Clinics and Practice

7 pages, 540 KiB

Open AccessArticle

Clinical and Epidemiological Characteristics of COVID-19 Patients with SARS-CoV-2 Re-Detected on PCR Test after Discharge from Isolation

by Abdullah J. Alsahafi, Manal M. Al Daajani, Ahmed A. Osman, Abdulhamed L. Moawwad, Abdullah M. Algarni, Ibrahim M. Asiri, Wadea O. Nofal and Rayan M. Alselami

Clin. Pract. 2021, 11(4), 954-960; https://doi.org/10.3390/clinpract11040110 - 18 Dec 2021

Viewed by 2555

Abstract

There have been multiple reports of patients with coronavirus disease (COVID-19) testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after discharge; however, information on the characteristics of such cases is limited. In this case report, we aimed to identify clinical and [...] Read more.

There have been multiple reports of patients with coronavirus disease (COVID-19) testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after discharge; however, information on the characteristics of such cases is limited. In this case report, we aimed to identify clinical and epidemiological characteristics of patients who had a repeat positive polymerase chain reaction (PCR) test for SARS-CoV-2. We analyzed data of 22 COVID-19 patients who tested positive for SARS-CoV-2 on polymerase chain reaction (PCR) testing after two consecutive negative PCR results following discharge from hospitals. The interval between the two positive tests in the episodes of COVID-19 ranged from 4 to 117 days. More than one-third of the cases were healthcare workers (HCWs) and one-third of them had comorbidities. The main symptoms were cough and fever, and we noticed that males experienced more symptoms and signs of COVID-19 than females. Individuals with repeat SARS-CoV-2 positivity tend to experience milder illness during the second episode than the first episode. To confirm the reinfection of SARS-CoV-2, the results of other tests, such as viral culture and immunological assays of immunoglobulin G (IgG) and immunoglobulin M (IgM), need to be considered. Recovered COVID-19 patients should continue social distancing, using face masks, and practicing hand hygiene, especially HCWs who are more likely to be exposed to SARS-CoV-2. Full article

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7 pages, 235 KiB

Open AccessArticle

Tracheotomy Outcomes in 71 COVID-19 Patients: A Multi-Centric Study in Saudi Arabia

by Dakheelallah Almutairi, Raneem Alqahtani, Arwa Alghamdi, Dina Binammar, Suzan Alzaidi, Abdullah Ghafori and Hassan Alsharif

Clin. Pract. 2021, 11(4), 947-953; https://doi.org/10.3390/clinpract11040109 - 15 Dec 2021

Cited by 3 | Viewed by 2385

Abstract

Since its outbreak in late 2019, the COVID-19 pandemic has seen a sharp rise in the demand for oxygen and ventilation facilities due to the associated extensive damage that it causes to the lungs. This study is considered the first and largest study [...] Read more.

Since its outbreak in late 2019, the COVID-19 pandemic has seen a sharp rise in the demand for oxygen and ventilation facilities due to the associated extensive damage that it causes to the lungs. This study is considered the first and largest study in Saudi Arabia to evaluate the outcomes of tracheostomy in intubated COVID-19 patients. This is a retrospective, observational cohort study that was conducted at King Abdulaziz Medical City (KAMC) in Jeddah, Western Region, Saudi Arabia and King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. The findings of the study revealed that seventy-one patients with COVID-19 underwent tracheotomy between 1 March 2020 and 31 October 2020. The average period between intubation and tracheostomy was 9.97 days. Hypertension, diabetes, lung disease and obesity (BMI > 30) were significant risk factors of mortality. The overall 30-day mortality rate was 38.4%. Full article

5 pages, 1591 KiB

Open AccessCase Report

Zinner Syndrome—A Rare Cause of Recurrent Epididymitis and Infertility

by Magdalena Ostrowska, Magdalena Grześk, Szymon Kaczyński, Dominika Skwara, Kacper Kulik, Filip Kowalski, Adam Ostrowski and Tomasz Drewa

Clin. Pract. 2021, 11(4), 942-946; https://doi.org/10.3390/clinpract11040108 - 09 Dec 2021

Cited by 3 | Viewed by 3287

Abstract

Zinner syndrome (ZS) is a rare disorder that affects only men. It is characterized by a triad of abnormalities, including unilateral renal agenesis, ipsilateral seminal vesicle cysts, and atresia of the ejaculatory tract. Unfortunately, there is no consensus on the best treatment modality. [...] Read more.

Zinner syndrome (ZS) is a rare disorder that affects only men. It is characterized by a triad of abnormalities, including unilateral renal agenesis, ipsilateral seminal vesicle cysts, and atresia of the ejaculatory tract. Unfortunately, there is no consensus on the best treatment modality. We describe a case of a young male patient with recurrent epididymitis, dysuria, and frequent urination. In the diagnostic evaluation, we found an extended right seminal vesicle in the ultrasound with hyperechoic fluid inside and an absence of the right kidney. We performed magnetic resonance imaging, computed tomography, and semen analysis confirming Zinner syndrome and deteriorated semen parameters. Urethroscopic evaluation and ultrasound-guided puncture of the seminal vesicle were performed. An abscess was excluded. The cytologic evaluation showed hemosiderophages. Tamsulosin was introduced. We found no signs of relapse in a six-month observation, and the patient had no further symptoms. Therefore, minimally invasive treatment is a feasible option in young patients found with early-stage Zinner syndrome. Full article

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9 pages, 467 KiB

Open AccessArticle

Clinical Characteristics, Treatment, and Short-Term Outcome in Patients with Heart Failure and Cancer

by Jędrzej Piotrowski, Małgorzata Timler, Remigiusz Kozłowski, Arkadiusz Stasiak, Joanna Stasiak, Andrzej Bissinger, Dariusz Timler, Wojciech Timler, Michał Marczak, Roman Załuska and Grzegorz Piotrowski

Clin. Pract. 2021, 11(4), 933-941; https://doi.org/10.3390/clinpract11040107 - 06 Dec 2021

Viewed by 2368

Abstract

(1) Our study aimed to look at the clinical characteristics, treatment and short-term outcomes of patients hospitalized due to heart failure with coexisting cancer. (2) Methods: Seventy one cancer (Ca) patients and a randomly selected 70 patients without Ca, hospitalized due to heart [...] Read more.

