Evaluación de parámetros inflamatorios locales y sistémicos de quemadura periférica en un modelo animal / Assessment of local and systemic inflammatory parameters of peripheral burn in an animal model

RESUMEN Evaluar el volumen de edema y el recuento leucocitario, plaquetario y de fibrinógenos de quemadura periférica en un modelo animal. Se introdujo en agua a 60 °C y durante 60 s, la pata posterior izquierda de Rattus rovergicus (grupo experimental) o a temperatura ambiente (grupo control). Se realizó el análisis antes y después de la quemadura inducida (a las 4, 8, 12 y 24 h). El volumen del edema se determinó por fotografía ortogonal, los leucocitos y el recuento plaquetario, en un equipo automatizado, y el fibrinógeno por el método gravimétrico. El valor máximo del edema se obtuvo a las 4 h, y de leucocitos a las 24 h. El recuento plaquetario no varió a los diferentes intervalos de tiempo posinflamación. El fibrinógeno se incrementó a las 4 h y 24 h. Este modelo animal induce inflamación sistémica caracterizada por leucocitosis, nivel elevado de fibrinógeno y edema localizado en la zona de inducción.

ABSTRACT To evaluate the edema volume and leukocyte, platelet, and fibrinogen count of peripheral burn in an animal model. The back left leg of Rattus norvegicus (experimental group) was placed in water at 60 °C for 60 seconds or at room temperature (control group). An analysis was carried out before and after the induced burn (at 4, 8, 12, and 24 h). The edema volume was determined by an orthogonal photo, the leukocyte and platelet counts were determined using automated equipment, and the fibrinogen count was determined using the gravimetric method. The maximum value of the edema was recorded at 4 h and leukocytes at 24 h. The platelet count did not vary at different post-edema time intervals. The fibrinogen level increased at 4 h and 24 h. In this animal model we induced systemic inflammation characterized by leukocytosis and elevated fibrinogen levels, combined with edema located at the induction area.

Distress do paciente oncológico: prevalência e fatores associados na opinião de familiares / Distress of cancer patients: prevalence and associated factors in the opinion of family / Angustia de los pacientes con cáncer: prevalencia y factores asociados en la opinión de la familia

Este estudo verificou a prevalência e fatores associados ao distress de pacientes oncológicos, na opinião de familiares. Foram entrevistados 140 familiares responsáveis pelo cuidado de pacientes com câncer. O Termômetro de Distress foi adaptado para uso em familiares. Estes consideraram que 72,9% dos pacientes estavam com distress relacionado a preocupações (80,4%), nervosismo (78,4%), tristeza (74,5%), dor (67,6%), fadiga (67,6%) e problemas com alimentação (57,8%). Modelos de regressão logística hierárquica mostraram que, enquanto familiares do sexo masculino (OR=0,025) e idades mais avançadas (OR=0,006 a 0,059) tiveram menor risco de perceber o distress, indivíduos protestantes, comparados a católicos, tiveram chance 12,77 vezes maior de percebê-lo. Quanto aos fatores associados, nervosismo (OR=10,8) contribuiu significativamente mais com a percepção de distress pelos familiares quando comparado a fadiga (OR=3,38) ou ter plano de saúde privado (OR=2,55). Familiares podem ser grandes aliados na avaliação e acompanhamento do distress de pacientes com câncer.

The study aimed to verify the opinion of family members about distress on cancer patients and the factors associated with it. Interviews with 140 family members of cancer patients were conducted. The Distress Thermometer was adapted to be used with family members. Approximately 72.9% of patients were considered in distress, related to concern (80.4%), nervousness (78.4%), sadness (74.5%), pain (67.6%), fatigue (67.6%) and problems with eating (57.8%). The hierarchical logistic regression models showed that while male (OR=0.025) and older ages (OR=0.006 to 0.059) had lower risk of perceiving the distress, individuals Protestants, compared to Catholics, were 12.77 times more likely to perceive it. About the associated factors, nervousness (OR=10.8) contributed significantly more to the perception of distress for family members when compared to fatigue (OR=3.38) or have private health insurance (OR=2.55). Family can be great allies in the evaluation and monitoring of distress in patients with cancer.

