Background/Purpose: Analyse the outcomes of stages I–III inoperable endometrial cancer (IEC) patients treated with external-beam-irradiation (EBRT) and 3D-image-guided-brachytherapy (IGBT). Material and Methods: Medical records of IEC patients receiving EBRT + IGBT in eight European and one Canadian centres (2004–2019) were examined, including: pelvic ± para-aortic EBRT and lymph node boost; anaesthetic procedure, applicators, BT-planning imaging, clinical target volume (CTV), brachytherapy schedule, and EQD2 to the CTV(α/β=4.5Gy) and D2 cm3(α/β=3Gy) for organs at risk. Complications are evaluated using CTCAEv4 scores. The 2- and 5-year survival probability according to stages was estimated (cancer-specific survival (CSS), disease-free survival (DFS), local relapse-free survival (LRFS), loco-regional relapse-free survival (LRRFS), and distant metastasis-free survival (DMFS)). Statistics: descriptive analysis and the Kaplan–Meier method. Results: 103 patients (stages: I-44, II-14, III-44) were included. Median follow-up: 28 months (7–170). All patients received pelvic ± para-aortic EBRT. Median D90-EQD2(α/β=4.5) to the CTV:73.3 Gy (44.6–132.7), 69.9 Gy (44.7–87.9 and 75.2 Gy (55.1–97) in stages I, II, and III, respectively. Thirty patients presented relapse (stages: 10-I, 3-II, 17-III): 24 uterine (stages: 7-I, 3-II, 14-III), 15 nodal (stages: 4-I, 1-II, 10-III), and 23 distant (stages: 6-I, 2-II, 15-III). Five year CSS was 71.2% (stages: 82%-I-II and 56%-III) and DFS, LRFS, LRRFS, and DMFS were 55.5%, 59%, 72%, and 67.2%, respectively. Late G3-G4 complications (crude): 1.3% small bowel, 2.5% rectum, and 5% bladder. Conclusion: In stages I–III of the IEC, EBRT + IGBT offer good 2- and 5-year CSS of 88.7% and 71.2%, respectively, with the best outcomes in stages I–II. Prospective studies are needed to determine how better outcomes can be achieved.

ABSTRACTBACKGROUNDThe identification of the metabolic syndrome is essential for a timely diagnosis and to avoid type 2 diabetes, the objective was to determine the validity of the FINDRISC test and glycated hemoglobin for risk screening for diabetes mellitus in a high-altitude resident population (3600 m.a.s.l.) city of La Paz - Bolivia 2018.METHODSAnalytical study of diagnostic tests, the gold test was the definition of metabolic syndrome according to the criteria of the Harmonization Consensus, compared with the FINDRISC test and glycated hemoglobin. People with an age greater than or equal to 18, who agreed to participate, were included. Pregnant women, people with cancer or thyroid disease were excluded.RESULTS400 people were included. There were 358 women (89.5%) and 42 men (10.5%) with age of 48.38±14.1 years old. The prevalence of metabolic syndrome was 46.75%. The area under the curve, sensitivity, specificity, positive predictive value and positive likelihood ratio of FINDRISC with cut-off point 10 were 0.7073(CI95% 0.66-0.75), 74.33%(CI95% 67.34-80.30), 67.14%(CI95% 60.33-73.31), 66.51%(CI95% 59.62-72.78) and 2.26(CI95% 1.83-2.79) respectively. With FINDRISC’s (cut-off point 10) and HbA1c (cut-off point 5.7%) together, were 0.8025 (CI95% 0.74-0.84), 88.1%(CI95% 80.82-92.96), 72.41%(CI95% 63.21-80.11), 77.62%(CI95% 69.74-83.98) and 3.19 (CI95% 2.36-4.32) respectively.CONCLUSIONSThe FINDRISC test is a good metabolic syndrome screening test, with a cut point of 10, this is synergized with 5.7% for HbA1c in a high-altitude resident population (3600 m.a.s.l.).Summary BoxWhat is already known on this subject?To exist evidence that FINDRISC test is useful with HbA1c together. It to predict diabetes risk. But there are different cutoff points in both. In high altitude population as La Paz to 3600 m.a.s.l., it doesn’t know.What are the new findings?The FINDRISC test is a good metabolic syndrome screening test, with a cut point of 10, this is synergized with 5.7% for HbA1c in high altitude population as La Paz to 3600 m.a.s.l.How might these results change the focus of research or clinical practice?The FINDRISC test is easy to apply in primary care, plus the determination of glycosylated hemoglobin, enhances its diagnostic capacity to predict metabolic syndrome, in high altitude resident population, where insulin sensitivity is different.

