Resumo O diagnóstico do ceratoacantoma é desafiador e, portanto, esta publicação contribui para a literatura atual apresentando dados epidemiológicos e descrevendo características clínicas e histopatológicas e a decisão de tratamento. Homem caucasiano de 69 anos apresentava nódulo de crescimento exofítico em lábio inferior, de 10 mm, bem delimitado, de forma circular, consistência firme, cor rósea e superfície rugosa. A suspeita clínica foi de carcinoma de células escamosas. Foi realizada biópsia incisional e análise histopatológica, a qual revelou fragmentos de mucosa oral revestidos por epitélio pavimentoso estratificado hiperparaceratinizado com centro preenchido por ceratina, pérolas córneas, hiperplasia pseudoepiteliomatosa e áreas de displasia epitelial, concluindo o diagnóstico de ceratoacantoma. Foi feita a ressecção cirúrgica, removendo totalmente a lesão. A análise histopatológica confirmou o diagnóstico de ceratoacantoma. Indivíduos do sexo masculino, caucasianos, acima de 45 anos de idade são os mais acometidos pelo ceratoacantoma. A histopatologia do caso corrobora a caracterização clássica, principalmente a depressão central preenchida por ceratina. O tratamento escolhido foi a ressecção cirúrgica com pequena margem de segurança, de acordo com a literatura atual. Os ceratoacantomas são mais comuns em indivíduos do sexo masculino com idade acima de 45 anos. O principal fator etiológico é a exposição solar sem medidas de proteção. Esta lesão apresenta-se como nódulo exofítico, de consistência firme, superfície rugosa e centro preenchido por ceratina. A histopatologia caracteriza-se por estrutura crateriforme, disceratose e presença de pérolas córneas. O tratamento mais indicado é a ressecção cirúrgica.

Abstract Keratoacanthoma diagnosis is challenging, and therefore, this publication contributes to the current literature by presenting epidemiological data and describing clinical and histopathological characteristics and the treatment decision. A 69-year-old Caucasian male patient presented with a well-delimited exophytic growth nodule in the lower lip measuring 10 millimeters with circular shape, firm consistency, pink color, and rough surface. The clinical suspicion was squamous cell carcinoma. An incisional biopsy and histopathological analysis were performed, which revealed fragments of oral mucosa lined by hyperparakeratinized stratified squamous epithelium with a center filled with keratin, corneal pearls, pseudoepitheliomatous hyperplasia, and areas of epithelial dysplasia. The diagnosis of keratoacanthoma was determined. Surgical resection was performed, completely removing the lesion, and histopathological analysis confirmed the diagnosis of keratoacanthoma. The fact that the patient was male, over 45 years old, and Caucasian agrees with the epidemiology of the population most affected by keratoacanthoma. The histopathology of the case corroborates the classic characterization, mainly the central depression filled with keratin. The treatment chosen was surgical resection with a small margin of safety, according to the current literature. Keratoacanthomas are more common in males aged over 45 years and in Caucasian individuals. The main etiology is sun exposure without protective measures. It presents as an exophytic nodule with a firm consistency, rough surface, and center filled with keratin. Histopathology is characterized by a crateriform structure, dyskeratosis, and the presence of corneal pearls. The most indicated treatment is surgical resection.

Resumen Este estudio tiene como objetivo indicar el potencial de la inteligencia artificial (IA) en los informes epidemiológicos de dientes cariados, perdidos y restaurados. Como prueba de concepto, nuestro modelo de estudio utilizó imágenes panorámicas de rayos X y un algoritmo de inteligencia artificial para la numeración de dientes, la detección de caries y las restauraciones con una precisión superior al 80 % para dichas tareas de diagnóstico. El resultado fue el número de dientes cariados, perdidos y restaurados según la edad del paciente y el índice CPOD (número de dientes cariados, perdidos y obturados) que varió de 3,6 (hasta 20 años) a 20,4 (+60 años). Por tanto, se sugiere que la IA es un método prometedor para automatizar la recopilación de datos de salud mediante el análisis de rayos X.

