Systematic review and quality assessment of clinical and economic evidence for superabsorbent wound dressings in a population with chronic ulcers.

Effective exudate management is key for optimal ulcer healing. Superabsorbent dressings are designed to have high fluid handling capacity, reduced risk of exudate leakage, fluid retention under compression, and to sequester harmful exudate components. This study aimed to systematically identify existing evidence for the clinical efficacy and cost-effectiveness of superabsorbent dressings for the treatment of moderate-to-highly exudating chronic ulcers of various etiologies. The aim is focused on examining the 'class' effect of all superabsorbers, not any particular dressing. Clinical and cost effectiveness systematic reviews were conducted, searching Embase, MEDLINE, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature. The Cost Effectiveness Analysis Registry and Econ papers were also searched for the economic review. Outcomes of interest included ulcer closure, dressing properties, hospital- and infection-related outcomes, safety, and economic outcomes. Fourteen studies were included in the clinical systematic review. Eleven were case series, with one randomised controlled trial, one retrospective matched observational study, and one retrospective cohort study. The studies investigated eight superabsorbent dressings and were heterogeneous in their patient population and outcomes. Superabsorbent dressings may result in favourable outcomes, including reductions in frequency of dressing change and pain scores. As most studies were case series, drawing firm conclusions was difficult due to absence of a comparator arm. The economic systematic review identified seven studies, five of which were cost-utility analyses. These suggested superabsorbent dressings are a more cost-effective option for the treatment of chronic ulcers compared with standard dressings. However, the small number and low quality of studies identified in both reviews highlights the need for future research.

Retrospective Evaluation of Characteristics of Patients with Burn Injuries Treated at the Largest Reference Hospital in Brazil.

Burn injuries are a significant cause of morbidity and mortality in the Brazilian population. We conducted this study in a tertiary hospital in Brazil to discover the epidemiological characteristics of patients with burn injuries. We conducted a cohort review of patients admitted to the burn unit of our institute during a 5-year period. For each patient, we collected data that included age, gender, total percentage of burned body surface area, burn location, burn mode, and burn cause. We analyzed the data using the R programming language. We included a total of 496 patients in our study. The mean age of the patients was 28 ± 14.7 years. The median length of hospital stay was 2 weeks. We found a significant correlation between the total percentage of burned body surface area and the length of hospitalization (p < .001) and the length of hospitalization in the intensive care unit (p < .001). A total of 427 patients (86%) were discharged from the hospital after successful treatment. In contrast, 43 patients (8.67%) died. The mortality rate was highest in patients who had more than 70% of their total body surface area burned. The average length of hospitalization aligned with global and national statistics presented in the literature. The main causes of the burn injuries were thermal (e.g., fire, hot liquids). We found inhalation injuries present in more than one third of the patients who were hospitalized in the intensive care unit with thermal burns.

Hydrogel enriched with sodium alginate and vitamins A and E for diabetic foot ulcer: a randomized controlled trial.

INTRODUCTION: Diabetic foot ulcers usually are hard to heal, and amputation is sometimes necessary. Wound bed preparation helps promote the normal healing process, and debridement is fundamental to improving the wound microenvironment. Hydrogel enriched with sodium alginate and vitamins A and E is a new treatment that can aid in debridement and WBP. OBJECTIVE: This study evaluates the efficacy of the autolytic debridement promoted by hydrogel in the healing of DFU. MATERIALS AND METHODS: This was a single-blind randomized controlled trial with a 12-week follow-up period. Twenty-six patients were randomized into either the control group (cleaning and a simple dressing) or the experimental group (hydrogel treatment). Nineteen patients completed the trial. The wound area, healing, and wound severity classification based on PUSH were evaluated, and microscopic evaluation of the presence of inflammatory infiltrate and collagen production was performed. RESULTS: The average patient age, duration of the open wound, and presence of diabetes were similar between the groups. The initial wound area was larger in the experimental group than in the control group, however. No statistically significant differences were found in any of the outcomes (lesion area and PUSH subscores) between the groups. Histological analysis demonstrated a reduction in the inflammatory infiltrate in the experimental group; however, there was no increase in collagen production. CONCLUSIONS: The use of enriched hydrogel was found to be of no benefit compared with conventional dressings in the management of DFU.

Posttraumatic stress disorder in burn patient: A systematic review.

