Estimación de factores de riesgo del retardo en la cicatrización en pacientes quemados / Estimation of Risk Factors for Delayed Healing in Burn Patients

Introducción: La atención al paciente con retardo en la cicatrización parte de la optimización en sus cuidados. La reversión del cuadro requiere del conocimiento de los factores de riesgo. La literatura nacional e internacional describen factores locales o relacionados con la herida y generales o relacionados al estado general del paciente. Objetivo: Estimar los factores de riesgo del retardo en la cicatrización en pacientes quemados. Métodos: Estudio analítico de casos y control en pacientes quemados ingresados en el Servicio de Caumatología del Hospital Universitario Manuel Ascunce Domenech en el período 2017 a 2021. La población objeto de estudio comprendió a 267 pacientes. Se calculó el odds ratio y el intervalo de confianza. Resultados: El desarrollo de retardo en la cicatrización resultó tres veces y media más probable en pacientes quemados con 45 años y más, odds ratio 3,591. Además, fue nueve veces más probable en enfermedades crónicas asociadas, hasta seis veces en quemaduras no accidentales, 163 veces en la complicación local y 89 veces en la complicación sistémica. Conclusiones: Los factores de riesgo del retardo en la cicatrización en pacientes quemados identificados fueron los siguientes: edad de 45 años y más, presencia de comorbilidad, el fuego directo como agente causal, el modo de producción no accidental, la presencia de más de seis zonas anatómicas afectadas, la quemadura hipodérmica, la quemadura de 20 porciento de superficie corporal quemada y más de extensión, el apoyo de la lesión, el índice cubano de pronóstico con riesgo vital, la complicación local y la complicación sistémica(AU)

Introduction: The care for the patient with delayed healing starts from the optimization of their care. Reversing such condition requires knowledge of the risk factors. The national and international literature describes local factors related to the injury and general factors related to the patient's general condition. Objective: To estimate the risk factors for delayed healing in burn patients. Methods: An analytical case-control study was carried out with burn patients admitted to the caumatology service at Hospital Universitario Manuel Ascunce Domenech in the period from 2017 to 2021. The study population consisted of 267 patients. Odds ratio and confidence interval were calculated. Results: The development of delayed healing was three and a half times more likely in burn patients aged 45 years or over (odds ratio: 3.591). In addition, it was nine times more likely for associated chronic diseases, up to six times in nonaccidental burns, 163 times in local complications, and 89 times in systemic complications. Conclusions: The identified risk factors for delayed healing in burn patients were the following: age 45 years or over, presence of comorbidity, direct fire as causative agent, nonaccidental way of production, presence of more than six affected anatomical areas, hypodermic burn, burn extension of 20 percent or over on the burned body surface, injury contact pressure, the Cuban index of prognostic vital risk, as well as the local or the systemic complications(AU)

Fogo em campo cirúrgico - Medidas preventivas para cirurgia palpebral segura / Operating room fire prevention - preventive measures for safe eyelid surgery

Resumo Fogo em campo cirúrgico durante cirurgia palpebral é uma complicação intra-operatória que é dramática tanto para o paciente quanto para a equipe médica. Relatamos um caso de acidente cirúrgico durante cirurgia palpebral onde o paciente sofreu queimadura de supercílio. Houve interação entre o oxigênio usado para sedação (máscara aberta) e uma fonte de ignição representada pelo cautério monopolar. Embora o paciente tenha apresentado boa evolução clínica com recuperação total da lesão cutânea, este caso é um alerta para se evitar tais tipo de ocorrência. Ressaltamos neste trabalho quais as condições implicadas e o modo de prevenção.

Abstract Fire in the surgical field during eyelid surgery is an intra-operative complication that is dramatic for both the patient and the medical staff. It's being reported a case of surgical accident during eyelid surgery where the patient suffered a brow burn. There was interaction between the oxygen used for sedation (open mask) and a source of ignition represented by monopolar cautery. Although the patient presented good clinical evolution with complete recovery of the cutaneous lesion, this case is an alert to avoid such type of occurrence. This work highlights the conditions involved and the way of prevention.

Experimental models of scald burns. A scope review

Abstract Purpose: To conduct a scope review of the experimental model described by Walker and Mason, by identifying and analyzing the details of the method. Methods: The authors searched Pubmed-Medline, Cochrane-Bireme and PEDro databases for articles published between January 2016 and December 2018, using the following search queries: burns, burn injuries, models animal, and animal experimentation. All articles whose authors used Walker and Mason's model - with or without changes to the method in Wistar rats - were included in this study. Results: The search identified 45 mentions of Walker and Mason's model; however, after reading each summary, 20 were excluded (of which 5 due to duplicity). The inconsistencies observed after the scope review were: water temperature, length of time of exposure of the experimental model's skin to water, extent of the burnt area, and the description of the thickness/depth of the injury. Conclusions: Reproducibility of a scientific method is the basis to prove the veracity of the observed results. Thus, it is necessary to have a greater number of publications that adopt a reproducible scientific method, for this review found inconsistencies in the description of Walker and Mason's model.

