Domestic burns that occurred during the COVID-19 pandemic in Brazil: a descriptive cross-sectional study

Abstract BACKGROUND: Due to "stay at home" restrictions during the coronavirus disease 2019 (COVID-19) pandemic, people spent more time at home leading to an increase in home accidents, including burns. OBJECTIVE: To investigate the epidemiology of burns that occurred within homes during the COVID-19 pandemic in Brazil. DESIGN AND SETTINGS: This was a quantitative, descriptive, and cross-sectional study with a non-probabilistic sample. METHODS: Data were collected through the distribution of survey links on social networking sites and websites, and through email between December 2020 and February 2021. Participants were over 18 years of age, living in Brazil. Data analysis was performed using descriptive and dispersion statistics. RESULTS: A total of 939 adults (aged > 18 years) participated in this study. The mean age was 37.2 years (standard deviation [SD] = 12.5), 75.6% were female, 70.0% self-reported white skin color, 74% had completed higher education, and 28.1% had an income of 3 to 6 times the monthly minimum wage. A total of 21.6% suffered burns during the pandemic, 44.3% from a hot object. Approximately 49.3% never had access to a burn prevention campaign. CONCLUSION: It is necessary to develop burn prevention strategies that reach a wider population and to strengthen public policies to reduce the prevalence of domestic burns, especially during the pandemic.

Pain assessment and clinical profile of burn patients

Background:Burn injuries are a major global public health concern with up to 52% of burn patients suffering from chronic pain. Theaim of the study was to assesclinical profile and management of pain in burn patients.Methods:Thestudy was aprospectivehospital-basedstudy on a total of 300 patients admittedinburnunitofthedepartmentofsurgery over a period of two years. BSA burns was determined by Wallace's rule of nine in adults and in children by Lund and Browder chart. Pain was assessed using Wong-Baker FACES pain rating scale. Statistical analysis was done using SPSS program.Results:In the present study, most of the burns i.e., 46.7% were seen in <20 years age group, and more in male (58.7%) subjects. Accidental burns and superficial burns were the most common. There were 113 (53.3%) patients with pain score of 2 followed by 160 (53.3%) with pain score 3, 22 (7.3%) pain score 4 and 5(1.7%) with pain score of 1. For pain management, 171(57%) patients were given NSAIDS, 78 (26%) needed opioid and NSAIDs and 51 (17%) needed opioid only. Complications in our studied patients on follow up revealed 29 (9.7%) had PTSD, 22 (7.3%) had post burn contracture,16 (5.3%) had post burn pain, 15 (5.0%) were having anxiety.Conclusions:Pain in burn victims is present throughout the rehabilitation and so should be dealt with multimodal specialties.

Challenges in the rehabilitation management of a patient with Spinal Cord Injury without Radiographic Abnormality (SCIWORA) secondary to high-voltage electrical burn injury with multiple disabilities: A case report

@#A 22-year-old male who came in contact with a high-voltage wire, with entry point at the head and exit points at the ankles, presented with flaccid paraplegia and loss of sensation of bilateral lower extremities with no radiographic abnormalities. Several burn-related medical complications arose during the admission, as well as episodes of demotivation. Bilateral below the knee amputation was done because of extensive burn injuries of the lower extremities. The rehabilitation management for a patient with multiple disabilities needed to be tailored depending on the limitations and needs of the patient at a certain point in time. Despite the challenges, satisfactory results were achieved, through telerehabilitation and employing a multidisciplinary team approach.

Combination treatment of Umbilical Cord-derived Mesenchymal Stem Cell (UC-MSC) and Umbilical Cord Mesenchymal Stem Cell-derived Conditioned Medium (UCMSC-CM) for Keloid Post Chronic Burn Injury: A Case Report

@#A 44-years-old woman with hard and thick keloids after chronic mercury burn injury underwent a several times of reconstructive surgery. The patient had excised surgery and injected Umbilical Cord-derived Mesenchymal Stem Cells (UC-MSCs) and Umbilical Cord Mesenchymal Stem Cells-derived Condtioned Medium (UCMSC-CM) 9 times within 9 months. Seven times injection of UC-MSCs of 5x106 cells and UCMSC-CM of 20 cc 2 times at months 4 and 9. The results of this therapy showed gradual improvement without any side effects and the size of the keloid reduced from 25x16 cm to 23x14 cm after 9 months. Keloid thickness from 12 mm to 4 mm. Keloid color becomes lighter and skin texture is more supple and soft. The cases showed that UC-MSCs and UCMSC-CM can be a potential treatment for keloids after chronic burn either alone or in combination with surgery.