Abstract This study aims to indicate the potential of artificial intelligence (AI) in epidemiological reports of decayed, missed and restored teeth. As a proof of concept our study model used panoramic x-ray images and an AI algorithm for tooth numbering, detection of the caries and restorations with accuracy over 80% for such diagnostic tasks. The output came as the number of decayed, missed and restored teeth according to patient's age and the DMFT index (number of decayed, missing, and filled teeth) which varied from 3.6 (up to 20 years old) to 20.4 (+60 years old). Thus, it is suggested that AI is a promising method to automate health data collection through the analysis of x-rays.

Introduction Treatment of hemophilia A in Brazil is offered to all patients at no cost. However, several unmet medical needs exist. Method In this study, we applied the Delphi method to discuss with seven hemophilia A specialists the challenges that patients and the health system face regarding hemophilia A treatment and opportunities for improvement. Results A consensus was obtained regarding the number of weekly infusions and patient adherence to treatment. The bleeding profile, unfavourable pharmacokinetics (PKs), low adherence and high daily activity were patient profiles that would benefit from using the extended half-life (EHL) recombinant factor VIII (rFVIII). The advantages of treatment with the EHL rFVIII were the lower number of infusions per week, which could increase patient adherence and decrease the risk of bleeds, due to a more constant plasma level, a lower value. Additionally, the EHL rFVIII could improve quality of life, especially in patients with high daily activity, such as adolescents and young adults. The panelists mentioned that EHL rFVIII, if available, could be offered first to the priority group (adolescents between 12 and 19 years old), followed by adults (20 to 64 years old) and elderly people (over 65 years old). Conclusion In summary, the EHL rFVIII offers the optimal prophylaxis by decreasing the dose frequency, increasing the treatment adherence and improving the QoL, without compromising safety and efficacy. cost However exist study improvement profile PKs, PKs , (PKs) halflife half life (EHL rFVIII. . (rFVIII) week bleeds level value Additionally available 1 old, old 20 (2 6 over old. summary frequency QoL efficacy (PKs (rFVIII 2 (

Resumo O artigo tem por objetivo analisar o Editorial “1964” da Folha de São Paulo à luz da Abordagem Histórico-Discursiva (AHD), lastreando a discussão nos conceitos de discurso, mídia e história e a historiografia sobre imprensa e ditadura. Este texto, publicado em 30 de março de 2014, às vésperas do aniversário de cinquenta anos do golpe de 1964, se insere em um movimento mais amplo, que engloba também outros jornais da grande imprensa, de reavaliação e reescrita da sua história durante o período da ditadura militar brasileira (1964-1985). A metodologia empregou os oito estágios da AHD e suas cinco questões centrais. A partir da identificação de três macrotópicos dicotômicos (apoio à ditadura militar como erro versus apoio como longo e doloroso aprendizado; violências do regime versus realizações econômicas; e disputa entre socialismo revolucionário versus economia de mercado) e das estratégias discursivas utilizadas (predicação, argumentação, perspectiva, intensificação e mitigação), foi possível observar que o jornal discursivamente: a) invisibiliza os problemas causados pelo regime militar; b) enfatiza o crescimento econômico vivenciado pelo país no período e; c) justifica suas ações atrelando-as ao contexto da época, o que levanta questionamentos sobre o exame de sua posição. As principais conclusões sugerem que a ambiguidade com que a empresa se posiciona, de atenuação de sua contribuição para o regime militar e, ao tempo, de intensificação do seu papel democrático, faz sentido à luz da estratégia empresarial contextualizada e que deve ser considerada na discussão sobre as interfaces entre discurso, mídia e história. 1964 “1964 HistóricoDiscursiva Histórico Discursiva AHD, , (AHD) discurso texto 3 2014 amplo 19641985. 19641985 1985 . (1964-1985) centrais aprendizado econômicas mercado predicação, predicação (predicação argumentação perspectiva mitigação, mitigação mitigação) discursivamente b c atrelandoas atrelando época posição posiciona tempo democrático 196 “196 (AHD 201 1964198 198 (1964-1985 19 “19 20 196419 (1964-198 1 “1 2 19641 (1964-19 “ (1964-1 (1964- (1964 (196 (19 (1 (

