Clinics and Practice最新文献

{"title":"An Unusual Cause of Inguinal Mass in a Patient with Urolithiasis: A Case Report of Deep (Aggressive) Angiomyxoma in a Male Patient.","authors":"Christodoulos Chatzigrigoriadis, Vasileios Tatanis, Theodoros Spinos, Angelis Peteinaris, Angelos Samaras, Anastasios Thanos, Evangelos Liatsikos, Panagiotis Kallidonis","doi":"10.3390/clinpract14060213","DOIUrl":"10.3390/clinpract14060213","url":null,"abstract":"<p><p><b>Background:</b> Deep or aggressive angiomyxoma is an uncommon neoplasm of the pelvis. Although deep angiomyxoma is a benign tumor, its tendency to infiltrate soft tissues and reach a large size (typically > 10 cm) indicates aggressive biological behavior. It is usually present in female patients, but there have been recent reports of male-aggressive angiomyxoma. While rare, it is an important consideration in patients with a pelvic mass. The clinical presentation is non-specific; patients are either asymptomatic or present with non-specific complaints, such as dull pain, constipation, and dysuria. It is commonly mistaken for an inguinal hernia, hydrocele, testicular cancer, lipoma, and epididymal cyst in male patients, thus misguiding the management of these cases. Hence, preoperative evaluation with imaging studies (ultrasound, computed tomography, magnetic resonance imaging) and biopsy allows for an accurate diagnosis and treatment. Currently, the standard of treatment is surgical resection of the tumor with free margins. The role of hormone therapy is under investigation for patients with deep angiomyxoma positive for estrogen/progesterone receptors. Regular follow-up is necessary given the high recurrence rate of deep angiomyxoma (9-72%). <b>Methods:</b> We present a case of an elderly man who presented with hematuria due to urolithiasis and an asymptomatic inguinal mass mimicking an inguinal hernia. A computed scan (CT) of the abdomen confirmed the presence of the mass, which was removed surgically. <b>Results:</b> The pathologic examination of the tumor was consistent with deep angiomyxoma. <b>Conclusions:</b> The diagnosis of deep angiomyxoma should always be considered in patients with an inguinal mass to avoid delayed treatment and incomplete surgical excision.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 6","pages":"2705-2712"},"PeriodicalIF":1.7,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11674831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898911","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":"Methodology for a Series of Rapid Reviews on Virtual Care in Rehabilitation, Reviewing Its Advantages and Challenges to Inform Best Practices.","authors":"Jennifer Sigouin, Anne Hudon, Mirella Veras, Simon Beaulieu-Bonneau, Sabrina Cavallo, Dahlia Kairy","doi":"10.3390/clinpract14060214","DOIUrl":"10.3390/clinpract14060214","url":null,"abstract":"<p><p><b>Background/Objective</b>: Over the past two decades, the utilization of virtual care in rehabilitation has witnessed a significant surge; this is owing to the widespread availability of technological tools and the global impact of the COVID-19 pandemic. As a result, discussions surrounding the relevance and benefits of telerehabilitation have gained prominence among practitioners, who continually seek to enhance patient care while maintaining high standards of quality. Associated with these discussions are concerns over being able to provide care in an ethical way, as well as addressing equity issues that might be hindered or improved via telerehabilitation. To address the ethical and equity concerns around telerehabilitation, a series of five parallel rapid reviews of the scientific literature were conducted, focusing on different rehabilitation fields: physiotherapy and occupational therapy (1); speech therapy and audiology (2); psychology and neuropsychology (3); and in two age groups: older adults (4); and pediatrics and young adults (5). The objective of this series of rapid reviews is to evaluate the evidence presented regarding telerehabilitation; identifying and recommending best practices especially in the realm of ethics and equity. <b>Methods:</b> Medline; CINAHL; and EMBASE were searched between 2010 and 2023 for English or French-language reviews (2010-2020) and individual studies (2020-2023) pertaining to telerehabilitation and these fields of interest. Data were extracted following a standardized form focusing on: outcomes; findings; quality assessment/biases; limitations; and discussion of ethical and equity concerns. <b>Results:</b> The results are presented according to the most relevant themes, which include: findings; strengths; limitations; and ethical/equity considerations. <b>Conclusions:</b> This research presents a methodology rarely published before, on how to conduct multiple parallel rapid reviews on the theme of telerehabilitation, based on different rehabilitation fields and age groups. This research will shape future guidelines and standards in applying ethical and equity standards in telerehabilitation.