Journal Description
Journal of Clinical Medicine
Journal of Clinical Medicine
is an international, peer-reviewed, open access journal of clinical medicine, published semimonthly online by MDPI. The International Bone Research Association (IBRA), Italian Resuscitation Council (IRC), Spanish Society of Hematology and Hemotherapy (SEHH), Japan Association for Clinical Engineers (JACE), European Independent Foundation in Angiology/ Vascular Medicine (VAS) and others are all affiliated with JCM, and their members receive a discount on article processing charges.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within Scopus, SCIE (Web of Science), PubMed, PMC, Embase, CAPlus / SciFinder, and other databases.
- Journal Rank: JCR - Q1 (Medicine, General and Internal) / CiteScore - Q1 (General Medicine)
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 17.9 days after submission; acceptance to publication is undertaken in 2.6 days (median values for papers published in this journal in the second half of 2023).
- Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
- Companion journals for JCM include: Epidemiologia, Transplantology, Uro, Sinusitis, Rheumato, Journal of Clinical & Translational Ophthalmology, Journal of Vascular Diseases, Osteology, Complications, Therapeutics, and Sclerosis.
Impact Factor:
3.0 (2023);
5-Year Impact Factor:
3.4 (2023)
Latest Articles
The Rendezvous Technique: A Minimally Invasive Non-Surgical Approach for the Management of Iatrogenic Ureteral Injuries
J. Clin. Med. 2024, 13(13), 3820; https://doi.org/10.3390/jcm13133820 (registering DOI) - 28 Jun 2024
Abstract
Background/Objectives: The aim of our study is to evaluate the feasibility and efficacy of the rendezvous technique for the treatment of iatrogenic ureteral injuries. Methods: From 2014 to 2019, 29 patients treated with the rendezvous technique for mono- or bilateral iatrogenic
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Background/Objectives: The aim of our study is to evaluate the feasibility and efficacy of the rendezvous technique for the treatment of iatrogenic ureteral injuries. Methods: From 2014 to 2019, 29 patients treated with the rendezvous technique for mono- or bilateral iatrogenic ureteral injuries were enrolled in this retrospective study. All the leaks were previously assessed by CT-urography and antegrade pyelography. Ureteral continuity was restored by performing the rendezvous technique, combining antegrade trans-nephrostomic access and a retrograde trans-cystostomic approach. A double J stent was antegradely inserted, and a nephrostomy tube was kept in place at the end of the procedure. A post-procedure CT-urography and a 30-day nephrostogram follow-up were performed. In the absence of a contrast leak, the nephrostomy tube was removed. Patient follow-up was set with CT-urography at 3, 6, and 12 months and stent substitution every 4 months. The CT-urography was performed to confirm the restored integrity of the ureter before stent removal. Results: The rendezvous technique was successful in all cases with the resolution of the ureteral leak. No major complications were observed. In all the patients, the nephrostomy tube was removed after 30 days. After performing CT-urography, the stent was removed permanently after 12 months. Only three cases showed local post-treatment stenosis treated with surgical ureteral reimplantation. Conclusions: The rendezvous technique is a safe and effective minimally invasive procedure that can be used to restore the continuity of the ureter, avoiding open surgery and providing valuable support for the management of complications after gynecological surgery.
Full article
(This article belongs to the Special Issue Gynecological Surgery: New Clinical Insights and Challenges)
Open AccessArticle
The Usefulness of Outpatient Cardiac Telemetry in Patients with Cryptogenic Stroke
by
Anetta Lasek-Bal, Adam Konka, Przemysław Puz, Joanna Boidol, Katarzyna Kosarz-Lanczek, Agnieszka Puz, Anna Wagner-Kusz, Andrzej Tomasik and Sebastian Student
J. Clin. Med. 2024, 13(13), 3819; https://doi.org/10.3390/jcm13133819 (registering DOI) - 28 Jun 2024
Abstract
Introduction: Atrial fibrillation (AF), apart from non-stenotic supracardiac atherosclerosis and neoplastic disease, is the leading cause of cryptogenic stroke, including embolic stroke of un-determined source (ESUS). The aim of our study was to determine the prevalence of AF in ESUS patients based
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Introduction: Atrial fibrillation (AF), apart from non-stenotic supracardiac atherosclerosis and neoplastic disease, is the leading cause of cryptogenic stroke, including embolic stroke of un-determined source (ESUS). The aim of our study was to determine the prevalence of AF in ESUS patients based on 30-day telemetric heart rate monitoring initiated within three months after stroke onset. Another aim was to identify factors that increase the likelihood of detecting subsequent AF among ESUS patients. Material and Methods: patients with first-ever stroke classified as per the ESUS definition were eligible for this study. All patients underwent outpatient 30-day telemetric heart rate monitoring. Results: In the period between 2020 and 2022, 145 patients were included. The mean age of all qualified patients was 54; 40% of eligible patients were female. Six patients (4.14%), mostly male patients (4 vs. 2), were diagnosed with AF within the study period. In each case, the diagnosis related to a patient whose stroke occurred in the course of large vessel occlusion. Episodes of AF were detected between day 1 and 25 after starting ECG monitoring. Out of the analyzed parameters that increase the probability of, A.F.; only supraventricular extrasystoles proved to be an independent factor regarding an increased risk of AF [OR 1.046, CI 95% 1.016–1.071, p-value < 0.01]. Conclusions: The use of telemetry heart rhythm monitoring in an outpatient setting can detect AF in 4% of ESUS patients who have undergone prior diagnostic procedures for cardiogenic embolism. Supraventricular extrasystoles significantly increases the likelihood of AF detection in patients with ESUS within three months following stroke. Comorbid coronary artery disease, diabetes and hypertension, rather than a single-factor clinical burden, increase the likelihood of AF detection in older ESUS patients. ESUS in the course of large vessel occlusion is probably associated with an increased likelihood of cardiogenic embolism.
