The Dark Side of the Light: Phototherapy Adverse Effects

Phototherapy is a valuable therapeutic tool in Dermatology, but there may be drawbacks. Acute and long-term adverse effects, of variable severity, include skin erythema, xerosis, pruritus, blistering, altered pigmentation, photoaging, and photocarcinogenesis. Despite concerns over the carcinogenic potential of ultraviolet radiation, most studies have not found an increased risk of non-melanoma or melanoma skin cancer in patients treated with ultraviolet B (broadband and narrowband) and ultraviolet A1 phototherapy. These are therefore considered reasonably safe treatment modalities concerning the development of skin neoplasms, although caution and further investigation are warranted. Photoprotective measures, such as avoidance of concurrent sunlight exposure and covering skin areas not afflicted with disease, or more modern strategies, including phytochemical antioxidants and exogenous DNA repair enzymes, can minimize the hazards of phototherapy. Patients submitted to phototherapeutic regimens should undergo complete, careful dermatologic examination regularly and lifelong.info:eu-repo/semantics/publishedVersio

The Dark Side of the Light: Mechanisms of Photocarcinogenesis

Ultraviolet radiation (UVR) can have a beneficial biologic impact on skin, but it is also the most significant environmental risk factor for skin cancer development. Photocarcinogenesis comprises a complex interplay between the carcinogenic UVR, skin, and the immune system. UVB is absorbed by the superficial skin layers and is mainly responsible for direct DNA damage, which, if unrepaired, can lead to mutations in key cancer genes. UVA is less carcinogenic, penetrates deeper in the dermis, and mainly causes indirect oxidative damage to cellular DNA, proteins, and lipids, via photosensitized reactions. UVR not only induces mutagenesis, altering proliferation and differentiation of skin cells, but also has several immunosuppressive effects that compromise tumor immunosurveillance by impairing antigen presentation, inducing suppressive cells, and modulating the cytokine environment. This review focuses upon molecular and cellular effects of UVR, regarding its role in skin cancer development.info:eu-repo/semantics/publishedVersio

O cuidado do enfermeiro ao adolescente com sífilis na atenção primária à saúde : revisão de escopo

