Dosis de radiación por radiografías y factores asociados en neonatos de la Unidad de Recién Nacidos del Hospital Universitario San Ignacio, Bogotá, Colombia / X-ray radiation dose and associated factors in neonates from the newborn unit of Hospital Universitario San Ignacio, Bogotá, Colombia

Introducción. Las radiografías continúan usándose ampliamente, subestimando los riesgos. Esto sucede, especialmente, en las unidades de cuidado neonatal, lo que implica que los neonatos reciben una dosis de radiación ionizante mayor que los adultos. Objetivo. Cuantificar las dosis de radiación recibidas al tomar radiografías y evaluar los posibles factores asociados con el aumento de la dosis. Materiales y métodos. Se llevó a cabo un estudio observacional de 160 neonatos de la Unidad de Recién Nacidos del Hospital Universitario San Ignacio, Bogotá, Colombia. Se consideró como variable dependiente la dosis de entrada en piel por cada radiografía. Se hizo la caracterización de los pacientes, seguida de un análisis multivariado con regresión lineal múltiple para identificar factores asociados. Resultados. Se analizaron 160 pacientes y 492 radiografías en total. Entre los hallazgos más frecuentes, se encuentran: pacientes de sexo masculino (n=87; 54,4 %), nacimiento por cesárea (n=122; 76,3 %) e indicación de toma de radiografías por dificultad respiratoria (n=123; 24,9 %). El 1,8 % (n=9) de los pacientes no tenían una indicación para la toma de la radiografía. La radiografía más frecuente fue la de tórax (n=322; 65,4 %). La mayoría de las radiografías se tomaron con el equipo computarizado (n=352; 71,5 %) y no con el digital (n=140, 28,4 %). La mediana de la dosis de entrada en piel con el equipo computarizado fue de 0,112 mGy (0,022; 0,134 mGy) y, con el equipo digital, de 0,020 mGy (0,019, 0,022 mGy). Conclusiones. Se cuantificaron las dosis de radiación absorbida en neonatos, general y específica, con el equipo computarizado y el digital. Se identificaron mayores dosis con el equipo computarizado. Se reconoció la interacción entre el equipo computarizado con menores edades gestacionales corregidas como principal factor para el aumento de la dosis. Además, se reconoció la relación entre el equipo computarizado y una menor edad gestacional corregida, como principal factor para una mayor dosis.

Introduction. Radiographs are still widely used, underestimating the risks. This situation is frequent in neonatal care units, generating radiation doses than in adults. Objective. To quantify the received radiation doses when performing radiographs on neonates and the possible factors associated with higher doses. Materials and methods. We performed an observational study of 160 neonates from the newborn unit of the Hospital Universitario San Ignacio, Bogotá, Colombia. We considered the input dose of each radiograph as the dependent variable. Patients were characterized and a multivariate analysis with multiple linear regression was performed to identify associated factors. Results. We analyzed 160 newborns and 492 radiographs. The most frequent findings were male patients (n=87, 54.4%), cesarean delivery (n=122, 76.3%), and radiograph indication for respiratory distress (n=123, 24.9%). One-point eight percent of the patients (n=9) did not have radiograph indication. The most frequently taken radiograph was chest (322, 65.4%). Most radiographs were taken with a computerized equipment (n=352, 71.5%), compared to a digital one (n=140, 28.4%). The median input dose with computerized equipment was 0.112 mGy (0.022, 0.134 mGy), and with the digital equipment was 0.020 mGy (0.019, 0.022 mGy). Conclusions. The general and specific absorbed radiation doses were measured in neonates with a computerized and a digital equipment. We identified higher doses with the computerized equipment. In addition, it was recognized the correlation between computerized radiography equipment with lower corrected gestational ages as the main factor for dose increase.

Intervenções psicológicas necessárias: a prática como residente no serviço de medicina fetal / Necessary psychological interventions: the practice as a resident in the fetal medicine service / Intervenciones psicológicas necesarias: la práctica como residente en el servicio de medicina fetal

Com os avanços tecnológicos e o aprimoramento da prática médica via ultrassonografia, já é possível detectar possíveis problemas no feto desde a gestação. O objetivo deste estudo foi analisar a prática do psicólogo no contexto de gestações que envolvem riscos fetais. Trata-se de um estudo qualitativo sob formato de relato de experiência como psicólogo residente no Serviço de Medicina Fetal da Maternidade Escola da Universidade Federal do Rio de Janeiro (UFRJ). Os registros, feitos por observação participante e diário de campo, foram analisados em dois eixos temáticos: 1) intervenções psicológicas no trabalho em equipe em consulta de pré-natal, exame de ultrassonografia e procedimento de amniocentese; e 2) intervenções psicológicas em casos de bebês incompatíveis com a vida. Os resultados indicaram que o psicólogo nesse serviço é essencial para atuar de forma multiprofissional na assistência pré-natal para gravidezes de alto risco fetal. Ademais, a preceptoria do residente é relevante para sua formação e treinamento para atuação profissional no campo da psicologia perinatal.(AU)

Face to the technological advances and the improvement of medical practice via ultrasound, it is already possible to detect possible problems in the fetus since pregnancy. The objective of this study was to analyze the psychologist's practice in the context of pregnancies which involve fetal risks. It is a qualitative study based on an experience report as a psychologist trainee at the Fetal Medicine Service of the Maternity School of UFRJ. The records, based on the participant observation and field diary, were analyzed in two thematic axes: 1) psychological interventions in the teamwork in the prenatal attendance, ultrasound examination and amniocentesis procedure; and 2) psychological interventions in cases of babies incompatible to the life. The results indicated that the psychologist in this service is essential to work in a multidisciplinary way at the prenatal care for high fetal risk pregnancies. Furthermore, the resident's preceptorship is relevant to their education and training for professional performance in the field of Perinatal Psychology.(AU)

