Clinics and Practice最新文献

{"title":"Bony Anatomy, Soft-Tissue Adaptations and Neuromuscular Risk Factors of Shoulder Injury in Handball Players: A Narrative Review.","authors":"Zacharoula Papadopoulou, Angelo V Vasiliadis, Eleni Maria Vrampa, Nikiforos Galanis","doi":"10.3390/clinpract16100195","DOIUrl":"10.3390/clinpract16100195","url":null,"abstract":"<p><p>Handball is a high-intensity contact sport that imposes significant mechanical stress on the shoulder joint through repetitive, high-velocity overhead throwing, predisposing athletes to a wide spectrum of shoulder injuries. This narrative review examines the factors associated with shoulder injuries in handball players, highlighting underlying structural, adaptive and functional mechanisms across male and female athletes. A literature search of PubMed/MEDLINE was conducted to synthesize current evidence on bony anatomy, soft tissue adaptations and neuromuscular characteristics in handball cohorts. Factors associated with shoulder injury or symptoms can be broadly categorized into three conceptual domains: (i) bony anatomy and structural features, (ii) soft tissue adaptations and (iii) dynamic functional and neuromuscular factors. Bony factors include reduced acromiohumeral distance, increased humeral retrotorsion as a sport-specific skeletal adaptation and variations in glenoid morphology that may influence glenohumeral stability. Soft tissue adaptations include posterior capsular tightness, anterior capsular laxity and alterations in shoulder range of motion, particularly glenohumeral internal rotation deficit (GIRD) accompanied by external rotation gain (ERG), which may influence glenohumeral kinematics and potentially contribute to shoulder symptoms or overuse conditions. Beyond these structural features, dynamic functional factors, including shoulder rotator muscle strength imbalances, impaired scapular control and training-load management, play a central role in injury development. Therefore, a comprehensive assessment encompassing anatomical correlates, soft tissue characteristics and functional/neuromuscular characteristics may support the development of targeted injury-prevention and rehabilitation strategies in handball players.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13703634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149275310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dose-Informed Surgical Margin in Mandibular Osteoradionecrosis Surgery: Integrating Radiation Biology into Osteotomy Planning.","authors":"Efsun Somay, Erkan Topkan, Ugur Selek","doi":"10.3390/clinpract16100194","DOIUrl":"10.3390/clinpract16100194","url":null,"abstract":"<p><p>Mandibular osteoradionecrosis (ORN) remains one of the most challenging late complications of head and neck radiotherapy. Although surgical resection with vascularized reconstruction is the standard treatment for advanced disease, determination of the osteotomy margin continues to rely largely on anatomical findings, intraoperative assessment, and surgical judgment. However, accumulating evidence indicates that radiation-induced mandibular injury is spatially heterogeneous and biologically dynamic. Consequently, visible necrosis, geometric distance from disease, and punctate marrow bleeding may not reliably reflect the biological competence of residual irradiated bone. This review proposes the Dose-Informed Surgical Margin (DISM) framework, a biologically informed, hypothesis-generating concept that integrates patient-specific historical radiotherapy dosimetry with conventional anatomical, radiological, intraoperative, and host-related factors to support individualized osteotomy planning. We examine the radiobiological basis of mandibular injury, current concepts of surgical margin assessment, the limitations of bleeding-guided resection, and the potential contribution of three-dimensional radiation dose mapping to identifying biologically more favorable residual bone. We further discuss technical considerations for clinical implementation, including image registration, multimodality imaging, virtual surgical planning, and integration with host-related determinants of tissue repair. Rather than advocating universal dose thresholds or replacing established surgical principles, DISM is intended as an adjunctive decision-support framework that adds biological context to conventional margin assessment. Prospective biological and clinical validation remains essential before routine clinical implementation. If validated, DISM may facilitate a transition from predominantly anatomical definitions of mandibular osteotomy toward biologically informed, patient-specific surgical planning for the management of mandibular ORN.