Intervenciones enfermeras en el abordaje de las quemaduras / Nursing Interventions in Burns Management

RESUMEN Introducción: Las quemaduras están consideradas como uno de los traumatismos más severos y complicados que existen, debido a las consecuencias físicas y psicológicas que provocan en los pacientes. Las intervenciones de enfermería van encaminadas a realizar un tratamiento eficaz, basado en el conocimiento y juicio clínico, para favorecer el resultado esperado del paciente. Objetivo: Analizar las intervenciones enfermeras más eficaces para el abordaje de las quemaduras. Métodos: Se realizó una revisión bibliográfica sistemática con análisis de contenido de los documentos. Las bases de datos consultadas fueron: PubMed, CINAHL, Scopus, Dialnet, Cuiden plus, IME y MEDES. Los criterios de inclusión fueron: Artículos de investigación sobre el tópico de estudio, publicados entre 2011-2016 y con acceso a texto completo. Los descriptores fueron: Quemaduras, terapéutica, y atención de enfermería. Las estrategias iniciales de búsquedas identificaron un total de 216 resultados y finalmente se seleccionaron 18 estudios. Conclusiones: Se encontraron intervenciones de enfermería eficaces para el tratamiento y cuidado de las quemaduras, unas encaminadas al manejo del dolor, otras para el cuidado de la herida ocasionada por la quemadura y otras dirigidas hacia los cuidados de la piel. Para las complicaciones se mostraron eficaces la reanimación y movilización temprana y la terapia nutricional(AU)

ABSTRACT Introduction: Burns are considered as one of the most severe and complicated traumas that exist, due to the physical and psychological consequences that they cause in patients. Nursing interventions are aimed at performing an effective treatment, based on clinical knowledge and judgment, in order to favor the expected outcome of the patient. Objective: To analyze the most effective nursing interventions for the management of burns. Methods: A systematic literature review was carried out with analysis of the content of the documents. The databases consulted were PubMed, CINAHL, Scopus, Dialnet, Cuiden plus, IME and MEDES. The inclusion criteria were research articles on the topic of study, published between 2011-2016 and with full-text acces. The descriptors were quemaduras [burns], terapéutica [therapeutics], and atención de enfermería [nursing care]. Thorough initial search strategies a total of 216 results were identified and 18 studies were finally selected. Conclusions: Effective nursing interventions were found for the treatment and care of burns, aimed at pain management, wound care caused by the burn or directed towards skin care. Resuscitation, early mobilization and nutritional therapy were effective for complications(AU)

Efectividad del esquema de reposición hídrica de Brooke modificado para el tratamiento del paciente quemado / Effectiveness of the Modified Brooke Formula of Hydric Substitution for Management of the Burnt Patient

Introducción: La reanimación hídrica del paciente quemado es vital para su supervivencia, el esquema de Brooke modificado puede resultar un método efectivo para lograrlo. Objetivo: Determinar la efectividad del esquema de reanimación hídrica de Brooke modificado en las primeras 72 horas del ingreso. Métodos: Estudio descriptivo, de corte transversal, realizado en pacientes quemados graves ingresados en el servicio de Caumatología y Cirugía Plástica del Hospital Universitario "Dr. Miguel Enríquez" de La Habana durante 2014. Universo de 211, se seleccionó una muestra probabilística sistemática de 80 pacientes, conformándose tres grupos según el pronóstico de grave (40), crítico (17) y crítico extremo (23). Se utilizaron técnicas estadísticas de distribución de frecuencia absoluta y porcentaje, a las variables estudiadas se les calculó desviación estándar considerándose un nivel de significancia para p < 0.05. Resultados: Predominó el sexo masculino (67,50 por ciento), la edad de 40 a 49 años en 45,00 por ciento, la categoría de grave (50,00 por ciento), 46,25 por ciento de los casos se comenzó a reanimar entre 4 y 8 horas de ocurrido el insulto térmico. La taquicardia y la sed fueron los parámetros clínicos de mayor importancia en las fases de reanimación (97,50 por ciento y 73,75 por ciento) y posreanimación (26,25 por ciento y 13,75 por ciento), disminuyeron en más de 70,00 por ciento de una etapa a otra. Conclusiones: En la fase de posreanimación de los pacientes quemados, los parámetros clínicos evaluados mejoraron en más de 70 por ciento, siendo esto un indicador satisfactorio de la eficacia de la utilización del esquema de Brooke modificado(AU)

