Epidemiology and diagnosis and treatment focus of papillary thyroid carcinoma / 西安交通大学学报(医学版)

The incidence rate of thyroid cancer is rising rapidly worldwide,and the academic community has different views on its causes.Some believe that thyroid cancer is caused by over-diagnosis,but according to a large sample of epidemiological studies,its incidence rate is rising.The latest study reports that the mortality rate of thyroid cancer in the United States is on the rise,which may be related to the downgrade of diagnosis and treatment for papillary thyroid cancer according to the ATA guidelines.The mortality rate in Asian countries such as South Korea is showing a decreasing trend over time,which might be related to the active diagnosis and treatment measures.The 5-year survival rate of thyroid cancer in China has increased from 67.5％in 2003-2005 to 84.3％in 2012-2015,which still lags far behind 98.3％in the United States.Considering the differences in homogeneous diagnosis and treatment of thyroid cancer in China,if we blindly follow the guidelines of other countries,it may lead to an increase in the mortality rate of thyroid cancer in China.

Discussion on hot topics and promotion paths for post-market surveillance and supervise of medical consumables based on non-active medical devices / 中国医学装备

Objective:To explore the research hotspots and effective promotion paths of post market surveillance and supervise of medical consumables with non-active medical devices.Methods:Data mining methods were used to collect related journal literatures and documents from the websites of China regulatory institutions and the China National Knowledge Infrastructure(CNKI),order sub item data of medical device adverse event reports,extract the MeSH element words of literatures and documents,perform bibliometric analysis and visual display.Results:The number of medical devices adverse event reports in China has been increasing year by year,reaching 694 866 in 2022,in the four statistical years from 2019 to 2022,the number of reports on non-active medical devices and IVD reagents also showed a parallel increasing trend,accounting for about 65.00% of the total number of adverse event reports on medical devices in the year.The bibliometric analysis of journal literature shows that research in this field has received varying degrees of participation from regulatory institutions,universities,medical institutions,and enterprises.Regulatory institutions have contributed 46 articles,accounting for 56.79% of the total number of articles,followed by 28 articles from universities.The co-occurrence analysis shows that hot topic is focused in 5 clusters:quality management,risk management,international experiences discussion and adverse event surveillance and re-evaluation and real-world research.China regulatory institutions attach great importance to post market surveillance and supervise,and have issued more than 20 relevant documents since 2006,focusing on specific topics and gradually deepening around safety and effectiveness.Conclusion:The post market surveillance and supervise of medical devices,especially medical consumables based on non-active medical devices,need to be promoted synchronously in three dimensions:regulatory institutions,medical institutions,and enterprises.Universities,research institutes,and industry organizations should work in coordinating to strengthen the collection,identification,and active surveillance of risk signals based on adverse event surveillance,safety evaluation based on risk management,and conducting real-world research,research and develop risk control and corrective and preventive measures.

Vigilancia activa en cáncer de próstata en un grupo de pacientes asistidos en el Centro Docente Asociado de Oncología Médica Rivera: Cooperativa Médica de Rivera (COMERI) / Active surveillance in prostate cancer in a group of patients assisted at the Rivera Associated Teaching Center for Medical Oncology: Rivera Medical Cooperative (COMERI) / Vigilância ativa do câncer de próstata em um grupo de pacientes atendidos no Rivera Associated Teaching Center for Medical Oncology: Rivera Medical Cooperative (COMERI)

Introducción: En Uruguay el cáncer de próstata ocupa el primer lugar en incidencia y el tercer lugar en mortalidad en el hombre. La mayoría de estos cánceres se diagnostican en estadios precoces. Hoy en día, para pacientes con adenocarcinoma de muy bajo riesgo, bajo riesgo o riesgo intermedio favorable, la vigilancia activa es una opción adecuada. Objetivos: Describir una población de pacientes con cáncer de próstata de muy bajo riesgo, bajo riesgo o riesgo intermedio favorable, en vigilancia activa en COMERI. Material y métodos: Estudio descriptivo, observacional, retrospectivo. Se incluyeron pacientes con cáncer de próstata de muy bajo riesgo, bajo riesgo o riesgo intermedio favorable, tratados entre 2010 y 2018 en COMERI. Se recopilaron datos en el sistema de registro clínico electrónico. Resultados: Se incluyeron 33 pacientes, la mediana de edad al diagnóstico fue de 74 años. Todos los pacientes fueron sometidos a controles clínicos y determinación de PSA cada 3 meses. El tacto rectal se realizó en forma anual. El tiempo mediano de vigilancia activa fue de 33 meses. Durante el seguimiento, se observaron pocas variaciones en los valores de PSA. El 21% de los pacientes fue sometido a una nueva biopsia durante el seguimiento activo, y en todos los casos, el Gleason se mantuvo incambiado. Ningún paciente abandonó la modalidad de vigilancia activa. Conclusión: En nuestro entorno, la vigilancia activa se considera una opción terapéutica válida para pacientes altamente seleccionados con cáncer de próstata de muy bajo riesgo, bajo riesgo o riesgo intermedio favorable, y es bien aceptada por ellos.

