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Clinics and Practice, Volume 16, Issue 4

2026 April - 18 articles

Cover Story: Fibromyalgia (FM) is a chronic pain syndrome characterized by central sensitization and impaired pain modulation, resulting in persistent musculoskeletal pain, sleep disturbances, depressive symptoms, and fatigue. Serotonin and norepinephrine play a key role in pain regulation, and dual reuptake inhibition appears to provide more effective analgesia than single-pathway approaches. In this integrative review, we assessed 18 randomized clinical trials published between 2015 and 2025 and found that SNRIs reduced pain, fatigue, and depressive symptoms while improving quality of life in patients with FM. Duloxetine showed greater efficacy for pain and depression, whereas milnacipran was more effective for sleep quality. Longer-term studies are still required to assess long-term outcomes. View this paper
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Articles (18)

  • Case Report
  • Open Access
1,171 Views
10 Pages

Clinical Significance of Serum Protein Electrophoresis in Rapid Progression of Multiple Myeloma: A Case Report

  • Silvia Iannelli,
  • Melania Scarcella,
  • Antonella Cusano,
  • Federica Feleppa,
  • Ylenia Pancione,
  • Luigi Michele Pavone and
  • Pasquale Cocchiaro

Background/Objectives: Serum protein electrophoresis (SPE) is a widely used laboratory test for the detection and monitoring of monoclonal gammopathies, including multiple myeloma (MM). Although SPE is usually recommended in the presence of specific...

  • Study Protocol
  • Open Access
546 Views
10 Pages

Assessment of Physical Activity During Radiation Therapy for Lung Cancer: Study Protocol of the APART-LUNG Study

  • Dirk Rades,
  • Maria Karolin Streubel,
  • Laura Doehring,
  • Stefan Janssen,
  • Sabine Bohnet,
  • Christian F. Schulz,
  • Hanne Falk Grauslund and
  • Charlotte Kristiansen

Background/Objectives: Radiation therapy is a common treatment modality for non-small-cell and small-cell lung cancer that can be associated with considerable side effects, mainly reactions of healthy tissues in the radiation field. Radiation therapy...

  • Article
  • Open Access
701 Views
12 Pages

Outcomes of Intracranial Haemorrhage in Patients Taking Direct Oral Anticoagulants or Vitamin K Antagonists: A Seven-Year Single-Centre Retrospective Analysis

  • Mallika Sathitwat,
  • Surat Tanprawate,
  • Atiwat Soontornpun,
  • Chayasak Wantaneeyawong,
  • Chutithep Teekaput,
  • Nopdanai Sirimaharaj,
  • Angkana Nudsasarn,
  • Chatree Chai-Adisaksopha and
  • Kitti Thiankhaw

Background: The clinical outcomes of patients with intracranial haemorrhage (ICH) whilst using direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) are uncertain. This study aimed to assess outcomes and management in patients receiving...

  • Article
  • Open Access
546 Views
16 Pages

Recommended Cardiometabolic Screening Guidelines for Unhoused Adults: A Street Medicine Needs Assessment

  • Sanjana Arun,
  • Joaquin Cardozo,
  • Andre Shon Hirakawa,
  • Teresa Anh Tran,
  • Van Dexter Calo and
  • Robert Fauer

Background: Unhoused individuals face disproportionately high rates of preventable chronic disease due to fragmented access to care and prolonged exposure to environmental stressors. Street medicine programs offer a mobile, low-barrier model to asses...

  • Systematic Review
  • Open Access
13,183 Views
10 Pages

Systematic Review: The Impact of COVID-19 Vaccination on Myocarditis Risk and Recovery

  • Yibo Liu,
  • Christopher Khatchadourian,
  • Luke Sanders,
  • Quincy Eweroke,
  • Cyvannah Warner-McCutcheon,
  • Jackson Lewis,
  • Joaquin Santos and
  • Vishwanath Venketaraman

Background: Myocarditis is an uncommon but recognized adverse event following mRNA COVID-19 vaccination, with risk varying by age, sex, dose number, and vaccine product. Clarifying the magnitude of risk, clinical course, and recovery—relative t...

  • Article
  • Open Access
512 Views
13 Pages

Angiogenic Imbalance Defines Multisystem Phenotypes of Preeclampsia: A Phenotype-Oriented Cohort Study

  • Anca Tătaru-Copos,
  • Florin Szasz,
  • Anca Carmen Huniadi,
  • Rodica Georgeta Negrini,
  • Mircea Ioachim Popescu,
  • Paula Trif,
  • Gelu Florin Murvai,
  • Radu Galiș,
  • Cristian Sava and
  • Romina Viorela Murvai

Background: Preeclampsia is a heterogeneous multisystem disorder characterized by endothelial dysfunction and angiogenic imbalance. While the sFlt-1/PlGF ratio is widely used for diagnostic purposes, its role in defining biological phenotypes of pree...

  • Review
  • Open Access
1,065 Views
15 Pages

Efficacy and Safety of Platelet-Rich Plasma in Knee Osteoarthritis: Umbrella Meta-Analysis Based on Clinical Evidence, Methodological Quality and Therapeutic Positioning

  • María Ángeles Ventura-García,
  • Tesifón Parrón-Carreño,
  • David Lozano-Paniagua,
  • Bruno José Nievas-Soriano,
  • Antonio Fernando Murillo-Cancho,
  • Elena María Gázquez-Aguilera and
  • Delia Cristobal-Cañadas

Background/Objectives: Despite being a standard biological therapy for knee osteoarthritis, inconsistent results across studies—due to varied protocols—have obscured the clinical standing of platelet-rich plasma. This meta-analysis evalua...