Con los avances tecnológicos y la mejora de la práctica médica a través de la ecografía, ya se puede detectar posibles problemas en el feto desde el embarazo. El objetivo de este estudio fue analizar la práctica del psicólogo en el contexto de embarazos de riesgos fetal. Es un estudio cualitativo basado en un relato de experiencia como residente de psicología en el Servicio de Medicina Fetal de la Escuela de Maternidad de la Universidade Federal do Rio de Janeiro (UFRJ). Los registros, realizados en la observación participante y el diario de campo, se analizaron en dos ejes temáticos: 1) intervenciones psicológicas en el trabajo en equipo, en la consulta prenatal, ecografía y los procedimientos de amniocentesis; y 2) intervenciones psicológicas en casos de bebés incompatibles con la vida. Los resultados señalaron como fundamental la presencia del psicólogo en este servicio trabajando de forma multidisciplinar en la atención prenatal en el contexto de embarazos de alto riesgo fetal. Además, la tutela del residente es relevante para su educación y formación para el desempeño profesional en el campo de la Psicología Perinatal.(AU)

Impact of photoinitiator quality on chemical-mechanical properties of dental adhesives under different light intensities / Impacto da qualidade de fotoiniciadores nas propriedades químico mecânicas de adesivos dentais sob diferentes intensidades de luz

Objective: Evaluate the mechanical properties of experimental adhesive models with different photoinitiators (PI) polymerized by LED units of different power densities. Material and Methods: Three groups of adhesive models based on HEMA/BisGMA (45/55) were prepared in association with different PI combinations: G2 (control) ­ 2 PI: 0.5% CQ, 0.5% EDMAB; G3 - 3 PI: 0.5% CQ; 0.5% DMAEMA, 0.5% DPIHP; G4 - 4 PI: 0.5% CQ; 0.5% EDMAB; 0.5% DMAEMA; 0.5% DPIHP. The three formulations were polymerized at two different LED power densities: 550 mW/cm2 and 1200 mW/cm2. The degree of conversion (DC) of adhesive monomers was monitored in situ through the FTIR for 600 s. Specimens were prepared for each formulation for analysis mong adhesive systems (G2

Objetivo: Avaliar as propriedades mecânicas de modelos adesivos experimentais com diferentes fotoiniciadores (PI) polimerizados por unidades de LED de diferentes densidades de energia. Material e Métodos: Três grupos de modelos adesivos baseados em HEMA/BisGMA (45/55) foram preparados em associação com diferentes combinações de PI: G2 (controle) ­ 2 PI: 0,5% CQ, 0,5% EDMAB; G3 - 3PI: 0,5% CQ; 0,5% DMAEMA, 0,5% DPIHP; G4 - 4 PI: 0,5% CQ; 0,5% EDMAB; 0,5% DMAEMA; 0,5% DPIHP. As três formulações foram polimerizadas em duas densidades de potência de LED: 550 mW/cm2 e 1200 mW/cm2. O grau de conversão (DC) dos monômeros adesivos foi monitorado in situ através do FTIR durante 600 s. Amostras foram preparadas para cada formulação para análise de resistência à flexão (FS), módulo de elasticidade (ME), sorção (SOR) e solubilidade (SOL). Os dados foram submetidos aos testes ANOVA 2-fatores e Tukey (5%). Resultados: DC: houve diferença significativa entre os sistemas adesivos (G2

Radiación y medios de contraste en embarazo y lactancia: lo que el clínico necesita saber / Radiation and contrast media in pregnancy and lactation: what the clinician needs to know

Introducción: el uso de técnicas de imagenología es habitual e incluso indispensable en algunos procesos diagnósticos. Sin embargo, su indicación en mujeres embarazadas y en período de lactancia es controvertida. Objetivo: presentar una revisión narrativa sobre los riesgos asociados al uso de imágenes con radiación y medio de contraste en embarazo y periodo de lactancia, con énfasis en las recomendaciones y aplicaciones clínicas que el médico tratante debe tener presente al momento de su indicación. Métodos: se realizó una revisión bibliográfica de la literatura relevante sobre los riesgos y consideraciones especiales del uso de medios de contraste en el embarazo y lactancia. Resultados: los riesgos de la radiación ionizante sobre el feto varían de acuerdo al estadio del embarazo, por lo que la indicación del estudio debe ponderar los riesgos y beneficios. En las dosis clínicas en embarazo y lactancia, el uso de contraste yodado como basados en gadolinio no tienen efectos deletéreos en la salud de la madre ni la del feto. Sin embargo, las sociedades internacionales recomiendan limitar su uso. Conclusión: si bien la indicación de estudios de imagen que utilizan radiación ionizante en el embarazo y lactancia es seguro, el médico clínico debe conocer los posibles riesgos de la radiación ionizante en este grupo de pacientes. Respecto a los medios de contraste, el único efecto adverso reportado es la disfunción tiroidea transitoria en hijos de madres que recibieron medios de contraste yodado.

Introduction: the use of imaging techniques is essential in some diagnostic processes. However, its indication in pregnant and lac-tating women is controversial. Objective: To present a narrative review of the risks associated with using images with radiation and contrast media in pregnancy and lactation. Emphasis will be put on the recommendations and clinical applications that the physician must consider before its indication. Methods: a bibliographic review of the relevant literature on the risks and special considerations of contrast media in pregnancy and lactation was performed. Results: the risks of ionising radiation on the fetus vary according to the stage of pregnancy, so the indication of the study must balance the risks and benefits. The use of iodinated and gadolinium-based con-trast agents in clinical doses in pregnancy and lactation has no effects on the health of the mother or the fetus. However, international societies recommend limiting its use. Conclusion: Although the indication for imaging studies using ionising radiation in pregnancy and lactation is safe, the clinician must be aware of the possible risks of ionising radiation in this group of patients. The only adverse effect reported is transient thyroid dysfunction in children of mothers who received iodinated contrast media.

Ionizing Radiation Exposure in Children with Vesicoureteral Reflux: Should We Be Alarmed? / Exposición a radiacion ionizante en niños con reflujo vesicoureteral: Debemos preocuparnos?

