Clinics and Practice最新文献

{"title":"Comparison of Post-Tonsillectomy Hemorrhage Rate After Different Tonsillectomy Techniques: Systematic Review and Meta Analysis.","authors":"Mazyad M Alenezi, Faisal A Al-Harbi, Albaraa Nasser M Almoshigeh, Sultan S Alruqaie, Nada M Alshahrani, Alwaleed Mohammed Alamro, Abdulmalik Abdulaziz Aljulajil, Rayan Abduallah Alsaqri, Lama A Alharbi","doi":"10.3390/clinpract15050085","DOIUrl":"10.3390/clinpract15050085","url":null,"abstract":"<p><p><b>Introduction</b>: Post-tonsillectomy hemorrhage is a serious complication that varies according to the surgical technique used, potentially compromising patient safety and recovery. Even though several techniques were frequently used, including cold steel dissection, coblation, monopolar diathermy, and bipolar diathermy, there were certain discrepancies in hemorrhage rates in the literature. This meta-analysis aims to compare the rates of primary and secondary hemorrhage among these surgical techniques, with a focus on guiding clinical decision-making. <b>Methodology</b>: A total of 12 studies, published between 2005 and 2024, were selected from the PubMed, Web of Science, Scopus, and Cochrane Library databases, comprising 1684 participants from both pediatric and adult groups. Primary and secondary hemorrhage rates, surgical techniques, and study characteristics were extracted as data. Therefore, the aim of performing this meta-analysis with random-effects models was to calculate pooled estimates for hemorrhage rates and the heterogeneity index (I²). The techniques studied included cold steel dissection, coblation, monopolar diathermy, and bipolar diathermy. <b>Results</b>: The pooled primary hemorrhage rate across all techniques was 1.0% (95% Cl: 0.5-1.4%), with insignificant heterogeneity (I² = 0.0%, <i>p</i> < 0.665). By contrast, pooled secondary hemorrhage occurred at a rate of 5.8% (95% CI: 3.9-7.6%). Cold steel tonsillectomy was associated with the lowest secondary hemorrhage rate of 3.7% (95% CI: 0.8-6.6%, I² = 43.558%, <i>p</i> = 0.115), while bipolar diathermy had the highest secondary hemorrhage rate of 8.6% (95% CI: 2.3-15.0%, I² = 86.448%, <i>p</i> < 0.001). <b>Conclusions</b>: This meta-analysis underscores the considerable variability in rates of post-tonsillectomy hemorrhage frequency among various surgical techniques. Cold steel dissection appears to be the safest regarding secondary hemorrhage, while coblation likely minimizes primary bleeding. Bipolar diathermy comes across as the technique with the highest risk for primary hemorrhage and requires special caution during its use. Such results emphasize the need for careful selection of the surgical technique concerning patients' particular conditions and the need to enhance care periods to reduce the bearing of any hemorrhagic complications.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12110027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152382","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":"Tetranectin and Paraoxonase 1 in Patients with Varying Stages of Heart Failure: A Cross-Sectional Analysis.","authors":"Paula Alexandra Vulciu, Luminita Pilat, Maria-Daniela Mot, Voicu Dascau, Calin Daniel Popa, Norberth-Istvan Varga, Maria Puschita","doi":"10.3390/clinpract15050086","DOIUrl":"10.3390/clinpract15050086","url":null,"abstract":"<p><p><b>Background:</b> Heart failure (HF) is a leading cause of mortality across the globe, prompting ongoing research into novel biomarkers for improved risk stratification and patient management. <b>Methods:</b> This cross-sectional study aimed to investigate the relationship between two promising biomarkers, tetranectin and paraoxonase 1, and the severity of heart failure in a cohort of 87 patients with cardiovascular risk factors. Participants were categorized into three groups based on their New York Heart Association (NYHA) classification: no HF (Control), NYHA class I (G1), and NYHA class II-IV (G2). <b>Results:</b> Our analysis revealed a stepwise decrease in both TETRA and PON1 levels with increasing HF severity, with the Control group exhibiting the highest levels and the G2 group the lowest. Interestingly, a significant positive correlation between TETRA and PON1 was observed only in the Control group, suggesting a potential interplay between these biomarkers in healthy individuals that may be disrupted with the onset of HF. Furthermore, both TETRA and PON1 were positively associated with left ventricular ejection fraction (LVEF) and negatively associated with diastolic dysfunction, indicating their potential involvement in both systolic and diastolic cardiac function. <b>Conclusions:</b> These findings suggest that TETRA and PON1 may serve as valuable biomarkers for assessing HF severity and prognosis. Further research is warranted to validate these findings in larger, prospective studies and to explore their clinical utility in guiding treatment decisions.