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13703690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149275389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inflammatory and Metabolic Biomarkers Associated with Chronic Subdural Hematoma Recurrence: A Single-Center Retrospective Cohort Study.","authors":"Bilal Ertuğrul, Harun Kömürcü","doi":"10.3390/clinpract16100193","DOIUrl":"10.3390/clinpract16100193","url":null,"abstract":"<p><p><b>Background:</b> Chronic subdural hematoma (CSDH) recurs in 5-20% of patients despite surgical treatment, and readily accessible biomarkers associated with recurrence remain limited. This study evaluated perioperative hematological, biochemical, and metabolic biomarkers associated with CSDH recurrence, focusing on preoperative lactate and the lactate-to-albumin ratio (LAR). <b>Methods:</b> This retrospective single-center cohort study included 163 adults who underwent burr-hole evacuation for CSDH between January 2021 and December 2025. All patients underwent saline irrigation without placement of a postoperative subdural drain, in accordance with the institutional surgical protocol. Clinical, radiological, laboratory, and perioperative arterial blood gas data were analyzed. Recurrence was defined as symptomatic re-expansion requiring repeat surgery within six months. Receiver operating characteristic (ROC) analysis and multivariable logistic regression were used to assess discrimination and associations with recurrence. <b>Results:</b> Postoperative recurrence occurred in 22 patients (13.5%). Recurrence was associated with higher preoperative lactate, LAR, neutrophil-to-lymphocyte ratio, and systemic immune-inflammation index, as well as lower serum albumin. LAR showed moderate discrimination (AUC 0.758, 95% CI 0.652-0.864), while lactate had an AUC of 0.744. Increased LAR (OR 1.42 per 0.1-unit increase, 95% CI 1.15-1.76; <i>p</i> = 0.001), bilateral hematoma (OR 2.91, 95% CI 1.08-7.84; <i>p</i> = 0.035), and mixed-density hematoma (OR 2.64, 95% CI 1.01-6.89; <i>p</i> = 0.047) were independently associated with recurrence in the fitted model. The age × lactate interaction did not reach conventional statistical significance (<i>p</i> = 0.058) and was considered exploratory. <b>Conclusions:</b> Higher preoperative LAR was associated with CSDH recurrence and showed moderate discriminative performance in this cohort. These findings are exploratory and require independent validation before LAR or the combined model can be considered for clinical risk prediction.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13703049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149275322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating Real-World Evidence, Patient-Reported Outcomes and Health Economics into Evidence-Based Public Health-A Narrative Review and Conceptual Framework.","authors":"Mariola Borowska, Piotr Bromber, Tomasz Kopiec, Magdalena Malinowska-Stelmachowska, Wojciech Miazga, Teresa Pakulska, Sylwia Jędrzejczyk-Kowalska, Urszula Religioni","doi":"10.3390/clinpract16100190","DOIUrl":"10.3390/clinpract16100190","url":null,"abstract":"<p><p>Contemporary healthcare systems operate in an environment characterized by the rapid development of digital technologies and the growing availability of health data. While these developments may increase the complexity of health policy decision-making, they also create new opportunities to support this process. In addition to clinical trial findings, RWD/RWE, PROMs, and PREMs, as well as analyses in the fields of health economics, HTA, and VBHC, are becoming increasingly important. The aim of this article is to present the current state of knowledge on the integration of these data and evidence sources within the EBPH approach and to discuss their relevance to the planning, implementation, and evaluation of health interventions. Based on a review of the literature, we propose an original conceptual model for health policy decision-making-the Integrated Evidence-Based Public Health Framework, which integrates epidemiological data, RWE, patient-reported information, and economic analyses within a single decision-support framework. The proposed model is consistent with the LHS concept and may provide a useful tool for supporting rational health policy planning and assessing the value of health interventions.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13703631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149275325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Bujdei-Tebeică et al. Myoprotective Fat-Loss Phenotypes in Obesity-Associated Type 2 Diabetes: A 12-Month Real-World Cohort Study of Metformin-Based Treatment Regimens. <i>Clin. Pract.</i> 2026, <i>16</i>, 141.","authors":"Ioana Bujdei-Tebeică, Anca Mihaela Pantea-Stoian, Doina Andrada Mihai, Simona Diana Ștefan, Cristian Serafinceanu","doi":"10.3390/clinpract16100191","DOIUrl":"10.3390/clinpract16100191","url":null,"abstract":"<p><p>In the original publication [...].