Feasibility of a snowball sampling survey to study active surveillance for thyroid microcarcinoma treatment among endocrinologists and surgeons of Brazil

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.

Are the anatomical, clinical, and ultrasound characteristics of thyroid nodules with Bethesda III or IV cytology and ACR TI-RADS 3, 4, or 5 able to refine the indications for molecular diagnostic tests?

ABSTRACT Objective: To analyze the association of clinical, anatomical, and ultrasound (US) characteristics of malignancies in Bethesda III or IV (III-B or IV-B) thyroid nodules. Subjects and methods: The association between malignancies and the following variables were analyzed: III-B or IV-B, age < 55 years and ≥ 55 years, sex, family history of thyroid cancer, history of irradiation, nodule size, and ACR TI-RADS classification in 62 participants who underwent thyroidectomy. Results: Of the 62 participants, 87.1% (54/62) were women, 74.2% were < 55 years old, 95.2% had no family history of thyroid cancer, 56.5% had nodules < 2 cm in size, 62.9% were IV-B, and 69.4% were ACR TI-RADS 4. Thirty-two patients had thyroid carcinoma, and 30 had benign histology. Among all factors associated with malignancy, only ACR TI-RADS 5 classification on US was found to be statistically significant (p = 0.014), while III-B with architectural atypia cytological classification was the only one significantly associated with benign status (p = 0.004). Conclusion: Only a high risk of malignancy as assessed using US was able to refine the indication for molecular tests in a group of patients with indeterminate nodules. We found 85% (53/62) of III-B or IV-B thyroid nodules would benefit from available molecular diagnostic tests.

Projeto-piloto de telemonitoramento glicêmico de pacientes com diabete melito tipo 2 na Atenção Primária em Belo Horizonte-MG / A pilot project on glycemic home telemonitoring in type 2 diabetes patients in a Brazilian primary healthcare unit

Introdução: O telemonitoramento aperfeiçoa o controle de doenças crônicas, reduz internações e readmissões hospitalares, possibilita alta mais precoce e aumenta a satisfação do paciente. Objetivo: O estudo objetiva avaliar o impacto de um projeto-piloto de telemonitoramento nos valores da hemoglobina glicada (HbA1C) de pacientes portadores de diabete melito tipo 2 (DM2) com controle glicêmico insatisfatório. Busca, ainda, avaliar a viabilidade dessa ferramenta na Atenção Primária, em relação ao uso e à qualidade da transmissão dos dados, segundo a percepção dos usuários. Materiais e Métodos: Selecionaram-se 28 pacientes insulinizados, entre 30 a 80 anos, com diagnóstico de DM2, assistidos pela equipe de Saúde da Família de uma Unidade Básica de Saúde, localizada em Belo Horizonte. Os pacientes apresentavam duas medidas de HbA1C >7% realizadas dentro dos últimos 360 dias, sendo a medida mais recente realizada até 30 dias antes do início do estudo. Os pacientes foram alocados aleatoriamente em dois grupos, sendo 15 pacientes em telemonitoramento domiciliar e 13 em acompanhamento tradicional. Mensurações das HbA1C dos pacientes foram coletadas ao início e após 90 dias de seguimento. Não houve perdas ou exclusões de pacientes. Resultados: Após 90 dias de intervenção, verificou-se redução significativa das médias dos valores de HbA1C apenas nos pacientes sob telemonitoramento (IC95%; p<0,01 em Teste T). Conclusão: Esse projeto-piloto sinaliza que o telemonitoramento em DM2 é viável, de fácil execução e tem impacto positivo e significativo na melhoria do controle glicêmico dos pacientes. Estudos com um número maior de pacientes se fazem necessários para corroborar esses achados. (AU)

Introduction: Decades of research has issued a lot of data about the cost effectiveness and efficacy of many telemedicine applications. Telemonitoring improves control of chronic diseases, it reduces the need for hospital care, the hospital readmission rate, and it allows earlier hospital discharge and increases patient satisfaction. Objective: We evaluate the impact of a pilot project on glycemic telemonitoring in type 2 Diabetes (DM2) patients on measures of glycated hemoglobin (HbA1C) and evaluate the viability of telemonitoring, about the use and quality of data transmission, in primary health care. Materials and Methods: We had 28 insulinized patients aged 30-80 years diagnosed with DM2, assisted by a Family Health Unit from Horizonte-Brazil. Those patients had at least two HbA1C> 7% within the 360 days prior to the survey and they were randomly divided into two groups, - 15 patients with home telemonitoring and 13 patients with traditional follow-up. The HbA1c values of patients were collected at the beginning and after 90 days. There were no 'loss to follow-up' or exclusions cases. Results: Comparison between HbA1C means of both groups revealed a statistically significant reduction in HbA1C levels only in telemonitored group (IC95%; p<0,01 t-test). Conclusions: This pilot project indicates that home telemonitoring in DM2 is viable, easy to perform, and it has a positive and significant impact on glycemic control of these patients. Larger studies are required to confirm these statements. (AU)