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12110643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152339","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":"Exploring the Potential Impact of SERPINE Gene Expression in Cumulus Cells During Fertility Treatments: A Single Center Study.","authors":"Sofoklis Stavros, Anastasios Potiris, Despoina Mavrogianni, Efthalia Moustakli, Kyriaki Tsiorou, Athanasios Zikopoulos, Nikolaos Kathopoulis, Charalampos Theofanakis, Dimitrios Loutradis, Ekaterini Domali, Peter Drakakis","doi":"10.3390/clinpract15050083","DOIUrl":"10.3390/clinpract15050083","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Cumulus cells have been proposed to be indicators of oocyte quality. In this study, oocyte cumulus cells were analyzed for SERPINE gene expression. High SERPINE gene expression in cumulus cells is associated with reduced oocyte maturity. However, high mRNA levels in granulosa cells are associated with follicles that result in pregnancy. This study aimed to evaluate SERPINE gene expression in cumulus cells across different ovarian stimulation protocols and its potential impact on follicle number, oocyte maturity, and embryo quality. <b>Methods</b>: The sample of the study consisted of 93 infertile women that underwent a five-day fixed antagonist protocol. Detection of SERPINE gene expression levels in cumulus cells was performed by extracting and isolating the total RNA produced in granulosa cells, and conducting cDNA synthesis and Real-Time Polymerase Chain Reaction. <b>Results</b>: The SERPINE gene expression in CCs was assessed in 71 samples. The SERPINE gene expression levels in CCs were categorized based on the ΔCp values. Most participants (65.9%) exhibited a high expression of the SERPINE gene, with ΔCp values greater than 2. Higher gene expression resulted in a higher number of follicles. However, no statistically significant results were observed regarding the number of follicles and the number of embryos. <b>Conclusions</b>: The study results provide insights into the expression patterns of the SERPINE gene in CCs and underscore the complexity of fertility-related biomarkers and the need for further investigation. SERPINE expression appears to be associated with follicle count, while its role in predicting oocyte quality and pregnancy success remains inconclusive.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12110122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152385","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":"Ocular Ultrasound as a Key to Diagnosing Uveitis-Masked Syndromes: Tips and Tricks.","authors":"Valeria Albano, Rosanna Dammacco, Ilaria Lolli, Claudia Ventricelli, Enrico Settimo, Angelo Miggiano, Maria Grazia Pignataro, Paolo Ferreri, Francesco Boscia, Silvana Guerriero, Giovanni Alessio","doi":"10.3390/clinpract15050084","DOIUrl":"10.3390/clinpract15050084","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background and Objectives&lt;/b&gt;: Uveitis-masked syndromes or masquerade syndromes (UMSs) are a group of ocular conditions with several systemic underlying causes, malignant or nonmalignant, that mimic the inflammatory status of the uvea. They are often difficult to detect and diagnose with traditional techniques, such as ophthalmic exams. Ocular B (bidimensional)-ultrasound (OBU) is a non-invasive, repeatable, rapid ultrasound method effective in indirect signs that lead back to systemic diseases. It is comparable in effectiveness with other imaging tools. The cause of UMSs can often be serious, and therefore early diagnosis and prompt treatment are critical. This study aimed to identify the sonographic signs of these forms, which can help physicians discover the cause underlying UMS. &lt;b&gt;Materials and Methods&lt;/b&gt;: This was a consecutive, retrospective, nonrandomized study. This study was conducted at the University Hospital Polyclinic of Bari, Italy, from January 2022 to December 2024. A total of 186 patients were included, from 10 to 85 years old. They all underwent B-scan ultrasonography (Quantel Medical ABSolu Ocular Ultrasound). &lt;b&gt;Results&lt;/b&gt;: All patients reported blurred vision, which could be accompanied by visual reduction (&lt;20/40, Snellen charts), photophobia, floaters, flashes, proptosis, and redness. In all cases, we noted peculiar ultrasonographic signs, which allowed us to discriminate the underlying systemic diagnosis, such as vitreous corpuscles, choroid thickening, and primitive or metastatic solid tumors. Finally, we identified different diseases, such as primary intraocular lymphoma (PIOL), other lymphoproliferative conditions, orbital plasmacytoma, uveal melanoma, metastasis, endogenous endophthalmitis, retinal detachment, central serous retinopathy, metallic foreign bodies, ocular amyloidosis, and drug-induced UMSs. The sensitivity and specificity of ocular ultrasound compared to multimodal ocular imaging in UMSs were as follows: for primary intraocular lymphoma (PIOL) and other lymphoproliferative conditions, 0.98 (95% CI, 0.80-1) and 0.68 (90% CI, 0.40-0.92), respectively; for orbital plasmacytoma, 0.64 (92% CI, 0.52-0.86) and 0.66 (93% CI, 0.48-0.89), respectively; uveal melanoma, 