Multidisciplinary Collaboration Research Articles

Tuberculosis-diabetes comorbidities: Mechanistic insights for clinical considerations and treatment challenges

Tuberculosis (TB) remains a leading cause of death among infectious diseases, particularly in poor countries. Viral infections, multidrug-resistant and ex-tensively drug-resistant TB strains, as well as the coexistence of chronic illnesses such as diabetes mellitus (DM) greatly aggravate TB morbidity and mortality. DM [particularly type 2 DM (T2DM)] and TB have converged making their control even more challenging. Two contemporary global epidemics, TB-DM behaves like a syndemic, a synergistic confluence of two highly prevalent diseases. T2DM is a risk factor for developing more severe forms of multi-drug resistant-TB and TB recurrence after preventive treatment. Since a bidirectional relationship exists between TB and DM, it is necessary to concurrently treat both, and promote recommendations for the joint management of both diseases. There are also some drug-drug interactions resulting in adverse treatment outcomes in TB-DM patients including treatment failure, and reinfection. In addition, autophagy may play a role in these comorbidities. Therefore, the TB-DM comorbidities present several health challenges, requiring a focus on multidisciplinary collaboration and integrated strategies, to effectively deal with this double burden. To effectively manage the comorbidity, further screening in affected countries, more suitable drugs, and better treatment strategies are required.

Multidisciplinary comprehensive treatment of massive hepatocellular carcinoma with hemorrhage: A case report and review of literature

BACKGROUND Hepatocellular carcinoma (HCC), a major contributor to cancer-related deaths, is particularly prevalent in Asia, largely due to hepatitis B virus infection. Its prognosis is generally poor. This case report contributes to the medical literature by detailing a unique approach in treating a large HCC through multidisciplinary collaboration, particularly in patients with massive HCC complicated by ruptured bleeding, a scenario not extensively documented previously. CASE SUMMARY The patient presented with large HCC complicated by intratumoral bleeding. Treatment involved a multidisciplinary approach, providing individualized care. The strategy included drug-eluting bead transarterial chemoembolization, sorafenib-targeted therapy, laparoscopic partial hepatectomy, and standardized sintilimab monoclonal antibody therapy. Six months after treatment, the patient achieved complete radiological remission, with significant symptom relief. Imaging studies showed no lesions or recurrence, and clinical assessments confirmed complete remission. This report is notable as possibly the first documented case of successfully treating such complex HCC conditions through integrated multidisciplinary efforts, offering new insights and a reference for future similar cases. CONCLUSION This study demonstrated effective multidisciplinary treatment for massive HCC with intratumoral bleeding, providing insights for future similar cases.

Improving malignant fungating wound management among oncology nurses: a best practice implementation project.

Appropriate malignant fungating wound (MFW) care is challenging for oncology nurses, leading to increased stress, compromised care quality, and poor patient outcomes. This study aimed to address best practice barriers and develop evidence-based guidelines for MFW care. This project was guided by the JBI Evidence Implementation Framework, which follows a seven-phase process. Both nurses' skills and patient charts were audited to determine compliance with best practices for comprehensive MFW assessment, wound photo records, use of validated wound assessment tools, appropriate wound care, and patient pain and satisfaction. Bandura's social learning theory was used to guide the development of an online education program and an objective structured clinical examination for skill improvement to prompt behavior change in nurses. A follow-up audit was conducted to measure improvements in knowledge, skills, and self-efficacy among nurses to validate the effectiveness of the intervention. The project resulted in improvements in all four evidence-based practice criteria: (1) comprehensive MFW assessments increased from 27% to 98%; (2) the inclusion of wound photos in medical records increased from 50% to 100%; (3) use of a validated wound assessment tool increased from 0% to 100%; and (4) appropriate interventions to manage wounds and maintain patients' quality of life increased from 50% to 90%. The project integrated a flexible education program, multidisciplinary collaboration, and leadership support to empower nurses to effectively manage MFWs. In addition, Bandura's social learning theory was used to influence nurses' behavior and bring about sustainable changes to organizational culture and practices. http://links.lww.com/IJEBH/A205.