Introduction: In Uruguay, prostate cancer ranks first in incidence and third in mortality among men. The majority of these cancers are diagnosed at early stages. Nowadays, active surveillance is an appropriate option for patients with adenocarcinoma of very low risk, low risk, or favorable intermediate risk. Objectives: To describe a population of patients with prostate cancer of very low risk, low risk, or favorable intermediate risk under active surveillance at COMERI. Materials and Methods: Descriptive, observational, retrospective study. Patients with prostate cancer of very low risk, low risk, or favorable intermediate risk treated between 2010 and 2018 at COMERI were included. Data were collected from the electronic clinical registry system. Results: Thirty-three patients were included, with a median age at diagnosis of 74 years. All patients underwent clinical monitoring and PSA determination every 3 months. Digital rectal examination was performed annually. The median time of active surveillance was 33 months. During follow-up, there were few variations in PSA values. 21% of patients underwent a repeat biopsy during active surveillance, and in all cases, the Gleason score remained unchanged. No patient discontinued active surveillance. Conclusion: In our setting, active surveillance is considered a valid therapeutic option for highly selected patients with prostate cancer of very low risk, low risk, or favorable intermediate risk, and it is well accepted by them.

Introdução: No Uruguai, o câncer de próstata ocupa o primeiro lugar em incidência e o terceiro lugar em mortalidade entre os homens. A maioria desses cânceres é diagnosticada em estágios precoces. Atualmente, para pacientes com adenocarcinoma de risco muito baixo, baixo risco ou risco intermediário favorável, a vigilância ativa é uma opção adequada. Objetivos: Descrever uma população de pacientes com câncer de próstata de risco muito baixo, baixo risco ou risco intermediário favorável sob vigilância ativa em COMERI. Material e métodos: Estudo descritivo, observacional, retrospectivo. Foram incluídos pacientes com câncer de próstata de risco muito baixo, baixo risco ou risco intermediário favorável, tratados entre 2010 e 2018 em COMERI. Os dados foram coletados no sistema de registro clínico eletrônico. Resultados: Foram incluídos 33 pacientes, com mediana de idade no diagnóstico de 74 anos. Todos os pacientes foram submetidos a controles clínicos e determinação de PSA a cada 3 meses. O toque retal foi realizado anualmente. O tempo médio de vigilância ativa foi de 33 meses. Durante o acompanhamento, houve poucas variações nos valores de PSA. 21% dos pacientes foram submetidos a uma nova biópsia durante a vigilância ativa, e em todos os casos, o Gleason permaneceu inalterado. Nenhum paciente abandonou a modalidade de vigilância ativa. Conclusão: Em nosso ambiente, a vigilância ativa é considerada uma opção terapêutica válida para pacientes altamente selecionados com câncer de próstata de risco muito baixo, baixo risco ou risco intermediário favorável, e é bem aceita por eles.

Active surveillance is a feasible and safe strategy in selected patients with papillary thyroid cancer and suspicious cervical lymph nodes detected after thyroidectomy

ABSTRACT Objective: After initial treatment, up to 30% of patients with papillary thyroid cancer (PTC) have incomplete response, mainly cervical lymph node (LN) disease. Previous studies have suggested that active surveillance (AS) is a possible option for these patients. Our aim was to report the results of AS in patients with PTC and cervical LN disease. Materials and methods: In this retrospective observational study, we included adult patients treated and followed for PTC, who presented with cervical LN disease and were managed with AS. Growth was defined as an increase ≥ 3mm in either diameter. Results: We included 32 patients: 27 (84.4%) women, age of 39 ± 14 years, all initially treated with total thyroidectomy, and 22 (69%) with therapeutic neck dissection. Cervical LN disease was diagnosed 1 year (0.3-12.6) after initial management, with a diameter of 9.0 mm (6.0-19.0). After a median AS of 4.3 years (0.6-14.1), 4 (12.5%) patients had LN growth: 2 (50%) of whom were surgically removed, 1 (25%) was effectively treated with radiotherapy, and 1 (25%) had a scheduled surgery. Tg increase was the only predictive factor of LN growth evaluated as both the delta Tg (p < 0.0366) and percentage of Tg change (p < 0.0140). None of the included patients died, had local complications due to LN growth or salvage therapy, or developed distant metastases during follow-up. Conclusions: In selected patients with PTC and suspicious cervical LNs diagnosed after initial treatment, AS is a feasible and safe strategy as it allows effective identification and treatment of the minority of patients who progress.

