ABSTRACT Objective: The risk of malignancy and diagnostic accuracy of fine-needle aspiration biopsy (FNAB) of thyroid nodules (TN) with diameters ≥ 3-4 cm remains controversial. However, some groups have indicated surgical treatment in these patients regardless of the FNAB results. We aimed to evaluate the diagnostic accuracy of the FNAB in systematically resected ≥4 cm TN and if the risk of malignancy is higher in these patients. Subjects and methods: We retrospectively evaluated 138 patients (142 nodules) with TN with diameters ≥4 cm who underwent thyroidectomy. Results: The FNAB results were nondiagnostic/unsatisfactory (ND/UNS) in 2.1% of the cases and benign in 51.4%. They indicated atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) in 23.9% of cases, follicular neoplasia/suspicious for a follicular neoplasm (FN/SFN) in 9.2%, suspicion of malignancy (SUS) in 8.5%, and malignant in 4.9%. The histopathological analysis after thyroidectomy revealed a thyroid cancer rate of 100% in the FNABs classified as malignant, 33.3% in SUS cases, 7.7% in FN/SFN, 17.6% in AUS/FLUS, and 4.1% in benign FNABs. None of the ND/UNS FNABs were malignant. The global malignancy diagnosis was 14.8% (n = 21). However, the rate of false negatives for FNAB was low (4.1%). Conclusion: We showed that the risk of malignancy in nodules with diameters ≥4 cm was higher compared to the risk of thyroid cancer in TN in general. However, we found a low rate of false-negative cytological results; therefore, our data do not justify the orientation of routine resection for these larger nodules.

Resumo Esta pesquisa teve como objetivo realizar um levantamento das características socioambientais e estudo etnobotânico de plantas medicinais utilizadas por uma comunidade tradicional do nordeste brasileiro, Alagoas, Brasil. O estudo se deu por meio de visitas com aplicação de um questionário contendo perguntas relacionadas aos fatores socio-econômicos e sobre a diversidade das plantas utilizadas como medicinais. O trabalho foi realizado no período de março/2019 a fevereiro/2020, onde foram entrevistadas famílias e catalogadas amostras de plantas para identificação botânica. A população estudada, com 24 entrevistados, foi composta por moradores da comunidade Quilombola Pau D’arco da cidade de Arapiraca - Alagoas. Dos moradores entrevistados, 15 (62,5%) apresentavam idade entre 56 e 80 anos, 11 dos entrevistados cerca de 46%, são naturais da comunidade e 13 (54%) possuíam ensino fundamental incompleto. Ao todo, foram citadas 30 espécies de plantas utilizadas para fins terapêuticos, das quais apresentam maior utilização as plantas contra a hipertensão arterial (Salvia rosmarinus Schleid), diabetes Mellitos (Croton heliotropiifolius Kunth), dor e inflamação (Alternanthera tenella Colla). As espécies citadas estão relacionadas a inúmeras utilizações medicinais, entre os quais predominaram as doenças associadas ao aparelho cardiovascular e processos inflamatórios. O chá é principal forma de preparo das plantas. Percebe-se que as plantas medicinais são amplamente utilizadas por essa comunidade quilombola e o cultivo no quintal é considerado uma tradição.

Abstract The aim of this research is to make a survey of the socio-environmental characteristics and the ethnobotanical study of medicinal plants used in a traditional community in the Brazilian Northeast, Alagoas. The study was made based on visits with the application of a questionnaire with questions related to the socio-economic element and on the diversity of plants used in herbal medicine. The research was made from March/2019 to February/2020, where families and interviewed plant exhibitors were interviewed for botanical identification. The studied community, which were 24 interviewees, was compiled by residents of the Quilombola community from Pau D’arco in Arapiraca city - Alagoas. Residents interviewed, 15 (62.5%) attended between 56 to 80 years, 11 interviewees about 46% were born in the community and 13 (54%) had a fundamentally incomplete nature. At the end, there were mentioned 30 plant species used for phytotherapeutic purposes, from which presents bigger usage as plants against arterial hypertension (Salvia rosmarinus Schleid), diabetes Mellitos (Croton heliotropiifolius Kunth), pain and inflammation (Alternanthera tenella Colla), present the biggest number of species in the community. The species cited are related to numerous medicinal uses, among which there will be predominant associations associated with cardiovascular and inflammatory processes. The tea is the main way of preparing plants. It is perceived that medicinal plants are only widely used by this Quilombola community of and growth of the crops in the backyard are considered a tradition.