Avaliação do emprego de videoconferências para a capacitação à distância dos médicos das equipes de saúde da família dentro do projeto nacional telessaúde / Evaluation of the use of videoconferencing for distance training of doctors in the family health teams within the national telehealth project

Introdução: o Programa Nacional de Telessaúde visa à atualização e capacitação dos médicos das Equipes de Saúde da Família por meio de videoconferências (VCs), com potencial impacto na melhoria da atenção à saúde em locais remotos e redução do deslocamento dos pacientes. Ainda, propõe mais interação da atenção primária com centros especializados. Objetivos: apresentação e avaliação do emprego desse sistema de videoconferências, possibilitando melhor planejamento das ações do projeto. Métodos: analisados 916 questionários de avaliação/retroalimentação preenchidos pelos participantes ao término de 84 VCs de Medicina, no período de 2009 até 2013. As VCssão um braço do Projeto Nacional de Telessaúde e alcançam 50 municípios em Minas Gerais, sob a coordenação da FM-UFMG. Elas realizam-se via web, exigindo aparelhagem mínima no centro difusor e receptor. Resultados: no período do estudo, obteve-se média de 12,64 municípios e 19,42 conferencistas por VC. Destes, a média de médicos foi 12,97. Quanto aos parâmetros de qualidade das VC, alcançaram avaliação positiva (?ótimo? ou ?bom?) o som em apenas 62% delas e a qualidade de imagem em 84%. O tema foi considerado ?interessante? ou ?muito interessante? em 98%. Conclusões: as VCs têm se fortalecido como alternativa para instituições educacionais. Porém, a participação de conferencistas e municípios nesse projeto foi aquém da almejada. Análises comparativas com VCs de outras áreas revelam, ainda, reduzida adesão dos médicos. Entre os problemas detectados, especialmente quanto à qualidade do som, a baixa qualidade de internet nos municípios pode ter contribuído para esse resultado.

Introduction: the National Telehealth Program aims at updating and training doctors in the Family Health Teams by means of videoconferencing (VCs), with potential impact on improving the health care in remote locations and reducing the displacement of patients. In addition, it proposes increased primary care interaction with specialized centers. Objectives: presentation and evaluation of the use of the videoconferencing system allowing for better planning of action in the project. Methods: 916 evaluation /feedback questionnaires were analyzed, completed by participants at the end of 84 VCs in Medicine, between 2009 and 2013. The VCs are a branch of the National Telehealth Project and reach 50 municipalities in Minas Gerais under the coordination of the FM-UFMG. They are held via web, requiring minimal equipment in diffuser and receiver centers. Results: in the study period, an average of 12.64 municipalities and 19.42 speakers were identified. Of these, the average number of doctors was 12.97. The quality parameters achieved positive assessment (?great? or ?good?) in just 62% for the sound, and 84% for the image. The theme was considered ?interesting? or ?very interesting? by 98%. Conclusions: the VCs have been strengthened as an alternative to educational institutions. However, the participation of speakers and municipalities in this project was lessthan desired. The comparative analysis of VCs from other areas also reveals a reduced adhesion of doctors. Among the problems detected, especially regarding the sound quality, the low quality of internet connection in the municipalities may have contributed to this result.

Duplication of the hypophysis associated with precocious puberty: presentation of two cases and review of pituitary embryogenesis

Duplicacão pituitária é uma malformacão rara muitas vezes associada a anomalias neurais/craniofaciais, facilmente demonstradas por imagens em ressonância magnética. Os autores descrevem duas criancas do sexo feminino com duplicacão da glândula pituitária e espessamento do hipotálamo, dismorfismo facial e desenvolvimento puberal precoce. Discute-se a etiopatogenia da duplicacão hipofisária e sua relacão com o quadro de puberdade precoce.