in Polish hospitals. Full article

(This article belongs to the Special Issue Clinical Nursing and Quality of Healthcare)

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9 pages, 3288 KiB

Open AccessCase Report

Extreme Leukocytosis and Gangrenous Cholecystitis Associated with Cytoreductive Surgery and HIPEC-Treated Mucinos Ovary Cancer: Case Report and Literature Review

by Stojan Latincic, Maja Pavlov, Jovica Vasiljevic, Dragan Vasin, Maja Dimic-Cumic, Marjan Micev, Milena Papovic, Miljan Doskovic, Stefan Bugarin, Stefan Milosevic and Dragutin Kecmanovic

Clin. Pract. 2023, 13(5), 1137-1145; https://doi.org/10.3390/clinpract13050102 - 18 Sep 2023

Viewed by 1664

Abstract

Mucinous ovarian cancer occurs sporadically, with a frequency of approximately 3–5% among all subtypes of ovarian cancer. Extreme leukocytosis >40,000 and 50,000 has been described in most solid tumors and is associated with a poor prognosis, although there is a lack of literal [...] Read more.

Mucinous ovarian cancer occurs sporadically, with a frequency of approximately 3–5% among all subtypes of ovarian cancer. Extreme leukocytosis >40,000 and 50,000 has been described in most solid tumors and is associated with a poor prognosis, although there is a lack of literal data of its occurrence after cytoreductive surgery and HIPEC in the treatment of advanced mucinous ovarian cancer. There is higher risk of the occurrence of cholecystitis in oncology patients compared to the general population, although there is no formal evidence for this, and the association with ovarian cancer is accompanied by a relative risk of 1.38. Hypercalcemia-hyperleukocytosis is a syndrome associated with head and neck cancers, although, to our knowledge, it has not been described in mucinous ovarian cancer, especially after cytoreductive surgery and HIPEC. Full article

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7 pages, 6424 KiB

Open AccessCase Report

Benign Mesothelial Proliferations of the Tunica Vaginalis Testis

by Claudia Manini, Estíbaliz López-Fernández, Nicola Cruciano, Alessandro Comandone and José I. López

Clin. Pract. 2023, 13(5), 1130-1136; https://doi.org/10.3390/clinpract13050101 - 15 Sep 2023

Viewed by 1346

Abstract

The correct diagnosis of mesothelial proliferations is a classic problem for pathologists, and one which has important clinical implications. A significant number of such cases appear associated with recurrent hydrocele, as an irritative/reactive response to this condition. The morphological spectrum of mesothelial lesions [...] Read more.

The correct diagnosis of mesothelial proliferations is a classic problem for pathologists, and one which has important clinical implications. A significant number of such cases appear associated with recurrent hydrocele, as an irritative/reactive response to this condition. The morphological spectrum of mesothelial lesions in this topography is broad, and a set of benign conditions may appear, sometimes with florid gross features and cytologic pseudo-atypia. Here, we present two different examples in which malignancy was initially considered in the differential diagnosis. Full article

(This article belongs to the Special Issue Teaching Pathology Towards Clinics and Practice)

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7 pages, 267 KiB

Open AccessBrief Report

Effect of Oral High Molecular Weight Hyaluronic Acid (HMWHA), Alpha Lipoic Acid (ALA), Magnesium, Vitamin B6 and Vitamin D Supplementation in Pregnant Women: A Retrospective Observational Pilot Study

by Eligio Parente, Giulia Colannino, Gabriele Bilotta, Maria Salomé Bezerra Espinola, Sara Proietti, Mario Montanino Oliva, Isabella Neri, Cesare Aragona and Vittorio Unfer

Clin. Pract. 2023, 13(5), 1123-1129; https://doi.org/10.3390/clinpract13050100 - 15 Sep 2023

Cited by 3 | Viewed by 5257

Abstract

Background—Pregnancy represents a nutritional challenge, since macro- and micronutrients intake can affect mother’ health and influence negative outcomes. The aim of this retrospective pilot study is to evidence whether the oral supplementation with high molecular weight hyaluronic acid (HMWHA), in association with alpha [...] Read more.

