RESUMO

Inflammation-proliferation transition plays a key role in the successful healing of a common burn type, second-degree burn. Gynura procumbens in vitro adventitious root nanohydrogel is currently being studied for its immunomodulatory to improve reparative environment. Root production and nanohydrogel preparation was done respectively by in vitro propagation and emulsion/ solvent diffusion with carbomer as a polymer. Characterization of nanohydrogel was performed afterward. An in vivo study was carried out in Balb/c mice having second-degree burns at different time and space. In vitro adventitious root was induced from leaf explant under indole butyric acid plant growth regulator (PGR). Rapid propagation was done through liquid culture. Upon formation into nanohydrogel (Gr-nh), it had a sphere shape with 6.88 nm in size and a PDI value of 0.16. Interaction among extract and polymer was proven by shifting in hydroxyl, alkene, and vinyl ether groups. Loading efficiency and loading amount were 99.99% and 56.39%, respectively. The percentage of release increased in line with pH (4-6). The pH of Gr-nh was 6.58 with spread diameter 8.83 ± 0.29 cm. Four days after the burn, Gr-nh showed a swift decline in local IL6 (116.1 pg/ml, p=0.0005), reduced levels of local (18.97 ng/l, p=0.69) and systemic (8.83 ng/l, p=0.0028) PGE2, and elevated local VEGF (343.6 ng/l, p=0.0005) compared to the control. By day 10, systemic IL6, as well as local and systemic PGE2 levels in Gr-nh, were notably lower compared to all treatments. Meanwhile, local VEGF remained elevated and significantly different from all other groups. Gr-nh showed better IL6 and PGE2 reduction than free extract during the inflammation stage and better VEGF enhancement than free extract in the proliferation stage. Pearson correlation analysis suggests that Gr-nh aids in coordinating IL6, PGE2, and VEGF spatially and temporally to optimize burn healing.

RESUMO

Evaluate the prognostic performance of the lactate-to-albumin ratio (LAR) for complications in children 5 years of age or younger with second and/or third degree burn injuries during hospitalization in the intensive care unit of a hospital in Lima, Peru. In this retrospective cohort study, we conducted prognostic tests by analyzing the medical records of children aged ≤ 5 years who suffered second- and/or third-degree burn injuries and were subsequently admitted to the ICU of a Lima-based hospital between 2017 and 2022. The LAR was calculated using lactate and albumin values measured within the first 48 h post-burn. The area under the curve (AUC) was utilized to evaluate the prognostic performance of the LAR in predicting complications. A cohort of 258 patients aged ≤ 5 years with second- and/or third-degree burn injuries was examined. Among them, 63 patients experienced complications (24.4%). The estimated AUC ROC for the LAR was 0.63 (95% confidence interval [CI]: 0.54-0.71). After adjusting for confounders, values of LAR above the threshold were found to be associated with a significantly increased risk of complications (adjusted relative risk: 2.23; 95% CI 1.51-3.29; p < 0.001). The LAR exhibited limited prognostic capability for complications in pediatric burn patients. Nevertheless, a significant association was observed between values of LAR above the threshold and increased risk of complications.

RESUMO

Since its foundation, the Hospital Emergency Public Assistance in Santiago, Chile, has been the national reference center for managing severe burn patients. In 2007, more than 6,000 hospital admissions for burns were registered in Chile due to the severity of the clinical condition. These patients must be treated in intensive care units. Therefore, the use of orotracheal tubes is essential for its management. The correct stabilization of these devices avoids complications or airway risks. In the Major Burn Unit, cotton cloth restraints and transpore-type adhesives are used on the user's face, but in patients with facial territory compromise, these cause tissue damage; due to this, the Dental Unit has innovative techniques of orotracheal tube fixation, using stainless steel and plastic wire ties, which have allowed to reduce the risks of extubation and accidental displacement of the tube, improving its stability. This work describes the technique used in orotracheal tube fixation in two patients with severe burns, performed by the Dental Unit of the Hospital Emergency Public Assistance, Dr. Alejandro del Río, Chile.

