Fotobiomodulação no tratamento do trismo em pacientes tratados por câncer de boca ou orofaringe: um ensaio clínico controlado randomizado / Photobiomodulation in the treatment of trismus in patients treated for oral or oropharyngeal cancer: a randomized controlled clinical trial

RESUMO Objetivo investigar a eficácia da associação entre a fotobiomodulação de baixa frequência e a terapia fonoaudiológica tradicional no tratamento do trismo, em pacientes tratados por câncer de boca ou orofaringe. Métodos ensaio clínico controlado, randomizado, longitudinal e prospectivo, realizado de acordo as normas da declaração CONSORT 2010. Para a coleta de dados, foi utilizado o questionário sociodemográfico, a avaliação clínica, a mensuração da abertura de boca por paquímetro, o protocolo de dor McGuill e o protocolo de qualidade de vida WHOQOL-Bref. A amostra foi composta por 30 participantes, de ambos os gêneros na faixa etária de 35-75 anos, divididos em dois grupos, controle e experimental, de forma controlada, mediante sorteio igualitário no que tange aos critérios de inclusão e exclusão. Resultados por meio dos dados analisados, observou-se que houve aumento da amplitude vertical de mandíbula em ambos os grupos, GC: p<0,005 e GE: p<0,001. Não houve correlação estatística entre os grupos na comparação da abertura de boca, p>0,19, assim como em relação à dor orofacial e à qualidade de vida, p= 0,72, ambas as avaliações após a intervenção fonoaudiológica, porém, com melhores resultados para o GE, p<0,001. Conclusão Conclui-se pela eficácia da intervenção fonoaudiológica tradicional e a associação com a fotobiomodulação de baixa frequência no tratamento do trismo. Para a dor orofacial e qualidade de vida, o tratamento associado é mais benéfico.

ABSTRACT Purpose to investigate the effectiveness of the association between low-frequency photobiomodulation and traditional speech therapy in the treatment of trismus in patients treated for oral or oropharyngeal cancer. Methods controlled, randomized, longitudinal and prospective clinical trial, carried out in accordance with the norms of the CONSORT 2010 declaration. For data collection, a sociodemographic questionnaire, clinical evaluation, measurement of mouth opening by caliper, the protocol of McGuill pain and the WHOQOL-Bref quality of life protocol. The sample consisted of 30 participants, of both genders, aged between 35-75 years, divided into two groups, control and experimental, in a controlled manner, through an equal draw with regard to the inclusion and exclusion criteria. Results through the analyzed data, it was observed that there was an increase in the vertical amplitude of the mandible in both groups, CG: p0.19, as well as in relation to orofacial pain and quality of life, p= 0.72, both assessments after the speech therapy intervention, however, with better results for the EG, p<0.001. Conclusion It is concluded that the traditional speech therapy intervention and its association with low-frequency photobiomodulation are effective in the treatment of trismus. For orofacial pain and quality of life, associated treatment is more beneficial.

The biological effects of different LED wavelengths in the health field. A review / Os efeitos biológicos de diferentes comprimentos de onda de LED na área da saúde. Uma revisão

Introduction: the use of light emitting diodes (LED) in domestic and public vias have increased in the last 20 years. In addition, the LED light has been used as a light source for medical applications. Objective: since humans are increasingly exposed to LEDs, there is an urgency to investigate the possible biological effects on tissues caused by this exposure. So, researchers have been focused their investigations in the application of this light in the health field. Material and method: in this review, a search in important databases was performed on the biological effects caused after application of different LED light protocols in in vitro and in vivo studies. Result: although most published papers have shown positive results, some of them reported negative biological effects of light LEDs technology on humans' cells/tissues. Conclusion: therefore, the comprehension of the biological effects caused by light LEDs will provide a better assessment of the risks involved using this technology.

Introdução: o uso de diodos emissores de luz ("LED") em vias domésticas e públicas tem aumentado nos últimos 20 anos. Além disso, a luz LED tem sido usada para aplicações médicas. Objetivo: pelo fato de seres humanos estarem cada vez mais expostos aos LEDs, há urgência em investigar os possíveis efeitos biológicos nos tecidos causados por esta exposição. Assim, pesquisadores têm focado suas investigações no uso desta luz na área da saúde. Material e método: nesta revisão foi realizada uma pesquisa em bancos de dados conceituados sobre os efeitos biológicos causados após aplicação de diferentes protocolos de luz LED em estudos in vitro e in vivo. Resultado: embora a maioria dos artigos publicados tenham mostrado resultados positivos, alguns deles relataram efeitos biológicos negativos da tecnologia de LEDs nas células/tecidos humanos. Conclusão: portanto, a compreensão dos efeitos biológicos causados pela luz LED proporcionará uma melhor avaliação dos riscos envolvidos no uso desta tecnologia.