Implementing active surveillance for low-risk thyroid carcinoma into clinical practice: collaborative recommendations for Latin America

ABSTRACT The incidence of thyroid cancer is increasing globally, but mortality rates have remained steady. Many patients with thyroid cancer have low-risk, nonmetastatic intrathyroidal tumors smaller than 2 cm. Active surveillance has shown benefits in these patients, but the adoption of this approach remains below standard in Latin America. The purpose of this article is to identify ways to improve the incorporation of active surveillance into clinical practice for patients with low-risk thyroid carcinoma in Latin America, taking into consideration cultural and geographic factors. Current recommendations include three steps involving patient participation. The first step, which consists of the initial clinical examination, has eight factors requiring special attention. Anxiety must be managed while considering individual, disease-related, cognitive, and environmental aspects. Terms like "overdiagnosis", "incidentaloma," and "overtreatment" must be explained to the patient. Implementing precise terminology contributes to adequate disease perception, substantially reducing stress and anxiety. Clarifying the nonprogressive nature of thyroid cancer helps dispel myths surrounding the disease. The second step includes advice about procedures and guidelines for patients who choose active surveillance. Flexible monitoring techniques should be implemented, with regular check-ins scheduled based on patient needs. Reasons for adjusting treatment must be clearly communicated to the patient, and changes in preference regarding active surveillance should be considered in advance. The third step includes assistance during follow-up. Patients must be educated about ultrasound results and receive surgical indications from specialized physicians. The effectiveness of active surveillance can be reinforced by explaining to the patients the dynamics of changes in nodule size using clear and concise visual aids.

Current management of patients with cutaneous melanoma with a positive sentinel lymph node / Tratamiento actual de pacientes con melanoma cutáneo y ganglio centinela positivo

Abstract Introduction : Immediate completion lymph node dissection (CLND) performed in patients with a positive sentinel lymph node biopsy (SLNB) cutaneous melanoma is not associated with improved melanoma specific survival versus active surveillance (AS) using nodal ul trasound. Clinical practice experience and outcomes of AS and adjuvant therapy is now starting to be published in literature. Methods : Retrospective analysis of patients with a positive-SLNB between June/2017-February/2022. Impact of management on any-site recurrence free survival (RFS), isolated nodal recurrence (INR), distant metasta sis-free survival (DMFS) and melanoma-specific survival (MSS) was evaluated. Results : From 126 SLNB, 31 (24.6%) were positive: 24 received AS and 7 CLND. Twenty-one (68%) received ad juvant therapy (AS, 67% and CLND, 71%). With a median follow-up of 18 months, 10 patients developed recur rent disease with an estimated 2-yr RFS of 73% (CI95%, 0.55-0.86) (30% in AS group vs. 43% in dissection group; P = 0.65). Four died of melanoma with an estimated 2-yr MSS of 82% (CI 95%, 0.63-0.92) and no differences between AS and CLND groups (P = 0.21). Estimated 2-yr DMFS of the whole cohort was 76% (CI 95%, 0.57-0.88) with no differences between groups (P = 0.33). Conclusion : Active surveillance strategy has been adopted for most positive-SLNB cutaneous melanoma patients. Adjuvant therapy without immediate CLND was delivered in nearly 70% of patients. Our results align with outcomes of randomized control trials and previous real-world data.

Resumen Introducción : La linfadenectomía inmediata (LI) re alizada en pacientes con biopsia de ganglio centinela (BGC) positivo por melanoma cutáneo no está asociada a mejoría en la supervivencia libre de enfermedad vs. vigilancia activa (VA). Resultados oncológicos y experi encia en la práctica clínica con dicha conducta asociados a tratamiento adyuvante comienzan a ser publicados en la literatura. Métodos : Análisis retrospectivo incluyendo paci entes con BGC-positiva por melanoma cutáneo entre junio/2017-febrero/2022. Se evaluó impacto del manejo en: supervivencia libre de recurrencia (SLR), recurren cia ganglionar aislada (RGA), supervivencia libre de metástasis a distancia (SLMD) y supervivencia libre de enfermedad (SLE). Resultados : De 126 pacientes, 31 (24.6%) fueron positi vos: en 24 se realizó VA y en 7 LI. Veintiún pacientes (68%) recibieron tratamiento adyuvante (VA, 67% y LI, 71%). Con una media de seguimiento de 18 meses, 10 pacientes presentaron recurrencia de la enfermedad con una SLR estimada a 2 años del 73% (CI95%, 0.55-0.86) (30% en VA vs. 43% en LI; P = 0.65). Cuatro murieron de melanoma con una SLE a 2 años del 82% (CI 95%, 0.63-0.92); sin diferencia entre ambos grupos (P = 0.21). La SLMD a 2 años de toda la cohorte fue de 76% (CI 95%, 0.57-0.88; P = 0.33). Conclusión : La vigilancia activa se ha adoptado como conducta para la mayoría de los pacientes con BGC-positivo. El tratamiento adyuvante sin linfadenectomía inmediata se realizó en cerca del 70% de nuestra serie. Los resultados de nuestra serie son similares a los re portados en la literatura.