RESUMO

BACKGROUND: Pediatric burn injuries are a significant public health issue in low- and middle-income countries, leading to substantial morbidity and mortality. This study aimed to evaluate the efficacy of the No+Quema2 educational program, implemented in Aguascalientes, Mexico, in preventing burn injuries among children under nine years old. METHODS: The No+Quema2 program, initiated in 2014, included educational courses for children, training for health workers, and specialized care for children with burn sequelae. Epidemiological data on burn injuries from 2014 to 2022 were retrieved from the National System of Epidemiological Surveillance of the Health Ministry of Mexico. Monthly incidence rates per 100,000 inhabitants were analyzed using the Mann-Kendall trend test and segmentation analysis to detect trends and changes. RESULTS: The program trained over 25,000 scholars from 1750 elementary schools and distributed medical kits for immediate burn care. Additionally, 200 children with burn sequelae received scheduled treatment. The analysis showed a significant decrease in the state incidence rate of burn injuries compared to the national mean post-implementation. The estimated number of burn injuries prevented during the study period was approximately 3839, or 604 per year. CONCLUSION: The No+Quema2 program has made a significant impact on burn prevention among children in Aguascalientes, Mexico. Despite the limitations of relying on government-reported data, the correlation between the program's activities and the observed decrease in burn injuries is promising. These findings underscore the critical importance of the No+Quema2 program's activities in achieving sustained, targeted educational interventions and long-term reductions in burn injury incidence. They also highlight the need for more robust study designs to validate these outcomes, emphasizing the importance of evidence-based strategies in future burn prevention efforts.

RESUMO

BACKGROUND: Cadaveric skin grafts were initially used for the management of acute burn wounds. The biological coverage of the wound improves the quality of the wound bed, which prepares it to receive an autologous skin graft. The benefits of cadaveric skin graft in burn wounds have led to its use in the management of acute and chronic wounds of diverse etiologies. OBJECTIVE: To evaluate the use of cadaveric skin graft and subsequent autologous split-thickness skin graft (STSG) in the management of wounds of diverse etiologies at a single institution. MATERIALS AND METHODS: A retrospective analysis was performed of patients with wounds of different etiologies managed with cadaveric skin grafts followed by a second procedure in which autologous STSG was performed from May 2017 through May 2022 in the Plastic and Reconstructive Surgery Department of German Hospital, Buenos Aires, Argentina. RESULTS: A total of 25 patients with wounds of different etiologies were included. The mean affected body surface area (BSA) was 1.87%. The mean engraftment percentage of the cadaveric skin graft was 96.6%. The mean engraftment percentage of the STSG was 90.6%. All patients demonstrated improvement in local edema and inflammation, reduced secretions, and reduced pain after treatment. Two patients (8%) had complications, with 1 case of delayed healing of the donor site and 1 case of hypertrophic scarring. CONCLUSIONS: Cadaveric skin graft with subsequent STSG is a simple, safe, and effective alternative for the management of complex wounds of diverse etiologies. This technique is particularly useful in patients with multiple comorbidities who are at risk of recurrence and of developing multiple wounds during their lifetime.

RESUMO

Burn patients often face elevated pain, anxiety, and depression levels. Music therapy adds to integrative care in burn patients, but research including electrophysiological measures is limited. This study reports electrophysiological signals analysis during Music-Assisted Relaxation (MAR) with burn patients in the Intensive Care Unit (ICU). This study is a sub-analysis of an ongoing trial of music therapy with burn patients in the ICU. Electroencephalogram (EEG), electrocardiogram (ECG), and electromyogram (EMG) were recorded during MAR with nine burn patients. Additionally, background pain levels (VAS) and anxiety and depression levels (HADS) were assessed. EEG oscillation power showed statistically significant changes in the delta (p < 0.05), theta (p = 0.01), beta (p < 0.05), and alpha (p = 0.05) bands during music therapy. Heart rate variability tachograms high-frequencies increased (p = 0.014), and low-frequencies decreased (p = 0.046). Facial EMG mean frequency decreased (p = 0.01). VAS and HADS scores decreased - 0.76 (p = 0.4) and - 3.375 points (p = 0.37) respectively. Our results indicate parasympathetic system activity, attention shifts, reduced muscle tone, and a relaxed state of mind during MAR. This hints at potential mechanisms of music therapy but needs to be confirmed in larger studies. Electrophysiological changes during music therapy highlight its clinical relevance as a complementary treatment for ICU burn patients.Trial registration: Clinicaltrials.gov (NCT04571255). Registered September 24th, 2020. https//classic.clinicaltrials.gov/ct2/show/NCT04571255.

RESUMO

Bloodstream infection is one of the most important and increasing complications in patients with severe burns. Most of the species affecting this population are Gram-negative bacilli that exhibit antimicrobial resistance. We conducted this study to determine the antimicrobial susceptibility profile and resistance mechanisms of these bacterial infections and their clinical associations on morbidity and mortality. We analyzed a retrospective cohort of burn patients. All patients included in this study had monobacterial blood stream infections during their hospital stay. We performed phenotypic and genotypic tests to determine the antimicrobial resistance mechanism and profile of each strain. Univariate and multivariate logistic regression analysis was performed between variables. We found 109 patients with monobacterial bacteremia. Pseudomonas spp. (50.7%), A. baumannii (46.4%), and Klebsiella spp. (13.8%) were the most common causative microorganisms. The Pseudomonas spp. isolates showed resistance to imipenem (81.5%), mainly by class A and class B carbapenemases. The A. baumannii isolates conferred resistance to imipenem (56.2%), mainly by class D carbapenemases. One quarter of Klebsiella spp. showed resistance to 3rd generation cephalosporins. We also observed that a total body surface area greater than 40% and three or more different types of invasive procedures might be related to increased mortality. Multidrug resistance is highly present. The extent of the burned area and a high number of different types of invasive procedures had an impact in decreasing survivorship in burn patients with bacteremia.