The effect of “Cibo” ointment on mechanical wound in rats / Монголын эм зүй, эм судлал

Introduction@#In Mongolia, there is opportunity to replace importing products by using raw materials based on the animal and minerals. Those products can be used for medical purposes.</br> In traditional medicine, yellow marrow has been widely used to treat burns and mechanical wounds, as well as frozen and open wounds. The purpose of this study was to determine the pharmacological action of “CIBO” ointment. We created a model of mechanical wound to evaluate the healing of wounds and its index after applying the ointment contains the above mentioned raw materials. @*Material and methods@#Four different groups of “CIBO” ointment was prepared in the technology sector of the Drug Research Institute. Mebo wound ointment was used for comparison as control. The study was con- ducted in the Pharmacology Sector of the Drug Research Institute on white rats of the WISTAR breed under one feeding regime and one condition (12h / 12h). Mechanical wound injury and exposure to open wounds in experimental rats and its size were measured on the 3^rd, 7^th, 14^th, 21^st, and 28^th days of treatment. Wound healing, morphology, structure, size, and its index was quan- tified based on the defects. The ointment were applied once a day during the treatment period of 28 days to cover the wound.@*Result@#Mechanical wound showed that study treatment group healed 0-6.2% on the 3^rd day, 21.4-35.7% on the 7^th day, 50-60% on the 14^th day, and 33.3-50% on the 21^st day separately compared with the untreated group. On the 28^th day, all the groups were decreased by 66.6%. The wound index was between from 0.002 to 0.0005 in the all experimental groups. Among experimented groups, the group consists of yellow marrow and Chinese white cinder was showed better performance than other groups.@*Conclusion@#The study group 4 (Yellow marrow + Chinese white cinder) has been showed to have a pharmacological action of rapid healing and regeneration of burn wounds caused by experimental rats. It has also been shown to have pharmacological action to regenerate skin tissue and suppress caused by mechanicals. Inclusion of Chinese white cinder in “CIBO” ointment promotes regener ation and healing of “CIBO” ointment.

Perceptions and experiences of female burn survivors with facial disfigurement / 中华创伤杂志(英文版)

PURPOSE@#This study aimed at exploring the perceptions and experiences of female burn survivors with facial disfigurement in Pakistan.@*METHODS@#Two different quantitative and qualitative studies were conducted, of which the data were collected from 100 burn patients. A pilot interview protocol was developed. An indepth interview of five female burn survivors with facial disfigurement was taken in Lahore, Pakistan. The transcripts were analyzed using thematic analysis and four major themes were identified, respectively physical appearance, posttraumatic growth, relationships and coping strategies.@*RESULTS@#Thematic analysis reflected differences in attributional style, perceptions and individual experiences of female burn survivors with facial disfigurement. The study showed the importance of physical appearance for different burn survivors and how their life had changed after suffering from a burn injury.@*CONCLUSION@#It could be easy to have a positive outlook towards life and accept visible differences post injury for the burn survivors, who are grateful for life, get a strong family support and have available resources. On the contrary, with low self-esteem, lack of a family support and available resources, patients would be dissatisfied with their life.

Infección en la lesión por quemadura / Infection by burn injury

RESUMEN Fundamento: La infección de la lesión por quemadura constituye una de las principales causas de morbilidad y mortalidad en el paciente quemado, y una de las complicaciones más temibles en estos pacientes, por lo que el diagnóstico microbiológico de la infección representa un paso importante para el tratamiento oportuno de los mismos. Objetivo: Determinar mediante el estudio microbiológico cualitativo y cuantitativo de la lesión por quemadura el diagnóstico de infección en los pacientes quemados. Metodología: Se realizó un estudio descriptivo, transversal para determinar mediante el estudio microbiológico de la lesión por quemadura la presencia de infección en los pacientes quemados ingresados en el servicio de Caumatología del Hospital Universitario Manuel Ascunce Domenech de la provincia de Camagüey. Se estudiaron 34 enfermos por quemaduras en quienes se evaluaron el estado nutricional de los pacientes al ingreso, la reanimación prehospitalaria, la positividad del cultivo cuantitativo y cualitativo y los gérmenes más comunes aislados. Resultados: En 8 de los pacientes clasificados como bajo peso, sus lesiones estaban colonizadas por microorganismos. Del 79.42 % de los pacientes que tuvieron una reanimación adecuada, se encontró cultivos cualitativos positivos en 12 de ellos. En el 44.12 % de los pacientes lesionados se encontró la presencia de gérmenes con una cuantificación mayor de 105 bacterias por gramo de tejido. La Pseudomonas aeruginosa se aisló en el 38.23 % de los pacientes estudiados. Conclusiones: El estudio bacteriológico cuantitativo constituye un elemento importante en el diagnóstico de la infección en la herida por quemaduras. La Pseudomonas aeruginosa es uno de los gérmenes principales que colonizan e infectan estas lesiones.

