St Martins Hospital

Primary pulmonary synovial sarcoma (SS) is a tumor derived from pluripotential mesenchymal cells. It accounts for 0.1-0.5% of all pulmonary tumors and typically occurs in young, non-smoking individuals, classified according to the cellular pattern as monophasic or biphasic. Intrathoracic involvement can occur in various locations, including the pleuropulmonary region, mediastinum, thoracic wall, trachea, and diaphragm. Diagnosis is challenging and treatment includes surgery, chemotherapy, and radiotherapy. We present the case of a 65-year-old male patient with no smoking history who was admitted due to progressive dyspnea, chest pain, and weight loss. Thoracic computed tomography revealed moderate pleural effusion associated with a heterogeneous mass in the left hemithorax. Histopathology of the tissue obtained by percutaneous biopsy reported a primarily monophasic synovial sarcoma. Palliative treatment with serial pleural drainage, chemical pleurodesis, and pain management was indicated. The patient passed away 10 months after the onset of symptoms.

SummaryPapillary thyroid carcinoma (PTC) is the most frequent type of differentiated thyroid cancer, while thyroglossal duct cysts (TGDCs) are common congenital anomalies of the neck. The coexistence of PTC within a TGDC is exceptionally rare, with a reported incidence of less than 1.5%. We present three Peruvian cases of PTC arising in TGDCs. The patients (two females and one male; age range: 34–47 years) presented with progressive midline cervical masses of two to four years’ duration. All underwent cervical ultrasound, contrast-enhanced computed tomography, and fine-needle aspiration biopsy. Histopathology confirmed PTC, including classical and follicular variants. Surgical management varied: two patients underwent Sistrunk procedure alone, while one required Sistrunk surgery followed by total thyroidectomy, cervical lymph node dissection, and radioactive iodine (RAI) therapy. All patients remain disease-free after 6–12 years of follow-up. The diagnosis of carcinoma in TGDC is often incidental, but preoperative imaging and cytology can raise suspicion. Optimal management remains controversial; while the Sistrunk procedure may be sufficient in most cases of PTC confined to TGDC without extracapsular extension, in some scenarios, such as the presence of suspicious thyroid nodules, extracystic extension, and cervical lymph node metastasis, an additional thyroidectomy and RAI therapy may be warranted. In conclusion, PTC in TGDC is a rare entity with generally favorable prognosis. Early recognition, individualized treatment, and multidisciplinary decision-making are essential for optimal outcomes.Learning pointsSuspect malignancy in any persistent or enlarging midline neck mass, especially when imaging shows solid components or calcifications.FNAB may have variable diagnostic yield in cystic lesions due to low cellularity; accuracy can be improved by aspirating cystic contents first or targeting the solid components of the cyst.Treat with the Sistrunk procedure, adding total thyroidectomy and/or radioiodine based on oncologic risk and nodal involvement.Expect a generally favorable prognosis, but maintain long-term surveillance given the (low) risk of recurrence.Guidelines regarding management of thyroglossal duct cyst cancer have recently been included within ATA 2025 thyroid cancer guidelines.

Objective: The objective of this research was to establish the relationship between work environment and organizational commitment among the healthcare worker at Clinica Internacional of San Borja in the year 2023. Materials and methods: The study employedan analytical, cross-sectional correlational survey design with a prospective approach. The sample size consisted of 254 healthcare workers, including physicians, nurses, and nursing technicians, selected through simple random sampling without replacement.Two survey questionnaires were used: one assessing work environment, covering five dimensions: professional development, job involvement, supervision and control, communication, and working conditions. While the other evaluated organizational commitmentacross three dimensions: affective commitment, normative commitment, and continuance commitment. Results: The results indicated that the average age was 41.8 ± 12.15 years, with 74.4% female participants. Physicians accounted for 37% of the sample, while nursing technicians comprised 40.6%. The work environment was perceived as good by 50.8% and poor by 5.9% of the respondents, whereas organizational commitment was perceived as high by 46.9% and low by 7.5%. The relationship between these variables showed a direct linear correlation, with a Spearman's Rho coefficient of 0.651 (p=0.000). Conclusions: There is a direct linear relationship between work environment and organizational commitment, indicating that a better work environment correlates with higher organizationalcommitment among the healthcare staff at Clinica Internacional of San Borja.

Las auras epilépticas gustativas son poco frecuentes y han sido descritas como localizadoras de inicio ictal en la región mesiotemporal, insular u opercular parietal. Se presenta el caso de una paciente con crisis epilépticas focales farmacorresistentes, semiología límbica, y auras gustativas y de miedo. Tras completar la fase 1 de estudios prequirúrgicos de epilepsia, la paciente fue evaluada con estereoelectroencefalograma (SEEG). Los hallazgos electroclínicos y el análisis de la dinámica espacio-temporal permitieron concluir que se trataba de una red epileptógena con inicio ictal mesiotemporal e insular anterior izquierdo (temporal plus). El aura gustativa, cuando forma parte de la semiología ictal temprana, sugiere la participación de la región ínsulo-opercular en la zona de inicio ictal. Se discute el origen ictal de las auras gustativas en la paciente y se revisa la literatura correspondiente.