(1) Our study aimed to look at the clinical characteristics, treatment and short-term outcomes of patients hospitalized due to heart failure with coexisting cancer. (2) Methods: Seventy one cancer (Ca) patients and a randomly selected 70 patients without Ca, hospitalized due to heart failure exacerbation in the same time period constituted the study group (Ca patient group) and controls (non-Ca group), respectively. Data on clinical characteristics were collected retrospectively for both groups. (3) Results: Cancer patients presented with a less advanced NYHA class, had more frequent HFpEF, a higher peak troponin T level, and smaller left atrium size, as compared with controls. The in-hospital deaths of Ca patients were associated with: a higher New York Heart Association (NYHA) class, lower HgB level, worse renal function, higher K and AST levels, presence of diabetes mellitus, and HFpEF. By multivariate logistic regression analysis, impaired renal function was the only independent predictor of in-hospital death in Ca patients (OR-1.15; CI 1.05; 1.27); p = 0.017). The following covariates entered the regression: NYHA class, HgB, GFR, K⁺, AST, diabetes mellitus t.2, and HFpEF. (4) Conclusions: The clinical picture and the course of heart failure in patients with and without cancer are different. Full article

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14 pages, 615 KiB

Open AccessArticle

Bridging the Gap between Ophthalmology and Emergency Medicine in Community-Based Emergency Departments (EDs): A Neuro-Ophthalmology Guide for ED Practitioners

by Kristina Thomas, Cindy Ocran, Anna Monterastelli, Alfredo A. Sadun and Kimberly P. Cockerham

Clin. Pract. 2021, 11(4), 919-932; https://doi.org/10.3390/clinpract11040106 - 02 Dec 2021

Cited by 6 | Viewed by 3035

Abstract

Coordination of care for patients with neuro-ophthalmic disorders can be very challenging in the community emergency department (ED) setting. Unlike university- or tertiary hospital-based EDs, the general ophthalmologist is often not as familiar with neuro-ophthalmology and the examination of neuro-ophthalmology patients in the [...] Read more.

Coordination of care for patients with neuro-ophthalmic disorders can be very challenging in the community emergency department (ED) setting. Unlike university- or tertiary hospital-based EDs, the general ophthalmologist is often not as familiar with neuro-ophthalmology and the examination of neuro-ophthalmology patients in the acute ED setting. Embracing image capturing of the fundus, using a non-mydriatic camera, may be a game-changer for communication between ED physicians, ophthalmologists, and tele-neurologists. Patient care decisions can now be made with photographic documentation that is then conveyed through HIPAA-compliant messaging with accurate and useful information with both ease and convenience. Likewise, external photos of the anterior segment and motility are also helpful. Finally, establishing clinical and imaging guidelines for common neuro-ophthalmic disorders can help facilitate complete and appropriate evaluation and treatment. Full article

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5 pages, 561 KiB

Open AccessCase Report

Hormonal Contraception and Massive Pulmonary Embolism in a COVID-19 Ambulatory Patient: A Case Report

by Laura Valenzuela-Vallejo, David Corredor-Orlandelli, Sergio Alzate-Ricaurte, Valentina Hernández-Santamaría, Juan Felipe Aguirre-Ruiz and Adwar Peña-Peña

Clin. Pract. 2021, 11(4), 914-918; https://doi.org/10.3390/clinpract11040105 - 26 Nov 2021

Cited by 4 | Viewed by 3408

Abstract

Coronavirus 19 disease (COVID-19) presents a highly variable clinical presentation and course, ranging from asymptomatic patients to rapidly progressive, fatal pneumonia. The known heterogeneous outcomes can affect both previously healthy patients and those with significant comorbidities, who develop clinical courses with possibly more [...] Read more.

Coronavirus 19 disease (COVID-19) presents a highly variable clinical presentation and course, ranging from asymptomatic patients to rapidly progressive, fatal pneumonia. The known heterogeneous outcomes can affect both previously healthy patients and those with significant comorbidities, who develop clinical courses with possibly more multisystemic compromise. Likewise, the development of thrombotic phenomena during the acute course of the disease is associated with complications that worsen patient prognosis. We present a case report of a 45-year-old multiparous patient with a history of overweight and chronic use of oral hormonal contraception with low doses of levonorgestrel and estradiol as the only risk factors favoring the development of thrombotic events. During her outpatient COVID-19 clinical course, she developed massive pulmonary thromboembolism resulting in secondary obstructive shock, which required pharmacological thrombolysis. At discharge, hormonal contraception was considered contraindicated, and the patient was released from our institution with continued oral anticoagulant therapy. COVID-19 infection, contraceptive hormone therapy, and overweight are known risk factors for the development of thromboembolic events. The impact of their concomitance has not been studied to date. From our experience, we discuss the impact these risk factors have when present together and invite others to report similar cases. Full article

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13 pages, 1130 KiB

Open AccessReview

Disease-Modifying Adjunctive Therapy (DMAT) in Osteoarthritis—The Biological Effects of a Multi-Mineral Complex, LithoLexal^® Joint—A Review

by Erik Fink Eriksen, Osvandre Lech, Gilberto Yoshinobu Nakama and Denise M. O’Gorman

Clin. Pract. 2021, 11(4), 901-913; https://doi.org/10.3390/clinpract11040104 - 26 Nov 2021

Cited by 3 | Viewed by 3405

Abstract

Modern advances in molecular medicine have led to the reframing of osteoarthritis as a metabolically active, inflammatory disorder with local and systemic contributing factors. According to the ‘inflammatory theory’ of osteoarthritis, immune response to an initial damage is the key trigger that leads [...] Read more.

