A case of corrosive digestive tract and lung injury caused by ingestion of pipeline dredging agent / 中华劳动卫生职业病杂志

Ingestion of corrosive substances can severely burn the upper digestive tract leading to bleeding or perforation, and may even be life-threatening. Less commonly, damage to the trachea and bronchi is involved. In this paper, a case of corrosive digestive tract injury and lung injury after oral administration of pipeline dredging agent (the main components are hydroxide, sodium carbonate, sodium hypochlorite, etc.) was analyzed. After active rescue treatment, the patient died of massive hemoptysis. It is suggested that serious complications may occur after ingestion of corrosive substances. Timely diagnosis and reasonable medical management are needed to improve the level of recognition and treatment of such diseases.

Resiliência: avaliação de pacientes queimados em um hospital de urgência e emergência / Resilience: evaluation of burned patients in an urgency and emergency hospital / Resiliencia: evaluación de pacientes quemados en un hospital de urgencias y emergencias

A recuperação de vítimas de queimaduras é longa e dolorosa e afeta diversas esferas da vida do paciente. A resiliência, que se refere à capacidade humana de enfrentar e se adaptar a eventos adversos, exerce grande importância no processo de recuperação da queimadura. Logo, este trabalho objetiva avaliar a capacidade de resiliência de pacientes queimados, no momento da admissão e da alta hospitalar, em um hospital de emergência e urgência de Goiânia. Trata-se de um estudo descritivo, quantitativo e transversal que utiliza a Escala de Resiliência de Connor-Davidson (CD-RISC) como instrumento de mensuração. Na admissão hospitalar, a média da resiliência foi de 71,35, tendo sido observada uma relação significativa entre o fator Amparo da escala CD-RISC e a presença do(a) companheiro(a). O escore de resiliência encontrado nesta pesquisa é consistente com outros achados da literatura científica internacional e nacional referente à expressão da resiliência em vítimas de queimaduras e outros adoecimentos. A relação entre o fator Amparo e a presença de um(a) companheiro(a) enfatiza a importância da rede de apoio familiar na reabilitação do paciente queimado.(AU)

The recovery of burned patients is long and painful and impacts on different areas of people's lives. Resilience, which refers to the human capacity to face and adapt to adverse events, plays a major role in the process of recovery from burns. Therefore, the present study aims to assess the resilience of burned patients, on admission and hospital discharge, in an emergency and urgency hospital in Goiânia. This is a descriptive, quantitative and cross-sectional study that uses the Connor-Davidson Resilience Scale (CD RISC) as a measuring instrument. At hospital admission, the mean resilience was 71.35, with a significant association between the Support factor on the CD RISC scale and the presence of a partner. The resilience score found in the present study is consistent with other findings in the international and national scientific literature regarding the expression of resilience in victims of burns and other illnesses. The relationship between the Support factor and the presence of a partner emphasizes the importance of the family support network in the rehabilitation of the burned patient.(AU)

La recuperación de los pacientes quemados es larga y dolorosa e impacta en diferentes esferas de la vida de las personas. La resiliencia, que se refiere a la capacidad humana para enfrentar y adaptarse a eventos adversos, juega un papel importante en el proceso de recuperación de las quemaduras. Por tanto, el presente estudio tiene como objetivo evaluar la resiliencia de los pacientes quemados, en el momento del ingreso y el alta, en un hospital de emergencia y urgencia en Goiânia. Se trata de un estudio descriptivo, cuantitativo y transversal que utiliza la Escala de Resiliencia Connor-Davidson (CD RISC) como instrumento de medida. Al ingreso hospitalario, la resiliencia media fue de 71,35, con associación significativa entre el factor Amparo de la escala CD RISC y la presencia de pareja. El puntaje de resiliencia encontrado en el presente estudio es consistente con otros hallazgos en la literatura científica nacional e internacional sobre la expresión de resiliencia en víctimas de quemaduras y otras enfermedades. La relación entre el factor Amparo y la presencia de pareja enfatiza la importancia de la red de apoyo familiar en la rehabilitación del paciente quemado.(AU)

Risk of induction of corneal neovascularization with topical erythropoietin: an animal safety study