Introdução: A Atenção Primária à Saúde é considerada a porta de entrada do Sistema Único de Saúde, nesse sentido, o acompanhamento, prevenção e controle da sífilis pelos enfermeiros junto aos adolescentes de forma integral e resolutiva é fundamental. Objetivo: identificar as práticas dos enfermeiros no acompanhamento de adolescentes com sífilis na Atenção Primária à Saúde. Metodologia: Trata-se de uma revisão sistemática da literatura por meio de uma revisão de escopo, a questão de pesquisa deste estudo foi: Quais são as práticas dos enfermeiros no acompanhamento de adolescentes com sífilis na Atenção Primária à Saúde? Foram verificadas as bases: Literatura Latino-Americana e do Caribe da Saúde (LILACS), Literatura Internacional em Ciências da Saúde (MEDLINE), Índice Bibliográfico Espanhol de Ciências da Saúde (IBECS), Base de Dados de Enfermagem (BDENF). A biblioteca Medical Literature Library Online (SciELO) e a PubMed também foi verificadas. A ferramenta Google Acadêmico e as listas de referências da literatura relevante também foram verificadas. As buscas foram realizadas em fevereiro de 2020. Incluíram-se artigos originais, sobre a atenção à saúde de adolescentes, cujos sujeitos de pesquisa fossem os próprios adolescentes e/ou os enfermeiros. Resultados: Do total de 1.361 artigos encontrados nas bases de dados, foram incluídos 16 estudos na revisão, publicados entre 2008 e 2019, tendo sido realizada seleção destes devido a sua recorrência e relevância. Das análise resultaram duas categorias: As ações de enfermagem no cuidado de adolescentes com sífilis e as Potencialidades e desafios vivenciadas pelos enfermeiros no cuidado a adolescentes com sífilis. Considerações finais: constatou-se que há poucos estudos frente ao cuidado do adolescente com sífilis na atenção primária, evidenciando a necessidade de novos estudos sobre o tema. O enfermeiro é o profissional de saúde habilitado para o acompanhamento de adolescentes com sífilis na Atenção Primária à Saúde por sua capacidade de construção de vínculo com o usuário e a comunidade.Introduction: Primary Health Care is considered the gateway to the Unified Health System, in this sense, the monitoring, prevention and control of syphilis by nurses with adolescents in an integral and resolutive manner is fundamental.Objective: To identify nurses' practices in attendance adolescents with syphilis in Primary Health Care.Methodology: This is a systematic review of the literature through a scoping review, the research question of this study was: What are the nurses' practices in attendance adolescents with syphilis in Primary Health Care? The bases were verified: Latin American and Caribbean Health Literature (LILACS), International Health Sciences Literature (MEDLINE), Spanish Health Sciences Bibliographic Index (IBECS), Nursing Database (BDENF). The Medical Literature Library Online (SciELO) and PubMed were also checked. The Google Scholar tool and reference lists from the relevant literature were also checked. The searches were carried out in February 2020. Original articles on adolescents' health care were included, whose research subjects were the adolescents and/or nurses themselves. Results: From the total of 1.361 articles found in the databases, 16 studies were included in the review, published between 2008 and 2019. The analysis resulted in two categories: Nursing actions in the care of adolescents with syphilis and the potentials and challenges experienced by nurses in the care of adolescents with syphilis.Final considerations: it was found that there are few studies on the care of adolescents with syphilis in primary care, showing the need for further studies on the topic. The nurse is the health professional qualified to accompany adolescents with syphilis in Primary Health Care due to their ability to build bonds with the user and the community

Intra- and Interreader Variability of Orbital Volume Quantification Using 3D Computed Tomography for Reconstructed Orbital Fractures

Purpose: Management of orbital fractures continues to present some difficulties, particularly regarding the prediction of late complications. Radiographic assessment provides a detailed evaluation, but the results lack consistency to be considered a standard factor in the decision-making process. Studies focusing on reliability of post-operative imaging are lacking. Materials and methods: We performed a retrospective study using patients from a major trauma center with unilateral orbital floor fracture who underwent surgery. Using three-dimensional volume assessment software, we performed a volume calculation and determined the intra- and interreader variation by intraclass correlation coefficient analysis. Results: Twenty-four orbits were assessed. Mean orbital volume (SD) was 24.02 (2,43) cm3 for reader 1 and 24.08 (2,51) cm3 for reader 2. The intraclass correlation coefficient (95% CI) was 0.95 (0.91-0.98) between readers and 0.96 (0.91-0.98) for intra-reader variability. Normal and reconstructed orbits assessed separately also showed very high correlation coefficient for both intra- and inter-subject variability. Conclusion: Results show an almost perfect agreement of volume assessment between readers. The presence of reconstruction material does not seem to add variability. Although reproducible and reliable, radiological volume assessments have not yet shown a clear correlation with clinical outcomes and post-operative management decisions should be based mainly on clinical findings.info:eu-repo/semantics/publishedVersio

Unknown Primary Merkel Cell Carcinoma With Cutaneous Spread

The authors present the case of a woman in the seventh decade of life with medical history of: left nephrectomy for renal tuberculosis and non-Hodgkin's lymphoma treated with chemotherapy (QT) and radiotherapy. She presented with a 2-month history of non-tender, left inguinal lymph node enlargement. Positron Emission Tomography (PET)-CT -scanshowed hypermetabolic inguinal and retroperitoneal lymphadenopathies, no primary tumour. On the second dermatological examination a pink, 2 cm plaque on the anterior left knee was noted. The histopathological analysis revealed Merkel cell carcinoma. The patient underwent two lines of systemic QT, with life-threatening toxicities limiting treatment. Followed overwhelming disease progression with lymphoedema and numerous skin metastases in the left lower limb. The patient received palliative care until death. The rare incidence of such neoplasia and its uncommon clinical presentation justifies reporting this case and highlights the importance of multidisciplinary teams in the management of cancer patients.info:eu-repo/semantics/publishedVersio

