Temporomandibular disorders (TMDs) are musculoskeletal conditions affecting the TMJ. Myofascial pain, a common condition associated with TMD, accounts for 45.3% of cases, often involving the masseter muscle, characterized by trigger points and muscle stiffness. Manual palpation assesses muscle hardness but relies on the examiner's skill and experience. The primary objective was to evaluate and compare the stiffness of the masseter muscles using the Muscle Hardness Meter and Ultrasound elastography in patients with TMDs and healthy adult volunteers.

Materials and Methods

This case-control study included 80 patients with myofascial pain and 80 healthy volunteers. Diagnostic criteria for temporomandibular disorders were analyzed in cases within the pain group. A portable muscle hardness meter (Neutones TDM) was used to measure muscle stiffness on both sides. Strain wave elastography was performed using a LOGIQ P9 with a transducer. The thickness and elasticity index of the masseter muscle were evaluated bilaterally.

Results

The study involved 160 patients, with 80 cases and 80 controls, with an average age of 32.9 years. Mean pain was 8.34, mouth opening 30.95 mm, both significantly different from controls (p<0.001). Bruxism was present in 50% of myofascial pain patients, showing a strong link (p<0.001). Muscle hardness and elasticity were higher in cases, with significant differences on both sides, especially in areas with complaints, indicating stiffness. ROC analysis demonstrated high diagnostic accuracy (hardness meter: 0.941, elasticity index: 0.877). Principal component analysis identified three TMD subtypes: (0) high stiffness, pain, limited opening; (1) moderate stiffness, often linked to parafunctions; (2) low stiffness, minimal pain, near-normal functions.

Conclusion

SWE revealed increased stiffness associated with TMD, consistent with global research findings. The muscle hardness meter provides an affordable, non-invasive, chairside tool for assessing muscle stiffness, particularly where elastography isn't available. Principal component analysis grouped patients based on pain and stiffness, aiding in personalized treatment, reducing pain, and improving quality of life.

Background: Stroke is a leading cause of mortality and long-term disability in Brazil, making access to rehabilitation within the public health system (SUS) a critical issue. Physiotherapy is essential for functional recovery, yet national-level data on care integration remains limited. This study analyzes over a decade of hospitalization and rehabilitation data to quantify trends in care provision. Methods: This descriptive ecological study used public data from Brazil's SIH/SUS (stroke hospitalizations, ICD-10 I60-I64) and SIA/SUS (neuro-kinetic-functional physiotherapy and acute stroke treatment codes). We analyzed trends across complete calendar years from 2015 to 2024, with data from the first semester of 2025 reported separately to indicate the most recent trajectory. Results: From 2015-2024, 2,269,871 stroke hospitalizations occurred, with 355,143 in-hospital deaths (case-fatality rate: 15.6%). Over the decade, annual hospitalizations increased 125% (from 123,844 to 278,125), despite a temporary decline in 2020. Concurrently, physiotherapy procedures grew at an even faster pace of 146% (from 2.9 to 7.0 million annually), totaling 51.5 million. This disproportionate growth, however, only slightly increased the sessions-per-hospitalization ratio from 23 to 25. Preliminary 2025 data (139,630 hospitalizations; 3.2 million procedures) confirm these trends. Conclusion: Our findings show expanded access to post-stroke physiotherapy in SUS, though this growth mainly absorbed an increasing patient load rather than deepening the care intensity per individual. The persistently high in-hospital mortality (15.6%) points to significant gaps in the acute care chain. This underscores a dual policy priority: improving acute stroke management to reduce mortality, while simultaneously strengthening multidisciplinary rehabilitation. Integrating speech and occupational therapy is essential to address the diverse functional deficits and truly reduce the long-term disability burden of stroke in Brazil.

