Abstract Background: One of the main adverse reactions of adjuvant radiotherapy for breast cancer is radiodermatitis. Objective: To assess the incidence of radiodermatitis in women with breast cancer, identify factors associated with its severity and determine the time at which this event occurs. Methods: Prospective cohort study in 113 women with breast cancer who were evaluated before radiotherapy and at every fifth session until the end of treatment. Logistic regression and Cox proportional regression model were used for the assessment of risk factors; P values < 0.05 were considered significant. Results: The incidence rate of radiodermatitis was 98.2% and it was demonstrated that for each additional point of the Body Mass Index (BMI), the chance of occurrence of grades II to IV radiodermatitis increases by 14% (OR = 1.14 [95% CI 1.04–1.26]; p = 0.004) and statin use increases the risk of more severe skin lesions by four-fold (OR = 4.27 [95% CI 1.11–16.42]; p = 0.035). The exclusive use of hydrogel for skin hydration was an independent factor in delaying the onset of radiodermatitis (HR = 0.55 [95% CI 0.36–0.82]; p = 0.004). Study limitations: The main limitation of this study was its external validity. The identified factors should be considered for services and populations similar to those in this study. Conclusions: There was a high incidence of radiodermatitis and its severity was related to higher BMI, statin use; there was a protective effect of hydrogel use. Background Objective occurs Methods 11 treatment 005 0 05 0.0 significant Results 982 98 2 98.2 BMI , (BMI) 14 OR 114 1 1.1 95% 95 [95 1.04–1.26 104126 04 26 1.04–1.26] 0.004 0004 004 fourfold four fold 427 4 27 4.2 1.11–16.42 1111642 16 42 1.11–16.42] 0.035. 0035 0.035 . 035 0.035) HR 055 55 0.5 0.36–0.82 036082 36 82 0.36–0.82] 0.004. limitations validity Conclusions 00 0. 9 98. (BMI 1. [9 1.04–1.2 10412 0.00 000 4. 1.11–16.4 111164 003 0.03 03 5 0.36–0.8 03608 3 8 [ 1.04–1. 1041 1.11–16. 11116 0.36–0. 0360 1.04–1 104 1.11–16 1111 0.36–0 036 1.04– 10 1.11–1 111 0.36– 1.04 1.11– 0.36 1.0 1.11 0.3

RESUMO Objetivo: Realizar a adaptação transcultural do CALCULATE para o português brasileiro. Método: Estudo metodológico, desenvolvido de janeiro a dezembro de 2021 e dividido em seis etapas: tradução, síntese, retrotradução, comitê de especialistas com aplicação de índice de validade de conteúdo, pré-teste em 40 pacientes adultos e envio às autoras. O estudo ocorreu nas unidades de terapia intensiva em hospital público de ensino de nível terciário no interior do estado de São Paulo, Brasil. O CALCULATE original tem oito itens de avaliação (fatores de risco) e é estratificado com escore 0-3 (alto risco) e 4-8 (risco muito alto). Resultados: Após avaliação dos especialistas, a validade de conteúdo final foi de 0,9. Eles sugeriram palavras e frases que deveriam sofrer alterações quanto às equivalências textuais, assim como definições de siglas e terminologias. No pré-teste, os itens foram avaliados como adequados na compreensão; apenas um item precisou de explicação complementar para adequação. Conclusão: Foi realizada a adaptação transcultural do CALCULATE para o português do Brasil, a qual revelou ter bom índice de validade de conteúdo, sendo verificada a pertinência e relevância de seus itens. O CALCULATE está adequado para utilização em unidades de terapia intensiva e centros de pesquisa e ensino. Objetivo brasileiro Método metodológico 202 etapas tradução síntese retrotradução préteste pré teste 4 autoras Paulo Brasil fatores risco 03 0 3 0- alto 48 8 4- alto. . alto) Resultados 09 9 0,9 textuais terminologias préteste, teste, compreensão adequação Conclusão 20 0, 2