RESUMO

Introducción. Las quemaduras y sus secuelas implican un alto impacto socieconómico en salud pública. Materiales y métodos. Presentación de serie de casos de pacientes con quemaduras tipo ABB en el Servicio de Cirugía Plástica Parque de la Salud, Posadas, Misiones, por diversos agentes causales en fase aguda que requirieron escarectomía tangencial, muestra de tejido para bacteriología previamente negativo con posterior cobertura únicamente con tejido adiposo en el período 2023-2024. Se realizaron biopsias incisionales tanto pre- como poscobertura con tejido adiposo. Resultados. En este trabajo de investigación se pudo demostrar que con la cobertura temprana y oportuna con tejido adiposo se logra la regeneración tanto del tejido dérmico como epidérmico, evidenciada a través de las biopsias evaluadas por el Servicio de Anatomía Patológica, así como óptimos resultados tanto estéticos como funcionales en cuanto a la pigmentación, fl exibilidad de la piel, ausencia de dolor y secuelas cicatrizales muy frecuentes en este tipo de patología. Conclusión. Consideramos al tejido adiposo como una opción óptima de cobertura temprana en defectos remanentes posescarectomía en quemaduras tipo ABB

Introduction. Burns and their sequelae imply a high socioeconomic impact on public health. Materials and methods. Presentation of a series of cases of patients with ABB-type burns in the Plastic Surgery Service of Parque de la Salud in Posadas, Misiones, due to various causal agents in the acute phase that required tangentiales charectomy, a tissue sample for bacteriology previously negative with subsequent coverage only with adipose tissue in the period 2023-2024. Incisional biopsies were performed both pre and post coverage with adipose tissue. Results. In this research work it was possible to demonstrate that with the early and timely coverage with adipose tissue, the regeneration of both dermal and epidermal tissue is achieved, as evidenced through the biopsies evaluated by the pathological anatomy service, as well as optimal aesthetic and functional results in terms of pigmentation, skin fl exibility, absence of pain and scarring sequelae very frequent in this type of pathology. Conclusion. We consider adipose tissue as an optimal option for early coverage in post- escharectomy remnant defects in ABB-type burns.

RESUMO

OBJECTIVES: The Fluconazole pharmacokinetic-pharmacodynamic relationship was investigated in a few clinical settings and only limited studies regarding burned patients are available. Thus, the authors aimed to investigate fluconazole pharmacokinetics changes and its impact on antifungal therapy coverage against dose-dependent Candida spp. applying the PK/PD approach in critically ill severely burned patients. METHODS: Fluconazole was administered as a one-hour intravenous infusion of 200 mg q12h. Doses were increased according to the coverage based on the PK/PD approach. Blood samples were collected at the end of the infusion (1st hour), two hours after (3rd hour), and before the next dose (12th or 24th hour). Serum concentrations were obtained by HPLC-UV. Pharmacokinetic parameters were estimated by noncompartmental analysis and compared with data described in healthy subjects. The effectiveness predictive index was based on the AUCss0-24h/MIC ratio, with a target above 25. RESULTS: Every pharmacokinetic parameter was reduced throughout all three sets of the study. Compared to healthy subjects, the volume of distribution was decreased about 3‒7 times, biological half-life was 2‒3 times shorter and total body clearance was slightly altered but statistically significant. Both half-life and total body clearance were correlated to the volume of distribution. Consequently, an increase in fluconazole daily dose was necessary to improve empiric coverage. CONCLUSIONS: Fluconazole pharmacokinetics is altered in critically ill severely burned patients, mainly related to the volume of distribution. Doses higher than usual may be necessary to reach the PK/PD target and guarantee antifungal coverage against dose-dependent Candida spp. up to MIC 32 mg/L.

