Correlation between thyroid fine needle aspiration and pathological examination: a 10 year retrospective study

ABSTRACT Objective To establish the diagnostic performance of fine-needle aspiration in detecting benign and malignant neoplasm in comparison with post-thyroidectomy histopathological findings among patients who received a thyroidectomy. Methods Retrospective observational data collected between 2011-2021 were included from patients who received partial or total thyroidectomy. The Bethesda system was used to classify neoplasms from fine-needle aspiration procedures as benign or malignant. Sample characteristics, diagnostic accuracy, sensitivity, specificity, and predictive values were evaluated. Results Patients (n=360) who underwent thyroidectomy were analyzed, of whom 142 (39.4%) and 218 (60.6%) had benign and malignant neoplasms, respectively. Using the Bethesda system, 23 (6.4%) were classified as unsatisfactory result (BI), 83 (23.1%) as benign (BII), 50 (13.9%) as atypia of undetermined significance (BIII), 23 (6.4%) as suspected follicular or Hürthle cell neoplasia (BIV), 102 (28.3%) as suspected malignancy (BV) and 79 (21.9%) as malignant (BVI). The fine-needle aspiration diagnostic accuracy for carcinomas was 92%, while the sensitivity and specificity were 94.4% and 86.9%, respectively. The negative and positive predictive values were 87.9% and 93.9%, respectively. Conclusion Fine-needle aspiration has high diagnostic accuracy, sensitivity and specificity, and is a reliable test for distinguishing between benign and malignant thyroid pathologies.

Maternal prepregnancy obesity and gestational diabetes influence on adverse perinatal outcomes

ABSTRACT Objective: Evaluate the influence of isolated and associated prepregnancy obesity and gestational diabetes mellitus (GDM) on adverse perinatal outcomes. Materials and methods: Cross-sectional observational study with women who delivered at a Brazilian Maternity Hospital, between August and December 2020. Data were collected by interview with application form, and medical records. Sample was stratified by body mass index (BMI) and GDM screening in four groups: no obesity (BMI < 30 kg/m2) no GDM - reference; isolated GDM; isolated obesity (BMI ≥ 30 kg/m2); and obesity with GDM. Preeclampsia (PE), cesarean section (CS), large-for-gestational-age (LGA) newborn and admission to neonatal intensive care unit (NICU) were analyzed by odds ratio (OR) adjusted for confounding factors, adopting 95% confidence interval (CI) and P < 0.05 statistically significant. Results: From 1,618 participants, isolated obesity group (233/14.40%) had high chance of PE (OR = 2.16; CI: 1.364-3.426; P = 0.001), isolated GDM group (190/11.74%) had high chance of CS (OR = 1.736; CI: 1.136-2.652; P = 0.011) and NICU admission (OR = 2.32; CI: 1.265-4.261; P = 0.007), and obesity with GDM group (121/7.48%) had high chance of PE (OR = 1.93; CI: 1.074-3.484; P = 0.028), CS (OR = 1.925; CI: 1.124-3.298; P = 0.017) and LGA newborn (OR = 1.81; CI: 1.027-3.204; P = 0.040), compared with reference (1,074/66.38%). Conclusion: Obesity and GDM enhances the chance of different negative outcomes, worsening this prognosis when associated.

Once-Weekly Insulin Icodec vs. Once-Daily Insulin Glargine U100 for type 2 diabetes: a systematic review and meta-analysis of phase 2 randomized controlled trials