Objetivo: Establecer la correlación entre la probabilidad de contagio por la COVID-19 y el estrés laboral en las enfermeras del Servicio de Emergencia para adultos del Hospital Edgardo Rebagliati Martins, Lima, durante el 2022. Materiales y métodos: Se desarrolló una investigación cuantitativa, de nivel correlacional. La muestra fue de 80 profesionales de enfermería, a quienes se aplicaron dos encuestas, una para medir el estrés en el trabajo con 27 ítems y otra para medir el riesgo de contagio con 29 ítems. Resultados: Los hallazgos indican que el 83,8 % de los empleados tenía un alto riesgo de contagio, mientras que el 56,3 % evidenció un nivel moderado de estrés en el trabajo y el 38,8 % un nivel elevado. Se detectó una correlación estadísticamente relevante entre las dos variables (chi² = 15,724; p = 0,003). Conclusiones: Se determinó que existe una correlación directa y relevante entre el riesgo de contagio por la COVID-19 y el grado de estrés laboral en las enfermeras evaluadas, subrayando la importancia de aplicar estrategias institucionales para reducir los riesgos biológicos y psicosociales en el equipo de atención médica.

Abstract This paper argues that there has been a recent “folkloric turn” in contemporary fashion, by analyzing Irish designer Simone Rocha’s AW23 collection “Lughnasadh.” Drawing on a theoretical framework informed by Walter Benjamin’s ideas on time, this work of applied theory decodes the material and symbolic expressions of Irish heritage and identity that can be seen on the runway in 2023. This paper posits that the contemporary folkloric turn is a response to the increased globalization and secularization of Western culture in an era of digital capitalism, which produces an aesthetic interest in the “traditional” beliefs, customs, and histories of a given community. While folklore’s commercialization raises questions of authenticity, this paper argues that its presence in fashion offers an alternative way of engaging with “fashion time” that fosters sustainability and deeper engagement with cultural heritage.

Hyperandrogenism represents a prevalent yet diagnostically challenging endocrine condition in adolescents, with polycystic ovary syndrome (PCOS), non-classic congenital adrenal hyperplasia, and androgen-secreting tumors constituting the most common etiologies. The physiological overlap with normal pubertal development creates significant diagnostic complexity, necessitating evidence-based approaches tailored to this unique population. This narrative review synthesizes evidence from a comprehensive literature search (PubMed/Scopus/Web of Science/EMBASE/Cochrane, 2000-2025) evaluating diagnostic and therapeutic approaches for adolescent hyperandrogenism. We prioritized clinical practice guidelines (including 2023 international PCOS guidelines), randomized controlled trials, and large cohort studies (n ≥ 50), excluding conference abstracts and non-peer-reviewed sources. Data extraction focused on diagnostic accuracy, treatment efficacy, safety profiles, and quality-of-life outcomes across 122 included studies. Current diagnostic frameworks demonstrate critical limitations in adolescent populations, particularly regarding age-specific biochemical cutoffs (testosterone, dehydroepiandrosterone sulphate, and 17-hydroxyprogesterone) and imaging interpretation. While combined oral contraceptives remain first-line therapy, emerging data highlight both metabolic risks (particularly with long-term use) and the potential of insulin sensitizers such as myo-inositol. Psychological comorbidities (anxiety, depression) are prevalent (38%-45% prevalence) yet are frequently under-addressed in clinical management. Key knowledge gaps persist regarding optimal (1) diagnostic thresholds for diverse ethnic groups; (2) longitudinal safety of hormonal therapies; and (3) integrated mental health interventions. Adolescent hyperandrogenism demands multidisciplinary management involving endocrinologic, gynecologic, dermatologic, and psychological expertise. Future research must prioritize (1) validated age- and puberty-stage-specific diagnostic criteria; (2) safety/efficacy data for emerging therapies; and (3) standardized protocols for mental health screening. This synthesis provides a framework for evidence-based, individualized care while highlighting urgent research priorities.

ABSTRACTAimWe aimed to develop and test machine learning algorithms for the prediction of severe outcomes associated with MIS‐C.MethodAn observational ambispective cohort study was conducted including children aged from 1 month to 18 years old in 84 hospitals from the REKAMLATINA (Red de la Enfermedad de Kawasaki en America Latina) network diagnosed with MIS‐C from 1st January 2020 to 31st June 2022. Multiple models were developed to predict four main outcomes: paediatric intensive care unit (PICU) admission, need for inotropes, need for mechanical ventilation, and death. Performance measures were accuracy for PICU admission, inotropes use and mechanical ventilation, and the area under the receiver operating characteristic curve (AUROC) for death. Variable contribution was analysed using Shapley Additive Explanations (SHAP) values.ResultsWe included 1303 children with a diagnosis of MIS‐C. The model for the prediction of PICU admission (random forest [RF]) reached an accuracy of 0.80 (95% CI: 0.76–0.84), the model for inotrope use (RF) an accuracy of 0.86 (95% CI: 0.82–0.90), the model for mechanical ventilation (histogram‐based gradient boosting [HBGB]) an accuracy of 0.84 (95% CI 0.80–0.88), and the model for death (RF) reached an AUROC of 0.85 (95% CI 0.77–0.93).ConclusionsWe developed and validated machine learning models for the prediction of MIS‐C related outcomes that can help clinicians risk stratify patients to identify those most likely to have a severe outcome from MIS‐C.