Objectives: Stroke is a significant cause of disability. In addition, self-efficacy, which is the confidence in one’s ability to carry out a task or achieve a goal, can be affected after a stroke, and reduced self-efficacy can negatively impact quality of life. This study aimed to identify the factors that influence self-efficacy and quality of life in individuals with stroke. Study design: This is a cross-sectional study. Methods: The Stroke Self-Efficacy Questionnaire, the SF-8 questionnaire, the Edinburgh Handedness Questionnaire, and the Modified Rankin Scale were used to assess the participants’ self-efficacy, quality of life, handedness, and level of disability, respectively. Standard linear multiple regression was used to determine the factors that will significantly predict self-efficacy and quality of life. Results: A total of 120 patients with stroke, with a mean age of 46.81±12.75 years, participated in the study. For self-efficacy, the total variance explained by the whole model was significant, accounting for 67.0% of the variance, F(7,120)=13.027, R²=0.449, p<0.001. In the final model, only the level of disability (Beta= -0.585, p<0.001) and time since stroke (Beta= 0.154, p=0.034) significantly predicted self-efficacy, with level of disability as the strongest predictor. For quality of life, the total variance explained by the whole model was significant, accounting for 48.2% of the variance, F(8,120)=4.189, R²=0.232, p<0.001. In the final model, only the level of disability (Beta= -0.259, p=0.018) and self-efficacy (Beta=0.211, p=0.0261) significantly predicted quality of life, with level of disability as the strongest predictor. Conclusions: Time since stroke and level of disability significantly predict self-efficacy after stroke. Similarly, the level of disability and self-efficacy significantly predict quality of life after stroke. Therefore, rehabilitation after a stroke should begin as soon as possible to help improve patients’ self-efficacy.

Introduction

Long-term survival studies need to be interpreted relative to background population mortality. Net survival, estimated with the Pohar–Perme method, provides an unbiased cancer-specific survival measure by adjusting for competing risks of death. We report population-adjusted long-term survival outcomes after lung cancer resection in a regional cohort undergoing curative-intent lung resection.

Methods

We analysed a consecutive cohort of patients with primary lung cancer treated surgically between 2012 and 2019 at two major thoracic centres in North West England. Patient data were linked with UK life tables from the Human Mortality Database to derive expected survival by sex, age, and calendar year. Net survival was estimated using the Pohar–Perme method implemented in the relsurv package in R. Follow-up time and patient age were expressed in years, with results reported at 1–5 years post-surgery.

Results

A total of 3,426 patients were included, with a median follow-up of 6.2 years. Stage I and II disease accounted for 37% and 40% of cases, respectively. There were 1,996 (59%) observed deaths versus 871 expected background mortality, corresponding to 1,125 excess deaths. Observed overall survival was 95.9% at 1 year, 79.2% at 3 years, and 62.4% at 5 years. Net survival, adjusted for background mortality, was higher at all timepoints, measuring 98.8% (95% Confidence Interval [CI] 98.2–99.4) at 1 year, 93.7% (95% CI 92.5–94.9) at 3 years, and 85.8% (95% CI 84.1–87.5) at 5 years. The overall standardized mortality ratio (SMR) was 2.29 (95% CI 2.19–2.39).

Conclusion

Population-adjusted net survival highlights the true mortality burden of lung cancer. Our findings show that surgery in carefully selected early-stage lung cancer achieves excellent outcomes, underscoring the sustained benefit of surgical management after adjusting for background mortality. These results provide a robust benchmark for future comparisons across regions and treatment eras.

Introduction

Iatrogenic pneumothorax is a rare but serious complication of nephrectomy, especially during open procedures involving subcostal or lombotomy approaches. The anatomical proximity of the kidney, particularly the left upper pole, to the pleura and diaphragm increases the risk of pleural injury. We report a rare case of symptomatic postoperative pneumothorax following left nephrectomy in a young patient, highlighting the diagnostic challenges and therapeutic strategies.

Case Report

A 22-year-old Mauritanian woman with no relevant medical or surgical history presented with chronic intermittent left-sided lumbar pain. Imaging revealed severe left hydronephrosis due to ureteropelvic junction obstruction, with significant parenchymal thinning and no evidence of stones. A non-functional kidney led to the decision to perform a left nephrectomy via subcostal lombotomy.
During surgery, a pleural breach was identified and sutured after lung expansion under positive pressure ventilation. On postoperative day 2, the patient developed acute left-sided chest pain and respiratory distress . Clinical examination revealed signs consistent with a large left-sided pneumothorax. Thoracic CT confirmed the diagnosis. The patient was immediately managed with chest tube drainage, which ensured evacuation of intrapleural air and represented a critical lifesaving intervention in this context. A small-bore anterior drain connected to suction was inserted, resulting in rapid clinical improvement. The drain was removed on day 5. On day 7, upon referral to the pneumology unit, the patient was clinically stable, but chest X-ray revealed a partial residual pneumothorax with minimal effusion. A conservative management strategy with oxygen therapy was adopted. Full re-expansion of the lung was observed by day 10.

Conclusion

Iatrogenic pneumothorax after nephrectomy is rare but clinically significant. Lifesaving chest tube drainage may be required in acute cases, while conservative management can suffice in stable patients, underscoring the importance of early recognition and tailored treatment.

Title:

What are the most clinically and cost-effective strategies to improve medication adherence in adults with asthma who are non-adherent to prescribed medicines?

