Factores de riesgo asociados a bacteriemias en niños quemados internados en una unidad de cuidados intensivos pediátricos especializada: estudio de casos y controles / Risk factors associated with bacteremia in burn children admitted to a specialized pediatric intensive care unit: A case-control study

Introducción. Las infecciones con bacteriemias en pacientes quemados son causa frecuente de complicaciones y aumento de días de internación. El conocimiento de los microorganismos causales y la identificación de factores de riesgo asociados permiten disminuir las complicaciones infecciosas, la morbimortalidad y los costos en cuidados de la salud. Este trabajo evalúa el grado de asociación entre los factores de riesgo y los episodios de bacteriemias en pacientes quemados, e identifica los microorganismos aislados más frecuentemente en hemocultivos. Población y métodos. Estudio de casos y controles realizado en la Unidad de Cuidados Críticos de Quemados del Hospital de Pediatría S.A.M.I.C. "Prof. Dr. Juan P. Garrahan" entre el 1 de junio de 2014 y el 30 de septiembre de 2019 en pacientes que presentaron episodios de bacteriemia con hemocultivo positivo (casos) y los que presentaron hemocultivos negativos (controles). Resultados. Durante el período estudiado se identificaron 29 casos de bacteriemias. La mediana de días de internación al momento del episodio de bacteriemia fue de 23 días. El microorganismo más frecuentemente identificado fue Pseudomonas (7 casos). El único factor de riesgo con el que se pudo establecer asociación significativa fue la presencia de acceso venoso central con 7 días o más (OR 3,18; IC 95 %: 1,20-8,38). La mortalidad global fue del 9,1 %, en los casos fue del 13,8 %, y en los controles, del 3,4 %. Conclusiones. Los accesos venosos centrales con duración mayor a 7 días son un factor de riesgo independiente de bacteriemias en niños quemados críticos. No se pudo establecer una asociación estadísticamente significativa con otros factores de riesgos analizados. Pseudomonas, Acinetobacter y Staphylococcus coagulasa negativo fueron los microorganismos más frecuentemente identificados en las bacteriemias

Introduction. Infections due to bacteremia in burn patients are a common cause of complications and an extended length of stay. Knowing causative microorganisms and identifying associated risk factors allow to reduce infectious complications, morbidity, mortality, and health care expenditure. This study assesses the extent of the association between risk factors and bacteremia in burn patients and identifies the most common microorganisms found in blood cultures. Population and methods. Case-control study conducted at the Burn Intensive Care Unit of Hospital de Pediatría S.A.M.I.C. "Prof. Dr. Juan P. Garrahan" between June 1st, 2014 and September 30th, 2019 in patients with bacteremia events and a positive blood culture (cases) and patients with a negative blood culture (controls). Results. During the study period, 29 cases of bacteremia were identified. The median length of stay at the time of bacteremia was 23 days. The most commonly identified microorganism was Pseudomonas (7 cases). The only risk factor that showed a significant association was the presence of a central venous line for 7 days or more (OR: 3.18; 95 % confidence interval: 1.20- 8.38). The overall mortality rate was 9.1%; 13.8% for cases and 3.4% for controls. Conclusions. Central venous lines for more than 7 days are an independent risk factor for bacteremia in critically ill burn children. No statistically significant association was established with other studied risk factors. Pseudomonas, Acinetobacter, and coagulase-negative Staphylococcus were the most common microorganisms found in bacteremia

Comparison of Hemodynamic Response and Vasopressor Requirement Following Spinal Anesthesia between Normotensive and Hypertensive Women Undergoing Elective Cesarean Section