Background—Pregnancy represents a nutritional challenge, since macro- and micronutrients intake can affect mother’ health and influence negative outcomes. The aim of this retrospective pilot study is to evidence whether the oral supplementation with high molecular weight hyaluronic acid (HMWHA), in association with alpha lipoic acid (ALA), magnesium, vitamin B6 and vitamin D, in pregnant women, could reduce adverse effects, such as PTB, pelvic pain, contraction and hospitalization. Methods—Data were collected from n = 200 women treated daily with oral supplements of 200 mg HMWHA, 100 mg ALA, 450 mg magnesium, 2.6 mg vitamin B6 and 50 mcg vitamin D (treatment group) and from n = 50 women taking with oral supplements of 400 mg magnesium (control group). In both groups, supplementation started from the 7th gestational week until delivery. Results—Oral treatment with HMWHA, in association with ALA, magnesium, vitamin B6 and vitamin D in pregnant women, significantly reduced adverse events, such as PTB (p < 0.01), pelvic pain and contractions (p < 0.0001), miscarriages (p < 0.05) and admission to ER/hospitalization (p < 0.0001) compared with the control group. Conclusions—Despite HMWHA having been poorly used as a food supplement in pregnant women, our results open a reassuring scenario regarding its oral administration during pregnancy. Full article

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

12 pages, 834 KiB

Open AccessArticle

Pleural Fluid-to-Blood BNP Ratio May Contribute to Prognosis in Malignant Pleural Mesothelioma

by Vasiliki Tsolaki, George E. Zakynthinos, Sotirios Zarogiannis, Paris Zygoulis, Ioannis Kalomenidis, Rajesh Jagirdar, Ioannis Triantafyllou, Konstantinos I. Gourgoulianis, Demosthenes Makris and Epaminondas Zakynthinos

Clin. Pract. 2023, 13(5), 1111-1122; https://doi.org/10.3390/clinpract13050099 - 13 Sep 2023

Viewed by 1422

Abstract

Background: Brain natriuretic peptide (BNP) seems to be produced from malignant mesothelial cells other than cardiomyocytes. We aimed to evaluate whether an increased pleural fluid-to-blood BNP ratio in patients with malignant pleural mesothelioma (MPM) could facilitate prognosis beyond diagnosis. Materials and Methods: Patients [...] Read more.

Background: Brain natriuretic peptide (BNP) seems to be produced from malignant mesothelial cells other than cardiomyocytes. We aimed to evaluate whether an increased pleural fluid-to-blood BNP ratio in patients with malignant pleural mesothelioma (MPM) could facilitate prognosis beyond diagnosis. Materials and Methods: Patients with MPM were included (observational study). One- and two-year survival and factors affecting it were tested. To evaluate the prognostic significance of the natriuretic peptide precursor B (NPPB) gene expression in MPM, we constructed a survival curve from data derived from The Cancer Genome Atlas. Results: Nineteen consecutive patients with MPM were included (age: 67 (61, 80), male 78.9%). One- and two-year survival were 52.6% and 31.6%, respectively. Age, performance status, and the other variables tested did not differ between survivors and non-survivors. Non-survivors presented higher pleural fluid BNP in two years (699 (210, 5000) vs. 379.5 (5, 567), p = 0.036) and BNP ratios than survivors (1-year: 28.75 (4.05, 150.24) vs. 3.49 (0.3, 26) p = 0.001, 2-years: 22.8 (2.42, 150.24) vs. 3.49 (0.3, 7.76), p = 0.001). One- and two-year survival rates in patients with BNP ratios above/equal to the median value (8.82) were 20% and 0%, and 88.9% and 66.7%, respectively, in patients with BNP ratios below 8.82 (p = 0.006 and p = 0.002, respectively). MPM patients with low NPPB expression presented significantly higher survival rates compared to patients with higher expressions (p = 0.032). Conclusion: A high pleural fluid/blood BNP ratio, an easily performed in everyday practice, costless biomarker seems to predict poorer survival better than the commonly reported prognostic factors in MPM. Full article

(This article belongs to the Special Issue Thoracic Oncology in the Era of Precision Medicine)

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11 pages, 25706 KiB

Open AccessOpinion

Importance of Early Detection of Wire Syndrome: A Case Series Illustrating the Main Stages of the Clinical Gradient

by Carole Charavet, Nathan Israël, France Vives and Sophie-Myriam Dridi

Clin. Pract. 2023, 13(5), 1100-1110; https://doi.org/10.3390/clinpract13050098 - 11 Sep 2023

Cited by 3 | Viewed by 2519

Abstract

(1) Context and Objective: Wire syndrome (WS) refers to dental displacements which can be qualified as aberrant, unexpected, unexplained, or excessive of teeth still contained by an intact orthodontic retainer wire without detachment or fracture, leading to evolving aesthetic and/or functional consequences, both [...] Read more.

