Primeiro atendimento em queimaduras: a abordagem do dermatologista

Toward a Platform for the Treatment of Burns: An Assessment of Nanoemulsions vs. Nanostructured Lipid Carriers Loaded with Curcumin

Curcumin is a highly promising substance for treating burns, owing to its anti-inflammatory, antioxidant, antimicrobial, and wound-healing properties. However, its therapeutic use is restricted due to its hydrophobic nature and low bioavailability. This study was conducted to address these limitations; it developed and tested two types of lipid nanocarriers, namely nanoemulsions (NE-CUR) and nanostructured lipid carriers (NLC-CUR) loaded with curcumin, and aimed to identify the most suitable nanocarrier for skin burn treatment. The study evaluated various parameters, including physicochemical characteristics, stability, encapsulation efficiency, release, skin permeation, retention, cell viability, and antimicrobial activity. The results showed that both nanocarriers showed adequate size (~200 nm), polydispersity index (~0.25), and zeta potential (~>-20 mV). They also showed good encapsulation efficiency (>90%) and remained stable for 120 days at different temperatures. In the release test, NE-CUR and NCL-CUR released 57.14% and 51.64% of curcumin, respectively, in 72 h. NE-CUR demonstrated better cutaneous permeation/retention in intact or scalded skin epidermis and dermis than NLC-CUR. The cell viability test showed no toxicity after treatment with NE-CUR and NLC-CUR up to 125 μg/mL. Regarding microbial activity assays, free curcumin has activity against P. aeruginosa, reducing bacterial growth by 75% in 3 h. NE-CUR inhibited bacterial growth by 65% after 24 h, and the association with gentamicin had favorable results, while NLC-CUR showed a lower inhibition. The results demonstrated that NE-CUR is probably the most promising nanocarrier for treating burns.

The impact of social isolation by COVID-19 on the epidemiological and clinical profiles of the burn patients. A retrospective study

BACKGROUND

Social isolation, imposed by the COVID-19 pandemic, may imply changes in the clinical-demographic and epidemiological profiles of burn trauma victims.

OBJECTIVE

Evaluate the changes in the epidemiological profile of patients with burns that resulted in hospitalization during the social isolation period due to the COVID-19 pandemic, comparing with the same period in the previous year.

METHODS

The medical records of burn patients who were hospitalized in our Burn Center during the local confinement period (March 18th to August 31st, 2020) and during the same period in 2019 were analyzed. Data on demographic, clinical and hospitalization aspects were studied.

RESULTS

470 patients were evaluated. In the pediatric population, a significant increase in the number of cases up to 2 years old (P = 0.0003), median of %TBSA (P = 0.037), full-thickness burns (P < 0.0001), involvement of hands (P = 0.024), debridement (P = 0.046) and grafting (P = 0.032) procedures, and higher scores of severity (P < 0.0001) were noted. In the adult population, it was only observed an increase in the burn-hospitalization interval (P = 0.029).

CONCLUSION

The pediatric population was heavily impacted by the imposed period of social isolation, presenting a greater severity of burns. In contrast, the epidemiology of burns for the adult population was slightly altered during the pandemic period.

Therapy for patients with burns - an integrating review

OBJECTIVE

to identify, through an integrative review, national studies published over the last ten years highlighting products and therapies used in burns.

METHODS

integrative research with studies published in the last ten years. Including clinical studies describing the use of the already established or innovative therapies in burns and the results obtained, published in national journals in the last ten years. Excluding articles published before 2007 and those that did not present results regarding the use of products in burns.

RESULTS

ten articles that met the inclusion criteria were selected. Collagenase, 1% silver sulfadiazine, and porous cellulose membrane were some of the therapies cited.

CONCLUSION

the casuistry was low; however, the good results obtained with porous cellulose membrane and silver nanocrystalline dressing are highlighted, since they were used in a larger number of patients in the studies evaluated.

LED phototherapy in full-thickness burns induced by CO2 laser in rats skin

Many studies have been conducted on the treatment of burns because they are important in morbidity and mortality. These studies are mainly focused on improving care and quality of life of patients. The aim of this study was evaluate the LED phototherapy effects in rats skin full-thickness burns induced by CO₂ laser. The animals were divided in NT group that did not received any treatment and LED group that received LED irradiation at 685 nm, 220 mW, and 4.5 J/cm² during 40 s by burned area. Biopsies were obtained after 7, 14, and 21 days of treatment and submitted to histological and immunohistochemical analysis. The LED phototherapy shows anti-inflammatory effects, improves angiogenesis, and stimulates the migration and proliferation of fibroblasts. The T CD8+ lymphocytes were more common in burned areas compared to T CD4+ lymphocytes since statistically significant differences were observed in the LED group compared to the NT group after 7 days of treatment. These results showed that LED phototherapy performs positive influence in full-thickness burns repair from the healing process modulated by cellular immune response. The obtained results allowed inferring that burns exhibit a characteristic cell immune response and this cannot be extrapolated to other wounds such as incision and wounds induced by punch, among others.

