Clinics and Practice最新文献

{"title":"Addressing Healthcare Disparities Among the Homeless: Insights from a Student-Run Clinic in Houston, TX.","authors":"Damien Kelly, Umer Khan, Elizabeth Bixler, Gabriella Becerra, Chakema Carmack","doi":"10.3390/clinpract15090161","DOIUrl":"10.3390/clinpract15090161","url":null,"abstract":"<p><p><b>Background:</b> Unhoused individuals face significant health disparities and encounter numerous barriers to accessing adequate healthcare, resulting in high rates of chronic disease, mental illness, and untreated conditions in Houston, TX. The purpose of this study was to identify prevalent health conditions within a sample of unhoused adults and to identify patterns in patient characteristics and clinical health outcomes. <b>Methods</b>: This study utilized clinical and demographic data from <i>n</i> = 191 patients who received care at a student-run clinic embedded within a homeless drop-in center in Houston, TX. Data included patient demographics, chief complaints, social determinants of health (SDOHs), past medical history, on-site diagnoses, and provider actions. <b>Results</b>: The most prevalent issues were housing insecurity (36.1%), cardiovascular conditions (38.7%), and substance use (17.8%). Nearly half of all patients (46.6%) declined treatment or left before receiving care. Significant associations were found between patient demographics and provider responses, including differences by gender and age in treatment type and diagnostic categorization. <b>Conclusions</b>: These findings underscore critical challenges in treatment adherence, diagnostic bias, and retention among unhoused populations. The study provides actionable recommendations for improving care coordination and continuity in low-barrier, student-run clinics serving medically underserved communities.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 9","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151323","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":"Implantable Cardioverter-Defibrillator Therapies Following Generator Replacements-Long-Term Remote Monitoring Data.","authors":"Maciej Dyrbuś, Łukasz Pyka, Anna Kurek, Jacek Niedziela, Elżbieta Adamowicz-Czoch, Katarzyna Sokoła, Joanna Machowicz, Mateusz Ostręga, Damian Pres, Michał Skrzypek, Mariusz Gąsior, Mateusz Tajstra","doi":"10.3390/clinpract15090160","DOIUrl":"10.3390/clinpract15090160","url":null,"abstract":"<p><p><b>Background</b>: The rate of long-term outcomes, including arrhythmic episodes following implantable cardioverter-defibrillator (ICD) device replacements, is often unknown. Thus, the aim of this manuscript was to evaluate the risk of ICD or cardiac resynchronization therapy-defibrillator (CRT-D) therapies in remotely monitored patients following device replacement. <b>Methods</b>: Data from 134 patients who underwent ICD/CRT-D replacement or upgrade were analyzed. Kaplan-Meier estimates, as well as Cox proportional hazards regression, were used to present long-term outcomes and predictors of study endpoints, these being all-cause mortality, and appropriate and inappropriate ICD/CRT-D therapies. <b>Results</b>: Among the cohort, 51.5% of patients received ICDs and 48.5% received CRT-Ds; the median (quartile 1-quartile 3) LVEF at replacement was 23.0% (18.0-28.0%). In 11 (8.2%) patients, the LVEF at replacement was higher than 35%. During the median (Q1-Q3) follow-up of 3.0 (1.4-5.0) years, 32.1% experienced appropriate and 6.0% experienced inappropriate therapies. The all-cause mortality rate was 38.0%, and appropriate antitachycardia pacing (ATP), a reduced baseline LVEF, and no history of myocardial infarction were independent predictors of death (odds ratios of 1.87 for appropriate ATP, 0.88 per 1% of the LVEF and 0.54 for a history of MI, respectively). The rate of appropriate device therapies was numerically lower in patients whose LVEF improved (19.8% vs. 33.3% and 0% vs. 6.5%, for appropriate and inappropriate therapies). An LVEF of >35% at replacement did not influence the analyzed outcomes. <b>Conclusions</b>: In patients who underwent ICD/CRT-D replacement, an improvement in LVEF was not identified as either a predictor of improved survival or of a lower risk of needing device therapies. Further stratification models are needed to evaluate the arrhythmic risk in patients after generator replacements.