The experience of fathers of children hospitalised with advanced heart disease.

BACKGROUND: There are little reported data on the perspectives of fathers caring for children with chronic conditions. Although survival of children with advanced heart disease has improved, long-term morbidity remains high. This study describes the experience and prognostic awareness of fathers of hospitalised children with advanced heart disease. METHODS: Cross-sectional survey study of parents caring for children hospitalised with advanced heart disease admitted for ≥ 7 days over a one-year period. One parent per patient completed surveys, resulting in 27 father surveys. Data were analysed using descriptive methods. RESULTS: Nearly all (96%) of the fathers reported understanding their child's prognosis "extremely well" or "well," and 59% felt they were "very prepared" for their child's medical problems. However, 58% of fathers wanted to know more about prognosis, and 22% thought their child's team knew something about prognosis that they did not. Forty-one per cent of fathers did not think that their child would have lifelong limitations, and 32% anticipated normal life expectancies. All 13 fathers who had a clinical discussion of what would happen if their child got sicker found this conversation helpful. Nearly half (43%) of the fathers receiving new prognostic information or changes to treatment course found it "somewhat" or "a little" confusing. CONCLUSIONS: Fathers report excellent understanding of their child's illness and a positive experience around expressing their hopes and fears. Despite this, there remain many opportunities to improve communication, prognostic awareness, and participation in informed decision-making of fathers of children hospitalised with advanced heart disease.

Formal Ethics Consultation in Extracorporeal Membrane Oxygenation Patients: A Single-Center Retrospective Cohort of a Quaternary Pediatric Hospital.

OBJECTIVE: To examine characteristics associated with formal ethics consultation (EC) referral in pediatric extracorporeal membrane oxygenation (ECMO) cases, and document ethical issues presented. DESIGN: Retrospective cohort study using mixed methods. SETTING: Single-center quaternary pediatric hospital. PATIENTS: Patients supported on ECMO (January 2012 to December 2021). INTERVENTIONS: We compared clinical variables among ECMO patients according to the presence of EC. We defined optimal cutoffs for EC based on run duration, ICU length of stay (LOS), and sum of procedures or complications. To identify independent explanatory variables for EC, we used a forward stepwise selection multivariable logistic regression model. EC records were thematically characterized into ethical issues. MEASUREMENTS AND MAIN RESULTS: Of 601 ECMO patients and 225 patients with EC in 10 years, 27 ECMO patients received EC (4.5% of ECMO patients, 12% of all ECs). On univariate analysis, use of EC vs. not was associated with multiple ECMO runs, more complications/procedures, longer ICU LOS and ECMO duration, cardiac admissions, decannulation outcome, and higher mortality. Cutoffs for EC were ICU LOS >52 days, run duration >160 hours, and >6 complications/procedures. Independent associations with EC included these three cutoffs and older age. The model showed good discrimination (area under the curve 0.88 [0.83, 0.93]) and fit. The most common primary ethical issues were related to end-of-life, ECMO discontinuation, and treatment decision-making. Moral distress was cited in 22 of 27 cases (82%). CONCLUSION: EC was used in 4.5% of our pediatric ECMO cases, with most ethical issues related to end-of-life care or ECMO discontinuation. Older age, longer ICU LOS, prolonged runs, and multiple procedures/complications were associated with greater odds for EC requests. These data highlight our single-center experience of ECMO-associated ethical dilemmas. Historical referral patterns may guide a supported decision-making framework. Future work will need to include quality improvement projects for timely EC, with evaluation of impacts on relevant endpoints.

Social Drivers of Health and Pediatric Extracorporeal Membrane Oxygenation Outcomes.

