Clinics and Practice最新文献

{"title":"Beyond Passive Immunity: Three Neonatal Influenza Cases Highlighting Impact of Missed Maternal Vaccination.","authors":"Irina Profir, Cristina-Mihaela Popescu, Gabriel Valeriu Popa, Aurel Nechita","doi":"10.3390/clinpract15070124","DOIUrl":"https://doi.org/10.3390/clinpract15070124","url":null,"abstract":"<p><p><b>Background</b>: Neonatal influenza is a rare condition. Young infants have immature immune defenses and are unable to receive direct vaccination; this can result in significant illness. Maternal anti-influenza immunization during pregnancy provides passive antibodies to the newborn via transplacental transfer, significantly decreasing the incidence and severity of influenza in early infancy. Nevertheless, the vaccination coverage during pregnancy remains low in many regions, leaving certain neonates without adequate protection. <b>Methods</b>: We present three cases of laboratory-confirmed influenza infection in neonates admitted to the \"Sf. Ioan\" Clinical Emergency Pediatric Hospital in Galați and conduct a literature review. The clinical presentation, co-infections, timing of antiviral therapy, laboratory findings, maternal vaccination status, and outcomes (including the hospitalization duration and recovery) were systematically analyzed for each case. <b>Results</b>: All three neonates were full-term and previously healthy, born to mothers who had not received influenza vaccinations during their pregnancies. They presented at ages ranging from 2 to 4 weeks with fever, respiratory symptoms including a cough, nasal congestion, and respiratory distress, as well as feeding difficulties. One case involved a co-infection with Bordetella pertussis, which manifested as a severe paroxysmal cough, cyanosis, and apnea. Laboratory findings in the cases with influenza alone indicated leukopenia accompanied by normal C-reactive protein levels. In the co-infection case, leukocytosis, lymphocytosis, and thrombocytosis were observed. All the infants received oseltamivir treatment within 48 h of the symptom onset; the case with pertussis co-infection also received azithromycin. Each infant required supplemental oxygen, but none necessitated mechanical ventilation. Clinical improvement was observed in all cases, with hospitalization ranging from 6 to 7 days and complete recovery without complications. <b>Conclusions</b>: Neonatal influenza may result in considerable morbidity, particularly in infants born to unvaccinated mothers. Positive outcomes, however, have been correlated with early diagnosis and antiviral treatment. Pertussis co-infection may exacerbate clinical progression, underscoring the importance of maternal immunization against both influenza and pertussis. In this case series, we aim to present three cases of laboratory-confirmed influenza in neonates born to mothers who were not immunized against influenza during pregnancy. These cases highlight the clinical presentations of neonatal influenza, underscore the risks associated with pertussis co-infection, and reinforce the importance of maternal influenza and Tdap vaccination for preventing severe outcomes in newborns.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking the Subjective Units of Distress Scale: Validity and Clinical Utility of the SUDS.","authors":"Elizabeth Mattera, Brian Zaboski","doi":"10.3390/clinpract15070123","DOIUrl":"https://doi.org/10.3390/clinpract15070123","url":null,"abstract":"<p><p>The Subjective Units of Distress Scale (SUDS) is a widely used self-report measure clinicians rely on during exposure and response prevention (ERP) to monitor progress, guide exposure pacing, and assess intervention efficacy. However, despite its ubiquity in clinical and research settings, foundational investigations of its psychometrics are often atheoretical, fail to evaluate its longitudinal properties, and lack a rigorous construct validation framework. This paper addresses these shortcomings by evaluating the SUDS as a measure of state negative affective intensity using the Strong Program of Construct Validation. Our evaluation demonstrates that the SUDS suffers from significant psychometric weaknesses, including construct