Telangiectasia macularis eruptiva perstans treated with narrow-band UVB phototherapy and heliotherapy during the COVID-19 pandemic

@#Telangiectasia macularis eruptiva perstans (TMEP) is a rare disease, previously classified as a variant of cutaneous mastocytosis. While no gold standard of treatment exists, several treatments have been studied. We report a case of a 63-year-old woman who presented with long-standing asymptomatic telangiectatic macules beginning on the upper chest, back, and bilateral arms, with occasional pruritus and no other systemic symptoms. Skin biopsy, along with Giemsa stain, revealed findings consistent with TMEP. The patient underwent testing for serum tryptase level, which was within normal limits. The patient was started on topical steroids for two weeks and antihistamine therapy, with a noted decrease in pruritus but no change in cutaneous lesions. She was then advised to start phototherapy, and subsequently underwent a total of five sessions of narrow-band ultraviolet B phototherapy, after which she noted lightening of the lesions. Due to the COVID pandemic, the patient was shifted to heliotherapy with continued lightening of lesions after two months of thrice weekly sessions. This rare case is supportive of narrow-band ultraviolet B phototherapy and heliotherapy as promising treatment options for cases of TMEP.

Cuidados de enfermagem aos recém-nascidos submetidos a fototerapia em unidades neonatais: um protocolo de scoping review / Nursing care for newborns undergoing phototherapy in neonatal units: a scoping review protocol

Objetivo: Mapear a produção do conhecimento sobre os principais cuidados de enfermagem realizados aos recém-nascidos submetidos a fototerapia em unidades neonatais. Método: Trata-se de um protocolo de revisão de escopo, realizado de acordo com a metodologia do Joanna Briggs Institute e checklist do Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), seguindo as seguintes etapas: seleção da questão de pesquisa; busca por estudos relevantes; seleção dos estudos; extração e análise dos dados; e, agrupamento, resumo e apresentação dos resultados. Para identificar os documentos as seguintes bases de dados bibliográficas serão pesquisadas: Medical Literature Analysis and Retrievel System Online, Cumulative Index to Nursing & Allied Health Literature, Web of Science, SciVerse Scopus, Base de Dados de Enfermagem, Literatura Latino-Americano e do Caribe em Ciências da Saúde, Scientific Electronic Library Online, Cochrane Library, Catálogo de Teses e Dissertações da Capes e Google Acadêmico. O resultado do fluxo de seleção, desta etapa metodológica, será apresentado em forma de figura, conforme o Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Resultados: O mapeamento dos dados permitirá o agrupamento dos cuidados além de evidenciar a necessidade destes para os recém-nascidos submetidos à fototerapia. Conclusão: Espera-se salientar a indispensabilidade dos cuidados de enfermagem a este público e reforçar a necessidade de educação continuada aos profissionais.

Objetivo: Mapear la producción de conocimiento sobre los principales cuidados de enfermería brindados a las criaturas recién nacidas sometidas a fototerapia en unidades neonatales. Revisión: Se trata de un protocolo de revisión del alcance realizado, según la metodología del Instituto Joanna Briggs y la lista de verificación Elementos de informe preferidos para revisiones sistemáticas y extensión de metaanálisis para revisiones de alcance (PRISMA-ScR). Lo anterior, siguiendo los siguientes pasos: selección de la pregunta de investigación, buscar estudios relevantes, selección de estudios, extracción y análisis de datos y, agrupar, resumir y presentar los resultados. Para identificar los documentos, se buscará literatura en las siguientes bases de datos: Sistema de recuperación y análisis de literatura médica en línea, Índice acumulativo de enfermería y Literatura relacionada con la salud, Web of Science, SciVerse Scopus, base de datos de Enfermería, Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Scientific Electronic Library Online, Cochrane Library, Capes Theses and Dissertations Catalog y Google Scholar. El resultado del flujo de selección de este paso metodológico se presentará en forma de figura, de acuerdo con PRISMA-ScR. Resultados: El mapeo de datos permitirá la agrupación de cuidados, además, resaltar la necesidad de estos para las criaturas recién nacidas sometidas a fototerapia. Conclusión: Se espera resaltar la indispensabilidad del cuidado de enfermería para este público y reforzar la necesidad de educación continua para las personas profesionales en esta área.

Objective: To map the production of knowledge on the main nursing care provided to newborns undergoing phototherapy in neonatal units. Method: This is a scoping review protocol carried out following the Joanna Briggs Institute methodology and the Preferred checklist Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The following the following steps were followd: selection of the research question, search for relevant studies, selection of studies, data extraction and analysis, and, grouping, summarizing and presenting the results. The following databases will be consulted to identify the documents: Medical Literature Analysis and Retrievel System Online, Cumulative Index to Nursing & Allied Health Literature, Web of Science, SciVerse Scopus, Database of Nursing, Latin American and Caribbean Literature in Health Sciences, Scientific Electronic Library Online, Cochrane Library, Capes Theses and Dissertations Catalog, and Google Scholar. The result of this methodological step's selection flow will be presented in figure form as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Results: The data mapping will allow the grouping of care and it will also highlight the need for care in newborns undergoing phototherapy. Conclusion: It is expected to highlight the indispensableness of nursing care for this public and reinforce the need for continuing education in professionals.