BACKGROUND: Relationships between social drivers of health (SDoH) and pediatric health outcomes are highly complex with substantial inconsistencies in studies examining SDoH and extracorporeal membrane oxygenation (ECMO) outcomes. To add to this literature with emerging novel SDoH measures, and to address calls for institutional accountability, we examined associations between SDoH and pediatric ECMO outcomes. METHODS: This single-center retrospective cohort study included children (<18 years) supported on ECMO (2012-2021). SDoH included Child Opportunity Index (COI), race, ethnicity, payer, interpreter requirement, urbanicity, and travel-time to hospital. COI is a multidimensional estimation of SDoH incorporating traditional (eg, income) and novel (eg, healthy food access) neighborhood attributes ([range 0-100] higher indicates healthier child development). Outcomes included in-hospital mortality, ECMO run duration, and length of stay (LOS). RESULTS: 540 children on ECMO (96%) had a calculable COI. In-hospital mortality was 44% with median run duration of 125 hours and ICU LOS 29 days. Overall, 334 (62%) had cardiac disease, 92 (17%) neonatal respiratory failure, 93 (17%) pediatric respiratory failure, and 21 (4%) sepsis. Median COI was 64 (interquartile range 32-81), 323 (60%) had public insurance, 174 (34%) were from underrepresented racial groups, 57 (11%) required interpreters, 270 (54%) had urban residence, and median travel-time was 89 minutes. SDoH including COI were not statistically associated with outcomes in univariate or multivariate analysis. CONCLUSIONS: We observed no significant difference in pediatric ECMO outcomes according to SDoH. Further research is warranted to better understand drivers of inequitable health outcomes in children, and potential protective mechanisms.

Cardiac arrest and cardiopulmonary resuscitation in pediatric patients with cardiac disease: a narrative review.

Children with cardiac disease are at a higher risk of cardiac arrest as compared to healthy children. Delivering adequate cardiopulmonary resuscitation (CPR) can be challenging due to anatomic characteristics, risk profiles, and physiologies. We aimed to review the physiological aspects of resuscitation in different cardiac physiologies, summarize the current recommendations, provide un update of current literature, and highlight knowledge gaps to guide research efforts. We specifically reviewed current knowledge on resuscitation strategies for high-risk categories of patients including patients with single-ventricle physiology, right-sided lesions, right ventricle restrictive physiology, left-sided lesions, myocarditis, cardiomyopathy, pulmonary arterial hypertension, and arrhythmias. Cardiac arrest occurs in about 1% of hospitalized children with cardiac disease, and in 5% of those admitted to an intensive care unit. Mortality after cardiac arrest in this population remains high, ranging from 30 to 65%. The neurologic outcome varies widely among studies, with a favorable neurologic outcome at discharge observed in 64%-95% of the survivors. Risk factors for cardiac arrest and associated mortality include younger age, lower weight, prematurity, genetic syndrome, single-ventricle physiology, arrhythmias, pulmonary arterial hypertension, comorbidities, mechanical ventilation preceding cardiac arrest, surgical complexity, higher vasoactive-inotropic score, and factors related to resources and institutional characteristics. Recent data suggest that Extracorporeal membrane oxygenation CPR (ECPR) may be a valid strategy in centers with expertise. Overall, knowledge on resuscitation strategies based on physiology remains limited, with a crucial need for further research in this field. Collaborative and interprofessional studies are highly needed to improve care and outcomes for this high-risk population. What is Known: • Children with cardiac disease are at high risk of cardiac arrest, and cardiopulmonary resuscitation may be challenging due to unique characteristics and different physiologies. • Mortality after cardiac arrest remains high and neurologic outcomes suboptimal. What is New: • We reviewed the unique resuscitation challenges, current knowledge, and recommendations for different cardiac physiologies. • We highlighted knowledge gaps to guide research efforts aimed to improve care and outcomes in this high-risk population.

Predictors of Serious Adverse Events and High-Level Cardiorespiratory Support in Patients Undergoing Transcatheter Pulmonary Vein Interventions.

Patients with pulmonary vein stenosis (PVS) often require frequent transcatheter pulmonary vein (PV) interventions for management of restenosis. Predictors of serious adverse events (AEs) and need for high-level cardiorespiratory support (mechanical ventilation, vasoactive support, and/or extracorporeal membrane oxygenation) 48 h after transcatheter PV interventions have not been reported. This is a single-center retrospective cohort analysis of patients with PVS who underwent transcatheter PV interventions from 3/1/2014 to 12/31/2021. Univariate and multivariable analyses were performed using generalized estimating equations to account for within-patient correlation. 240 patients underwent 841 catheterizations involving PV interventions (median 2 catheterizations per patient [1,3]). At least one serious AE was reported in 100 (12%) cases, the most common of which were pulmonary hemorrhage (n = 20) and arrhythmia (n = 17). There were 14 severe/catastrophic AEs (1.7% of cases) including three strokes and one patient death. On multivariable analysis, age less than 6 months, low systemic arterial saturation (< 95% in patients with biventricular [BiV] physiology, < 78% in single ventricle [SV] physiology), and severely elevated mean PA pressure (≥ 45 mmHg in BiV, ≥ 17 mmHg in SV) were associated with SAEs. Age less than 1 year, hospitalization prior to catheterization, and moderate-severe RV dysfunction were associated with high-level support after catheterization. Serious AEs during transcatheter PV interventions in patients with PVS are common, although major events such as stroke or death are uncommon. Younger patients and those with abnormal hemodynamics are more likely to experience serious AEs and require high-level cardiorespiratory support after catheterization.

