Clinics and Practice最新文献

{"title":"Beyond Disease Categories: The Adaptive Hierarchical Domain Network (AHDN) for Precision Phenotyping and Personalized Management of Chronic Orofacial Pain.","authors":"Takahiko Nagamine","doi":"10.3390/clinpract16080154","DOIUrl":"10.3390/clinpract16080154","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Chronic orofacial pain disorders are highly heterogeneous and therapeutically challenging. Although current classifications such as the International Classification of Orofacial Pain (ICOP) and the concept of nociplastic pain have improved diagnostic consistency, patients with the same diagnosis may show substantial differences in symptom severity, underlying biology, and treatment response. This suggests that disease classifications may describe clinical phenotypes more effectively than the biological mechanisms sustaining persistent pain. This article proposes the Adaptive Hierarchical Domain Network (AHDN) as a conceptual framework for understanding chronic orofacial pain from a precision medicine perspective. <b>Conceptual Framework:</b> AHDN integrates concepts from systems biology, network neuroscience, predictive processing, biomarker research, and precision medicine. It organizes chronic pain across five hierarchically related but dynamically interacting layers: biological susceptibility, peripheral nociceptive drivers, central adaptive plasticity, behavioral adaptation, and social embedding. The framework is intended to complement, rather than replace, established diagnostic classifications. <b>Implications:</b> The proposed framework suggests that burning mouth syndrome, persistent dentoalveolar pain disorder, persistent idiopathic facial pain, occlusal dysesthesia, and subsets of temporomandibular disorders may represent different mechanistic configurations within a shared adaptive network. AHDN provides a hypothesis-generating structure for mechanistic phenotyping, biomarker development, and individualized management. However, the framework remains conceptual and requires prospective clinical validation, standardized assessment methods, and evaluation of its clinical utility before routine implementation.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13510925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833179","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 General Practitioner's Sex and Documented Diagnoses of Female-Specific Disorders in German Primary Care: A Large Matched Cross-Sectional Study.","authors":"Karel Kostev, Ira Rodemer, Marcel Konrad, Matthias Kalder","doi":"10.3390/clinpract16080152","DOIUrl":"10.3390/clinpract16080152","url":null,"abstract":"<p><strong>Background/objectives: </strong>In Germany, women have direct access to gynaecologists without GP referral, making the GP's role in female-specific conditions largely secondary. It has not previously been examined whether the sex of the GP is nonetheless associated with the documented prevalence of these conditions in primary care records.</p><p><strong>Methods: </strong>This retrospective cross-sectional study used data from the IQVIA™ Disease Analyzer. All women aged ≥18 years with at least one visit to one of 1183 GPs in Germany in 2025 were included. Women attending female and male GPs were matched 1:1 by propensity score on age, statutory health insurance, practice size, consultation frequency in 2025, and the van Walraven comorbidity score (excluding malignancy), yielding 661,485 women per group. Associations between GP sex and the documented prevalence of eight female-specific conditions were examined using conditional logistic regression within the age strata clinically relevant to each condition (from 18-30 to >75 years), with the age × GP-sex interaction tested in a single model per condition and E-values calculated to assess robustness to unmeasured confounding.</p><p><strong>Results: </strong>The association between GP sex and documented prevalence was strongly age-dependent, with a significant age × GP-sex interaction for seven of eight conditions (all <i>p</i> < 0.001). Female GP sex was associated with higher documented prevalence in mid-life, including menopausal and perimenopausal disorders (46-60 years: OR 1.37, 95% CI 1.28-1.46), endometriosis (31-45 years: OR 1.15, 1.03-1.28) and benign neoplasm of the female breast and genital organs (46-60 years: OR 1.16, 1.04-1.29); in the oldest women, the pattern attenuated or reversed (menopausal disorders > 75 years: OR 0.81, 0.72-0.90). No association was observed for breast cancer or female genital organ cancer at any age.