Fototerapia neonatal: Vigilando la dosis óptima / Neonatal phototherapy: Monitoring the optimal dose

Introducción: La fototerapia es el tratamiento para la ictericia neonatal, pero debe asegurar una "dosis" suficiente de luz irradiada en la banda espectral correcta y sobre una superficie de piel suficientemente amplia. Varios equipos de fototerapia han sido desarrollados para cumplir con este requisito técnico, inclusive actualmente en el mercado se disponen de equipos de alta intensidad lumínica que permiten aplicar una fototerapia intensiva. Propósito de la revisión: El objetivo de la presente revisión es responder a las siguientes preguntas: ¿Cómo se determina si los equipos de fototerapia emiten la intensidad suficiente de luz para asegurar la dosis de tratamiento? En términos de mantenimiento de equipos, la principal directriz que se ha empleado en la mayoría de unidades de neonatología es el número de horas de uso, pero, ¿Es en realidad el parámetro adecuado? Hallazgos recientes: Con esta revisión invitamos a los profe-sionales de la salud en las unidades de neonatología a hablar en términos de irradiancia, entendida como la medida para determinar el tiempo ideal para el mantenimiento y recambio de las luces de los equipos de fototerapia y así asegurar el tratamiento efectivo en los neonatos. Conclusión: Los aparatos con tecnología LED deben ser verificados con emisiones de irradiancia >10 µW/cm2/nm, estableciendo la garantía de la degradación de la bilirrubina.

Introduction: Phototherapy is the treatment for neonatal jaundice; it has to ensure a sufficient dose of irradiated light in the correct spectral band and on a sufficiently large skin area. Therefore, much phototherapy equipment has been developed to achieve this goal; currently, high-light-intensity equipment provides intensive phototherapy. Purpose of the review: This review aims to answer the following questions: How do we determine if photothera-py equipment emits sufficient light intensity to ensure the treatment dose? Regarding equipment maintenance, the leading guideline used in most neonatology units is the number of hours of use, but is it the appropriate parameter? Recent findings: With this review, we invite health professionals in neonatology units to speak regarding irradiance, understood as the measure to determine the ideal time for maintenance and replacement of the lights of the phototherapy equipment and thus ensure an effective treatment in neonates. Conclusion: Devices with LED technology must be verified with irradiance emissions >10 µW/cm2/nm to guarantee bilirubin degradation.

Pitiríase liquenoide pós-vacinação contra COVID-19: um relato de caso / Pityriasis lichenoides after COVID-19 vaccination: a case report

O artigo aborda o primeiro relato de caso que associa o desenvolvimento de pitiríase liquenoide com a vacinação contra a COVID-19. Em uma revisão literária foram encontrados escassos estudos que associam a pitiríase liquenoide como reação a outras vacinas. O mecanismo de desenvolvimento da doença ainda não é bem conhecido. Sabe-se apenas que se trata de uma reação inflamatória imunomediada. O diagnóstico da pitiríase liquenoide é clínico e é considerado um desafio, devido ao grande número de diagnósticos diferenciais e das diferentes formas de apresentação da doença. Desse modo, a maioria dos casos exige amparo na biópsia e em exames laboratoriais. As opções terapêuticas podem incluir o uso de antibióticos e imunossupressores. Destaca-se ainda a efetividade da fototerapia como tratamento de escolha da pitiríase liquenoide, podendo proporcionar uma resolução quase que completa das lesões e não causar efeitos sistêmicos que outras terapias poderiam trazer.

This study addresses the first case report of pityriasis lichenoides development after COVID-19 vaccination. A literature review found few studies describing pityriasis lichenoides as an adverse reaction to other vaccines. Although it is an immune-mediated inflammatory response, the development mechanism of this disease remains not well known. The diagnosis of pityriasis lichenoides is clinical and is considered a challenge due to the considerable number of differential diagnoses and the different forms of presentation of the disease. Thus, most cases require confirmation by biopsy and laboratory tests. Therapeutic options may include the use of antibiotics and immunosuppressants. The effectiveness of phototherapy is also highlighted as the treatment of choice for pityriasis lichenoides, as it can promote an almost complete resolution of lesions without causing systemic effects, unlike other therapies.

Uso da fotobiomodulação laser no tratamento de úlceras venosas: uma revisão sistemática / Laser photobiomodulation in the treatment of venous ulcers: a systematic review

O objetivo do presente trabalho foi relatar a eficácia da fotobiomodulação laser na abordagem de úlceras venosas de membros inferiores e como se dá o papel da enfermagem nesse contexto. Tratou-se de uma revisão sistemática que utilizou as bases de dados eletrônicas PubMed, BVS, SCIELO e Lilacs, além da busca no repositório de teses e dissertações pelo cruzamento dos descritores livres e provenientes do DeCS através dos operadores booleanos AND e OR: "laserterapia", "fotobiomodulação laser" e "úlceras venosas". Os critérios de inclusão estabelecidos foram estudos prospectivos, teses e dissertações escritas nos idiomas inglês, português e espanhol, e publicações entre o período de 2010-2020. A revisão foi conduzida conforme metodologia PRISMA, utilizou-se os critérios de Jadad para avaliação da qualidade dos manuscritos. Dos 104 artigos encontrados, apenas 8 contemplavam os critérios de inclusão, tendo uma população total de 942 pacientes. Notou-se que a maioria dos estudos mostrou a eficácia do uso da laserterapia, principalmente quando associado ao uso da terapêutica comum, como a terapia compressiva, agentes tópicos e farmacoterapia. A fotobiomodulação laser demonstrou ser eficaz, porém ainda são necessários mais estudos com o objetivo de uniformizar os parâmetros de aplicação dessa modalidade terapêutica.

