Clinics and Practice最新文献

{"title":"Role of Cannabis in the Management of Chronic Non-Cancer Pain: A Narrative Review.","authors":"Lou'i Al-Husinat, Shrouq Obeidat, Saif Azzam, Yara Al-Gwairy, Fatima Obeidat, Sarah Al Sharie, Deema Haddad, Fadi Haddad, Martina Rekatsina, Matteo Luigi Giuseppe Leoni, Giustino Varrassi","doi":"10.3390/clinpract15010016","DOIUrl":"10.3390/clinpract15010016","url":null,"abstract":"<p><p>Chronic non-cancer pain, defined by the Center for Disease Control and Prevention (CDC) as lasting beyond three months, significantly affects individuals' quality of life and is often linked to various medical conditions or injuries. Its management is complex. Cannabis, containing the key compounds Delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), has garnered interest for its potential in pain management, though it remains controversial due to its psychoactive effects and illegal status in many countries. THC provides pain relief by blocking nociceptive stimuli but has psychoactive effects and may potentially induce dependency. CBD has calming and antipsychotic properties. The inhalation of cannabis offers quick relief but poses respiratory risks, while its oral administrations are safer but act more slowly. Short-term cannabis use can impair cognition and motor skills, while long-term use may lead to dependency and cognitive decline, especially if used from an early age. Adverse effects vary by gender and prior use, with addiction mainly linked to THC and influenced by genetics. Despite these risks, patients often report more benefits, such as improved quality of life and reduced opioid use, although the evidence remains inconclusive. The legal landscape for medical cannabis varies globally, with some positive public health outcomes like reduced opioid-related issues in areas where it is legalized. Cannabis shows promise in managing chronic pain, but its psychoactive effects and dependency risks necessitate cautious use. Future research should prioritize long-term clinical trials to establish optimal dosing, efficacy, and safety, aiding in the development of informed guidelines for safe cannabis use in chronic pain management. This review examines the use of cannabis in managing chronic non-cancer pain, focusing on its benefits, drawbacks, mechanisms, delivery methods, and impact on quality of life.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11764316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034477","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":"Impact of Comorbidities on Prognosis and Treatment Outcomes in Elderly Patients with Hodgkin Lymphoma.","authors":"Dávid Tóthfalusi, Boglárka Dobó, Fanni Borics, László Imre Pinczés, Árpád Illés, Zsófia Miltényi","doi":"10.3390/clinpract15010015","DOIUrl":"10.3390/clinpract15010015","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Hodgkin lymphoma (HL) primarily affects young adults, but about 20% of cases occur in patients over the age of 60 years. Older individuals often have comorbidities and poorer functional status, which can affect treatment choices. <b>Methods</b>: We retrospectively analyzed data from HL patients over 60 years old who were treated at our institution between January 2010 and December 2023. We examined various factors, such as blood parameters (e.g., platelet count, lactate dehydrogenase (LDH), C-reactive protein (CRP)), PET/CT results and comorbidities (e.g., hypertension, diabetes, cardiovascular diseases), to assess their impact on overall survival (OS) and progression-free survival (PFS). Diagnostic efficiency was determined via receiver operating characteristic analysis, while the survival outcomes were evaluated using the Cox proportional hazards model. <b>Results</b>: A total of 35 patients with a median age of 68 were treated. The most common subtype was nodular sclerosis, and 72% of patients were in advanced stages at diagnosis. Treatment varied by age, with younger patients receiving ABVD and older patients (80-89) receiving brentuximab vedotin with dacarbazine. The survival of older patients, when analyzed by age groups, did not show a significant difference in the OS (<i>p</i> = 0.16) and PFS (<i>p</i> = 0.11). Comorbidities significantly worsened survival, with patients who scored > 7 on the Charlson Comorbidity Index (CCI) showing a 5-year PFS of 41.3%, compared to 91.3% for those who scored ≤ 7. Among the tested laboratory parameters, a platelet count over 310.5 G/L and an absolute lymphocyte count below 0.47 G/L were found to be independent risk factors for OS. Patients with neither or only one of these risk factors demonstrated a 5-year OS of 81.7%, whereas those presenting with both risk factors experienced a reduced 5-year OS of 70%. For PFS, a white blood cell count > 8.48 G/L, a platelet count > 310.5 G/L, and advanced age (>73.5 years) were identified as significant adverse prognostic factors. Patients with none of these risk factors had a 5-year PFS of 100%, whereas those with ≥ 1 risk factor had a 5-year PFS of 35.6%. <b>Conclusions</b>: Comorbidities play a greater role in prognosis than chronological age, emphasizing the need for personalized treatment approaches.