INTRODUCTION: Burns often cause severe physical and mental suffering and can become a trigger for the development of permanent psychological diseases, even after wound healing. Posttraumatic stress disorder (PTSD) is one such disorder, which involves the re-experiencing of many symptoms provoked by a previous traumatic situation. METHOD: This study is a systematic review of interventions used to reduce or prevent PTSD symptoms in burn victims. We included randomized clinical trials that described therapeutic interventions for the prevention of PTSD in burn patients. The search was conducted in the databases EMBASE and PUBMED/Medline between 2009 and 2020, and the main variables evaluated were%TBSA, age, number of hospitalization days, type of intervention, follow-up time and results. The analysis of the bias risk was carried out according to the guidance in the Cochrane Handbook for Bias Risk Assessment. RESULTS: Eight clinical trials were selected: three of them were performed in children, and five involved adults. The most common bias risks were related to participant/researcher blinding and loss of follow-up. Two interventions were identified: a pharmacological intervention and a psychological intervention. Medications (sertraline and propanolol) were not effective in reducing stress symptoms. Four studies used cognitive-behavioral therapies, which achieved the best results for PTSD improvement in burn patients. Hypnosis and an informational education program were also evaluated and did not show success in reducing PTSD. CONCLUSION: Cognitive-behavioral therapies may work to reduce PTSD symptoms in burn patients, and when they are adopted early by burn units, they may improve the psychological condition of burn patients.

Estudo de três modelos de predição de gravidade em uma unidade de terapia intensiva especializada no atendimento de pacientes com extensas queimaduras / Study of three severity prediction models in an intensive care unit specialized in the care of patients with extensive burns

OBJETIVO: Não existe na literatura consenso indicando o melhor índice mortalidade a ser aplicado para pacientes vítimas de grandes queimaduras. Contudo, os índices de gravidade podem determinar o quadro apresentado pelo paciente, além de avaliar a probabilidade de mortalidade e morbidade a partir do quadro patológico, possibilitando uma melhor compreensão sobre a gravidade da doença e efetividade do tratamento. O objetivo é avaliar se o índice de gravidade clínica fornecido por três escalas de prognóstico (LODS, APACHE II e Charlson) reflete a situação clínica dos pacientes nas primeiras 24 horas posteriores a sua admissão na UTI de queimados. MÉTODO: Trata-se de um estudo documental com análise retrospectiva utilizando dados de 225 pacientes internados em UTI especializada em tratamentos de grandes queimados. Os valores registrados no prontuário nas primeiras 24 horas de internação foram aplicados nos escores LODS, APACHE II e índice de comorbidade de Charlson. Os pacientes foram divididos em grupo 1 (alta, 229 pacientes) e grupo 2 (óbito, 26 pacientes). RESULTADOS: Como resultado, foi obtida diferença estatística entre os dois grupos no escore de LODS e APACHE II, havendo uma média de pontuação superior no grupo 2. Também houve diferença estatística significante em relação aos parâmetros renais e pulmonares no escore de LODS, predição da mortalidade do escore APACHE II e superfície corporal queimada. CONCLUSÕES: Este estudo indica que a porcentagem de superfície corporal queimada, a função pulmonar e renal são preditores significantes de morte para pacientes queimados. Os índices calculados pelo APACHE II e o LODS se mostraram úteis para uso junto a esta população.

OBJECTIVE: There is no consensus in the literature indicating the best mortality rate to be applied to patients suffering from major burns. However, the severity indexes can determine the condition presented by the patient, in addition to evaluating the probability of mortality and morbidity from the pathological condition, allowing a better understanding of the severity of the disease and the effectiveness of the treatment. The aim is to assess whether the clinical severity index provided by three prognostic scales (LODS, APACHE II and Charlson) reflects the clinical situation of patients in the first 24 hours after their admission to the burn ICU. METHODS: This is a study with a retrospective analysis using data from 225 patients admitted to an ICU specializing in the treatment of major burns. The values recorded in the medical records in the first 24 hours of hospitalization were applied to the LODS, APACHE II and Charlson comorbidity index scores. Patients were divided into group 1 (discharge, 229 patients) and group 2 (death, 26 patients). RESULTS: As a result, a statistical difference was obtained between the two groups in the LODS and APACHE II scores, with an average of higher scores in group 2. There was also a statistically significant difference in relation to renal and pulmonary parameters in the LODS score, predicting the mortality of the APACHE II score and burned body surface. CONCLUSIONS: This study indicates that the percentage of body surface burned, lung and kidney function are significant predictors of death for burn patients. The indices calculated by APACHE II and the LODS proved to be useful for use with this population.

