Evaluation of the Appropriateness of Thyroid Fine-Needle Aspiration

This study aims to perform an integrative literature review on FNAB of the thyroid and its current contributions facing thyroid nodules, as an important diagnostic tool to eliminate early thyroid cancer, a recurrent pathology in offices. Regarding the methods, because this is an integrative review of literature, through a descriptive study, we used databases such as Medical Literature Analysis and Retrieval System Online (Medline/PubMed), Scientific Electronic Library Online (SciELO) and Virtual Health Library (VHL). The query was performed using the controlled descriptors from DeCS/MeSH: "thyroid nodule", "fine needle biopsy", "thyroid", "liquid-based cytology", "molecular test". Moreover, as a result we obtained a general review about the appropriateness of FNAB of the thyroid, an efficient and reliable diagnostic method in the decision and selection of patients who will need surgery. However, this method presents some limitations, such as the need for improvement in the quality of the sample collection or in its interpretation, limitations that can be reduced, decreasing the cases of false positives and negatives, when collected by experienced professionals, guided by ultrasound, and can be combined with color Doppler, as well as, seek opinions from other specialists. The present study also addressed the new diagnostic methods for thyroid nodules, such as liquid-based cytology, used as a technique in conjunction with conventional smears when ancillary techniques are applied, and molecular tests, which have given professionals the opportunity to provide a more accurate evaluation in cases of indeterminate nodules. With this, we reiterate the importance of identifying the best individualized strategy for the patient, preventing unnecessary procedures and offering improved quality of life

Parentalidade e(m) trânsitos internacionais: a gestação de substituição entre casais gays brasileiros

This article is based on two interviews with Brazilian gay men couples who went abroad to hire the so-called cross-border reproductive care service, which are assisted reproduction procedures that cross national borders through companies specialized in the necessary procedures, which include the search for women who offer to give birth, the search for eggs, organization of the moment of fertilization and other mechanisms necessary to deliver a baby to those who intend this form of realization of their parental project. From these experiences, crossed by social and gender inequalities that mark this field of commercial surrogate pregnancy, we intend to discuss the ways in which biological and biomedical matrices constitute this decision for parenthood and the ways in which pregnancy, genes and affection organize family relationships and the existence or not of bonds between actors of the process drawing kinship relationships. The research is inspired by the methodological perspective of the psychosocial cartography.Este artículo se basa en dos entrevistas realizadas a parejas de hombres homosexuales brasileños que acudieron al extranjero para contratar el llamado servicio de cross-border reproductive care —procedimientos de reproducción asistida que traspasan las fronteras nacionales a través de empresas especializadas en los procedimientos necesarios que incluyen la búsqueda de óvulos y de mujeres que se ofrezcan a dar a luz, la organización del momento de la fecundación y otros mecanismos necesarios para entregar un bebé a quienes pretenden esta forma de realización de su proyecto parental—. A partir de estas experiencias, atravesadas por las desigualdades sociales y de género que marcan este campo de la gestación subrogada comercial, nos proponemos discutir los modos en que las matrices biológicas y biomédicas constituyen esta decisión de parentalidad y las formas en que el embarazo, los genes y los afectos organizan las relaciones familiares, a dibujar las relaciones de parentesco, y la existencia o no de vínculos entre los actores del proceso. La investigación se inspira en la perspectiva metodológica de la cartografía  psicosocial. Imagen de portada: Sofía Papadópulos. "Nosotros", 2021.Este artigo é baseado em duas entrevistas com casais de homens gays brasileiros que recorreram ao exterior para contratar o chamado serviço de cross-border reproductive care, que são procedimentos de reprodução assistida que atravessam as fronteiras nacionais através de empresas especializadas nos trâmites necessários, que incluem a busca por mulheres que se ofereçam para gestar, a procura por óvulos, organização do momento da fecundação e demais mecanismos necessários para que seja possível entregar um bebê para quem intenta esta forma de realização de seu projeto parental. A partir destas experiências, atravessadas pelas desigualdades sociais e de gênero que marcam este campo da gestação de substituição comercial, discutimos as formas como matrizes biológicas e biomédicas constituem esta decisão pela parentalidade e as formas como gestação, genes e afeto organizam as relações de família, desenhando relações de parentesco e a existência ou não de vínculos entre atores do processo. A pesquisa é inspirada na perspectiva metodológica da cartografia psicossocial