underrepresentation, construct irrelevance, poorly defined measurement occasions, and structural limitations, challenging its validity as a precise measure of subjective distress. These limitations have crucial implications for clinical practice, potentially leading to misinterpretations of patient distress and compromising treatment decisions. We discuss these clinical implications, highlight them with a brief clinical vignette, outline a research roadmap for potential improvement using modern psychometric methods, and provide practical recommendations for clinicians currently using the SUDS. Given these validity concerns, caution is warranted when interpreting SUDS scores in both clinical and research contexts until its psychometric properties are more robustly established and understood.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of Survival and Prognostic Factors in Patients Undergoing Liver Resection for Primary Hepatic Carcinoma-A Follow-Up Study.","authors":"Unenbat Gurbadam, Gantuya Dorj, Aryabilig Otgongerel, Munkhtsetseg Janlav, Serod Khuyagaa, Tsenguun Ganbat, Tserendorj Demchig, Amgalantuul Batdelger, Batsaikhan Bayartugs, Munkhdelger Byambaragchaa, Yerbolat Amankeldi, Munkhzaya Chogsom, Chinburen Jigjidsuren, Bayart-Uils Bayar, Lkham Nyam-Osor","doi":"10.3390/clinpract15070121","DOIUrl":"https://doi.org/10.3390/clinpract15070121","url":null,"abstract":"<p><p><b>Background:</b> Mongolia has a high incidence of hepatocellular carcinoma (HCC), with 85.6 cases per 100,000 population and 70% diagnosed at an advanced stage. HCC accounts for 35% of all cancer-related deaths in the country. The primary treatment for HCC remains hepatotectomy. This study aims to investigate the factors affecting the prognosis of patients undergoing liver resection for HCC in Mongolia. <b>Materials and Methods:</b> A retrospective cohort study was conducted using data from the National Cancer Centre's eHealth program and cancer registry. The study enrolled 1100 patients who underwent liver resection from 2015 to 2018, with a follow-up period of 5.25-9.25 years to determine survival rates. <b>Results:</b> The study included 980 patients, with a male-to-female ratio of 1.2:1 and an average age of 60 years. Tumour stage II patients had the highest survival rate (46.55%), and those with stage IIIb had the lowest (1.51%) (<i>p</i> = 0.0001). Smaller tumours (≤5 cm) were associated with better survival (<i>p</i> = 0.0006). Histologically, 19.4% had liver cirrhosis, and 80.7% had liver fibrosis. The preoperative median AFP level was 23.9 ng/mL (range 0-121,000 ng/mL). The average survival time post-liver resection was 6.675 years (<i>p</i> = 0.0006). Factors such as blood loss (<i>p</i> = 0.0004), vascular invasion (MaVI-<i>p</i> < 0.0001, MVI <i>p</i> = 0.0011), tumour size ≤ 5 cm (<i>p</i> = 0.0007), and elevated AST and ALT levels significantly influenced long-term survival (<i>p</i> = 0.0004, respectively). <b>Conclusions:</b> The study identified key prognostic factors influencing survival rates in HCC patients post-liver resection. Minimising blood loss, early detection, and managing vascular invasion, along with early-stage detection and treatment, are crucial for improving patient outcomes.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Like a Complete Unknown: An Audit of the Quality of the Referrals to the Cancer of Unknown Primary Clinic at a Tertiary Care Centre.","authors":"Ian Hirsch, Jonah Teich, Khaled Abdulalem, Samuel D Saibil","doi":"10.3390/clinpract15070122","DOIUrl":"https://doi.org/10.3390/clinpract15070122","url":null,"abstract":"<p><strong>Background: </strong>Carcinoma of Unknown Primary (CUP) constitutes approximately 3% of all advanced cancer cases globally, posing a distinct and complex medical challenge due to its metastatic nature, with no identifiable primary tumour site despite comprehensive investigations.</p><p><strong>Aim: </strong>This study aimed to assess the quality of referrals to the Cancer of Unknown Primary Clinic at the Princess Margaret Cancer Centre (PMCC) by conducting a retrospective audit of initial referrals between January 2022 and March 2023.