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034474","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":"Decoding Urinary Tract Infection Trends: A 5-Year Snapshot from Central Portugal.","authors":"Francisco Rodrigues, Patrícia Coelho, Sónia Mateus, Armando Caseiro, Hatem Eideh, Teresa Gonçalves, Miguel Castelo Branco","doi":"10.3390/clinpract15010014","DOIUrl":"10.3390/clinpract15010014","url":null,"abstract":"<p><strong>Introduction: </strong>This study analyzes urinary tract infections (UTIs) in a hospital in Central Portugal over a five-year period, focusing on bacterial prevalence, patient demographics, and antibiotic resistance patterns. This investigation aims to provide insights that can guide improved infection control and treatment strategies.</p><p><strong>Methods: </strong>A total of 6161 positive urine cultures collected over five years were examined, with particular emphasis on 2019 due to a peak in infection rates. The analysis explored bacterial prevalence, demographic factors such as sex and clinical service origin, and antibiotic resistance. Special attention was given to hospitalized patients, especially those undergoing invasive procedures, due to their increased vulnerability to infection.</p><p><strong>Results: </strong>This study found that UTIs were more prevalent in female patients, reflecting anatomical susceptibilities. Hospitalized individuals, particularly those requiring invasive procedures, were at greater risk. The predominant bacteria were <i>Escherichia coli</i>, <i>Klebsiella pneumoniae</i>, and <i>Enterococcus faecalis</i>, with differences in prevalence by patient sex and service origin. Resistance to Imipenem in <i>E. coli</i> increased, raising concerns about last-resort treatments. However, resistance to other antibiotics declined, suggesting improvements due to recent stewardship measures. During the COVID-19 pandemic, overall antibiotic consumption decreased due to changes in clinical practices.</p><p><strong>Conclusion: </strong>The findings highlight the importance of strict infection control, targeted prevention measures, and rational antibiotic use to combat resistance. Ongoing surveillance and personalized treatment approaches are essential to improve UTI management and outcomes.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034434","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":"Emergency Airway Management: A Systematic Review on the Effectiveness of Cognitive Aids in Improving Outcomes and Provider Performance.","authors":"Raisa Chowdhury, Ostap Orishchak, Marco A Mascarella, Bshair Aldriweesh, Mohammed K Alnoury, Guillaume Bousquet-Dion, Jeffrey Yeung, Lily Ha-Nam P Nguyen","doi":"10.3390/clinpract15010013","DOIUrl":"10.3390/clinpract15010013","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Emergency airway management is a critical skill for healthcare professionals, particularly in life-threatening situations like \"cannot intubate, cannot oxygenate\" (CICO) scenarios. Errors and delays in airway management can lead to adverse outcomes, including hypoxia and death. Cognitive aids, such as checklists and algorithms, have been proposed as tools to improve decision-making, procedural competency, and non-technical skills in these high-stakes environments. This systematic review aims to evaluate the effectiveness of cognitive aids in enhancing emergency airway management skills among health professionals and trainees. <b>Methods:</b> A systematic search of MEDLINE, Embase, CINAHL, Cochrane Library, Scopus, Web of Science, and ClinicalTrials.gov was conducted from February to March 2024. Studies examining the use of cognitive aids, such as the Vortex method, the ASA difficult airway algorithm, and visual airway aids, in emergency airway scenarios were included. Outcomes assessed included decision-making speed, procedural success rates, and non-technical skills. Data were extracted using standardized protocols, and the quality of included studies was appraised. <b>Results:</b> Five studies met inclusion criteria, encompassing randomized controlled trials, controlled studies, and mixed-methods research. Cognitive aids improved decision-making times (reduced by 44.6 s), increased procedural success rates, and enhanced non-technical skills such as teamwork and crisis management. Participants reported reduced anxiety and improved confidence levels (self-efficacy scores increased by 1.9 points). The Vortex method and visual cognitive aids demonstrated particular effectiveness in simulated scenarios. <b>Conclusions:</b> Cognitive aids significantly enhance emergency airway management skills, improving performance, reducing errors, and increasing provider confidence. Integrating cognitive aids into training programs has the potential to improve patient safety and outcomes. Further research is needed to validate these findings in clinical settings and optimize cognitive aid design and implementation.