Modern advances in molecular medicine have led to the reframing of osteoarthritis as a metabolically active, inflammatory disorder with local and systemic contributing factors. According to the ‘inflammatory theory’ of osteoarthritis, immune response to an initial damage is the key trigger that leads to progressive joint destruction. Several intertwined pathways are known to induce and govern articular inflammation, cartilage matrix degradation, and subchondral bone changes. Effective treatments capable of halting or delaying the progression of osteoarthritis remain elusive. As a result, supplements such as glucosamine and chondroitin sulphate are commonly used despite the lack of scientific consensus. A novel option for adjunctive therapy of osteoarthritis is LithoLexal^® Joint, a marine-derived, mineral-rich extract, that exhibited significant efficacy in clinical trials. LithoLexal^® has a lattice microstructure containing a combination of bioactive rare minerals. Mechanistic research suggests that this novel treatment possesses various potential disease-modifying properties, such as suppression of nuclear factor kappa-B, interleukin 1β, tumor necrosis factor α, and cyclooxygenase-2. Accordingly, LithoLexal^® Joint can be considered a disease-modifying adjunctive therapy (DMAT). LithoLexal^® Joint monotherapy in patients with knee osteoarthritis has significantly improved symptoms and walking ability with higher efficacy than glucosamine. Preliminary evidence also suggests that LithoLexal^® Joint may allow clinicians to reduce the dose of nonsteroidal anti-inflammatory drugs in osteoarthritic patients by up to 50%. In conclusion, the multi-mineral complex, LithoLexal^® Joint, appears to be a promising candidate for DMAT of osteoarthritis, which may narrow the existing gap in clinical practice. Full article

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23 pages, 6419 KiB

Open AccessEditor’s ChoiceReview

New Aspects of Sarcomas of Uterine Corpus—A Brief Narrative Review

by Stoyan Kostov, Yavor Kornovski, Vesela Ivanova, Deyan Dzhenkov, Dimitar Metodiev, Rafał Watrowski, Yonka Ivanova, Stanislav Slavchev, Dimitar Mitev and Angel Yordanov

Clin. Pract. 2021, 11(4), 878-900; https://doi.org/10.3390/clinpract11040103 - 22 Nov 2021

Cited by 15 | Viewed by 7190

Abstract

Sarcomas of the uterine corpus are rare malignant neoplasms, which are further classified into mesenchymal tumors, and mixed (epithelial plus mesenchymal) tumors. The main issues concerning these neoplasms are the small number of clinical trials, insufficient data from evidence-based medicine, insignificant interest from [...] Read more.

Sarcomas of the uterine corpus are rare malignant neoplasms, which are further classified into mesenchymal tumors, and mixed (epithelial plus mesenchymal) tumors. The main issues concerning these neoplasms are the small number of clinical trials, insufficient data from evidence-based medicine, insignificant interest from the pharmaceutical industry, all of which close a vicious circle. The low frequency of these malignancies implies insufficient experience in the diagnosis, hence incomplete surgical and complex treatment. Additionally, the rarity of these sarcomas makes it very difficult to develop clinical practice guidelines. Preoperative diagnosis, neoadjuvant and adjuvant chemoradiation, target and hormone therapies still raise many controversies. Disagreements about the role and type of surgical treatment are also often observed in medical literature. There are still insufficient data about the role of pelvic lymph node dissection and fertility-sparing surgery. Pathologists’ experience is of paramount importance for an accurate diagnosis. Additionally, genetics examinations become part of diagnosis in some sarcomas of the uterine corpus. Some gene mutations observed in uterine sarcomas are associated with different outcomes. Therefore, a development of molecular classification of uterine sarcomas should be considered in the future. In this review, we focus on the epidemiology, pathogenesis, pathology, diagnosis and treatment of the following sarcomas of the uterine corpus: leiomyosarcoma, low- and high-grade endometrial stromal sarcomas, undifferentiated sarcoma and adenosarcoma. Uterine carcinosarcomas are excluded as they represent an epithelial tumor rather than a true sarcoma. Full article

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8 pages, 835 KiB

Open AccessCase Report

Congenital Adrenal Hyperplasia: Diagnostic Pitfalls in Prolonged Neonatal Jaundice

by Nur Athirah Rosli, Md Yasin Mazapuspavina and Noor Shafina Mohd Nor

Clin. Pract. 2021, 11(4), 870-877; https://doi.org/10.3390/clinpract11040102 - 17 Nov 2021

Cited by 2 | Viewed by 3153

Abstract

Congenital Adrenal Hyperplasia (CAH) is a genetic disorder that leads to cortisol deficiency. However, prolonged neonatal jaundice is a rare presentation of CAH. The pathophysiology of hyperbilirubinemia in CAH is still ill-defined. Plausible causes are related to the synthesis of bile, maturity of [...] Read more.

Congenital Adrenal Hyperplasia (CAH) is a genetic disorder that leads to cortisol deficiency. However, prolonged neonatal jaundice is a rare presentation of CAH. The pathophysiology of hyperbilirubinemia in CAH is still ill-defined. Plausible causes are related to the synthesis of bile, maturity of the liver and adrenal function. This case reported a neonate who presented with severe prolonged jaundice that lasted for more than a month. A short Synacthen test confirmed diagnosis of CAH. He was started on steroid replacement. He had regular follow-up under paediatric endocrinologist and primary care physician for long-term monitoring and overall health care. This case demonstrates the importance of recognizing the clinical and biochemical features of CAH for early detection and referral. Long-term follow-up and monitoring is necessary due to the risk of complications and side effects of medications. This is the first case of CAH presented with persistent hyperbilirubinemia to be reported from Malaysia. The case describes the difficult workup that has been encountered in the patient’s care and management. Full article

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10 pages, 1284 KiB

Open AccessArticle

Quality of Life among Pediatric Neurocognitive, Speech, and Psychomotor Rehabilitation Professionals during the COVID-19 Pandemic: A Longitudinal Study on an Italian Sample

by Vincenza Cofini, Valeria Bianchini, Mario Muselli, Danila Budroni, Loreta Tobia, Giovanna Letizia Calò, Leila Fabiani and Stefano Necozione

Clin. Pract. 2021, 11(4), 860-869; https://doi.org/10.3390/clinpract11040101 - 15 Nov 2021

Cited by 7 | Viewed by 2306

Abstract

Objective: The aim was to estimate the perceived quality of life and its relationship with sociodemographic and professional factors, perception of susceptibility to COVID-19, and stress. Design: It was a longitudinal study. Subjects: Professionals, working in Italian centers for pediatric neurocognitive, speech, and [...] Read more.