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 9","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151271","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":"Effects of Dietary and Probiotic Interventions in Patients with Metabolic Syndrome and Obstructive Sleep Apnea.","authors":"Amina Venter, Amin-Florin El-Kharoubi, Mousa El-Kharoubi, Evelin Claudia Ghitea, Marc Cristian Ghitea, Timea Claudia Ghitea, Ciprian Florian Venter","doi":"10.3390/clinpract15090159","DOIUrl":"10.3390/clinpract15090159","url":null,"abstract":"<p><p><b>Background:</b> Metabolic syndrome (MS) and obstructive sleep apnea (OSA) frequently coexist, exacerbating systemic inflammation, oxidative stress, and metabolic dysregulation. This study evaluates the effects of dietary and probiotic interventions, compared to a non-intervention control group, on metabolic, hemodynamic, and neurochemical parameters, with a specific focus on the neurotransmitters GABA and glutamate. <b>Methods:</b> In a prospective randomized study (2020-2023), 120 patients with coexisting MS and OSA were assigned to three groups: control (<i>n</i> = 36), diet therapy (<i>n</i> = 42), and diet therapy combined with probiotics (<i>n</i> = 42). Interventions lasted six months and included personalized dietary plans and probiotic supplementation. Outcome measures included BMI, visceral fat, HOMA index, lipid profile, oxygen saturation, and urinary GABA and glutamate levels. Unsupervised K-means clustering and principal component analysis (PCA) were applied to identify phenotypic response patterns based on delta values. <b>Results:</b> Diet therapy led to significant reductions in BMI (-15.7%, <i>p</i> = 0.001), visceral fat (-17.3%, <i>p</i> = 0.001), triglycerides (-14.6%, <i>p</i> = 0.003), uric acid (-9.5%, <i>p</i> = 0.011), and C-reactive protein (CRP) (-21.4%, <i>p</i> = 0.007). The combined intervention group exhibited further improvements in visceral fat (-22.8%, <i>p</i> = 0.001), glutamate (-18.2%, <i>p</i> = 0.002), and GABA levels (+19.5%, <i>p</i> = 0.001). Oxygen saturation improved across all groups, with the greatest increase in the probiotics group (+2.3%). Clustering analysis revealed three distinct response phenotypes-strong, moderate, and non-responders-highlighting inter-individual variability in treatment efficacy. <b>Conclusions:</b> Personalized dietary interventions, especially when paired with probiotics, effectively improve metabolic, inflammatory, and neurochemical profiles in patients with MS and OSA. Integrating clustering algorithms enables phenotype-specific stratification, offering a step toward precision lifestyle medicine. Future studies should explore long-term outcomes and refine microbiota-targeted approaches to optimize intervention efficacy.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 9","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151326","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":"Transcutaneous Electrical Nerve Stimulation for Muscle Recovery: Insights into Delayed Onset Muscle Soreness.","authors":"Sebastian Szajkowski, Jarosław Pasek, Grzegorz Cieślar","doi":"10.3390/clinpract15090157","DOIUrl":"10.3390/clinpract15090157","url":null,"abstract":"<p><p><b>Background:</b> Delayed onset muscle soreness (DOMS) frequently occurs after engaging in strenuous physical activity. The manifestation of DOMS is often associated with changes in the biomechanical and viscoelastic characteristics of the affected muscles. <b>Materials and Methods:</b> Forty participants were enrolled and randomly assigned to two groups: the intervention group receiving transcutaneous electrical nerve stimulation (TENS, <i>n</i> = 20) and a control group (<i>n</i> = 20). A fatigue-inducing protocol targeting the gastrocnemius muscle was implemented to elicit DOMS. The effectiveness of TENS was assessed by evaluating alterations in the biomechanical and viscoelastic properties of the muscle. Pain intensity was recorded using the Numeric Rating Scale (NRS) at five time points: before the study began, three times during the intervention, and once at the conclusion of the study. <b>Results:</b> No statistically significant changes have been found regarding muscle tone (<i>p</i> = 0.162) and stiffness (<i>p</i> = 0.212) in Group 1. However, a statistically significant lower level of stiffness in Group 1 after the end of therapy has been detected (<i>p</i> = 0.008). Decrement values decreased statistically significantly, both in Group 1 (<i>p</i> = 0.015) and in Group 2 (<i>p</i> = 0.014). There were no statistically significant differences in decrement level between Group 1 and 2. Relaxation and creep decreased statistically insignificantly in both groups. At the end of the observation period (Day 4), statistically significant (<i>p</i> = 0.027) lower pain intensity was observed in Group 1. <b>Conclusions:</b> It has been demonstrated that TENS has had limited effectiveness in restoring baseline biomechanical and viscoelastic parameters of muscles that undergo changes during DOMS. TENS significantly relieves pain symptoms occurring in DOMS.