Full article
(This article belongs to the Special Issue Acute Ischemic Stroke: Current Status and Future Challenges)
Open AccessArticle
Impact of Upadacitinib on Atopic Keratoconjunctivitis Exacerbated by Dupilumab Treatment in Atopic Dermatitis Patients: A Prospective Dermatological and Ophthalmological Clinical Evaluation in Common Clinical Practice
by
Claudia Paganini, Sara Spelta, Lorenzo Tofani, Marina Talamonti, Luca Bianchi, Marco Coassin, Antonio Di Zazzo and Marco Galluzzo
J. Clin. Med. 2024, 13(13), 3818; https://doi.org/10.3390/jcm13133818 (registering DOI) - 28 Jun 2024
Abstract
Introduction: Atopic dermatitis (AD) is a prevalent chronic inflammatory skin condition with a substantial impact on patients, particularly due to ocular involvement known as atopic keratoconjunctivitis (AKC). Current therapeutic approaches, such as dupilumab, often lead to conjunctivitis, prompting exploration of alternative treatments like
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Introduction: Atopic dermatitis (AD) is a prevalent chronic inflammatory skin condition with a substantial impact on patients, particularly due to ocular involvement known as atopic keratoconjunctivitis (AKC). Current therapeutic approaches, such as dupilumab, often lead to conjunctivitis, prompting exploration of alternative treatments like upadacitinib. Methods: We collected dermatological and ophthalmological prospective clinical evaluations of six adults with moderate-to-severe AD, undergoing treatment with upadacitinib after discontinuation of dupilumab due to the onset of AKC during therapy and the worsening of dermatitis in particular in the head and neck region. Clinical evaluations, including EASI scores, itch and sleep NRS, DLQI, and ocular parameters, were performed at baseline (during screening assessment before switching to upadacitinib) and then at week 12 and week 24. Clinical evaluation of AKC was performed by a team of ophthalmologists. Results: Upadacitinib not only improved atopic dermatitis in terms of EASI, itching, and sleep NRS, but also demonstrated a notable reduction in ocular signs and symptoms, as indicated by the Visual Analogue Scale (VAS), the Efron scale, and the Ocular Surface Disease Index Symptom Severity (OSDISS) scores. Discussion: Our observation of common clinical practice underscores the substantial impact of biological and small-molecule therapies on AD, emphasizing the limitation posed by dupilumab-associated conjunctivitis. Switching to upadacitinib significantly improved both clinical and functional ocular outcomes, suggesting its potential as an alternative therapeutic option for AD patients with ocular involvement. Conclusion: The presented data provides insights into the complex interplay between systemic therapies and ocular manifestations in AD. Upadacitinib emerges as a promising option to address dupilumab-associated conjunctivitis, offering improved quality of life for patients.
Full article
(This article belongs to the Special Issue Recent Advances in Inflammatory and Infectious Skin Diseases)
Open AccessArticle
Respiratory Symptoms and Changes of Oxidative Stress Markers among Motorbike Drivers Chronically Exposed to Fine and Ultrafine Air Particles: A Case Study of Douala and Dschang, Cameroon
by
Joseph Eloge Tiekwe, Nadine Ongbayokolak, Solange Dabou, Cerge Kamhoua Natheu, Marie Stéphanie Goka, Prosper Cabral Nya Biapa, Isabella Annesi-Maesano and Phélix Bruno Telefo
J. Clin. Med. 2024, 13(13), 3816; https://doi.org/10.3390/jcm13133816 (registering DOI) - 28 Jun 2024
Abstract
Recent studies revealed that the high production of reactive oxidative species due to exposure to fine or ultrafine particles are involved in many chronic respiratory disorders. However, the poor standard of clinical data in sub-Saharan countries makes the assessment of our knowledge on
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Recent studies revealed that the high production of reactive oxidative species due to exposure to fine or ultrafine particles are involved in many chronic respiratory disorders. However, the poor standard of clinical data in sub-Saharan countries makes the assessment of our knowledge on the health impacts of air pollution in urban cities very difficult. Objective: The aim of this study was to evaluate the distribution of respiratory disorders associated with exposure to fine and ultrafine air particles through the changes of some oxidative stress biomarkers among motorbike drivers from two cities of Cameroon. Methods: A cross-sectional survey using a standardized questionnaire was conducted in 2019 on 191 motorcycle drivers (MDs) working in Douala and Dschang. Then, the activities of superoxide dismutase (SOD) and the level of malondialdehyde (MDA) were measured using colorimetric methods. The data of participants, after being clustered in Microsoft Excel, were analyzed and statistically compared using SPSS 20 software. Results: The motorbike drivers recruited from both cities were from 21 to 40 years old, with a mean age of 29.93 (±0.82). The distribution of respiratory disorders, such as a runny nose, cold, dry cough, chest discomfort, and breathlessness, was significantly increased among MDs in Douala. According to the results of biological assays, SOD and MDA were significantly greater among the MDs recruited in Douala compared to those of Dschang. The change in these oxidative stress markers was significantly positively correlated with the mobilization of monocytes and negatively correlated with neutrophils, showing the onset and progression of subjacent inflammatory reactions, and it seemed to be significantly influenced by the location MDs lived in. Conclusions: Through this study, we have confirmed the evidence supporting that the onset and progression of oxidative stress is caused by the long-term exposure to fine or ultrafine air particles among working people living in urban cities. Further studies should be conducted to provide evidence for the cellular damage and dysfunction related to the chronic exposure to fine particulate matter (PM) in the air among working people in the metropolitan sub-Saharan Africa context.
Full article
(This article belongs to the Topic One Health Approach in Global Health and Clinical Medicine)
Open AccessReview
Models and Outcomes of Multidisciplinary Clinics in Colorectal Cancer
by
Seohyuk Lee, Kristen T. Crowell and Jessica A. Zerillo
J. Clin. Med. 2024, 13(13), 3815; https://doi.org/10.3390/jcm13133815 (registering DOI) - 28 Jun 2024
Abstract
Multidisciplinary clinics (MDCs) represent a potential platform through which high-quality, patient-centered care grounded in interdisciplinary expertise may be delivered for patients with colorectal cancer (CRC). This is increasingly important with the rapidly emerging diagnostic and treatment modalities as well as differential sequences of
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Multidisciplinary clinics (MDCs) represent a potential platform through which high-quality, patient-centered care grounded in interdisciplinary expertise may be delivered for patients with colorectal cancer (CRC). This is increasingly important with the rapidly emerging diagnostic and treatment modalities as well as differential sequences of therapies available. MDCs have been reported to improve various outcomes across numerous non-colorectal cancers; however, data specific to the use of MDCs in CRC are more limited. In this report, we provide a narrative review of the different models of CRC MDCs in the literature and their associations with cancer care outcomes. We found significant heterogeneity in MDC operational logistics as well as reported outcomes across different practice settings. Further research is needed to better understand how MDCs may be optimally structured to meet the unique needs of patients with CRC and how they may affect CRC outcomes.