(1) Context and Objective: Wire syndrome (WS) refers to dental displacements which can be qualified as aberrant, unexpected, unexplained, or excessive of teeth still contained by an intact orthodontic retainer wire without detachment or fracture, leading to evolving aesthetic and/or functional consequences, both dental and periodontal. The clinical diagnosis of WS in severe cases is often easy. On the other hand, emerging cases must be detected early to stop this evolutionary process as soon as possible, as well as to effectively manage unwanted dental displacements and associated dento-periodontal tissue repercussions. The aim of this retrospective study was to understand the challenges and importance of early diagnosis, highlight the clinical gradient of WS, and clarify the key elements of diagnosis for many practitioners confronted with this type of problem. (2) Materials and Methods: Three cases of increasing complexity were described: the history of wire syndrome, a description of the key elements of its diagnosis, and the final diagnosis itself. (3) Results: Different types and locations of wire syndrome have been observed, from early form to terminal wire syndrome. The three main stages of the clinical gradient are described as follows. In the first case, wire syndrome starting on tooth 41, called the “X-effect” type, was suspected. X-effect wire syndrome on 21, X-effect wire syndrome on 41, and Twist-effect wire syndrome on 33 were diagnosed in the second case, which can be classified as an intermediate case. In the extreme clinical situation of the last case, severe and terminal wire syndrome on tooth 41, the X-effect type, was observed. (4) Conclusions: This case series presents the main stages of the clinical gradient of WS. Although in the case of early WS it is very difficult to identify and/or differentiate it from movements related to a classical relapse phenomenon, the diagnosis of terminal WS is very easy. The challenge for the practitioner is therefore to detect WS as early as possible to stop the iatrogenic process and propose a personalized treatment depending on the severity of clinical signs. The earlier WS is detected, the less invasive the treatment. Full article

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

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10 pages, 4270 KiB

Open AccessCase Report

Surgical Treatment of Saphenous Nerve Injury Assisted by Plasma Rich in Growth Factors (PRGF): Lessons from a Case Report

by Homid Fahandezh-Saddi Díaz, Antonio Ríos Luna, Manuel Villanueva Martínez, María Elena Cantero Yubero, Roberto Prado, Sabino Padilla and Eduardo Anitua

Clin. Pract. 2023, 13(5), 1090-1099; https://doi.org/10.3390/clinpract13050097 - 6 Sep 2023

Cited by 1 | Viewed by 2446

Abstract

The infrapatellar branch of the saphenous nerve (SN) is a widely described anatomic and functional structure; however, its relevance in daily clinical practice is underestimated. All surgical procedures performed on the anteromedial aspect of the knee are associated with a risk of iatrogenic [...] Read more.

The infrapatellar branch of the saphenous nerve (SN) is a widely described anatomic and functional structure; however, its relevance in daily clinical practice is underestimated. All surgical procedures performed on the anteromedial aspect of the knee are associated with a risk of iatrogenic injury to this nerve, including knee arthroscopy, knee arthroplasty, tibial nailing, etc. We present the case of a saphenous nerve neuroma after treatment with radiofrequency thermal ablation due to a knee pain problem. After conducting an anaesthetic suppression test, we decided to perform a denervation of the medial saphenous nerve in Hunter’s canal. We performed surgery on the anteromedial aspect of the knee. The distal end of the medial SN was coagulated with a bipolar scalpel. The proximal end of the nerve was released proximally, and a termino-lateral suture was made at the free end of the nerve after creating an epineural window to inhibit its growth. A double crush was produced proximally to the suture site to create a grade II-III axonal injury. Autologous plasma rich in growth factors (PRGF) was used to reduce potential post-surgical adhesions and to stimulate regeneration of the surgical lesions. One year after surgery, the patient was living a completely normal life. Full article

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8 pages, 550 KiB

Open AccessCase Report

Bullous Pemphigoid Occurring after Stopping Imatinib Therapy of CML: Is a Continuation of Post-Treatment Follow-Up Needed?

by Alexander Yakobson, Ala Eddin Neime, Omar Abu Saleh, Kayed Al Athamen and Walid Shalata

Clin. Pract. 2023, 13(5), 1082-1089; https://doi.org/10.3390/clinpract13050096 - 5 Sep 2023

Cited by 2 | Viewed by 1427

Abstract

Advancements and the use of tyrosine kinase inhibitors (TKIs) have revolutionized the treatment of Chronic Myeloid Leukemia (CML), achieving unprecedented success rates and expanding their applications to various neoplasms. However, the use of TKIs is not without its drawbacks. Skin, gastrointestinal, and central [...] Read more.