ABSTRACT Background: Infection by burn injury is one of the main causes of morbidity and mortality in burn patients, and one of the most dreadful complications in these patients, so the microbiological diagnosis of infection represents an important step at the timely treatment. Objective: To determine through qualitative microbiological study and quantitative analysis of the burn injury the diagnosis of infection in burn patients. Methodology: A descriptive, cross-sectional study was carried out to determine through the microbiological study of the burn injury the presence of infection in burn inpatients from the Caumatology service at Manuel Ascunce Domenech University Hospital in Camagüey. 34 burn patients were studied, their nutritional status upon admission, pre-hospital resuscitation, positivity of the quantitative and qualitative crops and the most common isolated germs were also evaluated. Results: In 8 of the underweight classified patients, their injuries were colonized by microorganisms. In 12 of the 79.42 % of patients who had an appropriate resuscitation, qualitative crops were found positive. In 44.12 % of injured patients found the presence of germs with a quantification greater than 105 bacteria per gram of tissue. Pseudomonas aeruginosa was isolated in the 38.23 % of the studied patients. Conclusions: The quantitative bacteriological study constitutes an important element in the diagnosis of infection in the burn wound. The Pseudomonas aeruginosa is one of the main germs that colonize and infect these lesions.

Severe thermal injury of larynx in a child following accidental ingestion of hot tea

Thermal injury to the upper respiratory tract caused by aspiration of hot liquids resulting in laryngeal edema and subsequent obstruction of the airway is commonly not seen in the pediatric population. Unlike adults, children are more prone for subglottic injury, swelling and resulting obstruction of the airway due to the smaller size of the trachea and relatively large epiglottis. Examination of the airway with laryngoscopy hence should be recommended in all patients with inhalational and aspiration burn injury as it will help in guiding airway management and preventing development of complications. Authors report a case of a 3-year-old male child with accidental ingestion of just made hot tea. Upon presentation there was severe stridor and signs of respiratory distress requiring emergency intubation. Direct laryngoscopy revealed glottic edema and ulcer. Upper GI endoscopy showed erythematous arytenoids, esophagus and stomach showing few erythematous flat lesions. Chest radiographic examination showed bilateral para cardiac and perihilar inhomogeneous opacities suggestive of aspiration pneumonitis. The child was gradually weaned and extubated on day three of admission. Ingestion of hot liquids can cause airway and esophageal thermal burns. Rapid diagnosis and treatment are essential in management of inhalational and aspiration burn injury to reduce the morbidity, mortality and long-term sequelae in these patients. Children are more prone for burn accidents due to their curious and exploratory behavior and their inability to perceive the hazards. Since most of the pediatric burn accidents happen at home, parents should be offered education about prevention of burn and advised on how to manage and treat minor burn injuries and to watch for any warning signs in which case to rush to the nearest hospital.

Relationship between comorbid factors and mortality of inhalation trauma patients in Wahidin Sudirohusodo Hospital, Makassar