</p><p><strong>Methods: </strong>The adequacy of referrals was evaluated based on adherence to NICE guidelines, focusing on essential diagnostic investigations such as comprehensive history, physical examination, CT scans, and pathological assessment with immunohistochemistry. Our cohort consisted of 97 patients with a median age of 66 years.</p><p><strong>Results: </strong>The results indicated that only 55% of referrals met the criteria for adequacy, with significant deficiencies in computed tomography (CT) scans and immunohistochemistry (IHC). Notably, the adequacy of referrals varied by specialty, with the lowest rates in emergency medicine and family medicine, and the highest rates in medical oncology, gastroenterology, and neurosurgery.</p><p><strong>Conclusions: </strong>These findings underscore the need for improved standardization and education to enhance referral quality, ensuring that patients with CUP receive appropriate and timely care. This study marks the initial phase of the Knowledge-to-Action cycle, highlighting areas for quality improvement in the referral process to the CUP clinic.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association Between COVID-19-Related Persistent Symptoms, Psychological Flexibility, and General Mental Health Among People With and Without Persistent Pain in the UK.","authors":"Lin Yu, Lance M McCracken","doi":"10.3390/clinpract15070119","DOIUrl":"https://doi.org/10.3390/clinpract15070119","url":null,"abstract":"<p><p><b>Objectives:</b> Persistent symptoms following COVID-19 may adversely impact the general mental health of people with chronic pain, and psychological flexibility may buffer these impacts. However, it remains unclear whether such lasting implications of COVID-19 differ between people with and without chronic pain. This study investigated the relationships between persistent symptoms post-COVID-19, psychological flexibility, and general mental health among people with and without persistent pain during the COVID-19 pandemic in the UK. <b>Methods:</b> A total of 204 adults living in the UK were recruited via social media and completed an online survey, including measures of persistent symptoms, depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder-7), insomnia (the Insomnia Severity Index), and psychological flexibility (the Multidimensional Psychological Flexibility Inventory), and were included in the analyses. <b>Results:</b> Participants with persistent pain (n = 70) experienced more-persistent symptoms, poorer general mental health, and a higher level of psychological inflexibility compared with participants without persistent pain (n = 133). Overall, the relationships between persistent physical symptoms, general mental health, and psychological (in)flexibility showed similar patterns in the two groups. Participants with more-persistent physical symptoms experienced significantly poorer general mental health. Furthermore, people with higher levels of psychological inflexibility reported worse general mental health. There was little evidence that psychological (in)flexibility could \"buffer\" the association between persistent physical symptoms and general mental health. <b>Conclusions:</b> People with chronic pain appear more vulnerable to persistent symptoms and reduced general mental health compared with people without pain. Treatments that reduce psychological inflexibility, such as ACT, may improve outcomes for people with persistent symptoms post-COVID-19.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First Case of Infective Endocarditis Caused by <i>Vibrio metschnikovii</i>: Clinico-Diagnostic Complexities and a Systematic Literature Review.","authors":"Alessandro Carrozzo, Vittorio Bolcato, Luigi Martinelli, Ferdinando Dodi, Antonella Vulcano, Giuseppe Basile, Livio P Tronconi","doi":"10.3390/clinpract15070118","DOIUrl":"https://doi.org/10.3390/clinpract15070118","url":null,"abstract":"<p><strong>Background: </strong>Non-cholera Vibrio species are rare waterborne pathogens that can cause severe infections. Among these, few cases of <i>Vibrio metschnikovii</i> infections have been reported, especially in the gastrointestinal tract, with no cardiac tissue involvement as a result. Following the PRISMA checklist, we conducted a literature review, and thirteen articles for twenty-two cases overall were included: seven cases of sepsis (in three cases, the echocardiographic results were negative), seven cases of pneumonia, two skin infections, eleven cases of diarrhoea, and a gastroenteritis outbreak. This report documents the expanding clinical spectrum and the role played by <i>V. metschnikovii</i> in infective endocarditis.