</p><p><strong>Conclusions: </strong>In German primary care, the association between GP sex and the documented prevalence of female-specific disorders is age-dependent-most pronounced for conditions that require active clinical recognition and patient disclosure in mid-life, and absent for specialist-managed malignancies.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13510724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833052","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":"Awake Prone Positioning in Moderate ARDS: A Case Report.","authors":"Kapilan Kalaruban, Aristomenis Exadaktylos, Vincent Ribordy, Mairi Ziaka","doi":"10.3390/clinpract16080151","DOIUrl":"10.3390/clinpract16080151","url":null,"abstract":"<p><strong>Background: </strong><i>Legionella pneumophila</i> is a rare but severe cause of community-acquired pneumonia and can lead to acute respiratory distress syndrome (ARDS). Awake prone positioning (APP) has been recognized as an effective adjunct for non-intubated patients with hypoxemic respiratory failure, primarily studied in coronavirus disease 2019 (COVID-19) and other ARDS etiologies. Its application in <i>Legionella</i>-associated ARDS remains poorly documented. Therefore, in this work, we present a case of <i>Legionella</i>-associated ARDS successfully managed with APP, high-flow nasal cannula (HFNC), non-invasive ventilation (NIV), levofloxacin, and corticosteroids.</p><p><strong>Case presentation: </strong>A 62-year-old male with multiple comorbidities, including type 2 diabetes mellitus (T2DM) and a history of coronary artery bypass surgery, presented with a 3-day history of productive cough, exertional dyspnea, and general malaise. Oxygen saturation on admission was 90%, with fever and tachycardia. Inflammatory markers were markedly elevated. Chest computed tomography (CT) revealed extensive bilateral pulmonary infiltrates. Despite a negative urinary <i>Legionella</i> antigen test, sputum polymerase chain reaction (PCR) confirmed <i>Legionella pneumophila</i> on day 2. A Horowitz index of 147 mmHg on day 2 established moderate ARDS. The patient was treated with HFNC oxygen therapy, NIV, and APP for up to 12 h daily. Antibiotic therapy was initiated with amoxicillin/clavulanic acid and clarithromycin, subsequently streamlined to levofloxacin upon microbiological confirmation. Methylprednisolone 40 mg/day was administered for 8 days as adjunctive ARDS therapy. The patient demonstrated gradual clinical and respiratory improvement without requiring endotracheal intubation. Follow-up chest CT on day 7 showed regression of bilateral consolidations and ground-glass opacities (GGOs). The patient was transferred to pulmonary rehabilitation on day 11 and completed antibiotic therapy as an outpatient.</p><p><strong>Conclusions: </strong>This case illustrates the successful use of APP combined with HFNC and NIV alongside standard medical therapies, including appropriate antibiotics and corticosteroids, to avoid intubation in moderate ARDS secondary to <i>Legionella</i> pneumonia. Early initiation of APP may be a valuable strategy in <i>Legionella</i>-associated ARDS in carefully selected patients.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13510559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833161","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":"Severe Dengue and Dengue-Malaria Coinfection: A Case Series from a Referral Hospital in Montería, Colombia.","authors":"Paula A Avilés-Vergara, Dina Ricardo-Caldera, Osnamir Elias Bru-Cordero, Juan Alberto Miranda, Angie Paola Martínez Villera, Kevin Alexander Angulo Álvarez, María Carolina Geney Caro","doi":"10.3390/clinpract16080150","DOIUrl":"10.3390/clinpract16080150","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Severe dengue and dengue-malaria coinfection represent major diagnostic and therapeutic challenges in tropical endemic settings, where overlapping clinical manifestations may delay recognition of deterioration. This study aimed to describe the clinical and epidemiological characteristics of patients with severe dengue, dengue with warning signs, and dengue-malaria coinfection treated at a referral hospital in Montería, Córdoba, Colombia. <b>Methods:</b> A retrospective case series was conducted by reviewing medical records of patients diagnosed with dengue