Abstract The article aims to analyze the Folha de São Paulo editorial "1964" in the light of the historical-discursive approach (HDA), basing the discussion on the concepts of discourse, media and history, and the historiography of the press and dictatorship. This text, published on March 30, 2014, on the eve of the 50th anniversary of the 1964 coup, is part of a broader movement that also includes other newspapers of the mainstream press to reassess and rewrite their history during the period of the Brazilian military dictatorship (1964-1985). The methodology used was the eight stages of the HDA and its five central questions. By identifying three dichotomous macro-topics (support for the military dictatorship as a mistake versus support as a long and painful learning process; the regime's violence versus its economic achievements; and the dispute between revolutionary socialism versus the market economy) and the discursive strategies used (predication, argumentation, perspective, intensification, and mitigation), it was possible to observe that the newspaper discursively: (a) makes the problems caused by the military regime invisible; (b) emphasizes the economic growth that the country experienced during the period; and (c) justifies its actions by linking them to the context of the time, which raises questions about the examination of its position. The main conclusions suggest that the ambiguity with which the company positions itself, attenuating its contribution to the military regime and at the same time intensifying its democratic role, makes sense in the light of a contextualized business strategy and should be considered in the discussion about the interfaces between discourse, media and history. "1964 historicaldiscursive historical HDA, , (HDA) discourse text 30 2014 th 196 coup 19641985. 19641985 1985 . (1964-1985) macrotopics macro topics process regimes s achievements economy predication, predication (predication argumentation perspective intensification mitigation, mitigation mitigation) discursively (a invisible b (b c (c position itself role "196 (HDA 3 201 19 1964198 198 (1964-1985 "19 20 1 196419 (1964-198 "1 2 19641 (1964-19 " (1964-1 (1964- (1964 (196 (19 (1 (

RESUMO Objetivou-se analisar a utilização dos relatórios do e-SUS da Atenção Primária à Saúde (APS) na rotina de trabalho das equipes de Saúde da Família (eSF) do Distrito Federal (DF). Estudo descritivo de dados provenientes da Avaliação in loco e Plano de Ação para a Qualidade do 1º ciclo avaliativo do Programa de Qualificação da Atenção Primária à Saúde, entre 2021 e 2022. Incluíram-se todas 607 equipes. Associações entre as Regiões de Saúde foram identificadas mediante testes Qui-quadrado, p-valor < 0,05. Para quantificar problemas e ações, utilizaram-se técnicas de Mineração de Dados. A maioria das eSF do DF negaram o uso de qualquer relatório do e-SUS APS em sua rotina de trabalho (53,23%). Os relatórios que as eSF mais utilizaram foram os de produção (54,43%), e menos, os de gerenciais (31,60%). As regiões com maior proporção de uso foram Centro-Sul (73,67%), e com menor, Sudoeste (34,56%), p < 0,0001. Alguns dos principais problemas descritos foram intrínsecos ao e-SUS APS (erros, falhas, instabilidade do sistema e falta de unificação) e outros foram relativos a questões extrínsecas (desconhecimento, inconsistência e falta de registro). As equipes listaram em seus Planos de Ação, prioritariamente, as capacitações para uso correto do sistema de informação.