Retrospective Evaluation Of The Accuracy Of Five Different Severity Scores To Predict The Mortality In Burns Patients.

BACKGROUND: Patients with great clinical impairment, due to extensive burns, need to be admitted to intensive care units, in these treatment sites, indices are used to classify the severity of patients. The aim of the study was to compare the accuracy of the FLAMES score in relation to the Acute Physiologic and Chronic Health Evaluation II (APACHE II), the Simplified Acute Physiologic Score II (SAPS II), the Logistic Organ Dysfunction System (LODS) and the Abbreviated Burn Severity Index (ABSI) applied to the severe burn patient facing mortality in an ICU of a reference center for burns in Brazil. METHODS: A retrospective study conducted in ICU comparing the accuracy the APACHE II, SAPS II, LODS, ABSI and FLAMES instruments were applied to all the selected medical records. To evaluate the accuracy of the SIs, the Receiver Operating Characteristic curve was calculated and the area under the curve (AUC). RESULTS: Among the 574 patients included in the study, male individuals (70.13%), with an average age of 44.01 ± 28.64 prevailed and the majority of the burns were caused by accidents (76.53%). The outcome accounted for 35.29% of deaths. It was observed that the FLAMES and ABSI presented the two largest areas under the ROC curves and the highest sensitivities (96% and 89%, respectively). The APACHE II, SAPS II and LODS presented sensitivities equal to or greater than 80%. CONCLUSIONS: It has been demonstrated that indices specifically developed for burn patients, specifically the FLAMES and ABSI indices, presented better accuracies and prediction performances.

Effect of different human tissue processing techniques on SARS-CoV-2 inactivation-review.

The safety of the tissue transplant recipient is a top priority for tissue banks, and the emergence of the new coronavirus SARS-CoV-2 has raised significant concerns about the risks of releasing tissue for clinical use. In the present study, we conducted a literature review about the potential infectivity of SARS-CoV-2 in different biological tissues and the influence of various tissue processing and sterilization procedures on viral inactivation. The search revealed that SARS-CoV-2 binds to the human angiotensin-converting enzyme receptor to penetrate human cells. These receptors are present in skin cells, musculoskeletal tissue, amniotic membranes, cardiovascular tissue and ocular tissues, including the cornea. In general, we found that coronaviruses are stable at low temperatures, and inactivated upon exposure to extreme heat and pH. Notably, gamma irradiation, which has already been employed to inactivate SARS and MERS, could be useful for sterilizing skin, amnion and musculoskeletal tissues against SARS-CoV-2. We conclude that due to the limited information about the effects of physical and chemical tissue processing methods on viral neutralization, rigorous donor screening is still essential for tissue transplant recipient safety.

Complicated Surgical Wounds and Associated Factors in Oncology Patients.

The objective of this study was to identify the occurrence of complicated surgical wounds (CSWs) and to analyze the associated factors in hospitalized patients at an oncology institution. This was an epidemiological, observational, cross-sectional, descriptive, and correlational study conducted in the intensive care and hospitalization units forming part of a large cancer hospital. Sociodemographic and clinical data were collected from medical records and physical examinations of the skin. Associations between the dependent variable (presence of CSWs) and the independent variables were obtained by chi-square tests and odds ratio (OR) calculations with a 95% confidence interval. Logistic regression (LASSO) was used to verify the possible predictors of the outcome. The sample consisted of 341 patients, specifically individuals who are White (46.9%), married (53.4%), and men (58.1%) with an average age of 59.2 years. Complicated surgical wounds were present in 3.2% of patients, and the most frequent types of complications were dehiscence (40%), infection (26.7%), and fistula (20%) present in the abdominal (40%), cephalic (26.7%), and cervical (13.3%) regions. Senile purpura, diaper use, and infection were the clinical variables associated with the occurrence of CSWs (p = .044, p = .001, and p < .001, respectively). Based on the logistic regression, the presence of infection (p < .001; OR = 90.8; 95% CI [18.42, 538.79]) persisted as a predictor of the occurrence of CSWs. From these observations, recommendations regarding best practices for the prevention of CSWs are made, specifically for patients with cancer.

The Effect of Reduction Mammaplasty on Body Posture: A Preliminary Study.