To evaluate the preliminary results of the use of 68 Gy EQD2(α/β=3 Gy) as a dose limit to the lowest dose in the most exposed 2 cm3 of the vagina in order to reduce G2 late vaginal problems in postoperative endometrial carcinoma (EC). From November 2016 to October 2019, 69 postoperative EC patients receiving vaginal brachytherapy (VBT) ± external beam radiotherapy (EBRT) were prospectively analyzed. The median EBRT dose was 45 Gy (range: 44–50.4 Gy), 1.8−2 Gy/day, 5 fractions(Fr)/week. VBT was administered with the following schedule: 1Fr of 7 Gy after EBRT and 2 daily Fr × 7.5 Gy in exclusive VBT. The dose was prescribed at 0.5 cm from the applicator surface with an active length of 2.5 cm; 56 patients were treated with vaginal cylinders (49–3.5 cm, 6–3 cm, and 1–2.5 cm) and 13 with the colpostat technique. The overall VBT dose was adjusted to meet the vaginal restriction of < 68 Gy EQD2(α/β=3 Gy) at 2 cm3. Late toxicity was prospectively assessed using RTOG scores for bladder and rectum, and the objective LENT-SOMA criteria for vagina. With a median follow-up of 31.0 months, no vaginal-cuff recurrences were found. Late toxicity: only 1G1(1.4%) rectal toxicity; 21G1(30.4%) and 3G2(4.3%) vaginal complications. Only one (1.4%) of 3 G2 manifested as vaginal shortening. In postoperative EC patients treated with VBT, only one developed G2 vaginal stenosis with the use of 68 Gy EQD2(α/β=3 Gy) as a dose constraint. These preliminary results seem to indicate the value of this dose limit for reducing G2 vaginal stenosis. Nonetheless, these findings should be confirmed in a larger number of patients with longer follow-up.

INTRODUCTION Malaria case management is a pivotal intervention in malaria elimination. However, many remote areas in Brazil still lack access to basic health services. This study describes a community-based approach (CBA) for malaria case management in the large remote area of the Jaú National Park (JNP), Amazonas, Brazil. METHODS In 2001, a general health CBA was initiated with a motor group (MG); a participative community health diagnosis (PCHD) was subsequently implemented between 2001 and 2005. In 2006, a CBA for malaria case management started with an expanded MG including all sectors with a stake in malaria control, from the local residents to the federal government. In 2008, community microscopists were selected and trained to diagnose hemoparasites. A full malaria strategy was implemented in 2009 with subsequent quality control follow-up. RESULTS Two educational materials were co-created with local communities. The MG identified malaria as a major health problem and the malaria MG planned the control activities. Ten communities selected a resident to become malaria microscopists, and ten solar-operated health centers were built. The number of slide readings increased from 923 in 2006 to 1,900 in 2009, while malaria infections decreased from 354 cases in 2005 to 20 cases in 2015. The excess time (≥ 48 hours) between first symptoms and diagnosis/treatment decreased from 68.9% of cases in 2005 to 14.3% in 2010. CONCLUSIONS While many factors were likely involved in the reduction of malaria transmission in the JNP, the CBA played an important role in the sustained success of the initiative.