Full article
(This article belongs to the Special Issue State-of-the-Art in Colorectal Surgery)
Open AccessReview
From Rib Hump to Baby Hump—Common Questions of Patients Suffering from and Undergoing Treatment for Scoliosis—A Comprehensive Literature Review
by
Pawel Grabala, Piotr Kowalski and Michal Grabala
J. Clin. Med. 2024, 13(13), 3814; https://doi.org/10.3390/jcm13133814 (registering DOI) - 28 Jun 2024
Abstract
Background: Scoliosis, the most prevalent spinal deformity in children, is often associated with adolescent idiopathic scoliosis (AIS). Curves surpassing 50 degrees can deteriorate, especially thoracic curves, leading to pulmonary limitations. Surgical intervention is usually advised for curvatures exceeding 50 degrees to halt
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Background: Scoliosis, the most prevalent spinal deformity in children, is often associated with adolescent idiopathic scoliosis (AIS). Curves surpassing 50 degrees can deteriorate, especially thoracic curves, leading to pulmonary limitations. Surgical intervention is usually advised for curvatures exceeding 50 degrees to halt further progression. Severe AIS is notably more frequent in females, yet knowledge regarding subsequent pregnancies and associated risks is scarce. Female patients often inquire about conception, pregnancy, labor, and future back pain (BP) concerns. Reports on the long-term outcomes after pediatric AIS treatment and pregnancy consequences remain limited. Uncertainty looms over the likelihood of increased back pain (BP), cesarean sections (CSs), or other pregnancy-related issues following surgical AIS management. In this investigation, an attempt was made to scrutinize the existing research on individuals afflicted with scoliosis who received either conservative or surgical treatment, with the aim of delineating crucial and pragmatic findings that can serve as a compass for spine surgeons when counseling young patients with adolescent idiopathic scoliosis regarding the ailment, its repercussions, the available treatment modalities, and the associated outcomes. A comprehensive analysis pinpointed the optimal data at hand. Consequently, the primary objective of this investigation was to assess the patient-reported and clinical consequences in scoliosis patients who have undergone segmental posterior fusion and subsequently conceived. Conclusions: While the majority of individuals with AIS are capable of conceiving and bearing children, they may encounter greater challenges in fertility than healthy women unaffected by AIS. Pregnant women with a prior history of spinal fusion for AIS can undergo pregnancy and childbirth with no significant escalation in perinatal complications. Women who have undergone surgical procedures for AIS have been observed to exhibit a prevalence of back pain comparable with that of healthy pregnant women; however, a higher incidence of low back pain is evident when spinal fusion is extended to the L3 or L4 vertebra. Although back pain is a common occurrence in pregnant women with AIS, the spinal alterations induced by pregnancy are typically minor and transient. In comparison with healthy women, individuals with a history of spinal fusion necessitate cesarean sections more frequently. The degree of correction loss during pregnancy is lower in previous reports involving pedicle screw instrumentation than in previous reports involving Harrington or hybrid segmental instrumentation.
Full article
(This article belongs to the Special Issue Spine Surgery and Rehabilitation: Current Advances and Future Options)
Open AccessReview
Evolution of Stemless Reverse Shoulder Arthroplasty: Current Indications, Outcomes, and Future Prospects
by
Taku Hatta, Ryosuke Mashiko, Jun Kawakami, Gaku Matsuzawa, Yohei Ogata and Waku Hatta
J. Clin. Med. 2024, 13(13), 3813; https://doi.org/10.3390/jcm13133813 (registering DOI) - 28 Jun 2024
Abstract
Reverse total shoulder arthroplasty (rTSA) is increasingly being used as a reliable option for various shoulder disorders with deteriorated rotator cuff and glenohumeral joints. The stemless humerus component for shoulder arthroplasties is evolving with theoretical advantages, such as preservation of the humeral bone
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Reverse total shoulder arthroplasty (rTSA) is increasingly being used as a reliable option for various shoulder disorders with deteriorated rotator cuff and glenohumeral joints. The stemless humerus component for shoulder arthroplasties is evolving with theoretical advantages, such as preservation of the humeral bone stock and decreased risk of periprosthetic fractures, as well as clinical research demonstrating less intraoperative blood loss, reduced surgical time, a lower rate of intraoperative fractures, and improved center of rotation restoration. In particular, for anatomical total shoulder arthroplasty (aTSA), the utilization of stemless humeral implants is gaining consensus in younger patients. The current systematic review of 14 clinical studies (637 shoulders) demonstrated the clinical outcomes of stemless rTSA. Regarding shoulder function, the mean Constant-Murley Score (CS) improved from 28.3 preoperatively to 62.8 postoperatively. The pooled overall complication and revision rates were 14.3% and 6.3%, respectively. In addition, recent studies have shown satisfactory outcomes with stemless rTSA relative to stemmed rTSA. Therefore, shoulder surgeons may consider adopting stemless rTSA, especially in patients with sufficient bone quality. However, further long-term studies comparing survivorship between stemless and stemmed rTSA are required to determine the gold standard for selecting stemless rTSA.