ABSTRACT Introduction: Hydric resuscitation is vital for the survival of the burnt patient; the modified Brooke formulas can be used as an effective method to achieve it. Objective: To determine the effectiveness of the modified Brooke formula for hydric resuscitation in the first 72 hours of admission. Methods: Descriptive, cross-sectional study carried out with severely burnt patients admitted to the Caumatology and Plastic Surgery Department of Dr. Miguel Enríquez University Hospital of Havana, during 2014. Study population of 211, a systematic probabilistic sample of 80 patients was chosen, three groups being formed according to the prognosis of severe (40), critical (17) and extremely critical (23). Statistical techniques of absolute frequency and percentage distribution were used; for the variables studied, we calculated standard deviation considering a level of significance for p < 0.05. Results: There was a predominance of the male sex (67.50 percent), age 40-49 years (45.00 percent), the category of serious (50.00 percent), 46.25 percent of the cases began to be resuscitated from 4 to 8 hours after the thermal insult occurred. Tachycardia and thirst were the most important clinical parameters in the phases of resuscitation (97.50 percent and 73.75 percent) and post-resuscitation (26.25 percent and 13.75 percent), decreased by more than 70.00 percent from one stage to another. Conclusions: In the post-resuscitation stage of the burnt patients, the evaluated clinical parameters improved by more than 70 percent, this being a satisfactory indicator of the effectiveness of the use of the modified Brooke formula(AU)

Análise epidemiológica de 2 anos na Unidade de Queimados do Hospital de Urgências Governador Otávio Lage de Siqueira, Goiânia, Brasil / Epidemiological analysis over 2 years at the Burn Unit of the Urgency Hospital Governor Otávio Lage de Siqueira, Goiânia, Brazil

Introdução: Queimadura é um tipo de lesão que está entre as principais causas de mortalidade. A utilização da epidemiologia ajuda no fornecimento de subsídios para avaliação e organização de tratamento e prevenção, visando à melhora da saúde pública. O objetivo é descrever o perfil epidemiológico dos pacientes atendidos no Hospital de Urgências Governador Otávio Lages de Siqueira (HUGOL) na unidade de Queimados Nelson Picollo. Método: Este estudo analisou o perfil epidemiológico dos pacientes atendidos pela equipe de cirurgia plástica da unidade de tratamento de queimados Nelson Picollo, no período de julho 2015 até junho 2017, com idade superior a 12 anos. Critérios de exclusão: pacientes que não foram internados na unidade de queimados. Os dados foram colhidos do programa MVSoul R. Resultados: O total de atendimentos foi de 375 pacientes, dos quais 50% necessitaram de tratamentos unidade de terapia intensiva. O tempo médio de internação foi de 23,08 dias. A maioria do sexo masculino, com média de idade de 39,17 anos, com agente etiológico principal as chamas por álcool + gasolina. A média de superfície corporal queimada foi de 24,67%. Foram realizados 1490 intervenções cirúrgicas, média de 3,97 cirurgias por paciente. O total de óbitos foi de 40 pacientes, dos quais 29 apresentaram queimadura de via aérea. O total de pacientes com queimadura de via aérea foi de 73 casos. Conclusão: Este estudo demonstrou um perfil de queimaduras e internações na unidade de Queimados do HUGOL compatível com outros centros especializados neste tipo de tratamento.

Introduction: Burns are a type of injury that is among the leading causes of mortality. The use of epidemiology helps in providing subsidies for evaluation and organization of treatment and prevention, aiming at the improvement of public health. The objective is to describe the epidemiological profile of the patients treated at the Queimados Nelson Picollo unit of the Governador Otávio Lages de Siqueira Emergency Hospital (HUGOL). Method: This study analyzed the epidemiological profile of patients, aged more than 12 years, treated by plastic surgery at the burn treatment unit, Nelson Picollo, from July 2015 to June 2017. The patients who were not admitted to the burn unit were excluded from the study. Data were collected from the MVSoul R. program. Results: A total of 375 patients visited the hospital; of these, 50% of the patients needed intensive care unit treatments. The mean duration of hospital stay was 23.08 days. The majority of the patients were males, with a mean age of 39.17 years, and the main etiological agents were inflammable liquids, mainly alcohol and gasoline. The mean burned body surface area was 24.67%. A total of 1490 surgical interventions were performed, with an average of 3.97 surgeries per patient. Forty patients died; of these, 29 had airway burns. The total number of patients with airway burns was 73. Conclusion: This study provides a profile of burns and hospitalizations in the HUGOL burns unit, which corresponds with those from other centers specialized for this type of treatment.