Purpose: To evaluate the pro-angiogenic effect of topical erythropoietin on cornea in chemical burn-injured rabbit eyes. Methods: The corneal alkali-burn injury was induced in 10 eyes of 10 rabbits using filter paper saturated with 1.0 mol sodium hydroxide. The eyes were categorized into the treatment group (n = 5) that received topical erythropoietin (3000 IU/mL) every 8 hr for one month versus the control group (n = 5) that received normal saline every 8 hr for one month. All eyes were treated with topical ciprofloxacin every 8 hr until corneal re-epithelialization was complete. Corneal epithelial defects, stromal opacity, and neovascularization were evaluated after the injury. At the conclusion of the study, the rabbits were euthanized and their corneas were submitted to histopathological examination. Results: Baseline characteristics including the rabbits' weight and the severity of corneal injury were comparable in two groups. Time to complete corneal re-epithelialization was 37 days in the treatment group and 45 days in the control group (P = 0.83). There was no significant difference between the groups in the rate of epithelial healing or corneal opacification. Clinical and microscopic corneal neovascularization was observed in one eye (20%) in the treatment group and two eyes (40%) in the control group (P = 0.49). Conclusion: Recombinant human erythropoietin administered topically did not induce vessel formation in rabbit corneas after chemical burn.

Treatment of experimentally induced partial-thickness burns in rats with different silver-impregnated dressings

Purpose: To evaluate the morphometric, macroscopic and microscopic aspects of experimentally induced partial-thickness burns in rats treated with different silver-based dressings. Methods: Wistar rats were used, divided into six treatments: saline (NaCl 0.9%); silver sulfadiazine 1%; Silvercel; Mepilex Ag; Aquacel Ag and Acticoat. The animals were monitored daily and euthanized at 7, 14 and 30 days after injury induction (DAI). Results: At 7 DAI, necrosis/crust was greater in control, silver sulfadiazine and Mepilex Ag treatments, granulation tissue was induced by Aquacel Ag, polymorphonuclear infiltrate (PMN) infiltration was intensified by Mepilex Ag; mononuclear infiltrate (MN) infiltration and angiogenesis were increased by Silvercel. At 14 DAI, hemorrhage was decreased by Silvercel and Mepilex Ag, PMN infiltration increased by Acticoat. At 30 DAI, angiogenesis was greater in the Acticoat treatment and fibroblasts were increased by Acticoat and Mepilex Ag. Collagen was induced at 14 DAI by silver sulfadiazine and Aquacel Ag and, at 30 DAI, by silver sulfadiazine and Silvercel treatments. Conclusions: Silvercel and Acticoat presented better results than the other products. However, all the dressings were better than the control at some point during the process, and may contribute to the healing of partial thickness burns. Silvercel and Aquacel Ag treatments induced better cosmetic outcomes regarding wound closure and scarring.

Reconstrucción de cuero cabelludo, por quemadura química extensa, en tiempos de COVID / Scalp reconstruction, from extensive chemical burn, in time of COVID

Las quemaduras químicas en cuero cabelludo, que se producen en lugares públicos como salones de belleza o peluquerías causadas por mezclas de sustancias activas como persulfatos y peróxido de hidrógeno, secundarias a la decoloración de cabellos, producen graves secuelas de alopecias en pacientes jóvenes. Se trata de un caso clínico, de quemadura química, espesor completo, extensa, en cuero cabelludo. Productos utilizados en forma cotidiana en salones de belleza, peluquerías o domicilios, que tiene estrecha relación con el daño. Resolución del caso con colgajos locales, con tiempos de internación y quirúrgicos cortos, en tiempos de COVID. Enfoque de la falta de control de sustancias usadas en peluquerías, pocos casos publicados y secuelas psicosociales importantes, con pronta mejoría de calidad de vida y reinserción social

Chemical burns in scalp after hair bleaching are produced in public places such as hairdressing salons and are caused by the combination of active agents like persulfate and hydrogen peroxide. The burns leave severe sequels of alopecia in young patients. This is about a clinical case of a chemical burn in the sculp which is full thickness and has a great large. Products used on a daily basis in hairdressing salons or in the domiciles have a close connection with the hurt. In times of COVID the case was resolved with local flaps, and short period of hospitalization and surgical. Focus on the lack of control in the usage of substances made by hairdressing salons, the existence of few published cases and the main psychosocial sequels, a speedy recovery in the quality of life and social reintegration

Quemadura con cloroformiato de etilo en ocasión de la respuesta a una emergencia química. A propósito de un caso / Burning by Ethyl chloroformate in response to a chemical emergency. A case report

Resumen Se describe un caso de quemadura causada por cloroformiato de etilo en ocasión de la respuesta a un incidente que requirió el trasvase del producto desde contenedores defectuosos a otros seguros. La investigación del evento puso en evidenciala necesidad de mantener un protocolo de registro de materiales que ingresan a la zona caliente, que debe ser tenido en cuentaal momento del retiro de los mismos, procediendo a su correcta descontaminación bajo la fiscalización del oficial de seguridad.