Aim: To analyse the possible relationship between the EQD2((alpha/beta=3Gy)) at 2 cm(3) of the vagina and late toxicity in vaginal-cuff-brachytherapy (VBT) after external-beam-irradiation (EBRT) for postoperative endometrial carcinoma (EC). Materials and methods: From 2014 to 2016, 62 postoperative EC patients were treated with EBRT + VBT. The median EBRT dose was 45 Gy (44 Gy-50.4 Gy). VBT involved a single 7 Gy dose. Toxicity was prospectively evaluated using the RTOG score for the rectum and bladder and the objective LENT-SOMA criteria for the vagina. EQD2((alpha/beta=3Gy)) at 2 cm(3) of the most exposed part of the vagina was calculated by the sum of the EBRT + VBT dose. Statistics: Boxplot, Student's t and Chi-square tests and ROC curves. Results: Mean follow-up: 39.2 months (15-68). Late toxicity: bladder:0 patient; rectum:2 patients-G1; Vagina: 26 patients-17G1, 9G2; median EQD2((alpha/beta=3Gy)) at 2 cm(3) in G0-G1 patients was 70.4 Gy(SD2.36), being 72.5 Gy(SD2.94) for G2p. The boxplot suggested a cut-point identifying the absence of G2: 100 % of G2p received >68 Gy, ROC curves showed an area under the curve of 0.72 (sensitivity of 1 and specificity of 0.15). Conclusions: Doses >68 Gy EQD2((alpha/beta=3Gy)) at 2 cm(3) to the most exposed area of the vagina were associated with late G2 vaginal toxicity in postoperative EC patients treated with EBRT + VBT suggesting a very good dose limit to eliminate the risk of G2 late toxicity. The specificity obtained indicates the need for prospective analyses. (C) 2020 Greater Poland Cancer Centre. Published by Elsevier B.V. All rights reserved.

Background: To evaluate whether EQD2(α/β = 3Gy) at 2 cm3 of the most exposed area of the vagina is related to late vaginal toxicity in postoperative endometrial cancer (PEC) patients (p) treated with exclusive brachytherapy (BT). Methods: From 2014 to 2017, 43p were included in this study. BT was administered: 3-fractions of 6Gy in 37p and 2-fractions of 7.5Gy in 6p. The dose was prescribed at a depth of 5 mm from the applicator surface with dose-point optimization based on distance. The active treatment length was 2.5 cm. CTV-D90 and the dose to the most exposed 2 cm3 of the vagina was calculated for each patient. Late toxicity of the bladder and rectum was assessed using Radiation Therapy Oncology Group (RTOG) criteria, and vaginal toxicity by objective Late Effects Normal Tissue Task Force (LENT)-Subjective, Objective, Management, Analytic (SOMA) (LENT-SOMA) criteria. Statistics: frequency tables, mean, median, range, standard deviation, and box plot. Results: The median follow-up was 51 months (12–68). 20 p (46.5%) and 2 p (4.7%) developed G1 and G2 vaginal complications, respectively. Only 1/2 p-G2 receiving EQD2(α/β = 3Gy) at 2 cm3 >68Gy presented vaginal shortening and 18/20 p-G1 received doses < 68Gy. Conclusions: PECp receiving exclusive brachytherapy with doses < 68Gy EQD2(α/β = 3Gy) at 2 cm2 of the vagina presented only G0–G1 vaginal toxicity, except for one with bleeding telangiectasias. Larger prospective studies are necessary to confirm the present results.

Introduction Chagas disease presents bio-psycho-social and cultural determinants for infected patients, their family members, close friends, and society. For this reason, diagnosis and treatment require an active approach and an integral focus, so that we can prevent the disease from creating stigma and exclusion, as is actively promoting access to diagnosis, medical attention and social integration Methodology The study was conducted in the Metropolitan Area of Barcelona (Catalonia, Spain) from 2004 to 2017. After an increased detection rates of CHD in our region, the process of construction of community strategies started (2004-2013). Different community interventions with informational, educational, and communication components were designed, developed, implemented, and evaluated. The results of the evaluation helped to determine which intervention should be prioritized: 1) workshop; 2) community event; 3) in situ screening. Afterwards, those strategies were implemented (2014-2017). Results Each of the three strategies resulted in a different level of coverage, or number of people reached. Thein situscreening interventions reached the highest coverage (956 persons, 58.98%).Clear differences exist (p-value<0.001) between the three strategies regarding the percentage of screenings and diagnoses carried out. The largest number was in thein situscreening intervention, with a total of 830 persons screened despite the greatest number of diagnoses was among the workshop participants (33 persons, 20.75% of those screened). The prevalence of infection found is similar among the three strategies, ranging from 16.63% to 22.32% of the screened patients (p-value= 0.325). Conclusions The results of the study show that community interventions seem to be necessary to improve access to diagnosis and treatment of CHD in the area of Barcelona. They also show which strategy is the most appropriate based on the detected needs of the community, the proposed objectives of the intervention, and the given socio-temporal context.