The objective of this work was to investigate the effectiveness of laser photo-biomodulation in lower limb venous ulcers and the role of nursing in this context. This is a systematic review, using the PubMed, BVS, SCIELO and Lilacs electronic databases in addition to searching the repository of thesis and dissertations by crossing the free descriptors coming from the DeCS through the Boolean operators AND and OR: "laser therapy", "laser photo-biomodulation" and "venous ulcers". The inclusion criteria were prospective studies, theses and dissertations written in English, Portuguese, or Spanish, and publications in the 2010-2020 period. From the 104 articles found, only 8 met the inclusion criteria, with a total population of 942 patients. It could be observed that most studies showed the effectiveness of using laser therapy, especially when associated with the use of common therapy, such as the compressive therapy, topical agents, and pharmacotherapy. The laser photo-biomodulation was also shown as being effective, but further studies are needed to standardize the application parameters for this therapeutic modality.

Polyaspartic acid grafted dopamine polymer chelated Fe 3+ for magnetic resonance imaging visual photothermal therapy agent / 生物医学工程学杂志

This study aims to explore the potential of polyaspartic acid grafted dopamine copolymer (PAsp- g-DA) chelated Fe 3+ for magnetic resonance imaging (MRI) visual photothermal therapy. Polyaspartic acid grafted copolymer of covalently grafted dopamine and polyethylene glycol (PAsp- g-DA/PEG) was obtained by the ammonolysis reaction of poly succinimide (PSI), and then chelated with Fe 3+ in aqueous solution. The relaxivity in vitro, magnetic resonance imaging enhancement in vivo and photothermal conversion effect at 808 nm were investigated. The results showed that polymeric iron coordination had good near-infrared absorption and photothermal conversion properties, good magnetic resonance enhancement effect, and good longitudinal relaxation efficiency under different magnetic field intensities. In summary, this study provides a new magnetic resonance visual photothermal therapeutic agent and a new research idea for the research in related fields.

Intensive phototherapy vs. exchange transfusion for the treatment of neonatal hyperbilirubinemia: a multicenter retrospective cohort study / 中华医学杂志(英文版)

BACKGROUND@#Intensive phototherapy (IPT) and exchange transfusion (ET) are the main treatments for extreme hyperbilirubinemia. However, there is no reliable evidence on determining the thresholds for these treatments. This multicenter study compared the effectiveness and complications of IPT and ET in the treatment of extreme hyperbilirubinemia.@*METHODS@#This retrospective cohort study was conducted in seven centers from January 2015 to January 2018. Patients with extreme hyperbilirubinemia that met the criteria of ET were included. Patients were divided into three subgroups (low-, medium-, and high- risk) according to gestational week and risk factors. Propensity score matching (PSM) was performed to balance the data before treatment. Study outcomes included the development of bilirubin encephalopathy, duration of hospitalization, expenses, and complications. Mortality, auditory complications, seizures, enamel dysplasia, ocular motility disorders, athetosis, motor, and language development were evaluated during follow-up at age of 3 years.@*RESULTS@#A total of 1164 patients were included in this study. After PSM, 296 patients in the IPT only group and 296 patients in the IPT plus ET group were further divided into the low-, medium-, and high-risk subgroups with 188, 364, and 40 matched patients, respectively. No significant differences were found between the IPT only and IPT plus ET groups in terms of morbidity, complications, and sequelae. Hospitalization duration and expenses were lower in the low- and medium-risk subgroups in the IPT only group.@*CONCLUSIONS@#In this study, our results suggest that IPT is a safe and effective treatment for extreme hyperbilirubinemia. The indication of ET for patients with hyperbilirubinemia could be stricter. However, it is necessary to have a contingency plan for emergency ET as soon as IPT is commenced especially for infants with risk factors. If IPT can be guaranteed and proved to be therapeutic, ET should be avoided as much as possible.

Generalized Purpuric Lichen Nitidus in a 32-year-old Filipino male with Acute Myeloid Leukemia: Case report

@#A 32-year-old Filipino male managed as a case of acute myeloid leukemia presented with a 6-month history of generalized, red-brown papules. After chemotherapy, the patient was advised 30-minutes daily sun exposure as a form of natural phototherapy. On follow-up, most lesions flattened. This case demonstrates chemotherapy’s potential role in controlling the patient’s inflammatory state and using ultraviolet light therapy in the form of sunlight to manage generalized purpuric lichen nitidus.

Uso da fototerapia como método complementar no retratamento endodôntico: revisões sistemáticas e meta-análise de ensaios clínicos / Use of phototherapy as a complementary method in endodontic reintervention: systematic reviews and meta-analysis of clinical trials