</p><p><strong>Case report: </strong>A 28-year-old male patient was referred to the cardiac surgery unit for urgent mitral valve replacement due to suspicion of infective endocarditis. Microbiological tests yielded negative results. Following recovery and discharge with antimicrobial therapy for 6 weeks, the patient experienced prosthesis detachment, necessitating re-hospitalisation for an emergency valve replacement. <i>Vibrio metschnikovii</i> was identified on the prosthesis valve through PCR and successfully treated with ciprofloxacin. However, a spontaneous rupture of the ascending thoracic aorta led to a neurological injury.</p><p><strong>Discussion: </strong>This case represents the first case of valve infection caused by <i>Vibrio metschnikovii</i>, characterised by diagnostic and therapeutic challenges and the involvement of the great vessels. Also considered in this case, for a disease with a median age of 58 years (11-83) and a male-to-female ratio of 2.2, were one male neonate and six cases for whom neither sex nor age was indicated. Excluding gastrointestinal cases, the septic forms are associated with high morbidity, although the single case described involved a young and healthy subject. Risk factors for the pathogen or predisposing/pathological conditions for endocarditis did not emerge. The routes and the time of infection could not be determined, deepening the possibility of occupational exposure via the patient's position as a boat worker. Poor sensitivity to third-generation cephalosporins has been reported in the literature: the absence of an antibiogram does not allow for a comparison, although resolution was achieved with ciprofloxacin.</p><p><strong>Conclusion: </strong>The rising global incidence of non-cholera Vibrio infections, driven by environmental changes, calls for urgent research into the factors behind their pathogenicity and infection routes. Diagnostic complexities have emerged together with clinical severity.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends and Predictors of Venous Thromboembolism and Major Hemorrhagic Events in Hospitalized Leukemia Patients: A Cross-Sectional Analysis of the NIS (2016-2020).","authors":"Daniel Antwi-Amoabeng, Bryce D Beutler, Vijay Neelam, Mark Ulanja","doi":"10.3390/clinpract15070117","DOIUrl":"https://doi.org/10.3390/clinpract15070117","url":null,"abstract":"<p><strong>Background/objectives: </strong>Venous thromboembolism (VTE) and major hemorrhagic events are significant complications in hospitalized leukemia patients, but contemporary analyses of their epidemiology, predictors, and impact on clinical outcomes remain limited.</p><p><strong>Methods: </strong>We conducted a cross-sectional study using the National Inpatient Sample (NIS) database from 2016 to 2020. Hospitalized leukemia patients were identified using ICD-10 codes. Trends in the incidence of venous thromboembolism (VTE) and bleeding were assessed across the years, and multivariable logistic regression models were used to evaluate the predictors of VTE and bleeding. We assessed the influence thromboembolic and hemorrhagic complications on length of stay, cost, and mortality outcomes.