Full article
(This article belongs to the Special Issue Shoulder and Elbow Disease: Current Treatment and Future Options)
Open AccessArticle
Do the Gender and the Number of Comorbidities and the Use of Tertiary Prevention Play a Role in the Severity of Anxiety and Depression in Patients with Coronary Artery Disease? A POLASPIRE II Study
by
Józefa Dąbek, Zbigniew Gąsior, Marek Styczkiewicz, Aldona Kubica, Dariusz A. Kosior, Renata Wolfshaut-Wolak, Marek Rajzer, Magdalena Szynal, Piotr Jankowski and Karol Kamiński
J. Clin. Med. 2024, 13(13), 3812; https://doi.org/10.3390/jcm13133812 (registering DOI) - 28 Jun 2024
Abstract
Background/Objectives: The need to conduct research on anxiety and depression in patients with coronary artery disease in connection with factors such as gender or implemented tertiary prevention is very important for drawing practical conclusions and, consequently, implementing new recommendations and procedures. The aim
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Background/Objectives: The need to conduct research on anxiety and depression in patients with coronary artery disease in connection with factors such as gender or implemented tertiary prevention is very important for drawing practical conclusions and, consequently, implementing new recommendations and procedures. The aim of the study was to attempt to answer the question whether gender and the number of comorbidities, as well as the application of tertiary prevention principles, play a role in the severity of anxiety and depression in the studied group of patients with coronary artery disease. Material: The study involved 765 patients from 11 Polish cardiology centers. The presented material is part of the multicenter POLASPIRE II study. Methods: All patients completed The Hospital Anxiety and Depression Scale (HADS) questionnaire, and a medical interview was conducted with them. Conclusions: Although the intensity of anxiety and depression in the studied group of patients was low, gender differentiated them, which, however, did not influence undertaking tertiary prevention activities. In the study group of patients, the number of comorbidities and cardiac incidents/procedures after the event qualifying for the study, as well as preventive actions undertaken, were not associated with the severity of anxiety and depression. In the studied group of patients with coronary heart disease, there was still a large group of people who did not take preventive measures. Therefore, there is a need for systematic education regarding the benefits of implementing them to prevent the progression of the disease and premature death.
Full article
(This article belongs to the Section Cardiovascular Medicine)
Open AccessArticle
Incidence of Cervical Kyphosis and Factors Associated with Improvement in Postoperative Cervical Spinal Alignment in Idiopathic Scoliosis with Major Thoracolumbar/Lumbar and Thoracic Curves
by
Kai Mizukami, Tetsuro Ohba, Nobuki Tanaka, Kotaro Oda, Marina Katsu, Hayato Takei, Goto Go and Hirotaka Haro
J. Clin. Med. 2024, 13(13), 3811; https://doi.org/10.3390/jcm13133811 (registering DOI) - 28 Jun 2024
Abstract
Background: This study aimed to compare the incidence and severity of cervical kyphosis before and after surgery between patients with adolescent idiopathic scoliosis (AIS) with major thoracolumbar/lumbar curves (Lenke type 5C group) and those with major thoracic curves (Lenke type 1A group). Further,
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Background: This study aimed to compare the incidence and severity of cervical kyphosis before and after surgery between patients with adolescent idiopathic scoliosis (AIS) with major thoracolumbar/lumbar curves (Lenke type 5C group) and those with major thoracic curves (Lenke type 1A group). Further, factors associated with cervical spinal alignment changes after surgery in the two groups were examined. Methods: This study included consecutive patients with AIS who underwent posterior spinal fusion for Lenke type 1A and 5C curves and who were followed up for at least 1 year. To measure changes in sagittal alignment, all patients underwent radiography before, immediately after, and at 1 year after surgery. The correlation coefficients change the value of the C2–C7 angle before and after surgery (ΔC2–ΔC7) and other spinopelvic parameters were examined. Results: In total, 19 of 30 patients in the Lenke type 1A group and 21 of 36 in the Lenke type 5C group presented with cervical kyphosis preoperatively. Hence, the incidence of cervical kyphosis did not significantly differ between the two groups. Further, the two groups had significantly higher thoracic kyphosis (TK) and greater C2–C7 angles postoperatively. The TK of the Lenke type 5C group further increased at 1 year postoperatively. The Lenke 1A type group presented with a significant re-decrease in the C2–C7 angle at 1 year postoperatively. However, the C2–C7 angle of the Lenke type 5C group did not change. The ΔTK was closely associated with the ΔC2–ΔC7 in the Lenke type 1A group, but not in the Lenke type 5C group. Conclusion: In thoracic AIS, postoperative cervical alignment should achieve an adequate TK and promote correction of the coronal plane curve. Moreover, selective corrective surgery can improve postoperative cervical alignment in lumbar AIS.
