A comparison of two scar massage protocols in pediatric burn survivors.

The current evidence to support the use of massage for scar management is conflicting in the literature. The purpose of this study was to compare two scar massage protocols administered with pediatric burn survivors to determine if a more structured and standardized approach to scar massage could improve outcome. A retrospective review of the medical records of 100 children who received massage during the time period when two different protocols were implemented was conducted and data that was collected as part of the clinical exam regarding scar height, vascularity, pliability, itch and pain were extracted. Comparisons were made within subject for scar changes from baseline to follow up and between subjects receiving Protocol A and those receiving Protocol B for the same scar characteristics. Versions of the Vancouver Scar Scale were used to assess scars, while visual analogue scale, Itch Man Scale and Wong-Baker Faces Pain Scale were used to assess itch and pain. Results demonstrated improvements in itch and vascularity over time with both scar massage protocols. However, when comparing patients who received Protocol A to those who received Protocol B, there was no difference found in scar height, vascularity, pliability, itch or pain. Using commonly applied subjective scar assessment tools, we did not find clinically meaningful changes in scar characteristics with the implementation of a structured scar massage program compared to a general approach to massage. Further research is needed to better define the impact of massage on the recovery experience for burn survivors.

Radiofrecuencia pulsada para tratamiento de neuralgia de nervio pudendo bajo guía ultrasonográfica: a propósito de dos casos / Radiofrequency pulsed for treatment of neuralgia of nervio pudendo under ultrasonographic guide: a purpose of two cases

INTRODUCCIÓN: La neuralgia de nervio pudendo (NNP) se presenta como un dolor neuropático intenso, ardiente y difuso en la zona perineal, acompañado en ocasiones de hipoestesia, alodinia, hiperalgesia, sensibilidad dérmica, parestesia y entumecimiento que empeora el dolor en sedestación. Es un síndrome subdiagnosticado que, en ocasiones, se presenta refractario al tratamiento farmacológico y fisiátrico. OBJETIVOS: Evaluar la eficacia de la radiofrecuencia pulsada (RFP) guiada por ultrasonido para el tratamiento de dolor crónico, realizada a dos pacientes con NNP refractarios a tratamiento conservador. MATERIALES Y MÉTODO: Siendo positivo el bloqueo diagnóstico realizado con 0,5-1 ml de lidocaína al 2 por ciento, se practicó RFP bajo guía ecográfica a 2 pacientes (1 femenina de 36 años y 1 masculino de 54 años) con diagnóstico de NNP (según criterio de Nantes) y se realizó seguimiento a 1 semana y a 1 mes del procedimiento, observando la evolución del dolor mediante la utilización de la escala visual análoga (EVA), calidad de vida según lo informado en consulta y evolución en la ingesta y dosis de medicamentos. RESULTADOS: Luego del procedimiento la reducción del dolor fue significativa en ambos casos, en la paciente 1 (femenina) la EVA pasó de 10/10 (preoperatorio) a 1/10 a una semana del procedimiento y desapareció por completo al mes, retirándose en su totalidad la medicación indicada para la NNP. Asimismo, la paciente manifestó mejora en la calidad de vida, al no tener ya dolor durante el coito. Por su parte, en el paciente 2 (masculino), el dolor se redujo en un 50 por ciento registrándose un EVA que pasó de 8/10 (preoperatorio) a 4/10 a la semana y al mes de realizado el procedimiento. En su caso, al no haber desaparecido por completo el dolor, continuó tomando la medicación indicada (duloxetina 30 mg) y refirió poder sentarse con comodidad, ya sin el dolor intenso que lo aquejaba en esta posición, pudiendo incluso realizar un viaje de larga distancia. DISCUSIÓN: La RFP es un procedimiento efectivo en aquellos pacientes correctamente diagnosticados de neuralgia del nervio pudendo según el criterio de Nantes, refractarios a tratamiento farmacológico y/o fisioterápico, practicada por profesionales con entrenamiento y/o experiencia en la técnica de radiofrecuencia pulsada así como en el manejo de ultrasonido para ubicar sonoanatómicamente el nervio pudendo, en un ámbito seguro para la realización del procedimiento.