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature.

OBJECTIVES: To map the scope, methodological rigor, quality, and direction of associations between social determinants of health (SDoH) and extracorporeal membrane oxygenation (ECMO) utilization or outcomes. DATA SOURCES: PubMed, Web of Science, Embase, and Cochrane Library databases were systematically searched for citations from January 2000 to January 2023, examining socioeconomic status (SES), race, ethnicity, hospital and ECMO program characteristics, transport, and geographic location (context) with utilization and outcomes (concept) in ECMO patients (population). STUDY SELECTION: Methodology followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping review extension. Two reviewers independently evaluated abstracts and full text of identified publications. Exclusion criteria included non-English, unavailable, less than 40 patients, and periprocedural or mixed mechanical support. DATA EXTRACTION: Content analysis used a standardized data extraction tool and inductive thematic analysis for author-proposed mediators of disparities. Risk of bias was assessed using the Quality in Prognosis Studies tool. DATA SYNTHESIS: Of 8,214 citations screened, 219 studies were identified. Primary analysis focuses on 148 (68%) including race/ethnicity/SES/payer variables including investigation of ECMO outcomes 114 (77%) and utilization 43 (29%). SDoH were the primary predictor in 15 (10%). Overall quality and methodologic rigor was poor with advanced statistics in 7%. Direction of associations between ECMO outcomes or utilization according to race, ethnicity, SES, or payer varied. In 38% adverse outcomes or lower use was reported in underrepresented, under-resourced or diverse populations, while improved outcomes or greater use were observed in these populations in 7%, and 55% had no statistically significant result. Only 26 studies (18%) discussed mechanistic drivers of disparities, primarily focusing on individual- and hospital-level rather than systemic/structural factors. CONCLUSIONS: Associations between ECMO utilization and outcomes with SDoH are inconsistent, complicated by population heterogeneity and analytic shortcomings with limited consideration of systemic contributors. Findings and research gaps have implications for measuring, analyzing, and interpreting SDoH in ECMO research and healthcare.

Mental Health in COVID-2019 Survivors from a General Hospital in Peru: Sociodemographic, Clinical, and Inflammatory Variable Associations.

The current coronavirus disease-2019 (COVID-19) pandemic constitutes a significant public health problem worldwide, as well as mental health problems. This study aimed to evaluate the mental health of COVID-19 survivors, considering their sociodemographic, clinical, and immune variables. A cross-sectional and correlational study was conducted on 318 COVID-19 survivors from one hospital in Peru. Through telephone interviews, evaluation of the presence of depressive symptoms using the Patient Health Questionnaire-9, anxiety symptoms through the Generalized Anxiety Disorder-7, somatic symptoms through Patient Health Questionnaire-15, and posttraumatic stress disorder (PTSD) symptoms through Impact of Event Scale-Revised was carried out. Poisson regression analyses were performed with their adjusted variances to calculate the prevalence ratio (PR) with their 95% confidence interval. All regression models were adjusted (PRa) for follow-up time. A significant proportion of patients have depressive (30.9%), anxious (31.1%), somatic (35.2%), and PTSD (29.5%) symptoms. The variables associated with a higher frequency of clinically relevant mental symptoms were female sex, self-perception of greater COVID-19 severity, presence of persistent COVID-19 symptoms, loss of a family member due to COVID-19, and prior psychiatric diagnosis or treatment. In addition, the neutrophil-to-lymphocyte ratio was significantly higher in patients with clinically relevant symptoms of depression. COVID-19 survivors showed a high prevalence of negative mental symptoms. Our findings help to identify patients who are vulnerable and require psychiatric care.

Association between vitamin D serum levels and clinical, laboratory, and parasitological parameters in patients with malaria from an endemic area of the Amazon.