Objective: The aim was to estimate the perceived quality of life and its relationship with sociodemographic and professional factors, perception of susceptibility to COVID-19, and stress. Design: It was a longitudinal study. Subjects: Professionals, working in Italian centers for pediatric neurocognitive, speech, and psychomotor rehabilitation. Methods: Participants were interviewed online twice during the COVID-19 outbreak in Italy. The questionnaire included: (i) The measures of health-related quality of life to perform the Summary Index of Unhealthy Days, (ii) modified items from the “Standard questionnaire on risk perception of an infectious disease outbreak” and (iii) the items of the General Health Questionnaire. Results: One hundred and thirty professionals out of 130 participated in the first interview, while only 50 therapists took part in the second interview (dropout rate: 61%). The Summary Index of Unhealthy Days was 8 days at the first interview, and it decreased to 6 days at the second interview; however, the reduction was not significant (F = 3.22; p = 0.079). The multivariable analysis showed that the rehabilitation providers with moderate or severe stress level were more likely to have a negative perception of the quality of life (ORadj = 7.155; 95% CI: 2.8–18.2), and this result was confirmed at the second interview. Conclusions: Our results showed that in a severe public health emergency, the mental health and quality of life of rehabilitation professionals must be a topic of focus to enhance psychological resilience, to prevent burnout and to reduce rehabilitation errors. Full article

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10 pages, 270 KiB

Open AccessEditor’s ChoiceReview

Quantifying Remission Probability in Type 2 Diabetes Mellitus

by Sanjay Kalra, Ganapathi Bantwal, Nitin Kapoor, Rakesh Sahay, Saptarshi Bhattacharya, Beatrice Anne, Raju A Gopal, Sunil Kota, Ashok Kumar, Ameya Joshi, Debmalya Sanyal, Mangesh Tiwaskar and Ashok Kumar Das

Clin. Pract. 2021, 11(4), 850-859; https://doi.org/10.3390/clinpract11040100 - 09 Nov 2021

Cited by 4 | Viewed by 3389

Abstract

Type 2 diabetes mellitus (T2DM) is a chronic progressive disorder and is associated with significant morbidity and mortality. The concept of T2DM remission and the reversal of diabetic parameters to normal levels has been gaining momentum over the past years. T2DM remission is [...] Read more.

Type 2 diabetes mellitus (T2DM) is a chronic progressive disorder and is associated with significant morbidity and mortality. The concept of T2DM remission and the reversal of diabetic parameters to normal levels has been gaining momentum over the past years. T2DM remission is increasingly being recognized by various global guidelines. Multiple models have been developed and validated for quantifying the extent of remission achieved. Based on favorable clinical evidence, T2DM remission can be considered as the therapeutic goal in diabetes management and, in select cases, as an alternative to expensive treatment options, which can be burdensome as T2DM progresses. This narrative review discusses the available strategies, such as lifestyle interventions, physical activity, bariatric surgery, medical nutrition therapy, and non-insulin glucose-lowering medications, for achieving T2DM remission. Although the concept of T2DM remission has emerged as a real-world option, effective implementation in routine clinical practice may not be feasible until long-term studies prove the efficacy of different approaches in this regard. Full article

9 pages, 945 KiB

Open AccessArticle

Perinatal Outcomes in Premature Placental Calcification and the Association of a Color Doppler Study: Report from a Tertiary Care Hospital in Eastern India

by Sudarshan Dash, Banya Das, Soumya Ranjan Panda, Monalisa Rajguru, Pramila Jena, Abheepsa Mishra and Sudhanshu Kumar Rath

Clin. Pract. 2021, 11(4), 841-849; https://doi.org/10.3390/clinpract11040099 - 09 Nov 2021

Cited by 2 | Viewed by 6347

Abstract

Introduction: Placental calcification, identified before the 36th week of gestational age, is known as premature placental calcification (PPC). PPC could be a clue for the poor fetal outcome. However, its association with adverse perinatal outcomes is yet to be confirmed. Objective: The primary [...] Read more.

Introduction: Placental calcification, identified before the 36th week of gestational age, is known as premature placental calcification (PPC). PPC could be a clue for the poor fetal outcome. However, its association with adverse perinatal outcomes is yet to be confirmed. Objective: The primary objective was to determine and compare the perinatal outcomes in pregnancies with and without documented premature placental calcification. Methodology: The present study was a prospective cohort study performed from October 2017 to September 2019. We consecutively enrolled 494 antenatal women who presented to our antenatal OPD after taking consent to participate in our study. Transabdominal sonographies were conducted between 28–36 weeks of gestation to document placental maturity. We compared maternal and fetal outcomes between those who were identified with grade III placental calcification (n = 140) and those without grade III placental calcification (n = 354). Results: The incidence of preeclampsia, at least one abnormal Doppler index, obstetrics cholestasis, placental abruption, and FGR (fetal growth restriction) pregnancies were significantly higher in the group premature placental calcification. We also found a significantly increased incidence of Low APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) scores, NICU (Neonatal Intensive Care Unit) Admission, Abnormal CTG (cardiotocography), meconium-stained liquor, and low birth weight babies in those with grade III placental calcification. Conclusion: Clinicians should be aware of documenting placental grading while performing ultrasonography during 28 to 36 weeks. Ultrasonographically, the absence of PPC can define a subcategory of low-risk pregnant populations which probably need no referral to specialized centers and can be managed in these settings. Full article

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6 pages, 1554 KiB

Open AccessCase Report

Use of Cardiac Contractility Modulation in an Older Patient with Non-Ischemic Dilated Cardiomyopathy: A Case Report

by Gianvito Manganelli, Antonio Fiorentino, Gianluca Ceravolo, Stefana Minichiello, Giuseppe Bianchino, Gennaro Bellizzi, Giuseppe Pacileo and Daniele Masarone

Clin. Pract. 2021, 11(4), 835-840; https://doi.org/10.3390/clinpract11040098 - 03 Nov 2021

Cited by 3 | Viewed by 2974

Abstract

Cardiac contractility modulation (CCM) is a novel device-based therapy used in patients with HFrEF. CCM therapy is associated with an improvement in exercise tolerance, increased quality of life, reduced HF hospitalizations, and reverse remodelling of the left ventricle in patients with HFrEF. In [...] Read more.

Cardiac contractility modulation (CCM) is a novel device-based therapy used in patients with HFrEF. CCM therapy is associated with an improvement in exercise tolerance, increased quality of life, reduced HF hospitalizations, and reverse remodelling of the left ventricle in patients with HFrEF. In this case, we report the clinical benefit of CCM in an older patient with advanced HFrEF due to ischemic dilated cardiomyopathy with frequent heart failure-related hospitalizations and poor quality of life despite optimal medical therapy. Full article

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8 pages, 629 KiB

Open AccessArticle

A 5-Year Satisfaction Outcome Study of Patients Receiving Six-Implant-Supported Fixed Prosthesis

by Mazen A. Almasri

Clin. Pract. 2021, 11(4), 827-834; https://doi.org/10.3390/clinpract11040097 - 02 Nov 2021

Cited by 3 | Viewed by 2429

Abstract

The aim of the study was to analyze the satisfaction of patients treated with a protocol of six-implant-supported fixed prosthesis (6IFP) throughout 5 years of service. This retrospective study collected the data of all patients who had full-arch rehabilitations using 6IFP and followed [...] Read more.