ABSTRACT Objective: To perform the cross-cultural adaptation of CALCULATE for Brazilian Portuguese. Method: A methodological study conducted from January to December 2021, divided into six stages: translation, synthesis, back-translation, expert committee with the application of the content validity index, pre-testing in 40 adult patients, and submission to the authors. The study took place in the intensive care units of a public tertiary teaching hospital in the interior of the state of São Paulo, Brazil. The original CALCULATE has eight risk assessment items and is stratified with a score of 0-3 (high risk) and 4-8 (very high risk). Results: After expert evaluation, the final content validity was 0.9. They suggested words and phrases that should undergo changes regarding textual equivalences, as well as definitions of acronyms and terminologies. In the pre-test, the items were assessed as suitable for understanding; only one item required additional explanation for adequacy. Conclusion: The cross-cultural adaptation of CALCULATE for Brazilian Portuguese was successfully performed, revealing a good content validity index, confirming the relevance and appropriateness of its items. CALCULATE is suitable for use in intensive care units and research and teaching centers. Objective crosscultural cross cultural Method 2021 stages translation synthesis backtranslation, backtranslation back back-translation index pretesting pre testing 4 patients authors Paulo Brazil 03 0 3 0- 48 8 4- very risk. . Results evaluation 09 9 0.9 equivalences terminologies pretest, pretest test, test pre-test understanding adequacy Conclusion performed centers 202 0. 20 2

RESUMEN Objetivo: Realizar la adaptación transcultural de CALCULATE al portugués brasileño. Método: Un estudio metodológico llevado a cabo de enero a diciembre de 2021, dividido en seis etapas: traducción, síntesis, retrotraducción, comité de expertos con aplicación del índice de validez de contenido, preprueba en 40 pacientes adultos y envío a las autoras. El estudio se realizó en las unidades de cuidados intensivos de un hospital público de enseñanza terciaria en el interior del estado de São Paulo, Brasil. El CALCULATE original tiene ocho ítems de evaluación (factores de riesgo) y se estratifica con un puntaje de 0-3 (alto riesgo) y 4-8 (riesgo muy alto). Resultados: Después de la evaluación de los expertos, la validez de contenido final fue de 0,9. Sugirieron palabras y frases que debían cambiar en cuanto a equivalencias textuales, así como definiciones de siglas y terminologías. En la preprueba, los ítems se evaluaron como adecuados para la comprensión; solo un ítem requirió una explicación adicional para su adecuación. Conclusión: Se realizó con éxito la adaptación transcultural de CALCULATE al portugués brasileño, revelando un buen índice de validez de contenido, confirmando la relevancia y adecuación de sus ítems. CALCULATE es adecuado para su uso en unidades de cuidados intensivos y centros de investigación y enseñanza. Objetivo brasileño Método 2021 etapas traducción síntesis retrotraducción 4 autoras Paulo Brasil factores riesgo 03 0 3 0- alto 48 8 4- alto. . alto) Resultados 09 9 0,9 textuales terminologías comprensión Conclusión 202 0, 20 2

Abstract Background Several treatments are available for skin with advanced photodamage, which is characterized by the presence of actinic keratoses (AK). Objectives Evaluate the efficacy of using sunscreen with photolyase compared to regular sunscreen, as well as to compare the combination of a topical formulation of antioxidants versus placebo in the treatment of advanced photodamage. Methods This was a randomized, double-blind, factorial clinical trial. Participants with AKs on their forearms were randomized to apply regular sunscreen (SC) or sunscreen with photolyase (SC+P) on both forearms during the day. One of the forearms in each group was randomized again to receive topical antioxidants (AOx), and the other forearm received a placebo cream (both for night application). The four groups were SC/AOx, SC/placebo, SC+P/AOx, and SC+P/placebo. The duration of treatment was 8 weeks. Primary outcomes were total AK clearance, decrease in Forearm Photoaging Scale (FPS), and AK severity scores. Secondary outcomes were reduction in AK count, partial clearance rate, and safety. Results Forty participants (80 forearms) were included. All groups showed significant improvement in outcomes at week eight. There were no significant differences between SC and SC+P for either outcome. AOx led to a significant reduction in AK count (22%; p < 0.05). Partial clearance was obtained in 18 (47.4%) forearms treated with AOx and in 9 (23.7%) treated with placebo (p < 0.05). All groups reduced the FPS score, without significant differences among them. Conclusions There is no difference in the treatment of advanced photodamage skin when comparing the use of sunscreen with photolyase and regular sunscreen, and topical antioxidants were more efficient in reducing AK count than placebo. Study limitations Short interval of follow-up and absence of re-evaluation in the absence of treatment were limitations of the present study.

Abstract Paracoccidioidomycosis is an endemic systemic mycosis caused by Paracoccidioides brasiliensis complex and P. lutzii. It is a rare disease in non-HIV-induced immunosuppressed individuals. In organ transplant recipients, it is more frequently associated with immunosuppression after kidney transplantation. In a liver transplant patient, only one case has been published in the literature to date. The present report comprises the case of a 47-year-old female patient with disseminated skin lesions associated with signs and symptoms of systemic involvement of paracoccidioidomycosis that manifested one year after liver transplantation and under an immunosuppression regimen with tacrolimus and mycophenolate mofetil.