BACKGROUND: Some studies have suggested the importance of vitamin D [25(OH)D] in malaria clinical practice. The prevalence of 25(OH)D deficiency in the Amazon population is not well known, and there are few studies in patients with malaria. This study aimed to evaluate 25(OH)D serum levels in patients with malaria and determine their relationships with epidemiological, clinical, laboratory, and parasitemia data. METHODS: An analytical cross-sectional study of 123 patients with malaria and 122 individuals without malaria was performed in Itaituba, Pará, Brazil, from January 2018 to October 2019, by evaluating sociodemographic, clinical-epidemiological, parasitological, and laboratory data and adopting a 5% significance level. Parametric tests (Student's t-test), non-parametric tests (Mann-Whitney U), and Spearman's correlation ([rs], for non-parametric variables) were used according to the nature of the distribution of the variables. For the qualitative variables, Pearson's chi-square test, Fisher's exact test, and the G test were used. Spearman's correlation was used to compare the results of the 25(OH)D levels and blood counts performed among patients and the control group. RESULTS: Malaria patients residing in a mining area had 25(OH)D serum levels that were significantly lower than those in the control group residing in the mining area, though both were within normal levels. Red blood cell counts had an inverse correlation with parasitemia (Plasmodium falciparum), and platelet levels had an inverse correlation with parasitemia (Plasmodium vivax). 25(OH)D deficiency was evidenced in Itaituba, in the state of Pará, which is an endemic area of malaria in the Amazon region.

Consumo Alimentar de Macronutrientes e Estado Nutricional de Pessoas com Estomia / Food Consumption of Macronutrients and Nutritional Status of People With Ostomy / Consumo Alimentario de Macronutrientes y Estado Nutricional de Personas con Ostomía

Objetivo:Avaliar o consumo alimentar de macronutrientes e o estado nutricional de pessoas com estomia no contexto amazônico. Método: Estudo transversal quantitativo realizado na unidade de referência especializada às pessoas com estomia, no período de janeiro a março de 2020. A amostra foi constituída de 77 pessoas com estomias, com idade de 21 a 88 anos, de ambos os sexos. Foram utilizados informações sociodemográficas, aspectos clínicos e comportamentais, medidas antropométricas e recordatório 24 h. A análise estatística foi realizada por meio dos softwares BioEstat 5.0 e EpiInfo 3.5.1. Resultados: A maioria era do sexo masculino, com faixa etária entre 35 e 50 anos. Os tipos mais frequentes de estomia foram: colostomia (69%) e ileostomia (21%), com caráter temporário (43%), tendo em ambos os sexos a etiologia neoplásica (60%). Quanto ao estado nutricional, a maioria apresentou eutrofia segundo o índice de massa corporal, no entanto a circunferência da cintura demonstrou risco metabólico aumentado no sexo feminino, e a prega cutânea tricipital indicou obesidade no sexo masculino e eutrofia no sexo feminino (<0,0001). Com relação ao consumo alimentar, observou-se inadequação de energia e de macronutrientes. Conclusão: Os hábitos alimentares no contexto amazônico podem estar relacionados ao consumo alimentar inadequado e às alterações no estado nutricional.

Objective:To evaluate the food intake of macronutrients and nutritional status of people with ostomy in the Amazonian context. Method: Quantitative cross-sectional study carried out in the specialized reference unit for people with ostomy, in the period from January to March 2020. The sample consisted of 77 people with ostomies, aged 21 to 88 years old, of both genders. We used sociodemographic information, clinical and behavioral aspects, anthropometric measurements and 24-hour recall. Statistical analysis was performed using BioEstat 5.0 and EpiInfo 3.5.1 software. Results: Most were male, aged between 35 and 50 years old. The most frequent types of ostomy were: colostomy (69%) and ileostomy (21%), with a temporary nature (43%), with neoplastic etiology in both sexes (60%). As for the nutritional status, most presented eutrophy according to the body mass index, but waist circumference showed increased metabolic risk in females, and the triceps skinfold thickness indicated excess adiposity in males (<0.0001). Regarding food consumption, there was inadequacy of energy and macronutrients. Conclusion: Eating habits in the Amazonian context may be related to inadequate food consumption and changes in nutritional status.