The aim of the study was to analyze the satisfaction of patients treated with a protocol of six-implant-supported fixed prosthesis (6IFP) throughout 5 years of service. This retrospective study collected the data of all patients who had full-arch rehabilitations using 6IFP and followed them for 5 years. After applying the research inclusion/exclusion strategy, 37 cases were finally included in the study. All the patients had no previous complete dentures because they were partially edentulous, not interested in pursuing complete denture rehabilitation, had immediate dental extractions, implantation used the 2-stage protocol, and there was minor peri-implant socket grafting. Cases with severe bone loss that required extensive grafting were excluded. A total number of 222 implants were placed in the maxillary or mandibular arches in a total of 37 patients. The data presented the satisfaction outcomes concerning mastication, phonetics, and comfort during the first 5 years of the recall plan. The former was achieved based on the clinical record reviews, follow-up visits, and recall phone calls at the preoperative stage as well as annually thereafter. The mean satisfaction rate was 94.5%, with a mean record of 8.21 ± 1.7 out of 10, there was no gender predilection significance, and no age range variation significance was validated. Regarding the smoking status, the t-test score exhibited no significant effect on phonetics and mastication (p = 0.12, p = 0.16, respectively), whereas comfort was found to be significantly affected (p = 0.03). The comfort level was found to be slightly less at the immediate postoperative period among smokers when compared to non-smokers. In conclusion, partially edentulous patients who received the rehabilitation plan of arch dental extractions, six immediate implantations, and delayed prosthetic loading were found to be highly satisfied. Full article

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26 pages, 493 KiB

Open AccessReview

Quality of Life (QoL) among Health Care Workers with Diabetes Mellitus: A Literature Review

by Warda Alamri, Aisha Alhofaian and Nahed Mersal

Clin. Pract. 2021, 11(4), 801-826; https://doi.org/10.3390/clinpract11040096 - 30 Oct 2021

Viewed by 2851

Abstract

Objective: This scoping literature review explores the impact of diabetes mellitus (DM) on the health-related quality of life (HRQoL) of health care workers (HCWs). HCWs play a vital role in the global health care system, with the COVID-19 pandemic demonstrating their effectiveness and [...] Read more.

Objective: This scoping literature review explores the impact of diabetes mellitus (DM) on the health-related quality of life (HRQoL) of health care workers (HCWs). HCWs play a vital role in the global health care system, with the COVID-19 pandemic demonstrating their effectiveness and worth beyond any doubt. However, HCWs are among the most vulnerable members of the health care system because they are most susceptible to stress, exhaustion, and occupational health risks. Method: The review was conducted in 2021 and included articles published in English in the past five years that explore diabetic HCWs’ QoL and studies intended to assess the relationship between work stress and DM. In total, 27 relevant articles were found that satisfied the inclusion criteria and were critically and thematically analyzed. Results: Most DM studies have focused on the clinical management of patients, but researchers have paid little attention to the high-risk group of HCWs with diabetes. In addition to fulfilling their job mandate, HCWs are burdened with various sociological stressors that affect their QoL. Conclusion: This literature review suggests DM has a significant impact on QoL in the work–life context. However, there is limited evidence to demonstrate the impact of DM on the QoL of HCWs. Thus, further research is needed in this area to improve the provision of integrated care. Full article

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10 pages, 633 KiB

Open AccessEditor’s ChoiceArticle

Plasmatic Magnesium Deficiency in 101 Outpatients Living with Type 2 Diabetes Mellitus

by Hajer Zahra, Olfa Berriche, Ramla Mizouri, Fatma Boukhayatia, Marwa Khiari, Amel Gamoudi, Ines Lahmar, Nadia Ben Amor, Faten Mahjoub, Souheil Zayet and Henda Jamoussi

Clin. Pract. 2021, 11(4), 791-800; https://doi.org/10.3390/clinpract11040095 - 27 Oct 2021

Cited by 7 | Viewed by 2715

Abstract

(1) Background: Magnesium deficiency is usually associated with type 2 diabetes mellitus (T2DM). Individuals living with T2DM with hypomagnesemia show a more rapid disease progression and have an increased risk for diabetes complications. (2) Methods: This is a cross-sectional and descriptive study in [...] Read more.

(1) Background: Magnesium deficiency is usually associated with type 2 diabetes mellitus (T2DM). Individuals living with T2DM with hypomagnesemia show a more rapid disease progression and have an increased risk for diabetes complications. (2) Methods: This is a cross-sectional and descriptive study in the National Institute of Nutrition and Food Technology of Tunis in Tunisia, including all adult outpatients (≥18 years old) with a diagnosis of T2DM from 1 September 2018 to 31 August 2019. The aim of this study was to evaluate the prevalence of plasmatic magnesium deficiency in a Tunisian population of T2DM and to study the relationship between magnesium status and intake, glycemic control and long-term diabetes-related complications. (3) Results: Among the 101 T2DM outpatients, 13 (12.9%) presented with a plasmatic magnesium deficiency. The mean age was 56 ± 7.9 years with a female predominance (62%, n = 63). The mean of the plasmatic magnesium level was 0.79 ± 0.11 mmol/L (0.5–1.1), and the mean of 24 h urinary magnesium excretion was 87.8 ± 53.8 mg/24 h [4.8–486.2]. HbA1c was significantly higher in the plasmatic magnesium deficiency group than the normal magnesium status group (10% ± 1.3 vs. 8.3% ± 1.9; p = 0.04), with a significant difference in participants with a poor glycemic control (HbA1c > 7%) (100%, n = 13/13 vs. 53%, n = 47/88; p = 0.001). A weak negative relationship was also found between plasmatic magnesium and HbA1c (r = −0.2, p = 0.03). Peripheral artery disease was more commonly described in individuals with low plasmatic magnesium levels than in individuals with normal levels (39%, n = 5 vs. 0%, n = 0; p < 0.001). The mean plasmatic magnesium level in participants without diabetic nephropathy and also peripheral artery disease was significantly higher compared to individuals with each long-term diabetes-related complication (0.8 mmol/L ± 0.1 vs. 0.71 mmol/L ± 0.07; p = 0.006) and (0.8 mmol/L ± 0.1 vs. 0.6 mmol/L ± 0.08; p < 0.001), respectively. (4) Conclusions: Hypomagnesemia was identified in individuals with T2DM, causing poor glycemic control and contributing to the development and progression of diabetes-related microvascular and macrovascular complications. Full article

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6 pages, 448 KiB

Open AccessCase Report

Significant Leukocytosis with Hypereosinophilia Secondary to Trichuris trichiura in Adult: A Case Report

by Nasturah Abdullah, Noorhida Baharudin, Farah Roslinda Mohd Rustam and Zalizah Khalid

Clin. Pract. 2021, 11(4), 785-790; https://doi.org/10.3390/clinpract11040094 - 26 Oct 2021

Viewed by 2980

Abstract

Eosinophilic leukocytosis can be attributed to a number of clinical conditions such as parasitic infection, allergies, and neoplasms. Parasitic infection is the main cause of eosinophilia; however, a marked leukocytosis with hypereosinophilia secondary to Trichuris trichiura in adults has not been previously reported. [...] Read more.