Background: Inhalation trauma is the leading cause of death in burn patients. Inhalation trauma is caused mainly by inhalant poisons such as smoke, gas and steam. Many patients die immediately at the scene due to inhalation trauma. The purpose of this study was to determine the relationship between comorbid factors and mortality rates in patients with inhalation trauma.Methods: The research design was analytical research method with cross sectional design. The study sample consisted of 26 people (51.0%) inhalation trauma and 25 people (49.0%) without inhalation trauma obtained by consecutive sampling.Results: There was a significant relationship between inhalation trauma and death outcomes (p<0.001). The proportion of deaths in inhalation trauma (65.4%) was significantly higher than in nonhaled trauma (16.0%). There was no significant relationship between DM and outcome (p>0.05). There was no significant relationship between hypertension and outcome of death (p>0.05). There is a significant relationship between onset and outcome (p<0.05). The proportion of deaths at <24 hours onset (35.6%) was significantly lower than at onset >24 hours (83.3%). The mean blood glucose level of dead patients was higher than that of alive, which was 124.4 compared to 114.9 but was not statistically significant (p>0.05). Both the mean systole and diastole pressures of the dead patients showed significantly lower results than that of alive, i.e., the mean systole was 101.2 compared to 114.1 (p<0.05) and the mean diastole was 62.2 versus 71.4 (p<0.05).Conclusions: According to the results of the study, it was found that there was a relationship between the onset of more than 24 hours, high GDS levels, and lower blood pressure to mortality.

Epidemiological characteristics of hospitalized children with burn in Ningbo / 预防医学

Objective@#To analyze the epidemiological characteristics of hospitalized children with burn in Ningbo from 2013 to 2018,and to provide evidence for developing intervention strategies. @*Methods@#The pediatric burn cases,discharged from the Ningbo Women & Children's Hospital from 2013 to 2018,were registered using the Ningbo Hospitalized Injury Monitoring Report Card,and their distributions of time,places,groups,involved body parts and prognosis were analyzed. @*Results@#There were 3 862 pediatric burn inpatients included in this study,with 2 977（77.08%）cases aged 1-3 years and 2 532（65.65%）nonlocal cases. About 898（23.25%）cases occurred during 9:00-12:00 a.m. and 1 833（47.46%）cases occurred during 17:00- 21:00 p.m. Burns predominantly occurred at home,with 3 810（98.65%）cases. The top three body regions involved were multiple regions,lower limbs and upper limbs with 1 820（47.13%）,835（21.62%）and 541 cases（14.01%）. The proportions of involving multiple regions declined with age（Psingle<0.05）. The proportion of involving multiple regions in nonlocal children was higher than that of local children（P<0.05）. @*Conclusion@#Burn is one of the leading causes of child injury-related hospitalization in Ningbo. Home is the main burn scene. Nonlocal and 1-3 year-old children were especially at high risk of burns.

Bone Loss During the Acute Stage Following Burn Injury: Is It Local or Systemic? / La pérdida ósea durante la etapa aguda después de una lesión por quemaduras, ¿es local o sistémica?

ABSTRACT Objective: To examine post-burn bone loss and determine whether it was local or diffuse. Methods: Thirty-six patients with burn injuries were investigated, and the total body surface area of the burns and their locations were recorded. The bone mineral densities of the lumbar 1-4 vertebrae, bilateral distal forearm, and bilateral proximal femur of the patients were recorded, and these were compared with the measurements of the non-burnt extremity. Results: No statistically significant correlations existed among the total body surface area of the burns, their severity and the z-scores. In addition, when comparing the z-scores of the burnt extremity with those of the non-burnt extremity, no statistically significant difference was found (p > 0.05). Conclusion: In this study, a remarkable decrease in bone mass occurred during the second month following the burn injuries. The post-burn bone loss could not be correlated with the severity of the burns, but these injuries caused systemic bone loss.

RESUMEN Objetivo: Examinar la pérdida ósea después de una quemadura y determinar si era local o difusa. Métodos: Se investigó a 36 pacientes con lesiones por quemaduras y se registró el área total de la superficie del cuerpo con quemaduras y sus ubicaciones. Las densidades minerales óseas de las vértebras lumbares 1-4, del antebrazo distal bilateral, y del fémur proximal bilateral de los pacientes, fueron registradas y comparadas con las mediciones de la extremidad sin quemaduras. Resultados: No existieron correlaciones estadísticamente significativas entre el área total de la superficie corporal de las quemaduras, su severidad y las puntuaciones z. Además, al comparar las puntuaciones z de la extremidad quemada con las de la extremidad no quemada, no se encontró ninguna diferencia estadísticamente significativa (p > 0.05). Conclusión: En este estudio, se observó la ocurrencia de una disminución notable de la masa ósea durante el segundo mes tras las lesiones de la quemadura. La pérdida ósea posterior a las quemaduras no se pudo correlacionar con la severidad de las quemaduras, pero estas lesiones por quemadura causaron pérdida sistémica del hueso.