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 9","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151366","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":"Plasma Cell Gingivitis: Clinical Presentation, Histopathologic Correlation, and Therapeutic Challenges.","authors":"Davide Gerardi, Diana Torge, Sara Bernardi, Pierangelo Burdo, Maurizio Piattelli, Giuseppe Varvara","doi":"10.3390/clinpract15090158","DOIUrl":"10.3390/clinpract15090158","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Plasma cell gingivitis (PCG) is a rare, benign, non-dental-plaque-induced inflammatory condition characterized by dense subepithelial infiltration of polyclonal plasma cells. Due to its nonspecific clinical presentation, PCG represents a diagnostic challenge. This case report aims to describe a clinical case of PCG, highlighting the diagnostic process, histopathological correlation, and therapeutic approach. <b>Methods:</b> A 57-year-old male presented with a polypoid, erythematous, and edematous gingival lesion in the anterior maxillary region, with spontaneous bleeding on probing. Following clinic assessment, an incisional biopsy was performed, alongside complete hematological and inflammatory profiling. Histological and immunohistochemical analyses revealed the presence of an inflammatory infiltrate. <b>Results:</b> Histological evaluation revealed spongiotic squamous epithelium characterized by a dense plasma cell infiltrate with a liquenoid pattern of CD3-positive T and CD20-positive B lymphocytes. A polytypic expression of kappa and lambda light chains was also detected. The patient underwent topical corticosteroid therapy, showing progressive clinical improvement and resolution of symptoms, although minor mucosal involvement persisted. <b>Conclusions:</b> PCG remains a rare and underdiagnosed condition requiring integration of clinical, hematological, and histopathological data for accurate diagnosis. While corticosteroids remain the first-line therapy, emerging treatments, including photobiomodulation, may offer future adjunctive strategies to improve outcomes and reduce recurrence.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 9","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151397","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":"Diagnostic Overshadowing and the Unseen Spectrum: A Narrative Review of Rare Complications in Sickle Cell Disease.","authors":"Abdulrahman Nasiri, Manal Alshammari, Reem Alkharras, Albaraa Madkhali, Mostafa F Mohammed Saleh, Hazza Alzahrani","doi":"10.3390/clinpract15090156","DOIUrl":"10.3390/clinpract15090156","url":null,"abstract":"<p><p>Sickle cell disease (SCD) is a hereditary hemoglobin disorder characterized by chronic hemolysis and recurrent vaso-occlusive crises, leading to a wide spectrum of complications. While common SCD manifestations have well-established management protocols, rare and atypical complications pose significant diagnostic and therapeutic challenges. A critical barrier is diagnostic overshadowing, where common SCD symptoms (pain, fever, respiratory distress) mask infrequent but life-threatening conditions, resulting in delayed recognition and suboptimal outcomes. This narrative review synthesizes the literature from 2000-2025 on rare SCD complications, including atypical neurological events (e.g., spontaneous epidural or subdural hematoma, central retinal artery occlusion, cerebral arteriovenous malformations, posterior reversible encephalopathy syndrome), uncommon hematologic syndromes (acute leukemia, extramedullary hematopoiesis in unusual sites, hemophagocytic lymphohistiocytosis), severe cardiopulmonary emergencies (acute multiorgan failure and fat embolism syndromes), unusual hepatic crises (acute hepatic sequestration, intrahepatic cholestasis), and others (e.g., compartment syndrome). Key insights underscore the need for high clinical suspicion and prompt use of advanced diagnostics (e.g., MRI, specialized laboratory tests) when patients present with atypical or disproportionate symptoms. Clinical implications: Heightening clinician awareness of these rare complications and implementing structured diagnostic strategies can facilitate earlier intervention, improving outcomes and reducing the high morbidity and mortality associated with these infrequent but severe events.