Clinics and Practice最新文献

{"title":"Characteristics, Management, and Outcomes of Acute Life-Threatening Asthma in Adult Intensive Care.","authors":"Adam J R Watson, Thomas Roe, Oliver Arscott, Charlotte Thomas, James Ward, Ryan Beecham, David Browning, Kordo Saeed, Ahilanandan Dushianthan","doi":"10.3390/clinpract14050149","DOIUrl":"10.3390/clinpract14050149","url":null,"abstract":"<p><strong>Background: </strong>There is limited evidence regarding the management of acute life-threatening asthma in intensive care units (ICUs), and few guidelines have details on this. We aimed to describe the characteristics, management, and outcomes of adults with life-threatening asthma requiring ICU admission.</p><p><strong>Methods: </strong>In this single-centre retrospective observational study, we included consecutive adults with acute asthma requiring ICU admission between 1 January 2016 and 31 December 2023. Our primary outcome was requirement for invasive mechanical ventilation (IMV).</p><p><strong>Results: </strong>We included 100 patients (median age 42.5 years, 67% female). The median pH, PaCO₂, and white cell count (WCC) on ICU admission were 7.37, 39 mmHg, and 13.6 × 109/L. There were 30 patients (30%) who required IMV, and the best predictors of IMV requirement were pH (AUC 0.772) and PaCO₂ (AUC 0.809). In univariate analysis, IMV requirement was associated with both increasing WCC (OR 1.14) and proven bacterial infection (OR 8.50). A variety of respiratory support strategies were utilised, with 38 patients (38%) receiving only non-invasive respiratory support.</p><p><strong>Conclusions: </strong>Our data highlight key characteristics which may be risk factors for acute asthma requiring ICU admission and suggest that pH, PaCO₂, and WCC are prognostic markers for disease severity. Our overall outcomes were good, with an IMV requirement of 30% and a 28-day mortality of 1%.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 5","pages":"1886-1897"},"PeriodicalIF":1.7,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11417819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298113","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":"Musculoskeletal Disorders in the Clinical Practice of Dental Hygienists and Dentists, Prevention and Awareness among Italian Professionals: Focus on Enlarging Systems.","authors":"Andrea Butera, Carolina Maiorani, Giulia Fantozzi, Francesca Bergamante, Matteo Castaldi, Roberta Grassi, Cinzia Leuter, Andrea Scribante, Gianna Maria Nardi","doi":"10.3390/clinpract14050150","DOIUrl":"10.3390/clinpract14050150","url":null,"abstract":"<p><p>(1) Background: Musculoskeletal disorders of the upper limbs are a common medical condition among dental hygienists and dentists, making them a common occupational risk for dental professionals. The purpose of the work was to collect information about the dental professions and their habits to highlight what can be good practices to be carried out to prevent any musculoskeletal disorders. (2) Methods: To identify habits and problems inherent in the professional activity of dental hygienists and dentists, a questionnaire was formulated on the use of enlarging systems. (3) Results: The questionnaire was completed by 241 dental professionals. As for the use of magnifiers, 72.6% of participants use them: among dental hygienists, 67.8% use magnifiers, among dentists, 80.9% use magnifiers; there is a statistically significant difference. There is no statistically significant difference between professions regarding muscle disorders. (4) Conclusions: For a clearer assessment, it would be appropriate to submit the questionnaire to a wider sample of professionals, to define better the correlation between musculoskeletal disorders, work activity and the type of enlarging systems used.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 5","pages":"1898-1910"},"PeriodicalIF":1.7,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11417866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298127","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":"Thoracic Trauma: Current Approach in Emergency Medicine.","authors":"Giorgia Caputo, Stefano Meda, Andrea Piccioni, Angela Saviano, Veronica Ojetti, Gabriele Savioli, Gaia Bavestrello Piccini, Chiara Ferrari, Antonio Voza, Lavinia Pellegrini, Miriam Ottaviani, Federica Spadazzi, Gianpietro Volonnino, Raffaele La Russa","doi":"10.3390/clinpract14050148","DOIUrl":"10.3390/clinpract14050148","url":null,"abstract":"<p><p>Chest trauma is the leading cause of death in people under 40. It is estimated to cause around 140,000 deaths each year. The key aims are to reduce mortality and the impact of associated complications to expedite recovery and to restore patient's conditions. The recognition of lesions through appropriate imaging and early treatment already in the emergency department are fundamental. The majority can be managed in a non-surgical way, but especially after traumatic cardiac arrest, a surgical approach is required. One of the most important surgical procedures is the Emergency Department Thoracotomy (EDT). The aim of this review is to provide a comprehensive synthesis about the management of thoracic trauma, the surgical procedures, accepted indications, and technical details adopted during the most important surgical procedures for different thoracic trauma injuries. Literature from 1990 to 2023 was retrieved from multiple databases and reviewed. It is also important to emphasize the medico-legal implications of this type of trauma, both from the point of view of collaboration with the judicial authority and in the prevention of any litigation.