1.00 (98% CI, 0.88-1.00) and 0.98 (95% CI, 0.86-0.98), respectively; metastasis, 0.75 (95% CI, 0.53-0.85) and 0.85 (95% CI, 0.48-0.98), respectively; endogenous endophthalmitis, 1.00 (95% CI, 0.50-1.00) and 0.83 (95% CI, 0.48-0.98), respectively; retinal detachment, both were 1.00 (95% CI, 0.87-1.00 and 0.84-0.97, respectively); central serous retinopathy, 0.60 (80% CI, 0.41-0.88) and 0.85 (95% CI, 0.52-0.98), respectively; metallic foreign bodies, 1.00 (95% CI, 0.78-1.00) and 0.99 (95% CI, 0.99-1.00), respectively; ocular amyloidosis, 0.77 (82% CI, 0.52-0.90) and 0.83 (80% CI, 0.49-0.88), respectively; and drug-induced UMSs, 0.64 (95% CI, 0.49-0.88) and 0.85 (95% CI, 0.52-0.98), respectively. &lt;b&gt;Conclusions&lt;/b&gt;: Diagnosing UMS accurately ","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12110100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152389","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":"Microvascular Anastomosis in Practice: A Pilot Study on Microsurgical Training Efficiency.","authors":"Florin-Vlad Hodea, Andreea Grosu-Bularda, Andrei Cretu, Catalina-Stefania Dumitru, Vladut-Alin Ratoiu, Eliza-Maria Bordeanu-Diaconescu, Raducu-Andrei Costache, Razvan-Nicolae Teodoreanu, Ioan Lascar, Cristian-Sorin Hariga","doi":"10.3390/clinpract15050082","DOIUrl":"10.3390/clinpract15050082","url":null,"abstract":"<p><p><b>Background:</b> Microsurgery is a demanding surgical field requiring precision and extensive training. There is a continued need for standardized training models to improve skill acquisition and efficiency in microvascular anastomosis. <b>Objectives:</b> This study aimed to assess whether a standardized microsurgery training protocol, focusing on technique-specific objectives, improves performance among beginner trainees. <b>Material and Methods:</b> A three-month, non-randomized cohort study was conducted with entry-level plastic surgery residents. Participants were assigned to either a control group, practicing without structured guidance, or a test group, using a predefined microsurgery curriculum. Skill performance was measured at baseline, three weeks, and three months using a modified University of Western Ontario Microsurgical Skills Assessment (UWOMSA) tool. <b>Results:</b> While both groups improved over time, the test group demonstrated significantly greater improvement at the three-month mark (mean score: 59 vs. 38; <i>p</i> = 0.00027). The structured training model promoted more consistent progress and superior microsurgical technique. <b>Conclusions:</b> A standardized training protocol significantly enhances microsurgical proficiency over time. These findings suggest value in structured, low-cost training models for microsurgical education. Limitations include the small sample size, use of non-living models, and a non-randomized design.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12110448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152388","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":"A Quantitative Systematic Review on the Analgesic Efficacy and Adverse Effects of Ketorolac in Third Molar Surgery.","authors":"Mario Alberto Isiordia-Espinoza, Othoniel Hugo Aragon-Martinez, Nicolás Addiel Serafín-Higuera, Sandra López-Verdín, Eduardo Gómez-Sánchez, Nelly Molina-Frechero, Ronell Bologna-Molina, Juan Manuel Guzmán-Flores, Itzel Joselyn Mora-Falcón","doi":"10.3390/clinpract15040081","DOIUrl":"https://doi.org/10.3390/clinpract15040081","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to determine the number needed to treat (NNT) of ketorolac in comparison to placebo after third molar surgery.</p><p><strong>Methods: </strong>Studies located in PubMed, Scopus, and Web of Science were evaluated with the Cochrane Risk of Bias assessment tool. Data on the onset of analgesia, the number of patients requiring rescue medication, the global or general evaluation of the study medication, and adverse effects were extracted. Data analysis was performed using Review Manager 5.3 software for Windows.</p><p><strong>Results: </strong>The qualitative assessment of the included studies showed that ketorolac was more effective than a placebo and the quantitative evaluation on the onset of analgesia (NNT = 1.6 (95%CIs = 1.4, 1.9), n = 301), the number of patients who took rescue analgesics (NNT = 3.6 (95%CIs = 2.8 to 4.9), n = 563), and the global evaluation of the treatments (NNT = 1.7 (95%CIs = 1.5 to 1.9), n = 475) showed estimates of analgesic efficacy with a statistical difference in favor of ketorolac when compared with a placebo. No statistical difference was observed in adverse effects between ketorolac and placebo (n = 739).</p><p><strong>Conclusions: </strong>There is scientific evidence of moderate quality that allows estimators of the analgesic efficacy of ketorolac to be calculated, which will significantly help the clinician who performs pharmacological treatment after third molar surgery.