In recent years, pediatric research on tuberculosis (TB) has focused on addressing new biomarkers with the potential to be used as immunological non-sputum-based methods for the diagnosis of TB in children. The aim of this study was to characterize a set of cytokines and a series of individual factors (ferritin, 25-hydroxyvitamin D [25(OH)D], parasite infections, and nutritional status) to assess different patterns for discriminating between active TB and latent TB infection (LTBI) in children. The levels of 13 cytokines in QuantiFERON-TB Gold In-Tube (QFT-GIT) supernatants were analyzed in 166 children: 74 with active TB, 37 with LTBI, and 55 uninfected controls. All cytokines were quantified using Luminex or ELISA. Ferritin and 25(OH)D were also evaluated using CLIA, and Toxocara canis Ig-G antibodies were detected with a commercial ELISA kit. The combination of IP-10, IFN-γ, ferritin, and 25(OH)D achieved the best diagnostic performance to discriminate between active TB and LTBI cases in children in relation to the area under receiver operating characteristic (ROC) curve 0.955 (confidence interval 95%: 0.91-1.00), achieving optimal sensitivity and specificity for the development of a new test (93.2 and 90.0%, respectively). Children with TB showed higher ferritin levels and an inverse correlation between 25(OH)D and IFN-γ levels. The model proposed includes a combination of biomarkers for discriminating between active TB and LTBI in children to improve the accuracy of TB diagnosis in children. This combination of biomarkers might have potential for identifying the onset of primary TB in children.

PURPOSE: The purpose of this study was to analyze the direct economic impact of two vaginal cuff brachytherapy (VBT) schedules in postoperative endometrial carcinoma (PEC) with similar vaginal control and toxicity results. MATERIALS AND METHODS: From 2006 to 2015, 397 PEC patients (p) were treated with VBT: mean 40p/year, 67.5% received external beam radiotherapy (EBRT)+VBT and 32.5% exclusive VBT. Schedule 1: 3 fractions (Fr) after EBRT and 6Fr (4-6 Gy/Fr) in exclusive VBT. Schedule 2: 7Gy x 1Fr + EBRT and 6Gy x 3Fr in exclusive VBT. Differential cost analysis of the two schedules was retrospectively performed. The direct costs in each schedule were (1) Personnel: radiotherapy technicians, nurses, radiation oncologists, medical physicists, administrative personnel, orderlies; time dedicated by each professional during CT planning acquisitions and delineation of vagina/organs at risk, dosimetric study and evaluation, autoradiography, procedure reporting time during/after treatment, removal of bladder/rectal tubes and applicators, material cleaning and transportation for sterilization; (2) Health care material (gels, gauzes, gloves, etc); (3) Equipment (time equipment used). The differential between the two schedules was estimated. Indirect costs and evaluation of quality of life-adjusted costs were not considered. RESULTS: The overall reduction in the number of Fr per year in Schedule 2 was 93. Cost savings included treatment time per year: 4,185 min (70 h); personnel: 221(sic) ($246)/p in EBRT + VBT and 331(sic) ($368)/p in exclusive VBT; and health care material and equipment: 40(sic) ($44.5)/p in EBRT + VBT and 90(sic) ($100.2)/p in exclusive VBT. The overall savings per patient was 261(sic) ($295) in combined treatment and 421(sic) ($475.7) in exclusive VBT. The total savings per year with Schedule 2 in 40p was 12,503(sic) ($13,915.8). CONCLUSIONS: A 41% reduction in the fractions number in VBT for PEC allowed economic savings of 261(sic) ($290.5)/p in combined treatment and 421(sic) ($475.7)/p in exclusive VBT. Other benefits include patient comfort and fewer treatment visits. (C) 2020 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