Anesthesia strategies for elderly patients with craniocerebral injury due to foreign-body penetration in the plateau region: a case report

BackgroundThe administration of anesthesia for elderly individuals who are critically ill, suffering from severe craniocerebral injuries, and living in plateau regions presents a rare, intricate, and high-risk challenge. This case study outlines the specific anesthesia management protocols necessary for plateau-dwelling patients with significant craniocerebral damage undergoing prolonged invasive procedures.Case reportA 76-year-old male patient had a 26-year history of foreign-body penetration of the skull and had experienced local purulent discharge and pain for the previous 20 days. The diagnoses included right hypoplasia, a foreign body in the skull with an infection, hypokalemia, hypoproteinemia, pulmonary fibrous foci, and bilateral pleural effusion. For almost 6 months, the patient suffered from recurring headaches, blurred vision, and sluggish bodily movement. The patient had a poor diet, poor sleep quality, normal urination, and no noticeable weight loss since the onset of the illness. The right anterior ear had a 2 cm skin abscess with yellow pus and a black metal foreign body tip. The left eyelid was red and swollen, and the left conjunctiva was hyperemic; the right eyelid showed no abnormalities, and both pupils were wide and round, with light and adjustment reflexes and no cyanosis on the lips. Skull development was normal. No dry or moist rales were audible in either lung. The heart rhythm was regular, and the heart rate was 50 bpm. Chest CT revealed left lung calcification foci, bilateral pleural effusion, and fiber foci in the lower lobes of both lungs.ConclusionFurthermore, the patient in question was of advanced age and had a complex medical history, including prolonged exposure to high altitudes and previous instances of severe craniocerebral trauma, among other uncommon pathophysiological characteristics. In particular, the patient also underwent surgical interventions at both high and low altitudes, adding to the complexity of their case. To ensure patient safety, close multidisciplinary collaboration, the development of a precise surgical plan, and the implementation of a suitable perioperative anesthetic management strategy are imperative.

Application of 3D Printing in Cleft Lip and Palate Repair.

This manuscript reviews the transformative impact of 3-dimensional (3D) printing technologies in the treatment and management of cleft lip and palate (CLP), highlighting its application across presurgical planning, surgical training, implantable scaffolds, and postoperative care. By integrating patient-specific data through computer-aided design and manufacturing, 3D printing offers tailored solutions that improve surgical outcomes, reduce operation times, and enhance patient care. The review synthesizes current research findings, technical advancements, and clinical applications, illustrating the potential of 3D printing to revolutionize CLP treatment. Further, it discusses the future directions of combining 3D printing with other innovative technologies like artificial intelligence, 4D printing, and in situ bioprinting for more comprehensive care strategies. This paper underscores the necessity for multidisciplinary collaboration and further research to overcome existing challenges and fully utilize the capabilities of 3D printing in CLP repair.

Cardiovascular disease risk assessment in patients with rheumatoid arthritis: A scoping review.

Patients with rheumatoid arthritis (RA) have an increased risk of developing cardiovascular disease (CVD). Identification of at-risk patients is paramount to initiate preventive care and tailor treatments accordingly. Despite international guidelines recommending all patients with RA undergo CVD risk assessment, rates remain suboptimal. The objectives of this review were to map the strategies used to conduct CVD risk assessments in patients with RA in routine care, determine who delivers CVD risk assessments, and identify what composite measures are used. The Joanna Briggs Institute methodological guidelines were used. A literature search was conducted in electronic and grey literature databases, trial registries, medical clearing houses, and professional rheumatology organisations. Findings were synthesised narratively. A total of 12 studies were included. Strategies reported in this review used various system-based interventions to support delivery of CVD risk assessments in patients with RA, operationalised in different ways, adopting two approaches: (a) multidisciplinary collaboration, and (b) education. Various composite measures were cited in use, with and without adjustment for RA. Results from this review demonstrate that although several strategies to support CVD risk assessments in patients with RA are cited in the literature, there is limited evidence to suggest a standardised model has been applied to routine care. Furthermore, extensive evidence to map how health care professionals conduct CVD risk assessments in practice is lacking. Research needs to be undertaken to establish the extent to which healthcare professionals are CVD risk assessing their patients with RA in routine care. Key Points • A limited number of system-based interventions are in use to support the delivery of CVD risk assessments in patients with RA. • Multidisciplinary team collaboration, and education are used to operationalise interventions to support Health Care Professionals in conducting CVD risk assessments in practice. • The extent to which Health Care Professionals are CVD risk assessing their patients with RA needs to be established.

