Acute ischemic stroke and COVID-19 pandemic in Brazil: a comparative study of frequency and risk factors before and during SARS-CoV-2 era.

BACKGROUND: COVID-19 pandemic directly impacted the request for hospital care and medical assistance for several diseases worldwide, as occurred with acute ischemic stroke. The present study sought to compare the incidence and severity of acute ischemic stroke (AIS), in addition to sociodemographic, clinical, and radiological characteristics of patients hospitalized in the prepandemic (2018-2019) and pandemic (2020-2021) eras. METHODS: An incidence case-control, observational, and analytical research was carried out in the Stroke Unit of Hospital Governador Celso Ramos, Florianopolis, Santa Catarina, Brazil, including 171 patients admitted with acute ischemic stroke from April 2018 to April 2019 (prepandemic era) and 148 patients between January 2020 and January 2021 (during pandemic). RESULTS: The mean incidence of AIS hospital admissions was significantly lower in the pandemic period (CI 95%, 0.2 to 5.6; p = 0.04), being lower in the lockdown periods and when the incidence of new COVID-19 cases increased. Besides, referring to AIS severity, the mean areas of AIS were larger during the pandemic period (p < 0.01), especially in August, September, December, and January (p < 0.05). Sociodemographic and clinical variables did not show any difference between the two periods of the study. CONCLUSIONS: Hospital admissions for AIS decreased in the COVID-19 pandemic, mostly during months of higher incidences of new COVID-19 cases. When the incidence of admissions diminished, an increase in the severity of AIS was observed, characterized by larger areas. These findings might contribute to other similar referral centers in managing public policies related to stroke.

Effects of shoulder distraction on canine shoulder arthroscopy.

OBJECTIVE: To evaluate the use of the Leipzig distractor during canine shoulder arthroscopy. STUDY DESIGN: Experimental, ex vivo. SAMPLE POPULATION: Paired shoulder joints from 15 large breed canine cadavers. METHODS: Standard lateral shoulder arthroscopy was performed with or without the use of the Leipzig distractor (n = 15 each). Joint space width, procedure time, and visibility and palpability of the intra-articular structures were assessed during the arthroscopy. After the arthroscopic evaluation, each shoulder joint was disarticulated to assess the area and number of iatrogenic articular cartilage injury (IACI) lesions. Sites around the distraction device were assessed for the presence of iatrogenic injury. RESULTS: With shoulder distraction, median joint space width was 4 mm larger (P = .01), IACI area was 9.5 mm2 lower (P = .003), and there were two fewer total number of IACI lesions (P = .004) compared with nondistracted shoulders. The mean total surgery time was 93 seconds shorter (P = .01) in distracted shoulders. Although distraction was associated with increased visibility of the supraglenoid tubercle (P = .015), no significant differences were found for other intra-articular structures for their visibility and palpability. Unexpected lesions at the sites around the distraction device were not encountered. CONCLUSION: Use of the distraction device decreased the area and incidence of IACI lesions and shortened the arthroscopy time. However, no improvement was found in the visibility or palpability of the intra-articular structures. CLINICAL SIGNIFICANCE: Although additional clinical studies are required to evaluate the effect of the distraction device on pathologic articular conditions and intraoperative manipulation, the use of a shoulder distraction device might improve the outcomes of shoulder arthroscopy by decreasing IACI and arthroscopy time.

A 7-min video training intervention improves worker short-term radiation safety behavior during small animal diagnostic radiography.