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11764273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034453","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":"Clinical Characteristics and Mortality-Associated Factors in Trauma Patients Undergoing Permanent Versus Temporary Tracheostomy.","authors":"Ahmad K Alnemare","doi":"10.3390/clinpract15010012","DOIUrl":"10.3390/clinpract15010012","url":null,"abstract":"<p><p><b>Objective:</b> This study evaluated the characteristics, outcomes, and mortality-associated factors in patients who underwent tracheostomy after traumatic injury to optimize clinical decision-making and patient care in critical trauma settings. <b>Materials and Methods:</b> A retrospective cohort analysis was conducted using the National Trauma Data Bank (NTDB) records from 2013 to 2016. This study included 41,630 adult trauma patients who underwent tracheostomy procedures. Data analysis included descriptive statistics, univariate comparisons, and multivariate logistic regression analyses. The study protocol adhered to STROBE guidelines for observational studies. <b>Results:</b> Analysis of the total cohort revealed that patients with tracheostomy demonstrated high rates of severe injuries (75.2%) and a notable comorbidity burden, including cardiovascular disorders (4.0%) and blood disorders (5.8%). Multivariate analysis revealed that mortality risk was independently associated with advanced age (OR 1.018, 95% CI 1.016-1.021), higher injury severity scores (OR 1.004, CI 1.002-1.007), female sex (OR 1.187, CI 1.078-1.308), and cardiovascular surgical intervention (OR 1.487, CI 1.350-1.638). Among the study population, 7.6% underwent permanent tracheostomy procedures, with these patients showing some distinct clinical characteristics in terms of injury severity and comorbidity profiles. <b>Conclusions:</b> This comprehensive analysis demonstrates the complex clinical characteristics and mortality-associated factors in trauma patients requiring tracheostomy. Key factors influencing survival outcomes include age, injury severity, sex, and cardiovascular surgical intervention. These findings provide valuable insights for clinical decision-making and risk assessment in trauma patients requiring tracheostomy. The observed differences between permanent and temporary tracheostomy patients warrant further investigation with more detailed timing and indication data.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034317","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":"Distribution of Major HLA-A, -B, -DR, and -DQ Loci Potentially Associated with Multiple Sclerosis in a Healthy Population from Southern Morocco.","authors":"Abir Fguirouche, Fatimazahra Ouahmani, Ikram Brahim, Raja Hazime, Nissrine Louhab, Najib Kissani, Mohamed Chraa, Brahim Admou","doi":"10.3390/clinpract15010010","DOIUrl":"10.3390/clinpract15010010","url":null,"abstract":"<p><p><b>Background:</b> Many factors contribute to the development and the progression of Multiple Sclerosis (MS), including Human Leukocyte Antigen (HLA) molecules. Some of them are considered as predisposing, like DRB1*15, DRB1*13, DRB1*03, DRB1*04, DQB1*06, DQB1*02, while HLA A2, HLA B44, DRB1*11, and DRB1*12 are rather considered as protective. Data about such associations in the Moroccan population remain unknown. The aim of this study was to determine the frequency of HLA class I (A and B) and II (DR and DQ) linked to Multiple Sclerosis (MS) in a healthy population from the South of Morocco. <b>Materials and Methods:</b> A cross-sectional study was carried out over the 2016-2023 period on 685 Moroccan healthy individuals, including 355 males and 330 females. Of the total sample tested, 685 underwent HLA class I typing, of which 305 also benefited from HLA class II typing. HLA class I typing was executed using the CDC (complement dependent cytotoxicity) technique (OneLambda™, Los Angeles CA, USA), and HLA class II typing was performed by either PCR-SSP (sequence-specific primer, OneLambda) or PCR-SSO (sequence-specific oligonucleotides) using the Luminex Xmap (Lifecodes, Immucor, Peachtree, Corners, GA, USA) system. <b>Results:</b> From different HLA molecules potentially predisposing to MS, our investigations showed that DRB1*03, DRB1*13, DRB1*15, DRB1*04, and DQB1*02 were observed in 19.2%, 15.8%, 13.31%, 12.7% and 31% respectively, while the frequency of those considered as protective, namely HLA-A2, HLA-B44, and HLA-DRB1*11 was 23.31%, 9.21% and 10.1% respectively. <b>Conclusions:</b> The findings of our study give evidence that among predisposing HLA class II molecules, DR allele groups were more prevalent, mostly DRB1*03, with also a high frequency of DQB1*06, while HLA-A2 marked the supposed protective specificities. These results need to be supported by complementary studies particularly in MS patients.