The role of nurses for patients with Parkinson’s disease at home: a scoping review

BackgroundParkinson’s disease is a neurodegenerative disease, and many patients are cared for at home by nurses. Parkinson’s disease nurse specialists have been certified in several countries. This study aimed to provide an overview of what is known about the role of nurses in the care of patients with Parkinson’s disease at home and to determine the differences between nurses and Parkinson’s disease nurse specialists.MethodsA scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. PubMed, Scopus, Web of Science, and Cumulative Index to Nursing and Allied Health Literature were searched (keywords: Parkinson’s disease AND nurse AND [community OR home]) for studies published in English up to September 2023 describing the nurse’s role in caring for patients with Parkinson’s disease at home. Studies without abstracts were removed, along with protocols, systematic reviews, and studies concerned with other diseases or including data that were difficult to distinguish from those of other diseases. Roles were described and organized by category.ResultsA total of 26 studies were included. The nurses’ roles were categorized as overall assessment and support, treatment management, safety assessment regarding falls, care for non-motor symptoms, palliative care, support for caregivers, education for care home staff, multidisciplinary collaboration, and provision of information on social resources. Medication management and education of care home staff were identified as roles of nurse specialists.ConclusionsThis study revealed the role of nurses caring for patients with Parkinson’s disease at home. Because of the complexity of the patients’ medication regimens, nurse specialists provide assistance, especially with medication management and the provision of education to care staff. This study will facilitate the preparation of nurses to acquire the knowledge and skills necessary to help patients with Parkinson’s disease, even in countries where Parkinson’s disease nurse specialists are not officially certified, and will help patients feel comfortable with the care they receive.

Advancements and Challenges Forensic Odontology and Anthropology: Applications for Identification in Saudi Arabia

The evolution of forensic science has witnessed significant progress in dental identification techniques, originating from prehistoric eras but gaining prominence in the late 19th century. During the 1960s, forensic odontology experienced renewed interest, extending its relevance beyond dentistry to law enforcement agencies. This resurgence coincided with the emergence of forensic anthropology, vital in employing skeletal analysis to reconstruct the biological profiles of unidentified individuals. Collaborative efforts of forensic dentistry and anthropology have notably enhanced the accuracy and scope of forensic investigations, especially in cases involving incomplete or decomposed remains. In the Kingdom of Saudi Arabia, despite cultural challenges, the significance of multidisciplinary collaboration to assist the law enforcement agencies cannot be overstated. As forensic science advances, the integration of dental and skeletal analyses remains crucial for effective case resolution. Forensic odontology and anthropology jointly contribute to identifying individuals in mass disasters and criminal cases through dental record and skeletal remains analysis. Both disciplines boast rich historical backgrounds, dating back to ancient civilizations. Limited practices and training in Saudi Arabia pose obstacles for forensic investigations, although there is evident public acceptance regarding the importance of maintaining dental records and recognizing skeletal analysis significance. Therefore, establishing a national registry for dental and skeletal data, coupled with comprehensive training programs, is recommended for dentistry and anthropology students at all academic levels.

Suggestions for the management of pediatric obesity in Korea

Background: The prevalence of pediatric obesity has increased both globally and in South Korea over the past few decades, and obesity in childhood and adolescence is a serious public health concern.Current Concepts: The increasing prevalence of childhood and adolescent obesity is associated with an increase in comorbidities, such as type 2 diabetes mellitus, hypertension, nonalcoholic fatty liver disease, and dyslipidemia, which were previously observed in adults. Furthermore, pediatric obesity contributes to increased medical costs. Recent studies have reported an increase in the prevalence of severe obesity.Discussion and Conclusion: It is important to acknowledge the need for obesity management and responsive management capabilities in children and adolescents. Prevention of obesity in all children, screening for comorbidities in high-risk children, and establishment of treatment strategies are important measures. Pediatric obesity can be addressed by approaching it from a social perspective, providing a National Health Insurance System, and facilitating multidisciplinary collaboration between experts from various fields.

The efficiency of stem cell differentiation into functional beta cells for treating insulin-requiring diabetes: Recent advances and current challenges.

In recent years, the potential of stem cells (SCs) to differentiate into various types of cells, including β-cells, has led to a significant boost in development. The efficiency of this differentiation process and the functionality of the cells post-transplantation are crucial factors for the success of stem cell therapy in diabetes. Herein, this article reviews the current advances and challenges faced by stem cell differentiation into functional β-cells for diabetes treatment. In vitro, researchers have sought to enhance the differentiation efficiency of functional β-cells by mimicking the normal pancreatic development process, using gene manipulation, pharmacological and culture conditions stimulation, three-dimensional (3D) and organoid culture, or sorting for functional β-cells based on mature islet cell markers. Furthermore, in vivo studies have also looked at suitable transplantation sites, the enhancement of the transplantation microenvironment, immune modulation, and vascular function reconstruction to improve the survival rate of functional β-cells, thereby enhancing the treatment of diabetes. Despite these advancements, developing stem cells to produce functional β-cells for efficacious diabetes treatment is a continuous research endeavor requiring significant multidisciplinary collaboration, for the stem-cell-derived beta cells to evolve into an effective cellular therapy.