ABSTRACT The objective was to analyze the use of e-SUS Primary Health Care reports in the work routine of Family Health teams (eSF) in the Federal District (DF). This is a descriptive study of data from the on-site Assessment and Quality Action Plan of the 1st evaluation cycle of the Primary Health Care Qualification Program, between 2021 and 2022. All 607 teams were included. Associations between Health Regions were identified using Chi-square tests, p-value < 0.05. To quantify problems and actions, Data Mining techniques were used. The majority of eSFs in the DF denied using any e-SUS APS report in their work routine (53.23%). The reports that the eSF used most were production reports (54.43%), and management reports the least (31.60%). The regions with the highest proportion of use were Central-South (73.67%), and with the lowest, Southwest (34.56%), p < 0.0001. Some of the main problems described were intrinsic to e-SUS APS (errors, failures, system instability and lack of unification) and others were related to extrinsic issues (lack of knowledge, inconsistency and lack of registration). The teams listed in their Action Plans, as a priority, the training for correct use of the information system.

ABSTRACT Bartonella spp. are bacteria responsible for neglected diseases worldwide. Bartonella henselae is the species most associated with human infections. It is associated with a large spectrum of clinical manifestations and is potentially fatal. The identification of Bartonella spp. is considered a challenge in clinical routine. These bacteria are fastidious, and the time required to isolate them varies from one to six weeks. MALDI-TOF mass spectrometry has emerged as an application for research on Bartonella spp. , and has still been little explored. We investigated whether three different B. henselae strains with different growth times—14 and 28 days—could be correctly identified by MALDI-TOF mass spectra fingerprint comparison and matching. We found that the spectra from strains with different growth times do not match each other, leading to misidentification. We suggest creating database entries with multiple spectra from strains with different growth times to increase the chances of accurate identification of Bartonella spp. by MALD-TOF MS. spp worldwide infections fatal routine fastidious weeks MALDITOF MALDI TOF explored B times14 14 times—1 2 dayscould days could matching other misidentification MALDTOF MALD MS times1 1 times—

ABSTRACT Objective: We aimed to analyze the association of diabetes and subclinical hypothyroidism with subclinical atherosclerosis measured by coronary artery calcium (CAC) in the baseline of the ELSA-Brasil study. Materials and methods: CAC was measured using a 64-detector computed tomographic scanner. The association of CAC > 0 was presented as an odds ratio (OR) and 95% confidence intervals (95%CI) in logistic models and as β (95%CI) in linear models after multivariable adjustment for confounders. Results: We analyzed 3,809 participants (mean-age (SD) 50.5 (8.8); 51.7% women). In the main analysis, we did not find an association of diabetes and subclinical hypothyroidism with CAC. However, in stratified analysis according to age strata, we found no significative interaction terms, an important heterogeneity between the groups, with the younger age strata showing an association of the group with both diseases and CAC > 0 (OR 7.16; 95%CI, 1.14; 44.89) with a wide but significative 95%CI, suggesting that the smaller number of participants in the younger group may influence the results. Our findings also showed an association of CAC > 0 and log (CAC+1) with diabetes in logistic (OR, 1.31; 95%CI, 1.05-1.63) and linear models (β, 0.24, 0.16, 0.40), respectively. Diabetes was independently associated with CAC > 0 in linear models. Discussion: In conclusion, our results showed a great heterogeneity in stratified analysis based on age in the younger age strata. Although we found no significant interaction factors, the smaller sample size for the analysis may influence the negative findings. Objective (CAC ELSABrasil ELSA Brasil study methods 64detector detector 64 scanner OR 95 95%CI 95CI CI (95%CI confounders Results 3809 3 809 3,80 meanage mean SD (SD 505 50 5 50. 8.8 88 8 (8.8) 517 51 7 51.7 women. women . women) However terms groups 7.16 716 16 1.14 114 1 14 44.89 4489 44 89 CAC+1 CAC1 (CAC+1 OR, 1.31 131 31 1.051.63 105163 1.05 1.63 05 63 1.05-1.63 β, (β 024 24 0.24 016 0.16 0.40, 040 0.40 , 40 0.40) respectively Discussion conclusion factors 6 9 380 80 3,8 8. (8.8 51. 7.1 71 1.1 11 44.8 448 4 CAC+ (CAC+ 1.3 13 051 1.051.6 10516 105 1.0 163 1.6 1.05-1.6 02 2 0.2 01 0.1 04 0.4 38 3, (8. 7. 1. 44. 1.051. 1051 10 1.05-1. 0. (8 1.051 1.05-1 ( 1.05-

