RESUMO Com o objetivo de analisar a atuação das equipes multiprofissionais conformadas nos Núcleos Ampliados de Apoio à Família e Atenção Básica, frente às dimensões clínico-assistencial e técnico-pedagógica no contexto da Atenção Primária à Saúde no Brasil, delineou-se estudo multicêntrico, de natureza qualitativa, realizado no período de 2018 a 2020, em três municípios no estado do Ceará. A coleta de dados ocorreu através de observação e grupo focal com as equipes multiprofissionais. Os registros das observações e dos discursos dos grupos focais foram tabulados no software Interface de R pour L Analyses Multidimensionnelles de Textes L de Questionnaires (IRAMUTEQ®). Na Classificação Hierárquica Descendente, obteve-se um aproveitamento de 75,46% do corpus textual, formando cinco classes, cujos vocábulos têm associação estatisticamente relevante (p<0,0001). Os resultados evidenciam avanços na atuação das equipes multiprofissionais na produção do cuidado integral dos indivíduos e coletivos, a partir de ações de planejamento e tomada de decisões partilhadas com vistas à melhoria da qualidade de vida destes. Outrossim, identifica-se uma ênfase na dimensão clínico- -assistencial do cuidado, o que torna a dimensão técnico-pedagógica um desafio. Contudo, reconhece-se o potencial indutor da atuação das equipes para um trabalho colaborativo e orientado pela interprofissionalidade, corroborando o fortalecimento da Atenção Primária à Saúde.

ABSTRACT In order to analyze the performance of the multiprofessional teamwork at the Family Primary Health Care Expanded Support Centers, regarding the clinical-assistance and technical-pedagogical dimensions in Brazilian Primary Health Care, a multicentered study was outlined. This study is qualitative and descriptive in nature, and it was carried out between 2018 and 2020 in three northeast Brazilian towns. Data were collected through observation and focus groups with multiprofessional teams which worked in Primary Health Care. Observations were made during the baseline phase, follow-ups one and two. Documentation of observations and focal group’s speech were tabulated using the Interface de R pour L Analyses Multidimensionnelles de Textes L de Questionnaires (IRAMUTEQ®) software. 106 text units were identified in the Descending Hierarchical Classification, with 807 follow-ups, 28.304 occurrences, 1.809 active forms with average frequency ≥3:737, chi2≥57,64, and 75.46% use of textual statistics, which formed five classes of statistically relevant words (p<0,0001). The results show advances in the work done by the multiprofessional teams on the production of comprehensive care of both individuals and collectivity, due to action plans and collaborative decision seeking improvements in the quality of life of individuals and collectivity. It is also possible to identify emphasis on the clinical-assistance dimension of care and that makes the technical-pedagogical dimension a challenge. However, we highlight the teams’ collaborative driving force that was guided by the interprofessionality, corroborating, thus, the strengthening of Primary Health Care.

RESUMO Com o objetivo de analisar a atuação das equipes multiprofissionais conformadas nos Núcleos Ampliados de Apoio à Família e Atenção Básica, frente às dimensões clínico-assistencial e técnico-pedagógica no contexto da Atenção Primária à Saúde no Brasil, delineou-se estudo multicêntrico, de natureza qualitativa, realizado no período de 2018 a 2020, em três municípios no estado do Ceará. A coleta de dados ocorreu através de observação e grupo focal com as equipes multiprofissionais. Os registros das observações e dos discursos dos grupos focais foram tabulados no software Interface de R pour L Analyses Multidimensionnelles de Textes L de Questionnaires (IRAMUTEQ®). Na Classificação Hierárquica Descendente, obteve-se um aproveitamento de 75,46% do corpus textual, formando cinco classes, cujos vocábulos têm associação estatisticamente relevante (p<0,0001). Os resultados evidenciam avanços na atuação das equipes multiprofissionais na produção do cuidado integral dos indivíduos e coletivos, a partir de ações de planejamento e tomada de decisões partilhadas com vistas à melhoria da qualidade de vida destes. Outrossim, identifica-se uma ênfase na dimensão clínico- -assistencial do cuidado, o que torna a dimensão técnico-pedagógica um desafio. Contudo, reconhece-se o potencial indutor da atuação das equipes para um trabalho colaborativo e orientado pela interprofissionalidade, corroborando o fortalecimento da Atenção Primária à Saúde.