between 2018 and 2023. Cases classified as dengue without warning signs were excluded. The final analysis included patients with dengue-warning signs, severe dengue, and dengue-malaria coinfection. Dengue classification followed the 2009 World Health Organization criteria, and malaria was confirmed by thick blood smear. Sociodemographic, clinical, laboratory, geographic, and outcome-related variables were collected. Descriptive analyses were performed, and selected categorical variables were compared using Fisher's exact test. <b>Results:</b> Fifty-three patients were included: 25 (47.17%) with severe dengue, 14 (26.42%) with dengue with warning signs, and 14 (26.42%) with dengue-malaria coinfection. Severe dengue was more frequent among females, whereas dengue with warning signs and coinfection predominated in males. Children accounted for the highest proportion of severe dengue cases, while coinfected cases were mainly distributed between childhood and adolescence. Fever was documented in all patients. Edema, elevated hematocrit, severe plasma leakage, and hemodynamic compromise were more frequent among severe dengue cases, whereas myalgia differed significantly across clinical groups. Ten deaths were recorded, six occurring in coinfected patients. <b>Conclusions:</b> Severe dengue and dengue-malaria coinfection are clinically complex conditions with overlapping manifestations and potentially fatal outcomes, highlighting the need for early recognition, differential diagnosis, and close monitoring.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13510872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833488","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":"Development and Preliminary Assessment of a Mortality Risk Score in Patients with Coronary Artery Disease Receiving Dual Antiplatelet Therapy After Percutaneous Coronary Intervention.","authors":"Friba Nurmukhammad, Sholpan Zhangelova, Akhmetzhan Sugraliyev, Alexander Arutyunov, Yermagambet Kuatbayev, Zhanetta Mukanova, Dina Kapsultanova","doi":"10.3390/clinpract16080149","DOIUrl":"10.3390/clinpract16080149","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background&lt;/b&gt;: Patients with coronary artery disease (CAD) receiving dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) remain at risk of early adverse outcomes, including in-hospital mortality. Simple risk stratification based on routinely available variables may help identify higher-risk patients, but a limited number of outcome events constrains robust prediction-model development and validation. &lt;b&gt;Aim&lt;/b&gt;: This exploratory study aimed to derive a preliminary, interpretable clinical score based on routinely available variables for risk stratification of all-cause in-hospital mortality in CAD patients receiving DAPT after PCI. In the clopidogrel-dominant practice setting of the participating centers, the score was conceived as a hypothesis-generating risk-enrichment framework rather than a validated treatment-selection tool or a surrogate measure of platelet reactivity. &lt;b&gt;Methods&lt;/b&gt;: We analyzed a retrospective cohort of 1600 adults with CAD admitted between 2022 and 2024; 36 in-hospital deaths occurred. Twenty demographic, clinical, laboratory, and instrumental variables were evaluated. The primary outcome was all-cause in-hospital mortality during the index hospitalization. For exploratory score derivation, the dataset was randomly divided into a derivation subset (75%; &lt;i&gt;n&lt;/i&gt; = 1200) and a hold-out assessment subset (25%; &lt;i&gt;n&lt;/i&gt; = 400). Predictors were explored using univariable and multivariable logistic regression with stepwise selection. Continuous variables were categorized using Weight of Evidence binning, and an integer point score was derived. Performance was summarized using ROC analysis, AUC, sensitivity, specificity, and accuracy. Given the small number of deaths and the data-driven modelling workflow, all performance estimates were considered preliminary rather than definitive internal validation. &lt;b&gt;Results&lt;/b&gt;: The exploratory six-variable score included age ≥ 57 years, estimated glomerular filtration rate &lt; 45 mL/min/1.73 m&lt;sup&gt;2&lt;/sup&gt;, body mass index ≥ 25 kg/m&lt;sup&gt;2&lt;/sup&gt;, troponin I ≥ 100, prior myocardial infarction, and current smoking. In the derivation subset, each additional point was associated with higher odds of mortality (OR 1.39; 95% CI 