Abstract A burn by Ethyl chloroformate in occasion of response to a chemical emergency which required to transfer products from defective containers to safe containers is described. The investigation of the event highlighted the need to maintain aprotocol for the registration of materials to be entered in the hot zone, which must be considered al the moment of remove andproceeding to the proper decontamination under the supervision of the security officer.

Cordycepin prevents the esophageal stricture formation in the alkali-burn rat model by exerting anti-inflammatory and antifibrotic effects

ABSTRACT Purpose To investigate the efficacy of cordycepin, an adenosine analogue, on prevention of esophageal damage and stricture formation due to esophageal caustic burns in rat model comparing with prednisolone. Methods Caustic esophageal burn was introduced by 37.5% of NaOH to distal esophagus. Thirty-two Wistar albino rats were divided in four groups: sham rats undergone laparotomy, treated with 0.9% NaCl; control rats injured with NaOH without cordycepin treatment; cordycepin group injured with NaOH, treated with 20 mg/kg cordycepin; prednisolone group injured with NaOH, treated with 1 mg/kg prednisolone for 28 days. Efficacy was assessed by histopathological and immunohistochemical analysis of esophageal tissues. Results Cordycepin treatment significantly decreased inflammation, granulation tissue and fibrous tissue formation and prevented formation of esophageal strictures shown by histopathological damage score and stenosis indexes compared to control group (p < 0.01). These effects are relatively more substantial than prednisolone, probably based on attenuation of elevation of proinflammatory cytokines hypoxia-inducible factor 1-alpha (HIF-1?), tumor necrosis factor alpha (TNF-?), proliferative and fibrotic factor fibroblast growth factor 2 (FGF2) and angiogenic factor vascular endothelial growth factor A (VEGFA) (p < 0.05). Conclusions The findings suggest that cordycepin has a complex multifactorial healing process in alkali-burned tissue, more successful than prednisolone in preventing the formation of esophageal strictures and may be used as a therapeutic agent in the acute phase of esophageal alkali-burn.

Vivenciando o deserto: Relato de caso de um paciente queimado com sede / Experiencing the desert: Case report of a burnt thirsty patient

OBJETIVO: Apresentar o relato de uma paciente queimada em relação à sede no período pré-operatório imediato e o alívio após a ação do picolé de gelo. RELATO DE CASO: Obtido por meio de entrevista semiestruturada com a paciente M.S.S., 33 anos, sexo feminino, encaminhada para o Centro de Tratamento de Queimados, com queimadura por combustível em região de membros superiores e tórax, totalizando 24% da área corporal. Até o momento da entrevista, havia sido submetida a oito procedimentos anestésicos, para a realização de cirurgias e balneoterapias. Durante o período de jejum pré-operatório imediato, relatou sede, classificando-a como superior à fome e até mesmo à dor Relatou a aflição de sentir sede e o alívio vivenciado ao receber o manejo da sede. CONSIDERAÇÕES FINAIS: A sede foi relatada pela paciente como um desconforto de alta relevância e gerador de angústia, durante o período de jejum pré-operatório imediato. Em sua experiência tratou-se de um sintoma que superou a dor e a fome. Quando aplicado o manejo da sede e ofertado o picolé de gelo, foi possível prover maior conforto e minorar a sede vivenciada.

OBJECTIVE: To present the report of a burned patient in relation to thirst in the immediate preoperative period and the relief after the action of the ice popsicle. CASE REPORT: It was obtained through a semi-structured interview with the patient M.S.S., 33 years old, female, at the Burnt Treatment Center, due to fuel burn in the upper limbs and chest area, totaling 24% of the body area. Up to the moment of the interview, she had been submitted to eight anesthetic procedures, between surgeries and balneotherapies. During the immediate preoperative fasting period, she reported thirst, classifying it as superior to hunger and even pain. She reported the distress of feeling thirst, and the relief experienced when receiving the management of thirst. FINAL CONSIDERATIONS: Thirst was reported by the patient as a highly relevant discomfort and anguish generator, during the pre-anesthetic fasting period. In her experience, it was a symptom that overcame pain and hunger. When thirst management was applied and ice popsicles were offered, it was possible to provide greater comfort and alleviate the thirst experienced.

Severe corneal burn due to the accidental application of salicylic acid packed in a plastic dropper bottle / Quemadura corneal grave debida a la aplicación accidental de ácido salicílico envasado en un frasco gotero plástico

Eye burns due to the accidental application of pharmacological or nonpharmacological substances packaged in plastic dropper bottles have been described for more than three decades and continue to occur. These burns can cause potentially serious corneal injuries. We report the case of a patient who mistakenly applied salicylic acid to the right eye after confusing it with an eye lubricant, which caused him a severe corneal burn. Fortunately, after aggressive medical and surgical management (including oxygen therapy and amniotic membrane grafting), the visual results were good. We suggest conducting educational campaigns and taking legislative measures in our country to avoid packaging corrosive substances in this type of dropper bottle to reduce the risk of accidental burns.