</p><p><strong>Results: </strong>Among 430,780 leukemia hospitalizations, the overall incidence of VTE was 5.4% and remained stable throughout the study period (<i>p</i> = 0.09), while hemorrhagic events = 5.6%) showed a significant upward trend (<i>p</i> = 0.01). Cerebrovascular accidents, central venous catheter insertion, and protein calorie malnutrition (PCM) were significant predictors of both VTE and hemorrhage. PCM demonstrated a dose-dependent relationship with both complications. VTE was associated with a 33.5% increase in length of stay (LOS) and a 35% increase in cost of care (COC). Hemorrhage was associated with 23.2% increase in LOS and 32.6% increase in COC. Only hemorrhagic events were independently associated with increased mortality (adjusted OR 2.88, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>The incidence of VTE in hospitalized leukemia patients has remained stable while hemorrhagic complications have increased significantly. Nutritional status represents a potentially modifiable risk factor for both VTE and bleeding complications. The competing risk between thrombosis and hemorrhage varies with age and nutritional status, suggesting the need for nuanced thromboprophylaxis strategies in this vulnerable population.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endothelial Damage in Sepsis: The Interplay of Coagulopathy, Capillary Leak, and Vasoplegia-A Physiopathological Study.","authors":"Gianni Turcato, Arian Zaboli, Lucia Filippi, Alessandro Cipriano, Paolo Ferretto, Michael Maggi, Fabrizio Lucente, Massimo Marchetti, Lorenzo Ghiadoni, Christian J Wiedermann","doi":"10.3390/clinpract15070120","DOIUrl":"https://doi.org/10.3390/clinpract15070120","url":null,"abstract":"<p><p><b>Background:</b> Sepsis remains a leading cause of mortality worldwide, and understanding endothelial damage is crucial for improving patient outcomes. Endothelial dysfunction in sepsis contributes to coagulopathy, increased capillary permeability, and vasoplegia, but the interplay between these processes remains underexplored. The study aims to evaluate the clinical relationship between those factors due to sepsis-induced endothelial damage. <b>Methods:</b> A prospective single-center study on 75 community-acquired septic patients admitted to an Intermediate Care Unit. The Sepsis-Induced Coagulopathy (SIC) score, serum albumin (as a surrogate for capillary leak), and Total Peripheral Resistance Index (TPRI) (as a surrogate for vasoplegia) were assessed. Structural Equation Modeling (SEM) explored the relationship between variables, hypothesizing a common latent factor (endothelial damage). Principal Component Analysis assessed the shared variance among variables. <b>Results:</b> The mean SIC score was 3.4 (SD 1.3), with 44% of patients affected. TPRI and albumin had mean values of 1954 (SD 738) and 2.58 (SD 0.59), respectively, both negatively correlated with SIC: TPRI -0.263 (<i>p</i> = 0.023) and albumin -0.454 (<i>p</i> < 0.001). SEM showed SIC, albumin, and TPRI are associated with a latent factor (endothelial damage), explaining 68% of the variance (CFI = 1.000, RMSEA = 0.000). Albumin was inversely correlated (<i>p</i> = 0.004), and TPRI was significantly associated (<i>p</i> = 0.003). <b>Conclusions:</b> This pilot study suggests that coagulopathy, increased vascular permeability, and vasoplegia may be clinically interrelated manifestations of endothelial injury in sepsis. These findings support the feasibility of modeling a unified pathophysiological construct using accessible bedside data, potentially guiding future individualized approaches in sepsis management.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of the Quality of Care for Adults with Acute Asthma in the Emergency Department of a Tertiary Hospital: A 1-Year Follow-Up Study.","authors":"Carlos Martinez Rivera, Agnes Hernandez Biette, Anna Núñez Condominas, Ignasi Garcia Olive, María Basagaña Torrentó, Clara Padró Casas, Leandro Tapia Barredo, Antoni Rosell Gratacós","doi":"10.3390/clinpract15070116","DOIUrl":"https://doi.org/10.3390/clinpract15070116","url":null,"abstract":"<p><p><b>Background/Objectives</b>: This study evaluates the adherence to guidelines for the management of asthma exacerbations in the ED, recommendations at discharge, and impact at a 1-year of follow-up. <b>Methods</b>: An observational study of 87 asthma patients who attended the ED during 2022 and were discharged within 24 h was carried out. Data before the ED admission, care in the ED, and discharge reports, as well as the clinical characteristics at follow-up, were recorded. The relationship between complete ED discharge reports and outcome at 1 year, and factors associated with new exacerbations were analyzed. <b>Results</b>: The mean age was 51 years, 80% of the patients were women, and 50% had severe