Although manual restraint for small animal diagnostic radiography is common, worker protection is often not optimized, particularly for hands and eyes. Radiation safety training videos generally include hours of material on content other than personal protective equipment (PPE), have limited content, if any, on reducing dose to the lens of the eye, and are presented at the level of veterinary professionals. The objectives of this prospective, observational study were to develop a short, open access video training intervention at the layperson level, focused on proper use of PPE, and to test the effectiveness of the training video in changing behavior of workers. The use of PPE, optimal head position, and body position relative to the source of scattered radiation were compared before and after the video training was completed by workers. Results of unconditional and multivariable analyses were similar. In final multivariable analysis, workers wore gloves correctly more frequently (odds ratio [OR] = 2.09; 95% confidence interval [CI], 1.68-2.59; P < .001) and wore eyewear more frequently (OR = 1.85; 95% CI, 1.23-2.78; P = .003) after completing the training intervention. Workers also had an optimal head position more frequently (OR = 1.27; 95% CI, 1.03-1.58; P = .03) and stood straight or leaned back more frequently (OR = 1.85; 95% CI, 1.48-2.23; P < .001) after completing the training. The video training developed in this study is an effective tool that can be incorporated into a radiation protection program to improve worker radiation safety behaviors during manual restraint for small animal diagnostic radiography.

Variables associated with physical health-related quality of life in Parkinson's disease patients presenting for deep brain stimulation.

Deep brain stimulation (DBS) benefits Parkinson's disease (PD) patient's quality of life specially in domains as mobility, activities of daily living (ADL) and bodily discomfort (BD), but little is known about the variables associated with these HRQOL domains in patients presenting for DBS. The objective is to evaluate variables associated with of HRQOL in a Brazilian sample of PD patients presenting for DBS treatment, specifically in the domains related with motor symptoms. In a cross-sectional study of 59 PD patients evaluated at outpatient Unit for Movement Disorders, multiple linear regression analysis was performed to identify independent variables associated with mobility, ADL and BD domains of the 39-item Parkinson's disease questionnaire (PDQ-39). UPDRS III "on" scores, duration of the disease, age, presence of comorbidities and anxiety and depressive symptoms quantified by hospital anxiety and depression scale (HADS), were the independent variables. In our results, HADS scores were independently associated to mobility domain: ß coefficient 1.36 (95 % CI 0.55-2.15) and BD domain: ß coefficient 1.57 (95 % CI 0.67-2.48). UPDRS III "on" scores were independently associated to mobility domain: 0.42 (95 % CI 0.03-0.81). The model of each multiple linear regression analysis explains 25 % of the mobility domain variability (p < 0.01) and 24 % of the BD domain variability (p < 0.01). Psychiatric symptoms were at least as relevant to quality of life as motor symptoms in PD patients presenting for DBS treatment. The effect of treating these psychiatric symptoms on patients' HRQOL deserves further investigation.

Endometrial polyps: when to resect?

PURPOSE: To determine the prevalence of malignant and premalignant endometrial polyps and to investigate the association of malignancy with specific factors. METHODS: This is a retrospective study of women submitted to hysteroscopic resection of endometrial polyps between January 2005 and July 2013 at a university hospital in southern Brazil. Data regarding clinical characteristics and pathology findings were collected from patient charts. RESULTS: Of 359 patients, 87.2% had benign polyps and 9.9% had hyperplasia without atypia. Atypical hyperplasia was found in 2.6% of the sample. Endometrial adenocarcinoma was found in one woman (0.3%). A correlation was observed between malignant/premalignant polyps and patient age, menopausal status, and uterine bleeding. All patients with malignancies/premalignancies had abnormal uterine bleeding. Higher frequency of malignant polyps was observed in tamoxifen users, however, without statistical significance (p = 0.059%). Malignancy was not correlated with arterial hypertension, diabetes mellitus, obesity, hormone therapy, endometrial thickness, and polyp diameter. CONCLUSIONS: Malignant/premalignant findings had low prevalence and were absent in asymptomatic patients. From the data of this retrospective study, it is unclear whether routine polypectomy should be performed in asymptomatic patients. Further prospective studies including larger numbers of patients are required to guide treatment recommendations.

Early hematological and immunological alterations in gasoline station attendants exposed to benzene.