Este trabalho objetivou realizar duas revisões sistemáticas com as seguintes propostas: 1) Avaliar se a fototerapia com laser resultaria em menor dor pós-operatória (PP) em pacientes submetidos a reintervenção endodôntica; e 2) Avaliar se o uso da terapia fotodinâmica antimicrobiana (aPDT) seria eficaz na desinfecção de canais radiculares em casos de reintervenção endodôntica. As Revisões Sistemáticas foram registradas no PROSPERO (CRD42021243500 e CRD42021260013, respectivamente) e seguiram as diretrizes dos Itens de Relatório Preferenciais para Revisões Sistemáticas e Meta-análise (PRISMA). As buscas foram realizadas nas bases de dados eletrônicas PubMeb, Scopus, Web of Science, Embase, Web of Science, Clinical Trials e Cochrane Library e nos bancos de dados da literatura cinza. A qualidade metodológica e o risco de viés foram avaliados pela ferramenta Cochrane Risk of Bias para ensaios clínicos randomizados (RCT) e pelo qualificador NewcastleOttawa (NOS) para estudos não RCT (prospectivos). A análise da qualidade de evidência foi realizada com base na abordagem GRADE. A meta-análise foi realizada com o R software Meta package, utilizando um intervalo de confiança (IC) de 95%. Quanto aos resultados do Artigo 1: Cinco artigos foram incluídos para análise. Os estudos foram classificados como "baixo" risco de viés. Dos cinco estudos clínicos, quatro estudos mostraram uma diminuição significativa da PP após a reintervenção endodôntica nos grupos de fototerapia a laser quando comparados ao grupo controle, principalmente nos primeiros dias após a intervenção. A certeza de evidência foi classificada como baixa. Devido à alta heterogeneidade clínica entre os estudos, não foi possível realizar qualquer meta-análise. Apesar das limitações desta revisão sistemática, a fototerapia se mostrou uma alternativa promissora na redução e controle da PP na reintervenção endodôntica não cirúrgica. Nos resultados do Artigo 2, dez estudos atenderam aos critérios de elegibilidade e foram incluídos, sendo 8 utilizados na síntese quantitativa. A meta-análise mostrou que todos os dados dos estudos apresentaram diferença significativa antes e depois da terapia fotodinâmica antimicrobiana na redução da carga microbiana em infecções endondônticas secundárias (OR 0,15 [0,07; 0,32], p < 0,0001). No geral, os estudos apresentaram baixo risco de viés e a análise das evidências foi classificada como moderada. Sugere-se que a terapia fotodinâmica seja uma ferramenta benéfica e promissora, mostrando eficácia na redução da carga microbiana nos casos de reintervenção endodôntica. Em suma, a abordagem da utilização da fototerapia se demonstrou eficaz na diminuição da dor pós-operatória e na desinfecção dos canais radiculares, podendo ser uma terapia indicada nos casos de reintervenção endodôntica(AU)

This study aimed to carry out two systematic reviews with the following proposals: 1) Evaluate whether laser phototherapy would result in less postoperative pain (PP) in patients undergoing endodontic reintervention; and 2) Evaluate whether the use of antimicrobial photodynamic therapy (aPDT) would be effective in disinfection of root canals in cases of endodontic reintervention. Systematic Reviews were registered in PROSPERO (CRD42021243500 and CRD42021260013, respectively) and followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Metaanalysis (PRISMA). Searches were performed in the electronic databases PubMeb, Scopus, Web of Science, Embase, Web of Science, Clinical Trials and Cochrane Library and in the gray literature databases. Methodological quality and risk of bias were assessed by the Cochrane Risk of Bias tool for randomized clinical trials (RCT) and by the Newcastle-Ottawa (NOS) qualifier for non-RCT (prospective) studies. The analysis of the quality of evidence was performed based on the GRADE approach. The meta-analysis was performed using the R Meta package software, using a 95% confidence interval (CI). As for the results of Article 1: Five articles were included for analysis. Studies were classified as "low" risk of bias. Of the five clinical studies, four studies showed a significant decrease in PP after endodontic reintervention in the laser phototherapy groups when compared to the control group, mainly in the first days after the intervention. The certainty of evidence was rated low. Due to the high clinical heterogeneity between studies, it was not possible to perform any meta-analysis. Despite the limitations of this systematic review, phototherapy proved to be a promising alternative for the reduction and control of PP in conventional endodontic reintervention. In the results of Article 2, ten studies met the eligibility criteria and were included, being 8 used in the quantitative synthesis. The meta-analysis showed that all data from the studies showed a significant difference before and after antimicrobial photodynamic therapy in reducing the microbial load in secondary endodontic infections (OR 0.15 [0.07; 0.32], p < 0.0001). Overall, the studies presented a low risk of bias and the analysis of evidence was rated as moderate. It is suggested that photodynamic therapy is a beneficial and promising tool, showing efficacy in reducing the microbial load in cases of endodontic reintervention. In summary, the approach to the use of phototherapy has been shown to be effective in reducing postoperative pain and disinfection of root canals, and may be an indicated therapy in cases of endodontic reintervention(AU)

Rhinophototherapy, an alternative treatment of allergic rhinitis: Systematic review and meta-analysis / Rinofototerapia, uma alternativa para o tratamento de rinite alérgica: revisão sistemática e metanálise

Abstract Introduction: Allergic rhinitis is a chronic inflammatory disease of the nasal mucosa, mediated by immunoglobulin E, affecting 1 in 6 individuals. The treatment aims at attaining symptomatic control with minimal side effects, a requirement for new alternative therapies, including phototherapy, as it has an immunosuppressive and immunomodulatory effect. Objective: To identify the effectiveness of phototherapy in the treatment of allergic rhinitis through a meta-analysis. Methods: We searched Web of Science, Scielo, PubMed, SCOPUS, PEDro, and LILACS databases, using the terms: ''intranasal irradiation'', ''phototherapy'' and ''allergic rhinitis''. The R software Metafor package was used for the meta-analysis and the effect size was calculated for each symptom individually. Results: All symptoms decreased considerably after phototherapy: rhinorrhea (ES• = -1.35; p < 0.0001; I2 = 91.84%), sneezing (ES• = -1.24; p < 0.0001; I2 = 91.43%), nasal pruritus (ES• = -1.10; p < 0.0001; I2 = 91.43%); nasal obstruction (ES• = -1.11; p < 0.0001; I2 = 91.88%). The effects were more significant in perennial allergic rhinitis than in the seasonal type. Conclusion: Considering the effect size and the statistical significance attained in our study, rhinophototherapy showed to be an effective treatment for reducing the nasal symptom scores triggered by AR.