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 6","pages":"2713-2724"},"PeriodicalIF":1.7,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11674943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Awareness Levels of Diabetic Ketoacidosis Risk Among Patients with Diabetes: A Cross-Sectional Study.","authors":"Elhassan Hussein Eltom, Abdulrahman Omar A Alali, Rakan Khalid Marzouq Alanazi, Ali Ahmad M Alanazi, Meshal Ahmed Abdullah Albalawi, Saud Alraydh N Alanazi, Mansour Sarhan G Alanazi, Abdelnaser A Badawy, Naglaa Mokhtar, Manal S Fawzy","doi":"10.3390/clinpract14060211","DOIUrl":"10.3390/clinpract14060211","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Diabetic ketoacidosis (DKA) is a critical complication of diabetes mellitus, posing significant health. While global studies have indicated a concerning lack of awareness regarding DKA among patients with diabetes, research specific to the northern area of Saudi Arabia remains limited. This study aims to explore the level of knowledge and awareness of DKA among patients with diabetes residing in the local region. <b>Methods</b>: A cross-sectional analysis was conducted utilizing a non-probability convenient sampling technique, with 339 participants recruited from March to August 2024. Data were gathered through a self-administered pre-validated questionnaire distributed via different social media platforms to assess demographic characteristics and awareness levels relating to DKA, including knowledge of its symptoms, causes, and treatment options. <b>Results</b>: Although there was moderate awareness of DKA, with 68.4% having heard of the condition, two-thirds of the participants exhibited significant gaps in overall knowledge. Among those aware, 76.3% recognized DKA as an emergency requiring immediate medical intervention. At the same time, 64.6% understood the causes of DKA, and only 25.6% identified insulin deficiency as a major contributing factor. Although 62.5% felt knowledgeable about treatment, 66.0% incorrectly identified oral sugar as a DKA treatment. Notably, 30.1% cited social media as their main information source. Age emerged as an essential factor impacting knowledge, with younger participants (ages 18-30) demonstrating higher awareness than older individuals. Additionally, single participants displayed a higher percentage of good knowledge than married participants (<i>p</i> = 0.000). Non-working individuals showed better overall knowledge about DKA (<i>p</i> = 0.002). The duration of diabetes did not show a significant association with knowledge levels about DKA across the various duration categories. <b>Conclusions</b>: The present findings underscore a substantial knowledge gap concerning DKA among the local community, highlighting a critical need for targeted public health educational interventions.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 6","pages":"2681-2692"},"PeriodicalIF":1.7,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11674616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899145","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":"Developmental Psychology and Healthcare Professions: Autism Knowledge Among Nurses: An Observational Study.","authors":"Rosaria Ferrara, Giuseppe Campagna, Pasquale Ricci, Felice Damato, Lidia Ricci, Leonardo Iovino, Flavio Marti, Roberto Latina, Roberta Simeoli","doi":"10.3390/clinpract14060212","DOIUrl":"10.3390/clinpract14060212","url":null,"abstract":"<p><p><b>Background:</b> One of the biggest limitations faced by autistic people is the lack of knowledge of their condition. Our study aims to evaluate and discuss the knowledge of autism among nurses, which is a social and health category often in close contact with autistic people. <b>Objective:</b> Given the limited exploration of awareness levels about autism among healthcare professionals, this study aims to investigate general and specific knowledge of autism within a group of nursing students enrolled in a master's degree. <b>Methods:</b> A total of 66 nurses completed the questionnaire. Descriptive analyses were conducted on the results for the four subcomponents of the questionnaire: (i) general knowledge, (ii) symptomatology, (iii) screening and diagnosis, and (iv) intervention and treatment. A correlation analysis was performed between the participants' demographic variables and questionnaire scores. Additionally, a multivariable logistic regression was conducted to analyze the association between the participants' basic demographic characteristics and questionnaire scores. <b>Results:</b> Results showed a good percentage of correct answers in the \"general knowledge\" category. Furthermore, a good level of knowledge regarding the fact that ASD is a developmental disorder and a congenital disease also emerged. <b>Conclusions:</b> Regarding the knowledge of typical autism symptoms, participants answered most of the questions correctly. Correct answers decreased for questions related to screening and diagnosis. In particular, participants had limited knowledge of the DSM-5 and the timing of ASD diagnosis. Similar levels of knowledge were observed for the fourth category, \"intervention and treatment\".