Introduction: Spinal anesthesia (SA) is the technique of choice in cesarean sections, but it is not widely accepted in hypertensiondue to fear of sudden and extensive sympathetic blockade. Sympathetic blockade induced hypotension may occur in up to64–100% of pregnant women who have been given spinal anesthesia for cesarean delivery, especially when hyperbaric solutionsare used. Severely pre-eclamptic patients were previously believed to be at high risk of severe hypotension, with maternaland fetal consequences because of reduced plasma volume and because of the need to limit i.v. fluids to avoid iatrogenicpulmonary edema.Methodology: The present study, “comparison of hemodyanamic response and vasopressor requirement following spinalanesthesia between normotensive and hypertensive women undergoing elective cesarean section” 100 women of age20–35 years, the American Society of Anesthesiologists physical Status Ι and ΙΙ carrying a singleton pregnancy and scheduledto have elective cesarean section in Netaji Subhash Chandra Bose Medical College, Jabalpur, were enrolled into two groups.GroupA: 50 were normotensive women and Group B: 50 were hypertensive women. All patients received a standard subarachnoidblock under all aseptic precautions with 12.5 mg 0.5% hyperbaric bupivacaine.Results: Based on the data from our study, it could be concluded that after spinal anesthesia in patients undergoing electivecesarean section-hypertensive group of parturients had less fall in mean systolic blood pressure (SBP), diastolic BP, and meanarterial BP in comparison to normal healthy pregnant women which were statistically significant (P < 0.05). Hypertensive group ofpatients required less ephedrine to treat hypotension in comparison to normotensive patients which were statistically significant(P < 0.05). The incidence of hypotension was almost 7 times less in hypertensive parturients than healthy parturients (oddsratio = 23.14, relative risk of hypotension in Group A = 7.2, confidence interval = 7.6–70.3).Conclusion: To summarize, our results showed that hypotension following SA administered for cesarean section wassignificantly less in hypertensive patient than in healthy pregnant women. In addition, vasopressor requirements were also lessin hypertensive parturients and neonatal outcome was comparable between the two groups. Therefore, subarachnoid blockis an acceptable technique to perform in hypertensive parturients due to its virtue of simplicity, rapidity, cost-effectiveness,and intensity of block.

Experiences of Parents of Children with Burn Injuries in a Tanzanian Referral Hospital: A Qualitative Consideration.

Aims: Burns injuries are the most common causes of physical and psychological trauma in both children and parents globally. It is characterized by prolonged hospitalization, as well as reduced productivity of parents due to family conflicts and economic implications. This study aimed to reveal the experiences of parents of children with burn injuries in a developing context to inform future care directions and improvements to care. Study Design: A qualitative exploratory study design was used. Place and Duration of Study: The study was conducted at Muhimbili National Hospital, Tanzania in early 2014 over a 4 month time period. Methodology: Four female participants were recruited via purposive sampling method. They participated in in-depth interviews as well as semi-structured questionnaires. All interviews were audio-recorded and transcribed verbatim later. Data analysis was done using a modified version of Colaizzi’s (1978) seven step approach, whereby themes and sub-themes were identified. Results: Based on a thematic analysis of the transcripts of interviews, it was revealed that parents of children with burn injuries experienced a mix of positive and negative feelings and challenges associated with the medical procedures, nursing care, hospital environment, coping mechanisms, and impacts of hospitalization. The participants spoke of the balance of parents (i.e., skills, coping, assets), people (i.e., others for support, comfort); professionals (skills, compassion, resources) and place (i.e., hospital network and resources). Conclusion: Parents of children with burn injuries experience a range of challenges immediately after the burn injury and during the hospitalization period. Thus, psychological support from a range of sources (personal, external, professional, social) is necessary to address, identify, and minimize these challenges, thereby improving the health care experience and overall well-being of the child and their parents.

Epidemiology and outcome of burn injuries in tertiary care hospital of Northern India.