Pyoderma Gangrenosum in a Patient with Ulcerative Colitis

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Odontoameloblastoma: a Clinical Case Report

O odontoameloblastoma é um tumor odontogénico misto muito raro. Reportam-se 29 casos bem documentados na literatura inglesa consultada, dos quais apenas 5 têm envolvimento do segmento anterior da mandíbula. Um homem de 51 anos apresentava um tumor da região anterior da mandíbula, com tumefacção dura, difusa e indolor na região parassinfisária direita da mandíbula. Radiograficamente existia extensa lesão radiolucente, bem delimitada, desde o dente 46 ao dente 34, com pequenas estruturas calcificadas no interior. Observava-se expansão óssea com provável perfuração cortical e reabsorções radiculares. Após biópsia realizou-se resseção cirúrgica. O exame anatomopatológico permitiu o diagnóstico de odontoameloblastoma. Não houve recorrência nos 30 meses de seguimento. O odontoameloblastoma é um tumor localmente agressivo com comportamento aparentemente semelhante ao dos ameloblastomas, em termos de crescimento, expansão óssea, rizólise e recorrência, parecendo prudente adotar o mesmo critério terapêutico para ambos

Use of thoracoepigastric flap in the closure of large chest wall defects after surgical treatment of locally advanced breast tumor: a case report

Breast cancer is the most common type of malignancy among women in Brazil and worldwide, excluding non-melanoma skin cancers. The purpose of this report is to describe the case of a patient with invasive breast carcinoma, associated with a large extent of skin involvement and nipple-areola complex, whose lesion was unchanged after neoadjuvant chemotherapy. After a Halsted mastectomy, the thoraco-epigastric flap was used to close the thoracic defect, with a favorable evolution of the patient. The use of the thoraco-epigastric flap has been described as a reliable tool because it is characterized as a technique that is easy to perform, safe and with minimal post-surgical complications

Changes in the epidemiology of maxillofacial trauma

Objectives: Due to COVID-19 pandemic, social distancing policies were enacted worldwide, including by the Portuguese official authorities. However, the impact of these measures on maxillofacial trauma and fracture surgical repair remains poorly understood. The aim of this study was to evaluate and compare the incidence and aetiology of facial fractures submitted to surgical repair during 1-year of COVID-19 pandemic versus the previous 4 years, in a level III Trauma Centre located in Lisbon, Portugal. Materials and methods: All emergency episodes registered in our hospital between March 2016 and February 2021 that resulted in patient admittance for surgical treatment of facial fracture were included. Comparative analysis was performed for variables such as fracture type and aetiology. Results: Analysis showed that surgeries performed during the 1st year of COVID-19 were reduced by 37.5 %. Considering only the 75-day lockdown period at the beginning of the pandemic, reduction was even more pronounced and reached-66.7 %. Significant differences in the aetiology were also found, with physical assault and sport accidents relative frequency decreasing. Moreover, despite being systematically the second most common cause of fracture, during lockdown, fall ranked first, over physical assault. The relative frequency of nasal fractures, the most common facial fracture treated in our hospital, decreased during both the 1st year of COVID-19 and the lockdown period, while mandible fractures ranked first during lockdown. Conclusions: Our study shows that COVID-19 pandemic and enacted policies have significantly changed the epidemiology of maxillofacial trauma.publishersversionpublishe

Neoplastic Cutaneous Infiltration by Lymphoplasmacytic Lymphoma in a Patient with Waldenström's Macroglobulinemia

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