Objectives Ionizing radiation imaging is commonly used for diagnosis and follow up in children with vesicoureteral reflux (VUR). We aim to measure the effective dose (mSv) in patients with VUR. Methods We reviewed our electronic database of patients under 8-years-old with VUR. Primary endpoint was to calculate the effective radiation dose (ED). Absolute frequencies and percentages were reported for global qualitative variables. This study conducted a logistic regression model to calculate the odds ratio for radiation exposure. Analysis was performed using STATA version 14.0 (StataCorp LLC, College Station, TX, EEUU). Results A total of 140 patients were found, 97 were assessed for eligibility. We included 59 patients in the final analysis. Mean age was 20 ± 17.9 months, 66% were females. Most cases of VUR were bilateral (44%) and high grade (93.4%). The lowest number of studies per patient was two, with a minimum radiation of 5.7 mSv. The highest radiation was estimated at 20.7 mSv corresponding to a total of five studies. Logistic regression showed that highest grades of VUR and age of first UTI episode were associated with higher ED (OR, 1.7; 95% CI, 0.87-3.31), (OR 1.02; 95% CI 0.97-1.07) respectively. A mean ED for children with VUR was estimated of 5.5 ± 3 mSv/year. Conclusion In our study, the children with VUR were exposed to 5.5 mSv/year without counting the natural background radiation, which is alarming, and we believe should raise awareness worldwide in how we are unnecessarily diagnosing indolent VUR cases and following patients.

Objetivos La imagenología por radiación ionizante es una herramienta usada frecuentemente para el diagnóstico y seguimiento de pacientes con reflujo vesicoureteral (RVU). El objetivo del presente trabajo es calcular la dosis estimada en milisieverts (mSv) de pacientes con RVU. Métodos Se realizó una revisión retrospectiva de todos los pacientes menores de 8 años con RVU. El objetivo principal fue calcular la dosis de radiación efectiva recibida por los pacientes con base en los estudios imagenológicos realizados hasta el momento de la revisión de la base de datos. Las frecuencias y porcentajes fueron reportados para las variables cualitativas. Se realizó una regresión logística para calcular la asociación de factores de riesgo con la exposición a radiación. El análisis estadístico fue realizado con el programa STATA versión 14.0 (StataCorp LLC, College Station, TX, EEUU). Resultados Se identificaron 140 patientes, de los cuales 97 fueron evaluados para coprobar su elegibilidad. En total, 59 pacientes fueron incluidos para el análisis final. La edad promedio de los pacientes fue de 20 ± 1,.9 meses, y 66% eran mujeres. La mayoría de casos fueron bilaterales (44%) y de alto grado (93,4%). El menor número de estudios realizados por paciente fue 2, con una dosis mínima de radiación acumulada de 5,7 mSv. La máxima radiación acumulada fue de 20,7 mSv, correspondiente a un total de 5 estudios. La regresión logística demostró que altos grados de reflujo y la edad a la cual tuvieron la primera infección se asociaban con mayores dosis de radiación efectiva (razón de probabilidades [RP]: 1.7; intervalo de confianza del 95% [IC95%]: 0,87­3,31), (RP: 1,02; IC95%: 0,97­1,07), respectivamente. Estimamos una dosis efectiva de radiación de 5,5 ± 3 mSv/año en nuestra población. Conclusión Nuestro estudio demuestra que pacientes con reflujo son expuestos a un promedio de 5,5 mSv/año sin contar la radiación de base a la que se exponen todos los humanos anualmente, lo cual resulta alarmante. Esto debe generar introspección al momento de evaluar pacientes con reflujo y evitar efectos a largo y mediano plazos.

Uma reflexão sobre o uso da tomografia computadorizada em Endodontia / Considerations on the use of computed tomography in Endodontics

Será o exame de tomografia computadorizada realmente de alto custo para o paciente, ou existe uma resistência por grande parte dos profissionais em indicá-lo? Paradigmas já foram quebrados com relação à dose de radiação. Ela é tão pequena que, em muitas universidades nos EUA, o paciente não utiliza avental de chumbo durante o exame. Isso se dá porque o exame usado para Endodontia tem algumas diferenças em relação à tomografia médica (AU).

Is the CT scan really a high cost for the patient, or is there a resistance on the part of most professionals to indicate it? Paradigms have already been broken with regard to the radiation dose. In many universities in the USA, the patient does not wear a lead apron during the exam because the dose is so small. The reason for this is that the exam used for Endodontics has some differences in relation to medical tomography (AU).

Actividad fotoprotectora de una crema con extracto acuoso liofilizado de Lepidium meyenii (MACA) frente a la irradiación ultravioleta en piel de ratones / Photoprotective activity of a cream containing lyophilized aqueous extract of Lepidium meyenii (MACA) against ultraviolet irradiation on mouse skin

RESUMEN Objetivos: Evaluar la actividad fotoprotectora de una crema con extracto acuoso liofilizado de maca (ELM) frente a la irradiación ultravioleta (UV) en la piel de ratones. Materiales y métodos: Se realizó un estudio experimental en 35ratones BALB/c. Los tratamientos fueron aplicados por vía tópica en el dorso de los animales y posteriormente irradiados con rayos ultravioleta B, para luego medir el grosor en micras (µm) de muestras histológicas de la piel de los ratones. Se asignaron siete grupos divididos en no irradiado: blanco (G1) e irradiados con luz UV: sin tratamiento (G2); con protector solar comercial con factor de protección solar (FPS) 30 (G3); crema (placebo) (G4); ELM al 15% en agua (G5); ELM al 5% en crema (G6); y ELM al 15% en crema (G7). Se determinó el FPS in vitro, mediante el método de Mansur. Se realizaron las lecturas de las absorbancias en un espectrofotómetro ultravioleta-visible (UV-VIS) y se determinaron los FPS para las siguientes formulaciones: ELM al 5% en crema, benzofenona-4 (BZF-4) y bloqueador solar comercial FPS 30. Resultados: El grosor de piel de ratón en micras (µm) fue de 27,28 en G2; 18,31 en G3; 27,33 en G4; 19,51 en G5 y 18,04 en G6; no hubo diferencia significativa entre el grupo no expuesto a la radiación (G1) y el grupo ELM al 15% en crema (G7), ambos presentaron los menores grosores (12,76 y 14,20 µm, respectivamente). El FPS de ELM al 15% en crema fue 5,480 ± 0,020. Conclusiones: La formulación con ELM en crema presentó actividad fotoprotectora frente a la irradiación UV, los alcaloides fueron los componentes fitoquímicos mayormente encontrados y la formulación fue compatible con el activo (ELM).