Full article
(This article belongs to the Section Orthopedics)
Open AccessArticle
Surgical Outcome and Microbial Colonization of Standardized Smear Locations after Pancreatic Head Resection (Pylorus-Preserving Pancreatoduodenectomy, PPPD) for Chronic Pancreatitis and Pancreatic Head Carcinoma
by
Max Grabowski, Ronny Otto, Ina Tammer, Dörthe Jechorek, Henry Ptok, Sara Al-Madhi, Roland Croner and Frank Meyer
J. Clin. Med. 2024, 13(13), 3810; https://doi.org/10.3390/jcm13133810 (registering DOI) - 28 Jun 2024
Abstract
Introduction: Patients with chronic pancreatitis (CP) as well as with pancreatic head carcinoma (CA) undergo the surgical intervention named “pylorus-preserving pancreatoduodenectomy according to Traverso–Longmire (PPPD)”, which allowed a comparative analysis of the postoperative courses. The hypothesis was that patients with CA would have
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Introduction: Patients with chronic pancreatitis (CP) as well as with pancreatic head carcinoma (CA) undergo the surgical intervention named “pylorus-preserving pancreatoduodenectomy according to Traverso–Longmire (PPPD)”, which allowed a comparative analysis of the postoperative courses. The hypothesis was that patients with CA would have worse general as well as immune status than patients with CP due to the severity of the tumor disease and that this would be reflected in the more disadvantageous early postoperative outcome after PPPD. Methods: With the aim of eliciting the influence of the different diagnoses, the surgical outcome of all consecutive patients who underwent surgery at the Dept. of General, Abdominal, Vascular and Transplant Surgery at the University Hospital at Magdeburg between 2002 and 2015 (inclusion criterion) was recorded and comparatively evaluated. Early postoperative outcome was characterized by general and specific complication rate indicating morbidity, mortality, and microbial colonization rate, in particular surgical site infection (SSI, according to CDC criteria). In addition, microbiological findings of swabs and cultures from all compartments as well as preoperative and perioperative parameters from patient records were retrospectively documented and used for statistical comparison in this systematic retrospective unicenter observational study (design). Results: In total, 192 cases with CA (68.1%) and 90 cases with CP (31.9%) met the inclusion criteria of this study. Surprisingly, there were similar specific complication rates of 45.3% (CA) vs. 45.6% (CP; p = 0.97) and in-hospital mortality, which differed only slightly at 3.65% (CA) vs. 3.3% (CP; p = 0.591); the overall complication rate tended to be higher for CA at 23.4% vs. 14.4% (CP; p = 0.082). Overall, potentially pathogenic germs were detected in 28.9% of all patients in CP compared to 32.8% in CA (p = 0.509), and the rate of SSI was 29.7% (CA) and 24.4% (CP; p = 0.361). In multivariate analysis, CA was found to be a significant risk factor for the development of SSI (OR: 2.025; p = 0.048); the underlying disease had otherwise no significant effect on early postoperative outcome. Significant risk factors in the multivariate analysis were also male sex for SSI and microbial colonization, and intraoperatively transfused red cell packs for mortality, general and specific complications, and surgical revisions. Conclusions: Based on these results, a partly significant, partly trending negative influence of the underlying disease CA, compared to CP, on the early postoperative outcome was found, especially with regard to SSI after PPPD. This influence is corroborated by the international literature.
Full article
(This article belongs to the Special Issue Hepatobiliary and Pancreatic Surgery: Management and Future Opportunities)
Open AccessArticle
Changes in Working Situations of Employed Long COVID Patients: Retrospective Study in Japanese Outpatient Clinic
by
Yui Matsuda, Yasue Sakurada, Yuki Otsuka, Kazuki Tokumasu, Yasuhiro Nakano, Naruhiko Sunada, Hiroyuki Honda, Toru Hasegawa, Ryosuke Takase, Daisuke Omura, Keigo Ueda and Fumio Otsuka
J. Clin. Med. 2024, 13(13), 3809; https://doi.org/10.3390/jcm13133809 (registering DOI) - 28 Jun 2024
Abstract
Purpose: The present study aimed to uncover the impact of long COVID on the working situations of Japanese patients. Methods: Changes in the working situations of the patients who visited our long COVID clinic were evaluated from medical records for the
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Purpose: The present study aimed to uncover the impact of long COVID on the working situations of Japanese patients. Methods: Changes in the working situations of the patients who visited our long COVID clinic were evaluated from medical records for the aspects of physical status, quality of life (QOL), and mental conditions. Results: Of 846 long COVID patients who visited our clinic from Feb 2021 to Dec 2023, 545 employed patients aged between 18 and 65 years were included in this study. A total of 295 patients (54.1%) with long COVID (median age: 43 years, female: 55.6%) experienced changes in their working status. Those patients included 220 patients (40.4%) who took a leave of absence, 53 patients (9.7%) who retired, and 22 patients (4%) with reduced working hours. Most of the patients (93.2%) with changes in working conditions had mild disease severity in the acute phase of COVID-19. The majority of those patients with mild disease severity (58.8%) were infected in the Omicron-variant phase and included 65.3% of the female patients. The major symptoms in long COVID patients who had changes in their working situations were fatigue, insomnia, headache, and dyspnea. Scores indicating fatigue and QOL were worsened in long COVID patients who had changes in their working situations. In addition, 63.7% of the long COVID patients with changes in their working situations had decreases in their incomes. Conclusions: Changes in the working situation of long COVID patients who were employed had a negative impact on the maintenance of their QOL.
Full article
(This article belongs to the Special Issue Clinical Consequences of COVID-19: 2nd Edition)
Open AccessArticle
Assessment of the Relationship between Antero-Posterior Dental Malocclusions, Body Posture Abnormalities and Selected Static Foot Parameters in Adults
by
Monika Nowak, Joanna Golec, Piotr Golec and Aneta Wieczorek
J. Clin. Med. 2024, 13(13), 3808; https://doi.org/10.3390/jcm13133808 (registering DOI) - 28 Jun 2024
Abstract
Objectives: This study aimed to find if a relationship exists between antero-posterior malocclusions and the level of musculoskeletal disorders in adults, including body posture and static foot analysis. Methods: In all, 420 participants were recruited through convenience sampling (Kraków University students
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Objectives: This study aimed to find if a relationship exists between antero-posterior malocclusions and the level of musculoskeletal disorders in adults, including body posture and static foot analysis. Methods: In all, 420 participants were recruited through convenience sampling (Kraków University students and patients of a local dentist’s practice). Following general medical interviews, dental examinations and consideration of inclusion and exclusion criteria, 90 healthy volunteers (ages 19–35) were enrolled and assigned to three groups (n = 30) based on occlusion type (Angle’s molar Class I, II or III). The research procedure involved occlusion and temporomandibular disorder assessment conducted by a dental specialist. Comprehensive morphological measurements of body asymmetry were performed using the Videography 2D package and FreeSTEP software, which calculated the parameters determined from anterior, posterior and lateral projection photos. Foot loading distribution was analyzed using the FreeMED baropodometric platform. Results: Significant differences were demonstrated in the positioning of the head, cervical and lumbar spine in the sagittal plane among individuals with the analyzed occlusal classes (p < 0.05). Individuals with Angle’s Class II exhibited significantly greater forward head positions and greater depths of cervical and lumbar lordosis compared with individuals with Class III or Class I. Those with overbites had higher forefoot loading. The Class III individuals exhibited greater L-R displacement, indicating a larger angle of displacement of the centers of the right and left feet relative to the lower edge of the measurement platform, suggesting pelvic rotation. Conclusions: An inclination for concurrent occurrences of malocclusions and posture deviations in the sagittal plane was observed. An interdisciplinary approach involving dentistry and physiotherapy specialists which utilizes tools for comprehensive posture assessment is crucial for diagnosing and treating such conditions.