</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 6","pages":"2693-2704"},"PeriodicalIF":1.7,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11675031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899054","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":"Metabolic Syndrome as a Risk Factor Among Lebanese Patients with Substance Use Disorder Undergoing Treatment for Recovery Through Rehabilitation or Opioid Substitution Treatment.","authors":"Nadine Mahboub, Elissa Ayoub, Carine Mounzer, Tatiana Kate Baltagi, Dimitrios Papandreou, Nanne de Vries, Rana Rizk","doi":"10.3390/clinpract14060210","DOIUrl":"10.3390/clinpract14060210","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Data about metabolic syndrome (MS) in people who use drugs (PWUD) undergoing treatment for recovery are limited. We aimed to explore the extent of the MS and its predominant components and determinants in a sample of PWUD undergoing treatment for recovery through rehabilitation or opioid substitution treatment (OST) in Lebanon. Furthermore, we investigated the effect of each treatment modality on the MS; <b>Methods:</b> This was a cross-sectional study, in which demographics and treatment-related, nutritional, and biochemical data of the participants were collected. MS was defined according to the American Heart Association and the National Heart, Lung, and Blood Institute (AHA/NHLBI) criteria. Descriptive statistics were presented, and bivariate and multivariate analyses were conducted; <b>Results:</b> A total of 155 male subjects with the following characteristics were included: OST: n = 80; rehabilitation: n = 75; mean age: 32.53 ± 8.39 years; mean body mass index (BMI): 27.41 ± 4.99 Kg/m²; mean duration of treatment: 18 months. More than half of the sample had low HDL-C (56.8%) and/or elevated blood pressure (51.6%), 42.9% had elevated WC, 21.9% had elevated TG, and 12.3% had elevated FBS. Furthermore, 7.2% of the sample had no components of the MS, 29.2% had one component, 40.9% had two components, 16.9% had three components, and 5.8% had four components. MS was identified in 22.7% of the sample. Higher age was associated with higher odds of being diagnosed with MS (OR = 1.072; 95% CI: 1.021-1.126), whereas higher duration of current treatment was associated with lower odds (OR = 0.969; 95% CI: 0.944-0.995); <b>Conclusions:</b> MS and its components are prevalent in PWUD undergoing treatment for recovery. Routine screening and preventive measures are essential to prevent metabolic syndrome, particularly among older people and treatment newcomers.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 6","pages":"2661-2680"},"PeriodicalIF":1.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11674342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899166","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":"Relationship Between Sleep Disturbances and Chronic Pain: A Narrative Review.","authors":"Sejal V Jain, Geoffrey D Panjeton, Yuri Chaves Martins","doi":"10.3390/clinpract14060209","DOIUrl":"10.3390/clinpract14060209","url":null,"abstract":"<p><p>Sleep disturbances and chronic pain are prevalent and interrelated conditions that have significant impact on individuals' quality of life. Understanding the intricate dynamics between sleep and pain is crucial for developing effective treatments that enhance the well-being of affected individuals and reduce the economic burden of these debilitating conditions. This narrative review examines the complex relationship between sleep disturbances and chronic pain. We describe the prevalence and types of sleep disturbances and sleep disorders in chronic pain patients. Posteriorly, we critically review the clinical and experimental evidence, investigating the relationship between sleep disturbances and chronic pain, aiming to clarify the impact of chronic pain on sleep and, conversely, the impact of sleep disturbances on pain perception. In conclusion, the literature largely agrees on the existence of a bidirectional relationship between chronic pain and sleep disturbances, though the strength of each direction in this association remains uncertain. Current evidence suggests that sleep impairment more strongly predicts pain than pain does sleep impairment. Additionally, addressing sleep disturbances in chronic pain patients is crucial, as poor sleep has been linked to higher levels of disability, depression, and pain-related catastrophizing.