Introduction: Lung cancer (LC) is one of the most frequent tumors and remains the leading cause of cancer-related death. Improvements in treatment and the possible increase in cases diagnosed at early stages through screening programs mean that the number of long-term survivors of lung cancer is expected to increase. Objective: To review the concept of long-term survival in lung cancer and the clinical, psychosocial, and follow-up needs of this growing population of patients. Methods: A narrative review was prepared based on epidemiological data, clinical studies, and consensus documents on long-term survivors of lung cancer, particularly non-small cell lung cancer. The literature search was conducted across the PubMed, Scopus, and Cochrane Library databases. The search strategy employed MeSH terms and keywords including "Lung Neoplasms", "Survivors", "Long-Term Survivors", "Mass Screening", and "Primary Health Care", limited to articles published in English and Spanish. Results: Survival is strongly conditioned by stage at diagnosis. There is no single definition of long-term survivor: in early-stage non-small cell lung cancer is usually defined as survival of 5 years or more, whereas in advanced or metastatic disease definitions vary between 18 months and 3 years. Long-term survivors may present recurrence or progression, second neoplasms, comorbidities related to smoking, immune-mediated toxicities, pain, fatigue, anxiety, depression, and difficulties in social and occupational reintegration. Conclusions: The increasing number of long-term lung cancer survivors requires coordinated follow-up between primary care, hospital care, social and health services, patients, and families. Smoking cessation, management of comorbidities, physical exercise, psychological support, nutritional interventions, and monitoring of treatment-related toxicity should be integral parts of care.
Introduction: phototherapy (PT) is an effective treatment for neonatal hyperbilirubinemia; however, controversy persists regarding the need for in-hospital observation after discontinuation to detect possible “rebound.” The aim was to evaluate the frequency with which hospitalization is prolonged solely for bilirubin monitoring after discontinuing PT and its usefulness in identifying clinically significant rebound. Material and methods: a retrospective analytical cohort study was conducted in a tertiary hospital (2019–2022), including newborns ≥35 weeks admitted for hyperbilirubinemia and treated with PT. Two strategies after discontinuation of PT were compared: inpatient observation versus discharge with outpatient follow-up. The primary outcome was the detection of rebound, defined as the return of bilirubin to the phototherapy threshold within 72-96 hours. Results: 155 infants were included; 60 (38.7%) remained hospitalized for monitoring and 95 (61.2%) were discharged with outpatient follow-up. Baseline characteristics, bilirubin levels, and duration of PT were similar between groups. The total hospital stay was longer in the observation group (mean 2.57 days) than in the immediate discharge group (1.75 days), but this difference was not statistically significant (p=0.053). The overall incidence of rebound was 3.2% (5/155): one case was detected during in-hospital observation and four during outpatient follow-up (48–72 hours). No adverse events were reported. Conclusions: clinically significant rebound after phototherapy discontinuation was uncommon and rarely detected during immediate inpatient observation. In selected low-risk term newborns with reliable outpatient follow-up, routine prolongation of hospitalization for rebound monitoring may be unnecessary, whereas higher-risk infants may still require closer surveillance. These findings should be interpreted cautiously given the retrospective single-center design and the limited number of rebound events.
Pneumomediastinum is defined as the presence of free air within the mediastinal cavity and most commonly occurs as a result of spontaneous alveolar rupture or thoracic trauma. Iatrogenic pneumomediastinum secondary to dental procedures is exceedingly rare, particularly in the pediatric population. High-speed air-turbine dental drills may introduce pressurized air into disrupted dentoalveolar tissues, enabling air to dissect along cervical fascial planes and track into the mediastinum through the submandibular and retropharyngeal spaces. In this report, we present a rare case of pneumomediastinum developing after a routine dental filling in an adolescent patient.