INTRODUCTION: Elucidation of effective biomarkers may provide tools for the early detection of biological alterations caused by benzene exposure and may contribute to the reduction of occupational diseases. This study aimed to assess early alterations on hematological and immunological systems of workers exposed to benzene. METHODS: Sixty gasoline station attendants (GSA group) and 28 control subjects were evaluated. Environmental and biological monitoring of benzene exposure was performed in blood and urine. The potential effect biomarkers evaluated were δ-aminolevulinate dehydratase (ALA-D) activity, CD80 and CD86 expression in lymphocytes and monocytes, and serum interleukin-8 (IL-8). The influence of confounding factors and toluene co-exposure were considered. RESULTS: Although exposures were below ACGIH (American Conference of Governmental Industrial Hygienists) limits, reduced ALA-D activity, decreased CD80 and CD86 expression in monocytes and increased IL-8 levels were found in the GSA group compared to the control subjects. Furthermore, according to multiple linear regression analysis, benzene exposure was associated to a decrease in CD80 and CD86 expression in monocytes. CONCLUSIONS: These findings suggest, for the first time, a potential effect of benzene exposure on ALA-D activity, CD80 and CD86 expression, IL-8 levels, which could be suggested as potential markers for the early detection of benzene-induced alterations.

Exogenous and endogenous antioxidants attenuate the lipid peroxidation in workers occupationally exposed to paints.

Occupational exposure to organic solvents present in paints is responsible for an increased production of reactive species, thus enabling the development of several diseases. Besides, both exo- and endogenous antioxidant defense systems are necessary to avoid oxidative tissue damage. This study investigated possible protective effects of the exo- and endogenous antioxidants on oxidative damage in painters occupationally exposed to organic solvents (n = 42) and controls (n = 28). Retinol, lycopene and ß-carotene were significantly lower in the exposed group. Despite the fact that blood toluene was below the biological exposure limits, malondialdehyde levels and antioxidant enzyme activities were increased, whereas reduced glutathione levels were decreased in painters, compared to nonexposed subjects. Moreover, multivariate regression models showed that reduced glutathione and carotenoids (mainly ß-carotene) have the major influence on lipid peroxidation (LPO). The present work suggests that the exogenous antioxidants, such as carotenoids, could protect occupationally exposed subjects to xenobiotics from LPO.

Blood thioredoxin reductase activity, oxidative stress and hematological parameters in painters and battery workers: relationship with lead and cadmium levels in blood.

Oxidative stress has been shown to be involved in lead and cadmium toxicity. We recently showed that the activity of the antioxidant enzyme thioredoxin reductase (TrxR) is increased in the kidneys of lead-exposed rats. The present study evaluated the blood cadmium and blood lead levels (BLLs) and their relationship with hematological and oxidative stress parameters, including blood TrxR activity in 50 painters, 23 battery workers and 36 control subjects. Erythrocyte δ-aminolevulinate dehydratase (δ-ALA-D) activity and its reactivation index were measured as biomarkers of lead effects. BLLs increased in painters, but were even higher in the battery workers group. In turn, blood cadmium levels increased only in the painters group, whose levels were higher than the recommended limit. δ-ALA-D activity was inhibited only in battery workers, whereas the δ-ALA-D reactivation index increased in both exposed groups; both parameters were correlated to BLLs (r = -0.59 and 0.84, P < 0.05), whereas the reactivation index was also correlated to blood cadmium levels (r = 0.27, P < 0.05). The changes in oxidative stress and hematological parameters were distinctively associated with either BLLs or blood cadmium levels, except glutathione-S-transferase activity, which was correlated with both lead (r = 0.34) and cadmium (r = 0.47; P < 0.05). However, TrxR activity did not correlate with any of the metals evaluated. In conclusion, blood TrxR activity does not seem to be a good parameter to evaluate oxidative stress in lead- and cadmium-exposed populations. However, lead-associated changes in biochemical and hematological parameters at low BLLs underlie the necessity of re-evaluating the recommended health-based limits in occupational exposure to this metal.

Evaluation of lipid damage related to pathological and physiological conditions.