</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13703663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149275356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physiotherapy Interventions for Migraine: A Systematic Review of Clinical Trials.","authors":"Helena Małgorzata Strachanowska, Martyna Anna Kaczmarska, Marlena Robakowska, Michał Brancewicz","doi":"10.3390/clinpract16100192","DOIUrl":"10.3390/clinpract16100192","url":null,"abstract":"<p><p><b>Background</b>: Migraine is one of the leading causes of disability worldwide and significantly reduces quality of life. Standard pharmacological treatment is often associated with adverse effects and does not always provide satisfactory long-term outcomes. Consequently, increasing attention has been directed toward non-pharmacological interventions such as physiotherapy. The aim of this systematic review was to evaluate the effectiveness of physiotherapy used as a standalone or complementary treatment for migraine. <b>Methods</b>: A systematic review of randomized controlled trials (RCTs) published between 2015 and 2025 was conducted in accordance with PRISMA 2020 guidelines. Electronic databases (PubMed, Cochrane Library, Scopus and PEDro) were searched using predefined search strategies. Studies involving adults diagnosed with migraine who received physiotherapy interventions (e.g., manual therapy, exercise therapy) were included. Two reviewers independently screened records and extracted data. Methodological quality of included studies was assessed using the PEDro scale. <b>Results</b>: Thirteen clinical trials (including 12 RCTs) involving 1021 participants were included. The most frequently investigated interventions were manual therapy and exercise therapy. Improvements in at least one primary clinical outcome (migraine frequency, pain intensity, or disability scores such as MIDAS or HIT-6) were observed in 8 out of 13 studies. A reduction in migraine frequency was reported in 4 studies. However, results were inconsistent across trials, and several studies found no statistically significant differences between the intervention and control groups. <b>Conclusions</b>: Physiotherapy may represent a beneficial complementary approach in migraine management, particularly for improving pain intensity and disability outcomes. However, the available evidence is limited by significant heterogeneity in intervention protocols, outcome measures, and follow-up duration, as well as the lack of quantitative synthesis. Further high-quality randomized trials with standardized methodology and longer follow-up periods are required to strengthen the evidence base.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13703453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149275350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medication Complexity and Insomnia Severity in Psychiatric Outpatients: A Moderation Analysis Across Mood and Non-Mood Disorders.","authors":"Vassilis Martiadis, Enrico Pessina, Azzurra Martini, Marco Marzolla, Chiara Bergesio, Francesca Barbaro, Alex Cavallo, Fabiola Raffone, Carlo Ignazio Cattaneo","doi":"10.3390/clinpract16100189","DOIUrl":"10.3390/clinpract16100189","url":null,"abstract":"<p><p><b>Background:</b> Insomnia is common and occurs across psychiatric diagnoses. A prior analysis of this outpatient cohort found that psychotropic medication complexity was associated with insomnia severity, but whether this association is stronger in particular diagnostic groups was not examined. We preregistered a moderation analysis to test whether mood disorder status modifies the association between medication complexity and insomnia, and additionally examined modification by sex and by insomnia domain. <b>Methods:</b> A secondary analysis was performed of cross-sectional, routinely collected data from 502 adult outpatients (from an initial cohort of 506) at an Italian community mental health centre. The primary model regressed the Insomnia Severity Index (ISI) total score on medication complexity × mood disorder status (depressive and bipolar vs. other psychiatric disorders), adjusting for age, sex and education; it was preregistered on the Open Science Framework before any interaction model was estimated. <b>Results:</b> Medication complexity was associated with the ISI total (b = 1.54 per class, 95% CI 0.92 to 2.16; attenuated but retained after benzodiazepine adjustment, b = 1.00, <i>p</i> = 0.009). The prespecified medication complexity × mood interaction was not statistically significant (b = -1.02, 95% CI -2.25 to 0.21, <i>p</i> = 0.103). The medication complexity × sex interaction was also non-significant (b = 0.28, <i>p</i> = 0.64), and the moderation did not differ between ISI domains (three-way interaction <i>p</i> = 0.67). Benzodiazepine prescription was independently associated with the ISI (b = 1.87, <i>p</i> = 0.011). <b>Conclusions:</b> The prespecified hypothesis of a stronger medication complexity-insomnia association in mood disorders was not supported. Because no equivalence margin was prespecified, the analysis cannot establish that the association is equivalent across groups; it indicates only that the hypothesised stronger association was not detected. Findings are exploratory with respect to mechanism and should be read in light of the cross-sectional design and probable confounding by indication.