Previvors, defined as those who learn that they carry a germline pathogenic or likely pathogenic (P/LP) variant that increases their risk of cancer in the absence of a cancer diagnosis, are a unique yet growing patient population. Identification of a genetic predisposition to cancer and implementation of subsequent risk-reduction strategies are increasingly common aspects of clinical practice, and the era of direct-to-consumer genetic testing expands the relevance of these issues. Comprehensive care for these patients requires a multidisciplinary approach that addresses both immediate risk-management decisions and lifelong follow-up. Essential components of care include counseling on risk-reduction options, the safety and benefits of estrogen-only hormone replacement therapy, lifestyle modification strategies, and targeted nutrition guidance. Although the term previvor encompasses individuals with a variety of hereditary cancer predisposition syndromes, this article focuses on previvors with P/LP variants in BRCA1 or BRCA2 and aims to raise awareness of the far-reaching impact of this diagnosis on female previvors.

The diagnosis and management of ankyloglossia, commonly referred to as tongue-tie, has become a controversial topic spanning multiple subspecialties within pediatrics, dentistry, and rehabilitation medicine. Changing perspectives on clinical significance, increased awareness of breastfeeding challenges, and a stronger emphasis on a multidisciplinary approach have contributed to a dramatic rise in both diagnosis and intervention in this condition. Between 1997 and 2012, inpatient diagnoses of ankyloglossia in the United States increased nearly 10-fold, from 3,934 to 32,837 cases, with a similar increase in lingual frenotomy procedures, from 1,279 to 12,406. Providers may encounter tongue-tie in diverse settings, ranging from the newborn nursery to outpatient pediatric primary care to otolaryngology clinics. In the absence of a validated standalone threshold for surgical intervention, clinical decision-making can be challenging. This article provides clinically relevant, evidence-based recommendations to guide the diagnosis and management of ankyloglossia. Current guidance emphasizes direct assessment of the breastfeeding dyad, skilled lactation support, close monitoring of milk transfer and growth, and treatment of competing causes before frenotomy is considered.

Seasonal affective disorder (SAD) is most often recognized as a fall-winter subtype characterized by hypersomnia, hyperphagia, and anergia. Less commonly, patients experience a reverse presentation with spring-summer onset marked by irritability, insomnia, appetite loss, and psychomotor agitation. Pathophysiologic contributors to reverse SAD include circadian misalignment, neuroendocrine dysregulation, environmental stressors, and genetic susceptibility. Management requires a multimodal approach incorporating psychoeducation, psychotherapy (notably cognitive behavioral therapy [CBT]-SAD), pharmacotherapy tailored to symptom profile, vitamin D assessment, sleep hygiene, and lifestyle adjustments. Recognition of summer-onset depression is critical in primary care, as underdiagnosis may delay effective intervention. Rising global temperatures and prolonged light exposure underscore the importance of clinician awareness and proactive screening for reverse SAD to optimize patient outcomes. In this article, a fictional, illustrative case report describes a 35-year-old woman with a 3-year pattern of summer depression meeting DSM-5-TR criteria for major depressive disorder with seasonal pattern, summer onset. In this case, treatment with desvenlafaxine, sleep/environmental modification, and CBT leads to significant improvement.