Eosinophilic leukocytosis can be attributed to a number of clinical conditions such as parasitic infection, allergies, and neoplasms. Parasitic infection is the main cause of eosinophilia; however, a marked leukocytosis with hypereosinophilia secondary to Trichuris trichiura in adults has not been previously reported. We describe a case of a 39-year-old man who presented with fever and diarrhea. The investigation revealed a white blood cell (WBC) count of 20.69 × 10⁹/L with an absolute eosinophil count of 12.44 × 10⁹/L. Fecal microscopic examination demonstrated T. trichuria eggs. The WBC count returned to normal following treatment with albendazole. The literature pertaining to hematological findings associated with Trichuris trichiura is explored in this report. This case highlights that a significant elevation of leukocyte count with hypereosinophilia can be one of the manifestations of trichuriasis infection in adults. Empirical treatment with anti-helminthic agents may play a role in suspected cases to avoid severe complications, such as Trichuris dysentery syndrome. Full article

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7 pages, 1032 KiB

Open AccessEditor’s ChoiceReview

Analysis of the Delta Variant B.1.617.2 COVID-19

by Shayan Shiehzadegan, Nazanin Alaghemand, Michael Fox and Vishwanath Venketaraman

Clin. Pract. 2021, 11(4), 778-784; https://doi.org/10.3390/clinpract11040093 - 21 Oct 2021

Cited by 188 | Viewed by 12378

Abstract

With the delta variant of COVID-19, known as B.1.617.2, quickly ramping up infections around the world, we need to understand what makes this variant more contagious. One study has reported that the delta variant is 60% more transmissible than the alpha variant. As [...] Read more.

With the delta variant of COVID-19, known as B.1.617.2, quickly ramping up infections around the world, we need to understand what makes this variant more contagious. One study has reported that the delta variant is 60% more transmissible than the alpha variant. As of August 2021, the delta variant has quickly become the dominant strain. Despite countries like the US, where most of the population is vaccinated, COVID-19 has made a resurgence in infections. Collectively, as a country, we ask: is it more deadly? What makes it more “contagious” or “transmissible”? This review article delves into the information we already know about the delta variant and how it compares with the other SARS-CoV-2 variants. The current vaccine companies like AstraZeneca, Pfizer/BioNTech, and Moderna have reported that their vaccines can provide protection against this variant but with a slightly reduced efficacy. In this article, we do a comprehensive review and summary of the delta B.1.617.2 variant and what makes it more contagious. Full article

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3 pages, 198 KiB

Open AccessCase Report

Regurgitation under the ERAS Program: A Case Report

by Marta Pires and Margarida Marcelino

Clin. Pract. 2021, 11(4), 775-777; https://doi.org/10.3390/clinpract11040092 - 17 Oct 2021

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Abstract

Introduction: Enhanced recovery after surgery (ERAS) is an evidence-based concept that reduces the recovery period after major abdominal surgery. Ingestion of carbohydrate solutions up until two hours before elective surgery has shown positive results. The authors present a case of regurgitation in a [...] Read more.

Introduction: Enhanced recovery after surgery (ERAS) is an evidence-based concept that reduces the recovery period after major abdominal surgery. Ingestion of carbohydrate solutions up until two hours before elective surgery has shown positive results. The authors present a case of regurgitation in a patient with apparently low risk for delayed gastric emptying who drank a carbohydrate solution two hours before induction of anaesthesia. Case report: An 80-year-old male patient with a relevant history of ischemic heart disease, atrial fibrillation, stage 3 chronic kidney disease and hypertension, was diagnosed with rectal cancer. He was scheduled for an anterior rectal resection hand-assisted laparoscopic surgery under the ERAS program, which included a 200 mL carbohydrate drink the night before and in the morning of the surgery, no less than two hours before the induction of anaesthesia. Immediately after loss of consciousness, there was regurgitation of a significant amount of clear fluid. Discussion: Even though ingestion of oral carbohydrate drinks is considered to be safe up to two hours before anaesthesia, further evaluation (e.g., gastric ultrasonography) may be considered in non-high-risk patients. Full article

12 pages, 1575 KiB

Open AccessArticle

Prostate Magnetic Resonance Imaging Analyses, Clinical Parameters, and Preoperative Nomograms in the Prediction of Extraprostatic Extension

by Natalia Majchrzak, Piotr Cieśliński, Maciej Głyda and Katarzyna Karmelita-Katulska

Clin. Pract. 2021, 11(4), 763-774; https://doi.org/10.3390/clinpract11040091 - 09 Oct 2021

Cited by 2 | Viewed by 2352

Abstract

Introduction: Proper planning of laparoscopic radical prostatectomy (RP) in patients with prostate cancer (PCa) is crucial to achieving good oncological results with the possibility of preserving potency and continence. Aim: The aim of this study was to identify the radiological and clinical parameters [...] Read more.