Rivaroxaban with or without aspirin in stable cardiovascular disease

BACKGROUND: We evaluated whether rivaroxaban alone or in combination with aspirin would be more effective than aspirin alone for secondary cardiovascular prevention. METHODS: In this double-blind trial, we randomly assigned 27,395 participants with stable atherosclerotic vascular disease to receive rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily), rivaroxaban (5 mg twice daily), or aspirin (100 mg once daily). The primary outcome was a composite of cardiovascular death, stroke, or myocardial infarction. The study was stopped for superiority of the rivaroxaban-plus-aspirin group after a mean follow-up of 23 months. RESULTS: The primary outcome occurred in fewer patients in the rivaroxaban-plus-aspirin group than in the aspirin-alone group (379 patients [4.1%] vs. 496 patients [5.4%]; hazard ratio, 0.76; 95% confidence interval [CI], 0.66 to 0.86; P<0.001; z=−4.126), but major bleeding events occurred in more patients in the rivaroxaban-plus-aspirin group (288 patients [3.1%] vs. 170 patients [1.9%]; hazard ratio, 1.70; 95% CI, 1.40 to 2.05; P<0.001). There was no significant difference in intracranial or fatal bleeding between these two groups. There were 313 deaths (3.4%) in the rivaroxaban-plus-aspirin group as compared with 378 (4.1%) in the aspirin-alone group (hazard ratio, 0.82; 95% CI, 0.71 to 0.96; P=0.01; threshold P value for significance, 0.0025). The primary outcome did not occur in significantly fewer patients in the rivaroxaban-alone group than in the aspirin-alone group, but major bleeding events occurred in more patients in the rivaroxaban-alone group. CONCLUSIONS: Among patients with stable atherosclerotic vascular disease, those assigned to rivaroxaban (2.5 mg twice daily) plus aspirin had better cardiovascular outcomes and more major bleeding events than those assigned to aspirin alone. Rivaroxaban (5 mg twice daily) alone did not result in better cardiovascular outcomes than aspirin alone and resulted in more major bleeding events

Ezetimibe added to statin therapy after acute coronary syndromes

BACKGROUND: Statin therapy reduces low-density lipoprotein (LDL) cholesterol levels and the risk of cardiovascular events, but whether the addition of ezetimibe, a nonstatin drug that reduces intestinal cholesterol absorption, can reduce the rate of cardiovascular events further is not known. METHODS: We conducted a double-blind, randomized trial involving 18,144 patients who had been hospitalized for an acute coronary syndrome within the preceding 10 days and had LDL cholesterol levels of 50 to 100 mg per deciliter (1.3 to 2.6 mmol per liter) if they were receiving lipid-lowering therapy or 50 to 125 mg per deciliter (1.3 to 3.2 mmol per liter) if they were not receiving lipid-lowering therapy. The combination of simvastatin (40 mg) and ezetimibe (10 mg) (simvastatin-ezetimibe) was compared with simvastatin (40 mg) and placebo (simvastatin monotherapy). The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, unstable angina requiring rehospitalization, coronary revascularization ( 6530 days after randomization), or nonfatal stroke. The median follow-up was 6 years. RESULTS: The median time-weighted average LDL cholesterol level during the study was 53.7 mg per deciliter (1.4 mmol per liter) in the simvastatin-ezetimibe group, as compared with 69.5 mg per deciliter (1.8 mmol per liter) in the simvastatin-monotherapy group (P<0.001). The Kaplan-Meier event rate for the primary end point at 7 years was 32.7% in the simvastatin-ezetimibe group, as compared with 34.7% in the simvastatin-monotherapy group (absolute risk difference, 2.0 percentage points; hazard ratio, 0.936; 95% confidence interval, 0.89 to 0.99; P = 0.016). Rates of pre-specified muscle, gallbladder, and hepatic adverse effects and cancer were similar in the two groups. CONCLUSIONS: When added to statin therapy, ezetimibe resulted in incremental lowering of LDL cholesterol levels and improved cardiovascular outcomes. Moreover, lowering LDL cholesterol to levels below previous targets provided additional benefit