Clinics and Practice最新文献

{"title":"Metabolic Dysfunction-Associated Steatotic Liver Disease in Chronic Hepatitis C Virus Infection: From Basics to Clinical and Nutritional Management.","authors":"Karina Gonzalez-Aldaco, Luis A Torres-Reyes, Claudia Ojeda-Granados, Leonardo Leal-Mercado, Sonia Roman, Arturo Panduro","doi":"10.3390/clinpract14060200","DOIUrl":"https://doi.org/10.3390/clinpract14060200","url":null,"abstract":"<p><p>Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely associated with obesity and other cardiometabolic risk factors. MASLD has rapidly become the most common cause of liver disease worldwide, currently affecting 38% of the global population. Excess weight causes chronic inflammation and the activation of different pathways involved in liver damage. MASLD can progress from simple steatosis to steatohepatitis, giving way to its inflammatory component, metabolic dysfunction-associated steatohepatitis (MASH), previously recognized as non-alcoholic steatosis hepatitis (NASH). Chronic hepatitis C virus (HCV) infection remains a significant challenge to liver health as it triggers hepatic inflammation, metabolic disruption, and hepatic steatosis. The convergence of MASLD and chronic HCV infection can significantly alter the course of liver disease and accelerate the progression to severe liver damage. Currently, HCV treatment has a high cure rate. However, in patients who achieve a sustained virological response after treatment with direct-acting antivirals, weight gain, and excessive calorie intake may contribute to increased liver steatosis and a higher risk of liver disease progression. Therefore, the effective clinical and nutritional management of HCV patients, both before and after viral eradication, is crucial to reducing the risk of death from hepatocellular carcinoma. Understanding the complex interactions between MASLD and HCV infection is crucial for managing these patients appropriately. Herein, host and viral mechanisms inducing liver damage during the coexistence of MASLD and HCV infection are described, and their therapeutic and dietary management are discussed.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 6","pages":"2542-2558"},"PeriodicalIF":1.7,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extraperitoneal Open Radical Cystectomy: A New Standard in Frail Patients with Muscle-Invasive Bladder Cancer?","authors":"Daniel Porav-Hodade, Silvestru-Alexandru Big, Vlad-Ilie Barbos, Bogdan Gherle, Ernő Jerzicska, Victor Ona, Bogdan-Ovidiu Feciche","doi":"10.3390/clinpract14060201","DOIUrl":"https://doi.org/10.3390/clinpract14060201","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Radical cystectomy (RC) represents one of the most complex and morbid surgical procedures in the field of Urology. Extraperitoneal open RC has emerged as an alternative to the traditional transperitoneal approach for the treatment of muscle-invasive bladder cancer. Frailty is one of the most important risk factors for perioperative morbidity and mortality, and this category of patients can benefit the most from the extraperitoneal approach. The purpose of this study was to evaluate the feasibility and the safety of extraperitoneal open RC in our experience; <b>Methods</b>: We retrospectively collected the data of 75 frail patients who underwent an extraperitoneal open RC, performed by a single experienced surgeon. We assessed their frailty status using the simplified frailty index (sFI). We recorded data regarding general characteristics, intraoperative, pathological, and postoperative complications, and mortality (within 90 days); <b>Results:</b> We analyzed 61 males and 14 females with an sFI equal to or higher than 3. The median age was 77 years. Fifty-one patients had an ASA score of 3 or more. Sixty procedures were with radical intention, while fifteen were palliative. Cutaneous ureterostomy was performed in 70 cases and extraperitonized ileal conduit in five cases. The median operative time was 150 min. The median blood loss was 400 mL. The median time to flatus was 2 days. The median postoperative stay was 7 days. Thirteen patients had Clavien-Dindo III or IV complications. Two patients died in first 90 days postoperatively; <b>Conclusions</b>: The extraperitoneal open RC in frail patients was demonstrated to be a feasible and safe alternative approach in definitive treatment or a palliative setting in our experience.