Abstract Objectives: This study aims to investigate if a sampling method using virtual networks is feasible to survey AS adoption among this “hard-to-reach” population of Brazilian doctors. Methods: An online piloted 11-point structured survey questionnaire (designed using Googleforms®) probed the actual treatment patterns for adult patients with PTMCs, including treatment decision-making nonoperative options, was undertaken between 10 November and 30 November 2020. Participants were reached by the mobile phone Application (APP) and a snowball sampling strategy was used to recruit a total of 4783 members (maximum number of potential reach), which is the total of doctors of the all 21 social media WhatsApp® groups. Results: From a total of 4783 members (maximum number of potential reach), there were 657 (13.7%) doctors (actual reach) who clicked the web link of the questionnaire, out of whom 512 (10.7%) fully completed the online survey. Among the survey respondents, 361 were endocrinologists (70.5%) and 151 were surgeons (29.5%). Overall, for low-risk PTMCs in an elderly patient, 118 responders (23%) recommend AS, while 390 (76%) recommend immediate surgery as the management, including lobectomy (18.5%) and Total Thyroidectomy (58.2%). The present responders tended to recommend surgery for PTMCs that were located adjacent to the dorsal surface of the thyroid, were multiple, or raised the size during the follow-up. Conclusion: Using snowball sampling strategy as an innovative route to conduct surveys was feasible and applicable but the rate of response was still very low. Our data also suggests the need to investigate if AS is embraced by Brazilian doctors.

Resumo Objetivo: Bócios e nódulos benignos detectados na tireoide são lesões em crescimento e a pandemia de Covid-19 impactou negativamente seu tratamento cirúrgico. A seleção adequada de pacientes para o tratamento vai melhorar o estado geral de saúde. Esta revisão de artigos se concentrará no impacto da pandemia de Covid-19 no tratamento de condições benignas da glândula tireoide e suas implicações. Método: Esta revisão evidenciou a situação do sistema de saúde em países em desenvolvimento e os problemas para tratar doenças cirúrgicas benignas da tireoide. Aspectos da epidemiologia, incidência, apresentação clínica e tratamento cirúrgico do bócio, impacto econômico e no estado de saúde foram relatados. Resultados: Todos os tratamentos cirúrgicos de bócio e outras condições benignas foram adiados, forçados a se redirecionar e a remarcar todas as cirurgias benignas, situação agravada pela má gestão pública e fechamento de leitos hospitalares. Essas condições têm causado deterioração do estado de saúde física (doença da tireoide descompensada) e mental dos pacientes, aumentam as incapacidades para o trabalho e sobrecarregando a sociedade e o custo social e de saúde. A situação geral pode ser catastrófica em países emergentes, onde esse aumento dos gastos sociais relacionados à doença sob tratamento cirúrgico pode aumentar o risco de empobrecimento nacional à medida que aumenta o custo do tratamento. A Sociedade Brasileira de Cirurgia de Cabeça e Pescoço forneceu algumas recomendações e novas sugestões foram feitas para tratar com segurança essas condições cirúrgicas de alto risco potencial. Conclusão: As cirurgias para bócio e condições benignas da tireoide podem ser feitas durante a pandemia de Covid-19, se forem seguidos rigorosos protocolos de segurança para o paciente e equipe médica, o que reduz o impacto negativo na economia e na saúde do paciente.

Abstract Objective: Goiters and benign nodules detected in the thyroid are growing lesions and the COVID-19 pandemic have negatively impacted on their surgical treatment. The appropriate selection of patients to treatment will improve the overall health status. This article review will focus on the impact of the COVID-19 pandemic on treatment of benign conditions of the thyroid gland and their implications. Methods: This review pointed out the status of the health system in developing country and the problems to treat benign surgical diseases of thyroid. Aspects of epidemiology, incidence, clinical presentation and surgical treatment of goiters, economic and health status impact were cited. Results: All surgical treatment of goiter and other benign conditions were postponed, forced to redirect, and reschedule all benign surgeries, situation aggravated by poor public management and closure of hospital beds. These conditions have caused deterioration in patients’ physical (decompensated thyroid disease) and mental health status, increasing work disabilities and burdening society by increasing the social and health cost. The overall situation could be catastrophic in emergent countries where this increased disease-related social expenditure on surgical treatment may increase the risk of national impoverishment as increase the treatment cost. Brazilian Society Head and Neck Surgery related some recommendations and new suggestions were made to safely treat these high potential hazard surgical conditions. Conclusions: Surgeries for goiter and benign thyroid conditions can be performed during the COVID-19 pandemic, following strict safety protocols for the patient and the medical team, reducing the negative economic and on patient health impact.