Objetivo:Evaluar el consumo alimentario de macronutrientes y el estado nutricional de personas con estoma en el contexto amazónico. Método: Estudio transversal cuantitativo, realizado en la Unidad de Referencia Especializada en personas con ostomía durante el periodo de enero a marzo del 2020. La muestra estuvo constituida por 77 personas con estoma. Entre los 21 y los 88 años, de los dos sexos. Se usó información sociodemográfica, aspectos clínicos, comportamentales, medidas antropométricas y recordatorio de 24 horas. El análisis estadístico se realizó con los programas BioEstat 5.0 y EpiInfo 3.5.1. Resultados: La mayoría eran de sexo masculino, con un grupo etario de 35 a 50 años. Los tipos de ostomía más frecuentes fueron: colostomía (69%) e ileostomía (21%), de carácter temporal (43%), con etiología neoplásica en ambos sexos (60%).Por otro lado, con relación al estado nutricional, la mayoría presentó eutrofia según el índice de masa corporal. Sin embargo, la circunferencia de cintura demostró riesgo metabólico más grande en el sexo femenino y el pliegue cutáneo tricipital indicó exceso de adiposidad en el sexo masculino y eutrofia en feminino (<0,0001). Con relación al consumo alimentario, se observó la inadecuación de energía y macronutrientes. Conclusión: Los hábitos alimentarios en el contexto amazónico pueden estar relacionados con el consumo inadecuado de alimentos y cambios en el estado nutricional.

The Use of Extracorporeal Life Support in Children With Immune-Mediated Diseases.

OBJECTIVES: To describe the use and outcomes of extracorporeal membrane oxygenation support among children with immune-mediated conditions. DESIGN: Retrospective cohort study. SETTING: The Extracorporeal Life Support Organization registry. PATIENTS: Patients 1 month to 18 years old with International Classification of Diseases, 9th Edition and International Classification of Diseases, 10th Edition codes for immune-mediated conditions from 1989 to 2018. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: During the study period, 207 patients with an immune-mediated condition received extracorporeal membrane oxygenation, and 50% survived to discharge. Most patients (63%) received extracorporeal membrane oxygenation for respiratory support with 53% survival, 21% received cardiac support (55% survival), and 15% received extracorporeal cardiopulmonary resuscitation (34% survival). The most common diagnosis among nonsurvivors was hemophagocytic lymphohistiocytosis/macrophage activation syndrome with 37% survival. Patients with juvenile idiopathic arthritis (23%) and dermatomyositis (25%) had the lowest survival. Nonsurvivors had a higher frequency of infections, neurologic complications, and renal replacement therapy use. Use of preextracorporeal membrane oxygenation corticosteroids was associated with mortality. CONCLUSIONS: Children with immune-mediated conditions can be successfully supported with extracorporeal membrane oxygenation. Extracorporeal membrane oxygenation use has increased over time, and survival varies considerably by diagnosis.

Hyperoxia after pediatric cardiac arrest: Association with survival and neurological outcomes.

OBJECTIVE: To evaluate the association between hyperoxia in the first 24 hours after in-hospital pediatric cardiac arrest and mortality and poor neurological outcome. METHODS: This is a retrospective cohort study of inpatients in a freestanding children's hospital. We included all patients younger than 18 years of age with in-hospital cardiac arrest between December 2012 and December 2019, who achieved return of circulation (ROC) for longer than 20 minutes, survived at least 24 hours after cardiac arrest, and had documented PaO2 or SpO2 during the first 24 hours after ROC. Hyperoxia was defined as having at least one level of PaO2 above 200 mmHg in the first 24 hours after cardiac arrest. RESULTS: There were 187 patients who met eligibility criteria, of whom 48% had hyperoxia during the first 24 hours after cardiac arrest. In-hospital mortality was 41%, with similar mortality between oxygenation groups (hyperoxia 45% vs no hyperoxia 38%). We did not observe an association between hyperoxia and in-hospital mortality or poor neurological outcome after adjusting for confounders (odds ratio 1.2, 95% confidence interval 0.5-2.8). On sensitivity analysis using two additional cutoffs of PaO2 (>150 mmHg and > 300 mmHg), there was also no association with in-hospital mortality or poor neurological outcome after adjusting for confounders. Similarly, on multivariable logistic regression using SpO2 > 99% as the exposure, there was no difference in the frequency of death or poor neurological outcome at hospital discharge. CONCLUSION: Hyperoxia after pediatric cardiac arrest was common and was not associated with worse in-hospital outcomes.