Chagas disease (CHD) has become a challenge in Spain due to the high prevalence of immigrants coming from endemic areas. One of the main difficulties for its control and elimination is its underdiagnosis. The identification and integral treatment of CHD are key to increasing rates of diagnosis, overcoming psycho-social barriers and avoiding CHD progression. Community interventions with in situ screening have proven to be a useful tool in detecting CHD among those with difficulties accessing health services. To determine the underdiagnosis rate of the population most susceptible to CHD among those attending two different Bolivian cultural events celebrated in Barcelona; to describe the sociodemographic characteristics of the people screened; and to analyse the results of the screening. The community interventions were carried out at two Bolivian cultural events held in Barcelona in 2017. Participants were recruited through community health agents. A questionnaire was given to determine the participants’ prior knowledge of CHD. In situ screening was offered to those who had not previously been screened. Those who did not wish to be screened were asked for the reason behind their decision. Results were gathered in a database and statistical analyses were performed using STATA v14. 635 interviews were carried out. 95% of the subjects reported prior knowledge of CHD. 271 subjects were screened: 71.2% women and 28.8% men, of whom 87.8% were of Bolivian origin. The prevalence of CHD was 8.9%. Community health interventions with in situ screening are essential to facilitating access to diagnosis.

Purpose To determine whether brachytherapy with a single hypofractionated dose of 7 Gy provides the similar vaginal-cuff relapses and safety profile in terms of complications compared to schedules of 2 or 3 fractions of lower doses in patients treated previously with external beam irradiation in postoperative endometrial carcinoma. Methods/material From June 2003 to December 2016, 325 patients were treated with 3 different schedules of high-dose-rate brachytherapy after external beam irradiation for postoperative endometrial carcinoma. The patients were divided into 3 groups: Group-1: 125 patients were treated with 3 fractions of 4–6 Gy per fraction (3 fractions/week) between 2003 and 2008; Group-2: 93 patients were treated with 2 consecutive daily fractions of 5–6 Gy between 2008 and 2011; Group-3: 107 patients received a single fraction of 7 Gy between 2011 and 2016. Bladder and rectum complications were assessed using RTOG scores and with the objective scores of LENT-SOMA for the vagina. Statistics: the chi-square test. Results The mean follow-up of Groups 1, 2 and 3 was 95, 67 and 51 months, respectively. Three patients in Group-1, 2 in Group-2, 1 in Group-3 developed vaginal-cuff relapse ( p = 0.68). No differences were found in late toxicity among the three groups. Conclusions One single dose of 7 Gy is safe and effective and may be the best treatment schedule with a similar incidence of vaginal-cuff relapses, complications and patient comfort with less hospital attendance.

To analyze if there is a relationship between the EQD2(α/β=3Gy) at 2cm3 of the most exposed region of the vagina and late vaginal toxicity in vaginal-cuff brachytherapy (VBT) after external beam irradiation (EBRT) for postoperative endometrial carcinoma (PEC). From 2014-2017, 62 PEC patients were treated with EBRT+VBT after 3D planning. The mean and median EBRT dose were 45.3Gy and 45Gy (range 44Gy-50.4Gy) with 1.8-2Gy/fraction, 5 fractions/week. VBT was administered with a single dose of 7Gy. The median active length was 2.5cm, and dose prescription was at 5mm. from the applicator surface. Toxicity was prospectively evaluated using the RTOG score for the rectum and bladder and objective criteria of LENT-SOMA for the vagina. EQD2(α/β=3Gy) was calculated by the sum of the EBRT and VBT dose. Statistics: Boxplot, Student’s t test and ROC curves. The mean follow-up was 39.2 months (range 15-68). No bladder toxicity was detected. Rectal and vaginal toxicity appeared in 2 patients (G1) and 26 patients (17G1, 9G2), respectively. In G0-G1 patients EQD2(α/β=3Gy) at 2cm3 of the most exposed part of the vagina was 70.37Gy (SD 2.36), being 72.51Gy (SD 2.94) for G2 patients. An association was found between EQD2(α/β=3Gy) at 2cm3 of the most exposed dose area of vagina and late vaginal toxicity for G0-G1 and G2 (P=0.018). The boxplot suggested a cut point to identify the absence of G2 toxicity: 100% of G2 toxicity cases received doses greater than 68Gy. ROC curves showed an area under the curve of 0.72, and 68Gy had a sensitivity of 1 and a specificity of 0.15. Doses over 68Gy EQD2(α/β=3Gy) at 2cm3 of the most exposed area of the vagina were associated with late G2 vaginal toxicity in PEC patients treated with EBRT+VBT. These results suggest that 68Gy is a very good dose limit to eliminate the risk of G2 late vagina toxicity. The specificity of the present finding indicates the need for prospective analyses to evaluate the efficacy of doses less than 68Gy. Grant: Spanish association against cancer (AECC) Foundation.

