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ABSTRACT INTRODUCTION: Thyroid disorders affect a significant proportion of the population and often necessitate surgical intervention, particularly in cases of malignancy. In this study, we analyzed thyroidectomy procedures performed within the public health system (SUS) of Brazil from 2008 to 2023, with a focus on factors influencing in-hospital mortality. METHODS: In the retrospective analysis, data on 230,345 thyroidectomies were extracted from SUS records and stratified by hospital volume and state-level distribution of head and neck specialists. Mortality rates were evaluated using non-parametric statistical analyses, including the Kruskal–Wallis and Spearman’s correlation tests. RESULTS: The overall in-hospital mortality rate was 0.15%. States with fewer than 0.5 head and neck specialists per 100,000 inhabitants exhibited significantly higher mortality rates (0.2 versus 0.15, p = 0.02). Hospitals performing fewer than 25 procedures annually (very low-volume) had a fivefold increase in mortality compared with high-volume hospitals (0.51 versus 0.10, p < 0.001). When hospitals performing fewer than 10 procedures per year were excluded, significant differences in mortality among volume groups were no longer observed. CONCLUSION: Mortality increased significantly in very low-volume hospitals performing fewer than 25 thyroidectomies per year; however, this difference was no longer observed after excluding hospitals that performed fewer than 10 interventions per year. These results support restricting thyroidectomies to hospitals performing at least 10 procedures annually and promoting centralization to improve outcomes. Structured regionalization policies are needed to ensure equitable access to specialized surgical care across Brazil.

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ABSTRACT BACKGROUND: In the area of nutrition, telehealth regulations were established on October 22, 2023, through Resolution No. 760, which defines and regulates telenutrition as a form of care and/or provision of services in food and nutrition through Information and Communication Technologies. OBJECTIVES: To present the profile of telenutrition users in the TeleNordeste-BP project. Design and setting: Descriptive study carried out by hospital BP – A Beneficência Portuguesa de São Paulo. METHODS: All services were provided through teleconsultation with nutritionists from the TeleNordeste project between May and December 2023. RESULTS: Of the 884 services, 873 (98.8%) were tele-interconsultation. The distribution of services by state was: 430 (48.6%) from Maranhão; 301 (34%) from Alagoas and 153 (17.3%) are from patients from Piauí. Among the services provided, 671 (75.9%) users were female and 213 (24.1%) were male; the average age was 39.54 years (standard deviation +/− 19.9). Most adult patients were overweight: 135 (25.9%) were classified as overweight, 121 (23.2%) as grade 1 obese, 100 (19.2%) as grade 2 obese, and 66 (12.6%) as grade 3 obese. CONCLUSION: chronic non-communicable diseases (NCDs) were the main reasons for seeking nutritional services, with more than 90% of the main reasons for consultation. Access to the telenutrition service offered by the TeleNordeste-BP project not only impacted the patient in ensuring access to nutritional care but also enabled the increase of Vigilância Alimentar e Nutricional (VAN).

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ABSTRACT BACKGROUND: Synovial tissue proliferation in the bare area of the joint is an early indicator of synovitis. Vascularization of the pannus helps differentiate between inactive and inflammatory processes, directly impacting therapeutic management. Synovitis can be diagnosed through clinical assessment, ultrasound, and magnetic resonance imaging (MRI); however, uncertainty remains regarding the optimal imaging modality. OBJECTIVE: This study aimed to determine the accuracy of ultrasonography with microbubble contrast and contrast-enhanced MRI in diagnosing synovitis, irrespective of its etiology. In addition, the study aimed to determine the joints that were most accurately assessed for synovitis using microbubble ultrasound. METHODS: Electronic searches were conducted in the Cochrane Library, MEDLINE, EMBASE, LILACS, SCOPUS, CINAHL, and Web of Science up to February 8, 2025, with additional screening of reference lists. Studies assessing diagnostic accuracy or detection rates of contrast-enhanced ultrasound (CEUS) and contrast-enhanced MRI for synovitis were included without restrictions on language or publication status. Two studies were selected after quality assessment using QUADAS-2, and eight studies were assessed using the RTI item bank methodology. RESULTS: Diagnostic accuracies of contrast-enhanced ultrasonography (87%) and contrast-enhanced MRI (87.7%) were comparable. For knee evaluation, CEUS showed a higher detection rate (93.8%) than MRI (82.9%). Across different joints and underlying diseases, the detection rates were 81.9% and 88.3% for contrast-enhanced MRI. In patients with rheumatoid arthritis, MRI demonstrated a higher detection rate (96.2%) compared with ultrasound (67.2%). These findings indicate a similar overall diagnostic performance, although the limited number of included studies restricted generalizability. CONCLUSION: CEUS demonstrated diagnostic accuracy comparable to contrast-enhanced MRI, except in patients with rheumatoid arthritis. Given its low cost, portability, and favorable safety profile, CEUS may serve as a useful screening or follow-up tool for synovitis, pending validation in larger multicenter studies.