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 6","pages":"2559-2567"},"PeriodicalIF":1.7,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Acceptance of Digitally Produced Zirconia and Metal Post and Cores, Based on the Impression Method.","authors":"Paula Perlea, Cosmin Stefanescu, Alexandru Eugen Petre","doi":"10.3390/clinpract14060199","DOIUrl":"https://doi.org/10.3390/clinpract14060199","url":null,"abstract":"<p><strong>Background: </strong>The existing literature predominantly examines post and core assessments post-cementation, neglecting the critical pre-cementation phase. Research on the clinical acceptance of dental posts received from dental laboratories before cementation is notably lacking. This study investigates the percentage of zirconia and metal dental posts that are deemed suitable for cementation by clinicians, among the total received from the dental laboratory. Additionally, it aims to examine whether this percentage varies based on the type of impression made by the clinician: digital impression versus conventional impression.</p><p><strong>Methods: </strong>This article introduces the application of computer-aided design-computer-aided manufacturing (CAD-CAM) technology for manufacturing customized zirconia and Cobalt-Chromium (Co-Cr) post and cores. Intraoral scanning is employed to capture the canal anatomy. In contrast to the traditional casting process, a three-dimensional (3D) metal printer machine is utilized to 3D print the metal post and core from Co-Cr, resulting in enhanced toughness and superior adaptability to the canal. Two null hypotheses were formulated, investigating the clinical acceptance of zirconia and metal posts obtained through traditional versus digital impressions.</p><p><strong>Results: </strong>Among 577 post and cores, 95% of metal posts from both impression methods received clinical approval. However, for zirconia posts, a significantly higher acceptance rate (95% versus 88%) was observed for those from traditional impressions. The Chi-squared test yielded a <i>p</i>-value < 0.05, underscoring the clinical superiority of conventionally obtained zirconia posts and supporting the null hypothesis for metal posts.</p><p><strong>Conclusions: </strong>A significantly higher acceptance rate is apparent among zirconia post and cores manufactured through conventional impressions, in contrast to zirconia post and cores produced via digital impressions. No statistically significant difference was identified between metal post and cores obtained through digital impressions and those acquired through conventional impressions.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 6","pages":"2533-2541"},"PeriodicalIF":1.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge, Attitudes, and Practices of Parents Regarding Ophthalmological Screening of Preschool-Aged Children in Jazan, Saudi Arabia.","authors":"Mohamed Salih Mahfouz, Samy Shaban Mahmoud, Saleha Qaseem Haroobi, Latifah Mohammed Bahkali, Shahad Ibrahim Numan, Areen Mohsen Taheri, Ohoud Ali Hakami, Orjuwan Adel Zunquti, Sarah Mohammed Khered","doi":"10.3390/clinpract14060198","DOIUrl":"https://doi.org/10.3390/clinpract14060198","url":null,"abstract":"<p><strong>Background: </strong>Children's eye disorders are a major cause of irreversible vision loss. Delays in diagnosing eye problems in children are recurring problems that require quick attention. This study assesses parents' knowledge, attitudes, and practices regarding the early ophthalmological screening of preschool-aged children in Jazan, KSA.</p><p><strong>Methods: </strong>An observational cross-sectional study was conducted among 522 parents of preschool-aged children in the Jazan region. A self-administered web-based questionnaire was randomly distributed to the parents via WhatsApp. The survey tool consisted of four main sections: socio-demographic data, knowledge about eye care, attitudes toward eye screening, and eye care practices.</p><p><strong>Results: </strong>Parents' level of knowledge regarding children's eye care was distributed as follows: low (21.5%), medium (40.2%), and high (38.4%). Parent gender, age, occupation, level of income, and nationality showed no statistically significant association with the knowledge level (<i>p</i> > 0.05 for all). However, parent education played a significant role (<i>p</i> = 0.013). Further, parents expressed a positive attitude toward the early screening of eye problems, as more than 90% agreed that early eye examinations for children reduce complications from visual problems and that the increased use of electronic devices requires early eye examinations. Almost 47.0% of the parents had examined their children's eyes when they were between 1 and 5 years of age, compared with only 10.3% of parents of children less than 1 year of age. The multiple linear regression model for factors that predict knowledge level among the study participants showed that having a child undergo early screening is positively associated with an increased knowledge score (<i>p</i> < 0.05).</p><p><strong>Conclusions: </strong>Jazan parents showed a positive attitude toward the early screening of eye problems, and one-third had a high level of knowledge regarding children's eye care. However, the proportion of those who practiced early eye screening was low. More health education is necessary to increase parents' awareness regarding early eye care practices.