Analysis of epidemiological features of food-borne diseases through active surveillance in Wenchang， Hainan Province from 2017 to 2021 / 上海预防医学

ObjectiveTo understand the epidemiological and etiological characteristics of food-borne diseases in Wenchang， Hainan Province， and to analyze the suspected food exposure sites and sources so as to provide scientific data for early prevention. MethodsThe data of food-borne disease cases， including basic information， time， population， region， suspected exposed food， etiology， etc.， from the sentinel hospitals of the surveillance systems in Wenchang from 2017 to 2021 were statistically analyzed. ResultsA total of 2 219 food-borne disease cases were collected from 2017 to 2021. The male-to-female sex ratio was 1.2：1， and there was no significant statistical difference （χ2=5.732， P>0.05）. Cases were mainly concentrated in children aged <7 years （43.26%）， followed by 7 to 18 years （15.41%）， 19 to 30 years （11.72%） and >60 years （11.36%）， and there was a significant statistical difference （χ2=168.125， P<0.001）. The highest number of cases were found in preschool children （36.05%）， followed by students （17.49%） and farmers （16.18%）. The peak incidence occurred from July to November （54.44%）. The suspected exposure foods reported in the monitored cases were mainly vegetable foods （17.49%） and mixed foods （17.08%）. The exposure sites were primarily households （76.30%） and catering services （13.56%）. The positive rate of pathogens was 12.26% in 1085 tested samples， and there was no statistically significant difference in the annual detection rate （χ2=1.086， P>0.05）. The main pathogens of food-borne pathogens were Salmonella （9.95%）， followed by norovirus （2.03%） and rotavirus （0.28%）. ConclusionThe surveillance of foodborne disease cases in Wenchang shows seasonal peak patterns according to population and pathogen epidemiological features. The main affected groups are preschool children， students， farmers， and the elderly. The exposures are mainly related to vegetable foods and mixed foods in households and catering service establishments. Efforts should be made to strengthen food safety awareness， health education， and supervision targeting residents and food operators in order to reduce the incidence of foodborne diseases in the Wenchang area.

Advances in active surveillance of metastatic renal cell carcinoma / 中华泌尿外科杂志

At present, systemic therapy is the main treatment option for metastatic renal cell carcinoma. However, active surveillance may be an alternative for patients with poor physical status or slow disease progression. Active surveillance can appropriately delay the timing of systematic treatment for some patients with metastatic renal cell carcinoma without affecting their prognosis. We have combined the latest researches to clarify the clinical significance, applicable population, disadvantages, scheme and prognosis of active surveillance in metastatic renal cell carcinoma in recent years in detail.

Joint application of active and passive surveillance of occupational injuries: Based on UK HSE data / 环境与职业医学

Background The United Kingdom (UK) adopts active surveillance and passive surveillance to jointly collect occupational injury data, and builds a relatively complete occupational injury surveillance system, which can provide reference for the construction of China's occupational injury surveillance system. Objective To compare the results of active surveillance and passive surveillance of occupational injuries in the UK, and to explore the joint application value of active and passive surveillance methods in the field of occupational injury prevention and control. Methods The non-fatal occupational injury active surveillance data from Labor Force Survey were used to calculate indicators such as number of reported cases, reporting rate, lost workdays per year, lost workdays per capita, and average lost workdays per case. The fatal passive surveillance data reported by the employers were used to calculate number of reported deaths, reported mortality, and other indicators. Join-point regression was used to estimate the reported trends of fatal and non-fatal occupational injuries from 2004 to 2020, and the annual percentage change (APC) and average annual percentage change (AAPC) were calculated. Results The active surveillance data showed that from 2004 to 2020, the number of reported cases of absenteeism ≥0 d due to occupational injury decreased from 89.7 (95%CI: 85.2, 94.2) per ten thousand to 44.1 (95%CI: 39.1, 49.2) per ten thousand, and the reporting rate of occupational injury decreased from 32100/100000 (95%CI: 3050/100000, 3370/100000) to 1410/100000 (95%CI: 1250/100000, 1570/100000), showing a linear downward trend (both APC and AAPC were −3.88%, P<0.05); the average lost workdays per case in 2019 was 9.1 (95%CI: 6.8, 11.5) d. The passive surveillance data showed that from 2004 to 2020, the number of reported deaths due to occupational injury decreased from 223 to 142, and the reporting rate of occupational injury decreased from 0.78/100000 to 0.44/100000, showing a linear downward trend (both APC and AAPC were −4.59%, P<0.05). Conclusion The reporting rates of fatal and non-fatal occupational injuries in the UK are showing a linear downward trend. The active surveillance method based on Labor Force Survey provides more surveillance indicators for non-fatal occupational injuries, and the passive surveillance method based on employer report has more advantages in assessment of fatal occupational injuries. Jointly applying the two surveillance modalities and the combination of trend analysis indicators, such as AAPC, provide a more comprehensive picture of the epidemiological characteristics of occupational injuries.