Advancements and the use of tyrosine kinase inhibitors (TKIs) have revolutionized the treatment of Chronic Myeloid Leukemia (CML), achieving unprecedented success rates and expanding their applications to various neoplasms. However, the use of TKIs is not without its drawbacks. Skin, gastrointestinal, and central nervous systems are particularly susceptible to adverse effects, including a higher incidence of autoimmune responses in treated individuals. In this report, we present a unique case of bullous pemphigoid, a rare autoimmune disease, which has not been previously associated with TKI therapy as an adverse effect, particularly appearing after discontinuing Imatinib^® treatment. Full article

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9 pages, 247 KiB

Open AccessOpinion

The Practice of Teaching and Scientific Research on Cadaveric Material Remains Crucial for Medical Education

by Giorgio Bolino, Vittorio Fineschi, Camilla Cecannecchia, Gianpiero D’Antonio and Paola Frati

Clin. Pract. 2023, 13(5), 1073-1081; https://doi.org/10.3390/clinpract13050095 - 1 Sep 2023

Cited by 5 | Viewed by 1588

Abstract

The practice of teaching and scientific research on cadaveric material remains crucial for medical education, especially in surgical disciplines. However, in Italy, this practice has been neglected due to legislative insufficiency and financial constraints. Although innovative methods and tools like simulators and e-learning [...] Read more.

The practice of teaching and scientific research on cadaveric material remains crucial for medical education, especially in surgical disciplines. However, in Italy, this practice has been neglected due to legislative insufficiency and financial constraints. Although innovative methods and tools like simulators and e-learning have been adopted, direct hands-on experience with human cadavers remains irreplaceable for medical and surgical education. The absence of clear legislation governing cadaveric dissection has limited availability for teaching and research, resulting in economic burdens for universities and individuals seeking proper surgical training. To address this issue, Law No. 10/2020 and the recent implementing decree were introduced in Italy, providing detailed legislation on the donation of bodies for educational and research purposes. The law emphasizes the importance of respecting the donor’s specific choices and aligns with constitutional principles promoting culture, research, and health protection. However, some critical issues related to consent procedures, duration of body availability, and preservation of anatomical parts remain. Additionally, the law’s dissemination among the population needs improvement. Future optimization could include allowing donors to choose the timing of body donation and considering different timeframes for body availability. Furthermore, the implementation of consent procedures could be simplified to increase donations. The law should also address the need for appropriate reception centers and allocate resources for effective dissemination. Despite these challenges, Law No. 10/2020 represents a significant step forward in enhancing medical-surgical training, scientific research, and the overall quality of patient care in Italy. Full article

(This article belongs to the Special Issue Teaching Pathology Towards Clinics and Practice)

14 pages, 1581 KiB

Open AccessReview

RETRACTED: Traditional and Recent Root Canal Irrigation Methods and Their Effectiveness: A Review

by Alfredo Iandolo, Massimo Pisano, Alessio Buonavoglia, Francesco Giordano, Alessandra Amato and Dina Abdellatif

Clin. Pract. 2023, 13(5), 1059-1072; https://doi.org/10.3390/clinpract13050094 - 27 Aug 2023

Cited by 7 | Viewed by 6812 | Retraction

Abstract

According to contemporary dental standards, the primary goal of endodontic therapy is the chemo-mechanical cleaning of the complex root canal system. Watering root canals with approved solutions and activating them are essential parts of this operation. This review outlines various irrigant activation methods [...] Read more.

According to contemporary dental standards, the primary goal of endodontic therapy is the chemo-mechanical cleaning of the complex root canal system. Watering root canals with approved solutions and activating them are essential parts of this operation. This review outlines various irrigant activation methods for root canal therapy. Specifically, a comparison among the methods of manual dynamic activation, sonics (subsonic, sonic, and ultrasonic), internal heating, and lasers, was conducted. The results in this work were gathered using Scopus, Web of Science, Google Scholar, and PubMed databases by searching the following keywords: sodium hypochlorite, cleaning, activation, and irrigation methods. The present work concluded that the use of irrigant activation has a greater benefit than its absence. Regardless, it is impossible to point to a single effective activation method. Full article

(This article belongs to the Special Issue Contemporary Endodontic Approaches for Children)

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16 pages, 987 KiB

Open AccessArticle

Evaluation of Abfraction Lesions Restored with Three Dental Materials: A Comparative Study

by Bogdan Constantin Costăchel, Anamaria Bechir, Alexandru Burcea, Laurența Lelia Mihai, Tudor Ionescu, Olivia Andreea Marcu and Edwin Sever Bechir

Clin. Pract. 2023, 13(5), 1043-1058; https://doi.org/10.3390/clinpract13050093 - 26 Aug 2023

Cited by 1 | Viewed by 2699

Abstract

Background: Abfraction lesions are manifested as damage to hard tissues in the cervical area of dental crowns. The study aimed to assess the direct restoration of abfraction lesions according to the modified United States Public Health Service (USPHS) criteria for 24 months. The [...] Read more.

