ABSTRACT Introduction: The COVID-19 pandemic necessitated a shift from in-person to remote learning, including team-based learning activities. Many studies have explored several aspects of team-based learning; however, there is still a lack of knowledge regarding the factors affecting students’ attitudes and performance. Objective: To evaluate the impact of the COVID-19 pandemic on medical students’ performance in individual readiness assurance tests during team-based learning activities, given that their grades were excluded from the final course grades. Methods: We compared the number of team-based learning applications, student absences, and individual readiness assurance tests grades of medical undergraduate students in three different scenarios: Group 1, in-person individual readiness assurance tests before the pandemic; Group 2, remote individual readiness assurance tests during the lockdown period when their grades were excluded from the final grade calculation; and Group 3, in-person individual readiness assurance tests during the pandemic after lockdown restrictions eased. Results: Remote team-based learning led to significantly lower grades than in-person evaluations. Moreover, the number of students with failing or insufficient grades (below seven) increased during the remote learning period, when their grades were excluded from the final grade calculation, compared to in-person individual readiness assurance tests before the pandemic. Furthermore, absenteeism was higher when the online strategy was applied. Conclusion: We observed lower academic performance by medical students during remote team-based learning sessions, likely owing to the exclusion of individual readiness assurance tests grades from the final course grade calculations during the COVID-19 pandemic.

Abstract Objective To compare the oncological results and the functional outcomes of patients undergoing Total Laryngectomy (TL) with the non-surgical treatment (organ preservation protocol) in the treatment of advanced laryngeal carcinomas through systematic review and meta-analysis. Methods A literature survey strategy was employed in order to perform a systematic review of the available evidence. Success rate and functional outomes after oncological treatment of patients with advanced laryngeal carcinomas was evaluated through systematic review and metanalysis, comparing TL and organ preservation protocol. Results The surgical treatment was associated with better survival outcomes. When stratifying by T stage, while patients with T4 staging have less risk of mortality with TL, there is no difference between the different treatments for patients with T3 tumors. Surgery is related to a lower chance of recurrence, late dysphagia and feeding tube dependence. Conclusion Patients with T4 tumors should undergo TL as their treatment of choice. For patients with T3 tumors, there is no differences on the risk of mortality according to the therapeutic option, however, there is a greater chance of recurrence and dysphagia when surgery is not performed.

RESUMO Introdução: A empatia tende a diminuir ao longo da formação médica. A relação entre espiritualidade e empatia não tem sido amplamente explorada. Objetivo: Este estudo teve como objetivo correlacionar empatia e religiosidade/espiritualismo por meio de questionário voluntário, entre estudantes e residentes de Medicina. Método: Trata-se de um estudo transversal exploratório por meio de um questionário online para preenchimento voluntário entre estudantes de medicina e residentes, composto por: dados sociodemográficos, questionário de empatia e questões sobre religiosidade/espiritualismo. Resultado: De 1.550 convites, 273 participantes voluntários responderam (17,6%). A maioria era católica (103 - 37,7%), seguida de agnósticos (84 - 30,8%), protestantes e kardecistas (27 - 9,9% cada). A Escala de Empatia de Jefferson apresentou pontuação média de 120,4 (de 90 a 140). Não se constatou correlação entre a crença religiosa e o grau de empatia. Ambos os conceitos não indicaram diferença significativa ao longo do período da educação médica. Conclusão: Empatia e religiosidade/espiritualismo não apresentaram correlação entre estudantes e residentes de Medicina.

ABSTRACT Introduction: Empathy tends to decline throughout the course of medical training. The relationship between spirituality and empathy has not been widely explored. Objective: To correlate empathy and religiosity/spiritualism by means of a voluntary questionnaire applied to medical students and residents. Methods: This is an exploratory cross-sectional study using an online questionnaire completed on a voluntary basis by medical students and residents, consisting of: socio-demographic data, an empathy questionnaire and questions about religiosity/spiritualism. Results: From 1,550 invitations, 273 volunteer participants responded (17.6%). Most were Catholic (103 - 37.7%), followed by agnostics (84 - 30.8%), and Protestants and Kardecists (27 - 9.9% each). The Jefferson Empathy Scale had a mean score of 120.4 (from 90 to 140). Religious belief and degree of empathy did not present any correlation. Neither concept presented significant difference over the course of medical training. Conclusion: Empathy and religiosity/spiritualism did not present any correlation among medical students and residents.