ABSTRACT Objective: Insulin Icodec is a novel basal insulin analogue designed for once-weekly administration, therefore might propitiate reduction in the frequency of injections and facilitate treatment adherence. This study aimed to determine the glycemic control and safety profile of Insulin Icodec, compared with Glargine U100 in patients with diabetes mellitus type 2. Materials and methods: We performed a systematic review and meta-analysis of randomized controlled trials (RCT) data comparing Once-Weekly Insulin Icodec and Once-Daily Insulin Glargine U100 in patients with type 2 diabetes mellitus. PubMed, Embase, and Cochrane databases were searched for trials published up to May 14, 2022. Data were extracted from published reports and quality assessment was performed per Cochrane recommendations. Results: Three studies were included comprising 453 patients, 230 (50.77%) using Once-Weekly Insulin Icodec and 223 (49.22%) using Once-Daily Insulin Glargine U100. In the pooled data, Glycated Hemoglobin (MD -0.20% CI -0.33 to -0.07%; P=0.002) change from baseline demonstrated a significantly higher reduction in the Icodec group. Time with Glucose in Range (MD 6.60% CI 3.63 to 9.57%; P < 0.0001) and Insulin Dose Difference (MD 0.97UI CI 0.76 to 1.18UI; P < 0.0001) were higher in the Icodec group. There was no significant difference in fasting plasma glucose, body weight change, hypoglycemia or any adverse event evaluated. Conclusions: Once-Weekly Insulin Icodec was associated with a small reduction in Glycated Hemoglobin, as well as higher Time with Glucose in Range, with similar hypoglycemic adverse events, when compared with Once-Daily Insulin Glargine U100.

Evaluation of prenatal care according to indicators for the Prenatal and Birth Humanization Program / Avaliação da assistência pré-natal segundo indicadores do Programa de Humanização no Pré-natal e Nascimento

Abstract Objectives: to evaluate prenatal care provided to low-risk pregnant women users of the Sistema Único de Saúde (SUS) (Public Health System) in the city of Joinville, SC. Methods: this is a cross-sectional observational study carried out from March 2018 to February 2019, through interview and analysis of the Pregnant Card of puerperal over 18 years old, from Joinville, who underwent prenatal care at SUS, excluding recent given up puerperal. Prenatal care was evaluated according to the recommended criteria by the Prenatal and Birth Humanization Program. Results: 683 mothers were interviewed. The criteria with the highest levels of adequacy were accessibility (99.6%), early initiation on prenatal care (92.7%) and 6 or more consultations (87.1%) and the criteria with the lowest rates of adequacy were the set of guidelines (17.7%) and the third and first trimester exams (42.5% and 63.5% respectively). Conclusion: it is concluded that the prenatal care provided by SUS in the city of Joinville, despite the almost universal accessibility, the early onset and the prevalence of puerperal women with more than 6 consultations, showed a sharp decline in the analysis of the recommended indicators.

Resumo Objetivos: avaliar a assistência pré-natal prestada a gestantes de baixo risco usuárias do Sistema Único de Saúde da cidade de Joinville - SC. Métodos: trata-se de um estudo observacional transversal realizado de março de 2018 a fevereiro de 2019, mediante entrevista e análise do Cartão da Gestante de puérperas maiores de 18 anos, procedentes de Joinville, que realizaram o pré-natal no SUS, sendo excluídas puérperas desistentes. Avaliou-se a assistência pré-natal mediante critérios preconizados pelo Programa de Humanização no Pré-natal e Nascimento. Resultados: foram entrevistadas 683 puérperas. Os critérios com maiores índices de adequação foram acessibilidade (99,6%), início precoce do pré-natal (92,7%) e realização de 6 ou mais consultas (87,1%) e os critérios que apresentaram as menores taxas de adequação foram o conjunto de orientações (17,7%) e os exames do terceiro e primeiro trimestre (42,5% e 63,5% respectivamente). Conclusão: conclui-se que a assistência pré-natal realizada pelo SUS da cidade de Joinville, não obstante da acessibilidade praticamente universal, do início precoce e da prevalência de puérperas com mais de 6 consultas, demonstrou declínio acentuado na análise dos indicadores preconizados.

Factors associated with the need for insulin as a complementary treatment to metformin in gestational diabetes mellitus / Fatores associados à necessidade de insulina como tratamento complementar à metformina na diabetes mellitus gestacional