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12025813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029585","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":"An Overview of the Etiopathogenic Mechanisms Involved in the Expression of the Oral Microbiota.","authors":"Ion Alexandru Popovici, Cristian Ionut Orasanu, Georgeta-Camelia Cozaru, Anita-Cristina Ionescu, Lidia Kajanto, Bogdan Cimpineanu, Anca Chisoi, Adrian Nelutu Mitroi, Ionut Poinareanu, Raluca Ioana Voda, Oana Andreea Ursica, Mihaela Butcaru Pundiche","doi":"10.3390/clinpract15040080","DOIUrl":"https://doi.org/10.3390/clinpract15040080","url":null,"abstract":"<p><p><b>Background/Objectives</b>: The diversity of the oral microbiota exerts its effects in maintaining dental and overall health. The unique genetic profile of each individual influences the composition of the oral microbiota, determining susceptibility to certain diseases. The aim is to observe its role by highlighting the pathogenic mechanisms involved in oral dysbiosis and identify genetic determinism's influence in maintaining balance. <b>Methods</b>: This study was designed as a narrative review of the oral microbiota, utilizing some of the principles and guidelines of systematic review to increase methodological rigor. We examined 121 articles such as reviews, meta-analyses, editorials, and observational studies, which met the inclusion and exclusion criteria. The inclusion criteria for studies were as follows: (1) studies that evaluated the impact of the microbiota in oral or/and systemic diseases; (2) studies that observed pathogenic mechanisms in the oral microbiota; (3) studies that evaluated the interaction of the microbiota with the immune system (4); studies that evaluated genetic implications in the microbiota. <b>Results</b>: Host genes regulate inflammatory and immunological reactions that play a role in microbiological balance. This explains the increased resistance of some to diseases, including gingivitis or periodontitis. Also, the implications of oral dysbiosis are reflected not only locally, but also generally, being associated with various systemic conditions. <b>Conclusions</b>: Understanding the pathogenic mechanisms and genetic determinants involved in oral dysbiosis may help create individualized therapies for preventing and managing oral and systemic disorders. A healthy lifestyle and adequate oral hygiene can facilitate a diverse and balanced microbiome, crucial for overall health.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12026067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050695","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":"Factors Influencing Adherence to Non-Invasive Telemedicine in Heart Failure: A Systematic Review.","authors":"George Koulaouzidis, Lamprini Tsigkriki, Orestis Grammenos, Sotiria Iliopoulou, Maria Kalaitzoglou, Panagiotis Theodorou, Ioannis Bostanitis, Karolina Skonieczna-Żydecka, Dafni Charisopoulou","doi":"10.3390/clinpract15040079","DOIUrl":"https://doi.org/10.3390/clinpract15040079","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Telemedicine (TM) has emerged as a promising tool for improving heart failure (HF) management by allowing non-invasive, remote patient monitoring. However, patient adherence to TM plays a critical role in its effectiveness. This systematic review aims to assess adherence levels to non-invasive TM interventions and explore factors influencing compliance. <b>Methods:</b> This systematic review followed the PRISMA guidelines. A literature search was conducted across the PubMed, Medline, Web of Science, and Google Scholar databases to identify prospective randomized controlled trials published between January 2010 and June 2024. The inclusion criteria included studies focused on non-invasive TM in HF patients with a follow-up period longer than three months. Adherence rates were categorized as high (≥80%), moderate (60-79%), or low (<60%). <b>Results:</b> Of the 136 identified studies, 6 met the inclusion criteria. Three studies reported high adherence (>80%), and three moderate adherence (60-79%). Older patients (≥65 years) showed higher adherence, with two studies exceeding 85% adherence. Studies with higher female participation (>30%) reported better adherence, with two exceeding 88%. Across studies, a lack of racial diversity was especially notable, apart from a study that included a population with 69% black and 31% Hispanic participants, where adherence was 50% for ≥10 uploads over a 90-day period. Seasonal variations affected adherence, with December being the lowest (47-69%) and August the highest (>85%). Monitoring multiple health parameters correlated with better adherence (>85%) compared to single-parameter tracking (50-74%). <b>Conclusions:</b> TM is a promising tool for HF management, but adherence differs by age, sex, and the complexity of monitoring. To optimize TM use, standardized adherence measures and tailored strategies are needed.