Quemaduras en niños provocadas por rotura de bolsa para agua caliente / Children's scalds from tearing of hot water bottle

INTRODUCCIÓN: La quemadura en niños por rotura de bolsa de agua caliente, presentó un incremento brusco y significativo alrededor del año 2000 en Chile. Ante ello, la Corporación de Ayuda al Niño Quemado (COANIQUEM) difundió conceptos de prevención en su uso y alerta a autoridades. Posteriormente el Instituto de Normalización Nacional introdujo normativas de certificación de calidad de los productos comercializados en el país. OBJETIVO: Determinar el impacto de medidas preventivas y de certificación de calidad de las bolsas de agua caliente en las quemaduras por rotura del producto en niños. PACIENTES Y MÉTODO: Revisión de ingresos de 795 pacientes menores de 15 años, con quemaduras por rotura de bolsa de agua caliente, entre 2000-2014, en COANIQUEM-Santiago. Se determinó evolución de las frecuencias de quemaduras por el agente etiológico y se comparó el perfil epidemiológico en los períodos quinquenales inicial y final. RESULTADOS: Entre 2000-2004, se registró un incremento de 272,7% en los ingresos y un descenso de 81,3% entre 2005-2014. Las características demográficas, mes de ocurrencia de las quemaduras y necesidad de algún tipo de cirugía, fueron similares en los períodos comparados. El número de localizaciones disminuyó concentrándose en una quemadura (77,8%). En el segundo período incluyó además de extremidad inferior, abdomen y pelvis como ubicaciones frecuentes. CONCLUSIONES: Se verifica un importante descenso de las quemaduras por bolsa de agua caliente en niños, y un cambio significativo en sus características epidemiológicas, coincidiendo con medidas de prevención y normativa de certificación de calidad de los implementos.

INTRODUCTION: Children scalded by the tearing of hot-water bottles presented a sudden and significa tive increase around 2000 in Chile. For this reason the Aid to Burned Children Corporation (COA-NIQUEM) publicized prevention concepts concerning the careful use of this device and raised a voice of alarm to authorities. Later, the National Normalization Institute introduced quality certification standards for hot water bottles sold in the country. OBJECTIVES: Determine the impact of preventive measures and quality certification for hot water bottles in burns caused by tearing of the device on children. PATIENTS AND METHOD: Review of 795 patients under 15 admitted with injuries caused by hot-water bottle rupture between 2000 and 2014 at COANIQUEM Santiago. The frecuency of burns by the ethiological agent is determined and the epidemiological profile are compared in the initial and final quinquenial period. RESULTS: Between 2000-2004, an increase of 272.7% was recorded and then a decrease of 81.3 % was found between 2005-2014. Demographic characteristics, month of occurrence and need of some kind of surgery were similar in both periods. The number of locations and injuries diminished, and are concentrated in one burn (77.8%). In the first period the main anatomical region affected was lower limbs and in the second period abdominal and pelvis are also frequent. CONCLUSIONS: An important decrease of burns by hot-water bottle rupture with significant changes in their epidemiological characteristic is verified. This coincides with preventive measures and manufacturing standards regulations and quality control.

Edema laringotraqueal a causa de una lesión térmica: Complicación tras una tiroidectomía en niños / Laryngotracheal edema due to thermal injury: A complication after thyroidectomy in children

La insuficiencia respiratoria posoperatoria es una complicación grave de la tiroidectomia, y su origen puede ser multifactorial, especialmente en los niños. Presentamos el caso de dos hermanos sometidos a una tiroidectomia que luego tuvieron dificultad respiratoria. Para la disección de la tiroides se emplearon un bisturí armónico y el sistema de sellado vascular bipolar electrotérmico. Ambos pacientes presentaron problemas para respirar tempranamente en el posoperatorio. El hermano mayor tuvo dificultad respiratoria leve durante 24 horas, que se resolvió espontáneamente. Se extubó a la hermana menor, pero tuvo estridor grave acompañado de tiraje intercostal y retracción abdominal. Se la volvió a intubar y se la trasladó a la UCI, donde se la conectó a un respirador. Permaneció en la UCI durante 14 días debido a múltiples intentos fallidos de extubación. Es probable que los síntomas fueran más graves en la niña pequeña debido a que la pared de la tráquea era más blanda y los cartílagos, más débiles. Es necesario considerar las posibles complicaciones respiratorias posoperatorias a causa de una lesión térmica o una técnica quirúrgica inadecuada tras una tiroidectomía.

Postoperative respiratory insufficiency is a serious complication of total thyroidectomies which can be multifactorial, especially in children. We report two siblings who had undergone thyroidectomy with subsequent respiratory distress. Electrothermal bipolar and harmonic scalpel were used during thyroid dissections. Both patients had early postoperative respiratory problems. The older one suffered from mild respiratory distress for 24 hours and then he spontaneously recovered. The younger one was extubated but then she had serious stridor accompanied with abdominal and intercostal retractions. She was re-intubated and admitted to ICU for mechanical ventilatory support, where she stayed for 14 days due to multiple failed extubation attempts. The symptoms were more severe in the younger child probably due to softer tracheal wall and weaker tracheal cartilages. We should keep in mind the probable postoperative respiratory complications due to thermal injury or inappropriate surgical technique after thyroid surgeries.

