Menopause transition or perimenopause is the transitional period preceding menopause, marked by hormonal variability and menstrual irregularity. This period is associated with a wide range of clinical findings due to reduced levels of estrogen. The skin, in particular, is affected by the decline in estrogen, specifically 17β-estradiol and dehydroepiandrosterone, along with an increase in cortisol. The sudden onset of various menopause symptoms can be distressing for many women and significantly impacts their quality of life. The genitourinary syndrome of menopause, a typical result of hypoestrogenism, is characterized by signs and symptoms relevant to urogenital atrophy. In this discussion, we focus on the aesthetically relevant symptoms of perimenopause and the approach to management. Most of these findings, including hot flashes, rosacea flares, worsening skin quality with dryness, sagging, and increased wrinkling, dyschromia, hair thinning, and cellulite, can be effectively managed. The provider should be aware of the emotional changes that occur during perimenopause and ensure that patients have a healthy and balanced motivation for seeking treatment. We discuss valid treatment options such as hormone replacement therapy, minimally invasive procedures, and topical products, including the new dermocosmetic regimens. Because many of these treatments are geared toward maintaining results, consistency is paramount for achieving successful outcomes.
Introduction ChatGPT is a cost-effective artificial intelligence (AI) tool designed to facilitate virtual interactions with humans, and its application in healthcare is expanding. However, research on ChatGPT's effectiveness in public healthcare, particularly for cardiac patients, is still limited. This study aims to evaluate ChatGPT's potential in managing cardiovascular health for patients with acute or chronic cardiac conditions.Methods We analyzed real medical records from 'The Cardiovascular Care' program, affiliated with a university outpatient clinic. ChatGPT's performance was evaluated in terms of its ability to analyze clinical cases, propose diagnoses, and recommend appropriate actions. We also assessed whether ChatGPT's accuracy and errors varied depending on disease severity, rarity, mortality risk, and urgency.Results When compared to physicians' records, ChatGPT provided correct responses in 43% of diagnostic hypotheses, 5% of recommended supplementary exams, and 10% of laboratory tests. It showed significant accuracy and discernment in diagnosing conditions influenced by factors such as severity, rarity, risk of death, and urgency. However, this discernment did not extend to recommendations for supplementary exams and laboratory tests. Interestingly, while ChatGPT's responses in these areas were often only partially accurate, they tended to be more detailed, sometimes unnecessarily so, than those provided by physicians. Diagnostic hypotheses from multiple models, including ChatGPT Health, DeepSeek, Gemini Pro, Perplexity AI, and ESC Chat, were also evaluated. Performance varied across models, with ChatGPT demonstrating the highest diagnostic accuracy among those assessed, despite still producing incorrect outputs.Conclusion Although ChatGPT demonstrates some diagnostic capability, its overall reliability remains questionable, with performance at times approaching random chance. Caution is advised when considering its use in clinical decision-making.
Mastopexy is a widely performed plastic surgery procedure for aesthetic breast correction and may present infectious complications. The main agents isolated in this context are staphylococci, especially Staphylococcus aureus. A 38-year-old female patient, previously healthy, with a history of breastfeeding both children up to six months of age, underwent mastopexy on 06/24/2023 with a 275 mL implant in the subglandular plane, combined with lipoabdominoplasty, without immediate surgical complications. Approximately one year after the procedure, she developed pain and discomfort in the left breast, which led to hospital admission. Empiric antibiotic therapy with amoxicillin-clavulanate was started and, after therapeutic failure, trimethoprim-sulfamethoxazole (TMP-SMX) was used with initial clinical improvement; however, there was subsequent recurrence and worsening of the inflammatory condition. She then underwent ultrasound-guided breast aspiration and secretion culture, with sample collection performed on 06/28/2024. Serratia marcescens was identified, and the antibiogram showed resistance to aztreonam, cefepime, ceftazidime, and ciprofloxacin, with susceptibility to amikacin, gentamicin, meropenem, imipenem, ertapenem, piperacillin-tazobactam, trimethoprim-sulfamethoxazole, and levofloxacin (with increased exposure). The strain produced extended-spectrum beta-lactamase (ESBL) and had possible expression of AmpC beta-lactamase, which limits the use of cephalosporins and penicillins even when in vitro susceptibility appears favorable. Despite susceptibility to TMP-SMX, the favorable initial clinical response followed by recurrence raised the hypothesis of bacterial biofilm formation. After multiple antibiotic cycles, successive recurrences, and hyperbaric oxygen therapy sessions, the patient underwent removal of the breast implant and surgical drainage of the abscess on 08/13/2024, with progressive clinical improvement associated with TMP-SMX use. Breast abscess caused by Serratia marcescens, an opportunistic, multidrug-resistant enterobacterium, is uncommon, especially in late infections, and represents a therapeutic challenge. This report reinforces the importance of detailed microbiological investigation in atypical cases and therapeutic adaptation based on susceptibility testing. It highlights the need for vigilance in late postoperative follow-up and strict infection-control protocols in elective procedures, contributing to clinical management and prevention of similar cases.
O presente estudo revisa a literatura científica sobre as alterações na assimetria cerebral observadas em pacientes com Transtorno do Espectro Autista (TEA) e Transtorno do Desenvolvimento da Linguagem (TDL). A lateralização hemisférica é um processo neurobiológico fundamental para o processamento linguístico eficiente e a integração de informações sociais. Através de uma revisão sistemática, verificou-se que indivíduos com essas condições apresentam, frequentemente, uma redução na assimetria funcional e estrutural típica, especialmente nas regiões perissilvianas e no planum temporale. Os resultados sugerem que a organização cerebral mais simétrica, observada nestas populações, está correlacionada a déficits na fluência verbal e na capacidade de integração social. Conclui-se que a plasticidade cerebral e a neurobiologia da lateralização são campos promissores para o desenvolvimento de intervenções clínicas mais eficazes.