ABSTRACT Seven strawberry genotypes were analyzed in order to differentiate fruit production and quality. The discarded leaves (by-product) were also used to characterize their phytochemical profile with a view to potential use in the pharmaceutical and agricultural industries. The multivariate analysis gave rise to heterogeneous groups among the seven genotypes. ‘Fronteras’ and ‘Monterey’ were the most productive. ‘Camino Real’ produced fruits with the highest polyphenols concentrations. ‘Fronteras’ produced leaves with the best phytochemical profile and, together with ‘Camino Real’, the highest antioxidant activity. The genotypes differ in terms of the yield and fruit, and leaf phytochemical profiles. ‘Camino Real’ can be used to optimize and market all the organs produced (fruits and leaves) and ‘Fronteras’ to increase the fruit yield and the use of leaves as a cultivation by-product. quality byproduct by product (by-product industries ‘Fronteras Fronteras ‘Monterey Monterey productive Camino Real concentrations Real, , activity profiles byproduct. product. by-product

SUMMARY OBJECTIVE: The objective of this study was to analyze the factors that influence the positivity of treponemal and non-treponemal tests in cases of congenital syphilis. METHODS: This cross-sectional and correlational study was carried out from the analysis of the database of Disease and Notification Information System (SINAN, in Portuguese) using the data obtained through the Epidemiological Surveillance Group 29, with 639 notifications of congenital syphilis between 2007 and 2018. The data were analyzed by a descriptive and inferential analysis from logistic regression with a significance level of 5% (p≤0.05). RESULTS: The positivity of the treponemal test was higher by 4.5 times in infants living in rural areas and 19.6 times among those whose mothers obtained the diagnosis of syphilis after birth. The treponemal test showed positivity 3.2 times higher for the variable “having been diagnosed between 2007 and 2015” and 5.5 times higher for the variable “having been diagnosed with maternal syphilis in the postpartum period.” CONCLUSION: This study shows that testing during prenatal care is essential for early diagnosis and prevention of syphilis complications. OBJECTIVE nontreponemal non METHODS crosssectional cross sectional SINAN, SINAN (SINAN Portuguese 29 63 200 2018 5 p≤0.05. p005 p p≤0.05 . 0 05 (p≤0.05) RESULTS 45 4 4. 196 19 6 19. birth 32 3 2 3. having 2015 55 5. period. period CONCLUSION complications 20 201 p00 p≤0.0 (p≤0.05 1 p0 p≤0. (p≤0.0 p≤0 (p≤0. p≤ (p≤0 (p≤ (p

ABSTRACT Objective: To identify, synthesize, and analyze the scientific knowledge produced regarding the implications of using clinical simulation for undergraduate nursing or medical students' motivation for learning. Methods: The search for articles was conducted between July 28 and August 3, 2022, on the PubMed/MEDLINE, Scopus, Web of Science, and SciELO databases. The following was used for the search: P - undergraduate students attending Nursing or Medicine courses; C - motivation for learning, and C - skills and clinical simulation laboratory. The following research question guided the study: “What are the implications of clinical simulation on the motivation for learning of undergraduate students of nursing and medicine?” Of the 1,783 articles found, 13 were included in the sample for analysis. All stages of the selection process were carried out by two independent evaluators. The results were presented as charts and a discursive report. Results: The studies analyzed indicated the beneficial effects of clinical simulation on students' motivation, in addition to other gains such as competencies, technical and non-technical skills, knowledge, belonging, autonomy, clinical judgment, critical and reflective thinking, self-efficacy and decreased anxiety, self-management, and improvements in learning and learning climate. Conclusion: Clinical simulation provides a positive learning environment favorable to the development of technical and interpersonal skills and competencies, and raising the level of motivational qualities. Objective identify synthesize Methods 2 3 2022 PubMedMEDLINE PubMed MEDLINE PubMed/MEDLINE Scopus Science databases courses laboratory study What medicine medicine? 1783 1 783 1,78 found analysis evaluators report Results competencies nontechnical non belonging autonomy judgment thinking selfefficacy self efficacy anxiety selfmanagement, selfmanagement management, management self-management climate Conclusion qualities 202 178 78 1,7 20 17 7 1,