Las quemaduras oculares por aplicación accidental de sustancias farmacológicas o no farmacológicas envasadas en frascos goteros plásticos, se han descrito desde hace más de tres décadas y siguen ocurriendo. Estas quemaduras pueden causar lesiones potencialmente graves de la córnea. Se presenta el caso de un paciente que se aplicó ácido salicílico en el ojo derecho al confundir el envase con el de un lubricante ocular, lo que le causó una grave quemadura corneal. Afortunadamente, tras un manejo médico y quirúrgico agresivo (incluida oxigenoterapia e injerto de membrana amniótica) los resultados visuales fueron buenos. Se sugiere hacer campañas educativas y adoptar normas en el país para evitar el envase de sustancias corrosivas en este tipo de frascos goteros, con el fin de disminuir el riesgo de quemaduras accidentales.

Papel do fonoaudiólogo na disfagia por ingestão cáustica em crianças: revisão sistemática / Papel del terapeuta del habla y lenguaje en niños con disfagia por ingestión cáustica: una revisión sistemática / Role of speech language therapist in children in dysphagia due to caustic ingestion: a systematic review

Objetivo: Verificar o papel do fonoaudiólogo no gerenciamento da disfagia por ingestão cáustica em crianças. Estratégia de pesquisa: Bases: PubMed, SciELO e Bireme, pelo Medical Subject Heading Terms (MeSH); termos: [("Dysphagia") AND ("Children") AND ("Caustic")]. Critérios de seleção: Restrição quanto ao período de publicação de 5 anos e incluídos artigos com atuação fonoaudiológica, informações sobre via de alimentação, pediatria e queimadura por cáusticos. Resultados: Cinco artigos incluídos com crianças de 11 meses a 12 anos. A estenose esofágica tardia ocorreu na maioria dos estudos e todos relataram disfagia. Todos realizaram avaliação da deglutição antes e após tratamento médico para determinar a gravidade e a necessidade de via alternativa de alimentação. Conclusão: A atuação fonoaudiológica nestes casos compreende avaliar e auxiliar o manejo da alimentação e, na impossibilidade de via oral, na indicação de via alternativa em conjunto com a equipe.

Objective: To assess the role of the speech-language therapist in the management of dysphagia due to caustic ingestion in children. Research strategy: Databases: PubMed, SciELO, and BIREME, by Medical Subject Heading Terms (MeSH); terms: [("Dysphagia") and ("Children") and ("Caustic")]. Selection criteria: A 5 year restriction period of publication and articles with speech therapy, information on feeding, pediatrics and burn by caustics were included. Results: Five articles were included with children with 11 months to 12 years. The late esophageal stenosis was present in the majority of studies and all reported dysphagia. All carried out the evaluation of swallowing before and after medical treatment to determine the severity and the necessity of the use of an alternative food supply. Conclusion: Speech therapy in the management in these cases comprise of evaluating and assisting the management of oral intake, and when this is not possible orally, to indicate an alternative food supply in conjunction with the team.

Objetivo: evaluar el papel del logopeda en el tratamiento de la disfagia por ingestión cáustica en niños. Estrategia de investigación: Bases de datos: PubMed, SciELO y BIREME, por Medical Subject Heading Terms (MeSH); términos: [("Disfagia") y ("Niños") y ("Cáustico")]. Criterios de selección: Se incluyó un período de restricción de publicación de 5 años y artículos con terapia del habla, información sobre alimentación, pediatría y quemaduras por cáusticos. Resultados: se incluyeron cinco artículos con niños de 11 meses a 12 años. La estenosis esofágica tardía estuvo presente en la mayoría de los estudios y todos informaron disfagia. Todos llevaron a cabo la evaluación de la deglución antes y después del tratamiento médico para determinar la gravedad y la necesidad del uso de un suministro de alimentos alternativo. Conclusión: La terapia del habla en el manejo en estos casos consiste en evaluar y ayudar al manejo del suministro de alimentos, y cuando esto no es posible por vía oral, para indicar un suministro de alimentos alternativo en conjunto con el equipo.