Background:

Optimal asthma control depends on both pharmacological intervention and self-management, including adherence to treatment, symptom monitoring, correct inhaler use, and managing triggers. Consistent adherence reduces disease burden, hospitalizations, and mortality, while improving quality of life. Poor adherence to treatment strategies and prescribed medication remains a major concern across all age groups. Additionally, asthma imposes a significant economic burden, costing the NHS GBP 300 billion annually, largely from preventable events. Improving adherence is therefore a clinical and economic priority to ensure sustainable and accessible treatment. Strategies include behavioural support and patient education.

Method:

This systematic review was conducted based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The protocol was registered on PROSPERO. Multiple databases were searched using pre-determined terms. Eligible studies included randomized controlled trials and observational studies (case control, cohort, and cross-sectional) that investigated interventions aiming to improve adherence to prescribed asthma medications in adults. Two independent reviewers screened and extracted data. Outcomes reported include asthma control, hospitalizations, exacerbation frequency, and cost-effectiveness.

Results:

Eight included studies tested interventions to improve asthma outcomes and medication adherence, including personalised asthma action plans (PAAPs), digital and educational tools, and specialist follow-up after exacerbations. PAAP improved knowledge and satisfaction (p<0.05), but not adherence or lung function. Mobile apps and reminder tools showed modest benefit but no significant impact on clinical outcomes. Specialist follow-ups after exacerbations improved adherence (p<0.001). Additionally, when comparing individualised outcomes to caregiver-assisted approaches, the former showed better asthma control at 3 and 6 months (p<0.01).

Conclusion:

Interventions showed mixed effects, and adherence remained low overall. Further research is needed to study interventions that show promise, including individualised approaches, education, and follow-up support.

Introduction: Bronchiectasis is a chronic airway disease characterized by predominantly neutrophilic and occasionally eosinophilic inflammation. We aimed to evaluate the alterations and clinical relevance of plasma fibrinogen as a key player in neutrophilic inflammation, fractional exhaled nitric oxide (FeNO) as an indicator of eosinophilic inflammation, and the fibrinogen-to-FeNO ratio (FFR) as a novel biomarker in bronchiectasis.

Methods: We conducted a two-center, observational, cross-sectional study involving a total of 45 stable, non-cystic fibrosis bronchiectasis patients. Fibrinogen, FeNO, and FFR were measured and investigated in relation to respiratory symptoms, pulmonary function, radiological extension, airway infection, systemic inflammation, and validated disease severity scores.

Results: The 45 patients (33.3% males), with a median (interquartile range, IQR) age of 71 (22.4) years, presented a median (IQR) fibrinogen of 389 (152.7) mg/dL, FeNO of 18 (15.5) ppb, and FFR of 1.2 (1.3). Fibrinogen (1) and FeNO (2) were positively or negatively statistically significantly correlated with the percentage of predicted forced expiratory volume in 1 second (FEV₁%Pred, r₁=-0.476/p₁=0.002 and r₂=+0.470/p₂=0.038, respectively), total white blood cells (WBC, r₁=+0.373/p₁=0.012 and r₂=-0.411/p₂=0.013, respectively), and serum C-reactive protein (CRP, r₁=+0.750/p₁<0.001 and r₂=-0.330/p₂=0.057, respectively). Fibrinogen was additionally correlated with the number of affected lung lobes (r=+0.308/p=0.042) and erythrocyte sedimentation rate (r=+0.493/p=0.001). Interestingly, FFR was found to more strongly correlate with the FEV₁%Pred (r=-0.606/p<0.001), total WBC (r=+0.471/p=0.006), serum CRP (r=+0.592/p<0.001), blood neutrophils (r=+0.357/p=0.042) and eosinophils (r=-0.390/p=0.025), and the severity of airway infection based on the isolated pathogens, including Pseudomonas aeruginosa as the cardinal pathogen (r=+0.444/p=0.034).

Conclusions: In the context of the verified clinical importance of fibrinogen and FeNO, FFR is introduced as a novel potential biomarker in bronchiectasis, reflecting the balance between neutrophilic and eosinophilic inflammation and associating with key aspects of disease activity and severity.

*AMM and NB contributed equally.