Sleep is necessary for the psychological, physiological, and emotional growth of children and adolescents. Pediatric sleep disorders are common and sometimes overlooked by health professionals. Recent developments in screen time have led to more sleep-related problems among adolescents. Encouraging good sleep habits and limiting screen time in children is crucial for their health. Pediatricians have a responsibility to incorporate sleep hygiene advice and routine sleep checks into their practice to promote healthy child development. Heightened awareness, public health initiatives, and interdisciplinary collaboration are essential to tackle this pervasive problem effectively. This study is a narrative review of the literature on sleep disorders and sleep hygiene in children and adolescents. Relevant publications were identified through searches of PubMed, Scopus, and SciELO databases using the following keywords: "pediatric sleep disorders," "sleep hygiene children," "screen time sleep adolescents," "obstructive sleep apnea children," "parasomnias childhood," and "behavioral insomnia pediatric." Priority was given to publications from 2019 onwards; however, seminal studies published before this date were also included where appropriate. Articles were selected based on their relevance to the scope of the review. Editorials and opinion pieces without supporting data were excluded.
Case-based learning is considered a form of active learning that prepares and qualifies students for their future professional field. It has many positive educational impacts, such as bridging theoretical or academic concepts to clinical practice, enhancing critical thinking, improving long-term knowledge retention and the persistence of educational attainment, and developing collaboration and communication skills. However, its implementation in medical education faces obstacles and challenges, including resource limitations, untrained tutors, complex group dynamics, and integration issues with other modules and courses. These challenges and obstacles stem from a lack of practical experience or a poor understanding of the nature of this learning method and the extent of its differences from problem-based learning. So, this study aims to present a review scope about successful implementation and management of case-based learning sessions in medical education prompting positive aspects and avoiding negative points. Moreover, the study focused on other application forms of case-based learning sessions that may be applied in medical education, such as virtual case-based learning or introducing role-play simulation in case-based learning sessions.
Introduction: This prospective observational study evaluated the age at thelarche and menarche in internationally adopted girls in Spain and analyzed height and body mass index trends at these pubertal milestones. Material and methods: The study included 102 healthy girls adopted in Spain between 1998 and 2008 from Russia/Ukraine (38), China (34), India/Nepal (17), and Latin America (13). Growth and pubertal development were assessed using standardized procedures. Families were trained to recognize thelarche and menarche, allowing clinical confirmation and anthropometric evaluation. Measurements obtained at adoption, thelarche and menarche were compared with WHO Child Growth Standards, and z-scores were calculated. Pearson correlation coefficients were used to assess associations. Results: Mean age at adoption was 3.5 years. Girls from India/Nepal and Latin America were adopted later, whereas those from China were adopted younger. At adoption, the cohort showed height delay with greater deficits in height than weight. Mean age at thelarche was 9.7 years, occurring earlier in girls from Latin America and India/Nepal and later in girls from China. A significant negative correlation was found between age at adoption and age at thelarche (r = -0.43, p < 0.001), indicating that later adoption was associated with earlier pubertal onset. Height normalized at thelarche, reflecting marked catch-up growth, and no association was observed between anthropometric measures at adoption and at thelarche. Mean age at menarche was 11.7 years, with earlier onset in girls from Latin America and India/Nepal and later onset in girls from China. Age at adoption was also negatively correlated with age at menarche (r = -0.48, p < 0.001). Although menarche occurred earlier in girls adopted later, growth patterns at this pubertal milestone were unrelated to age at adoption. Conclusions: Internationally adopted girls in Spain experienced early thelarche and menarche, particularly when adopted at older ages, independent of later growth patterns.