Black spaces between maxillary incisors: what is the aesthetic limit? / Espaços negros entre incisivos superiores: qual é o limite estético?

The focus of this article was evaluates the degree of perception of laypersons of different age groups with respect to smile esthetics in cases involving black spaces between maxillary incisors. Changes were made in a photograph of a smiling female patient, simulating various configurations of black spaces between maxillary incisors. For this purpose an image manipulation Photoshop CS3 was used. For evaluation black spaces of 0.5, 1.0, 1.5, 2.0, and 2.5 mm in size were created. After digital manipulation, the photographs were printed on photographic paper, attached to a questionnaire, and distributed among laypersons in the age groups of 15-19; 35-44, and 65-74. To evaluate the degree of esthetics, a scale of attractiveness was used, in which a score of 0 would represent ''not very attractive'', 5 ''attractive'' and 10 ''very attractive''. Fisher's exact test, Kruskal-Wallis test and Mann-Whitney test was used (P<0.05). Results showed that the photographs without black space and with black space of 2.5 mm were scored as the most and least attractive, respectively, by all the age groups. The degree of perception of black spaces between maxillary incisors gradually diminished as the age of the groups increased (P<0.05). Black spaces have a negative repercussion on smile esthetics, perceived more easily by younger persons. The larger the black space, less attractive the smile.

O foco deste artigo foi avaliar o grau de percepção de leigos de diferentes faixas etárias em relação à estética do sorriso em casos que envolvam espaços negros entre incisivos superiores. As alterações foram feitas em uma fotografia de uma paciente do sexo feminino sorrindo, simulando várias configurações de espaços negros entre incisivos superiores. Para este efeito, um Photoshop CS3 para manipulação de imagem foi usado. Para avaliação dos espaços negros 0,5, 1,0, 1,5, 2,0 e 2,5 mm de tamanho foram criados. Após a manipulação digital, as fotografias foram impressas em papel fotográfico, incluídas em um questionário, e distribuídos entre leigos nas faixas etárias de 15-19; 35-44 e 65-74. Para avaliar o grau de estética, foi utilizada uma escala de atratividade, em que uma pontuação de 0 representaria ''não muito atraente'', 5 ''atraente'' e 10 ''muito atraente''. Foi utilizado o teste exato de Fisher, teste de Kruskal-Wallis e Mann-Whitney (P<0,05). Os resultados mostraram que as fotografias sem espaço negro e com espaço negro de 2,5 mm foram classificadas como as mais e menos atraente, respectivamente, por todos os grupos etários. O grau de percepção de espaços negros entre os incisivos superiores gradualmente diminui à medida que a idade dos grupos aumentou (P<0,05). Espaços negros têm uma repercussão negativa na estética do sorriso, percebida mais facilmente por pessoas mais jovens. Quanto maior o espaço negro, menos atraente o sorriso.

Análise das variáveis grau e porte da queimadura, tempo de internação hospitalar e ocorrência de óbito em pacientes admitidos em uma Unidade de Tratamento de Queimados / Variables analysis of the degree and size of the burn, length of hospital stay and occurrence of deaths in patients admitted in a Burn Care Unit

Objetivo: Correlacionar as variáveis tempo de internação x idade, tempo de internação x grau da queimadura e porte da queimadura x ocorrência de óbito em pacientes atendidos na Unidade de Tratamento de Queimados no Estado de Sergipe. Método: Trata-se de um estudo retrospectivo, descritivo e transversal, com abordagem quantitativa, cuja amostra foi constituída de pacientes admitidos no serviço fisioterapêutico da Unidade de Tratamento de Queimados (UTQ) do Hospital de Urgência de Sergipe (HUSE), no período de 2008 e 2012. Resultados: O período de hospitalização aumentou à medida que a faixa etária progrediu; as queimaduras de 2º grau influenciaram diretamente o tempo de internação; quanto maior a extensão da superfície corporal queimada, maior a mortalidade. Conclusão: Observou-se que o tempo de internação das vítimas variou significativamente conforme a idade do paciente e a profundidade da queimadura. No entanto, a mortalidade em relação ao porte da queimadura não demonstrou correlação relevante.