Full article
(This article belongs to the Special Issue Multidisciplinary Approach to Diagnosing and Treatment of Temporomandibular Disorders—Patient Care Challenges)
Open AccessArticle
Alcoholic Etiology, Severity of Liver Disease, and Post-Transplant Adherence Are Correlated with Worse Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) in Liver Transplant Candidates
by
Elisa Zanatta, Elisabetta Patron, Simone Messerotti Benvenuti, Filippo Pelizzaro, Francesco Paolo Russo, Martina Gambato, Giacomo Germani, Alberto Ferrarese, Alberto Zanetto, Federica Battermann, Francesca Buccheri, Chiara Cavalli, Rossana Schiavo, Marta Ghisi, Sara Pasquato, Paolo Feltracco, Umberto Cillo, Patrizia Burra and Marco Senzolo
J. Clin. Med. 2024, 13(13), 3807; https://doi.org/10.3390/jcm13133807 (registering DOI) - 28 Jun 2024
Abstract
Introduction: Psychosocial pre-transplant evaluation in patients undergoing liver transplantation (LT) could help identify those patients at higher risk of pharmacological non-adherence, organ rejection, and mortality. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a validated tool for assessing LT candidates’ psychosocial
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Introduction: Psychosocial pre-transplant evaluation in patients undergoing liver transplantation (LT) could help identify those patients at higher risk of pharmacological non-adherence, organ rejection, and mortality. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a validated tool for assessing LT candidates’ psychosocial well-being. Data on the ability of the SIPAT evaluation to predict post-transplant outcomes are sparse. Material and Methods: clinical and psychosocial data from a sample of 134 candidates for LT were analyzed. Moreover, the association between pre-transplant psychosocial evaluation and post-transplant clinical outcomes, including organ rejection, mortality, and immunosuppressant drug adherence, was calculated. Results: At the pre-transplant evaluation, patients who showed high SIPAT scores (77, 57%) also had more liver disease assessed by model for end-stage liver disease (MELD; F = 5.04; p < 0.05), alcoholic etiology (F = 35.80; p < 0.001), encephalopathy (F = 5.02; p < 0.05), and portal hypertension (F = 7.45; p < 0.01). Of the 51 transplant patients, those who had a high pre-transplant SIPAT score showed lower post-transplant immunosuppressive adherence, linked to more frequent immunological events. Conclusions: Patients with an alcoholic etiology of liver disease and more severe liver dysfunction are likelier to not adhere to medical prescriptions following transplantation. Current data suggests that this specific group of patients could benefit from early psychological pre-habilitation before undergoing liver transplantation.
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(This article belongs to the Special Issue Liver Transplantation: Clinical Advances and Challenges)
Open AccessArticle
Hypoglycemia in Oral Glucose Tolerance Test during Pregnancy and Risk for Type 2 Diabetes—A Five-Year Cohort Study
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Noa Haggiag, Moran Rotman, Mordechai Hallak, Yoel Toledano, Rinat Gabbay-Benziv and Esther Maor-Sagie
J. Clin. Med. 2024, 13(13), 3806; https://doi.org/10.3390/jcm13133806 (registering DOI) - 28 Jun 2024
Abstract
Objective: To evaluate the risk of progression to type 2 diabetes (T2D) following reactive hypoglycemia in 100 g oral glucose tolerance test (oGTT). Methods: A retrospective analysis of parturients with up to 5-year follow-up postpartum. Data were extracted from the computerized
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Objective: To evaluate the risk of progression to type 2 diabetes (T2D) following reactive hypoglycemia in 100 g oral glucose tolerance test (oGTT). Methods: A retrospective analysis of parturients with up to 5-year follow-up postpartum. Data were extracted from the computerized laboratory system of Meuhedet, an Israeli HMO and cross-linked with the Israeli National Registry of Diabetes. Included were parturients with no prior diabetesand available oGTT values during pregnancy. Reactive hypoglycemia was defined as glucose levels lower than 60 mg/dL in at least one of 3 post-glucose load values in oGTT. The cohort was divided into 3 groups: normal glucose status, reactive hypoglycemia, and GDM. Maternal characteristics, laboratory data, and progression to T2D over 5 years were compared. Univariate and survival analyses assessed the adjusted hazard ratio for T2D, stratified by obesity Results: Among 14,122 parturients, 16.8% had reactive hypoglycemia, 71% had normal glucose status, and 12.2% had GDM. Adjusted for age, obesity, and hypertension, Parturients with reactive hypoglycemia had similar T2D risk compared to normal glucose status and a lower risk compared to GDM patients, regardless of obesity status. Conclusions: Reactive hypoglycemia during oGTT does not increase the risk of progressing to T2D.
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(This article belongs to the Section Obstetrics & Gynecology)
Open AccessReview
VAC-Stent in the Treatment of Post-Esophagectomy Anastomotic Leaks: A New “Kid on the Block” Who Marries the Best of Old Techniques—A Review
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Giuseppe Dell’Anna, Lorella Fanti, Jacopo Fanizza, Rukaia Barà, Alberto Barchi, Ernesto Fasulo, Ugo Elmore, Riccardo Rosati, Vito Annese, Liboria Laterza, Lorenzo Fuccio, Francesco Azzolini, Silvio Danese and Francesco Vito Mandarino
J. Clin. Med. 2024, 13(13), 3805; https://doi.org/10.3390/jcm13133805 (registering DOI) - 28 Jun 2024
Abstract
Esophagectomy, while a pivotal treatment for esophageal cancer, is not without adverse events. Among these, anastomotic leak (AL) is the most feared complication, threatening patient lives and incurring significant healthcare costs. The management of AL is complex and lacks standardization. Given the high
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Esophagectomy, while a pivotal treatment for esophageal cancer, is not without adverse events. Among these, anastomotic leak (AL) is the most feared complication, threatening patient lives and incurring significant healthcare costs. The management of AL is complex and lacks standardization. Given the high morbidity and mortality rates associated with redo-surgery, which poses risks for already fragile patients, various endoscopic treatments have been developed over time. Self-expandable metallic stents (SEMSs) were the most widely used treatment until the early 2000s. The mechanism of action of SEMSs includes covering the wall defect, protecting it from secretions, and promoting healing. In 2010, endoscopic vacuum therapy (EVT) emerged as a viable alternative for treating ALs, quickly gaining acceptance in clinical practice. EVT involves placing a dedicated sponge under negative pressure inside or adjacent to the wall defect, aiming to clear the leak and promote granulation tissue formation. More recently, the VAC-Stent entered the scenario of endoscopic treatment of post-esophagectomy ALs. This device combines a fully covered SEMS with an integrated EVT sponge, blending the ability of SEMSs to exclude defects and maintain the patency of the esophageal lumen with the capacity of EVT to aspirate secretions and promote the formation of granulation tissue. Although the literature on this new device is not extensive, early results from the application of VAC-Stent have shown promising outcomes. This review aims to synthesize the preliminary efficacy and safety data on the device, thoroughly analyze its advantages over traditional techniques and disadvantages, explore areas for improvement, and propose future directions.