Excess breast volume can lead to changes in the postural pattern that may result in pain. This causes women to seek reduction mammaplasty, a surgical procedure that reduces breast volume and may provide relief from symptoms. The objective of this study was to evaluate whether reduction mammaplasty can influence the posture of women. The postures of women with breast hypertrophy were evaluated using postural assessment software and photographic recording performed on the day of surgery and 3 months after the procedure. After surgical breast reduction, the patients had statistically significant changes in their postural patterns related to the horizontal alignment of the anterosuperior iliac spines and the angle of the acromion and anterior superior iliac spines. The analysis of the results showed statistically significant data on postural changes in the patients 3 months after the surgical procedure.

Effect of Hydrogel Enriched With Alginate, Fatty Acids, and Vitamins A and E on Pressure Injuries: A Case Series.

Pressure injuries are a common kind of skin lesion that may be difficult to treat. The objective of this study was to analyze the effect of hydrogel enriched with alginate, fatty acids, and vitamins A and E in the treatment of pressure injuries. This case series with 12-week follow-up included applying daily dressings with hydrogel, maintaining a photographic record, using planimetry to calculate the lesion area, and classifying the healing process using the Pressure Ulcer Scale for Healing (PUSH). In addition, exudate collection from the ulcers was performed in the beginning and after 12 weeks of treatment to determine the dosage of metalloproteinase 9 (MMP9) and tissue inhibitor of metalloproteinase 1 (TIMP1). Of the 13 patients included in the study, 2 died and 11 were monitored for 12 weeks. Only 1 patient showed full wound healing, but all patients showed a significant 12.19% (p = .023) reduction in the lesion area. The PUSH score was also significantly reduced from 15.9 to 10.54 (p = .0052). Relative to the dosage of metalloproteinase and its inhibitor, there was a reduction in the level of MMP9 and there was no change in the level of TIMP1. This study showed that hydrogel enriched with alginate, fatty acids, and vitamins A and E provided promising results for the treatment of pressure injuries by reducing the lesion area, the general PUSH score, and the amount of MMP9 in the wounds' microenvironment.

Comparative study of Silver Sulfadiazine with other materials for healing and infection prevention in burns: A systematic review and meta-analysis.

The aim of this systematic review with meta-analysis was to compare the effect of Silver Sulfadiazine (SSD) with other new dressings, with or without silver, on healing and infection prevention in burns. The electronic search was carried out in the electronic databases of Pubmed, ScienceDirect, Lilacs and BVS. The articles included were randomized clinical trials about burn treatment with SSD, which evaluated the healing and infection of burn wounds in humans. The exclusion criteria included articles, editorials and letters published in the form of abstracts, unpublished reports and case series, cross-sectional, observational experimental studies, and the use of sulfadiazine for other types of wounds. The search identified 873 references, and 24 studies were included in accordance with the eligibility criteria. The results showed a statistically favorable difference related to the time of healing for silver dressings (p<0.0001; MD 3.83; 95% CI 2.03-5.62) and dressings without silver (p<0.007; MD 2.9; 95% CI 0.81-5.00) in comparison with SSD. The rate of infection showed no difference in the group treated with SSD compared with the group treated with dressings containing silver (p>0.05). The rate of infection was significantly higher in the SSD group compared with the group treated with dressings without silver (p<0.005; MD 25.29% and MD 12.97%). Considering the clinical trials conducted up to the present time, the authors concluded that new dressings with and without silver show better results than SSD for wound healing, and burns treated with dressings without silver are less likely to become infected than burns with SSD. No differences between SSD and new silver materials were observed in relation to infection prevention.

Aplicação do pressure ulcer knowledge test em enfermeiros de um hospital de atenção secundária ­ estudo transversal / Application of pressure ulcer knowledge test in nurses at a secondary care hospital - cross-sectional study

Objetivo: identificar o nível de conhecimento de enfermeiros sobre a avaliação, prevenção e classificação de lesões por pressão em um hospital do Rio de Janeiro. Métodos: Trata-se de um estudo do quantitativo com delineamento descritivo-exploratório. Os dados foram coletados sem a realização de qualquer tipo de orientação ou treinamento prévio dos profissionais sobre lesão por pressão (LPP). Para seu desenvolvimento, foi utilizado o Pressure Ulcer Pieper Knowledge Test (PUKT), que é composto de 41 questões sobre avaliação, classificação e prevenção de lesões por pressão. Destas, 8 questões referem-se a avaliação e classificação da LPP e 33 questões sobre prevenção. Resultados: Participaram 102 enfermeiros, sendo 71 do sexo feminino e 31 do sexo masculino. A predominância de idade dos participantes foi de 30 a 39 anos. Quanto ao tempo de formado a maioria possui entre 2 a 5 anos de conclusão de curso e formação em Latu senso. Em relação aos resultados globais do teste, 70% (68.63%) dos enfermeiros acertaram menos de 70 % das questões, indicando um déficit de conhecimento na área. Conclusão: Diante dos resultados, identifica-se um déficit no conhecimento sobre a avaliação, classificação e prevenção de LPP, indicando a necessidade da educação permanente para atualização dos profissionais de enfermagem