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 5","pages":"1869-1885"},"PeriodicalIF":1.7,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11417912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298130","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":"Comparing the Effectiveness of Open and Minimally Invasive Approaches in Coronary Artery Bypass Grafting: A Systematic Review.","authors":"Arwa Alsharif, Abdulaziz Alsharif, Ghadah Alshamrani, Abdulhameed Abu Alsoud, Rowaida Abdullah, Sarah Aljohani, Hawazen Alahmadi, Samratul Fuadah, Atheer Mohammed, Fatma E Hassan","doi":"10.3390/clinpract14050147","DOIUrl":"10.3390/clinpract14050147","url":null,"abstract":"<p><p>Coronary artery bypass grafting (CABG) is an essential operation for patients who have severe coronary artery disease (CAD). Both open and minimally invasive CABG methods are used to treat CAD. This in-depth review looks at the latest research on the effectiveness of open versus minimally invasive CABG. The goal is to develop evidence-based guidelines that will improve surgical outcomes. This systematic review used databases such as PubMed, MEDLINE, and Web of Science for a full electronic search. We adhered to the PRISMA guidelines and registered the results in the PROSPERO. The search method used MeSH phrases and many different study types to find papers. After removing duplicate publications and conducting a screening process, we collaboratively evaluated the full texts to determine their inclusion. We then extracted data, including diagnosis, the total number of patients in the study, clinical recommendations from the studies, surgical complications, angina recurrence, hospital stay duration, and mortality rates. Many studies that investigate open and minimally invasive CABG methods have shown that the type of surgery can have a large effect on how well the patient recovers and how well the surgery works overall. While there are limited data on the possible advantages of minimally invasive CABG, a conclusive comparison with open CABG is still dubious. Additional clinical trials are required to examine a wider spectrum of patient results.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 5","pages":"1842-1868"},"PeriodicalIF":1.7,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11417699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298116","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":"Comparative Perceptions of Fluoride Toxicity in Oral Hygiene Products: Insights from the General Population and Healthcare Professionals.","authors":"Marija Badrov, Lidia Gavic, Ana Seselja Perisin, Davor Zeljezic, Jasen Vladislavic, Ema Puizina Mladinic, Antonija Tadin","doi":"10.3390/clinpract14050146","DOIUrl":"10.3390/clinpract14050146","url":null,"abstract":"<p><strong>Background: </strong>The safety of oral hygiene products is a growing concern, particularly regarding the toxicity of specific ingredients used in their formulations. The purpose of this study was to evaluate the knowledge and attitudes of dentists, physicians, pharmacists, and the general public regarding ingredients in oral hygiene products, especially fluoride. Additionally, this study aimed to identify which ingredients may exhibit potential toxicity based on historical records of any adverse effects being induced by a material/component.</p><p><strong>Methods: </strong>A self-administered questionnaire was used in an online cross-sectional observational study to collect data on sociodemographic characteristics, knowledge of fluoride in dental medicine, fluoride usage practices in oral hygiene products, opinions on ingredient toxicity in oral hygiene products, and personal experiences of adverse reactions to products and their components. The collected data underwent descriptive and regression analyses to reveal patterns and relationships within the dataset.</p><p><strong>Results: </strong>The study found a moderate overall knowledge level regarding fluoride usage in dentistry among participants (Md = 5.00, IQR 2.50-7.00). Healthcare professionals exhibited significantly higher knowledge scores compared to the general population (<i>p</i> ≤ 0.001), with dental professionals displaying the highest scores. Regarding concerns about the usage of fluoride, the majority of respondents (77.0%) did not express any concerns. Minor concerns included the risk of ingestion (6.0%) and dental fluorosis (4.6%). Among the other ingredients in oral hygiene products, respondents named alcohol as the most toxic ingredient (70.3%), followed by artificial colors (53.1%), artificial sweeteners (50.4%), and parabens (50.1%). It is noteworthy that the majority of participants (61.6%) stated that they had never experienced any side effects associated with the use of oral hygiene products.