The impact of frailty on clinical outcomes of older patients undergoing enhanced recovery after lumbar fusion surgery: A prospective cohort study.

Frailty is recognized as a surrogate for physiological age and has been established as a valid and independent predictor of postoperative morbidity, mortality, and complications. ERAS can enhance surgical safety by minimizing stress responses in frail patients, enabling surgeons to discharge patients earlier. However, the question of whether and to what extent the frailty impacts the post-ERAS outcomes in older patients remains. An evidence-based ERAS program was implemented in our center from January 2019. This is a prospective cohort study of patients aged ≥75 years who underwent open transforaminal lumbar interbody fusion (TLIF) for degenerative spine disease from April 2019 to October 2021. Frailty was assessed with the Fried frailty scale (FP scale), and patients were categorized as non/prefrail (FP 0-2) or frail (FP ≥ 3). The preoperative variables, operative data, postoperative outcomes and follow-up information were compared between the two groups. Univariate and multivariate logistic regression analyses were used to identify risk factors for 90-day major complications and prolonged length of hospital stay (LOS) after surgery. A total of 245 patients (age of 79.8 ± 3.4 yr) who had a preoperative FP score recorded and underwent scheduled TLIF surgery were included in the final analysis. Comparisons between non-frail and prefrail/frail patients revealed no significant difference in age, sex, and surgery-related variables. Even after adjusting for multiple comparisons, the association between Fried frailty and ADL-dependency, IADL-dependency, and malnutrition remained significant. Preoperative frailty was associated with increased rates of postoperative adverse events. A higher CCI grade was an independent predictor for 90-day major complications, while Fried frailty and MNA-SF scores <12 were predictive of poor postoperative recovery. Frail older patients had more adverse post-ERAS outcomes after TLIF compared to non/prefrail older patients. Continued research and multidisciplinary collaboration will be essential to refine and optimize protocols for surgical care in frail older adults.

Navigating the uncommon: a case of caesarean section associated with exercise-induced anaphylaxis

Exercise-induced anaphylaxis (EIA) and food-dependent exercise-induced anaphylaxis (FDEIA) are rare but serious conditions where physical activity triggers severe allergic reactions. These are rarely reported in pregnant women undergoing caesarean section. We present the case of a 33-year-old woman with a history of EIA, scheduled for a caesarean section at 37 weeks of gestation. To manage the planned caesarean section, a multidisciplinary team strategy was devised to mitigate anaphylaxis risks. The surgery proceeded without complications under spinal anaesthesia, and the patient did not exhibit any anaphylactic reactions. The patient was monitored in the high dependency unit (HDU) and was discharged two days later. This case highlights the importance of individualized anaesthesia planning, multidisciplinary collaboration, and detailed preparation to ensure the safety of pregnant patients with EIA undergoing caesarean section.

HUNCHEST projects—advancing low-dose CT lung cancer screening in Hungary

Lung cancer, the leading cause of malignancy-related deaths worldwide, demands proactive measures to mitigate its impact. Low-dose computer tomography (LDCT) has emerged as a promising tool for secondary prevention through lung cancer screening (LCS). The HUNCHEST study, inspired by the success of international trials, including the National Lung Cancer Screening Trial and the Dutch NELSON study, embarked on the first LDCT-based LCS program in Hungary. The initiative assessed the screening efficiency, incorporating lung function tests and exploring the interplay between lung cancer and chronic obstructive pulmonary disease (COPD). Building upon this foundation, an implementation trial involving 18 Hungarian centers supported by the Ministry of Human Capacities demonstrated the feasibility of LCS within a multicentric framework. These centers, equipped with radiology capabilities, collaborated with multidisciplinary oncology teams, ensuring optimal patient pathways. However, a critical challenge remained the patient recruitment. To address this, the HUNCHEST 3 project, initiated in 2023, seeks to engage general practitioners (GPs) to reach out to eligible patients within a municipality collective of 60 thousand inhabitants. The project’s ultimate success is contingent upon the willingness of eligible individuals to undergo LDCT scans. In conclusion, the HUNCHEST program represents a crucial step in advancing lung cancer screening in Hungary. With a focus on efficiency, multidisciplinary collaboration, and innovative patient recruitment strategies, it endeavors to contribute to the reduction of lung cancer mortality and serve as a blueprint for potential nationwide LCS programs.