ABSTRACT Objectives: To evaluate the photoprotective activity of a cream with lyophilized aqueous extract of maca (LEM) against ultraviolet (UV) irradiation in the skin of mice. Materials and methods: An experimental study was carried out on 35 BALB/c mice. Treatment was applied topically on the dorsum of the animals, which were subsequently irradiated with ultraviolet B rays, and then we measured the thickness in microns (μm) of histological samples of the skin of the mice. Seven groups were assigned, divided into non-irradiated: Blank (G1) and irradiated with UV light: no treatment (G2); with commercial sunscreen with sun protection factor (SPF) 30 (G3); cream (placebo) (G4); LEM at 15% in water (G5); LEM cream at 5% (G6); and LEM cream at 15% (G7). In vitro SPF was determined using the Mansur method. Absorbance readings were taken in an ultraviolet- visible spectrophotometer (UV-VIS) and SPFs were determined for the following formulations: LEM cream at 5%, benzophenone-4 (BZF-4) and commercial sunscreen SPF 30. Results: Mouse skin thickness in microns (μm) was 27.28 in G2; 18.31 in G3; 27.33 in G4; 19.51 in G5 and 18.04 in G6. There was no significant difference between the group not exposed to radiation (G1) and the 15% LEM cream group (G7), both had the lowest thicknesses (12.76 and 14.20 μm, respectively). The SPF of LEM cream at 15% was 5.480 ± 0.020. Conclusions: The formulation with LEM cream showed photoprotective activity against UV irradiation, alkaloids were the phytochemical components mostly found and the formulation was compatible with the active principle (LEM).

Nivel de cumplimiento del uso del dosímetro como norma de protección radiológica de estudiantes de radiología / Level of compliance with the use of the dosimeter as a standard of radiological protection of radiology students

Introducción. La Organización Panamericana de la Salud pondera la importancia en la protección y seguridad contra la radiación y emergencias radiológicas, considerando beneficios y riesgos por los usos de radiaciones en aplicaciones industriales, médicas y de investigación. El uso de la radiación también tiene riesgos potenciales para la salud de pacientes, trabajadores (incluido personal de la salud), población en general y medio ambiente. La Universidad Central del Ecuador, a través de la Facultad de Ciencias Médicas cuenta con la Carrera de Radiología, que forma profesionales en esta área, con competencias para estudios de diagnóstico, promoción, prevención e investigación en beneficio de las personas en situación de enfermedad; en este contexto se inscriben los estudiantes de pregrado que realizan prácticas pre profesionales formativas en las unidades asistenciales de salud, y que se hallan expuestos continuamente a riesgos por radiaciones ionizantes.Objetivo. Determinar el nivel de cumplimiento del uso del dosímetro como norma de protección radiológica en imagenología. Material y métodos. El estudio es descriptivo, observacional, transversal y analítico. La muestra es de 58 estudiantes de pregrado (séptimo y octavo semestres) seleccionados al azar con el 95% de nivel de confianza, en el año 2019. Se aplicó análisis documental y encuesta (estudiantes y Jefes de Servicio de Radiología). Se analizó los tres últimos resultados de los exámenes de dosimetría. La estadística de fiabilidad del instrumen-to con Alfa de Cronbach es alta (0,833). Los datos fueron procesados a través EXCEL y PSPP. Los análisis estadísticos fueron descriptivos y tabla de contingencia con prueba de independencia de Chi2 de Pearson. Resultados. Los estudiantes, hombres y mujeres, no utilizan regularmente el dosímetro, en las tres mediciones. Por sexo, existe diferencia significativa según Chi2, en la primera medición y segunda medición (p<0,05). En la tercera medición, no existen diferencias significativas, pero los dos grupos igualmente no utilizan regularmente el dosímetro. Limitación: La muestra estudiada no corresponde a todos los estudiantes de la carrera de radiología, priorizándose a los últimos años de formación. Conclusiones. Existe incumplimiento en el uso del dosímetro como norma protección radiológica, lo que aumenta posibilidades de riesgos en la salud de los estudiantes que realizan prácticas pre profesionales formativas

Introduction. The Pan American Health Organization ponders the importance of protection and safety against radiation and radiological emergencies, considering benefits and risks for the uses of radiation in industrial, medical and research applications. The use of radiation also has potential risks to the health of patients, wor-kers (including health personnel), the public, and the environment. The Central University of Ecuador, through the Faculty of Medical Sciences, has the Radiology Career, which trains professionals in this area, with com-petencies for diagnostic studies, promotion, prevention and research for the benefit of people in a situation of illness; In this context, undergraduate students who carry out pre-professional training practices in health care units, and who are continuously exposed to risks due to ionizing radiation, are enrolled.Objective. Determine the level of compliance with the use of the dosimeter as a radiation protection standard in imaging.Material and methods. The study is descriptive, observational, cross-sectional and analytical. The sample is 58 undergraduate students (seventh and eighth semesters) randomly selected with a 95% confidence level, in the year 2019. Documentary analysis and survey (students and Heads of Radiology Service) were applied. The last three results of the dosimetry tests were analyzed. The reliability statistic of the instrument with Cron-bach's Alpha is high (0.833). The data was processed through EXCEL and PSPP. Statistical analyzes were descriptive and a contingency table with Pearson's Chi2 test of independence.Results. The students, men and women, do not regularly use the dosimeter, in the three measurements. By sex, there is a significant difference according to Chi2, in the first measurement and second measurement (p<0.05). In the third measurement, there are no significant differences, but the two groups also do not regu-larly use the dosimeter.Limitation: The studied sample does not correspond to all the students of the radiology career, prioritizing the last years of training.Conclusions. There is non-compliance in the use of the dosimeter as a radiation protection standard, which increases the chances of health risks for students who carry out pre-professional training practices.

Radioterapia hipofraccionada para cáncer de próstata localizado ¿Menos tiempo de tratamiento es mejor? / Hypofractionated radiotherapy for localized prostate cancer ¿Is less treatment time better?