Guía de práctica clínica Ibero-Latinoamericana sobre la esofagitis cáustica en Pediatría: aspectos terapéuticos (2a. Parte) / Ibero-Latinamerican Clinical Practical Guidelines on pediatric caustic esophagitis: therapeutical aspects (Part 2)

Resumen: La ingestión de cáusticos representa un grave problema médico-social por las consecuencias devastadoras e irreversibles que puede producir en el tracto digestivo superior. En Iberoamérica no se han publicado datos fidedignos sobre la incidencia o la prevalencia de lesiones inducidas por cáusticos. La información disponible sobre la presentación clínica, diagnóstico, tratamiento y pronóstico se basa en series retrospectivas de casos y, de hecho, su manejo clínico se sustenta en muchos casos fundamentalmente en la opinión de expertos. Recientemente como una iniciativa de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica (SLAGHNP) y con la co laboración de colegas de la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediá trica (SEGHNP), hemos diseñado una Guía de Práctica Clínica (GPC) la cual incluye una serie de enunciados y recomendaciones dirigidos a optimizar la atención a los pacientes y que se basan en la revisión sistemática de la evidencia. En dos (2) manuscritos sucesivos nos hemos enfocado primero, en los aspectos fisiopatológicos y de diagnóstico clínico-endoscópico de la esofagitis cáustica en niños (1a. Parte) y en segundo lugar, en los aspectos más relevantes del tratamiento (2a. Parte). Esperamos esta guía se convierta en una herramienta útil para el clínico en el difícil proceso de toma de decisio nes a la hora de evaluar un paciente posterior a la ingesta de una sustancia cáustica.

Abstract: Caustic ingestion represents a serious social-medical problem due to the devastating and irreversible consequences it can produce in the upper digestive tract. In Ibero-America, there are no published reliable data on the incidence or prevalence of caustic-induced injuries, and most of the available information on clinical presentation, diagnosis, treatment, and prognosis is based on retrospective clinical series and, indeed, its clinical management is often based primarily on expert opinion. Re cently as an initiative of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) and with the cooperation of the Spanish Society for Pediatric Gastroente rology, Hepatology and Nutrition (SEGHNP), we have designed a Clinical Practice Guideline that include a series of statements and recommendations aimed at optimizing patient medical care which is based on the systematic review of evidence. Two (2) separate papers focused on the evaluation of physiopathological and clinical-endoscopic diagnostic features of caustic esophagitis in children (1st. Paper) and, on the other hand, the most relevant therapeutic considerations (2nd. Paper). We expect this guideline to become a useful tool for the physician in the difficult decision-making process when assessing patients after caustic ingestion.

Guía de práctica clínica Ibero-Latinoamericana sobre la esofagitis cáustica en Pediatría: fisiopatología y diagnóstico clínico-endoscópico (1a Parte) / Ibero-latinamerican clinical practical guidelines on pediatric caustic esophagitis: physiopathology and clinical-endoscopic diagnosis (1st Part)

Resumen: La ingestión de cáusticos representa un grave problema médico-social por las consecuencias devastadoras e irreversibles que puede producir en el tracto digestivo superior. En Iberoamérica no se han publicado datos fidedignos sobre la incidencia o la prevalencia de lesiones inducidas por cáusticos. La información disponible sobre la presentación clínica, diagnóstico, tratamiento y pronóstico se basa en series retrospectivas de casos y, de hecho, su manejo clínico se sustenta en muchos casos fundamentalmente en la opinión de expertos. Recientemente como una iniciativa de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica (SLAGHNP) y con la co laboración de colegas de la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediá trica (SEGHNP), hemos diseñado una Guía de Práctica Clínica (GPC) la cual incluye una serie de enunciados y recomendaciones dirigidos a optimizar la atención a los pacientes y que se basan en la revisión sistemática de la evidencia. En dos (2) manuscritos sucesivos nos hemos enfocado primero, en los aspectos fisiopatológicos y de diagnóstico clínico-endoscópico de la esofagitis cáustica en niños (1a. Parte) y en segundo lugar, en los aspectos más relevantes del tratamiento (2a. Parte). Esperamos esta guía se convierta en una herramienta útil para el clínico en el difícil proceso de toma de decisio nes a la hora de evaluar un paciente posterior a la ingesta de una sustancia cáustica.

Abstract: Caustic ingestion represents a serious social-medical problem due to the devastating and irreversible consequences it can produce in the upper digestive tract. In Ibero-America, there are no published reliable data on the incidence or prevalence of caustic-induced injuries, and most of the available information on clinical presentation, diagnosis, treatment, and prognosis is based on retrospective clinical series and, indeed, its clinical management is often based primarily on expert opinion. Re cently as an initiative of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) and with the cooperation of the Spanish Society for Pediatric Gastroente rology, Hepatology and Nutrition (SEGHNP), we have designed a Clinical Practice Guideline that include a series of statements and recommendations aimed at optimizing patient medical care which is based on the systematic review of evidence. Two (2) successive papers focused on the evaluation of physiopathological and clinical-endoscopic diagnostic features of caustic esophagitis in children (1st. Paper) and, on the other hand, the most relevant therapeutic considerations (2nd. Paper). We expect this guideline to become a useful tool for the physician in the difficult decision-making process when assessing patients after caustic ingestion.