1.29-1.51; &lt;i&gt;p&lt;/i&gt; &lt; 0.001), and the AUC was 0.654. A Youden-index threshold of approximately 6 points yielded sensitivity of 0.41, specificity of 0.80, and accuracy of 0.72. In the hold-out assessment subset, sensitivity was 0.53, specificity was 0.70, accuracy was 0.70, and AUC was 0.61. These estimates indicate modest discrimination and should be interpreted cautiously because only 36 outcome events were available. &lt;b&gt;Conclusions&lt;/b&gt;: This exploratory clinical score showed modest discrimination for all-cause in-hospital mortality and should be regarded as a preliminary, hypothesis-generating risk-stratification approach. It is not sufficiently validated for routine prognostic classification, platelet-reactivity triage, or antiplatele","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13511506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833344","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":"Calcaneal Insufficiency Fracture: An Underrecognized Cause of Atraumatic Heel Pain in Older Adults.","authors":"Koji Nozaka, Naohisa Miyakoshi","doi":"10.3390/clinpract16080148","DOIUrl":"10.3390/clinpract16080148","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Calcaneal insufficiency fractures may be overlooked in older adults presenting with atraumatic heel-region pain because early radiographic findings can be absent or inconclusive. Evidence regarding how often these fractures are identified in routine outpatient practice remains limited. This study aimed to describe the observed frequency, diagnostic pathway, clinical characteristics, treatment, and documented clinical course of calcaneal insufficiency fractures in an orthopaedic outpatient cohort. <b>Methods</b>: We retrospectively reviewed consecutive patients aged 60 years or older who presented with atraumatic pain localised to the heel or calcaneal region between April 2012 and March 2020. All patients underwent initial plain radiography. Follow-up radiography and MRI were performed selectively when weight-bearing heel pain persisted, radiographic findings remained negative or equivocal, and clinical suspicion of an occult fracture remained. Observed fracture frequencies and exact 95% confidence intervals (CIs) were calculated. <b>Results</b>: Among 123 included patients, calcaneal insufficiency fractures were identified in 10, corresponding to an observed frequency of 8.1% (95% CI, 4.0-14.4%). Among 89 independently ambulatory patients, 9 fractures were identified, corresponding to an observed subgroup frequency of 10.1% (95% CI, 4.7-18.3%). These subgroup findings were descriptive and were not adjusted for potential confounders. All 10 fracture cases occurred in women, with a mean age of 78.4 years. Osteoporosis was newly identified in all fracture cases; the mean femoral-neck T-score was -3.42. Four fractures were identified on radiographic findings, whereas six required MRI to establish the diagnosis after radiographs remained negative or inconclusive. All cases were managed non-operatively. The mean interval from symptom onset to the first documented clinical improvement or resolution of heel pain was 28.4 days, and no displacement or subsequent surgical intervention was documented during the available follow-up. <b>Conclusions</b>: In this retrospective single-centre cohort, calcaneal insufficiency fractures were identified in a subset of older adults presenting with atraumatic heel-region pain. The observed frequencies should be interpreted as descriptive estimates rather than population prevalence figures. Calcaneal insufficiency fracture may be considered when focal heel pain persists despite normal or equivocal initial radiographs, with repeat radiography and MRI considered according to the clinical context. Prospective studies using standardised imaging and follow-up protocols are needed.