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(This article belongs to the Special Issue Esophageal Cancer: Diagnosis and Treatment)
Open AccessArticle
Monitoring the Effectiveness of High-Fluence Peripheral Crosslinking for Corneal Neovascularization with Anterior Segment Optical Coherence Tomography Angiography
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Ruth Donner, Gerald Schmidinger, Michal Klimek and Julia Aschauer
J. Clin. Med. 2024, 13(13), 3804; https://doi.org/10.3390/jcm13133804 (registering DOI) - 28 Jun 2024
Abstract
Background/Aims: To investigate the effectiveness of an accelerated high-fluence peripheral crosslinking (pCXL) treatment protocol for corneal neovascularization (cNV) and the viability of optical coherence tomography angiography (OCTA) to monitor cNV dynamics. Methods: This pilot study included six eyes of six adult patients with
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Background/Aims: To investigate the effectiveness of an accelerated high-fluence peripheral crosslinking (pCXL) treatment protocol for corneal neovascularization (cNV) and the viability of optical coherence tomography angiography (OCTA) to monitor cNV dynamics. Methods: This pilot study included six eyes of six adult patients with cNV in at least one corneal quadrant who were treated with pCXL (7.2 J/cm2, 9 mW). The degree of cNV regression was monitored with slit lamp photography and anterior segment OCTA. The main outcome measure was total vessel area one and four weeks after treatment. Results: OCTA allowed for the objective monitoring of vascular metrics: The total vessel area declined from an average of 1025.4 mm2 (min: 0.13 mm2; max: 3637 mm2) at the baseline evaluation to 382.4 mm2 (min: 0.08 mm2; max: 1528 mm2) (p = 0.096). The total vessel length lessened from an average of 107.1 mm (min: 2.8 mm; max: 321.1 mm) to 47 mm (min: 2.6 mm; max: 156.5 mm) (p= 0.27). The average number of junctions at baseline decreased from 46.67 (min: 3; max: 166) to 26.5 (min: 0; max: 50) (p = 0.23). The junction density decreased from an average of 10.75/mm2 (min: 0.0002 /mm2; max: 36.5056/mm2) to 7.37/mm2 (avg.) (min: 0; max 18.7356/mm2) (p= 0.24). PCXL was performed safely without adverse effects, but vascular occlusion was not complete in all eyes. Conclusions: High-fluence pCXL may represent a valuable treatment option to achieve cNV regression, whilst the optimal fluence dose still remains to be defined. Anterior segment OCTA is an innovative tool for non-invasive, objective, and quantitative cNV monitoring.
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(This article belongs to the Section Ophthalmology)
Open AccessArticle
Surgical Outcomes of Adults with Spinal Caries from 1992 to 2019: A Single-Center Study-Risk Factors for the Progression of Kyphosis after Anterior Spinal Fixation Reveal Cases Needing Additional Posterior Instrumentation
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Mitsuru Furukawa, Kanehiro Fujiyoshi, Takahiro Kitagawa, Reo Shibata, Shogo Hashimoto, Yoshiomi Kobayashi, Tsunehiko Konomi and Yoshiyuki Yato
J. Clin. Med. 2024, 13(13), 3803; https://doi.org/10.3390/jcm13133803 (registering DOI) - 28 Jun 2024
Abstract
Background: This study aims to investigate the postoperative improvement of paralysis, fusion rate and risk factors for kyphosis progression in adults affected with spinal caries. Methods: Overall, 134 patients with spinal caries from the thoracic to lumbar spine from 1992 to
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Background: This study aims to investigate the postoperative improvement of paralysis, fusion rate and risk factors for kyphosis progression in adults affected with spinal caries. Methods: Overall, 134 patients with spinal caries from the thoracic to lumbar spine from 1992 to 2021 were included in this study. Data concerning the affected level (thoracic, thoracolumbar, lumbar, and lumbosacral), bone fusion rate, and progression of the postoperative local kyphosis angle were collected. The risk factors for the progression of local kyphosis angle after anterior spinal fixation (ASF) were determined using linear regression analysis. Results: Preoperatively, the degree of spinal cord paralysis was D and E on Frankel classification. Improvement of paralysis was good with surgery, especially from C, D. The overall bone fusion rate was 83.2%. The only factor influencing the progression of local kyphosis angle after ASF was the level of the affected vertebra. Progression of kyphosis angle after ASF was very advanced in the thoracolumbar transition area. Conclusions: Surgical improvement in paraplegia and the fusion rate of ASF with only grafted bone was good. However, in patients affected in the thoracolumbar spine region, posterior instrumentation is desirable because of local kyphosis progression risk after surgery.
