Perfil epidemiológico de crianças e adolescentes queimados internados em um hospital público de Goiânia / Epidemiological profile of burned children and adolescents hospitalized in a public hospital in Goiânia

OBJETIVO: Identificar o perfil epidemiológico de crianças e adolescentes queimados internados em um hospital público de Goiânia e verificar se há relação entre a superfície corporal queimada (SQC) e a redução de amplitude de movimento (ADM), necessidade de unidade de terapia intensiva (UTI), óbito e causa da queimadura. MÉTODO: Este é um estudo transversal, foram coletados dados retrospectivos de indivíduos entre 0 e 17 anos que tiveram queimaduras e foram internados na enfermaria ou UTI, no período de janeiro de 2015 a dezembro de 2019. RESULTADOS: A amostra foi composta por 55 pacientes, mediana de idade de 12,25 anos, com predomínio de adolescentes (72,7%) do sexo masculino (65,5%). As principais causas de queimaduras foram líquidos inflamáveis (32,7%), chamas diretas (29,1%) e escaldaduras (21,8%). As escaldaduras foram identificadas como o principal agente causal das queimaduras nas crianças, e os líquidos inflamáveis nos adolescentes (p<0,01). Houve prevalência de queimaduras de 2° grau (85,5%), 54,6% dos pacientes tiveram a SQC >20%, sendo os membros superiores (78,2%) e inferiores (61,8%) as regiões corporais mais acometidas, 40% precisaram de UTI e 29,1% necessitaram de ventilação mecânica (VM). A taxa de óbito foi de 5,5%. Desbridamento (89,1%) e enxertia (41,8%) foram os procedimentos cirúrgicos mais realizados. A maior SQC associou-se com a redução da ADM, necessidade de UTI e óbito (p<0,05). CONCLUSÃO: As crianças de menor idade apresentaram queimaduras por escaldadura e os adolescentes foram mais propensos a se queimarem por líquido inflamável. A SQC associou-se com a redução da ADM, necessidade de UTI e óbito.

OBJECTIVE: To identify the epidemiological profile of children and adolescents burnt in a public hospital of Goiânia, Brazil, and to verify if there is a relationship between the total body surface area (TBSA) and reduced range of motion (ROM), the need for intensive care unit (ICU), death and cause of the burn. METHODS: This is a cross-sectional study, in which retrospective data was collected from burned individuals between 0 and 17 years hospitalized in the nursery or ICU from January 2015 to December 2019. RESULTS: The sample consisted of 55 patients with, a median age of 12.25 years, with a predominance of adolescents (72.7%) and males (65.5%). The main causes of burns were flammable liquids (32.7%), direct flames (29.1%), and scalding (21.8%). Scalding was identified as the main causal agent in children, and flammable liquids in adolescents (p<0.01). There was a prevalence of 2nd-degree burns (85.5%), 54.6% of the patients had TBSA >20%, with the upper limbs (78.2%) and lower limbs (61.8%) the most affected body regions, 40% needed ICU and 29.1% needed mechanical ventilation. The death rate was 5.5%. Debridement (89.1%) and grafting (41.8%) were the most commonly performed surgical procedures. Higher TBSA was associated with reduced ROM, need for ICU, and death (p<0.05). CONCLUSION: Younger children had scald burns and adolescents were more likely to be burnt by a flammable liquid. TBSA was associated with reduced ROM, need for ICU, and death.

Determinats of the distamce covered during a six-minute walk test in patients with chronic heart failure / Determinantes da distância percorrida durante teste de caminhada de seis minutos em pacientes com insuficiência cardíaca crônica