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13510305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833289","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":"Vitamin D and Postpartum Depression: A Narrative Review.","authors":"Afra Almashghouni, Haydar Hasan, Dimitrios Papandreou","doi":"10.3390/clinpract16080147","DOIUrl":"10.3390/clinpract16080147","url":null,"abstract":"<p><p><b>Background/objective:</b> Postpartum depression (PPD) is a significant public health issue affecting about 19% of mothers globally. It has well-documented impacts on maternal well-being, mother-infant relationships, and child developmental outcomes. At the same time, the level of vitamin D deficiency in women of reproductive age is very high (affecting 60-87 percent of pregnant women globally). The review aims to synthesize current evidence and highlight priority research areas to improve maternal mental health outcomes. <b>Methods:</b> A systematic literature search of PubMed, Scopus, and Google Scholar (2015-2026) was conducted, followed by narrative synthesis of mechanistic, observational, and interventional evidence. <b>Results:</b> Adequate vitamin D status may contribute to a reduced risk of postpartum depression through multiple interacting pathways, including serotonin synthesis and metabolism (via tryptophan hydroxylase 2 (<i>TPH2</i>) and monoamine oxidase-A (<i>MAO-A</i>) regulation), neuroplasticity via brain-derived neurotrophic factor (<i>BDNF</i>) signaling, and suppression of the pro-inflammatory cytokine cascade. Dose-response meta-analyses and large prospective cohort studies indicate consistent negative relationships between maternal vitamin D levels and postpartum depressive and anxiety symptoms with optimal serum 25-hydroxyvitamin D (25(OH)D) levels of 90-110 nmol/L. <b>Conclusions:</b> There is still limited evidence on the intervention; it is still methodologically diverse, and only a few randomized controlled trials have been carried out on specifically postpartum populations.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13511215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833499","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":"Guselkumab Every 4 Weeks as a Real-World Therapeutic Option for Psoriatic Arthritis Patients at High Risk of Joint Damage.","authors":"Nicoletta Bernardini, Giorgio Marotta, Nevena Skroza, Dario Graceffa, Maria Consiglia Bragazzi, Lucia Finistauri Guacci, Ersilia Tolino, Francesca Paola Sasso, Umberto Gallo, Antonio Giovanni Richetta, Annunziata Dattola","doi":"10.3390/clinpract16080146","DOIUrl":"10.3390/clinpract16080146","url":null,"abstract":"<p><p><b>Background:</b> Guselkumab, a monoclonal antibody selectively targeting the p19 subunit of interleukin-23, is typically administered with an induction phase at weeks 0 and 4 followed by maintenance dosing every 8 weeks for the treatment of psoriatic arthritis (PsA). In Europe, a four-week regimen (Q4W) has recently been approved for patients at high risk of joint damage progression; however, real-world evidence on this intensified schedule remains limited. This study aimed to evaluate the effectiveness and safety of guselkumab Q4W in routine clinical practice. <b>Methods:</b> This retrospective observational study included 18 PsA patients at high risk of structural damage treated with guselkumab Q4W at two psoriasis referral centers in the Lazio region of Italy. Baseline and 24-week clinical data were collected from medical records. Outcome measures included Disease Activity Index for Psoriatic Arthritis (DAPSA), Minimal Disease Activity (MDA), pain Visual Analog Scale (VAS), Dermatology Life Quality Index (DLQI), and Psoriasis Area and Severity Index (PASI). <b>Results:</b> After 24 weeks, mean DAPSA decreased from 34.3 ± 7.6 to 3.7 ± 3.0; 55.6% of patients achieved DAPSA remission and 77.8% achieved MDA. Significant improvements were observed in pain VAS, DLQI, and PASI scores. All patients achieved PASI 75, while 83.3% achieved PASI 90 and PASI 100. Treatment was generally well tolerated, with no adverse events or new safety signals documented during follow-up. <b>Conclusions:</b> In our study, guselkumab Q4W showed marked multidomain effectiveness and a favorable safety profile, supporting its use in PsA patients at high risk of joint damage progression.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13511598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833358","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":"Glycemic Status and Glycemic Variability Related to Mortality and Morbidity in Critically III Diabetic and Non-Diabetic Patients: A Prospective Observational Study.","authors":"Mădălina Diana Fehér, Codrin Dan Nicolae Ilea, Cosmin Mihai Vesa, Alina Cristiana Venter, Simona Daciana Birsan, Timea Claudia Ghitea, Rareș Cristian Daina, László Fehér, Cristian Marius Daina","doi":"10.3390/clinpract16080145","DOIUrl":"10.3390/clinpract16080145","url":null,"abstract":"<p><p><b>Background:</b> Glycemic dysregulation is frequent in critically ill patients