ABSTRACT Increasingly sensitive diagnostic methods, better understanding of molecular pathophysiology, and well-conducted prospective studies have changed the current approach to patients with thyroid cancer, requiring the implementation of individualized management. Most patients with papillary thyroid carcinoma (PTC) are currently considered to have a low risk of mortality and disease persistence/recurrence. Consequently, current treatment recommendations for these patients include less invasive or intensive therapies. We used the most recent evidence to prepare a position statement providing guidance for decisions regarding the management of patients with low-risk PTC (LRPTC). This document summarizes the criteria defining LRPTC (including considerations regarding changes in the TNM staging system), indications and contraindications for active surveillance, and recommendations for follow-up and surgery. Active surveillance may be an appropriate initial choice in selected patients, and the criteria to recommend this approach are detailed. A section is dedicated to the current evidence regarding lobectomy versus total thyroidectomy and the potential pitfalls of each approach, considering the challenges during long-term follow-up. Indications for radioiodine (RAI) therapy are also addressed, along with the benefits and risks associated with this treatment, patient preparation, and dosage. Finally, this statement presents the best follow-up strategies for LRPTC after lobectomy and total thyroidectomy with or without RAI.

RESUMO: A cisticercose bovina (CB) é uma doença importante no Brasil devido à sua detecção em abatedouros-frigoríficos que resulta em impactos econômicos aos criadores de bovinos, e um problema de saúde pública. Apesar da sua importância, o conhecimento sobre a sua epidemiologia e impacto persiste não completamente descritos em diversas áreas do país requer mais estudos. Portanto, esse estudo objetivou estabelecer a prevalência nos municípios e regiões do Estado do Espírito Santo de 2017 a 2019; estabelecer os fatores de risco associados; e estimar o impacto econômico aos pecuaristas. Durante o período, 2.330 casos de BC foram dectados entre os 407.529 bovinos inspecionados sob regime de inspeção federal (0,57%; I.C. 95% 0,55 - 0,60%), com maior frequência de cisticercos inviáveis (66,14%). Os pecuaristas perderam pelo menos US$153.000,20 devido à ocorrência de CB durante o período. As áreas de maior risco para a enfermidade nesse estado estão nas mesoregiões Metropolitana (OR = 9,19), Litoral Sul (OR = 7,77), Caparó (OR = 7,44), e Central Sul (OR = 7,19), respectivamente. A doença foi detectada em animais de 67 municípios e a prevalência da enfermidade foi maior em áreas com elevada densidade populacional humana (OR = 1,58; p = 0,01). Assim, conclui-se que a CB é uma importante doença para a cadeia da carne bovina no estado, além de uma importante causa de perdas econômicas, principalmente em algumas áreas, e necessita, urgentemente, da adoação de medidas profiláticas para reduzir a ocorrência desse parasita.

ABSTRACT: Bovine cysticercosis (BCC) is an important disease in Brazil due to its detection in abattoirs, resulting in economic losses for cattle farmers, and a public health corcern. Besides its importance, the knowledge about BCC epidemiology and impact remains not fully described in several areas in this country, requiring more studies. Thus, this study focused on establishing BCC prevalence in the regions and municipalities of the state of Espírito Santo from 2017 to 2019, establishing the associated risk factors, and estimating the economic losses for cattle farmers. A set of 2,330 cases of BCC was detected in the 407,529 bovine inspected by Federal Inspection Service (0.57%; C.I. 95% 0.55 - 0.60%) with a higher detection of unviable cysticercus (66.14%). The beef producers lost at least US$153,000.20 due to BCC through this period. The highest risk for BCC infection occurred in Metropolitana (OR = 9.19), Litoral Sul (OR = 7.77), Caparó (OR = 7.44), and Central Sul (OR = 7.19) mesoregions, respectively. The BCC was detected in animals from 67 municipalities and its prevalence increased in areas with high human population density (OR = 1.58;; p = 0.01). In conclusion, BCC is an important disease for beef production chain in the Brazilian state of Espírito Santo and a cause of economic losses, mainly in some areas, and urgently requires the adoption of prophylactic strategies to reduce the ocurrence of this parasite.