Personalized anesthesia and precision medicine: a comprehensive review of genetic factors, artificial intelligence, and patient-specific factors

Precision medicine, characterized by the personalized integration of a patient’s genetic blueprint and clinical history, represents a dynamic paradigm in healthcare evolution. The emerging field of personalized anesthesia is at the intersection of genetics and anesthesiology, where anesthetic care will be tailored to an individual’s genetic make-up, comorbidities and patient-specific factors. Genomics and biomarkers can provide more accurate anesthetic protocols, while artificial intelligence can simplify anesthetic procedures and reduce anesthetic risks, and real-time monitoring tools can improve perioperative safety and efficacy. The aim of this paper is to present and summarize the applications of these related fields in anesthesiology by reviewing them, exploring the potential of advanced technologies in the implementation and development of personalized anesthesia, realizing the future integration of new technologies into clinical practice, and promoting multidisciplinary collaboration between anesthesiology and disciplines such as genomics and artificial intelligence.

Marine bryozoan colonization of terrestrial biomineralized tissues: Taphonomic insights and forensic implications

AbstractThe taphonomy and diagenesis of bone and teeth recovered from any environments provide crucial information for forensic sciences and investigations. This leads to the estimation of the postmortem interval (PMI) and the postmortem submersion interval (PMSI) of the organism/s. Aquatic taxa can induce macroscopic and microscopic alterations in biomineralized tissues (e.g., grooves) or can colonize them by attachment (e.g., Bryozoa). Bryozoa are tiny invertebrates that form colonies in freshwater and saltwater. They can survive for years as suspension feeders in all climates. Most marine Bryozoa species have a biomineralized exoskeleton that can be preserved after their death. This research analyzes eight fragments of archeological elephant ivory with a known PMSI of 314 years, which were inhabited by three distinct bryozoan colonies. The variations in the preservation of the bryozoan exoskeletons and the overgrowth of different marine taxa reveal that one colony (lichenoporid cyclostomatid) was alive at the time of the ivory collection from the submerged archeological site while the two other colonies (cheilostomatid) had previously died at different times. The primary objective of this observation is to contribute to the understanding of the taphonomy of terrestrial mammalian biomineralized tissues recovered in marine environments. Additionally, the study discusses the potential forensic implications of this association, such as the evidence of marine submersion and the PMSI. A secondary objective is to present the Bryozoa colonies within a distinctive depositional context, considering that many bryozoan species of the Western Australian coast remain undescribed. The complexity of the Bryozoa ecobiology is also highlighted, with the need of further research (e.g., minimum time for colonization). Finally, this study highlights the urgency of multidisciplinary collaboration to advance aquatic forensic capabilities.

Digital Mental Health for Schizophrenia and Other Severe Mental Illnesses: An International Consensus on Current Challenges and Potential Solutions.

Digital approaches may be helpful in augmenting care to address unmet mental health needs, particularly for schizophrenia and severe mental illness (SMI). An international multidisciplinary group was convened to reach a consensus on the challenges and potential solutions regarding collecting data, delivering treatment, and the ethical challenges in digital mental health approaches for schizophrenia and SMI. The consensus development panel method was used, with an in-person meeting of 2 groups: the expert group and the panel. Membership was multidisciplinary including those with lived experience, with equal participation at all stages and coproduction of the consensus outputs and summary. Relevant literature was shared in advance of the meeting, and a systematic search of the recent literature on digital mental health interventions for schizophrenia and psychosis was completed to ensure that the panel was informed before the meeting with the expert group. Four broad areas of challenge and proposed solutions were identified: (1) user involvement for real coproduction; (2) new approaches to methodology in digital mental health, including agreed standards, data sharing, measuring harms, prevention strategies, and mechanistic research; (3) regulation and funding issues; and (4) implementation in real-world settings (including multidisciplinary collaboration, training, augmenting existing service provision, and social and population-focused approaches). Examples are provided with more detail on human-centered research design, lived experience perspectives, and biomedical ethics in digital mental health approaches for SMI. The group agreed by consensus on a number of recommendations: (1) a new and improved approach to digital mental health research (with agreed reporting standards, data sharing, and shared protocols), (2) equal emphasis on social and population research as well as biological and psychological approaches, (3) meaningful collaborations across varied disciplines that have previously not worked closely together, (4) increased focus on the business model and product with planning and new funding structures across the whole development pathway, (5) increased focus and reporting on ethical issues and potential harms, and (6) organizational changes to allow for true communication and coproduction with those with lived experience of SMI. This study approach, combining an international expert meeting with patient and public involvement and engagement throughout the process, consensus methodology, discussion, and publication, is a helpful way to identify directions for future research and clinical implementation in rapidly evolving areas and can be combined with measurements of real-world clinical impact over time. Similar initiatives will be helpful in other areas of digital mental health and similarly fast-evolving fields to focus research and organizational change and effect improved real-world clinical implementation.