Introducción: El hipofraccionamiento moderado (hRt) en cáncer de próstata, consisten en dismi-nuir el tiempo total de tratamiento con radioterapia, lo que mejora la adherencia terapéutica y opti-miza recursos tecnológicos. En cáncer de próstata, existe evidencia robusta con datos maduros a 5 años de seguimiento, donde se evidenció que hRtno es inferior al tratamiento con fraccionamiento estándar en control oncológico, con menor o igual toxicidad aguda y tardía. Se hace una revisión de la evidencia, dosis de tolerancia, contorneo de volúmenes objetivo (GTV-CTV-PTV) / órganos de ries-go, planificación y reproducibilidad del hRt en cáncer de próstata localizado.

Introduction: Moderate hypofractionation (hRt) in prostate cancer consists of reducing the total time of treatment with radiotherapy, which improves therapeutic adherence and optimizes technolog-ical resources. In prostate cancer, there is robust evidence with mature data at 5 years of follow-up, where it was evidenced that hRt is not inferior to treatment with standard fractionation in oncological control, with less or equal acute and late toxicity. A review of the evidence, tolerance dose, contouring of target volumes (GTV-CTV-PTV) / organs at risk, planning and reproducibility of hRt in localized prostate cancer is made.

Luz ultravioleta C: una alternativa eficiente contra la pandemia / Ultraviolet light C: an efficient alternative against the pandemic

La pandemia por COVID-19 ha generado un impacto negativo en los sistemas de salud y la economía mundial. El agente etiológico de la COVID-19, el SARS-CoV2, puede permanecer de horas a días en superficies y aerosoles, representando un desafío en la descontaminación de objetos y ambientes cerrados. Agentes químicos como el alcohol, peróxido de hidrógeno, hipoclorito de sodio se han empleado con éxito para erradicar al coronavirus de superficies. Dado que estos agentes pueden causar daños en elementos de protección personal (como las máscaras), son irritantes y no parecen ser efectivos para la descontaminación de aerosoles, la luz ultravioleta ha sido explorada como una medida de mitigación para el desconfinamiento seguro. En este trabajo se realiza una revisión acerca de los principios físicos de la irradiación con luz ultravioleta y su interacción con la materia biológica. También se esboza un esquema de irradiación que podría ser útil para eliminar al SARS-CoV2 de superficies y aerosoles en ambientes cerrados(AU)

The COVID-19 pandemic has had a negative impact on health systems and the global economy. The etiological agent of COVID-19, SARS-CoV2, can remain from hours to days on surfaces and aerosols, representing a challenge in the decontamination of objects and closed environments. Chemical agents such as alcohol, hydrogen peroxide, sodium hypochlorite have been used successfully to inactivate the coronavirus on surfaces. Since these agents can damage personal protective equipment (such as masks), are irritants, and do not appear to be effective for aerosol decontamination, UV light has been explored as a mitigation measure for safe deconfinement. In this work, it is made a review about the physical principles of ultraviolet light and its interaction with biological matter. An irradiation scheme that could be useful to eliminate SARS-CoV2 from surfaces and aerosols in closed environments is also presented(AU)

Acute corneal melting one week after an uncomplicated cataract surgery in a patient who previously underwent eyelid radiation and with undiagnosed rheumatoid arthritis: a case report / Ceratomalácia aguda uma semana após cirurgia de catarata sem complicações em uma paciente com irradiação prévia de uma pálpebra e artrite reumatoide não diagnosticada: relato de caso

ABSTRACT This is a rare case report of acute, paracentral corneal melting and perforation occurring 1 week after an uneventful cataract surgery, with discussions on possible pathogenetic mechanisms. Relevant literature was also reviewed. Herein, a case of an 86-year-old woman with acute, paracentral, and sterile corneal melting and perforation in her left eye at 1 week after an uncomplicated cataract extraction is described. This occurs at the base of ocular surface disorders due to previous radiation of her lower eyelid and cheeks for the treatment of cancer and previously undiagnosed rheumatoid arthritis. She underwent surgical treatment using Gundersen's conjunctival flap for the existing perforation due to low visual expectancies and reluctance to undergo corneal keratoplasty due to the risk of corneal graft rejection. The risk of coming across an acute corneal melting after an uncomplicated cataract surgery in the eyes with ocular surface disorders should always be considered.

RESUMO É apresentado um caso raro de ceratomalácia paracentral aguda estéril e perfuração da córnea em uma paciente de 86 anos, uma semana após cirurgia para catarata sem intercorrências. Também são discutidos possíveis mecanismos de patogênese e a literatura relevante é revisada. Esses distúrbios da superfície ocular ocorreram devido à irradiação da pálpebra inferior e da bochecha em um tratamento de câncer e a uma artrite reumatoide não diagnosticada anteriormente. A paciente submeteu-se a um tratamento cirúrgico com um flap conjuntival de Gundersen sobre a perfuração existente, devido às suas baixas expectativas visuais e à relutância em submeter-se a uma ceratoplastia da córnea, considerando o risco de rejeição do enxerto corneano. Deve-se sempre considerar o risco de ocorrência de ceratomalácia aguda após cirurgias de catarata sem complicações em olhos apresentando distúrbios da superfície ocular.

Antilipoperoxidative and anti-inflammatory efficacy of multifunctional sunscreens containing ferulic acid

Unprotected chronic exposure to ultraviolet radiation generates many harmful effects to human skin and UV filters are essential to health, however, traditional sunscreens do not provide enough protection against cutaneous oxidative stress, a process amplified by UV radiation. Therefore, is been proposed the development of multifunctional photoprotective formulations, acting in the absorption/reflection of UV radiation and assisting in cutaneous homeostasis. In the present study, ferulic acid is used in conjunction with two sunscreens, bemotrizinol and ethylhexyl triazone, for the determination of biosafety and efficacy methods, using techniques that better elucidate the effects of ferulic acid. Skin permeation assays were performed by applying a formulation containing the three substances in the stratum corneum of volunteers, which were removed by the tape stripping method (ex vivo) with follow quantification by high performance liquid chromatography (HPLC). The test was able to evaluate the penetration depth of the substances, characterizing them. In addition, the simultaneous quantification of the three substances was performed by a single and fast method, facilitating their analysis and improving the technique. Also, TBARS (thiobarbituric acid reactive substances) assays were performed in stratum corneum removed by tape stripping (ex vivo), evaluating the potential of cutaneous lipid peroxidation, with or without ferulic acid. To date, it is the first time that TBARS method is used to characterize the stratum corneum (ex vivo) and quantified by HPLC. The protocol developed may aid in the efficacy of antioxidant agents in studies aimed at elucidating the level of lipid peroxidation caused by drugs and cosmetics, and even in carrying out baseline studies characterizing different ethnicities and genders. As last, an anti-inflammatory in vivo assay with Laser Doppler flowmetry equipment was used to compare the sunscreen formulation with or without ferulic acid. Data indicated that the antioxidant reduced the angular coefficient of the perfusion units, mitigating the inflammatory effects. Furthermore, a significant difference was found between the genders, suggesting a more pronounced inflammatory reaction in women. Ferulic acid proved to be a valuable resource, besides being safe and raise the SPF of sunscreens, it also mitigates the effects of inflammation