Effects of red laser, infrared, photodynamic therapy, and green LED on the healing process of third-degree burns: clinical and histological study in rats

The aim of this study was to evaluate the effects of red laser, infrared, photodynamic therapy, and green light-emitting diode (LED) on the healing process of skin burns through clinical and histopathologic analysis in rats. For this, 100 animals were randomly divided into five groups: G1-untreated control (CTR), G2-red laser (LVER), G3-infrared (LINF), G4-photodynamic therapy (PDT), and G5-green LED. Burn was induced on the dorsum of the rat and the treatment of the experimental groups was red light (10 J/cm(2), 10 s, 40 mW, and λ660 nm), infrared (10 J/cm(2), 10 s, 40 mW, and λ780 nm), green LED irradiation (60 J/cm(2), 10 s, λ520, and 550 nm), and photodynamic therapy (10 J/cm(2), 40 mW, and λ660 nm), the latter combined with methylene blue photosensitizer at concentration 0.5 μg/mL. Applications were performed daily until day prior to sacrifice of the animal at 3, 7, 14, and 21 days with intraperitoneal anesthetic overdose. The specimens collected were clinically examined and soon after processed and stained with hematoxylin-eosin and Picrosirius for analysis under light and polarized light microscopy, respectively. Animals treated with LVER, LINF, PDT (p < 0.001), and LED (p < 0.05) stimulated production and maturation of collagen, and increased the consumption of food and water compared to the CTR (p < 0.001). Laser λ660 nm and λ780 nm showed the largest wound reductions in all groups (p = 0.001). In conclusion, red laser, infrared, photodynamic therapy, and green LED favored the healing process of third-degree burns in rats.

[Profile of children and adolescents admitted to a Burn Care Unit in the countryside of the state of São Paulo]

OBJECTIVE

To describe the profile of pediatric burn victims hospitalized at Hospital-Escola Padre Albino (HEPA), in Catanduva, São Paulo, Brazil.

METHODS

This was a cross-sectional, retrospective study analyzing 446 medical records of patient aged 0-18 years old hospitalized in the Burn Care Unit of HEPA, from 2002 to 2012. The following variables were recorded: demographic data, skin burn causes, lesions characteristics, complications, surgical procedures, length of hospital stay, and outcome. Descriptive statistics were used.

RESULTS

382 patients with full medical records were included in the study. Burns were more frequent in males (64.4%) and in children aged less than 6 years (52.9%). Most accidents occurred at home (67.3%) and hot liquids were responsible for 47.1% of them. Mean burnt body surface was 18% and the most affected body areas were chest and limbs. First- and second-degree burns were observed in 64.4% of the cases. Secondary infection and surgical procedures occurred in 6.5% and 45.0% of the patients, respectively. Mean length of hospital stay was 9.8 days. The mortality rate was 1.6%.

CONCLUSIONS

Preschool children were the main victims of burns occurring at home, representing the largest contingent of hospitalizations due to this cause in individuals aged < 18 years. It is important to develop strategies to alert parents and general society through educational programs and preventive campaigns.

Assessment of the quality of life of pediatric patients with the major chronic childhood skin diseases

BACKGROUND

The skin is the primary interface of the human being with the external environment and the presence of skin diseases can have substantial effects on the quality of life.

OBJECTIVE

This study aims to make a comparative evaluation of the quality of life of pediatric patients with atopic dermatitis, psoriasis and vitiligo and correlate the findings with the total body surface and the areas with the disease exposed to view.

METHODS

The sample consisted of 118 patients with atopic dermatitis, vitiligo and psoriasis, aged between 5 and 16 years, who were asked to answer the Children's Dermatology Life Quality Index (CDLQI) questionnaire. A dermatological examination for the measurement of total body surface affected by the disease was performed.

RESULTS

The three groups showed an impaired quality of life. Patients with atopic dermatitis and psoriasis showed a significantly greater impact on the QoL than the group with vitiligo. There is a trend towards impaired quality of life in patients from the three groups of dermatoses, which is related to increments in both the total affected area and affected area exposed to view (r = 0.428 and p <0.001, r = 0.381 and p <0.001, respectively).

CONCLUSION

The assessed children had impaired quality of life. However, there is a significantly greater impact in the groups with atopic dermatitis and psoriasis than in the group with vitiligo. This may be due to lack of symptoms in vitiligo and the fact this group presented a statistically smaller affected body surface than the other two groups.