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing International Guidelines for the Remission of Hypertension After Bariatric Surgery.","authors":"Carina Vieira Dias, Ana Lúcia Silva, Joana Dias, Paulo Cardoso, Rute Castanheira, Andreia Fernandes, Filipa Nunes, Tina Sanai, Mercedes Sanchez, João Maia-Teixeira, Ana Luísa De Sousa-Coelho","doi":"10.3390/clinpract15010011","DOIUrl":"10.3390/clinpract15010011","url":null,"abstract":"<p><strong>Background/objectives: </strong>Obesity remains a global health concern and is associated with increased risk of type 2 diabetes, hypertension, and cardiovascular disease overall. Dissimilar hypertension guidelines are available for clinicians, namely those prepared by the American Heart Association (AHA) and the European Society of Cardiology (ESC), which may lead to distinctive appreciation of health outcomes of patients with obesity after bariatric and metabolic surgery, such as hypertension remission. The main goal of this study was to compare the effects of applying stricter (AHA) versus looser (ESC) blood pressure criteria on hypertension diagnosis pre-bariatric surgery and remission assessment one year post-op.</p><p><strong>Methods: </strong>A retrospective analysis of clinical data from patients who underwent surgical treatment for obesity at a single university hospital was performed. To evaluate the hypertension improvement or remission, two different types of blood pressure (BP) categorization were considered (based on AHA and ESC guidelines), in which each patient would fit according to their BP values pre- (m0) and 12 months postoperative (m12).</p><p><strong>Results: </strong>From a sample of 153 patients submitted for surgical treatment of obesity, more patients were considered with hypertension based on the AHA guideline (130 vs. 102; <i>p</i> < 0.001), while a higher rate of hypertension remission at 12 months after bariatric surgery was observed when following the ESC guideline (58.82 vs. 53.08%). Baseline patients' clinical characteristics based on each hypertension outcome were mostly independent of the guideline used (<i>p</i> > 0.05), where only age and systolic blood pressure were relatively higher in \"ESC groups\".</p><p><strong>Conclusions: </strong>We conclude that only minor differences exist between the two guidelines used. If evaluated based on ESC guidelines, it is expected that less patients are considered with hypertension, and the remission rate may be, at least numerically, higher.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034329","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":"Guidelines for the Management of Complications of Diabetes in Saudi Arabia Using Delphi Technique for Consensus Among National Experts.","authors":"Raed Aldahash, Mohammed A Batais, Ashraf El-Metwally, Saja Alhosan, Mohammed Alharbi, Mohammed Almutairi, Abdulghani Alsaeed, Mohammed Alsofiani, Mohammed AlMehthel, Mohammed Aldubayee, Khaled Aldossari, Sulieman Alshehri","doi":"10.3390/clinpract15010009","DOIUrl":"10.3390/clinpract15010009","url":null,"abstract":"<p><p>(1) Background: Saudi Arabia has one of the leading cases of diabetes globally, with approximately 27.8% of adults suffering from the disease. Given the negative consequences of diabetes mellitus (DM), it is critical to develop guidelines for its management. (2) Methods: After a thorough review of the literature around diabetes management, a diverse panel of 14 clinical experts was identified to participate in the Delphi process. The Delphi process included three rounds to ensure all available evidence was accounted for. (3) Results: The Delphi method concluded with a total of 37 guidelines reviewed and approved by the panelists, followed by verification from a third party in Saudi Arabia. The Delphi and external evaluation confirmed that authentic, relevant, and applicable evidence for diabetes management in Saudi Arabia was accounted for. The process concluded with a list of 37 statements about the management of acute and chronic complications of diabetes in Saudi Arabia. (4) Conclusions: The preparation of contextual evidence for the management of diabetes in Saudi Arabia will be instrumental in addressing the burden of disease in the region. The guidelines offer useful insights into diabetes care, especially by prioritizing early detection and proactive management of complications. They highlight the importance of lifestyle changes and medical therapy. However, due to the ever-changing nature of diabetes, the document must be monitored and updated on a regular basis to ensure its continued relevance and effectiveness.