</p><p><strong>Conclusion: </strong>This study underscores disparities in fluoride knowledge between healthcare professionals and the general population in Croatia, with dental experts exhibiting a superior understanding. Despite lingering misconceptions about fluoride content and potential toxicity, the majority of participants acknowledge its oral health benefits and use fluoride products regularly.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 5","pages":"1827-1841"},"PeriodicalIF":1.7,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11417910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298114","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":"Electric Scooter Falls: The 2023-2024 Experience in the Clinical Emergency Children's Hospital in Galați.","authors":"Cristina-Mihaela Popescu, Virginia Marina, Floriana Popescu, Andreea Oprea","doi":"10.3390/clinpract14050145","DOIUrl":"10.3390/clinpract14050145","url":null,"abstract":"<p><p>(1) Introduction: Since electric scooters were launched in 2017, they have become increasingly popular worldwide and a cause of childhood trauma. (2) Case reports: This paper has a double-fold purpose: it reports two cases of epidural hematomas and compares them with electric scooter-related head trauma in the literature. An overview of the literature on this topic was performed to make such a comparison. Our cases are one of almost 52 cm³ and one of 129 cm^3, both in two eight-year-olds. (3) Discussion: Although usually mild, traumatic brain injuries following e-scooter falls can also be moderate and severe. Reduced helmet use, high speed, and a lack of experience are the perfect set-up for potential severe injuries. Intracranial bleeds are not frequent, and epidural hematomas are rare in such cases, but they can significantly impact the individual, community, and healthcare system. No other medium- or large-sized epidural hematomas were reported in children sustaining electric scooter-related head trauma. (4) Conclusions: Our review parallels the literature and our hospital's experience. Although there are both similarities and discrepancies between our cases and the literature, mild trauma should not be disregarded, for it may hide serious complications requiring immediate surgery.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 5","pages":"1818-1826"},"PeriodicalIF":1.7,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11417887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298120","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":"Is It Possible to Prevent the Thanatogenetic Processes in Premature Babies?","authors":"Sinziana Andra Ghitoi, Mariana Deacu, Mariana Aschie, Manuela Enciu, Anca Florentina Mitroi, Georgeta Camelia Cozaru, Antonela Anca Nicolau, Cristian Ionut Orasanu, Oana Andreea Ursica, Raluca Ioana Voda","doi":"10.3390/clinpract14050144","DOIUrl":"10.3390/clinpract14050144","url":null,"abstract":"<p><p>Preterm births comprise all pregnancies coming to an end before the gestational age of 37 weeks and remain the leading cause of death in children under 5 years old despite efforts to reduce their occurrence. We aim to analyze all morbidity and mortality data to understand causes and risk factors, helping in prevention efforts. This study includes 140 cases collected during 2018-2022. Demographic, maternal, and thanatogenetic data were statistically analyzed. We observed an upward slope of stillborn babies. In the case of live-born premature, the average survival was 301.76 h. The multivariate analysis noted that extremely low birth weight (HR = 5.141) and very low birth weight (HR = 4.177) are risk factors involved in mortality. Increased parity was associated with premature births with low and very low birth weight (<i>p</i> = 0.019). We observed that a mother's age of over 30 years is predictable for the development of pregnancy-induced hypertension. Cerebral and pulmonary hemorrhages were the most common intermediate morbid conditions, with prematurity and plurivisceral hemorrhages serving as their root causes. We have identified that anthropometric measurements have a high predictability on malformed babies. The identified associations indicate a shared mechanism for certain lesion processes, which can help optimize resources for predicting and preventing preterm neonatal issues.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 5","pages":"1801-1817"},"PeriodicalIF":1.7,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11417739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298126","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":"Robotic-Assisted Radical Cystectomy: Single-Center Analysis of Factors Impacting Clavien ≥ II Complications.","authors":"Maria Chiara Sighinolfi, Tommaso Calcagnile, Enrico Panio, Simone Assumma, Luca Sarchi, Marco Sandri, Emanuela Santangelo, Michele Petix, Mattia Sangalli, Filippo Turri, Giorgio Bozzini, Marcio Covas Moschovas, Vipul Patel, Bernardo Rocco","doi":"10.3390/clinpract14050143","DOIUrl":"10.3390/clinpract14050143","url":null,"abstract":"<p><p>Despite the advent of robotics and the decreasing rate of complications after radical cystectomy, several factors are renowned to impair the early outcomes of this procedure. The aim of this paper is to provide a multivariate analysis (MVA) of patient and surgical procedure-related variables likely to