ABSTRACT There is increasing interest in ultrasound-guided ablation treatments for thyroid diseases, including benign and malignant ones. Surgeons, radiologists, and endocrinologists carry out these treatments, and various organizations within these specialties have recently released multiple international consensus statements and clinical practice standards. The aim of the present consensus statement is to provide guidance, cohesion, and standardization of best practices for thermal ablation procedures of thyroid nodules. The statement includes the indications for these procedures, preprocedural evaluations, technical aspects of the procedures, posttreatment care, follow-up, complications, and training recommendations. This document was written by a panel of specialists from the Brazilian Society of Interventional Radiology and Endovascular Surgery (SOBRICE), the Brazilian Society of Head and Neck Surgery (SBCCP), and the Brazilian Society of Endocrinology and Metabolism (SBEM). The statement does not aim to provide criteria for assessing the capability of specialists to perform the procedure. Instead, it aims to promote the standardization of best practices to reduce potential adverse outcomes. Additionally, it strives to enhance the delivery of high-quality care and the widespread adoption of these technologies on a national level. The recommendations collectively serve as a guidebook for applying best practices in thyroid ablation.

Abstract Objectives: Sialendoscopy is a minimally invasive procedure used to diagnose and treat obstructive salivary gland diseases. Previous studies in the topic have shown mixed results. The present study aimed to evaluate the efficacy and safety of sialendoscopy through previous systematic reviews for different outcomes of several diseases. We also aimed to assess studies’ methodological quality and heterogeneity. Methods: We conducted a comprehensive systematic literature search of Pubmed, Embase, Lilacs and Cochrane Library. We included systematic reviews and meta-analyses that used sialendoscopy to treat both lithiasic and alithiasic salivary glands diseases. Data extraction included studies' characteristics and results. We assessed studies' methodological quality using the AMSTAR-2 (A Measurement Tool to Assess systematic Reviews 2) tool. Results: 13 studies were included in the review, being 9 in adult populations and 4 in pediatric populations. Sialendoscopy proved to be effective at the treatment of different lithiasic and other obstructive diseases, but with important heterogeneity. The technique was also considered highly safe in most studies. However, studies had a critically low quality of evidence. Conclusions: Most studies demonstrated high efficacy and safety of sialendoscopy, but with critically low quality of evidence. We still lack randomized studies in this field, and future systematic reviews on the topic should follow current guidelines to improve conduction and reporting.

Abstract Objective The outbreak of the COVID-19 pandemic had a considerable impact on the healthcare access, treatment, and follow-up of oncologic patients. The aim of this study was to evaluate how the COVID-19 pandemic has affected consultation and follow-up demand as well as treatment volume at Brazilian Head and Neck Surgery centers. Methods An anonymous online questionnaire was used for collection of data across all Brazilian Head and Neck Surgery Centers across a 3-month period (April‒June 2021). This information included the characteristics of each center, and the perceived self-reported impact of the COVID-19 pandemic on academic activities, residency training, and the diagnosis, treatment, and follow-up of patients with Head and Neck diseases between 2019 and 2020. Results The response rate across the 40 registered Brazilian Head and Neck Surgery Centers was 47.5% (n = 19). The data showed a significant reduction in the total number of consultations (24.8%) and number of attending patients (20.2%) between 2019 and 2020. The total number of diagnostic exams (31.6%) and surgical procedures (13.0%) conducted over this period also decreased significantly. Conclusions The COVID-19 pandemic had a significant national impact on Brazilian Head and Neck Surgery Centers. Future studies should examine the long-term effects of the pandemic on cancer treatment. Level of evidence Evidence from a single descriptive study. COVID19 COVID 19 COVID-1 access followup follow up centers 3month month 3 April‒June AprilJune April June 2021. 2021 . 2021) center selfreported self reported activities training diagnosis 201 2020 4 475 47 5 47.5 n 19. 19) 24.8% 248 24 8 (24.8% 20.2% 202 20 2 (20.2% 31.6% 316 31 6 (31.6% 13.0% 130 13 0 (13.0% significantly longterm long term COVID1 1 COVID- 47. 24.8 (24.8 20.2 (20.2 31.6 (31.6 13.0 (13.0 24. (24. 20. (20. 31. (31. 13. (13. (24 (20 (31 (13 (2 (3 (1 (

Abstract Introduction The identification of thyroid cancer may be conducted through clinical detection, imaging method, and histopathological examination. Both solitary nodules and multinodular goiter are associated with malignancy. Objective To assess the risk factors for malignancy among patients with multinodular goiter submitted to total thyroidectomy. Methods A series of 712 consecutive patients, submitted to total thyroidectomy between 2005 and 2016 with multinodular goiter regarding clinical, ultrasound, and pathological variables, was retrospectively evaluated. Results There were 408 cases of papillary carcinoma (57.3%), with the remaining being benign. Gender had no statistical significance (p = 0.169) for malignancy, unlike the Bethesda index, higher age group (p = 0.005), shorter clinical history time (p = 0.036), smaller number of nodules (p < 0.0001), and smaller nodule size (p < 0.0001), which were related to malignancy. Conclusion The Bethesda index, older age group, shorter clinical history, smaller number of nodules, and smaller size of nodule were related to the diagnosis of papillary carcinoma. detection method examination 71 200 201 ultrasound variables evaluated 40 57.3%, 573 57.3% , 57 3 (57.3%) benign p 0.169 0169 0 169 index 0.005, 0005 0.005 005 0.005) 0.036, 0036 0.036 036 0.036) 0.0001, 00001 0.0001 0001 0.0001) 7 20 4 57.3 5 (57.3% 0.16 016 16 000 0.00 00 003 0.03 03 0000 0.000 2 57. (57.3 0.1 01 1 0.0 (57. 0. (57 (5 (