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13703539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149275307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-Traumatic Nasal Pyramid Reconstruction with a Custom-Made Titanium Implant: A Case Report with Ultrastructural Evaluation.","authors":"Ioannis Chatzistefanou, Sophia Tsokkou, Sofia Karachrysafi, Kyriaki Papadopoulou, Ioannis Konstantinidis, Alexandros C Liatsos, Vasiliki Theodorou, Antonia Sioga, Georgia-Alexandra Spyropoulou, Vasileios Petsinis, Theodora Papamitsou","doi":"10.3390/clinpract16100188","DOIUrl":"10.3390/clinpract16100188","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background/Objectives&lt;/b&gt;: Post-traumatic nasal pyramid reconstruction is challenging in patients with severe deformity and exhausted autologous graft options, particularly after multiple failed surgeries. Custom-made titanium implants may offer precise structural support, but data on their mucosal integration and ultrastructural tissue response in nasal reconstruction are lacking. The aim of this study is to describe what is, to the best of our knowledge, the first reported case of nasal pyramid reconstruction using an IPS (Individual Patient Solutions) custom-made titanium implant and to evaluate peri-implant tissue response with transmission electron microscopy (TEM). &lt;b&gt;Methods&lt;/b&gt;: A 50-year-old male military personnel with long-standing saddle-nose deformity, nasal obstruction, and prior failed graft-based reconstructions underwent open rhinoplasty with placement of a patient-specific titanium implant designed with three-dimensional virtual surgical planning on the basis of established nasal anthropometric parameters and manufactured as a custom-made device under Regulation (EU) 2017/745. The implant reconstructed the nasal dorsum from nasion to tip and was stabilized with cortical screws; an additional thin titanium plate was used for tip support. Biopsies of nasal mucosa and adjacent connective tissue obtained 24 months postoperatively were processed for TEM to assess epithelial, stromal, vascular, and implant-tissue interface characteristics. &lt;b&gt;Results&lt;/b&gt;: Clinically, nasal airway patency improved immediately after packing removal, with restoration of nasal contour and stable functional and aesthetic outcomes at 24-month follow-up without complications. Ultra-structurally, the respiratory epithelium showed preserved stratification, intact basal and ciliated cells, normal nuclei and mitochondria, and organized extracellular matrix closely opposed to discrete titanium particles, without granulomatous foreign-body reaction, dense inflammatory infiltrate, or fibrotic encapsulation. Focal ciliary damage, cytoplasmic vacuolization, lamina propria thickening, and vascular elastic lamina remodeling were interpreted as adaptive or transient stress-related changes rather than chronic implant toxicity. &lt;b&gt;Conclusions&lt;/b&gt;: Custom-made IPS titanium implants can provide stable structural support, satisfactory functional and aesthetic outcomes, and a well-tolerated mucosal interface in complex post-traumatic nasal pyramid reconstruction after failed graft-based surgeries. The ultrastructural findings are being consistent with good local tolerance of the implant at 24 months, showing predominantly preserved epithelial and stromal architecture with only focal, adaptive stress-related changes rather than chronic implant-related toxicity. However, as this is a single case assessed without conventional histology, immunohistochemistry or objective measurement of nasal airflow, these observations cannot establish biocompatibility, efficacy or long-","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13703481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149275399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telemedicine-Enabled Medication Optimization for Adults with Polypharmacy: A Systematic Review and Implications for Saudi Vision 2030 Healthcare Transformation.","authors":"Bobakr Bawazir, Yaslam Ba Srada, Saad Mohammad Aghi, Mohamed Elsayed, Hisham Yousif, Mohamed Ibrahim, Kareem Eltohamy, Mark Sim","doi":"10.3390/clinpract16100187","DOIUrl":"10.3390/clinpract16100187","url":null,"abstract":"<p><strong>Background/objectives: </strong>Polypharmacy may increase the risk of medication discrepancies, drug-drug interactions, potentially inappropriate prescribing, nonadherence, adverse drug events, and avoidable healthcare use. Telemedicine may improve access to medication review, particularly for older adults, people with multimorbidity, and geographically underserved populations. This review evaluated the effectiveness, safety, acceptability, and implementation requirements of telemedicine-enabled medication optimization and considered implications for Saudi Vision 2030.