Este estudio examinó la prevalencia y los factores asociados con el distress de los pacientes de cáncer, de acuerdo con los familiares. Fueran entrevistados 140 cuidadores familiares de pacientes con cáncer. El Termómetro de Distress fue adaptado para el uso en los familiares. Ellos encontraron que el 72,9% de los pacientes estaban con distress relacionado con preocupaciones (80,4%), nerviosismo (78,4%), tristeza (74,5%), dolor (67,6%), fatiga (67, 6%) y problemas con la alimentación (57,8%). Modelos de regresión logística jerárquica mostraran que, mientras los familiares de sexo masculino (OR=0,025) y de edades más avanzadas (OR=0,006 a 0,059) tuvieron un menor riesgo de percibir el distress, los individuos protestantes, comparados a los católicos, tuvieron oportunidad 12,77 veces mayor para percibirlo. En cuanto a los factores asociados, el nerviosismo (OR=10,8) contribuyó significativamente más a la percepción del distress de los familiares, en comparación con la fatiga (OR=3,38) o tener un seguro de salud privado (OR=2,55). Familiares pueden ser grandes aliados en la evaluación y el seguimiento de sufrimiento en los pacientes con cáncer.

Innate and adaptive immunity gene expression of human keratinocytes cultured of severe burn injury

PURPOSE: Evaluate the expression profile of genes related to Innate and Adaptive Immune System (IAIS) of human Primary Epidermal keratinocytes (hPEKP) of patients with severe burns. METHODS: After obtaining viable fragments of skin with and without burning, culture hKEP was initiated by the enzymatic method using Dispase (Sigma-Aldrich). These cells were treated with Trizol(r) (Life Technologies) for extraction of total RNA. This was quantified and analyzed for purity for obtaining cDNA for the analysis of gene expression using specific IAIS PCR Arrays plates (SA Biosciences). RESULTS: After the analysis of gene expression we found that 63% of these genes were differentially expressed, of which 77% were repressed and 23% were hyper-regulated. Among these, the following genes (fold increase or decrease): IL8 (41), IL6 (32), TNF (-92), HLA-E (-86), LYS (-74), CCR6 (- 73), CD86 (-41) and HLA-A (-35). CONCLUSIONS: This study contributes to the understanding of the molecular mechanisms underlying wound infection caused by the burn. Furthermore, it may provide new strategies to restore normal expression of these genes and thereby change the healing process and improve clinical outcome. .

Wound-healing and benzodiazepines: does sleep play a role in this relationship?

Patients who have suffered burns frequently experience psychological consequences, among which anxiety disorders are prominent. Benzodiazepines are commonly administered to treat these symptoms. The effects of benzodiazepines on healing may not be direct but rather are modulated by alterations of the sleep architecture. This hypothesis is supported by studies that demonstrate the effects of benzodiazepines on the immune system and the inflammatory profile under both normal sleep conditions and during sleep deprivation, particularly rapid eye movement sleep deprivation.

Analysis of immunoglobulin deficiency cases: a five year study.

A total of 734 serum specimens from various clinical disorders along with 100 control samples from healthy subjects were processed for estimation of serum IgG, IgA and IgM employing single radial immunodiffusion procedure. Immunoglobulin deficiency, either selective or combined was noted in 31 males and 24 females in all age groups. Of the 55 cases encountered it was secondary immunoglobulin deficiency which was seen on a larger scale and encountered in patients with Multiple myeloma (16 out of 32) followed by Leprosy (14 out of 250), Lymphoma (5 out of 43), Malaria (4 out of 137), Burns (4 out of 52), Rheumatoid arthritis (2 out of 69) and non lymphoreticular malignancies (1 out of 41) in decreasing order of frequency. Primary immunoglobulin deficiency was observed in nine cases comprising of six belonging to Idiopathic late onset immunoglobulin deficiency, two of dysgammaglobulineamia and a solitary case of Ataxia telangiectasia. Panimmunoglobulin deficiency was observed in six cases, 11 had a dual deficiency while 38 showed deficiency of an isolated class with selective IgA deficiency in 20 cases. Furthermore, one patient each had total absence of IgG or IgA while IgM was not detectable in seven patients. A high suspicion index along with a regular rapport between the clinician and the laboratory personnel is necessary in the diagnostic set up of immunoglobulin deficiency states.