Feasibility study of active surveillance for low-risk papillary thyroid microcarcinoma / 中华健康管理学杂志

Objective:To investigate the feasibility of active surveillance for low-risk papillary thyroid microcarcinoma.Methods:This is a cross-sectional study. From 2013 to 2017, 61 patients with pathologically confirmed papillary thyroid microcarcinoma were followed-up dynamically. The growth of nodules, newly-developed nodules and lymph node metastasis were recorded and were set as the criteria for disease progression. And the disease progression was the outcome event of survival analysis. The patients were divided into two groups based on the median age at diagnosis. Univariate analysis of factors influencing disease progression in different age groups was performed using Cox proportional hazards regression. The differences in disease progression between different age groups were compared using the Kaplan-Meier method and the log-rank test.Results:Of the 61 patients, there were 9 males and 52 females. The median age of disease onset was 43 years (ranged 23-74 years). The median follow-up time was 2 years (ranged 2-7 years), and 22 (36.1%) patients with tumor diameter increased by ≥3 mm, including 5 males and 17 females. A total of 22 cases (36.1%) showed an increase in tumor diameter of ≥3 mm, including 5 males and 17 females. Thirteen cases (21.3%) developed new malignancies, including 2 males and 11 females. Three cases (5%) had lymph node metastasis, all of which were females. In total, 24 cases (39.3%) showed disease progression, including 5 males and 19 females. Disease progression was more frequent in the <43 years age group compared to the ≥43 years age group.Conclusions:For patients with low-risk papillary thyroid microcarcinoma, strict adherence to the indications for active surveillance and consideration of patient preferences make active surveillance a feasible tumor management approach.

Advances in active surveillance of prostate cancer / 中华泌尿外科杂志

The popularity of prostate-specific antigen screening has led to overdiagnosis and overtreatment of prostate cancer. Active surveillance can be used as a safe and reliable treatment option for some patients with localized prostate cancer. At the same time, compared with surgery and chemoradiotherapy, active surveillance can provide these patients with a better quality of life. A variety of new monitoring methods, including PSMA PET and biomarkers, can optimize the risk stratification of prostate cancer and reduce unnecessary puncture biopsies to further improve the quality of life of patients. However, there are still great controversies about the inclusion criteria, monitoring programs, and intervention indications for active surveillance of prostate cancer, and domestic doctors and patients still lack acceptance of it. This article reviews the research progress of active surveillance in prostate cancer.

Microcarcinoma papilar de tiroides: vigilancia activa. Revisión de la bibliografía / Papillary thyroid microcarcinoma: active surveillance. Literature review

El cáncer de tiroides ha aumentado en incidencia, sin embargo, la mortalidad se mantiene estable. Muchas de estas lesiones son a expensas de un microcarcinoma papilar de tiroides definido por la OMS como aquel carcinoma papilar de tiroides que en su diámetro máximo no sobrepasa los 10 mm. El avance de la imagenología sobre todo la ecografía de alta resolución y el hallazgo en pieza de anatomía patológica por lesiones benignas son las principales causas del aumento en el diagnóstico de esta entidad. La vigilancia activa surge entonces como alternativa de manejo para pacientes portadores de microcarcinoma papilar con bajo riesgo de progresión, obteniendo resultados oncológicos comparables. Independiente de su tratamiento el pronóstico de estos pacientes es excelente con sobrevida cercana al 100% en 10 años. A pesar de lo dicho la morbilidad de las distintas opciones terapéuticas es muy distinta. Será fundamental buscar elementos clínicos y paraclínicos que permitan tomar una decisión práctica, con el fin de determinar qué pacientes con microcarcinomas papilares que podrán entrar en un protocolo de vigilancia activa. Esta revisión pretende examinar la bibliografía publicada al respecto como alternativa de manejo, y su eventual aplicación en Uruguay.