Assistência de enfermagem a pessoas com queimaduras por fogo em decorrência de suicídio: revisão integrativa da literatura / Nursing care to people with burns after self extermination with fire: integrative review of literature / Atención de enfermería a personas con quemaduras por auto-extermínio con fuego: revisión integradora de la literatura

Objetivo: Caracterizar na literatura científica a assistência de enfermagem prestada aos suicidas vítimas de queimaduras térmicas por fogo. Método: Revisão integrativa a partir dos descritores: "tentativa de suicídio", "fogo", "queimaduras" e "enfermagem" nas bases de dados Lilacs e Scielo. Foram incluídos artigos disponíveis na íntegra em português e espanhol, publicados entre 2006 e 2015. A amostra constituiu-se de 12 publicações. Resultados: O cuidado de saúde ao indivíduo queimado é similar ao prestado em unidades de terapia intensiva. Exige do profissional conhecimento, compromisso e atuação multiprofissional livre de preconceito, além da valorização do apoio familiar. A assistência tem por finalidade a diminuição de riscos e complicações, contribuindo efetivamente no seu processo de cura e reabilitação. As relações interpessoais são difíceis, a carga horária é extensa, a assistência é complexa e leva à necessidade de estratégias de gestão para promover a qualidade de vida do profissional e uma assistência mais qualificada ao indivíduo. Conclusão: A complexidade assistencial às vítimas requer profissionais preparados e capacitados para atuar de forma eficaz, resolutiva, humanizada e integral. Quebrar tabus construídos ao longo da história humana, considerando a motivação para o autoextermínio, é produzir uma assistência livre de julgamentos e baseada em evidências e na sistematização dos cuidados.

Objective: To characterize the scientific literature to nursing assistance to suicide victims thermal burns fire. Methods: Integrative review using the descriptors: "suicide attempt", "Fire", "burns" and "nursing" in databases: Lilacs and Scielo. Full papers in Portuguese and Spanish, published between 2006 and 2015, were included. The sample consisted of 12 publications. Results: The health care to large individual burned is similar to that provided in intensive care units. It requires professional knowledge, commitment and prejudice-free multi-role, in addition to the enhancement of family support. The assistance aims at reducing risks and complications, effectively contributing to your healing and rehabilitation process. Interpersonal relationships are hard, the hours are long, the assistance is complex and leads to the need for management strategies to promote an improvement of the professional quality of life and a more skilled patient care. Conclusion: The complexity care for victims requires prepared and trained professionals to work effectively, termination, humane and comprehensive. Breaking taboos built throughout human history, taking into consideration which led the individual to attempt on his own life is to produce a free service trials and less mechanized, based on evidence and the systematization of care.

Objetivo: Caracterizar la asistencia de enfermería a las personas que intentaron suicidarse con el uso del fuego. Método: Revisión integradora de la literatura utilizando las palabras clave: "intento de suicidio", "Fuego", "quema" y "enfermería" en las bases de datos Lilacs y Scielo. Se incluyeron los artículos disponibles en su totalidad en portugués y español, publicados entre 2006 y 2015. La muestra consistió en 12 publicaciones. Resultados: La atención prestada a la persona quemada es similar a la prevista en las unidades de cuidados intensivos. Es necesario el conocimiento, el compromiso y la acción de diversos profesionales y el apoyo familiar. El objetivo sería reducir los riesgos y complicaciones, lo que contribuye eficazmente a su recuperación. Las relaciones interpersonales son difíciles, la carga de trabajo de los profesionales es muy amplia. La atención compleja requiere de estrategias de gestión en relación con los profesionales de la salud y para promover una atención de calidad. Conclusión: Romper tabúes construidos a lo largo de la historia humana, teniendo en cuenta la motivación para autoexterminio es producir un cuidado que no juzga y basada en la evidencia y la sistematización de la atención.

Antimicrobial and cytotoxic effects of phosphoric acid solution compared to other root canal irrigants

Phosphoric acid has been suggested as an irrigant due to its effectiveness in removing the smear layer. Objectives : The purpose of this study was to compare the antimicrobial and cytotoxic effects of a 37% phosphoric acid solution to other irrigants commonly used in endodontics. Material and Methods : The substances 37% phosphoric acid, 17% EDTA, 10% citric acid, 2% chlorhexidine (solution and gel), and 5.25% NaOCl were evaluated. The antimicrobial activity was tested against Candida albicans, Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, Actinomyces meyeri, Parvimonas micra, Porphyromonas gingivalis, and Prevotella nigrescens according to the agar diffusion method. The cytotoxicity of the irrigants was determined by using the MTT assay. Results : Phosphoric acid presented higher antimicrobial activity compared to the other tested irrigants. With regard to the cell viability, this solution showed results similar to those with 5.25% NaOCl and 2% chlorhexidine (gel and solution), whereas 17% EDTA and 10% citric acid showed higher cell viability compared to other irrigants. Conclusion : Phosphoric acid demonstrated higher antimicrobial activity and cytotoxicity similar to that of 5.25% NaOCl and 2% chlorhexidine (gel and solution). .

