Thyroid cancer is the most common endocrine malignancy and is rarely diagnosed during childhood, representing approximately 4% of all pediatric cancers. At the time of diagnosis, these patients often present with more advanced disease, larger tumors, frequent extrathyroidal extension, lymph node involvement, and distant metastases. We present a case of a 10-year-old male schoolchild diagnosed with papillary thyroid carcinoma presenting with metastatic pulmonary disease at debut. He was treated with total thyroidectomy, bilateral cervical lymph node dissection, radioiodine, sorafenib, and levothyroxine. During total body scanning, increased concentration of the radiotracer was observed in both kidneys, coinciding with hyperrefractive areas on computed tomography, confirming the diagnosis of renal metastasis. This pathology has been observed in less than 1% of cases of differentiated thyroid carcinoma in pediatric patients worldwide and is the first such case reported in the Venezuelan literature.
Introduction: Post-bronchodilator (BD) spirometry testing is required for a diagnosis of airflow obstruction (AO) and COPD. We compared the impact of pre- and post-BD AO, as well as that of pre-BD and post-BD reference values, on survival, exacerbations, and FEV1 decline. Methods: We analyzed data derived from the Proyecto Latinoamericano de Investigación en Obstrucción Pulmonar (PLATINO, Latin American Project for the Investigation of Obstructive Lung Disease) study, involving individuals residing in three Latin American cities and evaluated 5-9 years after baseline examination. Categories were formed by pre-and post-BD FEV1 /FVC < the 5th percentile (lower limit of normal) by PLATINO reference values (pre-BD and post-BD). Results: At baseline, 2,942 participants completed pre- and post-BD spirometry; 2,262 were normal (controls); 139 had pre-BD AO (FEV1 /FVC below the lower limit of normal; reversible AO); 230 had preBD and post-BD AO (persistent AO); 43 had only post-BD AO; and 148 had a preserved ratio impaired spirometry (PRISm) pattern. Additionally, 105 individuals had post-BD AO by post-BD reference values. When compared with controls, the reversible AO group (hazard ratio [HR] = 1.9; 95% CI, 1.1-3.1), the persistent AO group (HR = 2.99; 95% CI, 2.1-4.3), the PRISm group (HR = 1.6; 95% CI, 0.9-2.7), and the group of patients with AO by post-BD reference values (HR = 1.9; 95% CI, 1.1-3.4) had a higher mortality; those with a PRISm pattern and those with persistent AO had more exacerbations, and the latter group had an additional FEV1 decline in adjusted models (−13.4 mL/year; 95% CI, −6 to −21). The reversible AO group had a higher risk of developing COPD (post-BD AO) during follow-up (OR = 4.1; 95% CI, 2.0-8.5). Conclusions: Individuals with post-BD AO identified only with post-BD reference values had an increased risk of death. Those with pre-BD AO had higher mortality and an increased risk of developing COPD, therefore requiring close follow-up monitoring and being classified as pre-COPD patients.
Leadership in surgery is increasingly recognised as a core professional competency that extends beyond technical expertise and individual authority. In contemporary surgical practice, where patient care depends on multidisciplinary coordination, rapid decision-making, technological innovation, and high-risk clinical judgement, the surgeon’s leadership role directly influences team performance, patient safety, and surgical outcomes. This article critically examines leadership in the surgeon and its benefits in surgical practice by emphasising the integration of technical competence with non-technical skills, including communication, situational awareness, emotional intelligence, ethical judgement, teamwork, adaptability, and reflective decision-making. Rather than viewing leadership as a fixed personal attribute, the discussion conceptualises surgical leadership as a dynamic, context-sensitive practice shaped by team maturity, clinical complexity, institutional culture, and patient needs. Transformational, situational, democratic, and strategic leadership approaches are particularly relevant in promoting trust, reducing preventable errors, encouraging shared responsibility, and strengthening professional development within surgical teams. However, ineffective leadership, including authoritarian control, poor communication, micromanagement, and failure to value feedback, may undermine morale, increase burnout, and compromise clinical safety. The article argues that leadership training should be systematically embedded within surgical education and residency programmes to cultivate surgeons who are not only clinically competent, but also ethically grounded, emotionally intelligent, and capable of leading safer, more collaborative surgical systems.
La gestión del tiempo en cirugía es un factor crítico para el bienestar del cirujano, que trasciende el enfoque tradicional en la eficiencia intraoperatoria. El artículo argumenta que la excesiva atención en optimizar el tiempo dentro del quirófano (mediante estandarización de procedimientos y herramientas como el "timeout") ignora por completo la abrumadora carga de trabajo extraoperatoria. Esta incluye responsabilidades administrativas, gestión de consultas pre y postoperatorias, y obligaciones académicas y de investigación, las cuales a menudo se realizan en tiempo personal. La limitada autonomía para gestionar este tiempo fuera del quirófano y la falta de límites claros son factores determinantes que elevan el riesgo de síndrome de burnout, el cual afecta a aproximadamente un 40% de los cirujanos. Las consecuencias de esta mala gestión son un deterioro grave de la salud física y mental del profesional (fatiga crónica, privación de sueño) y un impacto negativo en la seguridad y calidad de la atención al paciente. Se trata de un problema sistémico que requiere soluciones institucionales. Las organizaciones de salud tienen la responsabilidad fundamental de implementar políticas de descanso adecuadas, invertir en personal de apoyo para aligerar la carga administrativa y fomentar una cultura que priorice el equilibrio laboral-personal. Para lograr esto, la integración del análisis de datos y la inteligencia artificial (IA) surge como una estrategia tecnológica clave, permitiendo desde la automatización de procesos de triaje preoperatorio hasta la programación predictiva y resolución de conflictos en la agenda de quirófanos. En conclusión, la inversión en el bienestar del cirujano, apoyada en estas tecnologías de gestión, es una inversión directa en la seguridad del paciente y la sostenibilidad del sistema de salud