Abstract Objective: The aim of the present study was to analyze the prognostic relationship of weight loss and preoperative hematological indexes in patients surgically treated for pT4a squamous cell carcinoma of the oral cavity. Methods: A retrospective cohort study. Results: Percent weight loss greater than 10% was identified in 49 patients (28.2%), and any weight loss in relation to the usual weight occurred in 140 patients (78.7%). Percent weight loss greater than 10% (HR = 1.679), Red cell distribution width (RDW) values greater than 14.3% (HR = 2.210) and extracapsular spread (HR = 1.677) were independent variables associated with risk of death. Conclusion: Patients with advanced squamous cell carcinoma of the oral cavity present significant weight loss and as significantly immunocompromised. Increased values of RDW and higher percentages of weight loss in relation to the individual’s usual weight, together with extracapsular spread of metastatic lymph nodes, were risk factors for lower survival, regardless of other clinical and anatomopathological characteristics. Level of evidence: 3. Objective pTa pT a Methods Results 10 4 28.2%, 282 28.2% , 28 2 (28.2%) 14 78.7%. 787 78.7% . 78 7 (78.7%) HR 1.679, 1679 1.679 1 679 1.679) (RDW 143 3 14.3 2.210 2210 210 1.677 1677 677 death Conclusion immunocompromised individuals individual s nodes survival characteristics evidence 28.2 (28.2% 78.7 (78.7% 167 1.67 67 14. 2.21 221 21 28. (28.2 78. (78.7 16 1.6 6 2.2 22 (28. (78. 1. 2. (28 (78 (2 (7 (

Resumo Introdução A biópsia de linfonodo sentinela é um método comprovado para estadiamento cervical em pacientes com carcinoma espinocelular inicial da cavidade oral, porque apresenta menor taxa de morbidade do que o método tradicional de esvaziamento cervical seletivo, com os mesmos resultados oncológicos. Porém, o verdadeiro efeito desse método na qualidade de vida desses pacientes permanece desconhecido. Objetivo Avaliar a qualidade de vida de pacientes com carcinoma espinocelular de cavidade oral T1/T2N0 submetidos a biópsia do linfonodo sentinela em comparação aos pacientes nos quais o esvaziamento cervical seletivo foi feito. Método Estudo transversal que incluiu 24 pacientes, após 36 meses de seguimento, dos quais 15 foram submetidos a biópsia do linfonodo sentinela e nove a esvaziamento cervical seletivo. Todos os pacientes responderam ao questionário de qualidade de vida da University of Washington. Resultados A avaliação dos questionários evidenciou pioria tardia dos domínios aparência (p = 0,035) e mastigação (p = 0,041), bem como diminuição de cerca de 10% da qualidade de vida geral (p = 0,025) nos pacientes submetidos a esvaziamento cervical seletivo em comparação com aqueles submetidos a biópsia do linfonodo sentinela. Conclusão Pacientes com carcinoma espinocelular de cavidade oral em estágio inicial submetidos a biópsia do linfonodo sentinela apresentaram melhores resultados tardios de qualidade de vida geral, principalmente quanto à aparência e à mastigação, quando comparados aos pacientes submetidos a esvaziamento cervical seletivo.

Abstract Introduction Sentinel lymph node biopsy is a proven method for staging the neck in patients with early oral cavity squamous cell carcinoma because it results in less comorbidity than the traditional method of selective neck dissection, with the same oncological results. However, the real effect of that method on the quality of life of such patients remains unknown. Objective The present study aimed to evaluate the quality of life of patients with oral cavity squamous cell carcinoma T1/T2N0 submitted to sentinel lymph node biopsy compared to those that received selective neck dissection. Methods Cross-sectional study including 24 patients, after a 36 month follow-up, 15 of them submitted to the sentinel lymph node biopsy and 9 to selective neck dissection. All patients answered the University of Washington quality of life questionnaire. Results The evaluation of the questionnaires showed a late worsening of the domains appearance (p = 0.035) and chewing (p = 0.041), as well as a decrease of about 10% of general quality of life (p = 0.025) in patients undergoing selective neck dissection in comparison to those undergoing sentinel lymph node biopsy. Conclusion Patients with early-stage oral cavity squamous cell carcinoma undergoing sentinel lymph node biopsy presented better late results of general quality of life, mainly regarding appearance and chewing, when compared to patients submitted to selective neck dissection.