A exposição crônica desprotegida à radiação ultravioleta (UV) contribui para o desenvolvimento de câncer de pele e os filtros solares são relevantes para evitar tais efeitos prejudiciais, porém, os protetores solares tradicionais não geram proteção suficiente contra o estresse oxidativo cutâneo. Logo, espera-se o desenvolvimento de formulações fotoprotetoras multifuncionais, atuando não somente na absorção e/ou reflexão da radiação UV, mas, também, auxiliando na homeostase cutânea, com presença de agentes antioxidantes. No presente estudo foi utilizado o ácido ferúlico conjuntamente com dois filtros solares, o bemotrizinol e a triazona de octila, para determinação de métodos de segurança e eficácia, utilizando técnicas que melhor elucidem e comprovem os efeitos do ácido ferúlico. Foram realizados ensaios de permeação cutânea pela aplicação tópica de formulação contendo as três substâncias em voluntários, sendo o estrato córneo retirado pelo método de tape stripping (ex vivo) com subsequente quantificação por cromatografia líquida de alta eficiência (CLAE). O ensaio pôde avaliar a profundidade de penetração das substâncias, caracterizando-as. Ademais, a quantificação simultânea das três substâncias foi efetuada por método único e rápido, facilitando análise com aprimoramento da técnica. Em adição, foi realizado ensaios de TBARS (substâncias reativas ao ácido tiobarbitúrico) em estrato córneo removido por tape stripping (ex vivo), para avaliar o potencial de peroxidação lipídica cutânea, contendo ou não o ácido ferúlico. Até o presente momento, é a primeira vez que o método TBARS é utilizado para caracterização do estrato córneo (ex vivo) e quantificada por CLAE. O protocolo desenvolvido pode auxiliar na eficácia de agentes antioxidantes, em estudos que visam elucidar o nível de peroxidação lipídica causada por medicamentos e cosméticos e, até mesmo, na realização de estudos de base, caracterizando etnias e gêneros. Ademais, um ensaio anti-inflamatório in vivo com equipamento de fluxometria Laser Doppler foi utilizado para comparar a formulação fotoprotetora com ou sem ácido ferúlico. Os dados indicaram que o antioxidante reduziu o coeficiente angular das unidades de perfusão, mitigando os efeitos inflamatórios. Ainda, foi identificada diferença entre os gêneros, sugerindo reação inflamatória mais pronunciada em mulheres. O ácido ferúlico provou ser um recurso valioso, além de ser seguro e elevar o FPS dos fotoprotetores, também atenuando os efeitos da inflamação

Clasificación ti-rads para diagnóstico y clasificación de los nódulos tiroideos / Ti-rads classification for diagnosis and classification of thyroid nodules

La prevalencia del nódulo tiroideo (NT) en la población general es de entre el 2 al 7% por palpación y de 19 a 76% por ultrasonido. Su incidencia es más alta con la edad, en personas provenientes de áreas con deficiencia de yodo, en mujeres, y después de exposición a radiación. Objetivo: Estudiar distintas fuentes bibliográficas para así establecer la importancia del uso práctico de la clasificación TI-RADS en el nódulo tiroideo. Metodología: Se constituye en una investigación de carácter documental, tanto bibliográfica como digital. Resultados: La importancia del estudio del nódulo tiroideo radica en la necesidad de excluir cáncer, por lo cual, todo nódulo tiroideo >1cm debe ser evaluado. Los nódulos <1cm serán sospechosos cuando se encuentren asociados a factores de riesgo y en presencia de hallazgos ultrasonográficos sugestivos de malignidad. La clasificación TI-RADS de los NT basada en un sistema de puntuación acorde a los criterios ecográficos más relevantes de malignidad tiene una mejor y más fácil aplicación en la práctica diaria. Conclusión: Según los criterios de malignidad y la puntuación asignada en este estudio, la posibilidad de que un NT con un punto en la escala sea maligno es de aproximadamente un 10%, mientras que la probabilidad para aquellos con dos puntos es casi del 50% y para los valorados con tres o cuatro puntos del 85%. Todos los NT con 5 o más puntos son malignos. El presente artículo resume una comparación de referencias bibliográficas para actualización y aplicación de la clasificación TIRADS(AU)

The prevalence of the thyroid nodule (TN) in the general population is between 2 to 7% by palpation and from 19 to 76% by ultrasound. Its incidence is higher with age, in people from iodine-deficient areas, in women, and after exposure to radiation. Objective: To study different bibliographic sources in order to establish the importance of the practical use of the TI-RADS classification in the thyroid nodule. Methodology: It constitutes a documentary research, both bibliographic and digital. Results: The importance of studying the thyroid nodule lies in the need to exclude cancer, therefore, any thyroid nodule> 1cm should be evaluated. Nodules <1cm will be suspicious when associated with risk factors and in the presence of ultrasonographic findings suggestive of malignancy. The TI-RADS classification of NTs based on a scoring system according to the most relevant ultrasound criteria of malignancy has a better and easier application in daily practice. Conclusion: According to the malignancy criteria and the score assigned in this study, the possibility that a TN with one point on the scale is malignant is approximately 10%, while the probability for those with two points is almost 50% and for those valued with three or four points of 85%. All TNs with 5 or more points are malignant. This article summarizes a comparison of bibliographic references for updating and applying the TIRADS classification(AU)

Enteritis por radiación: reporte de un caso y revisión de la literatura / Radiation enteritis. Case report and literature review

Resumen La enteritis por radiación es una patología causada por la radiación que se suministra durante el manejo de neoplasias radiosensibles. Esta enfermedad puede clasificarse en enteritis aguda o crónica, en las cuales es posible que se desarrollen síntomas por malabsorción u obstrucción intestinal, que alteran la calidad de vida de los pacientes. Presentamos el reporte de caso de un paciente masculino de 67 años, con antecedente de adenocarcinoma difuso con células en anillo de sello infiltrante y compromiso de todo el espesor de la pared gástrica, quien había recibido un manejo quirúrgico mediante gastrectomía total, asociado a quimio-radioterapia. El individuo consultó por síntomas de obstrucción intestinal. En principio, se consideró la existencia de una recaída tumoral. Sin embargo, se corroboró que los síntomas estaban relacionados con el compromiso causado por la radiación.