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(This article belongs to the Section Orthopedics)
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Open AccessArticle
Psychometric Analysis of the Spanish-Language Version of the Instrument for the Evaluation of Handovers in Critically Ill Patients in Urgent and Emergency Care Settings
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Ruth Tortosa-Alted, Silvia Reverté-Villarroya, Marta Berenguer-Poblet, Francesc Valls-Fonayet, José Fernández-Sáez and Estrella Martínez-Segura
J. Clin. Med. 2024, 13(13), 3802; https://doi.org/10.3390/jcm13133802 - 28 Jun 2024
Abstract
Background/Objectives: Patient handover is the process by which the responsibility for care is transferred from one health care professional to another. Given the lack of validated scales to assess the handover of critically ill patients, our aim was to evaluate the reliability
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Background/Objectives: Patient handover is the process by which the responsibility for care is transferred from one health care professional to another. Given the lack of validated scales to assess the handover of critically ill patients, our aim was to evaluate the reliability and validity of the Instrumento de Evaluación de la Transferencia de Enfermos Críticos (IETEC) (English: Instrument for the Evaluation of Handovers in Critically Ill Patients). Methods: Psychometric analysis of the reliability and validity (construct, convergent, and discriminant) of the IETEC. This single-center study included professionals (nurses, physicians, and emergency medical technicians) involved in the care of the critically ill in urgent care and emergency situations. Results: We evaluated 147 handovers of critically ill patients. The KR-20 score was 0.87, indicting good internal consistency. Of the 147 handovers, 117 (79.6%) were classified as unsafe and 30 (20.4%) as safe. The model fit showed an acceptable construct validity (24 items and four factors: Identification, Communication, Quality, and Family). The Communication domain had the strongest correlation with the total scale (r = 0.876) while Family had the weakest (r = 0.706). The Communication and Family domains were closely correlated (r = 0.599). The IETEC reliably differentiated between safe and unsafe handovers, with a mean (SD) score of 26.3 (1.2) versus 19.0 (4.8), respectively. No significant differences (p = 0.521) in mean IETEC scores were observed between the physicians and nurses. Conclusions: These results show that the IETEC presents adequate psychometric properties and is, therefore, a valid, reliable tool to evaluate handovers in critically ill patients in urgent care and emergency settings.
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(This article belongs to the Section Emergency Medicine)
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Open AccessArticle
Unexpected Genetic Twists in Patients with Cardiac Devices
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Emilia-Violeta Goanta, Cristina Vacarescu, Georgica Tartea, Adrian Ungureanu, Sebastian Militaru, Alexandra Muraretu, Adelina-Andreea Faur-Grigori, Lucian Petrescu, Radu Vătăsescu and Dragos Cozma
J. Clin. Med. 2024, 13(13), 3801; https://doi.org/10.3390/jcm13133801 - 28 Jun 2024
Abstract
Objective: To assess the frequency and types of genetic mutations in patients with arrhythmias who underwent cardiac device implantation. Methods: Retrospective observational study, including 38 patients with different arrhythmias and cardiac arrest as a first cardiac event. Treatment modalities encompass pacemakers, transvenous defibrillators,
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Objective: To assess the frequency and types of genetic mutations in patients with arrhythmias who underwent cardiac device implantation. Methods: Retrospective observational study, including 38 patients with different arrhythmias and cardiac arrest as a first cardiac event. Treatment modalities encompass pacemakers, transvenous defibrillators, loop recorders, subcutaneous defibrillators, and cardiac resynchronization therapy. All patients underwent genetic testing, using commercially available panels (106–174 genes). Outcome measures include mortality, arrhythmia recurrence, and device-related complications. Results: Clinical parameters revealed a family history of sudden cardiac death in 19 patients (50%), who were predominantly male (58%) and had a mean age of 44.5 years and a mean left ventricle ejection fraction of 40.3%. Genetic testing identified mutations in various genes, predominantly TMEM43 (11%). In two patients (3%) with arrhythmogenic cardiomyopathy, complete subcutaneous defibrillator extraction with de novo transvenous implantable cardioverter-defibrillator implantation was needed. The absence of multiple associations among severe gene mutations was crucial for cardiac resynchronization therapy response. Mortality in this group was around 3% in titin dilated cardiomyopathy patients. Conclusions: Integration of genetic testing into the decision-making process for patients with electronic devices represents a paradigm shift in personalized medicine. By identifying genetic markers associated with arrhythmia susceptibility, heart failure etiology, and cardiac resynchronization therapy response, clinicians can tailor device choices to optimize patient outcomes.
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(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure)
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Open AccessReview
Pyoderma Gangrenosum Post-Breast Surgery: A Case Report and Comprehensive Review of Management Strategies
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Ioan Constantin Pop, Radu Alexandru Ilies, Corina Baican, Stefan Strilciuc, Valentin Muntean and Maximilian Muntean
J. Clin. Med. 2024, 13(13), 3800; https://doi.org/10.3390/jcm13133800 - 28 Jun 2024
Abstract
Background/Objectives: Pyoderma gangrenosum (PG) is a rare, autoimmune skin condition characterized by painful, rapidly progressing ulcers, often associated with autoimmune dysregulation. Managing PG following breast surgery presents unique challenges due to its pathergy phenomenon, which complicates surgical interventions. This article outlines the
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Background/Objectives: Pyoderma gangrenosum (PG) is a rare, autoimmune skin condition characterized by painful, rapidly progressing ulcers, often associated with autoimmune dysregulation. Managing PG following breast surgery presents unique challenges due to its pathergy phenomenon, which complicates surgical interventions. This article outlines the case of PG in a 48-year-old female post-breast surgery and reviews management strategies through a systematic analysis of the literature. Methods: A systematic literature review from 2018 to 2023 identified 24 relevant articles on PG management post-breast surgery. The studies were analyzed to compare the efficacy and complications of conservative versus combined (conservative and surgical) treatment strategies. Results: Results indicate that while conservative management, primarily with corticosteroids, remains preferred, combined strategies, including systemic therapies, vacuum-assisted closure, and surgery, offer significant benefits in select cases. Conclusions: Our findings suggest that a personalized, multifaceted treatment plan is crucial for managing PG effectively, emphasizing the need for early detection, meticulous planning, and comprehensive care to optimize patient outcomes.
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(This article belongs to the Section Plastic, Reconstructive and Aesthetic Surgery/Aesthetic Medicine)
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