Thyroid cancer has increased in incidence; however, mortality remains stable. Many of these lesions are at the expense of papillary thyroid microcarcinoma defined by the WHO as papillary thyroid carcinoma that in its maximum diameter does not exceed 10 mm. The advance of imaging, especially high-resolution ultrasound and the finding of benign lesions in pathological anatomy specimens are the main causes of the increase in the diagnosis of this entity. Active surveillance arises then as a management alternative for patients with papillary microcarcinoma with low risk of progression, obtaining comparable oncologic results. Regardless of their treatment, the prognosis of these patients is excellent with a survival rate close to 100% in 10 years. In spite of what has been said, the morbidity of the different therapeutic options is very different. It will be essential to look for clinical and paraclinical elements that will allow making a practical decision, in order to determine which patients with papillary microcarcinomas will be able to enter an active surveillance protocol. This review aims to examine the literature published on this subject as a management alternative, and its eventual application in Uruguay.

Device-associated infections in neonatal care units in a middle-income country, 2016-2018

Abstract Objective: Describe the device-associated infections in the NICUs in Cali - Colombia, a middle-income country, between August 2016 to December 2018. Methods: Observational cross-sectional study evaluating reports of device-associated infections in 10 NICUs in Cali, Colombia, between August 2016 and December 2018. Socio-demographic and microbiological data were obtained from the National Public Health surveillance system, through a specialized notification sheet. The relationship of device-associated infections with several outcomes including birth weight, microorganisms, and mortality was evaluated using OR Cl95%, using the logistic regression model. Data processing was performed using the statistical program STATA 16. Results: 226 device-associated infections were reported. The rate of infection with central line-associated bloodstream infections was 2.62 per 1000 days of device use and 2.32 per 1000 days for ventilator-associated pneumonia. This was higher in neonates under 1000 g; 4.59 and 4.10, respectively. 43.4% of the infections were due to gram-negative bacteria and 42.3% were due to gram-positive bacteria. Time from hospitalization to diagnosis of all device-associated infections had a median of 14 days. When compared by weight, infants with a weight lower than 1000 g had a greater chance of death (OR 3.61; 95% CI 1.53-8.49, p = 0.03). Infection by gram-negative bacteria was associated with a greater chance of dying (OR 3.06 CI 95 1.33-7.06, p = 0.008). Conclusions: These results highlight the need to maintain epidemiological surveillance processes in neonatal intensive care units, especially when medical devices are used.

Genetic characterization of the rare Bruconha virus (Bunyavirales: Orthobunyavirus) isolated in Vale do Ribeira (Atlantic Forest biome), Southeastern Brazil

ABSTRACT Brazil is a great source of arbovirus diversity, mainly in the Amazon region. However, other biomes, especially the Atlantic Forest, may also be a hotspot for emerging viruses, including Bunyaviruses (Negarnaviricota: Bunyavirales). For instance, Vale do Ribeira, located in the Southeastern region, has been widely studied for virus surveillance, where Flavivirus, Alphavirus and Bunyaviruses were isolated during the last decades, including Bruconha virus (BRCV), a member of Orthobunyavirus genus Group C, in 1976. Recently, a new isolate of BRCV named Span321532 was obtained from an adult sentinel mouse placed in Iguape city in 2011, and a full-length genome was generated with nucleotide differences ranging between 1.5%, 5.3% and 5% (L, M and S segments, respectively) from the prototype isolated 35 years earlier. In addition, each segment placed BRCV into different clusters, showing the high variety within Bunyavirales. Although no evidence for reassortants was detected, this finding reiterates the need for new surveillance and genomic studies in the area considering the high mutation rates of arbovirus, and also to identify the hosts capable of supporting the continuous circulation of Orthobunyavirus.

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.