Resumo Introdução: A rinite alérgica é uma doença inflamatória crônica da mucosa nasal, imunomediada por imunoglobulina E, que afeta 1/6 dos indivíduos. O tratamento visa o controle dos sintomas com efeitos colaterais mínimos, uma prerrogativa para novas terapias alternativas, como a fototerapia, por apresentar efeitos imunossupressor e imunomodulador. Objetivo: Identificar, mediante uma metanálise, a eficácia da fototerapia no tratamento da rinite alérgica. Método: Usamos as bases de dados: Web of Science, Scielo, PubMed, SCOPUS, PEDro e LILACS, com os termos de busca: intranasal irradiation, phototherapy, allergic rhinitis. Para a metanálise foi usado o pacote metafor do software R, o tamanho do efeito foi calculado para cada sintoma separadamente. Resultados: Todos os sintomas apresentaram diminuição significante após a fototerapia: coriza (ES =-1,35; p < 0,0001; I2 = 91,84%), espirros (ES =-1,24; p < 0,0001; I2 = 91,43%), prurido nasal (ES =-1,10; p < 0,0001; I2 = 91,43%); obstrução nasal (ES =-1,11; p < 0,0001; I2 = 91,88%), com efeitos mais expressivos na rinite alérgica perene do que na rinite alérgica sazonal. Conclusão: Considerando-se a magnitude do efeito e a significância estatística alcançadas em nosso estudo, a rinofototerapia demonstrou-se um tratamento eficaz para a redução dos escores dos sintomas nasais desencadeados pela rinite alérgica.

Hipomelanosis macular progresiva: comunicación de un caso y revisión de la literatura científica / Progressive macular Hypomelanosis: case report andr review of scientic literature

La hipomelanosis macular progresiva es un trastorno adquirido de la pigmentación que aparece con más frecuencia en mujeres, adolescentes y adultas jóvenes. Se caracteriza por máculas hipopigmentadas asintomáticas, mal delimitadas, no descamativas, simétricas y de predominio en región lumbar. El estudio histopatológico evidencia disminución del contenido de melanina en la epidermis afectada, con número y distribución de los melanocitos conservados. En su etiopatogenia interviene el Cutibacterium acnes tipo III, bacteria responsable de la característica fluorescencia rojiza de distribución folicular que se observa con la lámpara de Wood. Por este motivo, los tratamientos propuestos incluyen el uso de tetraciclinas por vía oral y tratamientos tópicos como el peróxido de benzoílo, asociados a fototerapia UVA o UVB de banda angosta. Se presenta una paciente con hipomelanosis macular progresiva del tronco que respondió satisfactoriamente al tratamiento con doxiciclina vía oral

Progressive macular hypomelanosis is an acquired pigmentation disorder that occurs mostly in adolescent and young women. It is characterized by asymptomatic, poorly defined, non-scaly, symmetrical hypopigmented macules localized predominantly in the lumbar area. Histopathology shows a decrease in melanin content with preserved number and distribution of melanocytes in the affected epidermis. Cutibacterium acnes type III appears to be the responsible for the dermatosis and for the characteristic reddish fluorescence of follicular distribution observed with Wood´s lamp. Treatment include oral tetracyclines and topical benzoyl peroxide associated with UVA or narrow band UVB phototherapy. We present a patient with progressive macular hypomelanosis of the trunk with excellent response to treatment with oral doxycycline

Phototherapy

Abstract Of all the therapeutic options available in Dermatology, few of them have the history, effectiveness, and safety of phototherapy. Heliotherapy, NB-UVB, PUVA, and UVA1 are currently the most common types of phototherapy used. Although psoriasis is the most frequent indication, it is used for atopic dermatitis, vitiligo, cutaneous T-cell lymphoma, and cutaneous sclerosis, among others. Before indicating phototherapy, a complete patient assessment should be performed. Possible contraindications should be actively searched for and it is essential to assess whether the patient can come to the treatment center at least twice a week. One of the main method limitations is the difficulty that patients have to attend the sessions. This therapy usually occurs in association with other treatments: topical or systemic medications. Maintaining the regular monitoring of the patient is essential to identify and treat possible adverse effects. Phototherapy is recognized for its benefits and should be considered whenever possible.

Estratégias terapêuticas e atualizações no tratamento de vitiligo / Therapeutic strategies and updates for treatment of vitiligo

O vitiligo é uma desordem dermatológica complexa, cuja patogênese ainda não é totalmente esclarecida. Apesar de não apresentar complicações funcionais no organismo dos pacientes acometidos, o vitiligo pode resultar em um grande impacto psicossocial. Desse modo, é importante que os médicos saibam como conduzir o tratamento dessa patologia. O objetivo deste estudo foi documentar as terapias disponíveis para o tratamento do vitiligo, assim como apontar pesquisas que relataram a utilização dessas opções terapêuticas e os dados resultantes. As terapias abordadas foram corticoides tópicos e sistêmicos, fototerapia e fotoquimioterapias, antioxidantes, imunomoduladores, fenilalanina, despigmentação, procedimentos cirúrgicos e novas abordagens. A monoterapia parece ser menos eficaz no tratamento do vitiligo. A associação de medicação tópica e/ou sistêmica com o uso da fototerapia ultravioleta B de banda estreita parece ser o padrão-ouro para a repigmentação da pele dos pacientes. Medicamentos novos estão em estudo, porém sua eficácia e o estudo dos possíveis efeitos colaterais, principalmente a longo prazo, têm que ser melhores investigados. É necessário que o médico dermatologista, em conjunto com o paciente, escolha a melhor terapia dentre as disponíveis, de acordo com critérios clínicos e a possibilidade de acesso ao tratamento pelo portador. O acompanhamento e a abordagem por uma equipe multiprofissional também são importantes. (AU)