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 9","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151290","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":"Efficacy of Non-Invasive Monopolar Radiofrequency for Treating Genitourinary Syndrome of Menopause: A Prospective Pilot Study.","authors":"Mariachiara Palucci, Marta Barba, Alice Cola, Clarissa Costa, Desirèe De Vicari, Matteo Frigerio","doi":"10.3390/clinpract15080155","DOIUrl":"10.3390/clinpract15080155","url":null,"abstract":"<p><p><b>Introduction</b>: The decline of serum estrogen in postmenopausal women leads to several changes in the vulvovaginal and vesicourethral areas, resulting in the genitourinary syndrome of menopause (GSM), characterized by bothersome symptoms such as vaginal atrophy, lack of lubrication, dyspareunia, urgency, dysuria, and recurrent urinary tract infections. Nevertheless, this condition could also be experienced by younger women affected by hormone-dependent tumors. Although topical estrogens are considered \"the gold standard\", hormonal treatments cannot be indicated in cancer survivors. As a result, energy-based devices using radiofrequency and laser technologies have emerged as alternative options. This prospective study aimed to evaluate the benefits of non-invasive monopolar radiofrequency (RF) in women affected by GSM who have contraindications to, did not respond to, or declined local estrogen therapy. <b>Methods</b>: The patients underwent five weekly sessions of second-generation monopolar RF. At baseline and at the fifth session, two validated questionnaires were administered to the patients: the Visual Analogue Scale (VAS) and the Female Sexual Function Index (FSFI-19). On the other hand, the vaginal mucosa status was evaluated by clinicians through the Vaginal Health Index (VHI). At the end of the cycle, the Patient Global Impression of Improvement (PGI-I) questionnaire was collected. <b>Results</b>: Based on 44 patients who completed five sessions of radiofrequency, a significant improvement was observed in sexual function according to the FSFI scale (22.9 vs. 38.6; <i>p</i> < 0.001) and in VVA atrophy symptoms, as documented by the VAS score (223 vs. 125; <i>p</i> < 0.001). The mean VHI score increased by 3 points (<i>p</i> < 0.001). Moreover, according to PGI-I, 96% of patients reported a perceived improvement (PGI-I score ≤ 3). <b>Conclusions</b>: Radiofrequency could provide an innovative and safe therapeutic approach for patients suffering from GSM and VVA, especially when hormonal strategies are unsuitable.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 8","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12384446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973533","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":"Allelic and Genotypic Distribution of <i>MMP13</i>-77 A/G Polymorphism in Salvadoran Children With and Without Caries.","authors":"Wendy Escobar-González, Jorge Alegría-Torres, Yolanda Terán-Figueroa, Vianney Castañeda-Monroy, Aurelio Álvarez-Vargas, Carlo Eduardo Medina-Solís, Nuria Patiño-Marín","doi":"10.3390/clinpract15080154","DOIUrl":"10.3390/clinpract15080154","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Polymorphisms in metalloproteinases (MMPs) have the potential to be probable genetic biomarkers of dental caries. The aim of this study was to evaluate the distribution of the <i>MMP13</i> A/G rs2252070 single nucleotide polymorphism (SNP) according to caries experience in Salvadoran children. <b>Methods</b>: A cross-sectional study was carried out on 185 Salvadorian school children between 7 and 12 years of age. Demographic data, frequency of toothbrushing, dental flossing and consumption of sugar-sweetened beverages were recorded. Caries data were collected by clinical examination. Genomic DNA was obtained from oral cells of the children. Polymorphism genotyping was performed by PCR-RFLP. Allele and genotypic frequencies were compared between the healthy and caries-experiencing groups. Data were analyzed with SPSS 26.0 using the chi-square test, the Kruskal-Wallis test and logistic regression analysis. <b>Results</b>: The allele frequencies of <i>MMP13</i>-77 A/G were 0.7 and 0.3 following the Hardy-Weinberg equilibrium (X² = 0.22, <i>p</i> = 0.63). 72% of subjects with caries experience were carriers of the A allele. Caries experience was higher for the GG genotype group for permanent and primary surfaces (DMFS = 2.11; dmfs = 5.64) and for permanent teeth (DMFT = 1.50). No significant differences were found in the allelic and/or genotypic frequencies of the SNP polymorphism between subjects with dental caries and healthy subjects (<i>p</i> > 0.05). <b>Conclusions</b>: The distribution of <i>MMP13</i>-77 A/G rs2252070 in the study population showed no association with caries experience. However, our findings highlight the importance of promoting oral hygiene habits from an early age.