INTRODUCTION: The pudendal neuralgia is presented as a neurophatic pain that is intense, burning, difusse in the perineal area, sometimes accompanied by hypoesthesia, allodynia, hyperalgesia, dermal sensitivity, paresthesia and numbness that worsens by sitting. It ́s a syndrome underdiagnosed that can sometimes be refractory to traditional management like pharmacological or physical therapy. OBJECTIVES: Test the effectiveness of pulsed radiofrecuency by ultrasound-guided treatment of cronic pain done to two patients with pudendal neuralgia that were refractory to the conservative treatment. MATERIALS AND METHODS: As the diagnostic block done with 0,5-1 ml with 2 percent of lidocaine gave a positive outcome, we perform a pulsed radiofrecuency by an ultrasound-guide to two patients (36 year old female and a 54 year old male) with pudendal neuralgia diagnosted according to Nantes criteria and a tracing of 1 week and 1 month of the procedure was performed observing the pain evolution through visual analogue scale, quality of life according to the as reported in consultation and evolution in the intake and dose of medications. RESULTS: The reduction of pain was significant in both cases, in patient 1 (female) the VAS went from 10/10 (preoperative) to 1/10 to a week of the procedure and disappeared completely to 1 month, with the medicines completely withdrawn indicated for pudendal neuralgia. The female patient (1) showed improvement in the quality of life by not having pain during intercourse. On the other hand, in patient 2 (male), the pain was reduced by 50 percent, registering an EVA that went from 8/10 (preoperative) to 4/10 to 1 week and 1 month after the procedure was performed. In his case, since the pain had not completely disappeared, he continued to take the indicated medication (duloxetine 30 mg) and referred to be able to sit comfortably, without the intense pain that afflicted him in this position, even being able to travel long distances. DISCUSSION: Pulsed radiofrequency is an effective procedure in those patients correctly diagnosed with pudendal neuralgia according to the Nantes criterion, refractory to pharmacological and / or physiotherapeutic treatment, practiced by professionals with training and / or experience in the pulsed radiofrequency technique as well as in the management of ultrasound to locate the pudendal nerve sonoanatomically, in a safe environment for carrying out the procedure.

The Psychological Impact of First Burn Camp in Nicaragua.

Asociacion Pro-Ninos Quemados de Nicaragua (APROQUEN) is a comprehensive burn center that provides a holistic and integrated approach to treating burns. APROQUEN has set the standards internationally with acute treatment for burns, intensive care, reconstructive surgeries, nutritional care, rehabilitation, occupational therapy, and psychological treatment. APROQUEN is excelling within Central and South America with life-saving techniques and quality of care. It is imperative that burn centers in Central America recognize that the treatment of a child with a burn injury surpasses physical care to include psychological treatment for the complete well-being of the child. It is necessary to provide the tools necessary to reintegrate the child back into their environment. APROQUEN developed and implemented the first burn camp in Latin America, "Confio en Mi" (I trust myself). The camp theme focused on self-esteem. The camp program included theory (educational) and practice (applied) components where the campers through "classroom type" activities had the opportunity to reflect and share with other campers and camp staff on self-esteem, depression, and anxiety. Participants were children who survived major burns (N = 33; 58% women; ages 12-25; 61% <18) and were shown to have difficulty socializing. Comprehensive interviews were conducted to ensure fit for camp. Forty-two percent of the campers had not slept away from home since the burn injury. Mean TBSA = 20% and mean age at time of burn injury was 13. The majority of campers (46%) endured flame burn injuries, with 24% having scald injuries. Mean years postburn = 4.8 + 3.2. Most campers (40%) were enrolled in secondary school, 30% in elementary school, and 21% in college. Standardized measures (CDI-2 Parent Form and Child Form, Rosenberg Scale, APROQUEN Burn Camp Measure Parent and Child Form, Beck Anxiety Inventory, and Beck Depression Inventory) were given to all campers prior to attending camp. The same measures were given 2 weeks after the camp and again at 6 months. Paired samples' t-tests were conducted and significance was set at P <.05. The results indicate that Camp Confio en Mi had a significant impact on campers' level of anxiety, depression, and self-esteem. Future burn camps are an important part of the continued advancement of postpediatric burn care in Nicaragua. This study reveals the importance of future researches necessity to focus on generalizing the results of this study to other children who have experienced similar burn injuries.

Casos clinicos: sindrome de bilis simulando quiste de Colédoco / Clinical cases: bile syndrome mimicking choledochal cyst

Se presenta el caso clínico de un niño de 33 días de vida con síndrome de bilis espesa que simuló ser un quistedel colédoco. Se hace énfasis en el diagnóstico diferencial de la colestasis neonatal y de la observación meticulosadel cuadro clínico.

Estudio del proceso de decolaracion de jarabe de azucar con carbon activado

Se desarrolla un modelo matematico para describir el proceso de decolaracion de jarabe de azucar por adsorcion con carbon activado en polvo en tanque agitado, basandose en los fenomenos fisicoquimicos y de transporte que intervienen en el. Asimismo por medio de experimentacion se obtienen los coeficientes yconstantes que requiere el modelo, presentandose los resultados como instrumento de mejoramiento para la industria de bebidas gaseosas.