Vitiligo is a complex dermatological disorder, whose pathogenesis has not yet been fully elucidated. Although it does not present functional complications in the affected patients' body, vitiligo can result in a great psychosocial impact. Therefore, it is important that physicians know how to conduct its treatment. This study aimed at documenting the available therapies for the treatment of vitiligo, as well as pointing out studies reporting the use of these therapeutic options and their resulting data. The therapies addressed were topical and systemic corticosteroids, phototherapy, and photochemotherapies, antioxidants, immunomodulators, phenylalanine, depigmentation, surgical procedures, and new approaches. Monotherapy appears to be less effective in the treatment of vitiligo. The combination of topical and/or systemic medication with the use of narrowband ultraviolet B phototherapy seems to be the gold standard for the patients' skin repigmentation. New drugs are under study, but their effectiveness and study of possible side effects, especially in the long run, have to be better investigated. It is necessary that the dermatologist, together with the patient, choose the best therapy among those available, according to clinical criteria and the possibility of access to treatment by the patient. Monitoring and approach by a multiprofessional team is also important. (AU)

Liquen plano, estudio retrospectivo en un hospital pediátrico / Lichen planus, retrospective study in a pediatric hospital

Introducción: El liquen plano (LP) es una enfermedad inflamatoria crónica, de etiología desconocida, que puede afectar la piel, los anexos y las mucosas. Objetivo: Describir las características epidemiológicas y clínicas y el tratamiento realizado en los pacientes con diagnóstico clínico e histopatológico de LP, valorados en el Servicio de Dermatología del Hospital de Pediatría "Prof. Dr. Juan P. Garrahan" en los últimos 33 años. Diseño:Estudio descriptivo, retrospectivo y transversal. Materiales y métodos: Se revisaron las historias clínicas de los pacientes con diagnóstico histopatológico de LP atendidos en el Hospital desde agosto de 1987 hasta febrero de 2020 y se analizaron las variables epidemiológicas, clínicas y de tratamiento. Resultados: Se incluyeron datos de 26 pacientes, 18 de los cuales eran varones (69,3%). La media de edad en el momento del diagnóstico fue de 9,6 años. Presentaron la variedad de LP clásico 24 pacienes (93%). El compromiso ungueal y de la mucosa bucal se observó en 2 pacientes (7,7%). Ninguno tuvo asociación a fármacos ni a infecciones. En cuanto al tratamiento recibido, 4 pacientes (15,4%) tuvieron pérdida del seguimiento; 13 (50%) realizaron tratamiento tópico; 6 (23%), tratamiento sistémico y 3 (11,5%), tratamiento combinado. El promedio de seguimiento fue de 6 meses y se obtuvo una respuesta favorable en el 68% de los pacientes. Conclusiones: El LP es una patología de baja frecuencia en la infancia. No se encontró asociación a medicamentos ni a enfermedades infecciosas como se describe en la población adulta. Su curso es crónico y, en los pacientes que tuvieron un adecuado seguimiento, se obtuvo una buena respuesta al tratamiento indicado.

Introduction: Lichen planus (LP) is a chronic, inflammatory disease of unknown etiology, which can affect skin, adnexal tissues and mucosa. Objective: to describe the clinical, epidemiological characteristics and the treatment received by patients with clinical and histopathological diagnosis of LP, seen at the Dermatology Service of Pediatric Hospital "Prof. Dr. Juan P. Garrahan" in the last 33 years. Design: Descriptive, retrospective and cross-sectional study. Materials y methods: We reviewed the clinical history of patients with histopathological diagnosis of LP that were treated at our hospital from August 1987 to February 2020 and analysed the epidemiological, clinical and treatment variables. Results: Data of 26 patients were included in this study 18 of which are males (69.3%). The mean age of diagnosis was 9.6 years. 24 patients (93%) presented the classical type of LP. Ungual and mucosal compromise were observed in 2 patients (7.7%) and none had associations with infections or drugs. Regarding treatment, 4 patients (15.4%) did not continue follow-ups, 13 patients (50%) had topical treatment, 6 (23%) had systemic treatment and 3 patients (11.5%) received combined treatment. The average follow-up time was 6 months and 68% of patients had favorable outcome. Conclusions: LP is an uncommon pathology in children. During this study we did not find any etiologic relations with use of drugs or infectious diseases as is described in de adult population. Its course is chronic and in the patients that had a proper follow-up a good response to the indicated treatment was obtained.

Fibrosis pulmonar inducida por metotrexato en un paciente con psoriasis / Methotrexate-induced pulmonary fibrosis in a patient with psoriasis

La fibrosis pulmonar a causa del metotrexato es un efecto adverso infrecuente, observado principalmente en los pacientes con artritis reumatoide, aunque también se vio, de manera escasa, en el tratamiento de la psoriasis. Se presenta el caso de un paciente con psoriasis que desarrolló fibrosis pulmonar por metotrexato.