Microorganismos productores de carbapenemasa en muestras clínicas de pacientes internados en el hospital de clínicas durante los años 2020-2021

La Organización Mundial de la Salud ha declarado que la resistencia a los antimicrobianos es una de las 10 principales amenazas de salud pública a las que se enfrenta la humanidad. Actualmente, enzimas de las familias Klebsiella pneumoniae carbapenemase (KPC), Oxacillinase (OXA), New Delhi Metallo-beta-lactamase (NDM), Verona Integron En coded Metallo-beta-lactamase (VIM) e Imipenemase (IMP) son las que se detectan con mayor frecuencia a nivel mundial. El objetivo es describir los hallazgos de los aislamientos de microorganismos productores de carbapenemasas de pacientes internados en el Hospital de Clínicas durante los años 2020 y 2021. Se realizó un estudio descriptivo retrospectivo de corte transversal de datos obtenidos del laboratorio de microbiología del Hospital entre enero 2020 y diciembre 2021. Se estudiaron 216 muestras clínicas de las cuales 196(91%) fueron en pacientes adultos, 172 (80%) fueron positivos para enzimas metalo-ß-lactamasa (MBL), Klebsiella pneumoniae fue la especie más frecuente. En pacientes internados en la Unidad de Cuidados Intensivos predominaron estos aislamientos y en muestras de orina 91 (42%). Según sexo, 108(50%) para ambos sexos y una mediana de edad de 52 años, con un rango de 6 días de vida a 92 años. En cuanto a número de aislamientos hallados, fue mayor en el año 2020 con 121 (56%).La vigilancia activa junto a medidas de control de infecciones son necesarias para limitar la diseminación de microorganismos productores de carbapenemasas, además se hallan datos necesarios para justificar la introducción al país de antibióticos de elección para estos microorganismos.

The World Health Organization has declared antimicrobial resistance one of the top 10 public health threats facing humanity. Currently, enzymes from the families Klebsiella pneumoniae carbapenemase (KPC), Oxacillinase (OXA), New Delhi Metallo-beta-lactamase (NDM), Verona Integron En coded Metallo-beta-lactamase (VIM) and Imipenemase (IMP) are those that are more frequently detected worldwide. The objective is to describe the findings of the isolates of carbapenemase-producing microorganisms from patients hospitalized at the Hospital de Clínicas during the years 2020 and 2021. A retrospective descriptive cross-sectional study of data obtained from the Hospital's microbiology laboratory was carried out between January 2020and December 2021. 216 clinical samples were studied, of which 196 (91%) were in adult patients, 172 (80%) were positive for metallo-ß-lactamase (MBL) enzymes, Klebsiella pneumoniae was the most frequent species. In patients hospitalized in the Intensive Care Unit these isolates predominated and in urine samples 91 (42%). According to sex, 108 (50%) for both sexes and a median age of 52 years, with a range of 6 days to 92 years. Regarding the number of isolates found, it was higher in 2020 with 121 (56%). Active surveillance together with infection control measures are necessary to limit the spread of carbapenemase-producing microorganisms, in addition, there are necessary data to justify the introduction of antibiotics of choice for these microorganisms into the country.

Treatment strategies for low-risk papillary thyroid carcinoma: a position statement from the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism (SBEM)

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.

Impacto de un programa de vigilancia activa y medidas de control de infecciones sobre la incidencia de bacilos gram negativos resistentes a carbapenems en una unidad de cuidados intensivos

Resumen Las infecciones hospitalarias causadas por bacilos gram negativos resistentes a carbapenems (BGNCR) están asociadas al aumento de morbimortalidad y gasto sanitario. La identificación mediante cultivos de vigilancia y las medidas de control de infecciones permiten reducir su diseminación. El objetivo del estudio fue evaluar el impacto de un programa de vigilancia integrado a protocolos de control de infecciones sobre la incidencia de BGNCR y conocer su epidemiología molecular en una unidad de cuidados intensivos. Se realizaron auditorías seguidas de un programa de cultivo de vigilancia activa y caracterización molecular de BGNCR, antes y después de la implementación de programas de prevención y control de infecciones. El screening microbiológico se realizó en medios cromogénicos; la caracterización molecular de p-lactamasas (blaKPC, bla0XA-48-like, blaVIM, blaiMP, blaNDM, blaSHV y blaCTx-M) por PCR y la tipificación molecular por PFGE y MLST para Klebsiella pneumoniae. El protocolo desarrollado permitió reducir la colonización global de 16,92% al 9,67%. La diseminación de K. pneumoniae fue a expensas de diversos clones portadores de KPC-2 asociada a BLEE SHV-2 y CTX-M-15, y distribuidos en varios secuenciotipos (ST17, ST13, ST2256, ST353); no se observó persistencia de un clon particular y ningún aislamiento presentó factores de virulencia asociados a hipervi-rulencia. Los aislamientos de Acinetobacter baumannii fueron mayoritariamente productores de IMP-1. El análisis PFGE individualizó 3 clusters, asumiendo que la diseminación fue clonal.