Background: Abfraction lesions are manifested as damage to hard tissues in the cervical area of dental crowns. The study aimed to assess the direct restoration of abfraction lesions according to the modified United States Public Health Service (USPHS) criteria for 24 months. The restorations were accomplished with Fuji Bulk–GC, Omnichroma Flow-Tokuyama, and Beautifil^® II–Shofu dental materials, and the therapy was or was not associated with wearing thermoformed mouthguards. Methods: From the 53 selected and analyzed patients (n = 53), 28 patients (with restorations of abfraction lesions) belonged to the 1st group and 25 patients (with 105 restorations, who also wore mouthguards) belonged to the 2nd group. Blind determination assessments were effectuated at baseline and after 2, 6, 12, 18, and 24 months. Results showed that, regardless of the rating score, there are no significant statistical differences in the evaluation criteria between the two groups of patients Conclusions: For each material, the scores of USPHS criterion presented good clinical performances after 24 months, with no significant statistical differences between the fillings and the applied therapy in the two groups of patients. Full article

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

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8 pages, 1081 KiB

Open AccessArticle

The Efficacy, the Treatment Response and the Aquaretic Effects of a Three-Year Tolvaptan Regimen in Polycystic Kidney Disease Patients

by Vasiliki Gkika, Michaela Louka, Mihail Tsagkatakis and George Tsirpanlis

Clin. Pract. 2023, 13(5), 1035-1042; https://doi.org/10.3390/clinpract13050092 - 24 Aug 2023

Cited by 2 | Viewed by 1752

Abstract

Tolvaptan, a selective vasopressin V2 receptor antagonist, is the first and only approved specific treatment for Autosomal-Dominant Polycystic Kidney Disease (ADPKD), and is used in current clinical practice. Real clinical data are missing. In this retrospective study, 41 ADPKD patients received tolvaptan for [...] Read more.

Tolvaptan, a selective vasopressin V2 receptor antagonist, is the first and only approved specific treatment for Autosomal-Dominant Polycystic Kidney Disease (ADPKD), and is used in current clinical practice. Real clinical data are missing. In this retrospective study, 41 ADPKD patients received tolvaptan for 3 years, from 2018 to 2021. Total kidney volume (TKV) was measured using Magnetic Resonance Imaging, at initiation and at the end of the treatment period. A complete biochemistry/hematology profile and a 24 h urine volume collection were performed monthly for the first 18 months and every 3 months thereafter. At the end of the treatment period, the median (IQR) estimated Glomerular Filtration Rate (e-GFR) was 5.3 (−1.3, 8.7) mL/min higher than the expected e-GFR decline without treatment, while the prediction for End Stage Chronic Kidney Disease (ESKD) had been prolonged by 1 (0, 2) year. Total Kidney Volume did not change significantly (2250 (1357) mL at 3 years of treatment vs. 2180 (1091) mL expected without treatment, p = 0.48). Younger patients with a relatively preserved e-GFR, lower hypertension burden, better familiar renal prognosis and more severe imaging data showed better outcomes. The aquaretic adverse effects of tolvaptan did not affect renal function and electrolyte balance in 51 patients, in a follow-up period of 18 months. Consequently, tolvaptan seems to be effective in preventing progression of ADPKD when administered in a timely manner in patients with better familiar renal history, shorter hypertension duration and worse imaging profile. Increased diuresis does not affect treatment efficacy. Full article

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

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10 pages, 2537 KiB

Open AccessCase Report

Rare Complication Post-Conization for Cervical Dysplasia: Rectovaginal Fistula

by Paolo Meloni, Sara Izzo, Claudia De Intinis, Terenzia Simari, Mariangela Motzo, Riccardo Picazzo, Rodolfo Brizio, Cristina Vignale, Marcello Molle, Luciano Izzo and Paolo Izzo

Clin. Pract. 2023, 13(5), 1025-1034; https://doi.org/10.3390/clinpract13050091 - 24 Aug 2023

Cited by 1 | Viewed by 1749

Abstract

(1) Background: High-grade cervical dysplasia is primarily caused by human papillomavirus (HPV) infection. Conservative surgery is the preferred treatment approach for this condition. The most commonly employed technique is the loop electrosurgical excision procedure (LEEP), which involves removing the affected portion of the [...] Read more.