Intracranial calcification is a rare complication of endocrine disorders, such as hypothyroidism. We present a case of a 37-year-old woman who had recurrent generalized tonic-clonic seizures since the age of 19 that were unresponsive to antiepileptic medications. Upon examination, cerebellar ataxia was observed. A brain CT scan and laboratory investigations conducted in April 2023 revealed extensive bilateral symmetric cerebral and cerebellar calcifications, hypothyroidism, hypocalcemia, hypophosphatemia, vitamin D deficiency, and normal levels of parathyroid hormone and kidney, and liver function tests. Antithyroid peroxidase antibodies were negative. The patient's brain calcifications, epilepsy, and ataxia were attributed to chronic hypocalcemia secondary to hypothyroidism and vitamin D deficiency. Treatment included levothyroxine, calcium, vitamin D supplements, and antiepileptic drugs (oxcarbazepine and levetiracetam). Over a year of follow-up, significant medical and neurological improvements were noted, with normalization of thyroid function tests and well-controlled seizures on medication. In conclusion, extensive intracranial calcification and recurrent seizures are uncommon complications of hypothyroidism, likely due to chronic hypocalcemia and hypovitaminosis D. Management involved long-term therapy with levothyroxine, calcium, vitamin D supplements, and antiepileptic drugs.
Introduction: Musculoskeletal and voice disorders are common among teachers. The prevalence of musculoskeletal disorders in these workers can reach 77.9%. In addition, they suffer from voice disorder two or three times more often than the general population. The aim of this study is to recognize musculoskeletal disorders, vocal health conditions, and associated factors present in teachers. Material and methods: An integrative review with a comprehensive search of literature was carried out in seven databases: Embase, Medline Complete, ProQuest, PubMed, ScienceDirect, Virtual Health Library and Web of Science. Articles published in Spanish, English and Portuguese related to the topic of interest were considered. Results: The two studies that met the inclusion criteria and were analyzed in this review were conducted in Brazil. According to the results of the studies included, teachers are a population at risk of developing musculoskeletal disorders and voice disorders. Teachers with or without voice disorders report musculoskeletal pain in all body regions. Conclusions: Teachers are a profession with a high prevalence of musculoskeletal and voice disorders, but little is known about this relationship. Therefore, more research is needed to understand the behavior of occupational risk factors that can generate these problems during their daily activities to prevent possible occupational diseases through actions in safety and health at work.
Introduction: Eating disorders (EDs) are a group of entities that are characterized by a persistent alteration in behavior in the face of basic food needs, which cause alterations in the absorption of food and damages to physical health or psychosocial functioning. Although the DSM criteria are used for the diagnosis of EDs, screening with simple tools, such as the SCOFF scale, is recommended to identify people at risk and implement the necessary preventive measures. The objective was to determine the frequency of possible EDs and to establish their association with various clinical factors. Material and methods: A cross-sectional study belonging to the research project Quality of life in menopause and Colombian ethnicities [CAVIMEC]. It was performed in women self-identified as Afro-descendants, with skin phototype V-VI and aged between 40-59 years. The SCOFF questionnaire was applied, a five-item tool that allows establishing the existence of possible EDs. Bivariate and adjusted logistic regression was performed, considering possible EDs as a dependent variable, clinical factors as independent variables, and as covariates: age, coffee consumption, and smoking. Results: 420 women were studied, 22.8% postmenopausal and possible EDs in 130 (30.9%) of the participants. The following were associated with eating disorders: mood alterations with menstruation OR: 4.92 [95%CI: 2.60-9.32], more than one severe depressive episode OR: 4.81 [95%CI: 1.19-19.3], consultation with psychology OR: 4.11 [95%CI: 2.09-8.12], consultation with psychiatry OR: 3.73 [95%CI: 1.05-13.21], increased metabolic risk OR: 3.53 [95%CI: 2.09-5.95], abdominal hysterectomy: 3.19 [95%CI: 1.45-7.00], excessive sadness after childbirth OR: 3.15 [95%CI: 1.11-8.86], abdominal obesity OR: 3.14 [95%CI: 1.54-6.39], diabetes mellitus OR: 2.99 [95% CI: 1.56-5.72], obesity OR: 2.33 [95%CI: 1.26-3.94], postmenopause OR: 2.05 [95%CI: 1.25-3.37]. Conclusions: In a group of Afro-descendant women in middle age, it was found that one third had possible EDs. Several clinical factors were significantly associated with an increased chance of EDs.