Summary Total thyroidectomy, radioiodine (RAI) therapy, and TSH suppression are the mainstay treatment for differentiated thyroid carcinomas (DTCs). Treatments for metastatic disease include surgery, external-beam radiotherapy, RAI, and kinase inhibitors for progressive iodine-refractory disease. Unresectable locoregional disease remains a challenge, as standard therapy with RAI becomes unfeasible. We report a case of a young patient who presented with unresectable papillary thyroid carcinoma (PTC), and treatment with sorafenib allowed total thyroidectomy and RAI therapy. A 20-year-old male presented with severe respiratory distress due to an enlarging cervical mass. Imaging studies revealed an enlarged multinodular thyroid gland, extensive cervical adenopathy, severe tracheal stenosis, and pulmonary micronodules. He required an urgent surgical intervention and underwent tracheostomy and partial left neck dissection, as the disease was deemed unresectable; pathology revealed PTC. Treatment with sorafenib was initiated, resulting in significant tumor reduction allowing near total thyroidectomy and bilateral neck dissection. Postoperatively, the patient underwent radiotherapy for residual tracheal lesion, followed by RAI therapy for avid cervical and pulmonary disease. The patient's disease remains stable 4 years after diagnosis. Sorafenib has been approved for progressive RAI-refractory metastatic DTCs. In this case report, we describe a patient with locally advanced PTC in whom treatment with sorafenib provided sufficient tumor reduction to allow thyroidectomy and RAI therapy, suggesting a potential role of sorafenib as an induction therapy of unresectable DTC.

RESUMEN Objetivo. El objetivo de este estudio fue evaluar el efecto de la infección subclínica por agentes de la fiebre por garrapatas en el ganado lechero en producción de leche, la composición y calidad. Materiales y métodos. El estudio se realizó en una finca privada con 75 vacas lecheras alojadas-libre puesto, y de estas se evaluaron 37. Se recogieron muestras de leche individuales mensuales para determinar la composición (grasa, lactosa, proteína y sólidos totales) y la calidad (recuento de células somáticas (SCC)). Además, se recogieron muestras de sangre para identificar vacas que fueron negativas a fiebre de garrapatas y positivos por PCR para uno o más de los siguientes agentes etiológicos: Babesia bovis, Babesia bigemina y Anaplasma marginale. Resultados. Los resultados mostraron un aumento de SCC en los animales positivos, al menos para uno de los agentes cuando se comparó con vacas no infectadas (p<0.05). La producción de leche fue significativamente menor en A. marginale animales positivos (p<0.05). Un aumento de aproximadamente el 40% en el contenido de sólidos de la leche fue encontrado en vacas positivas a B. bovis. También, un incremento de aproximadamente el 23% de la lactosa se encontró en vacas positivas para B. bigemina. Conclusiones. Se puede concluir que la presencia de al menos uno de estos parásitos en el ganado lechero afecta composición o calidad de su leche.

ABSTRACT Objective. The objective of this study was to evaluate the effect of subclinical infection by agents of tick fever in dairy cattle on milk parameters, such as production, composition, and quality. Materials and methods. The study was conducted in a private farm with 75 free-stall-housed dairy cows, from which 37 were evaluated. Monthly, individual milk samples were collected for compositional (fat, lactose, protein, and total solids) and quality (somatic cell counts (SCC)) analyses. In addition, blood samples were collected in order to identify cows that were tick fever-negative and positive by PCR for one or more of the following etiological agents: Babesia bovis, Babesia bigemina and Anaplasma marginale. Results. The results showed increased SCC in positive animals for at least one of the agents when compared to non-infected cows (p<0.05). Milk production was significantly lower in A. marginale positive animals (p<0.05). An increase of about 40% in milk solids content was found in B. bovis positive cows. Also, an increment of approximately 23% in lactose was found on cows positives for B. bigemina. Conclusions. We may conclude that the presence of at least one of these parasites in dairy cattle affects composition or quality of their milk.