and may influence prognosis regardless of pre-existing diabetes status. This study aimed to evaluate the impact of glycemic status and glycemic variability on mortality and morbidity in diabetic and non-diabetic patients admitted to the intensive care unit (ICU). <b>Methods:</b> This prospective observational study included 244 critically ill patients. Demographic, clinical, biological, and glycemic data were collected during ICU hospitalization. Glycemic parameters included admission glucose, mean glucose, glucose standard deviation, coefficient of glycemic variability, hyperglycemia > 140 mg/dL, hyperglycemia > 180 mg/dL, hypoglycemia < 70 mg/dL, and intravenous insulin requirement. The primary outcome was in-hospital mortality. <b>Results:</b> In-hospital mortality was 58.6%. Non-survivors had significantly higher admission glucose, mean glucose, glycemic standard deviation, and coefficient of glycemic variability compared with survivors. Hyperglycemia > 140 mg/dL, hyperglycemia > 180 mg/dL, poor glycemic control, and intravenous insulin therapy were significantly associated with mortality. Patients with high glycemic variability, defined as coefficient of variation (CV) > 36%, had higher mortality than those with lower variability. In multivariable analysis, mean glucose remained the most robust glycemic predictor associated with mortality, while glycemic variability retained prognostic relevance in alternative models. <b>Conclusions:</b> Glycemic dysregulation was common and clinically relevant in critically ill diabetic and non-diabetic patients. Dynamic glucose monitoring, including mean glucose and glycemic variability, may improve risk stratification and support structured ICU glycemic management.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13510816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833437","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":"Mediastinal Lymphangioma of the Adult: Case Report and Literature Review.","authors":"Mihaela-Beatrice Tivadar, Amir-Andrei Sabha, Vasile Grigorie, Raluca Bobocea, Andrei-Cristian Bobocea","doi":"10.3390/clinpract16080144","DOIUrl":"10.3390/clinpract16080144","url":null,"abstract":"<p><p><b>Introduction</b>: Mediastinal lymphangiomas are rare, benign vascular malformations of the lymphatic system that are seldom diagnosed in adults. Due to their varied clinical presentation and heterogeneous imaging characteristics, they pose a significant preoperative diagnostic challenge, frequently mimicking other mediastinal masses. <b>Materials and Methods</b>: We conducted a thorough search of the PubMed/MEDLINE, PubMed Central, and Google Scholar databases. We included articles from 2000 to 2026. Our search yielded 150 articles, out of which we selected 45 articles. Inclusion criteria were strictly limited to adult patients with a solitary mediastinal lymphangioma. Cases involving diffuse systemic lymphangiomatosis, mixed histological features such as lymphangiomyomas or hemangiolymphangioma or studies on pediatric populations were explicitly excluded from the analysis. We also reported a case of mediastinal lymphangioma in a 42-year-old patient, which was surgically resected at the \"Marius Nasta\" National Institute of Pneumology in Bucharest, Romania. <b>Case Description</b>: An asymptomatic 42-year-old male presenting with exertional chest discomfort following minor trauma demonstrated a lower left hemithorax opacity on chest X-ray. Imagistic studies revealed a 13 × 9 × 6 cm cystic mass in the left supradiaphragmatic costophrenic recess. The patient underwent a complete radical excision. The postoperative recovery was uneventful. Histopathology confirmed a benign cystic mediastinal lymphangioma. <b>Conclusions</b>: Adult mediastinal lymphangiomas are rare entities that require a high index of clinical suspicion. While advanced cross-sectional imaging is invaluable for delineating their characteristics, definitive diagnosis relies on histopathological confirmation. Complete surgical resection, increasingly performed via minimally invasive approaches or standard thoracotomy, remains the therapeutic gold standard, offering an excellent long-term prognosis with virtually no risk of recurrence. For inoperable cases, several non-surgical approaches are available.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13510631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833394","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}