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 (

Resumo Introdução: Queixas neurológicas são frequentes na rotina de setores de emergência. Entre elas, a cefaleia é um distúrbio comum, que por seu diagnóstico diferencial amplo, exige certo grau de conhecimento em Neurologia. Objetivo: Avaliar o nível de conhecimento em cefaleias de médicos generalistas, além de traçar o perfil dos profissionais que atendem em setores de emergência nesta função, assim como de seus respectivos locais de trabalho em termos de abordagem neurológica. Métodos: Foram incluídos na avaliação médicos que atendem em unidades de pronto-atendimento para público adulto, na função de generalista. Um questionário foi aplicado com perguntas referentes ao conhecimento geral dos participantes sobre cefaleia, abordagem neurológica, perfil demográfico e perfil do local de trabalho. Resultados: 159 médicos responderam ao questionário. O perfil dos profissionais presentes na amostra correspondeu a indivíduos graduados recentemente (média de 6,31 anos). O conhecimento a respeito da abordagem de cefaleias foi regular. Aqueles que não possuem nenhuma especialização, nem estão cursando uma residência, se mostraram, de forma estatisticamente significativa, mais seguros no atendimento de pacientes neurológicos (p=0,006). Apenas 18,24% referiram ter acesso à Ressonância Magnética e 35,85% não tiveram acesso a nenhum tipo de neuroimagem. Conclusão: Médicos generalistas frequentemente não sentem segurança ao realizar atendimento e exame neurológicos, demonstrando pouco conhecimento acerca do assunto. O perfil dos profissionais que atuam nesses setores é predominantemente de recém graduados, o que pode impactar de alguma forma na qualidade de atendimento. Verificou-se também falta de estrutura para um atendimento adequado.

Abstract Background: Neurological complaints are frequent in emergency department routine. Among them, headache is a common disorder, which requires a certain degree of knowledge on Neurology because of its extensive differential diagnosis. Objective: To assess general practice physicians’ level of knowledge about headaches, in addition to outlining the profile of professionals who attend in emergency departments, as well as the profile of their respective workplaces in terms of neurological approach. Methods: We included in evaluation physicians who attend emergency care units for adult public as general practitioners. A questionnaire was applied with questions regarding participants’ general knowledge on headache, neurological approach, demographic profile, and workplace profile. Results: 159 physicians answered the questionnaire. The professionals’ profile corresponded to recently graduated individuals (mean of 6.31 years). Knowledge about headache management was regular. Those who do not have any specialization or are not majoring a specialization were statistically significantly more confident in neurological patients care (p=0.006). Only 18.24% reported access to Magnetic Resonance Imaging and 35.85% had no access to any type of neuroimaging. Conclusions: General practice physicians often do not feel confident when performing neurological exams, demonstrating low knowledge about the topic. The profile of professionals working in these departments is predominantly of newly graduates, which may affect in some way on care quality. There was also a lack of structure for adequate care.

ABSTRACT Objective The present study describes the clinical and tumor characteristics of patients that died from differentiated thyroid cancer and reports on the cause and circumstances of death in these cases. Subjects and methods Retrospective analysis of all the differentiated thyroid cancer (DTC) related deaths at a single institution over a 5-year period, with a total of 33 patients. Results Most of the patients were female (63.6%), with a mean age at diagnosis of 58.2 years. The most common histologic type was papillary (66.7%) and 30.3% were follicular. The distribution according to the TNM classification was: 15.4% of T1; 7.7% T2; 38.4% T3; 19.2% of T4a and 19.2% of T4b. Forty-four percent of cases were N0; 20% N1a and 36.6% of N1b. Twelve patients were considered non-responsive to radioiodine. Only one of the patients did not have distant metastases. The most common metastatic site was the lung in 69.7%. The majority of deaths were due to pulmonary complications related to lung metastases (17 patients, 51.5%), followed by post-operative complications in 5 cases, neurological disease progression in 3 cases, local invasion and airway obstruction in one patient. Median survival between diagnosis and death was reached in 49 months while between disease progression and death it was at 22 months. Conclusion Mortality from DTC is extremely rare but persists, and the main causes of death derive from distant metastasis, especially respiratory failure due to lung metastasis. Once disease progression is established, median survival was only 22 months.

ABSTRACT Objective The aim of the present study was to describe the epidemiologic data, histological type, treatment and follow-up of the 811 patients treated for thyroid cancer in Instituto do Câncer do Estado de São Paulo (ICESP) over 5 years. Materials and methods Retrospective analyses of electronic chart information. Results There were 679 cases (83.7%) of papillary thyroid cancer, 61 (7.5%) of follicular carcinoma, 54 (6.7%) of medullary carcinoma, 11 (1.4%) of poorly differentiated carcinoma and 6 of anaplastic carcinoma (0.7%). The majority of patients were female (82.2%), and the mean age was 50.5 ± 15 years. Two hundred forty-two patients had disease persistence or recurrence. At the last follow-up, 629 (77.6%) patients were alive and disease free, 141 (17.4%) were alive with disease, and 41 (5.1%) were deceased, with 37 deaths related to thyroid cancer. Conclusion This study was able to outline the profile, disease type and evolution of patients treated for thyroid cancer at a single tertiary hospital.