BACKGROUND:Survival methodology has not already been used in studies about postpartum depression (PPD) course. The aims of the present study were to estimate the duration of a Major Postpartum Depressive Episode (MPDE) during 2 years, as well as to explore factors associated with the course.METHOD:This was a prospective, naturalistic, longitudinal study with a cohort of 165 women with a MPDE (DSM-IV criteria). Potential predictors of prognosis were recorded at baseline. Follow-up was conducted using the Longitudinal Interval Follow-up Evaluation (LIFE).RESULTS:Of the total sample, 110 (66.7%) completed the 2 years follow-up. The mean time to full remission was 49.4 weeks (95% CI: 44.0-59.8). The probability of recovering was 30.2% (95% CI: 22.1%-37.4%) at 6 months of follow-up, 66.3% (95% CI: 57.4%-73.4%) at 12 months of follow-up, and 90.3% (95% CI: 79.8%-95.4%) at 24 months of follow-up. Mothers with financial difficulties, onset of depressive episode previous to birth, and those with prior treated depressive episodes took longer in achieving full remission.LIMITATIONS:Results are only generalizable to mothers with PPD treated in a psychiatric outpatient setting. Psychopharmacological treatment was uncontrolled and personality was not assessed.CONCLUSIONS:Our findings suggest that PPD could become a chronic disorder, particularly in mothers with an onset of the episode previous to birth, with a history of depression or with financial problems. Knowledge of these factors may help to improve the guidelines of depression management and treatment during the perinatal period.

To analyze the direct economic impact of two postoperative vaginal-cuff brachytherapy (VBT) schedules in endometrial carcinoma (EC) with similar vaginal control and toxicity results. Hypothesis: A lesser number of fractions should allow savings in VBT. From 2006-2015, 397 postoperative EC patients were treated with VBT with a mean of 40 patients/year; 70% of patients received EBI+VBT and the 30% exclusive VBT. Schedule 1: 3 fractions after external beam irradiation (EBI) and 6 fractions in exclusive BT (4-6Gy per fraction); Schedule 2: 1 fraction of 7Gy after EBI and 3 fractions of 6Gy exclusive BT. The differential cost analysis between the 2 schedules were performed retrospectively. The following were considered as a direct cost in each schedule: 1) Personnel costs (technicians in radiotherapy, nurses, medical physicists, administrative personnel, orderlies); the time dedicated by each professional during: CT Planning acquisitions and vagina and OAR delineation, dosimetric study, dosimetry evaluation, auto-radiography, procedure reporting time during and after treatment, removal of bladder and rectal tubes, removal and cleaning of applicators, sterilization procedures and transportation of material for sterilization; 2) Health care material (gels, gauzes, among others); 3) Imputation of treatment equipment costs (length of time of equipment use). The differential between the two schedules was estimated. A limitation of the study was that indirect costs and evaluation of quality of life adjusted costs were not considered in the present analysis. In schedule 2 the savings in treatment time per year was of 4.185 minutes (70 hours).The estimated savings in personnel was of 290€ per patient while that of sanitary material and equipment was of 23€ per patient treated. The overall savings per patient was 313€. Thus, the total savings per year with the use of schedule 2 in 40 patients was of 12,520€. A reduction of one third in the number of fractions in VBT of postoperative EC allowed an economic savings per patient of 313€ or 12520€ per year (40 patients). Other possible benefits of a reduction in the number of fractions include patient comfort and fewer treatment visits allowing investment in other patient benefits. Grant: Spanish Association against Cancer (AECC) Foundation.