An evaluation of the protective effect of an infusion of chilled glucose solution on thermal injury of the bile ducts caused by radiofrequency ablation of the liver

PURPOSE: To evaluate the protective effects of chilling the bile ducts with cold (5°C) 5% glucose solution (GS) during radiofrequency (RF) administration. METHODS: Twenty male pigs (3 mos. old; 25-30 kg) were subjected to RF delivery with chilling (experimental group, N=10) or without chilling (control group, N=10). Half of the animals in each group were euthanized immediately after the operation, and half were euthanized one week later. The following histological variables in relation to the bile ducts were evaluated by a pathologist (blind examiner): degenerative changes to the epithelium; epithelial necrosis; ulceration, regenerative changes of the epithelium; polymorphonuclear neutrophil infiltration; and thermal effects. RESULTS: The experimental group (88 bile ducts examined) showed reduced thermal damage relative to the control group (86 bile ducts examined) as demonstrated by significant differences in the following histopathological parameters: epithelial detachment of biliary epithelium (84.1% vs. 59.3%; p<0.006); elongation/palisade arrangement of nuclei (65.1% vs. 87.5%; p<0.001); pseudo-goblet cells (32.9% vs. 56.8%; p<0.001). CONCLUSION: Infusion of 5% glucose solution (5°C) has a protective effect on bile ducts subjected to heat (95-110°C, 12 min) from radiofrequency thermal ablation device. .

Extra corporeal shockwave lithotripsy resulting in skin burns – a report of two cases

Severe skin injury after extracorporeal shock wave lithotripsy (ESWL) is rare. We describe two patients who suffered full thickness skin burns following ESWL for renal calculi. One patient was treated conservatively and the other underwent debridement with skin grafting. We speculate that failure of the thermostatic mechanism of the lithotripter, leading to overheating of the water-filled cushion, resulted in this very rare adverse event. Proper preoperative patient counseling regarding the risk of serious burn injuries will help to avoid potential litigation.

"Carne crua e torrada": a experiência do sofrimento de ser queimada em mulheres nordestinas, Brasil / "Raw and charred flesh": the experience of burned women in Northeast Brazil / "Carne cruda y tostada": experiencia del sufrimiento en mujeres del nordeste de Brasil al padecer quemaduras

No Nordeste brasileiro, a morte por fogo é uma ameaça onipresente e banalizada entre mulheres empobrecidas. Este estudo antropológico descreve a experiência do sofrimento de ser queimada. Em 2009, foram investigados seis casos “ricos em informação” no Centro de Queimados, Fortaleza, Ceará, Brasil. Entrevistas etnográficas abertas com informantes-chave, narrativas de experiências vividas e observação participante na clínica e no domicílio foram realizadas. Utilizamos os métodos Análise de Conteúdo, Sistemas de Signos, Significados e Ações e Interpretação Semântica Contextualizada. Revelou-se que as metáforas emergentes são carregadas de significância cultural da “monstruosidade” e da violência de gênero pelo fogo – inscrita impiedosamente no corpo feminino. O “acidente por combustível” (álcool) esconde a cruel realidade de “carne crua e torrada”. A cicatriz é capaz de desfigurá-las em “não-pessoas”, maculando sua reputação moral e gerando a rejeição social. No Nordeste brasileiro, a vulnerabilidade social provocada pela sequela da queimadura exige uma política de humanização do cuidado.

In Northeast Brazil, death from burns is a widespread, pervasive threat to poor women. This anthropological study describes the experience of personal suffering among female burn patients. In 2009, six “information-rich” cases were investigated at the Burn Center in Fortaleza, Ceará State, Brazil. Open ethnographic interviews with key informants, narratives of lived experiences, and participant observation at the clinic and patients’ home were conducted. The methods included content analysis, systems of signs, meanings, and actions, and contextualized semantic interpretation. The emerging metaphors are embued with the cultural meaning of “monstrosity” and gender violence by fire – inscribed mercilessly in the woman’s body. “Accidents” caused by flammable liquids (alcohol) hide the cruel reality of “raw and charred flesh”. The scars can disfigure the victims as “non-persons”, destroying their moral reputation and leading to social rejection. In the Brazilian Northeast, the social vulnerability caused by sequelae from burns demands a policy for humanized care.