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 8","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12384091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973525","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":"Association Between Emotional Intelligence and Stress Management in Hemodialysis Patients.","authors":"Orchan Impis, Afroditi Zartaloudi, Eirini Grapsa, Georgia Gerogianni","doi":"10.3390/clinpract15080153","DOIUrl":"10.3390/clinpract15080153","url":null,"abstract":"<p><p><b>Background:</b> Emotional intelligence refers to individuals' ability to recognize and manage their own emotions as well as those of others, playing a crucial role in stress management. This study aimed to investigate the relationship between different dimensions of emotional intelligence and stress management strategies in patients undergoing hemodialysis. <b>Methods:</b> In this cross-sectional study, 468 patients on hemodialysis completed the (i) Wong and Law Emotional Scale (WLEIS) and (ii) Trait Emotional Intelligence Questionnaire Short Form (TEIQue-SF) for the assessment of emotional intelligence as an emotional ability or as a personality trait, respectively; (iii) the Brief COPEQuestionnaire (Brief- COPE) for the assessment of stress management strategies; and (iv) a questionnaire about demographic characteristics. Spearman's correlations coefficients were used to explore associations between two continuous variables. Multiple linear regression analysis was used with Brief-COPE dimensions as the dependent variable. <b>Results:</b> High levels of emotionality were associated with an active approach to coping with stress (<i>p</i> = 0.018), while increased well-being and high regulation of emotions were associated with decreased behavioral disengagement (<i>p</i> < 0.001). Moreover, high emotional appraisal of others was linked to an increased use of humor (<i>p</i> = 0.042), while self-control and use and regulation of emotions were associated with decreased expression of negative feelings (<i>p</i> < 0.001). <b>Conclusions:</b> The current findings suggest potential links between emotional intelligence and stress management strategies in patients undergoing hemodialysis.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 8","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12384424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973542","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":"Macrovascular Involvement in Systemic Sclerosis: Association Between Carotid Ultrasound Hemodynamics Parameters and Digital Ulcers.","authors":"Eugenio Capparelli, Francesco Lapia, Luca Clerici, Eleonora Zaccara, Giusy Cinzia Moltisanti, Francesca Capelli, Daniela Bompane, Laura Castelnovo, Antonio Tamburello, Maria Iacovantuono, Maria Sole Chimenti, Paola Maria Luigia Faggioli, Antonino Mazzone","doi":"10.3390/clinpract15080152","DOIUrl":"10.3390/clinpract15080152","url":null,"abstract":"<p><p><b>Background:</b> Digital ulcers (DUs) are among the most debilitating vascular complications in SSc and are commonly attributed to microvascular damage. However, recent evidence suggests a potential involvement of macrovascular abnormalities, including subclinical atherosclerosis and altered hemodynamic parameters. <b>Objectives:</b> This study aimed to investigate the association between a history of DUs and macrovascular involvement in SSc patients through carotid and vertebral Doppler ultrasonography, with a focus on hemodynamic indices such as Peak Systolic Velocity (PSV), End-Diastolic Velocity (EDV), Resistive Index (RI), and Intima-Media Thickness (IMT). <b>Methods:</b> A cross-sectional study was conducted on 107 SSc patients. Clinical, serological, cardiovascular, and metabolic data were collected, and carotid-vertebral ultrasound was performed. Patients were stratified based on DU history. Statistical analyses assessed associations between DU status and carotid-vertebral US findings. <b>Results:</b> Patients with DUs showed a significantly higher PSV in both right (86.9 ± 67.9 vs. 64.2 ± 20.5 cm/s, <i>p</i> = 0.010) and left ICA (78.9 ± 29.6 vs. 63.4 ± 18.2 cm/s, <i>p</i> = 0.002). Right ICA RI vas elevated in the DU group (<i>p</i> = 0.021). PSV in the external carotid arteries was also bilaterally increased in DU patients (<i>p</i> < 0.005). DU-positive patients had a higher prevalence of left carotid plaques (<i>p</i> = 0.012) and right-sided ICA RI > 0.75 (<i>p</i> = 0.01). Logistic regression identified DU history as an independent predictor of PSV at ICA (β = 31.89, <i>p</i> = 0.043) and carotid plaque presence at any side (OR 14.34, <i>p</i> = 0.012). <b>Conclusions:</b> A history of digital ulcers in SSc patients is associated with altered carotid hemodynamics and an increased subclinical atherosclerotic burden. These findings suggest that DUs may reflect not only microvascular damage, but also macrovascular dysfunction, supporting the need for integrated vascular assessment in SSc clinical practice.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 8","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12384628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973489","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}