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 6","pages":"2522-2532"},"PeriodicalIF":1.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Micropulse Laser Therapy in Central Serous Chorioretinopathy.","authors":"Flaviu Bodea, Andrei-Flavius Radu, Ruxandra-Florina Bodog, Teodora Maria Bodog, Cristina Ariadna Nicula","doi":"10.3390/clinpract14060194","DOIUrl":"https://doi.org/10.3390/clinpract14060194","url":null,"abstract":"<p><p><b>Background</b>: Central serous chorioretinopathy (CSCR) is a retinal condition characterized by the accumulation of subretinal fluid, often linked to elevated levels of endogenous corticosteroids and stress-related hormones, which can lead to visual disturbances. This connection may explain the association of CSCR with high stress levels and the use of corticosteroid medications. Although many cases resolve spontaneously, persistent or severe instances may require intervention. <b>Case Description</b>: Our report presents a case of acute CSCR in a 33-year-old male who developed the condition following corticosteroid treatment for acute parotiditis and left submandibular lymphadenopathy. Initial presentation was 6 weeks after corticosteroid treatment was initiated. Diagnostic evaluation with optical coherence tomography (OCT) and fluorescein angiography confirmed the presence of subretinal fluid at the retinal pigment epithelium-Bruch's membrane complex. Micropulse laser therapy (MPLT) was applied to address the leakage points, leading to significant fluid reduction at a two-week follow-up. By six weeks, the complete resolution of subretinal fluid was documented, with substantial visual recovery. <b>Conclusions</b>: This case confirms MPLT as an effective treatment for CSCR, particularly when conservative management is insufficient. Unlike traditional photocoagulation, MPLT offers a safer alternative, minimizing the risk of retinal damage, such as permanent scotomas. <b>Clinical Significance</b>: This case underscores the importance of carefully monitoring patients undergoing corticosteroid therapy for potential ocular complications and highlights the role of MPLT as a safe and effective option for managing persistent CSCR, protecting the surrounding retinal tissue from damage while achieving significant therapeutic outcomes.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 6","pages":"2484-2490"},"PeriodicalIF":1.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral Diadochokinesis, Tongue Pressure, and Lip-Seal Strength Among Japanese Male Workers in the Taxi Industry: A Cross-Sectional Study.","authors":"Akira Minoura, Yoshiaki Ihara, Hirotaka Kato, Kouzou Murakami, Yoshio Watanabe, Kojiro Hirano, Yoshinori Ito, Akatsuki Kokaze","doi":"10.3390/clinpract14060196","DOIUrl":"https://doi.org/10.3390/clinpract14060196","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Health management in workers in the taxi industry is particularly challenging due to irregular working hours and the need to prevent fatal accidents. In addition, drivers in Japan are aging, and the early prevention of age-related deterioration in oral health is an increasingly important issue. The aim of this cross-sectional study was to investigate the relationships between oral diadochokinesis (OD), tongue pressure, and lip-seal strength in Japanese male taxi workers. <b>Methods:</b> Measurements of tongue pressure and lip-seal strength were performed by dentists using specialized equipment. OD was measured using the number of consecutive \"Pa\", \"Ta\", and \"Ka\" vocalizations that could be produced in 5 s. We performed multiple regression analysis to examine the effects of lip-seal strength and tongue pressure on OD. <b>Results:</b> The study included 437 participants, excluding 17 who could not complete all oral cavity measurements. Tongue pressure showed a significant positive correlation with \"Pa\", \"Ta\", and \"Ka\" (correlation coefficients: 0.527-0.680). Lip-seal strength was not significantly correlated with OD. Tongue pressure showed a significant positive correlation with \"Pa\", \"Ta\", and \"Ka\". In the results of multiple regression analyses without the elderly participants, tongue pressure was associated with \"Pa\" (β[95% confidence interval]: 0.574[0.304, 0.843]), \"Ta\" (0.436[0.231, 0.640]), and \"Ka\" (0.424[0.210, 0.639]), and lip-seal strength was associated with \"Pa\" (0.128[0.032, 0.224]) and \"Ka\" (0.083[0.006, 0.160]). <b>Conclusions:</b> OD may be associated with lip-seal strength and tongue pressure even without including elderly workers. Regardless of age, maintaining good OD may help maintain lip-seal strength and tongue pressure, which may play a role in reducing the risk of age-related oral disorders.