Several diseases and xenobiotics are known to generate reactive species that may trigger oxidative stress when not properly scavenged by the antioxidant defenses and result in tissue damage. We investigated lipid peroxidation (LPO) as a possible mechanism for tissue damage in some pathologies, in the normal aging process, and in subjects exposed to organic solvents. Plasmatic malondialdehyde (MDA) was quantified by high-performance liquid chromatography with visible wavelength detection in 239 subjects and divided into the following: acute myocardium infarction (AMI), diabetes without complications (D) and hemodialysis (HD) patients; into healthy children, adults, and elderly, all nonexposed to xenobiotics; and into painters occupationally exposed to organic solvents (P). Troponin, glycated hemoglobin, and transminases [aspartate aminotransferase (AST) and alanine aminotransferase] were analyzed. An increase in LPO was observed in AMI, D, HD, and P groups, when compared to healthy adults. No correlation between MDA and age was found. Further, we found positive correlations between MDA versus troponin (r = 0.47), MDA versus HbA1c (r = 0.56), and MDA versus AST (r = 0.41) in AMI, diabetics, and painters, respectively. This work has demonstrated increased lipid and protein damages in myocardium and blood, along with an alteration of hepatic transaminase activities and induction of LPO, suggesting that MDA levels are important to evaluate the extent of tissue alterations and development of acute and chronic conditions.

Crucial neuroprotective roles of the metabolite BH4 in dopaminergic neurons.

Dopa-responsive dystonia (DRD) and Parkinson's disease (PD) are movement disorders caused by the dysfunction of nigrostriatal dopaminergic neurons. Identifying druggable pathways and biomarkers for guiding therapies is crucial due to the debilitating nature of these disorders. Recent genetic studies have identified variants of GTP cyclohydrolase-1 (GCH1), the rate-limiting enzyme in tetrahydrobiopterin (BH4) synthesis, as causative for these movement disorders. Here, we show that genetic and pharmacological inhibition of BH4 synthesis in mice and human midbrain-like organoids accurately recapitulates motor, behavioral and biochemical characteristics of these human diseases, with severity of the phenotype correlating with extent of BH4 deficiency. We also show that BH4 deficiency increases sensitivities to several PD-related stressors in mice and PD human cells, resulting in worse behavioral and physiological outcomes. Conversely, genetic and pharmacological augmentation of BH4 protects mice from genetically- and chemically induced PD-related stressors. Importantly, increasing BH4 levels also protects primary cells from PD-affected individuals and human midbrain-like organoids (hMLOs) from these stressors. Mechanistically, BH4 not only serves as an essential cofactor for dopamine synthesis, but also independently regulates tyrosine hydroxylase levels, protects against ferroptosis, scavenges mitochondrial ROS, maintains neuronal excitability and promotes mitochondrial ATP production, thereby enhancing mitochondrial fitness and cellular respiration in multiple preclinical PD animal models, human dopaminergic midbrain-like organoids and primary cells from PD-affected individuals. Our findings pinpoint the BH4 pathway as a key metabolic program at the intersection of multiple protective mechanisms for the health and function of midbrain dopaminergic neurons, identifying it as a potential therapeutic target for PD.

The diversity present in 5140 human mitochondrial genomes.

We analyzed the current status (as of the end of August 2008) of human mitochondrial genomes deposited in GenBank, amounting to 5140 complete or coding-region sequences, in order to present an overall picture of the diversity present in the mitochondrial DNA of the global human population. To perform this task, we developed mtDNA-GeneSyn, a computer tool that identifies and exhaustedly classifies the diversity present in large genetic data sets. The diversity observed in the 5140 human mitochondrial genomes was compared with all possible transitions and transversions from the standard human mitochondrial reference genome. This comparison showed that tRNA and rRNA secondary structures have a large effect in limiting the diversity of the human mitochondrial sequences, whereas for the protein-coding genes there is a bias toward less variation at the second codon positions. The analysis of the observed amino acid variations showed a tolerance of variations that convert between the amino acids V, I, A, M, and T. This defines a group of amino acids with similar chemical properties that can interconvert by a single transition.