Abstract Radiation enteritis is a pathology caused by radiation therapy, used to treat radiosensitive tumors. Acute or chronic enteritis may be suspected in the presence of symptoms such as malabsorption or intestinal obstruction, which alter the patients quality of life. The following is the case report of a 67-year-old male patient, who consulted for symptoms of intestinal obstruction, with a history of diffuse type adenocarcinoma with infiltrating signet ring cells involving the entire thickness of the gastric wall. The patient underwent a total gastrectomy associated with chemoradiotherapy.

Obstrucción intestinal secundaria a enteritis por radiación: reporte de un caso / Bowel obstruction secondary to radiation enteritis: A case report

La enteritis por radiación o enteritis actínica es una complicación secundaria al uso de radioterapia para tratamiento de tumores pélvicos, que puede afectar con mayor frecuencia al intestino delgado (principalmente íleon) y al colon. La cirugía en pacientes con enteritis por radiación crónica debe reservarse ante la presencia de complicaciones, ya que está relacionada con una alta morbilidad y estancia hospitalaria prolongadas, así como posibilidad de re operación. Exponemos el caso de una paciente con oclusión intestinal secundaria a enteritis por radiación que desarrolló años después de la conclusión de su tratamiento por cáncer de cuello uterino, con el objetivo de que esta enfermedad sea sospechada en pacientes con antecedentes de radiación.

Radiation enteritis or actinic enteritis is a complication secondary to the use of radiotherapy to treat pelvic tumors, which can more frequently affect the small intestine (mainly ileum) and the colon. Surgery in patients with chronic radiation enteritis should be reserved in the presence of complications, since it is related to high morbidity and prolonged hospital stay, as well as the possibility of reoperation. We present the case of a patient with intestinal occlusion secondary to radiation enteritis who developed years after the conclusion of her treatment due to cervical cancer, with the objective that this disease has to be suspected in patients with history of radiation.

Sofrimento moral dos profissionais das técnicas radiológica em serviço de radiologia convencional de Santa Catarina / Moral distressof radiological technologistsin conventional radiology service in Santa Catarina

Introdução: ouso da radiação ionizante na prática médica pode ocasionar eventos nocivos à saúde do indivíduo exposto. Diante disso, o emprego ético da radiação ionizante deve contemplar o que preconiza a legislação nacional e internacional, assim como os princípios de proteção radiológica e da bioética. O sofrimento moral relaciona-se à dimensão ética na prática da saúde,podendo afetar os profissionais das técnicas radiológicas. Objetivo: identificar as situações desencadeadoras de sofrimento moral nos profissionais das técnicas radiológicas em um serviço de radiologia convencional. Metodologia: trata-se de uma pesquisa qualitativa, descritiva e exploratória. Usou-se como técnicas de coleta de dados a observação participante, a entrevista semiestruturada e a validação consensual. Os dados foram analisados por meio da análise temática. Resultados e discussão: observou-se situações de sofrimento moral quando o profissional da técnica radiológica se deparava com pacientes em condições clínicas de se dirigir a unidade de diagnóstico e imagem, diante da não indicação clínica do exame radiológico, ante ao desrespeito dos princípios de proteção radiológica e perante a falta de autonomia para fazer cumprir os preceitos éticos do emprego da radiação ionizante. Conclusão: o desrespeito dos princípios legais, assim como dos princípios de proteção radiológica e bioéticos levamo profissional das técnicas radiológicas ao sofrimento moral.

Introduction: The use of ionizing radiation in medical practice may cause harm to the health of the exposed individual. Thus, the ethical use of ionizing radiation must contemplate what is required by national and international legislation, as well as the principles of radiological protection and bioethics. Moral distress is related to the ethical dimension in healthpractice, and may affect radiological technologists. Objective:To identify the situations that trigger moral distress among radiological technologistsin a conventional radiology service.Methodology:This is a qualitative, descriptive and exploratory research. Data collection techniques were participant observation, semi-structured interview and consensus validation. Data were analyzed through thematic analysis. Results and discussion:Situations of moral distress were observed when the radiological technologist was faced with patients in clinical conditions to go to the diagnostic and imaging unit, due to the non-clinical indication of the radiological exam, due to the disrespect of the protection principles and lack of autonomy to enforce the ethical precepts of the use of ionizing radiation. Conclusion:Failure to respect the legal principles as well as the principles of radiological and bioethical protection lead the professional of radiological techniques to moral distress.

Revisión de las principales normas de protección radiológica para el uso de equipos de rayos X en odontología. Revisión de literatura / Review of the main radiation protection standards for the use of X-ray equipment in dentistry. Literature review

La odontología no es ajena al uso de equipos de rayos X, porque estos ayudan al diagnóstico, detección y control de patologías. Se calcula que 520 millones de personas se realizan estos exámenes cada año; pero la radiación emitida por los equipos de rayos X puede tener un efecto en el tejido celular, el cual depende de la dosis, el tiempo y el tipo de tejido. Por esto, las principales instituciones han establecido normas, guías e instrucciones sobre protección radiológica, las cuales ayudan a prevenir y disminuir los efectos y riesgos biológicos en las personas. El presente artículo tiene como propósito revisar las principales normas, reglamentos, guías e instrucciones acerca de la protección radiológica para el uso de equipos de rayos X en odontología. (AU)