ABSTRACT In order to analyze the performance of the multiprofessional teamwork at the Family Primary Health Care Expanded Support Centers, regarding the clinical-assistance and technical-pedagogical dimensions in Brazilian Primary Health Care, a multicentered study was outlined. This study is qualitative and descriptive in nature, and it was carried out between 2018 and 2020 in three northeast Brazilian towns. Data were collected through observation and focus groups with multiprofessional teams which worked in Primary Health Care. Observations were made during the baseline phase, follow-ups one and two. Documentation of observations and focal group’s speech were tabulated using the Interface de R pour L Analyses Multidimensionnelles de Textes L de Questionnaires (IRAMUTEQ®) software. 106 text units were identified in the Descending Hierarchical Classification, with 807 follow-ups, 28.304 occurrences, 1.809 active forms with average frequency ≥3:737, chi2≥57,64, and 75.46% use of textual statistics, which formed five classes of statistically relevant words (p<0,0001). The results show advances in the work done by the multiprofessional teams on the production of comprehensive care of both individuals and collectivity, due to action plans and collaborative decision seeking improvements in the quality of life of individuals and collectivity. It is also possible to identify emphasis on the clinical-assistance dimension of care and that makes the technical-pedagogical dimension a challenge. However, we highlight the teams’ collaborative driving force that was guided by the interprofessionality, corroborating, thus, the strengthening of Primary Health Care.

ABSTRACT Purpose The 2018 American Urological Association guidelines on the Evaluation and Management of Testosterone Deficiency recommended that 300 ng/dL be used as the threshold for prescribing testosterone replacement therapy (TRT). However, it is not uncommon for men to present with signs and symptoms of testosterone deficiency, despite having testosterone levels greater than 300 ng/dL. There exists scant literature regarding the use of hCG monotherapy for the treatment of hypogonadism in men not interested in fertility. We sought to evaluate serum testosterone response and duration of therapy of hCG monotherapy for men with symptoms of hypogonadism, but total testosterone levels > 300 ng/dL. Materials and Methods We performed a multi-institutional retrospective case series of men receiving hCG monotherapy for symptomatic hypogonadism. We evaluated patient age, treatment indication, hCG dosage, past medical history, physical exam findings and serum testosterone and gonadotropins before and after therapy. Descriptive analysis was performed and Mann Whitney U Test was utilized for statistical analysis. Results Of the 20 men included in the study, treatment indications included low libido (45%), lack of energy (50%), and erectile dysfunction (45%). Mean testosterone improved by 49.9% from a baseline of 362 ng/dL (SD 158) to 519.8 ng/dL (SD 265.6), (p=0.006). Median duration of therapy was 8 months (SD 5 months). Fifty percent of patients reported symptom improvement. Conclusions Treatment of hypogonadal symptoms with hCG for men who have a baseline testosterone level > 300 ng/dL appears to be safe and efficacious with no adverse events.

ABSTRACT Purpose: The baseline PSA has been proposed as a possible marker for prostate cancer. The PSA determination before 40 years seems interesting because it not suffers yet the drawbacks related to more advanced ages. Considering the scarcity of data on this topic, an analysis of PSA kinetics in this period seems interesting. Materials and Methods: A retrospective assay in a database of a private diagnostic center was performed from 2003 to 2016. All subjects with a PSA before 40 years were included. Results: 92995 patients performed PSA between the ages of 21 – 39. The mean value ranged from 0.66 ng / mL (at age 22) to 0.76 ng / mL (at age 39) and the overall mean was 0.73 ng / mL. As for outliers, 3783 individuals presented a baseline PSA > 1.6 ng / mL (p95). A linear regression model showed that each year there is a PSA increase of 0.0055 ng / mL (β = 0.0055; r2 = 0.0020; p < 0.001). A plateau in PSA between 23 and 32 years was found and there were only minimal variations among the ages regardless of the evaluated percentile. Conclusion: It was demonstrated that PSA kinetics before 40 years is a very slow and progressive phenomenon regardless of the assessed percentile. Considering our results, it could be suggested that any PSA performed in this period could represent the baseline value without significant distortions.

ABSTRACT A 41-year-old male presented at Emergency Department (ED) with right flank pain associated with hematuria for 3 days. Patient had a previous history of nephrolithiasis. The physical examination and blood tests were normal. Urine analyses showed haematuria > 1.000.000/μL. After clinical evaluation, a computer tomography (CT) showed right ureteral dilatation caused by a 5 mm proximal stone and a distal intraluminal mass of 8 cm in length. In this setting, an ureteroscopic biopsy was performed and revealed a large polypoid lesion histologically suggestive of fibroepithelial polyp. Due to technical difficulties (intraluminal mass length and technical issue for the passage of guidewire) and after discussing all available minimally invasive options, we opted for a laparoscopic approach. Instead of ureterectomy of the affected segment of the ureter, as classically performed, we proceeded with an ureterotomy, blunt dissection of the tumor and ureterolithotomy, with complete removal of the mass. This approach did not require ureteral anastomosis and the ureteral dilatation facilitated its primary closure. No complications occurred, even after 3 years of follow-up.