Cricopharyngeus muscle dysfunction: a poorly defined disorder from diagnosis to treatment.

Cricopharyngeus muscle dysfunction (CPMD) is a common clinical occurrence with very few clear diagnostic criteria and multiple pathways for treatment. Incidence of CPMD is not known, but some data suggest around 25% of people with dysphagia experience some degree of CPMD, which negatively impacts swallowing safety and efficiency. Workup and treatment of CPMD can require multidisciplinary collaboration across laryngologists, speech-language pathologists with training in dysphagia management, and gastroenterologists. The purpose of this paper is to review what is known about CPMD and identify areas of future research in CPMD diagnosis and treatment. An overview of CPMD, relative treatments and disorders, and a discussion of future areas of research needed to improve clinical care of CPMD. Details regarding historical background, pathophysiology and treatment practiced for CPMD are included. In summary, CPMD is a poorly defined disease due to a lack of understanding of its pathophysiology and the lack of consensus diagnostic criteria. Well-designed, prospective clinical trials are necessary to develop a better understanding of clinical incidence of CPMD, impact of the disorder on oropharyngeal swallowing, and how to approach treatment of the disorder surgically or in conjunction with therapy directed by a specialized speech-language pathologist.

Multidisciplinary proactive e-consults to improve guideline-directed medical therapies for patients with diabetes and chronic kidney disease: an implementation study

IntroductionWe hypothesized that multidisciplinary, proactive electronic consultation (MPE) could overcome barriers to prescribing guideline-directed medical therapies (GDMTs) for patients with type 2 diabetes (T2D) and chronic kidney disease (CKD).Research design...

The role of physical medicine and rehabilitation in the management of a pediatric female with Möbius syndrome: a case report

This case report presents a comprehensive analysis of a 4-year-old female patient with Möbius syndrome and associated conditions while emphasizing the role of pediatric physical medicine and rehabilitation (PM&R) in managing her complex medical profile. The patient’s clinical presentation encompassed congenital facial palsy, ocular abduction impairments, developmental delay, syndactyly, clubfoot, and G-tube dependence. The diagnosis was based on characteristic clinical criteria of Möbius syndrome. A multifaceted PM&R approach was employed, involving tailored physical therapy interventions targeting head control, sensory integration, trunk rotation, and positioning techniques. Concurrently, occupational therapy strategies enhanced her functional abilities and empowered caregivers with home-based support techniques. Long-term management considerations highlighted the potential of home-based and school-based therapies, emphasizing multidisciplinary collaboration for sustained progress. The case report underscores the effectiveness of PM&R in addressing the intricate challenges of Möbius syndrome and related conditions, offering insights for future clinical practice and research.

Bone age and dental late effects in childhood cancer survivors: Radiographic findings in a Brazilian sample.

Changes in bone age and tooth development are late side effects of cancer therapy and can be identified by imaging examination. To evaluate the late effects of antineoplastic treatment on bone age and dental development in childhood cancer survivors. This is a retrospective case-control study on paediatric cancer survivors of both sexes who underwent antineoplastic treatment with 5-15 years of survival. Carpal radiographs were assessed for bone age and growth curve, and panoramic radiographs were used to evaluate dental development and alterations. Carpal radiographs were analyzed using the Greulich and Pyle inspection method, and the Martins and Sakima method was used to analyze the growth curve. All tests were applied with a confidence level of 95%. The study and control groups comprised 28 and 56 patients, respectively. There was no significant difference in bone age and growth curve between the study and control groups. Nonetheless, when sex was compared to chronological and bone ages, there was a significant difference in bone age (p = 0.019) and an underestimation in both groups and sexes in the Greulich and Pyle method. As to late dental effects, dental agenesia, microdontia, gyroversion, and unerupted teeth were found. Dental shape alterations mainly involve the root region. Close multidisciplinary collaboration is necessary during the follow-up period of young patients who have survived cancer.