This study aimed at verifying the knowledge produced by nurses in Brazilian journals indexed in the database SCOPUS on the multidimensional assessment of the elderly, from 2005 to 2009. An integrative review was carried out in: Revista Latino-Americana de Enfermagem, Revista de Enfermagem da Universidade de São Paulo, Revista Acta Paulista de Enfermagem, online Brazilian Journal of Nursing, Revista Brasileira de Enfermagem, Revista Gaúcha de Enfermagem. For the data collection the following steps were followed: establishment of criteria for inclusion, choice of descriptors, development of an instrument of data collection, location of sources and instruments to collect data on items that met the inclusion criteria. The analysis was performed through analytical reading, where the following analyses were taken into consideration: textual, thematic and interpretative, with summary of results. It was found 102 articles, being 92 on different themes related to Gerontogeriatry/Care for the elderly, and 10 on the Multidimensional Assessment of the elderly, which is the corpus of this study. The knowledge produced by nurses on aging, elderly and old age is still slow, as for the theme of the multidimensional assessment of the elderly it is shown as timid. This competence is necessary considering that the multidimensional assessment is a new paradigm of multidisciplinary care and therefore must be learned by nurses.

Este estudio tuvo como objetivo verificar los conocimientos producidos por enfermeros, en periódicos brasileños indexadas en la base de datos SCOPUS, sobre la evaluación multidimensional del anciano, en el período 2005 a 2009. Revisión Integradora fue realizada en: Revista Latino-Americana de Enfermagem, Revista de Enfermagem da Universidade de São Paulo, Revista Acta Paulista de Enfermagem, Online Brazilian Journal of Nursing, Revista Brasileira de Enfermagem, Revista Gaúcha de Enfermagem. En la recogida de los datos se siguieron las etapas: establecimiento de criterios de inclusión, elección de descriptores, elaboración de instrumento de recogida de datos, localización de las fuentes y aplicación del instrumento de recogida de datos en los artículos que cumplieron los criterios de inclusión. El análisis ocurrió por lectura analítica en que se consideraron los análisis: textual, temático e interpretativa, con un resumen de los resultados. Fueron encontrados 102 artículos, 92, sobre diversos temas con relación a gerontogeriatría/cuidado al anciano y 10 sobre la evaluación multidimensional del anciano, corpus de este estudio. El conocimiento producido por enfermeros sobre envejecimiento, ancianos y vejez aun es lento, y sobre la temática de la evaluación multidimensional del anciano, se muestra tímido. Esta competencia se torna necesaria, considerándose que la evaluación multidimensional es un nuevo paradigma de la atención multidisciplinario y, consecuentemente, necesita ser aprendido por los enfermeros.

A avaliação multidimensional do idoso ocorre quando se investiga: condições individuais, funcional, cognitiva, afetiva, familiares, sociais, utilização de redes de suporte. Foi objetivo deste estudo verificar o conhecimento produzido por enfermeiros, em periódicos brasileiros indexados na base de dados SCOPUS, sobre a avaliação multidimensional do idoso, no período de 2005 a 2009. Revisão integrativa realizada no segundo semestre de 2009. Na coleta dos dados seguiram-se as etapas: estabelecimento de critérios de inclusão, escolha de descritores, elaboração de instrumento de coleta de dados, localização das fontes, aplicação do instrumento de coleta de dados nos artigos que atenderam aos critérios de inclusão. A análise ocorreu por leitura analítica, considerando: os textos, temáticas, interpretação e síntese. Foram encontrados 102 artigos, 92, sobre Temas Diversos, relacionados à Gerontogeriatria/Cuidado ao idoso e dez, acerca da Avaliação Multidimensional do Idoso. O enfoque da avaliação multidimensional foi mais verificado na utilização da avaliação funcional, tendo o Índice de Katz como o instrumento mais usado e sendo mais presente nos idosos domiciliados e atendidos por unidades de Estratégia de Saúde da Família, seguidos pelos idosos institucionalizados. Os enfermeiros têm elaborado instrumentos para avaliação multidimensional do idoso mais condizentes com o contexto de cuidado do idoso, sob sua responsabilidade.