OBJETIVO: Reunir informações atuais acerca dos efeitos do diabetes melito tipo 1 sobre o comportamento autonômico cardíaco de crianças.FONTES DE DADOS:A busca dos artigos foi realizada nas bases de dados PubMed, Ibecs, Medline, Cochrane, Lilacs, SciELO e PEDro por meio dos seguintes descritores da área da saúde (DeCS): "sistema nervoso autônomo", "diabetes mellitus", "criança", "diabetes mellitus tipo 1", "sistema nervoso simpático" e "sistema nervoso parassimpático" e suas respectivas versões em língua inglesa (MeSH). Os artigos foram publicados de janeiro de 2003 a fevereiro de 2013, envolvendo crianças de nove a 12 anos portadoras de diabetes melito tipo 1.SÍNTESE DOS DADOS: A busca resultou em quatro artigos que abordam a variabilidade da frequência cardíaca em crianças com diabetes melito tipo 1, demonstrando que, em geral, essas crianças apresentam redução da variabilidade da frequência cardíaca global e da atividade vagal. A prática de atividade física promove benefícios no organismo de crianças com diabetes melito tipo 1.CONCLUSÕES: Crianças diabéticas tipo 1 apresentam modificações na modulação autonômica, o que demonstra a necessidade de atenção precoce a essa população para evitar complicações futuras.

OBJECTIVE:To gather current information about the effects of type 1 diabetes mellitus on children's cardiac autonomic behavior.DATA SOURCES: The search of articles was conducted on PubMed, Ibecs, Medline, Cochrane, Lilacs, SciELO and PEDro databases using the MeSH terms: "autonomic nervous system", "diabetes mellitus", "child", "type 1 diabetes mellitus", "sympathetic nervous system" and "parasympathetic nervous system", and their respective versions in Portuguese (DeCS). Articles published from January 2003 to February 2013 that enrolled children with 9-12 years old with type 1 diabetes mellitus were included in the review.DATA SYNTHESIS: The electronic search resulted in four articles that approached the heart rate variability in children with type 1 diabetes mellitus, showing that, in general, these children present decreased global heart rate variability and vagal activity. The practice of physical activity promoted benefits for these individuals.CONCLUSIONS: Children with type 1 diabetes mellitus present changes on autonomic modulation, indicating the need for early attention to avoid future complications in this group.

OBJETIVO: Reunir informaciones actuales sobre los efectos de la diabetes mellitus tipo 1 sobre el comportamiento cardiaco de niños.FUENTES DE DATOS: La búsqueda de artículos se realizó en las bases de datos PubMed, Ibecs, Medline, Cochrane, Lilacs y PEDro por medio de los descriptores del área de salud (DeCS) a continuación: "sistema nervioso autónomo", "diabetes mellitus", "niño", "diabetes mellitus tipo 1", "sistema nervioso simpático" y "sistema nervioso parasimpático" sus respectivas versiones en lengua inglesa (MeSH).Los artículos fueron publicados de enero de 2003 a febrero de 2013, implicando a niños de nueve a 12 años portadores de diabetes mellitus tipo 1.SÍNTESIS DE LOS DATOS: La búsqueda resultó en cuatro artículos que trataban la variabilidad de la frecuencia cardiaca en niños con diabetes mellitus tipo 1, demostrando que, por lo general, esos niños presentan reducción de la variabilidad de la frecuencia cardiaca global y de la actividad vagal. La práctica de actividad física promueve beneficios al organismo de niños con diabetes mellitus tipo 1.CONCLUSIONES: Niños diabéticos tipo 1 presentan modificaciones en la modulación autonómica, lo que demuestra la necesidad de atención temprana a esa población para evitar complicaciones futuras.