Objective: to identify the level of nurses' knowledge on evaluation, prevention and classification of pressure ulcers in a hospital in Rio de Janeiro. Methods: This is a quantitative study with a descriptive-exploratory design. The data were collected without conducting any kind of orientation or training on pressure ulcer (LPP). For its development, the Pressure Ulcer Pieper Knowledge Test (PUKT) was used, which is composed of 41 questions about evaluation, classification and prevention of Pressure Ulcers. Of these, 8 questions refer to the evaluation and classification of the UPP and 33 questions are about prevention. Results: 102 nurses participated, 71 female and 31 male. The participants' predominance of age was 30 to 39 years. As for the time of training, the majority has between 2 to 5 years of conclusion of course and the majority has formation in Latu senso. Regarding the overall results of the test, 70% (68.63%) of nurses scored less than 70% of the questions, indicating a lack of knowledge in the area. Conclusion: In view of the results, a deficit in the knowledge about the evaluation, classification and prevention of LPP is identified, indicating the need for permanent education to update and improve nursing professionals

The Role of Biological Skin Substitutes in Stevens-Johnson Syndrome: Systematic Review.

Stevens-Johnson syndrome (SJS) is a disease that causes skin exfoliative lesions, characterized by fever, necrosis, and epidermal detachment. Biological skin substitutes may be considered interesting options for the treatment of this disease. This study aims at identifying in the literature the evidence on the current role of these biomaterials in the treatment of SJS and its related diseases. A systematic review with a search period between 2003 and 2017 was carried out, consulting the Lilacs, BVS, and PubMed databases. The quality of the included studies was evaluated by the Oxford Center for Evidence-Based Medicine Classification, for evaluating levels of evidence from the scientific publications. Ninety-five publications were found, and after applying inclusion and exclusion criteria, they resulted in 9 articles. In total, 20 patients with 73.87% average of body surface affected received SJS skin treatment with some biological substitutes, among them are cutaneous allograft, amnion, and xenograft. Mortality rate was 10%, and in these situations, literature indicates mortality rates ranging from 25% to 70%. Effectiveness of the use of biological dressings may be a possible explanation for this finding. Findings indicate the use of these biomaterials may favor reepithelialization, reduce water loss, decrease the chance of infection, and, consequently, improve the survival of patients with SJS and toxic epidermal necrolysis. Biological skin substitutes have characteristics that make them very promising in the topical treatment of these wounds, but their use remains very restricted in the treatment of SJS.

Effects of Hydrogel With Enriched Sodium Alginate in Wounds of Diabetic Patients.

Objective of this study was to evaluate the efficacy of the autolytic debridement promoted by hydrogel with sodium alginate enriched with fatty acids and vitamins A and E in the healing of foot wounds in diabetic patients. A clinical study was conducted at an outpatient clinic of medical specialties. The sample comprised 8 patients supervised for a 3-month period, from April to July 2017, by means of a clinical history, photographic record, planimetry, and classification of the wound severity by the Pressure Ulcer Scale for Healing (PUSH) system. Of the 8 patients supervised, 1 dropped out and 7 were followed up for 12 weeks. Only 2 had complete wound healing, but all presented a reduction of the lesion area of approximately 22.2% and PUSH score of 9.8 to 6.6. This study found that hydrogel showed good results for the treatment of diabetic feet, reducing the area and overall PUSH score of the wounds.

Manejo da dor em crianças queimadas: Revisão integrativa / Management of pain in burned children: An integrative review / Manejo del dolor en niños quemados: Revisión integrativa

A dor e o sofrimento estão associados com queimaduras, trazem efeitos fisiológicos e emocionais adversos, principalmente em crianças. O controle adequado da dor é um fator importante na melhora dos resultados clínicos. Este estudo tem como objetivo identificar na literatura os princípios ativos mais utilizados para a analgesia em crianças vítimas de queimaduras. Foi realizada uma revisão com um período de busca entre 2008 e 2018, consultando as bases de dados LILACS, Scielo e Medline/PubMed. Duzentas e vinte e cinco publicações foram encontradas e, após a aplicação dos critérios de inclusão e exclusão, 12 artigos relatavam os princípios ativos medicamentosos utilizados para analgesia em crianças queimadas. Os medicamentos mais encontrados foram paracetamol, morfina, ketamina, propofol, AINEs e fentanil. Os profissionais de saúde precisam reconhecer o significado da dor relacionada às crianças queimadas e estar atualizados sobre as várias opções farmacológicas disponíveis. Assim, ter aprofundamento sobre dosagem e via de administração, bem como o conhecimento com queimaduras pediátricas, pode romper barreiras para beneficiar o paciente com o início precoce da administração de analgésicos.