Evaluation of genotoxicity and oxidative damage in painters exposed to low levels of toluene.

Toluene is an organic solvent used in numerous processes and products, including industrial paints. Toluene neurotoxicity and reproductive toxicity are well recognized; however, its genotoxicity is still under discussion, and toluene is not classified as a carcinogenic solvent. Using the comet assay and the micronucleus test for detection of possible genotoxic effects of toluene, we monitored industrial painters from Rio Grande do Sul, Brazil. The putative involvement of oxidative stress in genetic damage and the influences of age, smoking, alcohol consumption, and exposure time were also assessed. Although all biomarkers of toluene exposure were below the biological exposure limits, painters presented significantly higher DNA damage (comet assay) than the control group; however, in the micronucleus assay, no significant difference was observed. Painters also showed alterations in hepatic enzymes and albumin levels, as well as oxidative damage, suggesting the involvement of oxidative stress. According to multiple linear regression analysis, blood toluene levels may account for the increased DNA damage in painters. In summary, this study showed that low levels of toluene exposure can cause genetic damage, and this is related to oxidative stress, age, and time of exposure.

Evaluation of Long-Term Results of Oberlin Surgery in Obstetric Brachial Paralysis.

Objective To evaluate elbow flexion in children with obstetric brachial plexus paralysis submitted to Oberlin transfer. Methods Retrospective study with 11 patients affected by paralysis due to labor who did not present spontaneous recovery from elbow flexion until 12 months of life, operated between 2010 and 2018. Results The children were operated between 5 and 12 months of life, with a mean of 7.9 months, and the mean follow-up time was 133.2 months, ranging from 37 to 238 months. Six patients (54.5%) presented a degree of muscle strength ≥ 3, measured by the strength scale of the Medical Research Council (MRC) and, according to the active movement scale (AMS), 5 patients obtained a score of ≥ 5. A negative correlation was identified between the AMS and the Narakas classification (r = -0.509), as well as between the strength scale (MRC) and the Narakas classification (r = -0.495). A strong positive correlation was observed (r = 0.935) between the AMS and the MRC demonstrating that the higher the score on the movement scale, the higher the score on the muscle strength scale. Conclusion The Oberlin surgery is a possible option for recovery of elbow flexion in children with neonatal plexopathy, demonstrating, however, very heterogeneous results, even in the long-term follow-up.

X-ray tube operators can be exposed to equal or higher scattered radiation doses to the hand as cassette holders during diagnostic radiographic procedures of the equine vertebral column and limbs.

OBJECTIVE: The objectives of this study were to investigate scattered radiation doses to the hands of equine workers holding the cassette and the x-ray tube by hand, for both limb and vertebral column studies, and to compare the scattered radiation attenuation of lead with radiation protection lead-free gloves. Radiation doses to the hands of the cassette holder in the primary beam were also investigated. SAMPLE: A whole-body horse cadaver. PROCEDURES: A portable x-ray unit was used to simulate 6 radiographic study types in the horse cadaver. Doses were measured with no shielding and, for cassette holders, with the ion chamber enclosed in a lead glove and a lead-free glove. Thirty exposures were performed for each study view and condition (n = 1,920). RESULTS: Mean scattered doses to x-ray unit operators were higher than doses to cassette holders for ungula (hoof), thoracic vertebrae, and lumbar vertebrae studies, whereas doses to cassette holders were higher than doses to x-ray tube operators for studies of the metacarpophalangeal joint (fetlock) and tarsus (hock). Doses did not differ for the stifle joint. Mean percentage decrease in scattered radiation dose was 99.58% with lead gloves and 98.9% with lead-free gloves. CLINICAL RELEVANCE: X-ray tube operators can be exposed to equal or higher scattered radiation doses to the hand as cassette holders. Lead-free hand shielding should only be considered as an alternative to lead gloves if their lighter weight increases frequency of use by workers.