En el nordeste brasileño, la muerte por fuego es una amenaza omnipresente y banal entre las mujeres pobres. Este estudio antropológico describe su experiencia al sufrir quemaduras. En 2009, fueron investigados seis casos “ricos en información” en el Centro de Quemaduras, Fortaleza, Ceará, Brasil. Se realizaron entrevistas etnográficas abiertas con informantes claves, narraciones de experiencias y una observación participativa en la clínica y domicilios. Utilizamos métodos de análisis de contenido, sistemas de signos, significados y acciones e interpretación semántica contextualizada. Las metáforas emergentes están cargadas de significado cultural de “monstruosidad” y la violencia de género por el fuego – sin piedad marcado en el cuerpo femenino. El “combustible por accidente” (alcohol) oculta la cruel realidad de la “carne cruda y tostada”. La cicatriz es capaz de desfigurarlas y transformarlas “no-personas” empañar su reputación moral y generar rechazo social. En el nordeste brasileño, la vulnerabilidad social, causada por las secuelas de quemaduras requiere una política de cuidado humano.

Perfil das hospitalizações para o tratamento agudo de crianças e adolescentes queimados, 2005-2010 / Hospitalization profile for acute treatment of burned children and adolescents, 2005-2010

Objetivo: O objetivo deste estudo foi descrever o perfil das hospitalizações para tratamento agudo de criança e adolescente queimados, entre zero e 19 anos de idade, em um Centro de Tratamento de Queimaduras (CTQ) localizado no interior paulista, entre 2005 e 2010. Método: Estudo descritivo e retrospectivo, que teve como fonte de informação dados secundários, a partir de um registro sistematizado de controle interno do CTQ. As variáveis estudadas foram: número e tempo de internação para tratamento agudo, idade, sexo, etiologia das queimaduras e área da superfície corporal queimada. Resultados: Identificaram-se 204 internações, sendo 60% do sexo masculino. A maioria das queimaduras ocorreu entre zero e 3 anos de idade, sendo a escaldadura o principal agente causador; enquanto que, dos 4 aos 19 anos, foram os líquidos inflamáveis. Conclusão: A caracterização das internações forneceu subsídios, contribuindo para dar visibilidade a esse agravo e motivar planejamento de ações, especialmente relacionadas à prevenção de queimaduras.

Purpose: The aim of this study was to outline the hospitalization profile for acute treatment of child and adolescent burns victims, between zero and 19 years of age, at a Burn Treatment Center (BTC) located in the interior of São Paulo State, Brazil, between 2005 and 2010. Method: A retrospective descriptive study, which had as an information source secondary data from a record systematized internal control BTC. The study variables were: number and duration of hospital admissions for acute treatment, age, gender, burn etiology and total body surface area. Results: In total were 204 hospital admissions, 60% of whom were male. Most burns affected between zero and three years of age; the scald was the main causal agent in this age range; where as, from four to 19 years, were flammable liquids. Conclusion: Characterizing the hospital admissions provided support, contributing to grant visibility to this problem and motivate action planning, especially related to burn prevention.

Manejo inicial del niño quemado: lo que el médico general debe saber / Initial management of burned children

Las quemaduras en los niños son un problema frecuente de salud pública . Presentan mortalidad asociada y morbilidad tanto aguda como a largo plazo pudiendo ocasionar tanto secuelas funcionales como estéticas. Estas a su vez pueden provocar trastornos psicológicos, sociales-familiares y laborales. A pesar de las campañas preventivas, las quemaduras continúan siendo prevalentes durante la infancia. El conocimiento de esta patología desde el punto de vista fisiopatológico y diagnóstico adecuado (determinar el agente causal, la extensión y la profundidad), permite optimizar el manejo inicial del niño quemado. De esta manera al tratar de forma adecuada y oportuna se evita la profundización de las quemaduras, las infecciones y complicaciones, logrando una mejoría más temprana y con menos secuelas.

Pediatric burns are a relevant public health problem, not only because of its mortality rate but for the esthetic and functional sequelaes that cause psychological and social dysfunction. It remains a prevalent accident during childhood, despite prevention campaings. The knowledge of the physiopathology and its adecuate diagnosis (determining the causal agent, the extent and depth), leads to a good initial management of burned children, improving the prognosis, reducing mortality and morbidity minimizing sequelae in order to provide a normal upbringing.

Fingertip and nasal tip thermal burn in crack cocaine user / Queimadura da polpa digital e da ponta nasal em usuario de crack

Crack cocaine addiction is a public health problem in Brazil. It is an endemic disease that affects rural and urban areas. The Ministry of Health has launched emergency programs for the treatment of dependents and to combat drug trafficking. Recognition of dermatological signs of this disease is important because through them the diagnosis can be suspected and early treatment of patients with crack cocaine addiction be provided.