Pain and suffering are associated with burns, they bring adverse physiological and emotional effects mainly on children. Adequate pain control is an important factor in improving clinical outcomes. This study aims to identify in the literature the active principles most used for analgesia in children victims of burns. A review was conducted with a search period between 2008 and 2018, consulting the LILACS, Scielo and Medline / PubMed databases. Two hundred and twenty five publications were found and, after the application of the inclusion and exclusion criteria, 12 articles reported the active drug principles used for analgesia in burned children. The most commonly found drugs were paracetamol, morphine, ketamine, propofol, NSAIDs and fentanyl. Health professionals need to recognize the meaning of pain related to burned children and be up to date on the various pharmacological options available. Thus, having in-depth dosing and route of administration as well as knowledge with pediatric burns can break down barriers to benefit the patient with the early onset of analgesic administration.

El dolor y el sufrimiento están asociados con quemaduras, traen efectos fisiológicos y emocionales adversos principalmente en los niños. El control adecuado del dolor es un factor importante en la mejora de los resultados clínicos. Este estudio tiene como objetivo identificar en la literatura los principios activos más utilizados para la analgesia en niños víctimas de quemaduras. Se realizó una revisión con un período de búsqueda entre 2008 y 2018, consultando las bases de datos LILACS, Scielo y Medline / PubMed. Se encontraron doscientas veinticinco publicaciones y, después de la aplicación de los criterios de inclusión y exclusión, 12 artículos relataban los principios activos medicamentosos utilizados para la analgesia en niños quemados. Los medicamentos más encontrados fueron paracetamol, morfina, ketamina, propofol, AINES y fentanil. Los profesionales de la salud deben reconocer el significado del dolor relacionado con los niños quemados y estar al día sobre las diversas opciones farmacológicas disponibles. Así, tener profundización sobre dosificación y vía de administración, así como el conocimiento con quemaduras pediátricas pueden romper barreras para beneficiar al paciente con el inicio precoz de la administración de analgésicos.

Biological effects of amniotic membrane on diabetic foot wounds: a systematic review.

OBJECTIVE: The amniotic membrane has biological properties that are beneficial to the wound healing process of diabetic foot ulcers (DFU). Our aim is to analyse the scientific evidence found in literature on the use of the amniotic membrane to stimulate DFU healing. METHOD: A systematic review of amniotic membrane's influence was undertaken, using the search terms 'placenta' 'diabetic foot' 'amnion' and biological dressing', assessing the outcomes 'wound healing' and 'wound healing time', in DFU. Following the inclusion and exclusion criteria, randomised controlled trials (RCT) were identified, and the risk of bias was analysed according to the Cochrane risk of bias tool. We conducted a meta-analysis of the two outcomes to evaluate the level of evidence. RESULTS: We identified six clinical trials, with a total of 331 patients. The most common risks of bias in the studies were selection, attrition, and detection biases. From the meta-analysis, the difference of the intervention group (amnion) in relation to the control group was statistically significant. We found that wound healing in the group treated with amniotic membrane occurs 2.32 times more often and is 32 days faster in comparison with the group that used conventional dressings. CONCLUSION: There is no statistical evidence to support the effectiveness of amniotic membrane in comparison with other conventional dressings. However, there is a clear tendency for the use of amniotic membrane treatment to result in a larger number of DFUs healing at a quicker rate.

Use of Oxidized Regenerated Cellulose/Collagen Matrix in Chronic Diabetic Foot Ulcers: A Systematic Review.