Dentistry is no stranger to the use of X-ray equipment, because it helps to diagnose, detect and control the evolution of pathologies. An estimated 520 million people take these exams in a year. The radiation emitted by X-ray equipment can have an effect on cell tissue, it will depend on the dose, time and type of tissue. That is why the main institutions have established standards, guidelines and instructions on radiation protection, which help to prevent, reduce the effects and biological risks in which the health of people is exposed. The purpose of this article is to review the main rules, regulations, guides and instructions about radiation protection for the use of X-ray equipment in dentistry of the main institutions. (AU)

Ultimate tensile strength of total and self-etch adhesives: effect of light irradiation distance

Objective: To evaluate the ultimate tensile strength (UTS) of total and self- etch adhesives irradiated at different distances. Materials and Methods: Sixty cylindrical specimens of 0.78mm diameter and 10 mm length were prepared of two types of adhesive systems total etch Excite DSC (EX ­ Ivoclar Vivadent, Schaan, Liechtenstein) and one-step self-etch Clearfil S3 Bond (S3, Kuraray Medical Inc., Tokyo, Japan). Specimens of each adhesive were divided into three groups according to the light irradiation distance (0, 2, 4mm) (n=10). Each specimen was attached to universal testing machine (Digital Force Gauge, IMADA CO., LTD, Japan) and loaded at cross head speed of 1mm/min until failure. Data were analyzed using two-way ANOVA and Independent Student t-test at p< 0.05. Results: Mean UTS for total etch (24.63, 18.19, 17.26 Mpa) and for self-etch (12.68, 8.53, 7.58Mpa) at (0, 2, 4mm) distances. Specimens irradiated directly show significantly the highest UTS while those irradiated at 4mm show the lowest values (p<0.05). Excite DSC total etch adhesive have higher UTS than Clearfil S3 self-etch adhesive regardless of irradiation distance (p<0.05).Conclusions: The UTS of the evaluated adhesives was light irradiation distance and adhesive system dependant.

Cancer incidence in the cohort exposed to Cesium-137 accident in Goiânia (Brazil) in 1987

Objective:to describe the incidence of cancer cases in the direct victims of the accident, Groups I and II, and compare with overall cancer incidence rates for the population of Goiânia. Method: A descriptive study is presented herein, on the cohort of patients directly exposed and contaminated (Groups I and II) during the cesium-137 accident, which occurred in Goiania (Midwest Brazil) in 1987. The incident cases of malignant neoplasms diagnosed between 1988 and 2017 are described. Analysis included calculation of the Incidence Rate Ratio (IRR) with 95% confidence intervals (CI95%), according to gender. Results: In the 30-year period (1987-2017) following individual exposure, there were seven cancer cases in six directly exposed victims of the cesium-137 accident. Of these, five neoplasms occurred in men, in the esophagus (1), prostrate (3), bladder (1), and two in women, involving breast cancer (1) and skin melanoma (1). The accumulated incidence rates in the direct victims of the Cesium-137 accident were 327.9/100,000 for men and 148.6/100,000 for women. For the overall population of Goiânia, rates were 221.4/100,000 and 231.2/100,000 in men and women, respectively. The ratios of brute incidence rates (direct victims of Cesium-137/population of Goiânia) were 1.5 (IC95%:0.4;5.9) in men and 0.6 (IC95%:0.1;3.8) in women, with no statistically significant differences. Conclusion: Cancer incidence in the direct victims of the Cesium-137 accident (Groups I and II), according to sex, was not different from the incidence in those not exposed to Cesium-137 in the municipality of Goiânia. Cancer risk was similar to that of the general population of the municipality of Goiânia

Objetivo: descrever a incidência de casos de câncer nas vítimas diretas do acidente Grupo I e II e comparar com as taxas de incidência de câncer na população de Goiânia. Método: Estudo descritivo da coorte de pacientes diretamente expostos e contaminados (Grupos I e II), no acidente com Césio 137, ocorrido em Goiânia (Brasil), em 1987. Descrevemos os casos incidentes de neoplasia maligna diagnosticados no período entre 1988 e 2017. Foram calculados a razão das taxas de incidência e os intervalos de confiança de 95% (IC95%), segundo o sexo na população de estudo. Resultados: No período de 30 anos (1987-2017), ocorreram sete casos de câncer, em seis vítimas diretas do acidente pelo césio-137. Desses, cinco ocorreram em homens (esôfago [1], próstata [3] e bexiga [1]) e dois, em mulheres (mama [1] e melanoma da pele [1]). As taxas de incidência acumulada nas vítimas diretas do Césio-137 foram de 327,9/100,000 entre homens e de 148,6/100,000 entre as mulheres. Na população de Goiânia, as taxas foram de 221,4/100,000 e 231,2/100,000 em homens e mulheres, respectivamente. As razões das taxas de incidência bruta (vítimas diretas do Césio-137/população de Goiânia) foram 1,5 (IC95%:0,4;5,9) em homens e 0,6 (IC95%:0,1;3,8) em mulheres, não houve diferenças estatisticamente significativas. Conclusão: A incidência de câncer nas vítimas diretas do acidente pelo Césio 137 (Grupos I e II), segundo o sexo, não foi diferente da população não exposta ao Césio-137 do município de Goiânia; portanto, o risco de câncer foi semelhante ao da população geral do Município de Goiânia.

Effects of gamma radiation on the stability and degradation kinetics of phenolic compounds and antioxidant activity during storage of (Oryza sativa L) black rice flour

Abstract The effects of gamma radiation (0, 1, 2 and 3 kGy) were used to evaluate the stability and thermal degradation kinetics of anthocyanins, as well as the stability of total phenolic compounds (TPC) and antioxidant activity at different temperatures (4, 25, 35 and 45 °C) during the storage (0, 30, 60, 90 and 120 days) of black rice flour. This flour can be used as ingredient for gluten-free cereal products with higher nutritional value. For this it is necessary to preserve the anthocyanin content during thermal processing and shelf-life periods. At time 0, the dose of 3 kGy provided all of the most available bioactive compounds, raising their antioxidant potential, except for TPC. During the storage at different temperatures up to 120 days, gradual losses occurred in all the analysed parameters. Regarding the total anthocyanin content and TPC, the sample irradiated with a 1 kGy dose remained most stable. The analysis of kinetic data indicated a first-order reaction for the degradation of anthocyanins. The combination of irradiation with different temperatures may improve the shelf-life of black rice flour.