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ABSTRACT BACKGROUND: Frailty in older adults is a multifactorial geriatric syndrome associated with inflammation, malnutrition, and hematological decline. Objective and easily applicable laboratory-based indices may complement clinical frailty assessment by providing rapid and low-cost screening tools, particularly in primary care and resource-limited settings. OBJECTIVES: To develop a simple laboratory-based frailty screening index (FINE, Frailty Index for the Elderly) using C-reactive protein (CRP), albumin, hemoglobin, and sex, and to evaluate its association with the Clinical Frailty Scale (CFS) in older adults. DESIGN AND SETTING: A retrospective descriptive study conducted using electronic health records of individuals aged 80 years and older. METHODS: Data from 322 older adults were analyzed. Their FINE scores were calculated by assigning 0 or 1 point to CRP, albumin, hemoglobin, and sex based on clinically accepted reference thresholds, yielding a total score ranging from 0 to 4. Frailty was assessed using pre-recorded CFS scores. Associations between FINE scores, CFS, and individual biomarkers were examined. The screening performance was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS: The mean age of participants was 84.9 ± 4.0 years, and 55.6% were female. The prevalence rate of frailty was 46.6%. FINE scores exhibited a positive correlation with CFS and CRP levels, and a negative correlation with albumin and hemoglobin levels (p < 0.005). ROC analysis demonstrated a statistically significant but moderate discriminatory ability for frailty (area under the curve = 0.642; 95% confidence interval: 0.5820.703). At a cut-off value of ≥ 0.5, FINE scores demonstrated high sensitivity (89.3%) but low specificity (22.1%). CONCLUSION: The FINE score is a simple, rapid, and low-cost laboratory-based frailty screening tool that is significantly associated with clinical frailty and key biological processes underlying frailty. Although low specificity limits its use as a diagnostic instrument, it may serve as a practical first-step screening approach in primary care and resource-limited settings. Further multicenter prospective studies are required to validate these findings.

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ABSTRACT BACKGROUND: Overseas military deployment poses a significant healthcare challenge, requiring the prevention of morbidity associated with physical strain and the environment, as well as the provision of effective medical care to ensure operational continuity in operations. OBJECTIVES: To describe and analyze the medical care activity during the deployment of the Spanish contingent from the General Command of Ceuta at the Union III base (Baghdad) and to evaluate the recorded morbidity, applied treatments, and the need for medical evacuation. STUDY DESIGN AND SETTINGS: A prospective, observational, and analytical study was conducted during the deployment between May and November 2025 at the Union III military base in Baghdad. METHODS: All medical encounters recorded by the deployed medical services were included. Demographic and clinical variables as well as the applied treatment, need for follow-up, and evacuation, were analyzed. Statistical analysis included descriptive statistics and association tests, with a p value < 0.05 considered significant. RESULTS: In total, 506 medical encounters were recorded. Traumatic injuries were the most frequent reason for consultation (25.7%), followed by infectious (20.9%) and digestive (17.2%) conditions. Most cases were resolved at Role 1 level, with a low evacuation rate (3.4%) and a high degree of local resolution. CONCLUSIONS: The deployed medical support demonstrated a high resolutive capacity, with a predominance of non-combat-related pathologies and a low need for evacuation. These results highlight the importance of maintaining effective medical structures and reinforcing preventive measures to reduce morbidity during future deployments.