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12025463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014273","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":"Time Capsule Medicine: A Mixed-Methods Pilot Study on Immersive Simulation for Chronic Disease Education in Medical Students.","authors":"Andreas Conte, Waseem Jerjes","doi":"10.3390/clinpract15040078","DOIUrl":"https://doi.org/10.3390/clinpract15040078","url":null,"abstract":"<p><p><b>Background</b>: Chronic diseases require long-term and multidimensional care, but traditional medical education has emphasised acute care and episodic interventions. This gap limits the understanding of future clinicians about the complexity of managing chronic conditions over decades. This mix-methods quantitative-qualitative pilot study describes \"Time Capsule Medicine\", an innovative educational framework in which medical students acted out the progressive challenges that patients with chronic illnesses might face over a continuous period of 20 years. This paper aims to report the outcomes of this innovative educational technique. <b>Methods</b>: Thirty final-year medical students were engaged in the three-phase programme which included preparation, immersive simulation, and reflection and evaluation. The preparation consisted of online workshops in chronic disease progression, age-related changes, and continuity of care, while the immersive simulation featured appropriate role-play exercises in small groups that simulated the chronic disease process across four five-year increments. The reflection and evaluation consisted of debriefing sessions and reflective journals, while pre- and post-simulation questionnaires tested learning outcomes. The physical constraints included weighted garments with visual impairments simulating the age-related limitations. <b>Results</b>: A gender- and ethnically diverse cohort of thirty final-year medical students from three medical schools in North London participated in the programme. The simulation significantly enhanced students' confidence in managing long-term disease trajectories (pre-simulation score: 2.8 ± 0.9; post-simulation score: 4.3 ± 0.6; <i>p</i> < 0.01) and understanding of age-related challenges (from 3.1 ± 1.0 to 4.5 ± 0.5; <i>p</i> < 0.01). Empathy scores increased from 3.0 ± 0.9 to 4.7 ± 0.5 <i>p</i> < 0.01. The qualitative analysis showed an increased appreciation of the continuity of care, recognition of systemic barriers, and insights into the emotional burdens of chronic conditions. For many students, the simulation was transformative, changing the way they approached holistic, patient-centred care. <b>Conclusions</b>: This experiential learning approach has succeeded in effectively addressing one of the most important gaps known in traditional medical education in developing empathy, understanding, and confidence in the long-term management of chronic diseases. The integration of similar simulations into medical curricula may adequately arm future clinicians with the complexities of continuity of care and patient management. Further studies need to be performed exploring scalability and its impact on long-term clinical practice.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12025795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040195","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":"Cutaneous Leishmaniasis in the Context of Global Travel, Migration, Refugee Populations, and Humanitarian Crises.","authors":"Janice Kim, Tarek Zieneldien, Sophia Ma, Bernard A Cohen","doi":"10.3390/clinpract15040077","DOIUrl":"https://doi.org/10.3390/clinpract15040077","url":null,"abstract":"<p><p>Cutaneous leishmaniasis (CL) is a vector-borne infection caused by protozoan parasites belonging to the genus <i>Leishmania</i>. CL is an emerging global health concern due to increasing migration, travel, and climate change. Traditionally, it was confined to endemic regions such as the Americas, the Middle East, and Central Asia; however, it is now spreading to non-endemic areas. Climate change has further contributed to the expansion of sandfly habitats, increasing CL transmission risk in previously unaffected areas. Healthcare providers in non-endemic regions often misdiagnose CL, delaying treatment and morbidity. Diagnosis remains challenging due to the need for species-specific identification, while treatment is limited by cost, availability, and personnel expertise. This review explores the epidemiology, clinical presentation, diagnostic challenges, and management of CL in the context of global mobility. It highlights rising CL cases in refugee settlements, particularly in Lebanon and Jordan, due to poor living conditions, inadequate vector control, and healthcare barriers. While there have been advances in systemic and topical therapies, access in refugee and resource-poor settings remains a barrier. Addressing the global burden of CL requires improved surveillance, healthcare provider training, and increased awareness. By enhancing global collaboration and policy changes, public health efforts can mitigate the expanding impact of CL.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12025697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020620","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}