RESUMO

OBJECTIVES: To analyze, through the responses of physicians who work in burn treatment units, their demographic profiles and academic backgrounds, the structure available for patient care, the adoption of care protocols, support from medical and multidisciplinary specialties, and the main challenges faced by these professionals. METHODS: Cross-sectional study of the survey type carried out from March 2020 to April 2021 through a questionnaire constructed according to the Delphi method. The questionnaire was applied online to plastic surgeons and intensivists who work in burn units. A list was obtained of Brazilian centers, as well as the epidemiological and academic profile of the medical team, level of structure, treatment protocols, and restrictions and challenges encountered. RESULTS: The majority of the burn centers are located in the South and Southeast of the country, and are references for care for populations of over 1000,000 inhabitants. Professionals are between 30 and 60 years old, and have been concentrating on burn victims for between 5 and 15 years. For the most part, the professionals performed their skills training in the centers where they work, which, in turn, have a strong academic tendency, with medical residency programs and other specialties. Burn care protocols, together with related clinical conditions such as surgery, measurement of the burned area, use of antibiotics, thromboembolic prophylaxis, nutrition, physical therapy, and nursing care are widespread and the greatest difficulties pointed out are the serious nature of the burn and infections. The demand for procedures, and regulatory and reception flows seem to be coordinated and in line with regional needs. CONCLUSIONS: Burn treatment units are widespread throughout the country, at different levels of complexity. The most frequent organization is a regional reference center, with care for more than one million inhabitants, located within a tertiary hospital. Most professionals are between 30 and 60 years old, with more than 5 years of experience in burns. The majority of centers demonstrate well-established clinical, surgical, dressing, and global patient care protocols. The complexity of cases, patterns of resistance, and bacterial colonization are important challenges throughout Brazil.

RESUMO

The role of the burn surgeon in Burn Treatment Centers (BTCs) is crucial for complementing the multidisciplinary approach in the treatment of burn patients. Globally, the areas of General Surgery and Plastic Surgery are the primary surgical specialties dedicated to this function. The structuring of the Burn Patient Care Line in Minas Gerais highlighted the need to expand the "Burn Care" Field of Expertise, extending it to General Surgery. With the inevitable expansion of the Care Line, pioneered by the state of Minas Gerais, to the federal level, the need for specialized surgical training encompasses both the state context and anticipates the national scenario in the short term. Therefore, the expansion of the "Burn Care" Field of Expertise is fundamental to meeting specific demands and improving the quality of care offered to burn patients, in accordance with international standarts.

RESUMO

Background and Objectives: burns are a leading cause of domestic accidents and the third leading cause of mortality in children and adolescents under 14 years old. This study aimed to identify demographic and clinical factors associated with healthcare-associated infections (HAIs) in burn victims under 18 years old treated at a Burn Treatment Center (BTC). Methods: this cross-sectional analytical study was conducted at the BTC of a public hospital using HAI notification records and medical records of patients under 18 years hospitalized from 2009 to 2019. The demographic variables considered were sex and age, while the clinical variables included causal agent, total body surface area (TBSA), burn depth, duration and location of hospitalization, dates of admission and infection detection, diagnosis of HAIs, invasive and surgical procedures, site of infection, etiological agent, antimicrobial susceptibility profile, antimicrobial agents used in the treatment of infections, diagnosis of sepsis and septic shock as well as the clinical outcome. Absolute and relative frequencies were used, and the chi-square test was applied for categorical variables. Multivariate analysis was conducted using Poisson regression with robust variance adjustment. Results: among the 591 victims, 187 (31.6%) developed HAIs. HAIs were associated with larger TBSA, third-degree burns, longer hospitalization, and mortality. Factors associated with HAIs included burn area ≥21%, hospitalization ≥15 days, and mortality. The prevalent microorganisms were multidrug-resistant (MDR) Acinetobacter baumannii and MDR Pseudomonas aeruginosa. Conclusion: children with severe burns and prolonged hospitalization were more vulnerable to HAIs and associated mortality.(AU)

Justificativa e Objetivos: as queimaduras são uma das principais causas de acidentes domésticos e a terceira principal causa de mortalidade em crianças e adolescentes menores de 14 anos. O objetivo deste estudo é identificar os fatores demográficos e clínicos associados às infecções relacionadas à assistência à saúde (IRAS) em vítimas de queimaduras menores de 18 anos atendidas no Centro de Tratamento de Queimados (CTQ). Métodos: estudo transversal analítico, realizado no CTQ de um hospital público, utilizando fichas de notificação de IRAS e prontuários de pacientes menores de 18 anos hospitalizados de 2009 a 2019. As variáveis demográficas consideradas foram sexo e idade, enquanto as variáveis clínicas incluíram agente causal, superfície corporal queimada (SCQ), profundidade da queimadura, tempo e local de hospitalização, datas de admissão e de detecção da infecção, diagnóstico de IRAS, procedimentos invasivos e cirúrgicos, sítio da infecção, agente etiológico, perfil de sensibilidade aos antimicrobianos, antimicrobianos utilizados no tratamento das infecções, diagnóstico de sepse e choque séptico, além do desfecho clínico. Foram utilizadas frequências absolutas e relativas, e o teste qui-quadrado foi usado para variáveis categóricas. A análise multivariada foi conduzida por regressão de Poisson com ajuste de variância robusta. Resultados: entre as 591 vítimas, 187 (31,6%) desenvolveram IRAS. As IRAS foram associadas a maior SCQ, queimaduras de 3° grau, maior tempo de hospitalização e óbito. Fatores associados às IRAS incluíram área queimada ≥21%, tempo de hospitalização ≥15 dias e óbito. Microrganismos prevalentes foram Acinetobacter baumannii multirresistente (MR) e Pseudomonas aeruginosa MR. Conclusão: crianças com queimaduras graves e prolongada hospitalização apresentaram maior vulnerabilidade às IRAS e óbitos associados.(AU)