Background: The evaluation of the functional capacity of patients with chronic heart failure (HF) by means of the distance covered in the six-minute walk test (6MWT) has assumed great importance, since the 6MWD is a predictor of mortality and hospitalization in this population, however the determinants of better distance traveled in patients with HF are little explored, especially in the Brazilian population. Objective: To evaluate the determinants of 6MWD in patients with chronic HF. Methods: A cross-sectional study was performed with 81 HF patients in outpatient treatment. 6MWD was used as the outcome variable and sociodemographic, clinical, physical-functional and emotional data were submitted to multiple regression analysis using the stepwise method with a significance level of 5%. Results: Mean age of participants was 56.71 years; the 6MWD showed a bivariate correlation with age (r = -0.27, p = 0.01), maximal inspiratory pressure (r = 0.42, p < 0.01), maximal expiratory pressure (r = 0.36, p < 0.01), handgrip strength (r = 0.38, p < 0.01), Borg scale (-0.22, p = 0.04), Charlson index (r = -0.25, p = 0.02) and modified Medical Research Council (mMRC) dyspnea scale (r = -0.42, p < 0.01). In the multivariate analysis, the variables gender (p = 0.001), age (0.004), forced vital capacity (FVC) (p = 0.016) and mMRC (p = 0.001) simultaneously explained 37% of variance in the 6MWD. Conclusion: Higher levels of dyspnea on daily life activities, female sex, older age and lower forced vital capacity are determinants of a shorter 6MWD in patients with chronic HF

A associação de técnicas de equilíbrio e condicionamento cardiorrespiratório diminui o risco de quedas e melhora a capacidade funcional em mulheres / La asociación de ejercicios de equilibrio con el acondicionamiento cardiorrespiratorio disminuye el riesgo de caídas y mejora la capacidad funcional de mujeres / Association of balance and cardiorespiratory conditioning techniques reduces risk of falls and improves functional capacity in women

RESUMO Verificou-se a efetividade da associação do treino de equilíbrio no solo com o treino cardiorrespiratório na água sobre a capacidade funcional e o risco de quedas em mulheres adultas. Esse ensaio clínico não controlado unicego foi composto por 24 mulheres (60,79±5,51), submetidas a três meses de treinamento. Instrumentos: Short Physical Performance Battery (SPPB), Quick Screen Clinical Falls Risk Assessment (QSCFRA) e Teste de Caminhada de Seis Minutos (TC6). Houve melhora dos índices de equilíbrio, mas sem significância estatística. Ocorreu melhora significativa para o risco de quedas (p<0,001) e TC6 (p=0,049), com aumento médio de 39,58±95,5 m na distância percorrida. Houve correlações significativas entre TC6 e SPPB pré-treinamento (r=0,56, p=0,008), idade e QSCFRA (r=0,538, p=0,012) e comorbidades e QSCFRA (r=0,696; p=0,006). Verificou-se efetividade na associação dos treinos propostos sobre a diminuição do risco de quedas e melhora da capacidade funcional.

RESUMEN Se estudia si hay eficacia la asociación de los ejercicios de equilibrio en el suelo con el acondicionamiento cardiorrespiratorio en el agua en la capacidad funcional y en el riesgo de caídas de mujeres mayores. De este estudio clínico no aleatorizado a ciegas participaron 24 mujeres (60,79±5,51), evaluadas durante tres meses. Se emplearon las siguientes: Short Physical Performance Battery (SPPB), Quick Screen Clinical Falls Risk Assessment (QSCFRA) y la Prueba de Caminata de 6 minutos (PC6). Aunque los índices de equilibrio presentaron mejoras, no fueron estadísticamente significantes. El riesgo de caídas (p<0,001) y la PC6 (p=0,049) tuvieron mejoras significativas, con un promedio de aumento de 39,58±95,5 m en la distancia cumplida. Presentaron correlaciones significativas la PC6 y la SPPB preejercicio (r=0,56; p=0,008), la edad y la QSCFRA (r=0,538; p=0,012) y las comorbilidades y la QSCFRA (r=0,696; p=0,006). Se concluye que la relación entre los ejercicios propuestos es eficaz para disminuir caídas y mejorar la capacidad funcional.