affect postoperative course and 30-day complication rate. Fifty-five robotic-assisted radical cystectomies (RARCs) performed at a single center from July 2021 to March 2023 were enrolled. Baseline demographics, comorbidities, and intraoperative and postoperative data were collected. Uni- and multivariate analyses were performed to evaluate the relationship with Clavien ≥ II complications arising within 30 days of surgery. A postoperative Clavien ≥ II complication was evident in 15 patients (28%), whereas Clavien ≥ III occurred only in 5 (9%). At MVA, the only independent predictor of Clavien ≥ II complications was a prior neoadjuvant chemotherapy (OR 5.6; 95% CI 1.22-25.3, <i>p</i> = 0.026). Recognized the small sample size, patients who received a prior NAC should deserve special care within the postoperative course.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 5","pages":"1790-1800"},"PeriodicalIF":1.7,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11417726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298129","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":"Electrolyte Imbalance in Acute Traumatic Brain Injury: Insights from the First 24 h.","authors":"Alina Săcărescu, Mihaela-Dana Turliuc","doi":"10.3390/clinpract14050141","DOIUrl":"10.3390/clinpract14050141","url":null,"abstract":"<p><strong>Background/objectives: </strong>Electrolyte disturbances are common in patients with traumatic brain injury (TBI), particularly affecting sodium, potassium, chloride, and calcium levels. This study aims to provide insights into these disturbances within the first 24 h post-injury.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of 50 TBI patients, excluding those with conditions affecting electrolyte balance. Electrolyte levels were measured, and correlations with demographic data, trauma mechanisms, imaging findings, and Glasgow Coma Scale (GCS) scores were analyzed.</p><p><strong>Results: </strong>The results indicated that chloride levels inversely correlated with GCS scores (ρ = -0.515; <i>p</i> = 0.002), suggesting that elevated chloride may indicate severe neurological impairment. Potassium levels were significantly associated with subdural hematoma (<i>p</i> = 0.032) and subarachnoid hemorrhage (<i>p</i> = 0.043), highlighting their potential as markers for severe brain injuries. No significant associations were found between sodium or calcium levels and the studied variables.</p><p><strong>Conclusions: </strong>These findings underscore the importance of early monitoring of chloride and potassium levels in TBI patients to improve management and outcomes. Future research should focus on larger, multi-center studies to validate these findings and develop comprehensive guidelines for managing electrolyte imbalances in TBI patients.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 5","pages":"1767-1778"},"PeriodicalIF":1.7,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11417862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298121","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":"Demographic Profile and Clinical Characteristics of Adults with Down Syndrome in North-Eastern Romania.","authors":"Nicoleta Lefter, Irina Mihaela Abdulan, Alexandra Maștaleru, Maria-Magdalena Leon, Cristina Rusu","doi":"10.3390/clinpract14050142","DOIUrl":"10.3390/clinpract14050142","url":null,"abstract":"<p><p>(1) Background: Down syndrome is characterized by physical abnormalities, intellectual disability (ID), and specific patterns of other health issues. Additionally, individuals with DS are known to experience premature aging and early onset of certain age-related medical conditions. These conditions are linked to higher incident disability and reduced survival rates compared to the general population. (2) Methods: Between July 2022 and February 2024, we conducted a prospective, observational study in the Cardiovascular Rehabilitation Clinic at Iasi Clinical Rehabilitation Hospital. The study included 28 patients diagnosed with Down Syndrome and a control group. Interdisciplinary interventions were tailored to address the needs of a complex patient, incorporating cardiological, endocrinological, genetical, biological and developmental support. Data on physical health, cognitive development, and psychosocial well-being were collected. (3) Results: Our DS group consisted of 11 (39%) females and 17 (61%) males. Their age ranged from 20 to 55 years with a mean of 28.07 ± 9.51. All patients were unmarried, living in urban areas, without a partner but with family support. In the study sample, 96.4% of participants had three or more comorbidities. (4) Conclusions: The high prevalence of multimorbidity, combined with little medication, contributes to a high level of clinical complexity, which appears to be similar to the one of the older non-trisomic population. As individuals with Down syndrome transition into adulthood, they may require a more comprehensive and holistic approach to their healthcare.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 5","pages":"1779-1789"},"PeriodicalIF":1.7,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11417845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298118","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}