Justificación y Objetivos: las quemaduras son una de las principales causas de accidentes domésticos y la tercera causa principal de mortalidad en niños y adolescentes menores de 14 años. Este estudio tiene como objetivo identificar los factores demográficos y clínicos asociados a las infecciones relacionadas con la asistencia sanitaria (IRAS) en víctimas de quemaduras menores de 18 años atendidas en el Centro de Tratamiento de Quemaduras (CTQ). Métodos: estudio transversal analítico, realizado en el CTQ de un hospital público utilizando registros de notificación de IRAS y prontuarios de pacientes menores de 18 años hospitalizados de 2009 a 2019. Las variables demográficas consideradas fueron sexo y edad, mientras que las variables clínicas incluyeron agente causal, superficie corporal quemada (SCQ), profundidad de la quemadura, tiempo y lugar de hospitalización, fechas de admisión y detección de la infección, diagnóstico de IRAS, procedimientos invasivos y quirúrgicos, sitio de la infección, agente etiológico, perfil de sensibilidad a los antimicrobianos, antimicrobianos utilizados en el tratamiento de las infecciones, diagnóstico de sepsis y shock séptico, además del desenlace clínico. Se utilizaron frecuencias absolutas y relativas, y se aplicó la prueba chi-cuadrado para variables categóricas. El análisis multivariado se realizó mediante regresión de Poisson con ajuste de varianza robusto. Resultados: de las 591 víctimas, 187 (31,6%) desarrollaron IRAS. Las IRAS se asociaron con una mayor SCQ, quemaduras de tercer grado, mayor tiempo de hospitalización y mortalidad. Los factores asociados a las IRAS incluyeron área quemada ≥21%, tiempo de hospitalización ≥15 días y mortalidad. Los microorganismos prevalentes fueron Acinetobacter baumannii multirresistente (MR) y Pseudomonas aeruginosa MR. Conclusión: los niños con quemaduras graves y hospitalización prolongada presentaron una mayor vulnerabilidad a las IRAS y a la mortalidad asociada.(AU)

RESUMO

Introducción: Las quemaduras son lesiones devastantes que se asocian a alta morbilidad y mortalidad. Se produce desbalance inmunológico, afectando los leucocitos, primera línea de defensa ante cualquier noxa, fundamentalmente los neutrófilos y linfocitos. Con el objetivo de evaluar el Índice Neutrófilos-Linfocitos en los lesionados severamente quemados, se realiza éste estudio. Método: . Estudio descriptivo, longitudinal y prospectivo, en el servicio de Caumatología del Hospital Universitario Calixto García, desde enero 2022 a diciembre 2022.Se incluyó a todos los ingresados clasificados como Grandes Quemados, con menos de 24 horas de evolución de la lesión, entre 19 a 60 años. Se excluyó a pacientes con enfermedades crónicas no transmisibles descompensadas. Se tomaron muestras de sangre venosa a las 72 horas y al 6to día post trauma, para determinar valores de Índice Neutrófilos Linfocitos. Se relacionaron dichos valores con el estado al egreso y con el Pronóstico de Vida. De un total de 134 ingresados, 36 cumplieron los criterios de inclusión. Resultados: . Predominaron los lesionados masculinos, el fuego directo el principal agente causal, y los accidentes prevalecieron sobre otros mecanismos de producción. El Índice Neutrófilos Linfocitos se elevó desde las primeras 72 horas de evolución, con valores mayores en los lesionados con peor pronóstico de vida, y en los egresados fallecidos. Conclusión: . Existió una asociación lineal entre los valores de Índice Neutrófilos/Linfocitos en lesionados egresados vivos y los que fallecieron, así como relación directamente proporcional con la gravedad de la lesión.

