Análisis del efecto de la fisioterapia temprana en la recuperación funcional de pacientes con quemaduras en miembros inferiores / Analysis of the effect of early physiotherapy on the functional recovery of patients with burns on lower limbs

Introducción: La recuperación de las actividades de la vida diaria de los pacientes quemados depende de una atención oportuna y eficaz, incluyendo la rehabilitación física. Objetivo: Evaluar la efectividad funcional de la rehabilitación temprana en pacientes con quemaduras en miembros inferiores. Métodos: Este es un estudio retrospectivo, longitudinal, observacional y analítico en el cual se evaluó la asociación que existe entre el número de sesiones de fisioterapia y diferentes variables de desenlace relacionadas con la funcionalidad del paciente quemado de miembros inferiores. Se realizaron de manera secuencial análisis uni-, bi- y multivariados para conocer las características de distribución en el primero, y la significación estadística en el segundo y tercero. Resultados: La información derivada de 32 pacientes que cumplieron con los criterios del estudio reveló una asociación simple entre la recuperación de los arcos de movilidad, sedestación, bipedestación y marcha con el número de sesiones de fisioterapia, sin que se favorezca la fuerza muscular. El análisis multivariado evidenció una correlación positiva entre el número de sesiones de fisioterapia y la sedestación, pero negativa cuando se asoció la ventilación mecánica con la bipedestación/marcha asistida. Conclusión: La aplicación de fisioterapia temprana contribuye directamente con la recuperación funcional del paciente quemado; sin embargo, es indispensable considerar que el estado catabólico de los individuos entorpece el progreso motriz

Introduction: Recovery of activities of daily living in burn patients depend on timely and effective care, including physical rehabilitation. Aim: To evaluate functional activity in lower limb burn patients after early rehabilitation. Methods: A retrospective, longitudinal, and analytic trial was conducted in order to assess the association between the number of physiotherapy sessions and the functional outcome in lower limb burn patients. Uni-, bi-, and multivariate analyses were performed in order to determine the distribution characteristics of the sample, and any significant association between variables. Results: After a review of data from 32 patients that fulfilled trial enrolment criteria, a simple association was shown between complete joint motion, sitting position, standing and walking vs. the number of physiotherapy sessions, but failed to maintain or improve muscle strength. Multivariate analysis demonstrated a positive correlation between the number of physiotherapy sessions and sitting position, but a negative one when mechanical ventilation was related to standing/walking. Conclusion: The early administration of physiotherapy helps in the functional recovery of burn patients; nevertheless it is critical to consider that catabolic processes impair motion

A novel hydrogel of poloxamer 407 and chitosan obtained by gamma irradiation exhibits physicochemical properties for wound management.

Application of polymers cross-linked by gamma irradiation on cutaneous wounds has resulted in the improvement of healing. Chitosan (CH) and poloxamer 407 (P407)-based hydrogels confer different advantages in wound management. To combine the properties of both compounds, a gamma-irradiated mixture of 0.75/25% (w/w) CH and P407, respectively, was obtained (CH-P), and several physical, chemical, and biological analyses were performed. Notably, gamma radiation induced changes in the mixture's thermal behavior, viscosity, and swelling, and exhibited stability at neutral pH. The thermal reversibility provided by P407 and the bacteriostatic effect of CH were maintained. Mice full-thickness wounds treated with CH-P diminished the wound area during the first days. Consequently, with this treatment, increased levels of macrophages, α-SMA, and collagen deposition in wounds were observed, indicating a more mature scar tissue. In conclusion, the new hydrogel CH-P, at physiologic pH, combined the beneficial characteristics of both polymers and produced new properties for wound management.

Subcutaneous administration of collagen-polyvinylpyrrolidone down regulates IL-1beta, TNF-alpha, TGF-beta1, ELAM-1 and VCAM-1 expression in scleroderma skin lesions.

In this study the effect of collagen-polyvinylpyrrolidone (collagen-PVP) vs. triamcinolone acetonide (Triam) in scleroderma (SSc) skin lesions was evaluated. Ten SSc patients were treated weekly with subcutaneous injections of 0.2 mL Triam (8 mg/mL) or 0.2 mL collagen-PVP (1.66 mg collagen). Skin biopsies were obtained from lesions before and after treatment. Tissue sections were evaluated by histology and immunohistochemistry (ELAM-1, VCAM-1, IL-1beta, TNF-alpha, TGF-beta1 and PDGF). The corticoid-treated group showed abnormal tissue architecture while the biodrug-treatment restored cutaneous appendages and type I/III collagen proportion. Cytokine and adhesion molecule expression was almost inhibited with Triam, while collagen-PVP down-regulated it. Collagen-PVP improved the tissue architecture of SSc lesions and down-regulated some proinflammatory parameters, without the side effects induced by corticoids.