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 6","pages":"2499-2506"},"PeriodicalIF":1.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence Applied in Early Prediction of Lower Limb Fracture Complications.","authors":"Aurelian-Dumitrache Anghele, Virginia Marina, Liliana Dragomir, Cosmina Alina Moscu, Iuliu Fulga, Mihaela Anghele, Cristina-Mihaela Popescu","doi":"10.3390/clinpract14060197","DOIUrl":"https://doi.org/10.3390/clinpract14060197","url":null,"abstract":"<p><p><b>Background</b>: Artificial intelligence has become a valuable tool for diagnosing and detecting postoperative complications early. Through imaging and biochemical markers, clinicians can anticipate the clinical progression of patients and the risk of long-term complications that could impact the quality of life or even be life-threatening. In this context, artificial intelligence is crucial for identifying early signs of complications and enabling clinicians to take preventive measures before problems worsen. <b>Materials and methods</b><i>:</i> This observational study analyzed medical charts from the electronic archive of the Clinical Emergency Hospital in Galați, Romania, covering a four-year period from 2018 to 2022. A neural network model was developed to analyze various socio-demographic and paraclinical data. Key features included patient demographics, laboratory investigations, and clinical outcomes. Statistical analyses were performed to identify significant risk factors associated with deep venous thrombosis (DVT). <b>Results</b><i>:</i> The analysis revealed a higher prevalence of female patients (60.78%) compared to male patients, indicating a potential gender-related risk factor for DVT. The incidence of DVT was highest among patients aged 71 to 90 years, affecting 56.86% of individuals in this age group, suggesting that advanced age significantly contributes to the risk of developing DVT. Additionally, among the DVT patients, 15.69% had a body mass index (BMI) greater than 30, categorizing them as obese, which is known to increase the risk of thrombotic events. Furthermore, this study highlighted that the highest frequency of DVT was associated with femur fractures, occurring in 52% of patients with this type of injury. The neural network analysis indicated that elevated levels of direct bilirubin (≥1.5 mg/dL) and prothrombin activity (≤60%) were strong predictors of fracture-related complications, with sensitivity and specificity rates of 78% and 82%, respectively. These findings underscore the importance of monitoring these laboratory markers in at-risk populations for early intervention. <b>Conclusions</b><i>:</i> This study identified critical risk factors for developing DVT, including advanced age, high BMI, and femur fractures, which necessitate longer recovery periods. Additionally, the findings indicate that elevated direct bilirubin and prothrombin activity play a significant role in predicting DVT development. These results suggest that AI can effectively enhance the anticipation of clinical evolution in patients, aiding in early intervention and management strategies.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 6","pages":"2507-2521"},"PeriodicalIF":1.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Running Cadence and the Influence on Frontal Plane Knee Deviations.","authors":"Jacob R Peterson, Collin R Sanders, Nathan S Reynolds, Conner A Alford, Michael J Platt, Jeffrey J Parr, Felix Twum, James R Burns, David R Dolbow","doi":"10.3390/clinpract14060195","DOIUrl":"https://doi.org/10.3390/clinpract14060195","url":null,"abstract":"<p><p><b>Background:</b> Patellofemoral pain is one of the most common injuries in recreational runners, with significant implications for dynamic knee valgus. The knee valgus angle can be corrected surgically or with a more conservative non-operative approach. Increasing running cadence may be an effective biomechanical gait retraining intervention to reduce knee valgus and thus patellofemoral pain. The primary purpose of this study was to examine if an increase in cadence could change the knee valgus angle. <b>Methods:</b> Ten asymptomatic recreational runners were recorded running on a treadmill during control and experimental intervals. Each interval lasted five minutes, and participants ran at 100% and 110% of their baseline cadence. Peak angles of knee valgus were compared between both intervals using the video analysis software application Dartfish Express. A paired sample, a two-tailed <i>t</i>-test, was used to determine the significant difference between bilateral frontal plane knee angle measurements during both intervals. <b>Results:</b> The average decrease in knee valgus measured in control versus experimental intervals was 2.23° for the right leg and 2.05° for the left leg, with a significance of <i>p</i> < 0.001 and <i>p</i> < 0.001, respectively. <b>Conclusion:</b> The results indicated a statistically significant decrease in angles of dynamic knee valgus, attributable to increased cadence. These changes in knee valgus angle are likely to have a positive impact on preventing and reducing pain associated with PFP.