A dependência química do crack é um problema de saúde pública no Brasil. Trata-se de uma endemia que afeta a zona rural e a zona urbana. O Ministério da Saúde lançou programas emergenciais para o tratamento dos dependentes e o combate ao tráfico de drogas. Reconhecer os sinais dermatológicos iniciais desta doença é importante, pois através deles, pode-se suspeitar do diagnóstico e então proporcionar ao paciente o tratamento precoce.

Fuego quirúrgico: un incidente prevenible / Surgical fire: an avoidable incident

Introduction: surgical fire requires the presence of three components, known as the "fire triad": a fuel, an ignition source and an oxidizer. Clinical case: we report a patient who, during an ambulatory surgery, suffered a facial burn from a fire. The use of an electrosurgical unit and supplementary oxygen through nasal cannula were important factors in this case. We describe how and why fire start, which are the high-risk surgeries and the strategies to reduce the risk of fire in surgical patients.

Introducción: el fuego quirúrgico requiere tres elementos para que se produzca, conocidos como "triada de fuego": un combustible, una fuente de ignición y un oxidante. Caso clínico: presentamos el caso de una paciente que sufrió una quemadura facial por fuego durante una cirugía ambulatoria, en la que fueron factores importantes el uso de una unidad electroquirúrgica y la administración de oxígeno a través de una cánula nasal. Describimos cómo y por qué se puede producir fuego, cuáles son las cirugías de alto riesgo y las estrategias para reducir el riesgo de fuego en pacientes quirúrgicos.

Epidemiología del paciente gran quemado adulto en Chile: experiencia del Servicio de Quemados del Hospital de la Asistencia Pública de Santiago / Sociodemographic/clinical characteristics and outcomes of patients admitted to the National Burn Center of Chile

Background: Approximately 150 subjects per year suffer severe burns in Chile. Aim: To analyze sociodemographic/clinical features and outcomes of severely burned patients. Material and Methods: Retrospective cohort study of 936 patients aged 47 ± 20 years (66% males), admitted to the National Burn Center of Chile between 2006 and 2010. Sociodemographic/clinical and burn variables and outcomes were studied. Results: Mean total percentage of body surface area burned was 27 + 20%. A quarter of the patients had social features that could jeopardize rehabilitation. Fire was the burning agent in 73%, which along with electricity presented greater lethality (p < 0.01). Inhalation injury was diagnosed in 22% of the patients. Twenty eight percent of patients had impaired consciousness at the moment of the accident, leading to larger burns, higher incidence of inhalation injury and greater lethality. Lethality for severe, critical and exceptional survival groups was 8.4,37.7 and 70.4%, respectively. Conclusions: Severely burned patients in Chile are mainly males at working age. Fire is the main agent and 28% had impaired consciousness, which was associated with an increase in the severity of burns. Knowledge of the characteristics and outcomes of the patients is important to implement prevention and treatment strategies adjusted to the national reality.

Burn patients; causes of death and factors affecting mortality a 4 years study at a tertiary care hospital

To determine major risk factors of mortality and causes of death in patients presented with burn injury. Prospective Descriptive Study. Setting and duration: Department of Burns and Plastic Surgery, Khyber Teaching Hospital, Peshawar, Pakistan from April 2008 and June 2012. A prospective descriptive study was performed among the patients who admitted to the Department of Burns and Plastic Surgery, Khyber Teaching Hospital, Peshawar, Pakistan between April 2008 and June 2012. All relative information was collected through a detailed proforma and patient's treatment files. Patients of any age, any degree of burns and burns exceeding 10% TBSA were included. Patients presenting after more than one week post burn or patients referred from other hospitals were excluded. Within this period, demographic data, treatment, and outcomes of treatment were reviewed and analyzed. Survivors and non-survivors among burn patients were compared to define the predictive factors of mortality. Between April 2008 and June 2012, 1850 patients were admitted with burn injuries. There were 1150 male patients [62%] and 700 female patients [38%]. Mean age was 36 years with range of 1-70 years. Inhalation injuries were present in 45 patients [2.40%]. Causes were flame burns [65.0%], electrical burns [15%], scalds [13%] and chemical burns [7.0%]. The total body surface area [TBSA] burn ranged from 10- 100%, with a mean of 38% TBSA burn. Mean length of hospital stay was 12 days [ranging from 24 hours to 170 days]. Mortality rate was 11.2%. Higher age, larger burn area, wound infection, longer hospital stay and the presence of multi-system organ failure significantly predicted increased mortality. Prevention is a key factor in reducing the morbidity and mortality associated with burn injury. A campaign to educate people that burns can be prevented will be important in our community. The prevention of multi-organ failure and septicemia are likely to be more effective than their treatment