  • Systematic Review
  • Open Access
883 Views
18 Pages

Background/Objectives: Knee joint instability is frequently reported in individuals with knee osteoarthritis (OA) and may persist after total knee replacement (TKR), where it represents a leading cause of revision. However, neuromuscular factors asso...

  • Article
  • Open Access
690 Views
13 Pages

Complications Related to Urgent Initiation of Peritoneal Dialysis in a Mexican Hospital with Limited Resources: A Prospective Cohort

  • Camila Baas-Yama,
  • Eduardo Rivera-Huerta,
  • Ivan Zepeda-Quiroz,
  • Carlos A. Guzmán-Martín,
  • Demian Trueba-Lozano,
  • Sebastian Toledo-Ramirez,
  • Ana Ortega-Gonzalez,
  • Irma Archundia-Riveros,
  • Brenda Barrera-Mota and
  • Daniel Juárez-Villa
  • + 2 authors

Background: Urgent-start peritoneal dialysis (UPD) has emerged as an alternative modality for initiating kidney replacement therapy when immediate hemodialysis is not available. However, early initiation after catheter placement may increase the risk...

  • Article
  • Open Access
581 Views
14 Pages

Real-World Distributions and Concordance of C-Reactive Protein and Erythrocyte Sedimentation Rate Across Rheumatic Diseases

  • Claudiu C. Popescu,
  • Luminița Enache,
  • Carmen Ștențel,
  • Corina Mogoșan and
  • Cătălin Codreanu

Objective: The objective of this study was to characterize real-world distributions of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) across major rheumatic diagnoses and to quantify concordance/discordance patterns and combined CR...

  • Technical Note
  • Open Access
794 Views
11 Pages

High-Volume LVA—New Surgical Technique for Treatment of Lymphoceles in the Groin

  • Daniel Schiltz,
  • Mahsa Bagheri Borgolte,
  • Stephan Schreml,
  • Philipp Lamby,
  • Adrian Vater,
  • Lukas Prantl and
  • Uwe von Fritschen

Background: Groin lymphoceles are common postoperative complications after vascular interventions that can be difficult to treat, especially in recurrent or complex cases. While lymphovenous anastomosis (LVA) is a potential, minimally invasive option...

  • Article
  • Open Access
582 Views
13 Pages

Objectives: Temporomandibular disorders (TMDs) are common but often underrecognized and inadequately managed in primary healthcare, which may delay diagnosis and appropriate care. This study aimed to compare TMD-related knowledge, awareness, and clin...

  • Article
  • Open Access
547 Views
13 Pages

Evaluation of a Cognitive Aid Application to Improve Non-Technical Skills in Simulated Cardiopulmonary Resuscitation (CPR): A Randomised Controlled Trial

  • Carlos Ramon Hölzing,
  • Tristan Ernst,
  • Thomas Wurmb,
  • Tobias Grundgeiger,
  • Patrick Meybohm and
  • Oliver Happel

Background/Objectives: The success of cardiopulmonary resuscitation relies on both technical and non-technical skills. Cognitive aids, such as checklists, have been shown to enhance technical performance in emergencies. The aim of this study was to e...

  • Review
  • Open Access
1 Citations
2,144 Views
23 Pages

Serotonin–Norepinephrine Reuptake Inhibitors in Fibromyalgia Management: An Integrative Literature Review of Clinical Evidence

  • Isabella Oliveira do Lago,
  • Bruna Moura Medina Diniz,
  • Daniela Vieira Buchaim and
  • Rogerio Leone Buchaim

Fibromyalgia (FM) is a chronic pain syndrome characterized by central sensitization and impaired pain modulation, involving dysfunctional descending inhibitory pathways and altered nociceptive processing. These processes contribute to persistent musc...

  • Article
  • Open Access
753 Views
12 Pages

Atrial Fibrillation Modifies the Relationship Between Beta Blocker Dose and Physical Capacity After Myocardial Infarction

  • Paulina Rabiej-Krzys,
  • Karolina Szczygiel,
  • Rafal Lenard,
  • Francesco Perone and
  • Joanna Popiolek-Kalisz

Background: Atrial fibrillation (AF) is a common arrythmia in post-myocardial infarction (MI) cardiac rehabilitation (CR) cohorts, and beta-adrenergic signaling remodeling and rate-control pharmacotherapy may influence functional capacity. Methods: W...

  • Article
  • Open Access
714 Views
10 Pages

Quality of ChatGPT-Generated Responses to Common Patient Questions About Peripheral Nerve Stimulation: A Cross-Sectional Study

  • Charles A. Odonkor,
  • Muhammad Uzair Siddique,
  • Sarvesh Palaniappan,
  • Jacob Locklear,
  • Sreekrishna Pokuri,
  • Alexandra Adler,
  • Peju Adekoya,
  • Annie W. Hsu,
  • Jonathan Paek and
  • Alaa Abd El Sayed
  • + 5 authors

Background: Peripheral nerve stimulation (PNS) is increasingly used in selected patients with neuropathic pain, and many individuals seek supplemental online information to clarify procedural expectations and postoperative care. Large language models...

  • Article
  • Open Access
546 Views
20 Pages

Background: Mild traumatic brain injury (mTBI) is frequently associated with persistent cognitive and psychosocial symptoms, yet biological correlates of recovery remain poorly understood, particularly among Asian and Pacific Islander (API) populatio...

  • Review
  • Open Access
1,131 Views
23 Pages

Background: Herpes simplex virus (HSV), Epstein–Barr virus (EBV), and cytomegalovirus (CMV) establish lifelong latency in sensory neurons, lymphoid tissue, and myeloid–endothelial cells, respectively. A substantial proportion of adults wo...

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Clin. Pract. - ISSN 2039-7283