RESUMO Objetivo: Realizar adaptação transcultural da escala Pasero Opioid-Induced Sedation para o cenário brasileiro. Método: Estudo metodológico, utilizado referencial de Beaton, composto por seis fases: tradução, síntese das traduções, retradução, comitê de especialistas, pré-teste e envio dos instrumentos adaptados ao autor do instrumento original. Estudo foi realizado de abril a dezembro de 2021. A pesquisa desenvolveu-se em um hospital privado, localizado no município de São Paulo, nas unidades de internação e críticas adultos. Recebeu aprovação do comitê de ética. Resultados: Após as etapas de tradução, síntese de tradução e retrotradução a versão foi avaliada pelo comitê de especialistas, com duas rodadas para obtenção de valores aceitáveis de índice de validade de conteúdo acima de 0,80. Na fase de pré-teste a escala apresentou boa compreensão com score de 0,98. Conclusão: A escala foi adaptada para o contexto brasileiro, no entanto, novos estudos serão necessários para análises de evidências de validade e confiabilidade. Objetivo OpioidInduced Opioid Induced brasileiro Método metodológico Beaton fases traduções retradução especialistas préteste pré teste original 2021 desenvolveuse desenvolveu se privado Paulo adultos ética Resultados 080 0 80 0,80 098 98 0,98 Conclusão entanto confiabilidade 202 08 8 0,8 09 9 0,9 20 0, 2

ABSTRACT Objective: Perform a cross-cultural adaptation of the Pasero Opioid-induced Sedation Scale to the Brazilian setting. Method: This is a methodological study using Beaton’s framework, which consists in six stages: translation, synthesis of translations, re-translation, expert committee, pre-test, and sending the adapted version of the instrument to the author of the original. The study was carried out from April to December 2021. The research was conducted in a private hospitalin the city of São Paulo, in the adult hospitalization and critical care units. It was approved by the research ethics committee. Results: After translation, translation synthesis and back-translation steps, the version was evaluated by the expert committee, requiring two rounds to obtain acceptable CVI values above 0.80. In the pre-test phase, the scale was well understood, with a CVI of 0.98. Conclusion: The scale was adapted for the Brazilian context; however, further studies will be needed to analyze validity and reliability evidence. Objective crosscultural cross cultural Opioidinduced Opioid induced setting Method Beatons Beaton s framework stages translations retranslation, retranslation re re-translation committee pretest, pretest pre test, test original 2021 Paulo units Results backtranslation back steps 080 0 80 0.80 phase understood 098 98 0.98 Conclusion context however evidence 202 08 8 0.8 09 9 0.9 20 0. 2