Stent biodegradable como tratamiento de la estenosis esofágica benigna refractaria / Biodegradable stent as treatment of refractory benign esophageal stricture (RBES)

Paciente mujer de 26 años de edad, natural y procedente de La Paz-Bolivia. Acudió con un tiempo de enfermedad de 15 meses caracterizado por disfagia progresiva. Un mes antes del comienzo de la sintomatología ingirió lejía con intenciones autolíticas. En el estudio de endoscopia digestiva alta diagnóstica se evidenció a los 25 centímetros de la arcada dentaria una estenosis, de unos 3 mm de diámetro, central y con el epitelio esofágico adyacente de aspecto conservado. En la radiografía de esófago contrastada se evidenció a nivel de tercio medio de esófago una estenosis tubular corta, de bordes lisos, de aproximadamente 2 cm de longitud. Se inició tratamiento mediante dilataciones mecánicas axiales con bujías Savary Guilliard con un intervalo entre sesiones de 2 a 3 semanas y con 8 sesiones en total. En la última sesión la bujía de mayor calibre usada fue 12,8 mm. Es entonces que tomando en consideración los criterios diagnósticos de Kochman, se hizo el diagnóstico de estenosis esofágica cáustica refractaria. Durante el periodo de realización de las dilataciones con bujías la paciente quedo embarazada, lo que dificultaba la realización de los procedimientos por el rutinario uso de control fluoroscópico. Con 14 semanas de gestación se implantó un Stent esofágico biodegradable no cubierto SX-ELLA de 10 cm de longitud. Presentamos el caso por ser un manejo alternativo y novedoso para este tipo de patología.

A 26-year-old female patient, from La Paz-Bolivia. She came with a disease period of 15 months characterized by progressive dysphagia. One month before the onset of the symptomatology she ingested bleach with autolytic intentions. In the study of diagnostic upper gastrointestinal endoscopy at 25 centimeters of the dental arch was evidenced a stenosis of about 3 mm in diameter, central and with adjacent esophageal epithelium of a preserved appearance. In the x-ray of contrasted esophagus at the level of the middle third of the esophagus was evidenced a stenosis, short tubular, with a smooth border, of approximately 2 cm in length. Treatment was initiated using axial mechanical dilatations with Savary Guilliard bougies with an interval between sessions of 2 to 3 weeks and with 8 sessions in total. In the last session the largest bougie used was 12.8 mm. It is then that taking into account the diagnostic criteria of Kochman, the diagnosis of refractory caustic esophageal stenosis was made. During the period of realization of the dilations with bougies the patient became pregnant, which made difficult the accomplishment of the procedures for the routine use of fluoroscopic control. At 14 weeks of pregnancy, a SX-ELLA uncovered biodegradable esophageal stent of 10 cm length was implanted. We present the case as an alternative and novel management for this type of pathology.

Impacto de micronutrientes en polvo sobre la anemia en niños de 10 a 35 meses de edad en Apurímac, Perú / Impact of micronutrient powder on anemia in children aged 10-35 months in Apurimac, Peru

RESUMEN Objetivos. Evaluar el impacto de la suplementación con micronutrientes en polvo (MNP) en la reducción de anemia en niños de 10 a 35 meses de edad de Apurímac, Perú. Materiales y métodos. Se realizó un análisis secundario de la base de datos de la Evaluación de suplementación con MNP en la región de Apurímac, realizada por el Centro Nacional de Alimentación y Nutrición (CENAN) entre 2009 y 2010. Se definió como grupo de intervención a los niños que consumieron 60 o más sobres de MNP, para generar los controles (niños sin consumo de MNP) aplicamos un propensity score matching (PSM), y en la estimación del impacto de los MNP comparamos la prevalencia de anemia en cada grupo de estudio, ponderada por la probabilidad de participación, aplicando tres algoritmos de emparejamiento: vecino más cercano, kernel y regresión lineal local. Todos los cálculos se realizaron en el programa estadístico Stata 14 SE. Resultados. La prevalencia de anemia fue significativamente menor hasta en 11 puntos porcentuales en el grupo de intervención comparado con los controles (p=0,001) y que el promedio de hemoglobina aumentó en 0,3 g/dL en el mismo grupo (p<0,001). Conclusiones. La suplementación con MNP mostró impacto para reducir la anemia e incrementar el nivel de hemoglobina en niños que consumieron 60 o más sobres de MNP en un periodo de seis meses. Se deben continuar los esfuerzos por reducir la anemia empleando los MNP para prevenir esta deficiencia nutricional.