The sympathetic nervous system mechanism of exendin-4 in respect of modulating T cell-mediated immune response to severe burns in mice / 中华急诊医学杂志

Objective To investigate the potential effect of glucagon-like peptide-1 (GLP-1) analogue exendin-4 (Ex-4) on immune function of T lymphocytes via neuroendocrine modulation mechanism in mice following severe burns.Methods Male BALB/C mice were randomly (ramdam number) divided into thermal injury group (n =50) and sham-thermal group (n =30).The thermal injury model was made by exposing the back skin of 15％ total body surface area (TBSA) to 95 ℃ water for 7 seconds,while in sham-thermal model the mice were immersed in 37 ℃ water instead.The expression of GLP-1 receptor (GLP-1 R) was determined in sorted CM + T cells from normal mice by immunofluorescence method.In ex vivo experiment,the mice were sacrificed at 24 h post-bum,then the mononuclear cells (MNC) from spleen were separated from both groups and cultured in RMPI 1640 with 10％ FCS (fetal calf serum) in presence of ConA (concanavalin A,5 μg/mL).Cells were pretreated with catecholamine receptor antagonist propranolol (prop) for 1 hour,followed by consecutive dose of Ex-4 for another 48 h.In in vivo experiment,prop (30 mg/kg) was i.p.injected 30 minutes before thermal injury,then Ex-4 (2.4 nmol/kg) was injected i.p.immediately after scalding.Mice were sacrificed at 6 h and 24 h after thermal injury,then the serum and the spleens were collected.Results GLP-1R was expressed on splenic CD4 + T cells from normal micc.Ex-4 exerted no marked effect on the functions of T cells in terms of proliferation and IL-2 secretion at all doses examined ex vivo,which was not affected by pretreatment with prop.In vivo,T cell functions were suppressed by Ex-4 in thermal mice (P ＜ 0.05),but was restored by pretreatment with prop.Regardless of ex vivo or in vivo,Ex-4 could induce T cells switched to Th2 response (P ＜ 0.05).Moreover,the Th2 switch by Ex-4 was greatly potentiated by prop intervention in thermal mice in vivo other than ex vivo.Norepinephrine level was increased and epinephrine was decreased by Ex-4 in thermal mice.Both norepinephrine and epinephrine levels were obviously enhanced by pretreatment with prop.Conclusions Ex-4 can inhibit the proliferation and IL-2 secretion of splenic T lymphocytes through the sympathetic nervous system,however,it might induce Th2 switch from Th cells by acting directly on GLP-1R.

Xuebijing Injection () increases early survival rate by alleviating pulmonary vasopermeability in rats subjected to severe burns / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate the effects of Xuebijing Injection (, XBJ) on survival rate and pulmonary vasopermeability in a rat model of severe scald injury.</p><p><b>METHODS</b>Rats were divided into two experiments: experiment 1 was monitored for 12 h post-injury for survival analysis after severe burns; in experiment 2, rats were killed for determination of pulmonary vascular permeability and pro-inflflammatory mediators. In both experiments, rats were subject to third-degree 50% total body surface area (TBSA) burns or sham injury followed by XBJ or normal saline (NS) treatment. In addition, rat pulmonary microvascular endothelium cells (PMECs) were pretreated with either XBJ or phosphate buffer saline (PBS), and then subjected to sham serum or scald serum stimulation for 2 or 6 h, followed by transwell examination for the permeability of PMECs. Meanwhile, pro-inflflammatory mediators in PMECs culture supernatant were also investigated.</p><p><b>RESULTS</b>The average survival time in the scald+XBJ group was 582.1±21.2 min, which was signifificantly longer than that in the scald + NS group (345.8±25.4 min, P<0.01). Plasma levels of tumor necrosis factor-alpha (TNF-α), E-selectin, interleukin-6 (IL-6), vascular permeability and water content of lung tissues were signifificantly increased in animals after severe burns (P<0.01). However, administration of XBJ signifificantly decreased these levels in plasma and lung tissue. In in vitro cell experiments, XBJ markedly attenuated permeability in PMECs monolayer and reduced the levels of TNF-α, IL-6 and soluble E-selectin after stimulation with scald serum (P<0.01).</p><p><b>CONCLUSIONS</b>XBJ increases early survival rate by alleviating pulmonary vasopermeability and inhibiting pro-inflflammatory mediators in rats subjected to lethal scald injury. XBJ may be a potent drug in treatment of severe burns.</p>