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 6","pages":"2491-2498"},"PeriodicalIF":1.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence Trends of Rheumatoid Arthritis in Korea for 11 Years (2006-2017).","authors":"Hanna Lee, Sang-Il Lee, Hyunjin Lim, Hyun-Ok Kim, Rock Bum Kim, Yun-Hong Cheon","doi":"10.3390/clinpract14060193","DOIUrl":"https://doi.org/10.3390/clinpract14060193","url":null,"abstract":"<p><strong>Background/objectives: </strong>Rheumatoid arthritis (RA) is a chronic inflammatory disorder characterized by joint damage. However, no incidence analyses have been conducted on a Korean population since 2013. We aimed to calculate the incidence of RA and examine trends using complete Korean National Health Insurance Service claims data from 2007.</p><p><strong>Methods: </strong>We used 16 years of Korean NHIS claims data from 1 January 2002 to 31 December 2017. Patients were defined as having RA when diagnosed with ICD-10 codes M05 and M06. We set the 5-year period prior to 2006 as disease-free.</p><p><strong>Results: </strong>From 2007 to 2017, the incidence rate of RA was 35 to 43 per 100,000 individuals. The female-to-male ratio was approximately 3-3.5 to 1. The sex-standardized incidence rate was highest in the 60-69 age group but gradually declined, resulting in a reversal in 2017, with the highest incidence rate observed in the 50-59 age group. The incidence of elderly onset RA (EORA) in individuals aged >60 years exhibited a decreasing trend during the study period (age 60-69, -6.45, 95% CI = -8.27 to -4.62, <i>p</i> < 0.001; age ≥70, -6.09, 95% CI = -7.66 to -4.53, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>This study is the first to analyze the incidence trend of RA over an 11-year period. In South Korea, the incidence of RA has shown a decreasing trend since 2011; the same trend was observed in the EORA group. Young-onset RA showed the opposite trend, suggesting that RA is diagnosed earlier, due to the new RA classification criteria.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 6","pages":"2475-2483"},"PeriodicalIF":1.7,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Body Mass Index on the Outcomes of Cryoballoon Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation.","authors":"Konstantinos A Papathanasiou, Dimitrios A Vrachatis, Charalampos Kossyvakis, Sotiria G Giotaki, Gerasimos Deftereos, Maria Kousta, Ioannis Anagnostopoulos, Dimitrios Avramides, George Giannopoulos, Vaia Lambadiari, Gerasimos Siasos, Spyridon Deftereos","doi":"10.3390/clinpract14060192","DOIUrl":"https://doi.org/10.3390/clinpract14060192","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is prevalent among obese patients, and cryoballoon ablation (CBA) is an effective strategy for the rhythm control of AF. The impact of body mass index (BMI) on the clinical outcomes of CBA for AF is not fully explored.</p><p><strong>Methods: </strong>85 consecutive patients with paroxysmal AF were enrolled and were categorized into three groups as per their BMI: normal weight (BMI 18.5-25 kg/m²), overweight (BMI 25-30 kg/m²), and obese patients (BMI > 30 kg/m²). The primary study endpoint was a late (12 month) recurrence of AF. Early recurrence of AF, symptom improvement, and procedural outcomes were some key secondary outcomes.</p><p><strong>Results: </strong>20 patients had normal weight, 35 were overweight, and 30 were obese. Obese patients featured a higher prevalence of diabetes mellitus, heavier exposure to smoking, and worse baseline symptoms (as assessed through EHRA class at admission and 12 months before CBA) compared to overweight and normal weight patients. Both late and early (<3 months) AF recurrence rates were comparable across the three groups. Of note, obese patients showed greater improvement in their symptoms post-CBA, defined as improvement by at least one EHRA class, compared to normal weight patients; this might be explained by improved diastolic function. Total procedure time and dose area product were significantly increased in obese patients. The multivariate logistic regression analysis indicated that early AF recurrence and the duration of hypertension are independent predictors of late AF recurrence.</p><p><strong>Conclusion: </strong>CBA is effective in overweight and obese patients with paroxysmal AF. Procedure time and radiation exposure are increased in obese patients undergoing CBA.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 6","pages":"2463-2474"},"PeriodicalIF":1.7,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}