ABSTRACT Objective. Objective. To assess the impact of micronutrient powder supplementation (MNP) in reducing anemia in children aged 10 to 35 months in Apurimac, Peru. Materials and Methods. A secondary analysis of the database of the Evaluation of supplementation with MNP in the Apurímac region, conducted by the National Food and Nutrition Center (CENAN, in Spanish) between 2009 and 2010, was conducted. The intervention group was defined as children who consumed 60 or more packets of MNP; to generate the controls (children who did not consume MNP), we applied a propensity score matching (PSM); and, to estimate the impact of the MNP, we compared the prevalence of anemia in each study group, weighted by the probability of participation, applying three matching algorithms: nearest neighbor, kernel and local linear regression. All calculations were performed in the Stata 14 SE statistical program. Results. The prevalence of anemia was significantly lower by up to 11 percentage points in the intervention group compared to controls (p=0.001), and mean hemoglobin increased by 0.3 g/dL in the same group (p<0.001). Conclusions. MNP supplementation showed impact in reducing anemia and increasing hemoglobin level in children who consumed 60 or more packets of MNP over a six-month period. Efforts to reduce anemia by using MNP to prevent this nutritional deficiency should continue.

Complications After endoscopic balloon dilatation of esophageal strictures in children. Experience from a tertiary center in Shiraz - Iran (Nemazee Teaching Hospital) / Complicaciones posteriores a dilatación endoscópica con balón en niños con estenosis esofágica. Experiencia de un centro de referencia en Shiraz - Iran (Nemazee Teaching Hospital)

Background: Esophageal stricture is one of the most important complication of the caustic ingestion. Objective: The aim of this study was to evaluate complications of balloon dilatation among children with esophageal stenosis. Material and methods: In this retrospective study 82 children were included. Children who underwent balloon dilatation for esophageal stenosis were included in our study. Duration of study was 14 year starting from 2001. Mean age of the cases was 3.95±0.4 year (Min: 15 days, Max: 14 year). Chart review and telephone calling were the methods of data collection. Data was analyzed using SPSS. Results: In this study, 47% of the patients were male and 53% of the cases were female. Caustic ingestion (33.7%) was the most common etiology for the esophageal stricture. Vomiting (87.8%) was the most common presenting symptom. Among our cases, 76.8% had no compliant after esophageal dilatation. Chest pain was the most common compliant after esophageal dilatation. Response rate was similar among boys and girls. Toddler age had the best treatment response after esophageal dilatation. Conclusion: Among our cases, 76.8% had no post procedural compliant after esophageal dilatation. Esophageal perforation was seen in 4.9% of the cases. Chest pain was the most common post dilatation complication.

Antecedentes: La estenosis esofágica es una de las más importantes complicaciones de la ingesta de caústicos. Objetivo: El objetivo del estudio fue evaluar las complicaciones de la dilatación endoscópica con balón en niños con estenosis esofágica. Material y métodos: En este estudio retrospectivo se incluyeron 82 niños. Se incluyeron todos los niños que se sometieron a una dilatación endoscópica con balón por estenosis esofágica. La duración del estudio fue 14 años iniciando en el año 2001. La edad media de los pacientes fue 3,95 +/- 0,4 años (Min. 15 días, Máx. 14 años). La recolección de datos se realizó revisando las historias clínicas y con llamadas telefónicas. Los datos se analizaron con el Sistema SPSS. Resultados: En este estudio, 47% de los casos fueron varones y 53% fueron mujeres. La ingesta de caústicos fue la causa más frecuente de estenosis esofágica (33,7%). El síntoma más común fueron los vómitos (87,8%). Entre nuestros casos, 76,8% no presentaron molestias luego de la dilatación esofágica. El dolor torácico fue la molestia más común luego de la dilatación esofágica. La tasa de respuesta al tratamiento fue similar entre hombres y mujeres. Los niños pequeños tuvieron la mejor respuesta al tratamiento luego de la dilatación esofágica. Conclusiones: Entre nuestros casos, 76,8% no presentaron molestias luego de la dilatación esofágica. La perforación esofágica se presentó en 4,9% de los casos. El dolor torácico fue la complicación más común posterior a la dilatación.

The diathermy scratch pad: A cheap and efficient tool for chemical and explosion-related burns

The burn center in our hospital is a national and regional (Southeast Asia) center. Of all admissions, 10% are related to blast explosions, and 8% due to chemical burns. In the acute burn management protocol of Singapore General Hospital, early surgical debridement is advocated for all acute partial-thickness burns. The aim of early surgical debridement is to remove all debris and unhealthy tissue, preventing wound infection and thereby expediting wound healing. In chemical burns, there can be stubborn eschars that are resistant to traditional debridement. We would like to present a novel technique using the diathermy scratch pad as a cheap and efficient tool for the dual purpose of surgical debridement and dermabrasion.