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ABSTRACT BACKGROUND: Complete blood count (CBC) is the most frequently requested laboratory test worldwide, providing essential clinical information. In Brazil, many laboratories still use reference intervals (RIs) that are inadequately defined or not representative of the local population. Establishing population-specific RIs is crucial for accurate interpretation, diagnosis, and clinical decision making. OBJECTIVE: To establish RIs for CBC parameters in a sample of Brazilian adults. METHODS: This cross-sectional study included 2,417 healthy individuals who participated in the baseline (2008–2010) of the Longitudinal Study of Adult Health (ELSA-Brasil). Venous blood collection and storage were performed according to the procedures established by the Clinical and Laboratory Standards Institute (CLSI) in 2018. CBC was performed in laboratories with laboratory proficiency. The RIs were calculated using the nonparametric method proposed by the CLSI. RESULTS: The RIs were stratified by sex only for the following parameters: Red blood cells (RBC; × 106/mm3): Male (4.4–5.6), Female (3.9–5.1); Hemoglobin (g/dL): Male (13.2–16.7), Female (11.8–14.9); Hematocrit (%): Male (39–49), Female (35.3–44.2); Mean corpuscular hemoglobin concentration (MCHC; g/dL): Male (32.3–35.7), Female (32–35.1); Platelets (× 103/mm3): Male (146–319), Female: (170–352). The other parameters were as follows: mean corpuscular volume (MCV) (fL): (79.9–96); mean corpuscular hemoglobin (MCH) (pg): (26.4–32.5); White blood cells (WBC; /mm3): (3,700–8,610); Neutrophils (/mm 3): (1,666–5,705); Eosinophils (/mm3): (23.8–530); Basophils (/mm3): (0–112); Lymphocytes (/mm3): (1,121–2,824); Monocytes (/mm3): (240–751.7). CONCLUSION: Our results agree with those of other studies that have proposed RIs for CBC parameters. The differences found in MCV, neutrophil and WBC parameters (total population), and MCHC (both sexes) may be due to differences in the study populations, sample sizes, and pre-analytical and analytical study variables.

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ABSTRACT BACKGROUND: Facial appearance plays a central role in gender recognition and identity congruence, particularly among transmasculine individuals. Although the demand for gender-affirming care has increased, evidence regarding the psychosocial implications of nonsurgical facial masculinization using hyaluronic acid remains limited, especially within public health systems. OBJECTIVES: To describe the subjective and psychosocial experiences related to nonsurgical facial harmonization with hyaluronic acid among transmasculine individuals receiving care in public health settings. DESIGN AND SETTING: A mixed-methods exploratory study with a qualitative core component was conducted in a public, gender-affirming outpatient clinic in Salvador. METHODS: Six transmasculine patients participated in semi-structured interviews. The FACE-Q Satisfaction with Facial Appearance Overall Scale (SFAOS) and Beck Anxiety Inventory (BAI) were administered before and 30 days after the procedure as complementary quantitative measures. Qualitative data were analyzed using thematic content analysis based on Bardin’s framework, with sampling guided by theoretical saturation. RESULTS: Participants reported perceived reductions in facial dysphoria, improvements in self-perception, and greater social confidence after the procedure. Complementary quantitative measures indicated consistent short-term increases in facial satisfaction scores and a trend toward reduced anxiety. CONCLUSIONS: In this exploratory study, nonsurgical facial harmonization with hyaluronic acid was associated with short-term improvements in self-perceived facial satisfaction and psychosocial comfort among transmasculine participants. Given the small sample size and short follow-up period, these findings should be interpreted as preliminary. Larger studies with longer follow-up periods and comparative designs are warranted to evaluate the durability and generalizability of our findings.