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 6","pages":"2650-2660"},"PeriodicalIF":1.7,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11674215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899217","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":"Body Composition Changes and Factors Influencing the Total Weight Loss Rate After Laparoscopic Sleeve Gastrectomy.","authors":"Hironobu Nakaguchi, Bunzo Matsuura, Teruki Miyake, Hidenori Senba, Shinya Furukawa, Motohira Yoshida, Shigehiro Koga, Yuji Watanabe, Taro Oshikiri, Kumiko Toshimitsu, Yoichi Hiasa","doi":"10.3390/clinpract14060206","DOIUrl":"10.3390/clinpract14060206","url":null,"abstract":"<p><p><b>Objectives:</b> While the effectiveness of metabolic/bariatric surgery has been confirmed, understanding the factors associated with weight loss is paramount for providing guidance in postoperative treatment strategies. Here, we aimed to examine the factors associated with long-term maintenance of weight loss after laparoscopic sleeve gastrectomy (LSG). <b>Methods:</b> This prospective observational cohort included patients who underwent LSG at a single academic health center between January 2017 and June 2022. We examined their body composition using InBody 720 or 770 and analyzed the factors associated with the percentage of total weight loss (%TWL) for 24 months. <b>Results:</b> The median body mass index (BMI) was 38.8 (interquartile range [IQR]: 35.6-46.7) preoperatively, 32.7 kg/m² (IQR: 28.2-38.7) at 12 months postoperatively, and 33.9 kg/m² (IQR: 29.1-40.1) at 24 months postoperatively. The lowest BMI was observed at 12 months (<i>p</i> < 0.001 vs. preoperative), followed by a significant increase at 24 months (<i>p</i> = 0.003). However, BMI remained significantly lower at 24 months than preoperatively (<i>p</i> < 0.001). The skeletal muscle mass to fat mass ratio (SMM/FM) was 0.59 (IQR: 0.50-0.71) preoperatively, 0.79 (IQR: 0.58-1.26) at 12 months, and 0.70 (IQR: 0.54-1.05) at 24 months, peaking at 12 months (<i>p</i> < 0.001 vs. preoperative) and decreasing significantly by 24 months (<i>p</i> < 0.001). Nevertheless, the SMM/FM ratio at 24 months remained higher than preoperative values (<i>p</i> < 0.001). Median body weight and %TWL were 86.0 kg and 15.6%, respectively, at 24 months after LSG. The SMM/FM ratio at 12 months was positively correlated with %TWL at 24 months after adjusting for age and sex. <b>Conclusions:</b> The effects of LSG persisted for up to 24 months postoperatively. The SMM/FM ratio 12 months after LSG was associated with the rate of weight loss at 24 months.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 6","pages":"2608-2622"},"PeriodicalIF":1.7,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11674615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899131","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":"Effect of Self-Measuring Blood Pressure Program on Hypertension Control: Analysis by Diabetes Status, Age, Gender, and Race in Rural Arizona.","authors":"Joy Luzingu, Aminata Kilungo, Randall Flores, Zoe Baccam, Tenneh Turner-Warren, Thelma Reis, Babasola Okusanya, John Ehiri","doi":"10.3390/clinpract14060208","DOIUrl":"10.3390/clinpract14060208","url":null,"abstract":"<p><strong>Background: </strong>Rural areas face numerous health challenges, including workforce shortages, limited training opportunities, and delayed care. These disparities can be mitigated by self-management interventions for diseases such as hypertension. This study assessed the implementation of a Self-Measuring Blood Pressure (SMBP) program in rural Arizona, documenting its barriers and patient experiences.</p><p><strong>Methods: </strong>In this before-after study, participants were loaned a digital device which they used to self-measure and record blood pressure (BP) over 1 week or more for hypertension diagnosis or 4 weeks or more for monitoring. Blood pressure (BP) control was assessed per the guidelines of the American Heart Association and American Diabetes Association. BP changes between baseline and post-program were assessed using paired-Student t tests. Effect modification by diabetes was analyzed using stratification.</p><p><strong>Results: </strong>Among 740 participants, significant associations were found with gender, age, and controlled BP among non-diabetic patients. Post-intervention, 63.4% of diabetic patients showed controlled BP, and 25.7% of non-diabetic patients had controlled BP, with higher control rates among females and older age groups (60-79 years). Baseline mean SBP was 148.3 ± 19.6 mmHg, improving to 133.9 ± 14.6 mmHg; baseline DBP was 88.5 ± 33.6 mmHg, improving to 83.4 ± 9.6 mmHg.</p><p><strong>Conclusions: </strong>The SMBP program effectively controlled BP, highlighting the value of combining clinical care with telemonitoring.