OBJECTIVES AND INTRODUCTION: Medullary thyroid carcinoma, a neoplasia of intermediate prognosis and differentiation, does not always respond predictably to known treatments. This study aimed to correlate the clinical progression of surgically treated patients with clinical and pathological data. METHODS: A total of 53 patients were followed for 75 months (mean average) in tertiary-care hospital. The clinical status of patients at the end of the study period was characterized to determine correlations with a range of disease aspects. A value of p < 0.05 was considered statistically significant. RESULTS: Twenty-two patients (41.5%) were alive and disease-free at the end of the follow-up period; twenty-three patients (43.4%) had persistent disease; and eight patients (15.1%) had recurrent disease. Four patients (7.6%) died from medullary thyroid carcinoma with clinical and/or imaging evidence of neoplasia. The following aspects demonstrated statistically significant correlations with the final medical condition: positive initial cervical examination (p = 0.002); neoplastic extensions to the thyroid capsule (p = 0.004) and adjacent tissues (p = 0.034); cervical lymph node metastases (p < 0.001); diameter of neoplasia (p = 0.018); TNM (tumor, node and metastasis) Stage (p = 0.001) and evidence of distant and/or cervical diseases in the absence of a cure (p = 0.011). Through logistic regression, the presence of cervical lymph node metastases was considered an independent variable (p < 0.001). CONCLUSIONS: Clinical and pathological aspects of patients with surgically treated medullary thyroid carcinomas are predictors of disease progression. Specifically, even treated cervical lymph node metastases are significantly correlated with disease progression.

OBJETIVOS: Abordar o diagnóstico, tratamento e evolução do carcinoma folicular da tireóide. MÉTODOS: Análise retrospectiva dos dados de 38 pacientes submetidos à tireoidectomia por carcinoma folicular puro, num período de 10 anos no HC-FMUSP. O tempo médio de seguimento foi de três anos e três meses. Nove pacientes eram do sexo masculino (23,7%) e 29 do sexo feminino (76,3%), com idades entre 19 e 87 anos (média=49,5). RESULTADOS: Em 17 (58,6%) dos doentes, observou-se nódulo único à ultra-sonografia, e 23 (79,3%) tinham nódulos frios à cintilografia. Sintomatologia esteve presente em 33 pacientes (86,8%). A punção aspirativa por agulha fina (PAAF), realizada em 27 pacientes, revelou padrão folicular em 24 (88,9%), carcinoma papilífero em 2 (7,4%) e bócio em 1 (3,7%). Tireoidectomia total foi o tratamento final em 34 pacientes e esvaziamento cervical foi realizado em três casos. Apenas 5 (13,1%) obtiveram confirmação diagnóstica ao exame de congelação intra-operatória. Houve 2 (5,2%) óbitos pela doença e 5 (13,1%) pacientes apresentam-se vivos com doença. O aumento da tireoglobulina (TG) correlacionou-se com o aparecimento de metástase em 100% dos casos. CONCLUSÕES: Concluímos que pacientes com carcinoma folicular de tireóide geralmente apresentam-se com nódulo único ou predominante ao primeiro exame, cuja PAAF é de padrão folicular. O exame de congelação raramente confirma o diagnóstico. Em nosso serviço, o tratamento de escolha é a tireoidectomia total, permitindo um seguimento mais adequado e confiável do paciente e prevenindo o crescimento de lesões subclínicas no lobo contralateral. A evolução geralmente é favorável.

BACKGROUND: Unlike papillary carcinoma, there are limited data regarding diagnosis, treatment and follow-up of patients with follicular thyroid carcinoma. METHODS: We retrospectively analyzed data on 38 patients submitted to thyroidectomy for exclusive follicular carcinoma over a 10 years period. Mean follow-up was 39 months (114 months the longest). Nine patients were males (23,7%) and 29 females (76,3%). Mean age was 49.5 (19 to 87 years). RESULTS: Thirty-three (86,8%) patients presented at least one symptom such as dyspnea, dysphagia or hoarseness. Seventeen (58,6%) patients had a solitary nodule shown by ultrasonography and 23 (79,3%) had "cold" nodules by scintigraphy. Twenty-seven patients underwent were submitted to fine-needle aspiration biopsy (FNA), which revealed a follicular neoplasm (benign or malignant) in 24 (88,9%) patients, goiter in 1(3,7%) and papillary carcinoma in 2 cases (7,4%). Total thyroidectomy was the final treatment in 34 patients and neck dissection operation was required in 3 cases. Only 13,1% of the patients were diagnosed as having follicular carcinoma by intraoperative frozen section. Two patients died from the tumor and 5 patients remain alive with the tumor all of them with distant metastasis. Elevation of serum levels of thyroglobulin correlated with metastasis in 100% of those cases. CONCLUSIONS: We conclude that follicular thyroid carcinoma usually presents as a solitary nodule diagnosed as a follicular neoplasm by FNA biopsy. Intra-operatory frozen section rarely confirms the diagnosis. O treatment of choice for thyroid follicular cancer total thyroidectomy followed by complementary therapy (radioiodine therapy) if necessary. We advocate total thyroidectomy because it is assumited with a better follow-up and avoids growth of subclinical lesions on the opposite lobe. Outcome is good in the majority of cases.