asthma. Prior to ED admission, 58.8% of patients used ICS-LABA, 26.2% triple therapy, 31.8% had not been treated, and 51.2% had presented at least one exacerbation. On ED admission, PEF was measured in 21% of patients only, decreasing to 6.8% at 3 h. In the ED discharge reports, the use of systemic corticosteroids was recommended in 76.5% of the cases and ICS-LABA in 46.9%. However, complete ED discharge reports were recorded for only 18.2% of patients. A total of 6.7% of patients were referred to a primary care physician and 29.9% to a pneumologist. Complete ED discharge forms did not improve asthma control at follow-up or reduce new exacerbations. Exacerbations before ED admission (OR 2.49, 95% CI 1.47-4.22, <i>p</i> = 0.001) and the use of any asthma controller treatment (OR 1.84, 95% CI 1.84-507, <i>p</i> = 0.017) were associated with ≥2 exacerbations at follow-up. <b>Conclusions</b>: Contact with ED did not improve disease control or reduce exacerbations. It is necessary to optimize care before, during, and after exacerbations by developing integrated programs with primary care to improve asthma management.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of Gallstones in Patients with Obesity After Bariatric Surgery in Northern Saudi Arabia: A Cross-Sectional Study.","authors":"Abdulrahman Omar A Alali, Abdualaziz Fayez Alhumidi Alanazi, Mohammed Abdulaziz M Albarghash, Rakan Nasser Abdullah Alruweli, Mohammed Bader H Alanazi, Ibrahim Farhan B Alanazi, Turkey Saleh H Alrowaily, Rakan Khalid Marzouq Alanazi, Baraah AbuAlsel, Fadih Nada M Alenezi, Rashad Qasem Ali Othman, Manal S Fawzy","doi":"10.3390/clinpract15070115","DOIUrl":"https://doi.org/10.3390/clinpract15070115","url":null,"abstract":"<p><strong>Background/objectives: </strong>Gallstone formation (cholelithiasis) is a common and important consequence following bariatric surgery, though regional data from the Northern Border Region are limited. This study aimed to investigate the incidence and risk factors of gallstones in this population, with the goal of optimizing postoperative treatment and reducing morbidity.</p><p><strong>Methods: </strong>We conducted a cross-sectional study using a non-probability convenience sampling technique to recruit 509 participants with varying degrees of obesity. Four hundred and ten study participants underwent bariatric surgery, of whom 73 were excluded for preoperative cholelithiasis and/or cholecystectomy. Data were collected through a self-administered, pre-validated questionnaire distributed via various social media platforms. These data included demographics, type/timing of surgery, pre/postoperative BMI, medical history, use of gallstone prophylaxis, and gallstone outcomes. Logistic regression analysis was used to identify independent predictors of gallstone formation.</p><p><strong>Results: </strong>Postoperative cholelithiasis developed in 60.8% of patients, most commonly within the first postoperative year, with risk peaking between 7 and 12 months after surgery. Rapid and substantial postoperative weight loss, as reflected in a lower current BMI and a transition to normal or overweight status within one year, was significantly associated with an increased incidence of gallstones. Female sex (OR: 2.62, 95% CI: 1.38-4.98, <i>p</i> = 0.003) and non-use of gallstone prevention medication (OR: 4.12, 95% CI: 1.34-12.64, <i>p</i> = 0.013) were independent predictors of gallstone formation. A longer time since surgery (OR: 0.76, 95% CI: 0.63-0.91, <i>p</i> = 0.004) and a lower current BMI (OR: 0.48, 95% CI: 0.28-0.83, <i>p</i> = 0.008) were associated with a reduced risk. Smoking status and comorbidities were not significantly related to the risk of gallstones.</p><p><strong>Conclusions: </strong>Gallstone formation after bariatric surgery in this population is influenced by female sex, rapid postoperative weight loss, and lack of prophylactic medication, while the type of surgical procedure does not significantly affect risk. Focused monitoring and preventive strategies, particularly in high-risk groups, are recommended to reduce gallstone-related complications following bariatric surgery.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}