RESUMEN Objetivo: Realizar la adaptación transcultural de la escala de Pasero Opioid-induced Sedation Scale para el contexto brasileño. Método: Estudio metodológico, utilizando el marco de referencia de Beaton, que consta de seis fases: traducción, síntesis de traducciones, traducción inversa, comité de expertos, prueba previa, y envío del instrumento adaptado ala autora del instrumento original. El estudio se realizó de abril a diciembre de 2021, y a la investigación se condujo en un hospital privado, ubicado en la ciudad de São Paulo, en las unidades de hospitalización de adultos y cuidados críticos. Recibió la aprobación del comité de ética. Resultados: Después de las etapas de traducción, síntesis de traducción y traducción inversa, la versión fue evaluada por un comité de expertos, con dos rondas para obtener valores aceptables de índice de validez de contenido superiores a 0,80. En la fase previa a la prueba, la escala mostró una buena comprensión, con una puntuación de 0,98. Conclusión: La escala fue adaptada para el contexto brasileño, sin embargo, serán necesarios más estudios para analizar las evidencias de validez y confiabilidad. Objetivo Opioidinduced Opioid induced brasileño Método metodológico Beaton fases traducciones inversa expertos original 2021 privado Paulo críticos ética Resultados 080 0 80 0,80 comprensión 098 98 0,98 Conclusión embargo confiabilidad 202 08 8 0,8 09 9 0,9 20 0, 2

Resumo Introdução: Com a evolução do ensino médico para currículos baseados em competências, fez-se necessária uma readequação dos currículos e dos métodos de avaliação, com maior enfoque sobre o cenário de prática profissional e, portanto, na utilização de ferramentas como o Mini-Clinical Evaluation Exercise (Mini-CEX). Objetivo: Este estudo teve como objetivo avaliar o uso da estratégia Mini-CEX como método de avaliação nos programas de residência médica. Método: Trata-se de uma revisão de escopo, cuja estratégia de busca realizada no PubMed resultou em 578 artigos. Após aplicar a metodologia do Instituto Joanna Briggs para inclusão e exclusão, foram selecionados 24 estudos transversais. Resultado: Selecionaram-se artigos referentes a estudos realizados entre 1995 e 2021, em diversos continentes, diferentes programas de residência, e cenários ambulatorial, internação e de emergência. O Mini-CEX mostrou-se aplicável no contexto da residência médica, pois trata-se de uma avaliação observacional direta do atendimento realizado pelo médico residente nos diversos cenários de atuação, como ambulatórios, internações e emergências. Trata-se de uma avaliação com tempo de observação variando de dez a 40 minutos e que permite a abordagem de vários aspectos do atendimento médico, como anamnese, exame físico, raciocínio clínico e aconselhamento, além de possibilitar a realização de um feedback sobre o desempenho dos residentes. Conclusão: O Mini-CEX constitui uma ferramenta de fácil aplicabilidade e promove alto grau de satisfação dos envolvidos, podendo ser utilizada de forma rotineira nos programas de residência médica. Introdução competências fezse fez se portanto MiniClinical Mini Clinical MiniCEX. MiniCEX CEX . (Mini-CEX) Objetivo médica Método Tratase Trata escopo 57 exclusão 2 transversais Resultado Selecionaramse Selecionaram 199 2021 continentes ambulatorial emergência mostrouse mostrou tratase trata atuação ambulatórios emergências 4 anamnese físico aconselhamento residentes Conclusão envolvidos (Mini-CEX 5 19 202 1 20

Abstract Introduction: With the evolution of medical education towards competency-based curriculum, the need has emerged to reconfigure curriculum and assessment methods, with increased focus on the professional practice setting, thus leading to the utilization of tools such as the mini-CEX (mini-Clinical Evaluation Exam). Objective: To evaluate the use of the mini-CEX strategy as an assessment method in medical residency programs. Method: This is a scoping review, and the search performed on PubMed resulted in 578 articles. After applying the Joanna Briggs Institute methodology for inclusion and exclusion, 24 cross-sectional studies were selected. Results: The selected articles were based on studies conducted between 1995 and 2021, in various continents and in both clinical and surgical residency programs, including outpatient, inpatient, and emergency settings. The Mini-CEX was shown to be applicable in the context of medical residency, as it is an observational assessment of the care provided by the resident physician in various practice settings such as outpatient clinics, inpatient wards, and emergency departments. It involves a variable observation time ranging from 10 to 40 minutes and allows for the evaluation of various aspects of medical care, including history taking, physical examination, clinical reasoning, counseling, and provides an opportunity for providing feedback on the residents’ performance. Conclusion: The mini-CEX is a tool that is easy to implement and promotes a high degree of satisfaction among stakeholders. It could be used more routinely in medical residency programs. Introduction competencybased competency methods setting miniCEX mini CEX miniClinical Clinical Exam. Exam . Exam) Objective programs Method review 57 exclusion 2 crosssectional cross sectional Results 199 2021 MiniCEX Mini clinics wards departments 1 4 taking examination reasoning counseling residents performance Conclusion stakeholders 5 19 202 20