Introduction: Proper planning of laparoscopic radical prostatectomy (RP) in patients with prostate cancer (PCa) is crucial to achieving good oncological results with the possibility of preserving potency and continence. Aim: The aim of this study was to identify the radiological and clinical parameters that can predict the risk of extraprostatic extension (EPE) for a specific site of the prostate. Predictive models and multiparametric magnetic resonance imaging (mpMRI) data from patients qualified for RP were compared. Material and methods: The study included 61 patients who underwent laparoscopic RP. mpMRI preceded transrectal systematic and cognitive fusion biopsy. Martini, Memorial Sloan-Kettering Cancer Center (MSKCC), and Partin Tables nomograms were used to assess the risk of EPE. The area under the curve (AUC) was calculated for the models and compared. Univariate and multivariate logistic regression analyses were used to determine the combination of variables that best predicted EPE risk based on final histopathology. Results: The combination of mpMRI indicating or suspecting EPE (odds ratio (OR) = 7.49 (2.31–24.27), p < 0.001) and PSA ≥ 20 ng/mL (OR = 12.06 (1.1–132.15), p = 0.04) best predicted the risk of EPE for a specific side of the prostate. For the prediction of ipsilateral EPE risk, the AUC for Martini’s nomogram vs. mpMRI was 0.73 (p < 0.001) vs. 0.63 (p = 0.005), respectively (p = 0.131). The assessment of a non-specific site of EPE by MSKCC vs. Partin Tables showed AUC values of 0.71 (p = 0.007) vs. 0.63 (p = 0.074), respectively (p = 0.211). Conclusions: The combined use of mpMRI, the results of the systematic and targeted biopsy, and prostate-specific antigen baseline can effectively predict ipsilateral EPE (pT3 stage). Full article

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8 pages, 981 KiB

Open AccessArticle

COVID-19 in Multimorbid Patients—A Controlled Microcost Description Analysis of Diagnosis Related Group (DRG)-Case Series in Acute Care without Non-Invasive Ventilation

by Tobias Romeyke and Harald Stummer

Clin. Pract. 2021, 11(4), 755-762; https://doi.org/10.3390/clinpract11040090 - 08 Oct 2021

Cited by 1 | Viewed by 2535

Abstract

Diagnosis-related cost analyzes are important for health economic planning and decision-making. They form the basis for further developing of remuneration systems for health services. The rapid increase in hospital stays by COVID-19 patients requires a valid and exact calculation of the treatment costs. [...] Read more.

Diagnosis-related cost analyzes are important for health economic planning and decision-making. They form the basis for further developing of remuneration systems for health services. The rapid increase in hospital stays by COVID-19 patients requires a valid and exact calculation of the treatment costs. COVID-19 patients with many accompanying illnesses increase the requirements for a cost calculation. The focus of this work is to carry out a DRG-related micro-cost analysis, considering the age, length of stay and comorbidities of COVID-19 patients. So far, there is little information about treatment costs for multimorbid patients with COVID-19 who have not received invasive ventilation. The method is based on a standardized cost unit calculation for determining the treatment costs in a German hospital. The costs (€) of inpatients treated with COVID-19 were compared with a control group of the same DRGs of patients without COVID-19. The average total costs for inpatient treatment were €2866. The highest share of costs falls on nursing, personnel, and material costs of the non-medical infrastructure. Frequent comorbidities were heart failure, diabetes mellitus, other respiratory diseases, dizziness, and impairment of the musculoskeletal system. Full article

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8 pages, 947 KiB

Open AccessCase Report

Delayed Onset Minimal Change Disease as a Manifestation of Lupus Podocytopathy

by Rasha Aly, Xu Zeng, Ratna Acharya and Kiran Upadhyay

Clin. Pract. 2021, 11(4), 747-754; https://doi.org/10.3390/clinpract11040089 - 06 Oct 2021

Cited by 2 | Viewed by 2722

Abstract

Lupus podocytopathy (LP) is an uncommon manifestation of systemic lupus erythematosus (SLE) and is not included in the classification of lupus nephritis. The diagnosis of LP is confirmed by the presence of diffuse foot process effacement in the absence of capillary wall deposits [...] Read more.

Lupus podocytopathy (LP) is an uncommon manifestation of systemic lupus erythematosus (SLE) and is not included in the classification of lupus nephritis. The diagnosis of LP is confirmed by the presence of diffuse foot process effacement in the absence of capillary wall deposits with or without mesangial immune deposits in a patient with SLE. Here we describe a 13-year-old female who presented with nephrotic syndrome (NS) seven years after the diagnosis of SLE. The renal function had been stable for seven years since the SLE diagnosis, as manifested by the normal serum creatinine, serum albumin and absence of proteinuria. Renal biopsy showed evidence of minimal change disease without immune complex deposits or features of membranous nephropathy. Renal function was normal. The patient had an excellent response to steroid therapy with remission within two weeks. The patient remained in remission five months later during the most recent follow-up. This report highlights the importance of renal histology to determine the accurate etiology of NS in patients with SLE. Circulating factors, including cytokines such as interleukin 13, may play a role in the pathophysiology of LP and needs to be studied further in future larger studies. Full article

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19 pages, 6396 KiB

Open AccessArticle

Local Defence System in Healthy Lungs

by Elizabeta Lohova, Zane Vitenberga-Verza, Dzintra Kazoka and Mara Pilmane

Clin. Pract. 2021, 11(4), 728-746; https://doi.org/10.3390/clinpract11040088 - 01 Oct 2021

Cited by 2 | Viewed by 2623

Abstract

Background: The respiratory system is one of the main entrance gates for infection. The aim of this work was to compare the appearance of specific mucosal pro-inflammatory and common anti-microbial defence factors in healthy lung tissue, from an ontogenetic point of view. Materials [...] Read more.

Background: The respiratory system is one of the main entrance gates for infection. The aim of this work was to compare the appearance of specific mucosal pro-inflammatory and common anti-microbial defence factors in healthy lung tissue, from an ontogenetic point of view. Materials and methods: Healthy lung tissues were collected from 15 patients (three females and 12 males) in the age range from 18 to 86. Immunohistochemistry to human β defensin 2 (HBD-2), human β defensin 3 (HBD-3), human β defensin 4 (HBD-4), cathelicidine (LL-37) and interleukine 17A (IL-17A) were performed. Results: The lung tissue material contained bronchial and lung parenchyma material in which no histological changes, connected with the inflammatory process, were detected. During the study, various statistically significant differences were detected in immunoreactive expression between different factors in all lung tissue structures. Conclusion: All healthy lung structures, but especially the cartilage, alveolar epithelium and the alveolar macrophages, are the main locations for the baseline synthesis of antimicrobial proteins and IL-17A. Cartilage shows high functional plasticity of this structure, including significant antimicrobial activity and participation in local lung protection response. Interrelated changes between antimicrobial proteins in different tissue confirm baseline synergistical cooperation of all these factors in healthy lung host defence. Full article

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13 pages, 766 KiB

Open AccessArticle

Assessment of Patient, Physician, Caregiver, and Healthcare Provider-Related Factors Influencing “Glycemic Happiness” of Persons with Type 2 Diabetes Mellitus: An Observational Survey

by Sanjay Kalra, Vijaya Bhaskar Reddy Sagili, Debmalya Sanyal, Pradeep G. Talwalkar, Nareen Krishna Polavarapu, Kumar Gaurav, Amey Mane and Colette Stephen Pinto

Clin. Pract. 2021, 11(4), 715-727; https://doi.org/10.3390/clinpract11040087 - 23 Sep 2021

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Abstract

A multicentric cross-sectional observational survey was conducted to understand the patient, physician, nurse, caregiver, and diabetes counselor/educator-related factors that define the “glycemic happiness” of persons with type 2 diabetes mellitus (T2DM). Five sets of questionnaires based on a five-point Likert scale were used. [...] Read more.