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034545","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":"ChatGPT, Google, or PINK? Who Provides the Most Reliable Information on Side Effects of Systemic Therapy for Early Breast Cancer?","authors":"Stefan Lukac, Sebastian Griewing, Elena Leinert, Davut Dayan, Benedikt Heitmeir, Markus Wallwiener, Wolfgang Janni, Visnja Fink, Florian Ebner","doi":"10.3390/clinpract15010008","DOIUrl":"10.3390/clinpract15010008","url":null,"abstract":"<p><p><b>Introduction:</b> The survival in early breast cancer (BC) has been significantly improved thanks to numerous new drugs. Nevertheless, the information about the need for systemic therapy, especially chemotherapy, represents an additional stress factor for patients. A common coping strategy is searching for further information, traditionally via search engines or websites, but artificial intelligence (AI) is also increasingly being used. Who provides the most reliable information is now unclear. <b>Material and Methods</b>: AI in the form of ChatGPT 3.5 and 4.0, Google, and the website of PINK, a provider of a prescription-based mobile health app for patients with BC, were compared to determine the validity of the statements on the five most common side effects of nineteen approved drugs and one drug with pending approval (Ribociclib) for the systemic treatment of BC. For this purpose, the drugs were divided into three groups: chemotherapy, targeted therapy, and endocrine therapy. The reference for the comparison was the prescribing information of the respective drug. A congruence score was calculated for the information on side effects: correct information (2 points), generally appropriate information (1 point), and otherwise no point. The information sources were then compared using a Friedmann test and a Bonferroni-corrected post-hoc test. <b>Results:</b> In the overall comparison, ChatGPT 3.5 received the best score with a congruence of 67.5%, followed by ChatGPT 4.0 with 67.0%, PINK with 59.5%, and with Google 40.0% (<i>p</i> < 0.001). There were also significant differences when comparing the individual subcategories, with the best congruence achieved by PINK (73.3%, <i>p</i> = 0.059) in the chemotherapy category, ChatGPT 4.0 (77.5%; <i>p</i> < 0.001) in the targeted therapy category, and ChatGPT 3.5 (<i>p</i> = 0.002) in the endocrine therapy category. <b>Conclusions:</b> Artificial intelligence and professional online information websites provide the most reliable information on the possible side effects of the systemic treatment of early breast cancer, but congruence with prescribing information is limited. The medical consultation should still be considered the best source of information.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11764162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034534","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":"Pedicled Radial Forearm \"Free\" Flap for Intraoral Reconstruction Based on an Unexpectedly High Origin of the Radial Artery-Case Report.","authors":"Marino Lupi-Ferandin, Dinko Martinovic, Ante Pojatina, Ante Mihovilovic, Ema Puizina, Sasa Ercegovic, Ivana Stula, Josko Bozic, Slaven Lupi-Ferandin","doi":"10.3390/clinpract15010006","DOIUrl":"10.3390/clinpract15010006","url":null,"abstract":"<p><p><b>Background:</b> Radial forearm free flap (RFFF) is considered one of the workhorses in modern head and neck reconstruction surgery due to its technical simplicity, versatility and less time-consuming harvest. <b>Methods:</b> In this report, we present the case of a 56-year-old woman with sublingual squamous cell carcinoma (SCC) who underwent surgical resection and reconstruction of the defect with a RFFF. <b>Results:</b> The preoperative Allen test showed normal blood flow, and the ultrasound did not recognize any blood vessel abnormalities in the left arm. However, during the RFFF harvest, when the dissection of the pedicle came to the cubital fossa, there was no brachial artery bifurcation. While trying to find the bifurcation, the dissection almost came to the axillary region. Hence, the RFFF was converted to a pedicle flap and was pulled through to the intraoral defect where it was used for reconstruction. <b>Conclusions:</b> Hence, during the preoperative radiological ultrasound, besides the usual characteristics such as the radial artery diameter, flow and possible obstructions, it is also important to explore if there are any other anatomical abnormalities that could influence the operation.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11764455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033008","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}