Introduction: Burns are devastating injuries associated with high morbidity and mortality. A disruption of the immune system is developed, affecting the function of neutrophils and lymphocytes, first defensing line against pathogens. In order to evaluate the association between the Neutrophil to Lymphocyte Ratio, and the prognosis of the burn injurie, the investigation was performed. Methods: . A descriptive, longitudinal, prospective investigation was developed at the Burn Unit of Calixto García Hospital, from January 2022nd to December 2022nd. All severely burned patients admitted, with ages between 19 and 60 years old, and less than 24 hours from the onset of the accident were included. Patients suffering from chronic conditions were excluded. To determinate the levels of Neutrophil to Lymphocyte Rates, blood samples were taken at the first 72 hours after injury and during the 6th day. A relationship between the levels of Neutrophil to Lymphocyte Ratio, and the prognosis of the trauma was established. Of a total of 134 patients admitted, 36th were included. Results: Male patients were the majority. Fire the main etiological agent, and accidents the first production mode. High levels of Neutrophil to Lymphocyte Ratio were detected since the first 72 hours after trauma, and stayed high during the 6th day of evolution. Patients with poorest life prognosis, showed higher levels of Neutrophil to Lymphocyte Ratio. Conclusion: A direct relationship was found between the levels of Neutrophil- to Lymphocyte Ratio and the severity of the burn injury, and the survival rate.

RESUMO

PURPOSE: Bacterial cellulose (BC) has shown high capacity for the treatment of wounds and burns, providing a moisty environment. Calcium alginate can be associated with BC to create gels that aid in wound debridement and contribute to appropriate wound healing. This study is aimed at characterizing and evaluating the use of bacterial cellulose/alginate gel in skin burns in rats. METHODS: Cellulose and cellulose/alginate gels were compared regarding the capacity of liquid absorption, moisture, viscosity, and potential cytotoxicity. The 2nd degree burns were produced using an aluminum metal plate (2.0cm) at 120ºC for 20s on the back of rats. The animals were divided into non-treated, CMC(Carboxymethylcellulose), Cellulose(CMC with bacterial cellulose), and Cellulose/alginate(CMC with bacterial cellulose and alginate). The animals received topical treatment 3 times/week. Biochemical (MPO, NAG and oxidative stress), histomorphometry and immunohistochemical assays (IL-1ß IL-10 and VEGF) were conducted on the 14th, 21st, 28th, and 35th days. RESULTS: Cellulose/Alginate gel showed higher absorption capacity and viscosity compared to Cellulose gel, with no cytotoxic effects. Cellulose/alginate presented lower MPO values, a higher percentage of IL-10, with greater and balanced oxidative stress profile. CONCLUSIONS: The use of cellulose/alginate gel reduced neutrophils and macrophage activation and showed greater anti-inflammatory response, which can contribute to healing chronic wounds and burns.

RESUMO

BACKGROUND: Burns are classified according to their mechanism of injury, depth, affected body area, affected region or part of the body, and extent of the lesions. Topical insulin modulates the healing process. However, studies evaluating the effects of topical insulin treatment on burns in human patients are lacking. PURPOSE: The purpose of this study was to investigate the effects of topical insulin on healing time of second-degree burns. METHODS: In this nonrandomized clinical trial, patients with second-degree burns were allocated to a control group (CG) or an intervention group (IG) in which wounds were treated with 1% silver sulfadiazine and topical insulin, respectively. RESULTS: Healing time was significantly shorter in the IG relative to the CG (9.1 ± 1.9 days and 12.7 ± 3.3 days, respectively; P < .05). The estimated burn area was similar in both groups (CG 1.44 ± 1.0%; IG 1.42 ± 0.53%). CONCLUSION: In this study, topical insulin reduced healing time in second-degree burns. Further investigation is warranted to support wider use in clinical practice.

RESUMO

OBJECTIVE: To examine the effectiveness of an education intervention for reducing physician diagnostic error in identifying pediatric burn and bruise injuries suspicious for abuse, and to determine case-specific variables associated with an increased risk of diagnostic error. STUDY DESIGN: This was a multicenter, prospective, cross-sectional study. A convenience sample of pediatricians and other front-line physicians who treat acutely injured children in the United States and Canada were eligible for participation. Using a web-based education and assessment platform, physicians deliberately practiced with a spectrum of 300 pediatric burn and bruise injury image-based cases. Participants were asked if there was a suspicion for abuse present or absent, were given corrective feedback after every case, and received summative diagnostic performance overall (accuracy), suspicion for abuse present (sensitivity), and absent (specificity). RESULTS: Of the 93/137 (67.9%) physicians who completed all 300 cases, there was a significant reduction in diagnostic error (initial 16.7%, final 1.6%; delta -15.1%; 95% CI -13.5, -16.7), sensitivity error (initial 11.9%, final 0.7%; delta -11.2%; 95% CI -9.8, -12.5), and specificity error (initial 23.3%, final 6.6%; delta -16.7%; 95% CI -14.8, -18.6). Based on 35 627 case interpretations, variables associated with diagnostic error included patient age, sex, skin color, mechanism of injury, and size and pattern of injury. CONCLUSIONS: The education intervention substantially reduced diagnostic error in differentiating the presence vs absence of a suspicion for abuse in children with burn and bruise injuries. Several case-based variables were associated with diagnostic error, and these data can be used to close specific skill gaps in this clinical domain.