Abstract Hospital-acquired infections caused by carbapenem-resistant Gram-negative bacteria (CRGNB) have been increasingly reported worldwide and are associated with high rates of mortality especially in intensive care units(ICUs). Early identification through rectal surveillance cultures and implementation of infection control measures(ICM) including contact precautions, staff education on cleaning and hand hygiene may reduce the spread of these microorganisms. The aim of this work was to assess the impact of enhanced ICM on CRGNB colonization and to describe the molecular epidemiology of these bacteria in a polyvalent ICU in a tertiary level hospital. A prospective study including audits and active surveillance culture program, with molecular characterization, was conducted before and after the implementation of prevention programs and infection control measures. Microbiological screening was performed in chromogenic media; PCR targeting p-lactamases genes (ó/qkpc, óíQndm, blaviM and blaoxA-48, blasHv and ó/qctx-m), molecular typing by PFGE; and MLST in K. pneumoniae were performed. CRGNB colonization was reduced from 16.92% to 9.67% upon implementing the infection control measures. In K. pneumoniae the most frequent carbapenemase type was KPC-2 associated with SHV-2 and CTX-M-15, and was disseminated in various STs (ST17, ST13, ST2256, ST353); there was no persistence of particular clones and virulence factors showed no association with hypervirulence. IMP-1 carbapenemase predominated in A. baumannii and the PFGE analysis individualized 3 clusters, assuming that the dissemination in the ICU was clonal. The early detection of patients colo-nized with CRBGN by using epidemiological surveillance cultures and the implementation of prophylactic measures are key to reducing the incidence of these microorganisms.

A participant centered surveillance of adverse events following coronavirus disease immunization phase 1 at a tertiary care teaching hospital

Background: Coronavirus disease (COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus. Vaccines could play an important role in increasing population immunity. Adverse events following immunization (AEFI) is a recent development to improve the speed and transparency of vaccine safety post-marketing. Aim and Objective: To describe adverse events following COVID-19 immunization phase 1. Materials and Methods: An observational primary questionnaire-based study was conducted regarding AEFI after getting approval from Institutional Ethics Committee. Total 241 health care providers were sent pretested and validated questionnaires through SMS containing online Google form link, data were collected. AEFI was classified and percentage value calculated, association between age and gender difference established by Chi-square test. Results: Among 241 health care providers 103 were voluntarily participated. Following 1st dose of vaccination, out of 103 healthcare provider 45 (44%) experienced local as well as systemic kind of reactions. Most common local and systemic reaction were pain at injection site and fever respectively. Following 2nd dose of vaccination, out of 103 healthcare providers, 29 (28.40%) experienced local as well as systemic reaction. Most common local and systemic reaction were pain at injection site and headache respectively. NSAIDS were most commonly used medication to resolve AEFI after 1st and 2nd dose of vaccine. Conclusion: Vaccine have side effects, but none of them are as severe as the disease itself. Active surveillance for adverse events to vaccine is a good method for detecting and quantifying mild adverse events.

Active surveillance for low-risk papillary thyroid microcarcinoma: A single center prospective observation study / 中华内分泌代谢杂志

Objective:To evaluate the feasibility, safety and effectiveness of the active surveillance as an alternative to surgery in patients with low-risk papillary thyroid microcarcinoma(PTMC); And to explore potential surgical indicators based on characteristics of patients and medical environment.Methods:A prospective cohort study was conducted in patients with low risk PTMC and received active surveillance management( n=98). Patient adherence, non-progression surgery rates were described, cumulative incidence of tumor growth≥3 mm and tumor volume increase≥50% under ultrasonic monitoring, as well as tumor doubling rate(TDR) were evaluated. Results:A total of 98 patients were enrolled in this prospective cohort. The median age was 39(30, 45) years, and the median baseline diameter of the index tumors was 5.0(3.8, 6.8) mm, with 63.3% of tumors being≤5 mm. After a median 22(12, 44) months follow-up, tumor size growth≥3 mm and tumor volume increase≥50% occurred in 11(11.2%) and 50(51.0%) patients, and no new lymph node metastasis, distant metastasis, and death occurred. Five cases(5.1%) required delayed surgery, and other five non-progression patients opted in surgery based on their own preferences. One patient lost to follow-up. The median post-tumor progression TDRs was significantly lower than that of pre-tumor progression TDRs [size growth per year: -0.09(-0.12, 0.48) vs 0.91(0.86, 1.25), P=0.014, n=8; volume increase per year: 0.29(-0.14, 0.70) vs 1.04(0.66, 2.17), P<0.001, n=39]. After tumor size and volume progression, 62.5% and 43.6% of tumors were remained stable or shrank, respectively. Conclusions:Actived surveillance can be considered as one of the management strategies for low-risk PTMC. Given the differences in population and clinical characteristics, it should be taken in to consideration in developing active surveillance management, such as candidate criteria, follow-up strategies, and intervention indications.