ABSTRACT Objective: Although thyroid microcarcinoma (TMC) usually has a favorable prognosis, some patients present a higher risk of disease recurrence or persistence. Thus, we aimed at identifying possible risk factors associated with an incomplete response to therapy in TMC. Subjects and methods: This was a retrospective study of 517 patients with TMC treated with total thyroidectomy, with or without radioactive iodine (RAI) therapy, reclassified after 1.1 ± 0.4 years according to the response to treatment into “favorable” (excellent/indeterminate) or “unfavorable” (biochemical/structural incomplete) responses. We evaluated participants' age, sex, tumor size, histological variants, multifocality, presence of vascular/lymphatic/perineural invasion, extrathyroidal extension, metastatic lymph nodes (LN), and distant metastasis. The effect of RAI therapy on the response range was analyzed in a given subgroup. Results: The mean age observed was 46.4 ± 12.0 years, and 89.7% were female. We noted 97.5% with papillary carcinoma, 27.8% with multifocality and 11.2% with LN metastasis. Although the majority of patients had a low risk of recurrence/persistence (78%), 75% were submitted to RAI therapy. Incomplete response (20.7%) was associated with multifocality (p=0.041; OR=1.619) and metastatic LN (p=0.041; OR=1.868). These variables were strongly correlated (p=0.000; OR=3.283). No cut-off of tumor size was identified as a predictor of incomplete response by the receiver operating curve analysis. RAI treatment did not influence the response of patients with multifocality or LN metastasis. Conclusion: Multifocality and LN metastasis are independent risk factors for incomplete response in TMC patients and are strongly correlated. Additional RAI therapy was not associated with a more favorable response in these subgroups.

ABSTRACT Objective: The intermediate-risk (IR) category includes tumors with different degrees of aggression. We aimed to identify the risk factors associated with unfavorable response to initial treatment and compare the effect of low/high radioactive iodine (RAI) therapy. Subjects and methods: A total of 614 IR patients were selected from a database, during 1972-2015. All patients underwent total thyroidectomy and RAI therapy and were reclassified after 12-18 months into the favorable (complete/indeterminate) response group and the unfavorable (biochemical/incomplete structural) response group. A total of 92 patients were assessed for late response (mean: 9.19 ± 5.73 years). Age, gender, tumor size, histology, multifocality, vascular invasion, extrathyroidal extension, presence and number of lymph node metastasis, and stimulated thyroglobulin at ablation (sTg) were evaluated. Results: Mean age at diagnosis was 41.47 ± 15.81 years, and 83.6% of the patients were female. Within 12-18 months after initial therapy, unfavorable response was detected in 41.2% of the patients and was associated, in multivariate analysis, with lymph node metastasis (p = 0.041; odds ratio [OR] = 1.9), presence of more than five metastatic lymph nodes (p = 0,017; OR = 2.6), and sTg > 10 ng/mL (p = 0.005; OR = 10.0). For patients with a longer follow-up, sTg >10 ng/mL was associated with unfavorable response (p = 0.002; OR = 6.8). A higher RAI dose was not related to better prognosis at the end of the follow-up. Conclusion: A sTg level of >10 ng/mL and lymph node metastasis were associated with an unfavorable response 12-18 months after initial treatment. A RAI dose below 150 mCi was proven sufficient to treat IR patients.

ABSTRACT Objective We aimed to evaluate the impact of minimal extrathyroidal extension (mETE) alone on the risk of recurrence of papillary thyroid carcinoma (PTC). The impact of other factors, including multifocality, age, tumor size, and stimulated thyroglobulin (sTg) values was also assessed. Subjects and methods We retrospectively analyzed 1,108 PTC patients from a medical institution, who presented tumors ≤ 4 cm without any adverse characteristics other than mETE. Patients were classified according to their response to initial treatment 12 to 24 months after surgery as proposed by the 2015 American Thyroid Association (ATA) guideline. Statistical analysis was performed using multivariate logistic regression and receiver operating characteristic (ROC) curve. Results In the multivariate logistic regression analysis, mETE did not have an impact on the response to initial treatment (p = 0.44), similar to multifocality, age, and tumor size. Initial Tg value was the only variable associated with a poor response (p < 0.01, odds ratio = 1.303, 95% confidence interval 1.25-1.36). The ROC analysis revealed that Tg was significant (area under curve = 0.8750); the cutoff value of sTg as a predictor of poor response was 10 ng/mL (sensitivity = 72.2%, specificity = 98.5%). Conclusion For low-risk PTC presenting mETE as the only aggressive feature, the initial sTg value is essential to identify patients who may have a poor response after initial treatment and benefit from further treatment. Arch Endocrinol Metab. 2020;64(3):251-6

Abstract The scope of this paper was to understand how CRISPR-Cas9 can function as a viable technology in the construction of the parenting project in order to promote freedom in the process of procreative autonomy. However, regarding the possibility of its use to cause genetic manipulation in the human germline, we sought to ascertain the limits and scope of this perception of freedom. Thus, through the use of documentary and bibliographical method, data about the viability of the preservation of the genetic patrimony as an expression of the diversity in humanity was researched. Therefore, it was perceived as necessary to overcome the hygienist thoughts of cleaning up "defects", considering all life as worthy of being lived.