OBJECTIVE: Diabetic wounds that do not heal completely usually exhibit inflammatory markers, increased protease activity, and reduced levels of growth factors and cell count. A systematic review was performed to determine whether there is enough evidence to support the use of an oxidized regenerated cellulose/collagen matrix (ORC+C) to treat diabetic foot ulcers (DFUs). METHODS: Study authors analyzed randomized controlled trials (RCTs) on ORC+C dressings for the treatment of DFUs. A literature search was conducted for all available reports of relevant studies published in journals indexed in PubMed, LILACS, and SciELO databases. There were no restrictions based on date of publication. A population-intervention-comparison-outcome framework was built on MeSH terms and keywords. Two independent researchers analyzed all articles for data collection and used the Cochrane Collaboration tool for risk-of-bias assessment. RESULTS: At first, 316 related studies were located in the databases. After evaluating these studies for methodological similarities, only 3 were considered eligible for the review. One RCT was considered at high risk of bias. Results from this meta-analysis of 2 studies showed no significant improvement in wound healing rates of DFUs when ORC+C was compared with standard wound care. CONCLUSIONS: Because of several methodology flaws in the reviewed studies, these results suggest that there is currently no research evidence to suggest that the use of ORC+C improves wound healing rates of DFUs. Additional research with high-quality RCTs focused on diabetic ulcers is necessary.

Estabelecimento de protocolo para armazenamento de pele autógena refrigerada / Establishment of a protocol for storage of refrigerated autologous skin

Introdução: Enxertos de pele autólogos são utilizados em tratamento de pacientes queimados. Esses enxertos podem ser armazenados e preservados, desde que o processo de armazenamento seja realizado com rígido controle de qualidade, para garantir a redução dos riscos de infecção. Métodos: Foi realizado um estudo de coorte retrospectivo na Unidade de Queimados do Hospital das Clínicas de São Paulo no período de fevereiro de 2015 a julho de 2016, em que foi estabelecido um protocolo para armazenamento de pele refrigerada com controle de coleta, preservação, embalagem e registro de todos os processos. Para garantia de qualidade, foram coletadas biópsias dos enxertos para microbiologia pré e pós-armazenamento e realizado um estudo transversal de prevalência de contaminação pré e pós-estocagem. Resultados: Os pontos críticos encontrados foram inadequação de embalagem, ausência de registros de processos, falta de coleta de biópsias para microbiologia e falhas no descarte. A maior parte das amostras estava contaminada tanto pré como pós-estocagem (84,2%). Apenas dois pacientes apresentaram microbiologia estéril no pré e contaminada no pós, porém foram encontrados germes da pele do tipo gram+. Conclusão: Foi estabelecido um método promissor de armazenamento de pele refrigerada que necessita alguns pequenos ajustes para adequação ao controle de qualidade.

Introduction: Autologous skin grafts are used for treatment of burn patients. These grafts can be stored and preserved, as long as the storage process is performed with strict quality control to reduce the risk of infection. Methods: A retrospective cohort study was conducted in the Burn Unit of the Hospital das Clínicas de São Paulo from February 2015 to July 2016. During this period, a protocol was established to store refrigerated skin, with control of collection, preservation, and packaging, and recording of all processes. To ensure quality, graft biopsies were collected for pre- and poststorage microbiology testing and a cross-sectional study for contamination was performed. Results: Critical deficiencies included inadequate packaging, lack of processing records, lack of biopsies for microbiology testing, and failure to discard specimens. Most of the samples were contaminated before and after storage (84.2%). Only two samples were sterile before storage but became contaminated after storage, with growth of Gram-positive skin bacteria. Conclusion: A promising method for the storage of refrigerated skin was established, but requires minor adjustments in quality control.

Perfil epidemiológico do doador de pele do Banco de Tecidos do Hospital das Clínicas da Universidade de São Paulo / Epidemiological characteristics of skin donors from São Paulo University Clinical Hospital / El perfil epidemiológico de los donantes de piel del Banco de tejidos del Hospital de las Clínicas de la Universidad São Paulo

OBJETIVO: Identificar o perfil epidemiológico dos doadores de pele do Banco de Tecidos do Hospital das Clínicas da Universidade de São Paulo. MÉTODO: Trata-se de um estudo documental, retrospectivo, transversal, com abordagem quantitativa de análise de prontuários de doadores de pele do Banco de Tecidos do Hospital das Clínicas de São Paulo, no período entre 2000 a 2015, para identificar as principais características epidemiológicas dos doadores de pele sendo analisadas por método estatístico descritivo. Inicialmente, foram encontrados 183 prontuários, porém 15 foram excluídos devido à falta de informações completas dos doadores. Aprovado pela Comissão de Ética para Análise de Projetos de Pesquisa do HCFMUSP (Nº CAAE 42751915.5.0000.0068). RESULTADOS: Entre os doadores pesquisados, houve predomínio do sexo masculino, com média de idade 43,3 anos, sendo a principal causa dos óbitos os acidentes cerebrais vasculares e causas externas. A retirada do tecido ocorre em geral entre 1 e 4 horas (76,1% dos casos) após a parada cardíaca. A maior parte recebeu antibioticoterapia (92,2%) e não apresenta comorbidades (81,54%). CONCLUSÃO: O doador de pele em geral é do sexo masculino, jovem e previamente hígido, sendo fundamental esta caracterização para o fortalecimento dos mecanismos de busca de doadores e aumento da oferta de tecidos no país.(AU)