Background: Burns represent a serious problem around the world especially in low and middle income countries. The aim of this study was to determine epidemiological characteristics, causes and mortality rate of burn deaths in tertiary care hospital of N India as well as to guide future education and prevention programs. Methods: A one year cross-sectional study of all burn patients admitted in Dr. RPGMC Tanda, Kangra, Himachal Pradesh, India was conducted between January 2014-December 2014. Results: Our study revealed that type II (absence of sutural bones) was commoner than type I (presence of type I) asterion. Total of 210 burn injury patients were admitted majority were males[54.5%] and females were [45.5%] males sustained burn injuries mostly at their work place with electric burns whereas females sustained burn injuries at home with cooking appliances. Conclusions: Burn injuries can be reduced by bringing about regulations to develop safer cooking appliances, promoting less inflammable fabrics to be worn out at home and educating the community especially women.

Queimaduras: pacientes autoinfligidos / Burn injuries: self-inflicted patients

INTRODUÇÃO: As queimaduras autoinfligidas geram consequências físicas, psicológicas e financeiras não só para a vítima, mas também para familiares e para sociedade. A prevalência desse tipo de acidente tem ampla variedade na literatura. O trabalho tem como objetivo analisar o perfil epidemiológico, a conduta e a taxa de letalidade dos pacientes com queimaduras por autoagressão atendidos em centro de tratamento de queimados, como uma forma de contribuir para intervenção efetiva em fatores e comportamentos de risco para tais acidentes. MÉTODO: Estudo retrospectivo por meio da análise dos prontuários de pacientes internados na Unidade de Queimados do Hospital Regional da Asa Norte, Brasília - DF, no período de janeiro de 2008 a dezembro de 2012. RESULTADOS: Foram incluídos no estudo 88 pacientes autoinfligidos, 54,5% do gênero feminino, idade média de 33 anos, média da superfície corporal queimada de 36%. A média de tempo de internação foi de 23 dias. A chama aberta foi o agente etiológico das queimaduras em 97,7% dos casos e o álcool foi o agente acelerador em 68,2%. A taxa de letalidade foi de 32,9%. Sessenta pacientes apresentavam comorbidades, sendo os distúrbios psiquiátricos e o etilismo os principais. CONCLUSÃO: As vítimas de queimaduras por autoagressão são geralmente mulheres, com idade média de 33 anos, utilizando álcool como agente da queimadura, afetando em média 36% da superfície corporal, com distúrbios psiquiátricos associados em 32,9% e com taxa de letalidade de 32,9%. No âmbito social, deve-se pensar em medidas públicas que detectem os pacientes em potencial para que seja instituída terapêutica adequada.

INTRODUCTION: Self-inflicted burn injuries lead to physical, psychological, and economic consequences not only to the victims but also to their families and the society. The prevalence of this type of accident varies greatly throughout the existing literatures. This study aimed to analyze the epidemiological profile, behavior, and lethality rate in patients with self-inflicted burn injuries who received treatment in a burn unit, as a way to contribute to the effective intervention to minimize the effects of risk factors and behaviors associated with this type of accident. METHOD: We conducted a retrospective study in which we analyzed medical records of patients hospitalized in the burn unit of Asa Norte's Regional Hospital, DF, Brazil, during the period between January 2008 and December 2012. RESULTS: The study sample consisted of 88 patients with self-inflicted burn injuries, of whom 54.5% were female, with a mean age of 33 years and mean burned body surface area of 36%. The mean hospitalization time was 23 days. Open flame was the etiological agent in 97.7% of the burn cases, and alcohol was the accelerating agent in 68.2% of these cases. The lethality rate was 32.9%. Sixty patients had comorbidities, with psychiatric disorders and alcoholism being the most common. CONCLUSION: The patients with self-inflicted burn injuries were generally women, with a mean age of 33 years, who used alcohol as accelerating agent. The mean body surface area affected was 36%. Of the patients, 32.9% had associated psychiatric disorders. The lethality rate was 32.9%. From a social perspective, public measures should be established to detect potential patients in order to administer appropriate therapies.

Epidemiology and Outcomes of Pediatric Burn Injuries in Cairo University Hospital- Egypt.