Dichloromethane-Induced Chemical Burn of the Hand: A Report of Two Cases

Closure of a full-thickness scalp burn that occurred during hair coloring using a simple skin-stretching method: A case report and review of the literature

Full-thickness scalp burns secondary to hair coloring are rare; however, such defects can be large and complex reconstruction of hair-bearing tissue may be necessary. Many skin-stretching devices that use gradual traction have been applied to take advantage of the viscoelastic properties of the skin. A 21-year-old female patient was seen with a burn defect on her occipital scalp leading to exposed subcutaneous tissue after chemical application of hair coloring in a salon. The dimensions of the wound were 10 cm×5 cm, and a skin graft or flap would have been necessary to close the defect. Two long transfixing K-wires (1.4 mm) and paired 3-wire threads (23 gauge), which are readily available in most hospitals, were applied over a period of 12 days for trichophytic closure of the defect. The remaining scalp scars after primary trichophytic closure with this skin-stretching method were refined with hair follicle transplantation. This skin-stretching method is simple to apply and valuable for helping to close problematic areas of skin shortage that would otherwise require more complicated procedures. This case shows a relatively unknown complication of hair coloring and its treatment.

Hallazgos endoscópicos en el tubo digestivo secundarios a la ingesta de cáusticos en niños atendidos en el Departamento de Urgencias / Endoscopic findings of the digestive tract secondary to caustic ingestion in children seen at the Emergency Department

Antecedentes. La ingesta de sustancias cáusticas en pediatría constituye una causa frecuente de atención médica en Urgencias. El uso indiscriminado de limpiadores químicos y la facilidad de adquisición son factores determinantes para estas lesiones. Población y métodos. Estudio descriptivo analítico. Se incluyeron niños < 16 años, entre enero de 1998 y diciembre de 2017. Se identificó el agente químico cáustico ingerido por el niño como ácido o alcalino. Se realizó una endoscopía digestiva para tipificar el grado de quemadura. Se comparó el grado de quemadura con el tipo de cáustico; por medio de la prueba de chi² o exacta de Fisher, se consideró significativo el valor de P < 0,05. Resultados. Ingresaron 133 niños en Urgencias por ingesta de cáusticos. El agente cáustico fue ácido en el 41 % y alcalino en el 59 %. El agente ácido más frecuente fue el ácido muriático (36,8 %), mientras que el alcalino fue la sosa (soda) cáustica (41,4 %). La quemadura del esófago fue más frecuente en la ingesta de sosa en comparación con otros cáusticos (p= 0,001), mientras que la quemadura del estómago (p= 0,001) y del duodeno (p= 0,002) fue estadísticamente significativa en la ingesta de ácido muriático. El grupo de edad que más frecuentemente ingirió algún cáustico (93,2 %) fueron los menores de 5 años. Conclusiones. El cáustico ingerido con mayor frecuencia fue un agente alcalino, que provocó quemadura esofágica, mientras que un agente ácido provocó quemaduras en el estómago y el duodeno evidenciadas por endoscopía.

Background. Caustic ingestion in pediatrics is a common cause of visits to the Emergency Department. An indiscriminate use of cleaning chemicals and an easy access to them are determining factors for these injuries. Population and methods. Descriptive, analytical study. Children aged < 16 years hospitalized between January 1998 and December 2017 were included. The ingested caustic substance was identified as acid or alkaline. A gastrointestinal endoscopy was done to establish the burn grade. The grade of the burn was compared to the type of caustic substance using the χ² test or the Fisher's exact test; a P value < 0.05 was considered significant. Results. A total of 133 children were admitted to the Emergency Department due to caustic ingestion. The caustic agent was acid in 41 % of cases and alkaline, in 59 %. The most common acid caustic substance was muriatic acid (36.8 %) and the most common alkaline caustic agent was caustic soda (41.4 %). An esophageal burn was the most common consequence of caustic soda ingestion compared to other caustic agents (p = 0.001), whereas muriatic acid ingestion was the most statistically significant cause of stomach burn (p = 0.001) and duodenal burn (p = 0.002). The age group that most commonly ingested some caustic agent (93.2 %) corresponded to children younger than 5 years. Conclusions. The most common type of ingested caustic agent was alkaline, which caused esophageal burn; whereas, the ingestion of an acid caustic substance caused stomach and duodenal burns, as evidenced by endoscopy.