Introduction: A prerequisite for ensuring a good clinical and functional outcome in total knee arthroplasty is knowing the preoperative leg alignment. This alignment is obtained using a long radiograph including the hip and knee, or a computer algorithm derived from palpation of landmarks and mapping of bone structures. It has been recommended to omit the preoperative radiograph if technology-assisted systems are to be used, but doubts exist regarding the similarity between both measurements, especially in frontal varus or valgus deformities. Material and methods: The preoperative leg alignment was analyzed in 123 patients scheduled for total knee arthroplasty. Thirty-eight had a preoperative valgus axis radiographically, and 85 had a varus axis. A computer program was used to perform the radiographic measurement of the mechanical axis of the leg, and at the start of the procedure, this same measurement was verified with a technology-assisted navigation system (TAS). Results: In the valgus group, the mean preoperative radiographic axis was 169.1º (SD 5.06), while the axis measured using the TAS was 171.9º (SD 3.96) (p=0.009). In the varus group, the mean radiographic axis was 191.9º (SD 5.86), and the axis measured using the TAS was 189.7º (SD 4.84) (p=0.008). The Pearson correlation coefficient comparing both measurements was 0.650 in the varus group and 0.237 in the valgus group (p=0.151). Conclusions: The discrepancy between limb axis measurements obtained radiographically and those obtained with technological aids does not preclude the use of radiography in the preoperative evaluation of total knee arthroplasties.
Introduction: Excessive video gaming is a problem between adolescent. COVID-19 increased this problem during the pandemic. This study aimed to assess how the COVID-19 pandemic influenced the gaming behaviors of adolescents who engaged in excessive video gaming. Material and methods: Conducted between June and July 2021, this research constitutes the second phase of a pre-pandemic study involving adolescents aged 11–18 who had previously been identified as playing video games for more than two hours daily. In this phase, the same participants were re-evaluated during the pandemic to assess changes in their gaming habits and associated risk factors. Adolescents who played less than two hours per day served as the control group. Data collected included screen time, substance use, exercise and nutrition habits, and scores from the Internet Gaming Disorder Scale–Short Form (IGDS9-SF), Pittsburgh Sleep Quality Index (PSQI), and Children’s Depression Inventory (CDI). Results: Among excessive video game players, both screen time (p < 0.001) and daily exercise duration (p = 0.001) increased significantly during the pandemic. There was also an increase in the popularity of online multiplayer and fantasy games. Although excessive players scored significantly higher than the control group on the PSQI and IGDS9-SF, no significant difference was observed in CDI scores (p = 0.091). Conclusions: Despite the increase in screen time among excessive players, problematic gaming behaviors did not escalate. These participants had received at least one motivational interviewing session following their initial identification of problematic video gaming behavior in the first phase of the study. This intervention may have served as a protective factor against the potential negative effects of the pandemic on problematic gaming, depressive symptoms, sleep disturbances, and sedentary behavior.
Mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episode (MELAS) syndrome is a rare genetic mitochondrial disease. Children are the most affected, but this syndrome can manifest at any age. The mA3243G is the most common mutation related to MELAS syndrome. Neurological complications are more frequently discussed in literature. However, it is imperative to address and discuss the non-neurological manifestations so that clinicians do not inadvertently overlook this disease. These are more common in adult patients and may appear before neurological symptoms. We conducted a narrative review of articles published between 2012 and 2024, with particular focus on on non-neurological disorders of MELAS syndrome. We found 657 papers related to MELAS syndrome. Only 31 papers discussed non-neurological complications. We divided those into cardiovascular, endocrinological, digestive, renal, and nutritional symptoms. The most prevalent disorders include hypertrophic cardiomyopathy, Wolff-Parkinson-White syndrome, chronic renal disease, intestinal pseudo-obstruction syndrome and malnutrition. The authors of this narrative review seek to shine light on non-neurological manifestations of MELAS syndrome. These are rarely described in the medical literature, despite their potentially significant clinical implications, especially in adult patients. Understanding the neurological and non-neurological complications associated with MELAS syndrome is essential for achieving a timely and definitive diagnosis.