Abstract Objective To evaluate the factors associated with the need for insulin as a complementary treatment to metformin in pregnant women with gestational diabetes mellitus (GDM). Methods A case-control study was performed from April 2011 to February 2016 with pregnant women with GDM who needed complementary treatments besides diet and physical exercise. Those treated with metformin were compared with those who, in addition to metformin, also needed the combination with insulin. Maternal characteristics and glycemic control were evaluated. Multinomial logistic regression models were developed to evaluate the influence of different therapies on neonatal outcomes. Results A total of 475 pregnant women who needed pharmacological therapy were evaluated. Of these, 366 (77.05%) were submitted to single therapy with metformin, and 109 (22.94%) needed insulin as a complementary treatment. In the analysis of the odds ratio (OR), fasting glucose (FG)<90 mg/dL reduced the odds of needing the combination (OR: 0.438 [0.235-0.815]; p=0.009], as well as primiparity (OR: 0.280 [0.111-0.704]; p=0.007]. In obese pregnant women, an increased chance of needing the combination was observed (OR: 2,072 [1,063-4,039]; p=0,032). Conclusion Obesity resulted in an increased chance of the mother needing insulin as a complementary treatment to metformin, while FG<90 mg/dL and primiparity were protective factors.

Resumo Objetivo Avaliar os fatores associados à necessidade de insulina como tratamento complementar à metformina em gestantes com diabetes mellitus gestacional (DMG). Métodos Um estudo caso-controle foi realizado de abril de 2011 a fevereiro de 2016 comgestantes portadoras de DMG que necessitaram de tratamentos complementares além de dieta e exercícios físicos. Aquelas tratadas commetformina foram comparadas com aquelas que, além da metformina, também precisaram de combinação com insulina. Foram avaliadas as características maternas e de controle glicêmico. Modelos de regressão logística multinomial foram construídos para avaliar a influência das diferentes terapias nos desfechos neonatais. Resultados Foram avaliadas 475 gestantes que necessitaram de terapia farmacológica. Destas, 366 (77,05%) utilizaram terapia única com metformina, e 109 (22,95%) necessitaram de insulina como tratamento complementar. Na análise da razão de possibilidades (RP), a glicemia de jejum (GJ)<90mg/dL reduziu as chances de necessidade da combinação (RP: 0,438 [0,235-0,815]; p=0,009), bem como a primiparidade (RP: 0,280 [0,111-0,704]; p=0,007). Em gestantes obesas, foi observada uma chance maior de necessidade da combinação (RP: 2.072 [1.063-4.039]; p=0,032). Conclusão A obesidade resultou em um aumento na chance de a mãe precisar de insulina como tratamento complementar à metformina, enquanto a GJ<90 mg/dL e a primiparidade foram fatores de proteção.

Auditoria de um serviço de atendimento de gestantes portadoras de Diabetes mellitus gestacional / An audit of a healthcare service for pregnant woman with Gestational Diabetes Mellitus (GDM)

Avaliar o tratamento utilizado e a classificação de peso de recém-nascidos (RN) de gestantes portadoras de Diabetes Mellitus Gestacional (DMG). Foi realizado um estudo transversal descritivo com gestantes portadoras de DMG, em gestação única, no período de abril de 2011 a fevereiro de 2016. Os dados avaliados foram o tipo de tratamento utilizado e a classificação de peso do RN. Foram avaliadas 893 gestantes. A dieta e a atividade física como única terapêutica foram utilizadas por 306 (34,3%), 366 (41%) necessitaram metformina, a associação de metformina e insulina foi necessária em 109 (12,2%) e utilizaram somente insulinoterapia 112 (12,5%) gestantes. Houve 27 (3,0%) RN pequenos para a idade gestacional (PIG), 687 (76,9%) RN adequados para a idade gestacional (AIG) e 179 (20,0%) RN grandes para a idade gestacional (GIG). A metformina foi a terapêutica mais utilizada e a maioria dos recém-nascidos foram AIG.

Evaluate the treatment used and the weight classification of newborns (NB) of pregnant women with Gestational Diabetes Mellitus (GDM). A descriptive cross-sectional study was developed with pregnant women with GDM in a single gestation from April, 2011 to February, 2016. The data evaluated were the type of treatment used and the weight classification of the newborn. A total of 893 pregnant women were evaluated. Dietary and physical activity as sole therapy was used by 306 (34,3%), 366 (41%) needed metformin, the combination of metformin and insulin was necessary in 109 (12,2%) and only used insulin therapy (12,5%) pregnant women. There were 27 (3,0%) small for gestational age NB (SGA), 687 (76,9%) adequate for gestational age NB (AGA) and 179 (20,0%) large for gestational age NB (LGA). Metformin was the most used therapy and most of the newborns were AIG.