RESUMO

AIM: Genital burns are rare injuries. Reconstruction of penile skin defects should consider cosmetic and functional outcomes. Skin grafts can develop scar contractures and carry hair follicles, causing unwanted results. These downsides remain unsolved issues. This work aimed to describe a new foreskin advancement flap method for completely reconstructing penile shaft skin defects in severely burned patients. MATERIALS AND METHODS: From 2021 to 2023, four patients with third-degree burns in the genital area were enrolled in this investigation. We describe a series of cases with deep burns to the penile shaft and surrounding area that needed debridement and reconstruction using a novel technique called "reverse circumcision," which consists of tangential excision of the penis and a foreskin advancement flap without longitudinal cuts with less morbidity, preservation of function, and a better aesthetic appearance. The patients had an average follow-up of nine months. RESULTS: The reverse circumcision technique was established for patients with severe burns in the genital area. The four patients were satisfied with the postoperative results and the aesthetic results of the procedure without reporting any complications. No scarring or contractures were observed on the glans or penile shaft after surgery. CONCLUSIONS: Compared with other flap methods, the use of a reverse circumcision foreskin advancement flap was more straightforward, feasible, and effective. In adults, the foreskin tissue completely covers the penile shaft skin defect. It is a viable reconstructive surgical technique that is easily reproducible and has excellent aesthetic and functional results. For this surgical technique, tissue transfers, bulky regional flaps, or skin grafts were not needed.

RESUMO

Objetivo: A síndrome do choque tóxico (SCT) é uma condição multissistêmica grave, causada por Staphylococcus aureus ou Streptococcus pyogenes,e o manejo inicial e contínuo das lesões de pele é essencial para o controle da infecção. Este relato teve o objetivo de descrever os cuidados com a pele nessa síndrome. Relato do caso: Paciente do sexo masculino com abscesso no quadril que evoluiu com febre e hipotensão e consequente transferência para a Unidade de Terapia Intensiva (UTI). Foi diagnosticado com choque séptico de provável foco no quadril, imediatamente abordado cirurgicamente para tratamento local da infecção. Apresentou insuficiência renal, além de disfunção multissistêmica (hepática e cardíaca), instabilidade hemodinâmnica e lesões disseminadas de pele. Com o isolamento do Staphylococcus aureus, iniciou-se clindamicina e o diagnóstico foi de SCT, uma vez que apresentou lesões epidermolíticas desde o início do quadro. Foram iniciadas medidas de recuperação cutânea com a sulfadiazina de prata e, posteriormente, com hidrofibra com prata com restauração do epitélio em 8 dias. Após 10 dias da pele restaurada, o paciente recebeu alta da UTI para enfermaria com manutenção do tratamento proposto. Conclusão: Neste caso, o uso da hidrofibra obteve uma performancesatisfatória, contudo ainda há necessidade de estudos robustos que comprovem tal eficácia. (AU)

Objective: Toxic shock syndrome (TSS) is a severe multisystemic condition caused by Staphylococcus aureus or Streptococcus pyogenes, and initial management of skin lesions is essential for infection control. This article aimed to describe skin care for TSS. Case report: We report a man with a hip abscess who developed fever and hypotension and was subsequently transferred to an intensive care unit (ICU). He was diagnosed with septic shock, probably of hip origin, and was immediately treated surgically for local infection control. He presented with renal failure besides multiple organ dysfunction (hepatic and cardiac), hemodynamic instability, and disseminated skin lesions. With the isolation of Staphylococcus aureus, clindamycin was initiated, and the diagnosis was TSS due to epidermolytic lesions since the onset of the condition. Cutaneous recovery measures were initiated with silver sulfadiazine, followed by silver hydrofiber with skin recovery in 8 days. After 10 days of skin recovery, the patient was discharged from the ICU to the ward with maintenance of the proposed treatment. Conclusion: In this case, the use of hydrofiber showed satisfactory performance; however, robust studies are needed to confirm such efficacy. (AU)