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ABSTRACT BACKGROUND: Obesity is a highly prevalent condition frequently associated with systemic arterial hypertension (SAH). Bariatric surgery (BS) is an effective strategy for weight loss and has been shown to improve blood pressure (BP) control, whereas physical activity (PA) is recognized as an important adjuvant therapy for treatment of SAH. Nevertheless, evidence regarding the combined impact of BS and PA on BP reduction remains inconsistent. OBJECTIVES: This review aimed to evaluate whether BS combined with PA contributes to additional BP reduction in individuals with obesity. METHODS: The review followed PRISMA guidelines and was registered in PROSPERO (CRD42024628299). Eligible studies included randomized controlled trials, cohort and cross-sectional studies involving adults who underwent BS, with or without PA. Searches were performed in CENTRAL, PubMed, LILACS, and BVS. Methodological quality was assessed using the RoB2 and JBI tools, and the certainty of evidence was graded according to GRADE. RESULTS: Of the 406 records screened, nine studies were included (n = 504 participants). BS alone was associated with significant reductions in BP. When PA was combined with BS, additional reductions were reported; however, the findings were heterogeneous and supported by low to very low certainty of evidence. The follow-up duration across studies ranged from 4 months to 5 years. CONCLUSION: The combination of BS and PA provides modest but clinically relevant benefits in BP reduction. However, the limited number of studies and short follow-up periods preclude definitive conclusions. High-quality, long-term randomized clinical trials are warranted to clarify the role of PA in optimizing BP control after BS. CLINICAL TRIAL OR SYSTEMATIC REVIEW REGISTRATION: The review followed PRISMA guidelines and was registered in PROSPERO (CRD42024628299).

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ABSTRACT BACKGROUND: Photobiomodulation therapy (PBMT) has been extensively researched for tissue repair, pain relief, and muscle recovery. However, melanin, a primary skin chromophore, can impede photon penetration into darker skin, potentially diminishing the efficacy of PBMT. Despite this, clinical protocols and guidelines seldom account for skin pigmentation when setting parameters, possibly exacerbating racial disparities in healthcare. OBJECTIVE: To examine the effect of melanin on the efficacy of PBMT and highlight the necessity for personalized strategies that account for skin pigmentation. DESIGN AND SETTING: Short communication conducted at the Universidade de São Paulo (USP), Ribeirão Preto, São Paulo. METHODS: A narrative review of PBMT mechanisms, light–tissue interactions, and the impact of melanin absorption on treatment outcomes was conducted. RESULTS: The clinical outcomes of PBMT depend on the technical parameters (wavelength, energy, and dose) and skin pigmentation. Darker skin tones with higher melanin content may lead to reduced photon penetration effectiveness. However, most studies and protocols do not consider this variable. Only a few clinical trials have categorized outcomes by skin tone, exposing a notable knowledge gap. CONCLUSION: Melanin plays a crucial role in PBMT response, and overlooking skin pigmentation in research and clinical practice could perpetuate disparities. Enhanced and tailored protocols are essential to optimize PBMT outcomes among diverse populations.

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ABSTRACT BACKGROUND: Monitoring tobacco consumption is important for supporting national and global agendas and commitments. OBJECTIVE: To analyze the prevalence and sociodemographic and geographic factors associated with e-cigarette use in Brazil, using data from Vigitel 2023. DESIGN AND SETTING: Cross-sectional analytical study was conducted using secondary data from Vigitel 2023. METHODS: Sociodemographic characteristics (sex, age, education, and ethnicity), geographic location, and e-cigarette use were analyzed. Descriptive analyses were performed using Chi-squared and Mann–Whitney U-tests. Additionally, weighted multivariable logistic regression models were used to examine independent associations between sociodemographic factors and current e-cigarette use. Post-stratification weights were applied, and adjusted odds ratios (aOR) with 95% confidence intervals (95% CI) were estimated. RESULTS: Among 16,093 adults, the prevalence of current e-cigarette use was 5.55%. In the adjusted model, younger age was strongly associated with use (aOR per year increase = 0.93; 95% CI 0.92–0.94; p < 1). Men had higher odds of use than women (aOR = 1.34; 95% CI 1.12–1.6; p < 0.01). Educational level was not independently associated with usage. Caucasian individuals had higher odds compared to mixed-race individuals (aOR = 1.29; 95% CI 1.05–1.58; p = 0.015). Residents of the southern region showed increased odds (aOR = 1.48; 95% CI 1.1–1.99). CONCLUSION: Current e-cigarette use in Brazil is independently associated with younger age, male sex, Caucasian ethnicity, and residence in southern Brazil. These findings underscore the importance of strengthening public policies that regulate and control these devices as well as educational campaigns targeting high-risk groups.