</p><p><strong>Methods: </strong>This PRISMA 2020 systematic review searched PubMed/MEDLINE, Europe PMC, and ClinicalTrials.gov from inception to 30 June 2026. Eligible studies evaluated telemedicine-supported medication reconciliation, medication therapy management, deprescribing, adherence support, or clinical-pharmacy consultation in adults with polypharmacy or explicitly defined high medication risk. Two reviewers independently screened records and extracted data. Clinical and methodological heterogeneity required narrative synthesis.</p><p><strong>Results: </strong>The search identified 168 records; 52 duplicates were removed, 12 reports underwent full-text assessment, and eight studies were included. Green et al. randomized 69 patient-care-partner dyads to immediate or delayed pharmacist telehealth deprescribing; approximately 80% in each arm completed the intervention, but changes in total medication count and regimen complexity were small and the latter was not clinically meaningful. Cole et al. reported 30-day readmission in 12/76 pharmacist-contacted patients and 3/12 patients who declined or could not be reached (<i>p</i> = 0.529); this nonrandomized comparison does not establish a reduction in readmissions. Process outcomes, including identification of discrepancies, interactions, and potentially inappropriate medicines, were more consistently favorable than clinical outcomes. Certainty was low for detection of medication-related problems and very low or absent for most clinical, utilization, and economic outcomes.</p><p><strong>Conclusions: </strong>Telemedicine-enabled medication optimization appears feasible, but evidence of clinical effectiveness and cost savings remains uncertain. Saudi implementation should begin with monitored pilots emphasizing safety, equity, Arabic-language accessibility, governance, and prospective evaluation.</p><p><strong>Registration: </strong>This completed review was retrospectively registered on the Open Science Framework (OSF).</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13703827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149275319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed Emergence Due to Prolonged Mivacurium Blockade in a Child with Markedly Reduced Butyrylcholinesterase Activity: A Case Report.","authors":"Daniela Saburova, Rihards Peteris Rocans, Irina Evansa, Arta Barzdina, Inna Babuskina, Natalija Zlobina, Olegs Sabelnikovs","doi":"10.3390/clinpract16100186","DOIUrl":"10.3390/clinpract16100186","url":null,"abstract":"<p><p><b>Background:</b> Delayed emergence after general anesthesia in pediatric patients is uncommon and requires prompt evaluation of pharmacological, metabolic, and neurological causes. Residual neuromuscular blockade remains an important reversible cause, particularly when short acting neuromuscular blocking agents dependent on plasma cholinesterase metabolism are used. <b>Case report:</b> We report the case of a previously healthy three-year-old boy who underwent elective adenoidectomy, tonsillotomy, and tympanostomy under general anesthesia with fentanyl, propofol, sevoflurane, and mivacurium. Following the procedure, the patient failed to regain spontaneous breathing, purposeful movements, or response to painful stimuli. In response, neostigmine was administered to reverse possible residual neuromuscular blockade; however, no immediate clinical improvement was observed, and mechanical ventilation was continued. Quantitative neuromuscular monitoring was unavailable. Therefore, residual blockade could not be objectively assessed, and the depth of blockade at the time of neostigmine administration remained unknown. The patient was transferred to a tertiary pediatric center for further evaluation. Several hours later, spontaneous breathing and motor activity recovered, and the patient was successfully extubated. Retrospective family history revealed prolonged recovery after anesthesia in the patient's grandfather. Subsequent laboratory testing demonstrated markedly reduced plasma butyrylcholinesterase activity (2493 U/L; reference range 7000-19,000 U/L), raising a strong suspicion of inherited butyrylcholinesterase deficiency. <b>Conclusions:</b> This case highlights the importance of considering residual neuromuscular blockade in delayed emergence after pediatric anesthesia, maintaining airway protection, and obtaining relevant family history to guide future management.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13702872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149275381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}