Objective: To correlate the variables length of hospital stay x age, length of hospital stay x degree burn and size of the burn x occurrence of death in patients treated at the Burn Care Unit in the State of Sergipe. Method: This research was a retrospective, descriptive, cross-sectional and quantitative approach, which sample was consisted of patients admitted in physiotherapy department at Burn care Unit of Sergipe Emergency Hospital (HUSE), from 2008 to 2012. Results: The hospital stay increased as the age progressed, the second degree burn was influenced directly on length of hospital stay, the greater extent of the burned body surface, higher the mortality. Conclusion: It was observed that the length of hospital stay of victims varied significantly according to the patient’s age and to the burn’s depth.

Unidade de Tratamento de Queimados: perfil epidemiológico dos pacientes admitidos na Fisioterapia / Burn care unit: epidemiological profile in patients admitted in a physiotherapy department

Objetivo: Analisar o perfil epidemiológico dos pacientes admitidos na Fisioterapia da Unidade de Tratamento de Queimados (UTQ) do Hospital de Urgência de Sergipe (HUSE). Método: Trata-se de um estudo retrospectivo, descritivo e transversal, com abordagem quantitativa, sendo analisados 1.247 casos obtidos a partir do registro de pacientes do serviço de Fisioterapia da UTQ, no período de janeiro de 2008 a dezembro de 2012. Resultados: Observou-se alto índice de pacientes admitidos na Fisioterapia, sendo que a predominância de queimaduras foi maior na população infantil, do gênero masculino, com maior ocorrência do 2º grau e de médio porte, provocadas por agentes térmicos, atingindo predominantemente as regiões de membros superiores e tronco. Foi constatado que o tempo de internação variou em média 13,36 ± 15,06 dias e que houve uma elevada taxa de alta hospitalar. Conclusão: O estudo demonstrou o perfil dos pacientes queimados acompanhados no Serviço de Fisioterapia da UTQ/HUSE, ressaltando a necessidade de políticas públicas voltadas à prevenção de queimaduras.

Purpose: To assess the epidemiological profile of patients admitted to the Physiotherapy at Burn Treatment Unit of Sergipe Emergency Hospital (HUSE). Method: This research was a retrospective, descriptive, cross-sectional and quantitative approach. We analyzed 1,247 cases obtained from patient registration at Physical therapy service, from January 2008 to December 2012. Results: There was a high rate of patients admitted to the physical therapy, the prevalence of burns was higher in children, males with more occurrence of the second degree burns and medium size, caused by thermal agents, affecting predominantly regions upper limbs and trunk. It was found an average 13.36 ± 15.06 hospitalization days and there was a high rate of hospitalar release. Conclusion: The study demonstrated the profile of burn patients followed at the Department of Physical therapy, showing the need for public policies to burns prevent.

Perspectivas en el estudio del fenómeno de Raynaud desde un punto de vista ecográfico / Perspectives of ultrasound in the assessment of Raynaud's phenomenon

Un correcto estudio de las alteraciones morfovasculares es un constante reto para el reumatólogo. Entre las manifestaciones clínicas más importantes para este fin, se encuentra el fenómeno de Raynaud en sus diferentes formas de presentación. La ecografía dinámica, mediante la modalidad del Doppler color y el Doppler de poder, encuentra cada vez mayores aplicaciones. El poder determinar la fase de actividad y severidad de la enfermedad vascular, contar con un dato predictivo de evolución del fenómeno de Raynaud y poder monitorear la respuesta al tratamiento son elementos en los cuales la ecografía ha generado últimamente una buena cantidad de datos que están despertando un gran interés por parte del reumatólogo. Esta revisión intenta abordar el concepto acerca de la utilidad de la ecografía en el estudio del fenómeno de Raynaud, haciendo un particular énfasis en sus potenciales y ventajas.

An adequate assessment of the microvascular changes is a continuous challenge for the rheumatologist. Raynaud’s phenomenon is the major clinical expression of this pathological condition. Dynamic ultrasound, using color Doppler or power Doppler systems, is generating a great interest by rheumatologist for its several potentialities. The possibility to determine the disease activity and severity, its potential in the predictive value and the capability of treatment monitoring are essential elements when the US is now firmly established. This paper was designed to give an up-to-date about the utility of US in the assessment of Raynaud’s phenomenon, with particular interest on its potentials and advantages.