Aim: To identify the epidemiology and outcome of pediatric burn injuries. Study Design: Retrospective hospital -based analytical study. Place and Duration of Duration: Burn unit at Cairo university hospital, in the period between the first of January 2007 till December 2011. Methodology: The study retrospectively evaluated 564 children with different burn injuries, who were admitted to Cairo University Hospital during the period of the study. Data about age, sex, burn size, etiology of burn, and outcome of admission to the intensive care unit were retrieved from the medical records and the burn treatment registry. In addition, average length of hospital stay (ALOS) and bed occupancy rate (BOR) were calculated. Further analysis was done in the last year of the study (2011), by interviewing mothers of the patients and residents in charge. Results: The average age of the children was 5.9 years (SD: ± 4.1).Under five children were found to be the most susceptible to burn injuries accounting for about 70% of the affected population There was no significant difference in the number of patients between genders (P= 0.3). While scald type of burn was the most prevalent etiology of burn injuries representing more than 60% of all causes. Total burn surface area. (TBSA)% was greater among females, patients from rural residencies and flame type of burn. The non- survivors represented 2.5% of the studied sample. Intensive care unit (ICU) admission was mainly due to renal impairment, sepsis and respiratory stress due to inhalation injury. LOS and decreasing in the BOR reflects better advances in care. Conclusion: Under five children are the most susceptible age group to burn injuries, this could be prevented by raising awareness of patients. More attention should be paid to reduce complications that necessitate ICU admission.

Contratura cicatricial severa em membros superiores após queimadura por escaldamento ? relato de caso / Severe upper extremities burn scar contractures after a scald burn ? case report

Objetivos: Descrever a história e o tratamento de um menino com severa contratura cicatricial em membros superiores após queimadura.Descrição do caso: Paciente de seis anos que evoluiu com importantes contraturas cicatriciais em tronco e membros superiores após queimadura por escaldamento. Foi realizado tratamento cirúrgico através de múltiplas zetaplastias em mais de um tempo cirúrgico, com resultado funcional satisfatório.Conclusões: As contraturas cicatriciais são complicações comuns após queimaduras e devem ser manejadas individualmente. A melhor forma de preveni-las é seguir um tratamento baseado em protocolos para pacientes queimados graves. No tratamento das contraturas deve-se sempre iniciar o manejo através da modalidade mais simples e resolutiva para cada caso. No caso relatado foram utilizados apenas zetaplastias e enxertos de pele parcial, obtendo-se um resultado eficaz com mínima morbidade e importante melhora na qualidade de vida do paciente.

Aims: To describe the medical history and surgical management of a boy presenting severe upper extremity scar contraction secondary to burn injury.Case description: We describe a case of a six years old patient presenting with an important upper extremity scar contraction secondary to a scald burn injury. Late surgical management included zetaplasties performed in multiple surgical stages with a satisfactory functional result.Conclusions: Scar contraction is a common complication following burn injuries and should be individually managed. The best way to prevent them is delivering an early appropriate treatment based on standard protocols for severe burn injuries. Treatment for contractions should be initiated by the simplest and most resolutive option for each case. In this case, zetaplasties and partial skin grafts were done, with a good effectiveness, minor morbidity and substantial improvement in the patient's quality of life.

Epidemiology and outcome of burn injuries.

Burn injury is a serious public health problem in developing countries. The causes vary in different communities and so this study was done to know the epidemiology and outcome of burn injuries. A one year cross sectional study was done of all the burn injury patients admitted during April 1st, 2004 to March 31st, 2005. Data was collected using a pre designed and pre tested proforma from the patients themselves or their relatives and analyzed using chi square test and percentages. A total of 76 burn injury patients were admitted. Majority were females (52.63%) and sustained burn injuries at home (p=0.000). Maximum number of females were wearing synthetic clothes (p=0.000) and suffered from flame injuries (0.006).The case fatality rate was 31.58%.Burn injuries can be reduced by bringing about regulations to develop safer cooking appliances, promoting less inflammable fabrics to be worn at home and educating the community especially women.