A multicentric cross-sectional observational survey was conducted to understand the patient, physician, nurse, caregiver, and diabetes counselor/educator-related factors that define the “glycemic happiness” of persons with type 2 diabetes mellitus (T2DM). Five sets of questionnaires based on a five-point Likert scale were used. A total of 167 persons with T2DM, 167 caregivers, and 34 each of physicians, nurses, and diabetes counselors/educators participated. For persons with T2DM, an adequate understanding of diabetes (mean score ± standard deviation: 4.2 ± 0.9), happiness and satisfaction with life (4.1 ± 0.8), flexibility (4.2 ± 0.8) and convenience (4.2 ± 0.7) of treatment, and confidence to handle hypo/hyperglycemic episodes (4.0 ± 0.9) were the factors positively associated with glycemic happiness. Caregivers’ factors included information from physicians on patient care (4.5 ± 0.6), constructive conversations with persons with T2DM (4.2 ± 0.8), helping them with regular glucose monitoring (4.2 ± 0.9), and caregivers’ life satisfaction (4.2 ± 0.8). Factors for physicians, nurses, and diabetes counselors/educators were belief in their ability to make a difference in the life of persons with T2DM (4.8 ± 0.4, 4.4 ± 0.5, and 4.5 ± 0.5), satisfaction from being able to help them (4.9 ± 0.3, 4.6 ± 0.5, and 4.6 ± 0.5), and professional satisfaction (4.9 ± 0.4, 4.4 ± 0.6, and 4.7 ± 0.4). Our survey identified the key factors pertaining to different stakeholders in diabetes care, which cumulatively define the glycemic happiness of persons with T2DM. Full article

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7 pages, 3754 KiB

Open AccessArticle

Nanosecond Q-Switched 1064/532 nm Laser to Treat Hyperpigmentations: A Double Center Retrospective Study

by Steven Paul Nisticò, Giovanni Cannarozzo, Eugenio Provenzano, Federica Tamburi, Gilda Fazia, Mario Sannino, Francesca Negosanti, Ester Del Duca, Cataldo Patruno and Luigi Bennardo

Clin. Pract. 2021, 11(4), 708-714; https://doi.org/10.3390/clinpract11040086 - 23 Sep 2021

Cited by 7 | Viewed by 3285

Abstract

(1) Benign hyperpigmentations are a common problem in cosmetic dermatology. Melasma, solar lentigo, and other acquired hyperpigmentations represent an aesthetic issue for an increasing number of patients. The gold standard in managing this condition is currently 1064/532 nanometers (nm) Q-Switched lasers. This study [...] Read more.

(1) Benign hyperpigmentations are a common problem in cosmetic dermatology. Melasma, solar lentigo, and other acquired hyperpigmentations represent an aesthetic issue for an increasing number of patients. The gold standard in managing this condition is currently 1064/532 nanometers (nm) Q-Switched lasers. This study reports our experience on the use of a Q-switched laser with a nanosecond pulse to treat these conditions. (2) Methods: A total of 96 patients asking for benign hyperpigmentation removal were consecutively enrolled at the Magna Graecia University of Catanzaro and Tor Vergata University of Rome. Treating parameters were the following: 1064 nm with a pulse duration of 6 nanoseconds (ns) for dermic lesions and 532 nm with 6 ns for epidermal ones. Up to five treatments with a minimum interval between laser treatments of thirty days were performed. A follow-up visit three months after the last session assessed patient satisfaction with a Visual Analogue Scale (VAS). Two blinded dermatologists assessed the cosmetic result using a five-point scale comparing pictures before treatment and at follow-up. (3) Results: 96 patients were included; 47 participants were women (49.0%) and 49 men (51.0%). The mean reported age was 50.0 ± 17.3 years. All patients reached a good to complete hyperpigmentation removal at the dermatological evaluation with a mean VAS score of 8.91 ± 1.07. (4) Conclusions: Q Switched 1064/532 nm laser may be considered the gold standard treatment for benign hyperpigmentations. Our results confirm the literature findings on the effectiveness of these devices. Full article

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14 pages, 1216 KiB

Open AccessBrief Report

Hyperlipidemia and Obesity’s Role in Immune Dysregulation Underlying the Severity of COVID-19 Infection

by Christopher Khatchadourian, Christina Sisliyan, Kevin Nguyen, Nicole Poladian, Qi Tian, Faraaz Tamjidi, Bao Luong, Manpreet Singh, Jeremiah Robison and Vishwanath Venketaraman

Clin. Pract. 2021, 11(4), 694-707; https://doi.org/10.3390/clinpract11040085 - 22 Sep 2021

Cited by 3 | Viewed by 3405

Abstract

Obesity and hyperlipidemia are known to be risk factors for various pathological disorders, including various forms of infectious respiratory disease, including the current Coronavirus outbreak termed Coronavirus Disease 19 (COVID-19). This review studies the effects of hyperlipidemia and obesity on enhancing the inflammatory [...] Read more.

Obesity and hyperlipidemia are known to be risk factors for various pathological disorders, including various forms of infectious respiratory disease, including the current Coronavirus outbreak termed Coronavirus Disease 19 (COVID-19). This review studies the effects of hyperlipidemia and obesity on enhancing the inflammatory response seen in COVID-19 and potential therapeutic pathways related to these processes. In order to better understand the underlying processes of cytokine and chemokine-induced inflammation, we must further investigate the immunomodulatory effects of agents such as Vitamin D and the reduced form of glutathione as adjunctive therapies for COVID-19 disease. Full article

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Clin. Pract., Volume 11, Issue 4 (December 2021) – 26 articles

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