The relationships between exogenous and endogenous antioxidants with the lipid profile and oxidative damage in hemodialysis patients.

BACKGROUND: We sought to investigate the relationships among the plasma levels of carotenoids, tocopherols, endogenous antioxidants, oxidative damage and lipid profiles and their possible effects on the cardiovascular risk associated with hemodialysis (HD) patients. METHODS: The study groups were divided into HD and healthy subjects. Plasma carotenoid, tocopherol and malondialdehyde (MDA) levels, as well as erythrocyte reduced glutathione (GSH), were measured by HPLC. Blood antioxidant enzymes, kidney function biomarkers and the lipid profiles were analyzed by spectrophotometric methods. RESULTS: Plasma lycopene levels and blood glutathione peroxidase (GPx) activity were significantly decreased in HD patients compared with healthy subjects. Total cholesterol, low-density lipoprotein cholesterol (LDL-c), creatinine, urea, MDA, GSH, superoxide dismutase (SOD) and catalase (CAT) were significantly increased in HD (p < 0.05). Lycopene levels were correlated with MDA (r = -0.50; p < 0.01), LDL-c (r = -0.38; p = 0.01) levels, the LDL-c/HDL-c index (r = -0.33; p = 0.03) and GPx activity (r = 0.30; p = 0.03). Regression models showed that lycopene levels were correlated with LDL-c (ß estimated = -31.59; p = 0.04), while gender was correlated with the TC/HDL-c index and triglycerides. Age did not present a correlation with the parameters evaluated. GPx activity was negatively correlated with MDA levels and with the LDL-c/HDL-c and CT/HDL-c indexes. CONCLUSIONS: Lycopene may represent an additional factor that contributes to reduced lipid peroxidation and atherogenesis in hemodialysis patients.

Hospital mortality of patients with severe traumatic brain injury is associated with serum PTX3 levels.

BACKGROUND: Traumatic brain injury (TBI) is a worldwide cause of morbidity and mortality. Pentraxin 3 (PTX3) is a humoral component of the innate immune system which has been studied as a marker of inflammatory, infections or cardiovascular pathologies. To investigate the association between serum levels of PTX3 and the hospital mortality of patients with severe TBI. METHODS: The independent association between serum PTX3 levels after severe TBI (Glasgow Coma Scale, GCS ≤ 8) and hospital mortality was analyzed in a prospective study of 83 consecutive patients by a multiple logistic regression analysis. The leukocyte count in the same sample was analyzed as another marker of inflammatory response. RESULTS: The mean age of patients was 35 years and 85% were male. Serum PTX3 levels were determined 18.0 (SD ± 17.0) h after TBI. Patients who died showed a mean serum PTX3 level of 9.95 µg/ml (SD ± 6.42) in comparison to 5.46 µg/ml (SD ± 4.87) of the survivor group (P = 0.007). Elevated serum PTX3 levels remain significantly associated with mortality (P = 0.04) in the subset of patients with isolated TBI (n = 34). There were no differences in the leukocytes count measured in the same blood sample used for PTX3 determination in survivors and non-survivors (P = 0.56). The final multiple logistic regression model including age, pupillary examination, GCS, associated trauma, and PTX3 levels shows that serum levels of PTX3 which were higher than 10 µg/ml were independently associated with the patients mortality (adjusted OR 3.06, CI 95% 1.03-9.15, P = 0.04). CONCLUSIONS: Serum PTX3 levels after severe TBI are independently associated with higher hospital mortality and may be a useful marker of TBI and its prognosis.

Effect of conjugated estrogen versus conjugated estrogen associated with medroxyprogesterone acetate in postmenopausal women on internal carotid artery pulsatility index: a randomized pilot study.