A case of neonatal major burn by electrical heating pad / 대한주산의학회잡지

Burn in neonates have been reported following the use of pulse oximeters, phototherapy blanket, infrared heating lamp, laryngoscope, and warming bottle. This case reports a newborn who had major burn injuries of 45% total body surface area (TBSA) including 3rd degree burns of 20% TBSA on her back, buttocks, both thighs and heels by exposure to an electrical heating pad for 3 hours. She developed significant systemic response, showing disseminated intravascular coagulation, electrical imbalance, jaundice, hypoalbuminemia, acute renal failure, and persistent pulmonary hypertension of the newborn. The potential hazard of the electric heating pad is reported in order to alert clinicians to this specific risk, to stimulate concern about other similar problems with materials in contact with skin, and to prevent burn of newborns in the neonate unit.

Características epidemiológicas y clínicas de las quemaduras eléctricas en la Unidad de Quemados, hospital Luis Vernaza / Epidemiologic and clinical characteristics of electrical burn injuries admitted to the burn unit of the hospital Luis Vernaza

Tipo de Estudio: Descriptivo epidemiológico retrospectivo en 644 pacientes ingresados en la Unidad de quemados del hospital “Luis Vernaza” período 2003. Objetivos: Ordenar y presentar la información obtenida en el manejo de las quemaduras por electricidad en esta unidad especializada. Resultados: Pacientes de sexo masculino 86.80%, 59.47%, con edades entre 21 y 40 años. El sitio con mayor ocurrencia de accidentes fue el lugar de trabajo con 351 (54.50%) reportes, en el hogar se produjeron 236 (36.65%) casos, 57 (8.85%) en la calle, automóvil, etc. Generalmente los pacientes presentaron quemaduras de II grado con una media de 9.3% de Superficie Corporal Quemada (SCQ). La secuela más importante fue la amputación; 64.3% de éstas se realizaron en miembros superiores. La estancia hospitalaria media fue de 38 días, la mortalidad 3.1%. Conclusiones: La tendencia del número de casos con quemaduras eléctricas atendidos en el hospital “Luis Vernaza” está elevándose y es importante el grado de discapacidad que producen, lo que puede significar para los sistemas de salud una significativa inversión de recursos.

Type of study: Descriptive, retrospective of 644 patients admitted to the Burn Unit of the “Luis Vernaza” Hospital period 2003.Objectives: To organize the information obtained in managing electrical burn injuries admitted to the unit.Results:We found that electrical burn injuries were most common in males (86.80%) between the age group of 21-40 (59.47%). Percentage of the most common places of injury was:•Place of work – 351 (54.50%)•Household – 236 (36.65%)•Street, automobile, etc 57 cases (8.85%)Most of the patients had 2nd degree burns and a mean burn size of 9.3% total body surface area. The most common sequelae were amputation (64.3%) of superior limbs. The mean hospital stay was of 38 days and a mortality of 3.1%.Conclusions: The number of cases of electrical burn injuries admitted at the Hospital “Luis Vernaza” and rate of disability is increasing.

The Effect of Combined Radiation-Burn Injury on Intestinal Epithelium in Mice / 第三军医大学学报

Seven hundred and forty-six mice, weighing 30-35 grams, were divided into four groups randomly. The animals of the first three groups were inflicted with radiation injury (12 Gy total body irradiation from a Co60 source) , burn injury (15% of third degree burns), and combined injury of radiation and burns(12 Gy total body irradiation and 15% of third degree burns) respectively. The fourth group worked as normal control.The mortality and the dynamic changes of the intestinal epithelium of the experimental animals were studied. It was found that the clinical course of the combined injury group was quite different from other two. The mortality of the combined injury group was higher and the damage on the intestinal epithelium was more severe than those of the radiation injury group in the first 48 hours after injury. In the second 48 hours, the mortality of the combined injury group became lower and the recovery of the intestinal epithelium faster.The reactions of the experimental animals to the combined injury of radiation and burn were-very complicate. Further investigation is essential to elucidate the mechanism and to formulate appropriate therapeutic measures.