Serum levels of immunoglobulins in thermal burns.

Thermal injury is known to induce alterations in the immune system. Sixty-four patients of thermal burns have been studied for serum immunoglobulins. Concentrations of IgG, IgA and IgM were decreased immediately after injury and gradually increased up to normal limits on the 30th postburn day.

Evaluación de la respuesta inmune inespecífica en los quemados graves / Evaluation of immune-unspecific response in severe burned patients

Células polimorfonucleares de la sangre circulante fueron colocadas sobre la superficie de un portaobjetos; las células no adheridas fueron removidad y las adheridas incubadas curante 30 minutos con una suspensión de levaduras. El indice fagocítico se determinó contando en número total de levaduras fagocitadas. Valor del indice fagocítico en pacientes normales: fue 3-5. Se estudiaron 30 pacientes con quemaduras tipo AB, B. Las quemaduras de tipo AB, B disminuyen la fagocitosis de los macrófagos. La máxima disminución del indice fagocítico fue observada en pacientes con quemaduras tipo AB, B que cubrían entre el 40 y el 65 por ciento de superficie corporal total, a los 10-15 días de ocurrida la quemadura. Mientras que la disminución del indice fagocítico era menos pronunciada en quemaduras tipo AB, B que cubrían menos del 15 por ciento de superficie corporal total. La biopsia bacteriológica cuantitativa mostraba un número de bacterias 10²-10 al cubo ufc/gr. cuando el indice fagocítico esataba entre 2,7-3 y un número de bacterias mayor a 10 a la quinta ufc/gr. cuando el índice fagocítico era inferior a 2. Además se detectó la adherencia de Pseudomonas Aeruginosa en las heridas cuando el índice fagocítico caía por debajo de 2,5. Conociendo el índice fagocítico podemos tener una idea de cuando los pacientes quemados graves están en peligro de infecciones severas

Bacterial translocation in burn injury

This experimental study was carried on 20 guinea pigs with burn injury involving 40% of their body surface areas. Animals were classified into four groups, five animals in each: Group [I]: with thermal injury perse, Group [II]: Burn wound was immediately contaminated with pathogenic staphylococci and Pseudomonas pyocyaneus, Group [III]: intestinal decontamination was achieved by giving oral combination of penicillin, Streptomycin and Metronidazol and Group [IV]: Intestinal decontamination was achieved and then animals were orally contaminated with E. coli of known serotype [078 K 80 B-] obtained from a case of haemorrhagic gastroenteritis in Mansoura University Hospital. In all groups animals were killed 48 hours after induction of burn injury. The study showed that bacterial translocation occurred maximammly [100%] in group [IV], which were orally contaminated with E. coli. The same species of E. coli was harvested from the mesentric lymph nodes. In group [III] in which the intestine was decontaminate, only 20% showed bacterial translocation and at the same time the histopathological changes were minimal where there was no mucosal erosion or disintegration of lamina propria

Aporte de la inmunología al estudio y tratamiento del paciente quemado / Contribution of immunology to the study and treatment of the burnt patient

Los pacientes con injuria térmica severa reúnen varias condiciones que los hacen más susceptibles a las complicaciones infecciosas. Una de ellas es la inmunodepresión post quemadura. Se analizan las alteraciones inmunológicas más frecuentes en estos pacientes, asi como sus mecanismos de producción. Se menciona el valor pronóstico de algunos parámetros de laboratorio inmunológico. Se revisan los fundamentos fisiopatológicos de terapias que intentan disminuir la inmunodepresión del paciente quemado