AIM: To compare the effect of conjugated estrogen (CEE) versus conjugated estrogen and medroxyprogesterone acetate (MPA) therapy on internal carotid artery pulsatility index (PI) in postmenopausal women. MATERIAL & METHODS: In the prospective, randomized, single-blinded comparative study, postmenopausal women meeting the inclusion criteria were randomized into one of two groups: CEE group (CEE 0.625 mg/day), or CEE + MPA group (CEE 0.625 mg/day plus MPA 2.5 mg/day). Patients were submitted to blood tests (total cholesterol, high-density lipoprotein cholesterol, triglycerides and total glucose) and to color Doppler ultrasound of the internal carotid artery to assess PI at the beginning of the study. Ultrasound was repeated after 16 weeks of treatment. Statistical analysis was performed using Student's t-test or two-way analysis of variance for repeated measures. Data were considered to be significant at P < 0.05. RESULTS: Seventy-five postmenopausal women (age 53.3 ± 5.5 years) were included in the study. There was a statistically significant reduction in PI in both groups after 16 weeks of hormonal treatment. However, there was no difference between the two groups (group 1: 0.8960 to 0.8450; group 2: 0.9048 to 0.8426). CONCLUSION: The use of CEE and CEE associated with MPA during 16 weeks led to an improvement in internal carotid flow as measured by PI, with no difference between the treatments.

Pilot Randomized Control Trial: Efficacy of a Group-Based Psychosocial Program for Youth with PTSD in the Brazilian Favelas.

The study aimed to evaluate Teaching Recovery Techniques (TRT) delivered to Brazilian youth who experienced drug violence in one Favela. Thirty children, 8 to 14 years, were randomly assigned to TRT (n = 14) or to a treatment as usual group (n = 16) involving boxing/martial arts. Youth received five 90-min sessions over successive weeks. Standardized measures assessed Posttraumatic Stress and Depression at 2 weeks pre and post-test. An exploratory assessment of posttraumatic growth was also utilized. An interview with group leaders explored perceptions of delivering TRT within the favela. Medium effect sizes were found for PTSD and Depression, and a small effect size for posttraumatic growth. Group leaders emphasized understanding the favela context for program adaptation. In conclusion, TRT was found to be effective for children with PTSD and Depression who experienced drug violence in a Brazilian favela. TRT is recommended for future delivery. Larger scale RCTs are needed in Brazilian favelas.

Survey of self-reported radiation safety practices among North American veterinary technicians involved in equine radiography using portable x-ray equipment.

OBJECTIVES: To describe self-reported radiation safety practices by equine veterinary technicians in North America and identify factors associated with these practices. SAMPLE: 154 equine technicians. PROCEDURES: An electronic questionnaire regarding radiation safety practices during the use of portable x-ray equipment was sent to 884 members of the American Association of Equine Veterinary Technicians and Assistants. Data were summarized, and various factors were evaluated for associations with reported safety practices. RESULTS: 221 of 884 (25.0%) questionnaires were completed, including 154 by equine technicians who had been involved in equine radiography as x-ray tube operators, cassette holders, or both in the previous year. Lead apron use was suboptimal, reported as "always" for 80.0% (104/130) of tube operators and 83.1% (123/148) of cassette holders. Approximately 20% of participants never wore thyroid shields, and approximately 90% never wore lead eyeglasses. Almost 50% of participants did not have lead eyeglasses available. Although > 55% of participants always held the x-ray equipment by hand, 58.4% (73/125) of tube operators and 25.0% (35/140) of cassette holders never wore gloves. Cassette holders wore lead gloves and personal radiation dose-monitoring devices significantly more frequently than did tube operators. CONCLUSIONS AND CLINICAL RELEVANCE: Compliance of North American equine technicians with radiation safety recommendations by the National Council on Radiation Protection and Measurements was suboptimal. Improvements in radiation safety training and education, strengthening the connection between academic institutions and private practices, and greater availability and requirement of personal protective equipment use by senior clinicians and employers might aid in improving safety practices.