Pulmonary fibrosis due to methotrexate is an infrequent adverse event, observed mainly in patients with rheumatoid arthritis, although it has also been poorly described in the treatment of psoriasis. We present the case of a patient with psoriasis who developed pulmonary fibrosis due to methotrexate.

Granuloma anular maculoso / Patch granuloma annulare

El granuloma anular maculoso es una variante rara de granuloma anular, que representa un desafío diagnóstico. Su incidencia se desconoce y se presenta con mayor frecuencia en las mujeres de entre 40 y 70 años. Se asocia a las mismas entidades y responde a los mismos tratamientos que las otras variantes clínicas de granuloma anular. Se presentan los casos de 5 mujeres con diagnóstico de granuloma anular maculoso, que recibieron diferentes tratamientos tópicos y sistémicos, con respuestas clínicas variables.

Patch-type granuloma annulare is a rare variant of granuloma annulare, thus which represents diagnostic challenge. It has an unknown incidence and occurs most often in women between 40 and 70 years of age. It presents similar associations and responds to treatment as the clinical variants. We present 5 emale patients with patch-type granuloma annulare, who received different topical and systemic treatments, with variable clinical responses.

Cuidados de enfermagem com o protetor ocular de recém-nascidos submetidos à fototerapia / Nursing care with the eye protector of newborns submitted to phototherapy / Atención de enfermería con protección ocular para recién nacidos sometidos a fototerapia

Objetivo: Avaliar os cuidados de enfermagem com o protetor ocular em recém-nascidos. Método: Estudo investigatório descritivo, com abordagem qualitativa, realizado em hospital-escola, localizado na cidade de Fortaleza-Ceará, Brasil, janeiro a fevereiro de 2016. Participaram do estudo 15 enfermeiras que prestavam cuidados a recém-nascidos em fototerapia, na Unidade de Cuidados Intermediários e Terapia Intensiva. A coleta dos dados ocorreu por meio de entrevista não estruturada. Resultados: O protetor ocular é utilizado na prevenção de lesão na retina de recém-nascidos, sendo que existem riscos na utilização desse artefato e, para evitar danos, são realizados cuidados essenciais direcionados aos recém-nascidos sob fototerapia. Conclusão: Os cuidados que as enfermeiras prestam aos recém-nascidos são realizados de forma sistematizada, aliando humanização e tecnologia.(AU)

Objective: To evaluate nursing care with eye protection for newborns. Method: Descriptive investigative study, with a qualitative approach, carried out in a teaching hospital, located in the city of Fortaleza-Ceará, Brazil, January to February 2016. The study included 15 nurses who cared for newborns undergoing phototherapy, at the Intermediate Care and Intensive Care. Data collection took place through unstructured interviews. Results: The eye protector is used to prevent injury to the retina of newborns, and there are risks in the use of this artifact and, to avoid damage, essential care directed to newborns under phototherapy is performed. Conclusion: The care that nurses provide to newborns is carried out in a systematic way, combining humanization and technology.(AU)

Objetivo: Evaluar los cuidados de enfermería con protección ocular para recién nacidos. Método: Estudio descriptivo de investigación, con abordaje cualitativo, realizado en un hospital universitario, ubicado en la ciudad de Fortaleza-Ceará, Brasil, de enero a febrero de 2016. Participaron del estudio 15 enfermeras que asistieron a recién nacidos en fototerapia, en el Intermedio. Cuidados y cuidados intensivos. La recolección de datos se realizó mediante entrevistas no estructuradas. Resultados: El protector ocular se utiliza para prevenir daños en la retina del recién nacido, existen riesgos en el uso de este artefacto y, para evitar daños, se realizan cuidados esenciales dirigidos al recién nacido sometido a fototerapia. Conclusión: La atención que brindan las enfermeras al recién nacido se realiza de manera sistemática, combinando humanización y tecnología.(AU)

Phototherapy Induces an Improvement in Clinical and Biochemical Scores in Patients with Rheumatoid Arthritis

ABSTRACT Objective: Rheumatoid arthritis (RA) is a common autoimmune disease for which there is no known cure. Ultraviolet light can induce immunosuppressive effects. Our main objective was to ascertain whether a complementary treatment with phototherapy would improve changes in functional scales in patients with RA. Methods: Seven women with RA were enrolled for this study and submitted to phototherapy sessions with a 425-650 nm lamp. Results: The Karnofsky scale changed from requiring frequent medical care to being capable of normal activity with few symptoms or signs of disease (p = 0.018), the rheumatoid arthritis-specific quality of life questionnaire decreased abruptly from 29 to 0 points (p = 0.018), the Steinbrocker functional capacity rating changed from limited to little or none of the duties of usual occupation or self-care to complete ability to carry out all the usual duties without handicaps (p = 0.017). The pain was remitted after the treatment period. The acute inflammation variables showed a significant decrease after the indicated sessions, C-reactive protein (p = 0.042) and erythrocyte sedimentation rate (p = 0.018). Conclusion: The evaluated scales clearly show a benefit with the phototherapy in patients with RA. Thus, phototherapy seems to be a plausible complementary option to reduce the symptoms of RA.