Abstract Objective To evaluate the laparoscopic skills of medical students and identify personal characteristics in terms of greater easiness in performing laparoscopic surgical procedures. Methods This study included medical students in the 6th semester of a Medical School in Brazil who answered 10 questions concerning their habits and characteristics. A laparoscopic platform and an abdominal synthetic model were used to assess surgical skills comprising the three following surgical steps: to pass the needle through the trocar and to place it in the laparoscopic needle holder, to perform a laparoscopic simple stitch in synthetic liver parenchyma and, to perform a laparoscopic surgical knot. The duration of the activity was limited to four minutes and the procedure was monitored by a laparoscopic surgeon. Results The study included 50 students. Of these, 18% completed the three surgical stages. Steps 1 and 2 were completed by 94% and 88% of students, respectively. No statistically significant variables were found when characteristics of the groups with and without success in the three stages were compared. The group that finished the activity had a faster time completing step 2 than the group that failed (mean time of 115.3 seconds against 157.8 seconds, p=0.03). Conclusion The minority of students could complete effectively all three surgical steps. No personal traits related to greater surgical skill were identified.

ABSTRACT Objective We performed a systematic review of the literature and meta-analysis on the efficacy and safety of hydroxychloroquine to treat COVID-19 patients. Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and LILACS (January 2019 to March 2021) for patients aged 18 years or older, who had COVID-19 and were treated with hydroxychloroquine versus placebo or standard of care. We also searched the WHO Clinical Trials Registry for ongoing and recently completed studies, and the reference lists of selected articles and reviews for possible relevant studies, with no restrictions regarding language or publication status. Random-effects models were used to obtain pooled mean differences of treatment effect on mortality, and serious adverse effects between hydroxychloroquine and the Control Group (standard of care or placebo); heterogeneity was assessed using the I2 and the Cochran´s Q statistic. Results Nine studies met the inclusion criteria and were included in the meta-analysis. There was no significant difference in mortality rate between patients treated with hydroxychloroquine compared to standard of care or placebo (16.7% versus 18.5%; pooled risk ratio 1.09; 95% confidence interval: 0.99-1.19). Also, the rate of serious adverse effects was similar between both Groups, Hydroxychloroquine and Control (3.7% versus 2.9%; pooled risk ratio 1.22; 95% confidence interval: 0.76-1.96). Conclusion Hydroxychloroquine is not efficacious in reducing mortality of COVID-19 patients. Prospero database registration (www.crd.york.ac.uk/prospero) under number CRD42020197070.

Abstract Introduction The COVID-19 pandemic has had a high impact on surgical training around the world due to required measures regarding the suspension of elective procedures and the dismissal of nonessential personnel. Objectives To understand the impact the pandemic had on head and neck surgery training in Brazil. Methods We conducted a 29-question online survey with head and neck surgery residents in Brazil, assessing the impact the pandemic had on their training. Results Forty-six residents responded to the survey, and 91.3% of them reported that their residency was affected by the pandemic, but most residents were not assigned to work directly with patients infected with the new coronavirus (71.4%). All residents reported decrease in clinic visits and in surgical procedures, mostly an important reduction of ∼ 75%. A total of 56.5% of the residents described that the pandemic has had a negative impact on their mental, health and only 4 (8.7%) do not have any symptoms of burnout. The majority (78.3%) of the residents reported that educational activities were successfully adapted to online platforms, and 37% were personally infected with the virus. Conclusion Most surgical residencies were greatly affected by the pandemic, and residents had an important decrease in surgical training. Educational activities were successfully adapted to online modalities, but the residency programs should search for ways of trying to compensate for the loss of practical activities.

Abstract Introduction Hashimoto thyroiditis (HT) shares many characteristics with papillary thyroid carcinoma (PTC), and some studies show that, when associated, PTC is diagnosed mostly with smaller lesions and multifocal pattern. Objective To evaluate the relationship between HT and PTC. Methods A retrospective study of 155 patients who underwent total thyroidectomy from 2009 to 2015. Demographical, clinical and ultrasonographical data, as well as anatomopathological findings were evaluated. Results There were signs of thyroidits in 35 patients, and 114 patients had a unifocal disease. There was no statistical significance between the variables studied and thyroiditis. However, when compared with the occurrence of unifocal or multifocal lesions, there was statistical significance regarding age (p = 0.038) and mass (p = 0.031). There was no direct relationship between thyroiditis and multifocality (p = 0.325) nor between thyroiditis and cervical extension of the disease (p = 0.300 e p = 0.434). Conclusion There was no relationship between thyroiditis and multifocality in cases of PTC.