OBJECTIVE: To identify the skin donors epidemiological profile from Clinical Hospital Tissue Bank. METHODS: This is a retrospective, cross-sectional documentary study with a quantitative approach to analysis medical records of skin donors from Clínicas' Hospital Tissue Bank, between 2000 and 2015, to identify the main epidemiological characteristics of skin donors, being analyzed by descriptive statistical method. Initially, 183 medical records were found, but 15 were excluded due to lack of complete donor information. Approved by the Ethics Committee for Analysis of Research Projects of HCFMUSP (CAAE No. 42751915.5.0000.0068). RESULTS: Among the donors surveyed, there was a predominance of males, with a mean age of 43.3 years, the main cause of death was cerebrovascular accidents and external causes. Tissue withdrawal usually occurs between 1 and 4 hours (76.1% of cases) after cardiac arrest. The majority received antibiotic therapy (92.2%) and was healthy (81.54%). CONCLUSION: The skin donor in general is male, young and previously healthy, and this characterization is fundamental for the strengthening of donor search mechanisms and an increase in the supply of tissues in Brazil.(AU)

Objetivo: Identificar el perfil epidemiológico de los donantes del Banco de Tejidos del Hospital das Clínicas de la Universidad de São Paulo. Método: Se realizó un estudio documental, retrospectivo, transversal, con un enfoque cuantitativo para el análises de las histórias clínicas de los donadores de piel del Banco de tejidos del Hospital das Clínicas de São Paulo, en el periodo de 2000 a 2015, para identificar las principales características epidemiológicas de los donantes de piel, siendo analisados popr método estadístico descriptivo. Inicialmente, se encontraron 183 registros, pero 15 fueron excluidos debido a la falta de información completa de los donantes. Aprobado por el Comité de Ética en Investigación (núm. CAAE 42751915.5.0000.0068). Resultados: Entre los donantes estudiados, hubo un predominio del sexo masculino, una edad media de 43,3 años, es la principal causa de muerte de los accidentes vasculares cerebrales y las causas externas. El tejido extraído es generalmente entre 1 y 4 horas (76,1% de los casos) después de un paro cardíaco. La mayoría recibió antibióticos (92,2%) y muestra comorbilidades (81,54%). Conclusión: La piel del donante es generalmente de sexo masculino, jóvenes y previamente sanos, siendo fundamental la caracterización para fortalecer los mecanimos de bísqueda de donadores y aumento de la oferta de tejidos en el país.(AU)

Assessment of health status of adolescent burn victims undergoing rehabilitation: a cross-sectional field study.

Teenagers may experience physiological and psychological changes when they suffer from a severe burn. The aim of this study was to assess the state of health of teenagers who were undergoing a rehabilitation process following a severe burn. A cross-sectional field study was carried out with 63 teenagers and young adults who had suffered burns. The tests applied were social, demographic, and clinical instruments. The specific tests included the Burn Specific Health Scale-Revised, Beck Depression Inventory, Rosenberg's Self-Esteem Scale, and Functional Independence Measurement. The results were analyzed by using descriptive statistics, multivariate analysis of variance, variance analysis, and Cronbach's reliability analysis. The social and demographic analysis of the population has shown a prevalence of female (60.3%), single subjects (93.7%), and ages between 12 and 20 years (mean age of 15.95 years). The mean total body surface area burn was 23.84%, with accidents as the main causative factor (92.10%). More than half (52.4%) reported functional and aesthetic effects after the burn, with 81% concerned about the visible scar. Cronbach's reliability analysis has shown statistically confident results for all the instruments as applied. The multivariate analysis showed a correlation between the work domain and marital status, whereas there was no evidence to show a correlation between sex, age, physical or aesthetic sequelae or visibility of burns, and depression, self-esteem, functional independence, or current state of health. The results obtained prove the reliability of the instruments applied, making it possible to assess the state of teenagers and young adults health during the rehabilitation process.