Anesthetic management with extracorporeal membrane oxygenation in a patient with acute airway obstruction after inhalation burn injury: A case report

A 36-year-old woman was admitted to the intensive care unit because of an inhalation burn injury. Five days after admission, she developed dyspnea and hypercarbia. Therefore, fiberoptic bronchoscopy was performed through the endotracheal tube, which revealed foreign bodies in the tube. Tracheostomy was performed to remove, albeit incompletely, the foreign bodies (endotracheal debris). As sudden movement of the patient or airway reaction could cause the foreign bodies to move deeper into the bronchus during manipulation of the rigid bronchoscope, general anesthesia was induced and maintained by using total intravenous anesthesia with extracorporeal membrane oxygenation (ECMO). The foreign bodies were successfully removed without any other complications. This case showed that sloughed endobronchial debris after an inhalation burn injury caused acute airway obstruction. In such cases, alternative ventilation methods such as tracheostomy and ECMO may have to be applied, which can support a surgeon to focus on the procedure regardless of prolonged procedural time.

Idosos queimados assistidos em centro de referência para queimados, no Distrito Federal, Brasil, no período de 2002 a 2012 / Burned elderly assisted at a referral center for burns, in the Federal District, Brazil, in the period 2002-2012 / Ancianos quemados asistidos en centro de referencia para quemados, en el Distrito Federal, Brasil, en el período de 2002 a 2012

Objetivou-se analisar tipo, extensão, gravidade, tratamento, prognóstico e letalidade de idosos queimados assistidos no centro de referência de queimados em Brasília, Distrito Federal, Brasil, no período de 2002 a 2012, mediante a realização de estudo retrospectivo, descritivo, e analítico, com dados coletados nos prontuários de pacientes, a partir de 60 anos. 93% das queimaduras foi por acidente; 7% por lesões auto-provocadas; 42% dos casos ocorreram na residência, por chama direta (36%), escaldadura (21%), letalidade de 21% por infecção da corrente sanguínea (29%). A prevenção, o rápido encaminhamento, e o treinamento de equipes se mostram essenciais no prognóstico de idosos queimados.

This study aimed to analyzed the type, extent, severity, treatment, prognosis and lethality of burned elderly people attended at the Burn Reference Center in Brasília, Federal District, Brazil, from 2002 to 2012, through a retrospective, descriptive study And analytical data collected from patients' charts from 60 years. In 93% of the burns it was by accident; 7% from self-inflicted injuries; 42% of the cases occurred in the home, due to direct flame (36%), scald (21%), lethality 21% from bloodstream infection (29%). Prevention, rapid referral, and team training are essential in the prognosis of the burned elderly.

Se analizó el tipo, extensión, gravedad, tratamiento, pronóstico y letalidad de ancianos quemados asistidos en el centro de referencia de quemados en Brasilia, del Distrito Federal, Brasil, en el período de 2002 a 2012, mediante la realización de estudio retrospectivo, descriptivo, descriptivo y analítico con datos recogidos de los prontuarios de pacientes a partir de 60 años. En el 93% de las quemaduras fue por accidente; 7% por lesiones auto-provocadas; El 42% de los casos ocurrieron en la residencia, por llama directa (36%), escaldadura (21%), letalidad del 21% por infección del torrente sanguíneo (29%). La prevención, el rápido encaminamiento y el entrenamiento de equipos se muestran esenciales en el pronóstico de los ancianos quemados.

Effects of Fluid Resuscitation on Testicular Damage in Severely Burned Rats.

Background: Severe burns cause a wide range of complications that challenge care in the short term and often leaves long term sequelae in survivors. Research evidence suggests that burns can affect testosterone secretion, and impair spermatogenesis and fertility. This study was designed to investigate the effects of fluid resuscitation on spermatogenesis and histology of the testes after major burns. Methodology: Third degree burns was induced on dorsal skin of 3 groups of male Wistar rats. Intra-venous resuscitation fluid was administered, ½ h and 3 h post-burn in the first 2 groups. A fourth group had sham burn only and served as negative control. After 8 weeks the animals were sacrificed evaluated for sperm parameters, testicular histology and assays of oxidative status. Main Findings: Fluid administration did not cause significant difference in sperm parameters or in levels of markers of oxidative stress among the animals with burn injury. Mean sperm density in groups 1 and 2 which had fluid treatment were 57.00±11.99 and 56.33±9.49 respectively compared to 49.00±6.24 in the untreated group 3 (p=0.921 and 0.947). However total counts were significantly lower in all burned groups than in the sham burn group. Fluid treatment produced a time-dependent relief from the histological disruptions associated with the burns. Tubules with germ cell loss were fewer in the fluid treated groups than in the untreated one. Conclusion: Fluid treatment in burn patients may not protect them from suppression of testicular function. Fertility damage in severe burns may involve mechanisms that do not depend on intravascular volumes and pressures.