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 6","pages":"2637-2649"},"PeriodicalIF":1.7,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11674944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899059","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":"Artificial Intelligence and Modern Technology in Dentistry: Attitudes, Knowledge, Use, and Barriers Among Dentists in Croatia-A Survey-Based Study.","authors":"Ana Ivanišević, Antonija Tadin","doi":"10.3390/clinpract14060207","DOIUrl":"10.3390/clinpract14060207","url":null,"abstract":"<p><strong>Aim: </strong>This study aims to assess Croatian dentists' knowledge, attitudes, and use of artificial intelligence (AI) and modern technology, while also identifying perceived barriers to AI and modern technology adoption and evaluating the need for further education and training.</p><p><strong>Materials and methods: </strong>A cross-sectional survey was conducted in February 2024 among general dentists in Croatia using a self-structured questionnaire. A total of 200 respondents filled out the questionnaire. It included five sections: socio-demographic and professional information, self-assessment of AI and modern technology use, knowledge of AI in dentistry, current innovations and devices used in practice, and barriers to AI and modern technology integration in practice. Data were analyzed using descriptive statistics and a regression analysis to explore relationships between socio-demographic factors and AI knowledge.</p><p><strong>Results: </strong>The mean knowledge of AI systems was 3.62 ± 2.56 out of a possible score of 7, indicating relatively poor knowledge, with 47.5% demonstrating knowledge below the median. Most respondents (76.0%) did not use AI systems and modern technology in practice; however, prosthodontics (13.0%) and oral surgery (10.0%) were identified as the primary fields utilizing these technologies. Respondents rated their knowledge of modern technologies and AI as weak or moderate, with 60.5% engaged in continuous education. Despite 76.0% not using AI daily, 71.0% believed that these technologies could enhance patient care. Participants interested in further training showed significantly better knowledge of AI applications (<i>p</i> = 0.030). Major barriers included acquisition and maintenance costs (59.0%) and financial constraints (58.0%).</p><p><strong>Conclusions: </strong>The study revealed that most respondents had poor knowledge of AI systems. Despite this, there is a recognition of AI's and modern technology potential in dentistry, emphasizing the need for enhanced education and training in this field.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 6","pages":"2623-2636"},"PeriodicalIF":1.7,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11674914/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899122","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":"The Use of Acetazolamide to Prevent Acute Kidney Injury in Patients with Cancer on High-Dose Methotrexate Treatment: A Retrospective Pilot Analysis.","authors":"Lindon Lin, Tracey Batt, Gregory M Peterson","doi":"10.3390/clinpract14060205","DOIUrl":"10.3390/clinpract14060205","url":null,"abstract":"<p><p><b>Background:</b> High-dose methotrexate (HDMTX) chemotherapy is associated with a significant risk of acute kidney injury (AKI). Acetazolamide is thought to increase methotrexate solubility via urinary alkalinisation, potentially reducing the risk of crystalline nephropathy. A tertiary hospital has included acetazolamide in its HDMTX protocols, although data on the risks and benefits are limited. This study evaluated the role of acetazolamide in managing patients receiving HDMTX and identified risk factors for AKI. <b>Methods:</b> The retrospective cohort pilot study included consecutive hospital patients who received HDMTX (≥500 mg/m²). Data collected from digital medical records included demographics, comorbidities, methotrexate dosages and serum concentrations, and pathology results. The development of AKI was defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Relationships between variables and AKI were initially assessed using Mann-Whitney U-tests and chi-square tests, and significant variables were further analysed using logistic regression to identify independent predictors of AKI. <b>Results:</b> Among 66 HDMTX treatment cycles in 31 patients, AKI occurred in 0/7 cycles with acetazolamide versus 14/59 cycles without (<i>p</i> = 0.33). Increasing age, the presence of hypertension, and concurrent use of beta-lactam antibiotics were associated with the development of AKI. Age was identified as the strongest independent risk factor for AKI (odds ratio 1.12, <i>p</i> = 0.034). <b>Conclusions:</b> Optimising management protocols, especially for older patients, is essential to reduce AKI risk during HDMTX therapy. While acetazolamide did not appear to reduce the risk of AKI, this pilot study was limited by a small sample size. Large randomised controlled trials are needed to assess efficacy and patient outcomes.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"14 6","pages":"2601-2607"},"PeriodicalIF":1.7,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11674466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899227","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}