Objetivo: El síndrome de shock tóxico (SST) es una afección multisistémica grave causada por Staphylococcus aureuso Streptococcus pyogenes, y el tratamiento inicial y continuo de las lesiones cutáneas es esencial para controlar la infección. Este informe tuvo como objetivo describir los cuidado de la piel en este síndrome. Reporte del caso:Paciente masculino con absceso en la cadera que desarrolló fiebre e hipotensión y fue tranferido a la Unidad de Cuidados Intensivos (UCI). Se diagnosticó shock séptico, probablemente focalizado en la cadera, por lo que fue inmediatamente abordado quirúrgicamente para tratamiento local de la infección. Presentó insuficiencia renal además de disfunción multisistémica (hepática y cardiaca), inestabilidad hemodinámica y lesiones cutáneas diseminadas. Con el aislamiento de Staphylococcus aureus, se inició clindamicina y el diagnóstico fue SST, ya que presentaba lesiones epidermolíticas desde el inicio del cuadro. Se iniciaron medidas de recuperación cutánea con sulfadiazina de plata y, posteriormente, se optó por hidrofibra con plata, con restauración del epitelio en 8 días. Después de 10 días de piel restaurada, el paciente fue dado de alta de la UCI a planta con mantenimiento del tratamiento propuesto. Conclusión: Alcen este caso, el uso de hidrofibra obtuvo un desempeño satisfactorio, sin embargo, aún se necesitan estudios robustos para probar tal eficacia. (AU)

RESUMO

Objetivo: Mapear a produção científica a respeito do uso da terapia de pressão negativa no tratamento de queimaduras, em pacientes adultos e idosos hospitalizados. Método: Revisão de escopo seguindo o método da JBI com busca da produção científica na PubMed, Scientific Electronic Library Online, Biblioteca Virtual de Saúde e Banco de Teses da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior nos meses de março a maio de 2021. Foram incluídos estudos com pacientes adultos e idosos com queimaduras, submetidos à terapia por pressão negativa no hospital. Não houve restrição de idioma, nem período de tempo. Resultados: Foram identificadas 106 publicações e, após o processo de seleção, cinco estudos compuseram a amostra final. Os resultados demonstraram que a aplicação da terapia por pressão negativa em queimaduras constituiu-se como uma ferramenta efetiva na cicatrização de queimaduras térmicas, químicas e elétricas, destacando-se a otimização do tempo de cicatrização, formação de um tecido de granulação saudável, diminuição do edema, redução da infecção, drenagem e monitorização do edema. Conclusão: O tratamento de queimaduras utilizando a pressão negativa tem se mostrado um método efetivo, visto os benefícios que promove no processo cicatricial. Sugere-se que a temática seja mais difundida, aprofundando-se o conhecimento sobre o uso desta tecnologia. (AU)

Objective: To map the scientific production regarding the use of negative pressure wound therapy in burn treatment of hospitalized adult and aged patients. Method: Scope review following the JBI method with a search for scientific production in PubMed, the Scientific Electronic Library Online, the Virtual Health Library, and the Thesis Database of the Coordination for the Improvement of Higher Education Personnel from March to May 2021. Studies with adult and aged burn patients undergoing negative pressure wound therapy in hospitals were included. There was no language or time frame restriction. Results: 106 publications were identified and 5 studies made up the final sample after the selection process. The results demonstrated that applying negative pressure wound therapy to burns was effective in healing thermal, chemical, and electrical burns, esoecially regarding healing time optimization, healthy granulation tissue formation, edema and infection reduction, and edema drainage and monitoring. Conclusion: Burn treatment using negative pressure has proven effective, given the benefits it promotes in the healing process. The theme should be more widely spread to deepen the knowledge about the use of this technology. (AU)

Objetivo: Mapear la producción científica sobre el uso de la terapia de presión negativa en el tratamiento de quemaduras en pacientes adultos y ancianos hospitalizados. Método: Revisión de alcance siguiendo el método JBI con búsqueda de producción científica en PubMed, Biblioteca Científica Electrónica en Línea, Biblioteca Virtual en Salud y Banco de Tesis de la Coordinación para el Perfeccionamiento del Personal de Educación Superior en los meses de marzo a mayo de 2021. Se incluyeron estudios con adultos y pacientes ancianos quemados sometidos a terapia de presión negativa en el hospital. No hubo restricción de idioma ni período de tiempo. Resultados: Se identificaron 106 publicaciones y luego del proceso de selección, 5 estudios conformaron la muestra final. Los resultados demostraron que la aplicación de la terapia de presión negativa en quemaduras constituyó una herramienta eficaz en la curación de quemaduras térmicas, químicas y eléctricas, destacándose la optimización del tiempo de curación, formación de tejido de granulación sano, reducción de edema, reducción de infección, drenaje y seguimiento del edema. Conclusión: El tratamiento de quemaduras mediante presión negativa ha demostrado ser un método efectivo, dados los beneficios que promueve en el proceso de cicatrización. Se sugiere que el tema sea más difundido, profundizando el conocimiento sobre el uso de esta tecnología. (AU)