Resum L'objectiu del article era comprendre com CRISPR-CAS9 pot funcionar com una tecnologia viable en la construcció del projecte de parentalitat per promoure l'exercici de la llibertat en el procés d'autonomia reproductiva. No obstant això, tot i la possibilitat del seu ús en la línia germinal humana, es van intentar investigar els límits i l'abast d'aquesta percepció de llibertat. Així, a través de l'ús d'investigacions documentals i bibliogràfiques, es van buscar dades sobre la viabilitat de la preservació del patrimoni genètic com a expressió de la diversitat a la humanitat. D'aquesta manera, es va percebre que cal superar pensaments higienistes de netejar "defectes", considerant que tota vida és digna de ser viscuda.

Resumen El objetivo de este artículo es comprender cómo el CRISPR-Cas9 puede funcionar como una tecnología viable en la construcción del proyecto de parentalidad para promover el ejercicio de la libertad en el proceso de autonomía reproductiva. Sin embargo, a pesar de la posibilidad del uso en la línea germinal humana, se intentó investigar los límites y el alcance de esta percepción de libertad. Así, a través del uso de investigaciones documentales y bibliográficas, se buscaron datos sobre la viabilidad de la preservación del patrimonio genético como expresión de la diversidad en la humanidad. De esta forma, se percibió que es necesario superar pensamientos higienistas de limpiar "defectos", considerando que toda vida es digna de ser vivida.

Resumo Os objetivos neste estudo foram descrever ocorrências do nematódeo Rhabditis spp., causando otite parasitária em bovinos leiteiros da raça Gir no estado do Espírito Santo, sudeste do Brasil, e avaliar o controle biológico desse nematódeo utilizando os fungos nematófagos Duddingtonia flagrans (AC001) e Monacrosporium thaumasium (NF34). Após a detecção e coleta dos nematódeos, três grupos foram formados: dois grupos que foram tratados com os isolados fúngicos, respectivamente; e um grupo controle, sem fungos. Os tratamentos foram os seguintes: (a) placas de Petri contendo o meio de cultura 2% ágar de água (WA) + 250 nematoides + AC001; (b) placas de Petri contendo 2% de WA + 250 nematoides + NF34; e (c) placas de contendo apenas 2% de nematódeos WA + 250. Após sete dias a 27 °C os tratamentos com fungos foram capazes de capturar e destruir os nematódeos, com porcentagens de 82,0% (AC001) e 39,0% (NF34) em relação ao grupo controle. Os resultados demonstram a ocorrência de Rhabditis spp., no Estado do Espírito Santo e a eficácia da atividade predatória in vitro dos isolados fúngicos utilizados. Assim, esses resultados são importantes, pois podem auxiliar no controle alternativo in vivo de Rhabditis spp. em bovinos com otite parasitária.

Abstract The objectives of this study were to describe occurrences of Rhabditis spp. causing parasitic otitis in dairy cattle of Gir breed in the state of Espírito Santo, southeastern Brazil, and to evaluate the biological control of this nematode using the nematophagous fungi Duddingtonia flagrans (AC001) and Monacrosporium thaumasium (NF34). After nematode detection and collection, three groups were formed: two groups that were treated, respectively, with the fungal isolates; and a control group, without fungus. The treatments were as follows: (a) Petri dishes containing the culture medium 2% water agar (WA) + 250 nematodes + AC001; (b) Petri dishes containing 2% WA + 250 nematodes + NF34; and (c) Petri dishes containing only 2% WA + 250 nematodes. After seven days at 27 °C the treatments with fungi were able to capture and destroy the nematodes, with percentages of 82.0% (AC001) and 39.0% (NF34) in relation to the control group. The results demonstrate the occurrence of Rhabditis spp. after animals physical examination and that there was efficacy of the in vitro predatory activity of both fungal isolates. Thus, these results are important because they can assist in future in vivo control of this nematode in cattle.