(1) Background: High-grade cervical dysplasia is primarily caused by human papillomavirus (HPV) infection. Conservative surgery is the preferred treatment approach for this condition. The most commonly employed technique is the loop electrosurgical excision procedure (LEEP), which involves removing the affected portion of the cervix. Excisional treatments are often curative, and complications are typically rare and minor. (2) Methods: The loop electrosurgical excision procedure (LEEP) is the standard method used for conservative surgery in high-grade cervical dysplasia. It entails the excision of the specific area of the cervix where the abnormal cells are present. The procedure employs a wire loop carrying an electrical current to remove the affected tissue. (3) Results: Excisional treatments, such as LEEP, have shown to be effective in treating high-grade cervical dysplasia. They have a high success rate in eliminating abnormal cells and reducing the risk of cervical cancer. Complications associated with LEEP are infrequent and usually minor. Short-term complications may include bleeding, which can be managed easily. Long-term complications may involve cervical canal stenosis, which can impact fertility. (4) Conclusions: Conservative surgery, particularly the loop electrosurgical excision procedure (LEEP), is the preferred and effective treatment for high-grade cervical dysplasia caused by HPV infection. It offers a high cure rate with rare and minor complications. While short-term bleeding is a common occurrence, it is manageable. Long-term complications such as cervical canal stenosis may impact fertility. However, an extremely rare and possibly unique complication described in this case is the development of a vaginorectal fistula. This complication is likely due to indirect thermal injury resulting from compromised tissue. Further research is needed to better understand and prevent such complications. Full article

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10 pages, 710 KiB

Open AccessArticle

Introduction of SGLT2 Inhibitors and Variations in Other Disease-Modifying Drugs in Heart Failure Patients: A Single-Centre Real-World Experience

by Erika Tabella, Michele Correale, Gianmarco Alcidi, Rosanna Pugliese, Sara Ioannoni, Matteo Romano, Gianpaolo Palmieri, Matteo Di Biase, Natale Daniele Brunetti and Massimo Iacoviello

Clin. Pract. 2023, 13(5), 1015-1024; https://doi.org/10.3390/clinpract13050090 - 24 Aug 2023

Viewed by 1642

Abstract

Background: The sodium–glucose cotransporter-2 inhibitors (SGLT2i) have emerged as a crucial therapeutic option for patients with chronic heart failure with reduced ejection fraction (HFrEF). The aim of this study was to evaluate, in a real-world population from a single centre, the feasibility of [...] Read more.

Background: The sodium–glucose cotransporter-2 inhibitors (SGLT2i) have emerged as a crucial therapeutic option for patients with chronic heart failure with reduced ejection fraction (HFrEF). The aim of this study was to evaluate, in a real-world population from a single centre, the feasibility of introducing SGLT2i and their interaction with other recommended drug classes. Methods: Consecutive patients affected by chronic heart failure (CHF) were evaluated beginning in January 2022. At the baseline clinical visit, both the patient’s current medication and the prescribed treatments were recorded. Over a 6- to 12-month follow-up, changes in concomitant therapy were analysed. Results: At baseline, among 350 patients evaluated, only 17 (5%) were already taking SGLT2i: 13 with HFrEF, five with mildly reduced (HFmrEF), preserved (HFpEF) or improved (HFimpEF) ejection fraction. After the baseline assessment, SGLT2i were prescribed to 224 (64%) of the patients, including 179 (84%) with HFrEF, 27 (42%) with HFmrEF/HFimpEF, and 18 (22%) with HFpEF/HFimpEF. After follow-up, SGLT2i therapy was well tolerated and was associated with a significant increase in sacubitril/valsartan prescriptions and a decrease in diuretic use. Finally, a significant improvement in functional status and left ventricular systolic function after SGLT2i therapy was observed. Conclusions: In this single-centre, real-world study, SGLT2i were primarily prescribed to HFrEF patients who were already on other recommended drug classes for their treatment. Additionally, there was a noticeable enhancement in the prescribed therapy during a short-term follow-up. These findings further bolster the inclusion of this therapeutic approach in regular clinical practice. Full article

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

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Clin. Pract., Volume 13, Issue 5 (October 2023) – 25 articles

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