To analyze the impact of age on radiotherapy results based on cancer-specific survival (CSS), vaginal-cuff relapses (VCR) and complications analysis in 438 patients with endometrial carcinoma (EC) receiving postoperative radiotherapy (PRT) divided into three age groups for analysis.

Introduction: Some studies indicate high prevalences of latent tuberculosis infection (LTBI) in the immigrant population, which is relevant because 5-10% of cases will develop active tuberculosis. The objective of this study is to describe the results of a sequential strategy in the newly-arrived immigrant population for the diagnosis of LTBI using the tuberculin skin test (TST) and IGRAs. Methods: A retrospective descriptive study was carried out with immigrants between 6 and 35 years of age from shelters, referred to an international health unit between July 2013 and June 2016. The TST was performed and when it was >= 5 mm, IGRAs were conducted. LTBI was defined as an IGRA >= 0.35 IU/ml and normal chest X-ray. Results: Of the 184 cases. 138 (75.0%) were men, 23.0 years of age. The most common geographical areas were: 63 (34.2%) from Asia, 42 (22.8%) from Eastern Europe and 41 (22.3%) from sub-Saharan Africa. The TST was >= 10 mm in 79 cases (42.9%). The prevalence of LTBI using the sequential strategy was 33/184 (17.9%). Cohen's Kappa index (between TST >= 10 mm and IGRAs) was 0.226. Conclusion: Basing LTBI screening on the TST alone could give rise to an overestimation. Some studies show that sequential screening would be the most cost-effective; this seems most evident in BCG-vaccinated populations. (C) 2017 Elsevier Espalia, S.L.U. and Sociedad Espanola de Enfermedades Infecciosas y Microbiologia Clinica. All rights reserved.

Purpose To evaluate if the dose equivalent to 2 Gy per fraction (EQD2)(α/β=3Gy) at 0.1 cm3, 1 cm3, and 2 cm3 of vagina in vaginal-cuff-brachytherapy (VBT) (high-dose-rate [HDR] 192Ir-source) ± external-beam-irradiation (EBRT) is associated with toxicity in post-operative endometrial carcinoma (P-EC). Material and methods From June 2014 till November 2015, 67 consecutive P-EC patients underwent VBT ± EBRT; 44 patients received EBRT (median, 45 Gy; range, 44-50.4) + VBT (7 Gy), and 23 exclusive-VBT (6 Gy x 3 fractions). The upper 2.5 cm of vagina was delineated on computed tomography (CT). The active-length source was 2.5 cm, and the brachytherapy dose was prescribed at 5 mm from the applicator. D90, V100, and EQD2(α/β=3Gy) at 0.1 cm3, 1 cm3, and 2 cm3 of the most exposed part of the vagina were calculated. Vaginal toxicity assessment was completed with a LENT-SOMA-objective-criteria. Statistics were done with the use of χ2 and Student’s-t test. Results The mean follow-up was 23.2 months (7.6-46.8). Median D90 was 7.8 Gy(α/β=3Gy). Late toxicity: 8 G1 and 9 G2. Median EQD2(α/β=3Gy) in vagina was 88.6 Gy (62.8-177.6) for 0.1 cm3, 72.4 Gy (57.1-130.4) for 1 cm3, and 69 Gy (53-113.4) for 2 cm3. Exclusive VBT vs. EBRT+VBT showed no differences in vaginal toxicity. There was no relationship between EQD2(α/β=3Gy) at 0.1 cm3 and 1 cm3 of vagina with G1-G2 toxicity (p = 0.62 and p = 0.58, respectively). G2 toxicity was related to EQD2(α/β=3Gy) at 2 cm3 (p = 0.03). EQD2(α/β=3Gy) > 68 Gy caused G2 late toxicity in 20.5% patients. All patients presenting G2 toxicity received > 68 Gy EQD2(α/β=3Gy). Conclusions More than 68 Gy EQD2(α/β=3Gy) at 2 cm3 was related to G2 toxicity in P-EC-VBT. Further studies including larger number of patients are needed to confirm these results. Patients receiving these doses should be informed of the risk of toxicity, with individualized treatment planning and follow-up to reduce G2 toxicity.