Mondor’s disease is a rare superficial thrombophlebitis, most often affecting the thoracoepigastric vein, with an estimated incidence of 0.5–0.9%. Although benign and self-limiting, it may mimic serious conditions such as inflammatory breast cancer or breast abscess, making clinical awareness essential. Mondor’s disease, though often idiopathic, may be associated with trauma, intense physical activity, iatrogenic interventions, or systemic conditions. This report aims to raise clinical suspicion in daily practice, facilitating timely diagnosis and appropriate management. We report the case of a 35-year-old male, active in competitive football, who presented with a 10-day history of a cord-like, painful induration along the right hemithorax. Examination confirmed a tender cord on the lateral chest wall, while laboratory tests and chest radiography were unremarkable. Ultrasound revealed thrombosis of a descending superficial thoracic vein. The patient was managed with nonsteroidal anti-inflammatory drugs, with complete spontaneous resolution within four weeks and no need for anticoagulation.
Introduction: Common technical errors in dual-energy X-ray absorptiometry (DXA) exams may compromise diagnostic accuracy. This study aims to analyze the frequency and types of those errors in DXA scans performed in a referral center. Material and methods: This cross-sectional study evaluated 100 DXA exams performed at multiple radiology clinics and analyzed at the General Outpatient Clinic of the Medical Residency Program in Endocrinology and Metabolism at Alcides Carneiro University Hospital (HUAC), in Campina Grande. Exams were assessed for technical errors, including improper positioning, vertebral exclusion, and inaccurate region of interest (ROI) definition. Patient demographic data (age, sex, body mass index) were also collected. Descriptive statistics were used to summarize patient characteristics and the frequency of errors. Results: The study population had a mean age of 65.6 years (± 10 years), with a predominance of female patients (95%). The mean BMI was 26.4 kg/m² (±4.8 kg/m²). Regarding ethnicity, 91% of the sample identified as white. A total of 76% of exams presented at least one technical error, with the most common being osteophyte presence (64%), inadequate femoral rotation (45%), and incorrect ROI (35%). Only 24% of the exams were free of errors. Conclusions: These findings highlight the need for systematic training and strict adherence to imaging protocols to improve diagnostic accuracy and patient outcomes.
Neuroborreliosis is a rare but significant manifestation of Lyme disease, particularly in immunosuppressed individuals. We present the case of a 43-year-old patient with a history of follicular lymphoma in remission, currently undergoing maintenance therapy with Rituximab, who presented with progressive neurological symptoms including peripheral facial paralysis, headache, tremors, and lower back pain. Initial cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis, but serological and PCR tests for Borrelia burgdorferi were negative. Given the epidemiological context and clinical presentation, a probable diagnosis of neuroborreliosis was made, with the seronegative results attributed to immunosuppression. The patient responded well to intravenous ceftriaxone with significant clinical improvement. This case highlights the diagnostic challenges of neuroborreliosis in immunosuppressed patients and emphasizes the importance of clinical judgment in the absence of confirmatory laboratory findings.
Diffuse alveolar hemorrhage (DAH) is a rare, life-threatening condition often presenting with non-specific symptoms such as hemoptysis and cough, and can lead to respiratory failure. It is primarily associated with small-vessel vasculitides, like granulomatosis with polyangiitis. We report a 56-year-old male with a history of Behçet's disease who presented with cough, hemoptysis, and low oxygen saturation. Imaging studies and posterior bronchoscopy with bronchoalveolar lavage (BAL) confirmed DAH. This article discusses the probable causes of DAH in this patient.