ABSTRACT This study aimed to test the effectiveness of the association of balance training on the ground with cardiorespiratory training in the water on the functional capacity and risk of falls on adult women. This single-blind uncontrolled clinical trial was formed by 24 women (60.79±5.51), subjected to three months of training. Instruments: Short Physical Performance Battery (SPPB), QuickScreen Clinical Falls Risk Assessment (QSCFRA) and Six-Minute Walk Test (6mwt). Balance improvement was noticed, although without statistical significance. Significant improvement occurred for risk of falls (p<0.001) and 6mwt (p=0.049), with a 39.58±95.5 mean increase of distance covered. Significant correlations happened between 6mwt and pre-training SPPB (r=0.56, p=0.008), age and QSCFRA (r=0.538, p=0.012), and comorbidities and QSCFRA (r=0.696; p=0.006). Effectiveness was observed in association with the proposed training on reduction of risk of falls and functional capacity improvement.

Efeitos do exercício físico não supervisionado na qualidade de vida e na capacidade funcional de portadores de insuficiência cardíaca crônica / Effects of unsupervised exercise training program in the quality of life and functional capacity of patients with chronic heart failure

Os pacientes com insuficiência cardíaca (IC) apresentam, frequentemente, sintomas limitantes, como dispneia e fadiga, que comprometem substancialmente a capacidade funcional e a qualidade de vida. Assim, este estudo teve como objetivo avaliar o efeito de um programa de exercício físico não supervisionado na qualidade de vida (QV) e na capacidade funcional (CF) de pacientes portadores de IC. Através de um ensaio clínico controlado, foram randomizados, em dois grupos, 22 pacientes com IC atendidos no ambulatório de IC de um hospital de referência do Estado de Goiás, com idade entre 18 e 85 anos, de ambos os sexos, pertencentes à classe funcional II ou III. O grupo treinamento(GT) (n=13) realizou caminhadas de forma não supervisionada por 10 semanas e recebeu oficina educacional. O grupo controle(GC) (n=9) recebeu somente oficina educacional. Ambos os grupos foram submetidos à avaliação da CF através do teste de caminhada de seis minutos (TC6) e à avaliação da QV pelo SF-36, pré e pós-intervenção. O GT (idade 62,1 ± 11,7 anos) apresentou melhora em seis domínios do SF-36: capacidade funcional (p=0,003), aspecto físico (p=0,01), dor (p=0,03), aspecto social (p=0,02), aspecto emocional (p=0,02) e saúde mental (p=0,003). Já o GC (idade 65,9 ±11,5 anos) apresentou melhora somente no domínio saúde mental (p=0,03). No TC6 ambos aumentaram a distância percorrida. O GT aumentou 64,1 m (p=0,004) e o GC aumentou 29,1m (p=0.03). Conclui-se que o exercício físico não supervisionado foi efetivo para a melhora da qualidade de vida e da capacidade funcional de portadores de IC crônica.

Patients with chronic heart failure (HF) often have limiting symptoms such as breathlessness and fatigue that impair substantially the functional capacity and quality of life. Thus, the present study aimed to evaluate the impact of a program of unsupervised exercise on the quality of life and functional capacity of patients with chronic heart failure. Using a controlled clinical trial randomized into two groups, 22 patients with heart failure, who attended the outpatient HF a reference hospital in the state of Goiás, aged between 18 and 85 years, both sexes, class II or III. The GT training group (n=13) have walked unsupervised for 10 weeks but attended educational workshop. The CG control group (n=9) received only educational workshop. Both groups underwent assessment of functional test through the six-minute walk (6MWT) and quality of life using the SF-36, pre and post intervention. Regarding quality of life, the TG (aged 62.1 ± 11.7 years) showed improvement in six areas of the SF-36: functional capacity (p=0.003), physical appearance (p=0.01), pain (p=0.03), social (p=0.02) and emotional role (p=0.02) and mental health (p=0.003). The GC (aged 65.9 ± 11.5 years) showed improvement only in the mental health domain (p=0.03). Both groups have increased the distance during the 6MWT, the GT increased 64.1 m (p=0.004) and GC 29.1 m (p=0.03). It was possible to conclude that unsupervised exercise was effective in improving functional capacity and quality of life in heart failure patients.