Faculdade de Ciências Médicas da Santa Casa de São Paulo

Metabolic and bariatric surgery (MBS) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are both effective strategies for obesity management, but their comparative efficacy remains uncertain. This systematic review and meta-analysis aimed to compare weight loss outcomes between MBS and GLP-1 RA therapy in adults with obesity. A systematic search of PubMed, Scopus, and Cochrane Library was conducted from inception to September 22, 2025. Eligible studies included randomized and observational comparisons between MBS-specifically sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB)-and GLP-1 RA therapy in adults with obesity. Pooled mean differences (MDs) for total weight loss (TWL) and body mass index (BMI) change were calculated using a DerSimonian-Laird random-effects model. Risk of bias was assessed using ROBINS-I V2, and certainty of evidence was graded with GRADE. Five retrospective observational studies (n = 5,944; 3,489 MBS, 2,455 GLP-1 RA) met the inclusion criteria. Pooled analysis showed significantly greater TWL in the MBS group (MD - 18.15%; 95% CI 16.41 to 19.90; p < 0.0001; I² = 95%) and larger BMI reduction (MD 8.73kg/m²; 95% CI 5.87 to 11.58; p = 0.0001; I² = 94.6%). Sensitivity analyses confirmed the robustness of these results. Overall risk of bias was moderate, primarily due to non-randomized designs and treatment selection bias. Certainty of evidence was rated as moderate. MBS achieves significantly greater and more durable weight loss compared with GLP-1 RA therapy, reaffirming its role as the most effective intervention for severe obesity. While GLP-1 RAs represent valuable noninvasive or adjunctive options, surgery remains the benchmark for sustained metabolic and weight outcomes.

O objetivo do artigo é acompanhar as controvérsias no debate sobre gênero, a ofensiva antigênero e a educação, localizando tensões e disputas recentes em políticas educacionais, no Brasil e na Espanha. Para isso, o artigo realiza a análise documental de duas políticas públicas educacionais: no Brasil, a Base Nacional Comum Curricular (BNCC) (Brasil, 2018) e, na Espanha, a Lei Orgânica de Modificação da Lei Orgânica de Educação (LOMLOE) (Espanha, 2020). Em um primeiro momento, a partir de revisão da literatura, é realizada a contextualização das disputas em torno do debate sobre gênero e educação, por meio de breve panorama no Brasil e na Espanha entre os anos 1990 e 2020. Em seguida, são analisadas como essas duas políticas educacionais recentes tratam as categorias de gênero e sexualidade em seus textos. Ao final, demonstra-se como a política espanhola incorporou diretamente as categorias de gênero, identidade de gênero e sexualidade, ao contrário da política brasileira, que excluiu esses debates considerados fundamentais para uma educação comprometida com a equidade e os direitos humanos.

To develop and validate a deep learning model for the detection of aberrant anterior tibial artery (AATA) on axial T2-weighted knee MRI, given the surgical relevance of unrecognized AATA and the lack of automated detection tools. This retrospective study included 70,260 MRI images from 2315 examinations (1441 without AATA and 874 with AATA) collected after institutional review board approval. Musculoskeletal radiologists performed image-level annotations. Data were split at the patient level into training, validation, and internal test sets; an independent dataset from another institution served as an external test set. A convolutional neural network was implemented in Python and PyTorch. Model performance was assessed at the patient level. At the slice level, the model achieved an F1-score of 0.838 on the internal test set. Patient-level classification using the validation-derived threshold (0.17) yielded F1-scores of 0.966 on the validation set, 0.979 on the internal test set, and 0.786 on the external test set. The area under the receiver operating characteristic curve for the external cohort was 0.97, indicating strong generalization despite a decrease in precision due to false positives. To our knowledge, this is the first study to apply artificial intelligence for automated detection of AATA on knee MRI. The proposed deep learning model performs this task with high sensitivity. Despite reduced precision in the external cohort, it demonstrates strong potential for enhancing preoperative risk assessment and surgical planning. Broader multicenter validation is warranted before clinical deployment.

The present study aimed to assess the viability of Social Skills Training through RPGs during the SARS-CoV-2 pandemic, employing qualitative discourse analysis of residents. Focus groups were conducted with a convenience sample of psychiatry residents who volunteered to participate in the RPG-based training. Eleven residents took part in video conference focus groups, with one researcher acting as a non-participant observer. Over a period of 4 months, residents engaged in weekly 3-h sessions structured around five fundamental steps: rapport building, task discussions, goal setting, gaming, and feedback. Results indicate positive impacts on group dynamics, communication skills, cooperation, assertiveness, empathy, mental health, and quality of life. However, given the exploratory nature of this study, further research incorporating pre- and post-intervention assessments is warranted to thoroughly evaluate the intervention’s effectiveness.

The authors describe a case involving a young male patient with an uncommon osteochondral lesion of the proximal phalanx of the hallux within the metatarsophalangeal joint, associated with a gouty tophus. The surgical approach included curettage of the subchondral cyst, filling the defect with autologous bone graft, and repairing the cartilage using autologous matrix-induced chondrogenesis (AMIC). The postoperative care protocol is detailed, and the results are discussed. Level of Evidence Level of evidence 4 — Case Report.