ABSTRACT Approximately 15–30% of all thyroid nodules evaluated with fine-needle aspiration biopsy (FNAB) are classified as cytologically indeterminate. The stepwise unraveling of the molecular etiology of thyroid nodules has provided the basis for a better understanding of indeterminate samples and an opportunity to decrease diagnostic surgery in this group of patients. Over the last 15 years, several studies have tested different methodologies to detect somatic mutations (by polymerase chain reaction and next-generation sequencing, for example), and to identify differentially expressed genes or microRNA, aiming at developing molecular tests to improve the presurgical diagnosis of cytologically indeterminate nodules. In this review, we will provide an overview of the currently available molecular tests and the impact of mutation testing on the diagnosis of thyroid cancer. We will also review current published data and future perspectives in molecular testing of thyroid nodule FNAB and describe the current Brazilian experience with this diagnostic approach. Based on currently available data, especially for countries outside the US-Europe axis, a rational use of these tests must be made to avoid errors with regard to test indication and interpretation of test outcomes. In addition to clinical, radiological, and cytological features, we still need to determine local malignancy rates and conduct more independent validation and comparative performance studies of these tests before including them into our routine approach to indeterminate FNAB.

Resumo A família monoparental é uma entidade familiar constitucionalmente protegida no artigo 226, § 4°, da Constituição Federal de 1988. No entanto, pairam ainda, sobretudo na doutrina, algumas dúvidas quanto à possibilidade de uma pessoa intencionalmente constituir uma família monoparental, fazendo uso das técnicas de reprodução humana assistida, a chamada “produção independente”. A partir de tal perspectiva, pergunta-se: seria legítimo escolher desempenhar individualmente uma paternidade ou maternidade? Com a finalidade de responder tal indagação, o presente trabalho objetivou analisar a legitimidade de uma pessoa solteira em empreender um projeto particular de parentalidade, recorrendo-se ao auxílio das modernas técnicas de procriação medicamente assistida. Para tanto, utilizou-se do método analítico-dedutivo, mediante o uso de revisão bibliográfica, com o intuito de buscar as formulações doutrinárias acerca da temática, analisando-as em conformidade com uma metodologia bioética-civil-constitucional. Assim, observou-se que, sob a ótica do planejamento familiar e de suas limitações legais, não há como se obstar legalmente à concretização de tais projetos de paternidade ou maternidade. Afinal, o ideal de família previsto pelo ordenamento brasileiro preserva a afetividade e o cuidado nas relações familiares, acima de qualquer padrão de constituição familiar predeterminado.

Abstract The single-parent family is a family entity legally protected by article 226, § 4° of the Federal Constitution of Brazil. However, there are still doubts about the feasibility of a single-parent family, constituted by means of assisted human reproduction techniques, the so-called “independent production” - a Brazilian idiomatic expression. From this perspective, one could wonder: would the choice to individually perform paternity or maternity be legitimate? In order to answer that question, the present work aims to analyze the legitimacy of a particular project of parenting held by a single person, resorting to the aid of modern medically assisted procreation techniques. For this purpose, we applied the analytic-deductive method, through a bibliographical review, with the intention of searching the doctrinal formulations on the subject, analyzing them in accordance to a bioethical-civil-constitutional methodology. Thus, it was observed that, from the point of view of family planning and its legal limitations, there is no way to legally restrain the implementation of such parental projects. After all, the ideal of family foreseen by the current Brazilian order preserves affection and care in family relations, above any predetermined pattern of family constitution.

ABSTRACT Objectives: We sought to assess the relationship between stimulated thyroglobulin (sTg) before radioactive iodine therapy (RIT), and the dynamic risk stratification 1 year after treatment, and to establish the utility of the sTg as a predictor of response to therapy in these patients. A retrospective chart review of patients with differentiated thyroid cancer (DTC) who underwent RIT after surgery and were followed for at least 1 year, was carried out. Subjects and methods: Patients were classified according to the dynamic risk stratification 1 year after initial treatment. The sTg values before RIT were compared among the groups. ROC curve analysis was performed. Results: Fifty-six patients were enrolled (mean age 44.7 ± 14.4 years, 80.7% had papillary carcinoma). Patients with excellent response had sTg = 2.1 ± 3.3 ng/mL, those with indeterminate response had sTg = 8.2 ± 9.2 ng/mL and those with incomplete response had sTg = 22.4 ± 28.3 ng/mL before RIT (p = 0.01). There was a difference in sTg between excellent and incomplete response groups (p = 0.009) while no difference was found between indeterminate and either excellent or incomplete groups. The ROC curve showed an area under the curve of 0.779 assuming a sTg value of 3.75 ng/mL. Conclusion: Our study results suggest that the higher the sTg before RIT, the greater the likelihood of an incomplete response to initial treatment. A sTg cut-off of 3.75 ng/mL was found to be a good predictor of response to initial treatment in patients with DTC.