Use of sugammadex on burn patients: descriptive study / Uso de sugamadex no paciente queimado: estudo descritivo / Utilización del sugammadex en el paciente quemado: estudio descriptivo

A burn patient is a challenge for any anesthesiologist, undergoing several surgeries during admission, and requiring general anesthesia and muscle relaxation most of the times. The victim may have respiratory system impairment and a response to muscle relaxants that differs from the healthy patient, thus proper monitoring and reversal is crucial. We analyzed sugammadex effectiveness and safety in this population.

O paciente queimado representa um desafio para o anestesiologista, pois se submete a várias intervenções cirúrgicas durante sua hospitalização e necessita de anestesia geral e relaxamento muscular na maior parte delas. Apresenta sistema respiratório comprometido e uma resposta aos relaxantes musculares que difere do paciente sadio; portanto, um monitoramento correto e reversão tornam-se imprescindíveis. Avaliamos a eficácia e segurança do sugamadex nessa população.

El paciente quemado supone un reto para el anestesista, pues se somete a varias intervenciones quirúrgicas durante su ingreso, requiriendo anestesia general y relajación muscular en la mayor parte de ellas. Presentan un sistema respiratorio comprometido y una respuesta a los relajantes musculares que difiere de la del paciente sano, por lo que se hace imprescindible una correcta monitorización y reversión. Valoramos la efectividad y seguridad del sugammadex en esta población.

Beneficial effects of Morus alba and Azadirachta indica leaf extract based combination cream in scalding type burn injury in rats.

Background: The present study was designed to evaluate the potential of a combination cream of aqueous extracts of leaves of Morus alba (MA) and Azadirachta indica (AI) in scalding type burn wound injury in rats. Methods: Plant material was successively extracted and aqueous extracts were selected. Three extract based cream formulations viz. 20% w/w (MA), 20% w/w (AI), and combination cream containing 10%+10% w/w (MA+AI) were prepared. Cream base and standard anti-burn cream containing silver sulfadiazine were also used for comparison. Scalding type burn was given by pouring water at 90°C on a shaved dorsal area of 20 mm2. Deep second-degree burn injury was produced which was evaluated for next 21 days for a percentage of wound contraction and period of epithelialization. On 21st day, animals were sacrificed and histopathological slides were prepared using hematoxylin-eosin staining. Burned tissue was also screened for levels of oxidative stress using thiobarbituric acid reactive substances (TBARS) and glutathione (GSH) estimation. Results: There was a significant increase in the percentage of wound contraction and significant decrease in period of epithelialization in MA, AI, and MA+AI combination cream treated group as compared with control group. However, most significant results were obtained with MA+AI combination cream. Histologically, MA+AI cream treatment resulted in almost complete re-epithelialization and restructuring of the wound tissue. There was a significant rise in TBARS and decrease in GSH levels in burn injury group which was reversed to a major extent by the application of combination cream. Conclusions: The results indicate toward the possible role of free radical scavenging potential of extracts in the Burn wound tissue healing.

Propofol inhibits burn injury-induced hyperpermeability through an apoptotic signal pathway in microvascular endothelial cells