Introduction: Malignant neoplasms of the bronchi and lungs represent one of the leading causes of morbidity and mortality in Brazil, reflecting the high burden of this disease on the healthcare system. Analyzing treatment times for these cases within the Brazilian Unified Health System (SUS) is essential to understanding the challenges related to early diagnosis, access to therapies, and their impact on clinical outcomes. Objective: To describe the number of cases according to staging, as well as the treatment time of malignant neoplasms of the bronchi and lungs in Brazil, between 2015 and 2024. Methods: This is an ecological, descriptive, and quantitative study, based on the analysis of secondary data extracted from the TABNET/DATASUS platform. Results: The analysis showed a total of 93,423 cases between 2015 and 2024, considering stages 0 (carcinoma in situ) to IV, as well as cases without staging information. Stage IV was the most prevalent (50,965 cases), while stage 0 was the least prevalent (2,844 cases), indicating that many patients already present with advanced disease when they arrive at specialized services. Regarding treatment time, the most prevalent interval was 61 to 90 days (13,056 cases). Of note, 1,061 cases had treatment times exceeding two years. No histological information was available in this database. Conclusion: Data analysis demonstrates the relevance of malignant neoplasms of the bronchi and lungs in Brazil, revealing not only the heterogeneity in treatment times but also the predominance of advanced-stage disease (stage IV). These findings underscore the need for public policies that aim to facilitate early diagnosis, expand access to therapy, and enhance information recording to reduce inequalities and improve clinical outcomes for patients.

Background: Lower respiratory tract infections (LRTIs) are one of the leading causes of mortality. Pharmacist-led interventions can enhance adherence to antibiotics; the present study aims to determine adherence to the antibiotics prescribed for LRTIs and related factors. Methods: An individual randomized control trial was conducted with 1:1 (intervention=205, control=205) participants aged >18 years recruited. The primary outcomes included adherence to therapy at weeks 1 and 2, awareness of antibiotic use, and appropriate discontinuation as prescribed. The secondary outcome measures were the overall clinical outcomes of the therapy and the effectiveness of educational interventions assessed at the final week 7 (overall assessment checked and treatment was not continued). The data were analyzed using different statistical methods, including descriptive statistics for data summarization, and inferential techniques were used. The WHO-PAS and BMQ questionnaires were scored on a 5-point (Likert Scale), with total and domain-specific scores computed and summarised as median (IQR); group comparisons were carried out by Mann–Whitney U statistics, while mean (SD) values were additionally calculated to descriptively summarise group-level differentiations. Finally, 187 patients remained in the intervention group, and a total of n=18 were lost to follow-up. The awareness was significantly increased through pharmacist-led interventions (n=106, 56.7%; p=0.01), along with the factors leading to antibiotic resistance knowledge. Overall, adherence to antibacterial therapy for the LRTIs has improved (p≤0.01), and a significant correlation exists between overall MMAS-8 mean scores and other demographic factors; interventions improved [0.441-2.151] with adherence (post-intervention). Higher adherence was found (p≤0.05) among the participants in the intervention group as compared to the control group, and with (OR: 1.050; CI: 0.150-1.024) demographics (education, p=0.05). Conclusion: Overall, the intervention group showed better awareness, understanding, and attitudes about antibiotics, and their adherence to antibiotic therapy improved significantly, along with the overall clinical outcomes.

Introduction: Polysomnography is the gold standard test to diagnose obstructive sleep apnea (OSA). The two common polysomnography available: home sleep apnea test (HSAT) or full attended polysomnography. Full attended polysomnography, gold standard test, is an expensive test and has a long waiting list. HSAT is cheap and sensitive, but it has the main limitation of respiratory effort-related arousal (RERA) detection. The presence of RERA results in a higher respiratory disturbance index (RDI) than apnea–hyponea index (AHI). Knowing factors associated with higher RDI than AHI in patients with OSA may reduce numbers of patients required full attended polysomnography which lower cost for OSA diagnosis. This study aimed to evaluate factors associated with higher RDI than AHI in patients with OSA.

Methods: This was a retrospective analytical study. The inclusion criteria were adult patients with OSA and diagnosed with OSA by full attended polysomnography. Clinical factors and polysomnography were collected from the hospital database. Factors associated with higher RDI than AHI were detected by multivariable logistic regression analysis.

Results: There were 72 patients with OSA met the study criteria. Of those, 27 patients (37.50%) had a higher RDI than AHI. There were five factors in the predictive model for higher RDI than AHI including age, sex, hypertension, diabetes, and body mass index. Only body mass index was independently associated with higher RDI than AHI. An adjusted odds ratio of body mass index was 1.10 (95% confidence interval of 1.01, 1.19). A body mass index of 26.03 kg/m² had a sensitivity of 81.48% and specificity of 33.33% in order to detect higher RDI than AHI.

Conclusions: Patients who are suspected for OSA with the body mass index of 26.03 kg/m² may have higher RDI than AHI. These patients may be required full attended polysomnography, while other patients may be tested with HSAT which may report comparable AHI values.