ABSTRACT Objective: To evaluate the association of TSH, free T3 (FT3), free T4 (FT4), and conversion (FT3:FT4) ratio values with incident hypertension. Materials and methods: The study included data from participants of the ELSA-Brasil study without baseline hypertension. Serum TSH, FT4 and FT3 levels, and FT3:FT4 ratio values were assessed at baseline, and incident hypertension (defined by blood pressure levels ≥ 140/90 mmHg) was estimated over a median of 8.2 years of follow-up. The risk of incident hypertension was evaluated considering a 1-unit increase in TSH, FT4, FT3, and conversion ratio values and after dividing these variables into quintiles for further analysis using Poisson regression with robust variance. The results are presented as relative risks (RR) and 95% confidence intervals (CIs) before and after adjustment for multiple variables. Results: The primary analysis incorporated data from 5,915 euthyroid individuals, and the secondary analysis combined data from all euthyroid individuals, 587 individuals with subclinical hypothyroidism, and 31 individuals with subclinical hyperthyroidism. The rate of incident hypertension was 28% (95% CI: 27%-29.3%). The FT4 levels in the first quintile (0.18-1.06 ng/dL) were significantly associated with incident hypertension (RR: 1.03, 95% CI: 1.01-1.06) at follow-up. The association between FT4 levels in the first quintile and incident hypertension was also observed in the analysis of combined data from euthyroid individuals and participants with subclinical thyroid dysfunction (RR: 1.04, 95% CI: 1.01-1.07). The associations were predominantly observed with systolic blood pressure levels in euthyroid individuals. However, in the combined analysis incorporating euthyroid participants and individuals with subclinical thyroid dysfunction, the associations were more pronounced with diastolic blood pressure levels. Conclusion: Low FT4 levels may be a mild risk factor for incident hypertension in euthyroid individuals and persons with subclinical thyroid dysfunction. Objective TSH T FT , (FT3) (FT4) FT3FT4 FTFT (FT3:FT4 methods ELSABrasil ELSA Brasil FT3:FT defined 14090 140 90 140/9 mmHg 82 8 2 8. followup. followup follow up. up follow-up 1unit unit 1 variance RR (RR 95 CIs (CIs Results 5915 5 915 5,91 58 hypothyroidism 3 hyperthyroidism 28 (95 CI 27%29.3%. 27293 27% 29.3% . 27 29 27%-29.3%) 0.181.06 018106 0.18 1.06 0 18 06 (0.18-1.0 ng/dL ngdL ng dL 103 03 1.03 1.011.06 101106 1.01 01 1.01-1.06 104 04 1.04 1.011.07. 101107 1.07 07 1.01-1.07) However Conclusion (FT3 (FT4 FT3FT (FT3:FT 1409 14 9 140/ 591 91 5,9 (9 27%29.3% 2729 293 29.3 27%-29.3% 181 0.181.0 01810 018 0.1 106 1.0 (0.18-1. 10 011 1.011.0 10110 101 1.01-1.0 1.011.07 107 1.01-1.07 (FT 59 5, ( 27%29.3 272 29. 27%-29.3 0.181. 0181 0. 1. (0.18-1 1.011. 1011 1.01-1. 27%29. 27%-29. 0.181 (0.18- 1.011 1.01-1 27%29 27%-29 (0.18 1.01- 27%2 27%-2 (0.1 27%- (0. (0