Recent studies have revealed that an intrinsic apoptotic signaling cascade is involved in vascular hyperpermeability and endothelial barrier dysfunction. Propofol (2,6-diisopropylphenol) has also been reported to inhibit apoptotic signaling by regulating mitochondrial permeability transition pore (mPTP) opening and caspase-3 activation. Here, we investigated whether propofol could alleviate burn serum-induced endothelial hyperpermeability through the inhibition of the intrinsic apoptotic signaling cascade. Rat lung microvascular endothelial cells (RLMVECs) were pretreated with propofol at various concentrations, followed by stimulation with burn serum, obtained from burn-injury rats. Monolayer permeability was determined by transendothelial electrical resistance. Mitochondrial release of cytochrome C was measured by ELISA. Bax and Bcl-2 expression and mitochondrial release of second mitochondrial-derived activator of caspases (smac) were detected by Western blotting. Caspase-3 activity was assessed by fluorometric assay; mitochondrial membrane potential (Δψm) was determined with JC-1 (a potential-sensitive fluorescent dye). Intracellular ATP content was assayed using a commercial kit, and reactive oxygen species (ROS) were measured by dichlorodihydrofluorescein diacetate (DCFH-DA). Burn serum significantly increased monolayer permeability (P<0.05), and this effect could be inhibited by propofol (P<0.05). Compared with a sham treatment group, intrinsic apoptotic signaling activation - indicated by Bax overexpression, Bcl-2 downregulation, Δψm reduction, decreased intracellular ATP level, increased cytosolic cytochrome C and smac, and caspase-3 activation - was observed in the vehicle group. Propofol not only attenuated these alterations (P<0.05 for all), but also significantly decreased burn-induced ROS production (P<0.05). Propofol attenuated burn-induced RLMVEC monolayer hyperpermeability by regulating the intrinsic apoptotic signaling pathway.

Fatores de risco e métodos de prevenção de queimaduras em idosos / Risk factors of burn injury and prevention methods in the elderly

INTRODUÇÃO: Com o envelhecimento populacional, os idosos estão sujeitos a aumento dos traumas por queimadura. Estudos que realizam mensuração de dados epidemiológicos e fatores de risco de queimadura em idosos são um recurso importante para avaliar resultados de tratamento e desenvolvimento de estratégias que visem à prevenção. OBJETIVO: Descrever os fatores de risco e os métodos de prevenção de queimadura em idosos, correlacionando-os aos dados epidemiológicos de incidência e mortalidade em estudos publicados na literatura mundial. MÉTODO: Na revisão da literatura realizada, foram consultados 21 artigos de 4 continentes nas bases de dados: Lilacs, Medline, PubMed, Cochrane e ScienceDirect, de janeiro de 2000 a dezembro de 2012. RESULTADOS: Foram selecionados 21 artigos de 4 continentes. O período variou de 2 anos a 28 anos. O total de pacientes idosos variou de 45 a 308. A idade média foi de 64,5 a 85 anos. O gênero foi descrito em 18 trabalhos, sendo 1132 homens e 1076 mulheres. O local predominante do acidente foi a residência (68 a 98%), com a cozinha sendo a localidade prevalente (17 a 65%), seguindo o banheiro em 9 a 31%. Os agentes principais foram o fogo direto ou líquidos inflamáveis (29 a 73%) e a escaldadura (17 a 66%). Lesão por inalação foi encontrada em 12 a 41% dos idosos e a mortalidade variou de 6 a 65%. CONCLUSÃO: Conclui-se que a residência é o local de maior importância e prevalência da queimadura em idosos e devem ser intensificadas as medidas de prevenção deste acidente neste ambiente.

INTRODUCTION: As the population ages, the elderly become more susceptible to burn injuries. Studies that assess the epidemiological data and risk factors of burn injuries in the elderly are valuable tools to evaluate the strategies developed with the aim of preventing these injuries. OBJECTIVE: We aimed to describe the risk factors of burn injury and prevention methods in the elderly. In addition, we aimed to determine the correlation between the risk factors and the epidemiological data on the incidence and mortality from studies published in the literature worldwide. METHODS: In the literature review, we consulted 21 articles published between January 2000 and December 2012 in 4 continents from the following databases: Lilacs, Medline, PubMed, Cochrane, and ScienceDirect. RESULTS: We selected 21 articles from 4 continents. The research period ranged from 2 to 28 years. The number of elderly patients ranged from 45 to 308. Their mean age ranged from 64.5 to 85 years. The predominant accident site was the place of residence (68% to 98%), with the kitchen being the most prevalent location (17% to 65%), followed by the bathroom (9% to 31%). The main causes were direct fire or flammable liquids (29% to 73%) and scalding (17% to 66%). Injury by inhalation was found in 12% to 41% of the elderly, with mortality ranging from 6% to 65%. CONCLUSION: We conclude that the place of residence is the most important and prevalent location of burn injuries in the elderly. Therefore, preventive measures against burn injuries in this type of environment should be intensified.