Anti-inflammatory effect of low-intensity laser on the healing of third-degree burn wounds in rats

Third-degree burn wounds are considered severe injuries because they destroy all the skin layers and may affect subcutaneous tissues, fasciae, muscles, and bones. To favor the healing process of the injured tissues, it is very useful to diminish the occurrence of the inflammatory process. The present study was aimed at comparing the effect of different energetic densities of AlGaInP laser on the inflammatory process and in the healing of third-degree burn wounds in Wistar rats. This study was approved by the Ethics Committee, in which 36 adult male rats were selected and suffered the induction of third-degree burn injury. These rats were divided as follows: group 1-control (treated with silver sulfadiazine), group 2-received energy density of 3 J/cm(2), and group 3-received energy density of 6 J/cm(2). All animals daily received an occlusive bandage with silver sulfadiazine and 8 % papain. The laser therapy was performed alternatively three times a week. The animals were evaluated on the 3rd, 7th, 14th, and 21st days after the initial lesion and euthanized for the macroscopic, histologic, and morphometric analysis. A higher production of collagen was observed at 7 days and a greater re-epithelialization at 21 days in group 3 (6 J/cm(2)). Furthermore, the latter when compared to the other groups presented macroscopically a better aspect of the scar at 21 days with more granulation tissue and fibrosis. We conclude that the AlGaInP laser used in dosages of 3 and 6 J/cm(2) favors the healing of third-degree burn wounds induced in rats.

Development of animal model for studying deep second-degree thermal burns

Thermal lesions were produced in 12 male Wistar rats, positioning a massive aluminum bar 10 mm in diameter (51 g), preheated to 99°C ± 2°C/10 min. on the back of each animal for 15 sec. After 7, 14, 21, and 28 days, animals were euthanized. The edema intensity was mild, with no bubble and formation of a thick and dry crust from the 3rd day. The percentage of tissue shrinkage at 28 days was 66.67 ± 1.66%. There was no sign of infection, bleeding, or secretion. Within 28 days reepithelialization was incomplete, with fibroblastic proliferation and moderate fibrosis and presence of modeled dense collagen fibers. It is concluded that the model established is applicable in obtaining deep second-degree thermal burns in order to evaluate the healing action of therapeutic agents of topical use.

Percepções da equipe de enfermagem sobre seu trabalho em uma unidade de queimados

O objetivo do estudo foi analisar a percepção dos profissionais de enfermagem sobre o seu trabalho em uma Unidade de Tratamento ao Queimado de um hospital público no Rio Grande do Sul. Trata-se de um estudo com abordagem qualitativa, desenvolvido a partir de entrevistas semi-estruturadas com 20 profissionais da equipe de enfermagem. A análise dos dados possibilitou a emergência de três categorias: O significado de trabalhar em uma Unidade de Tratamento ao Queimado; Dificuldades enfrentadas no cotidiano do trabalho; Estratégias utilizadas pela enfermagem no exercício do trabalho. Conclui-se que é dever das instituições, onde as Unidades de Tratamento ao Queimado estão locadas, proporcionar espaços de apoio psicológico no atendimento às demandas dos profissionais que prestam assistência às vítimas de trauma térmico. Às instituições de ensino, enfatiza-se a necessidade de dar maior ênfase a essa área durante a formação dos futuros profissionais.

Evaluation of the effects of polarized light (λ400-200 nm) on the healing of third-degree burns in induced diabetic and nondiabetic rats

OBJECTIVE

The study evaluated, by light microscopy, the repair process on third-degree burns on diabetic and nondiabetic rats, illuminated or not, with a polarized light (PL) source.

BACKGROUND DATA

Burns are severe injuries that result in the loss of fluid and destruction of tissue, infection, and shock that may result in death. Diabetes mellitus is a public health problem that, being uncontrolled, causes severe disturbance to the body metabolism, including on wound healing. PL sources have been shown to be effective in improving healing in many situations.

MATERIALS AND METHODS

Ninety male Wistar rats were divided into two groups (n=45): nondiabetic and diabetic. In one of the groups, diabetes mellitus was induced by streptozotocin. A third-degree burn, measuring 1.5×1.5 cm(2), was created in the dorsum of each animal. Phototherapy (λ400-2000 nm, 10.2 or 20.4 J/cm(2)) started immediately after burning and was repeated daily until animal death (7, 14, and 21 days). Specimens were taken, processed, and stained with H&E and Sirius red and immunomarked with cytokeratin (CK) AE1/AE3. Descriptive analysis was performed by light microscopy.

RESULTS

Animals subjected to phototherapy showed an acceleration of the repair, the dose of 10.2 J/cm(2) being the one that caused best results, including higher deposition of collagen, quicker inflammatory reaction, and improved revascularization.

CONCLUSIONS

Our results suggest that the use of PL (10.2 J/cm(2)) improves the healing of third-degree burns on both diabetic and nondiabetic animals.

[Clinical and epidemiological aspects of burned patients hospitalized in a teaching hospital]

The objectives of this study were to characterize burned patients according to epidemiological and clinical variables and identify the treatments, invasive procedures and complications. This is a retrospective, descriptive and quantitative study. The sample consisted of 138 burned patients hospitalized in a teaching hospital from January 2003 to December 2007, in Uberaba-MG. Of the 138 hospitalized patients, 98 (71.0%) were male, and the average age was 26.1 years. The average length of stay was 16.2 days; 93 (67.4%) of the burns were caused by accidents and the main cause (68; 49.3%) was an open flame. The average burned body surface was 20.8% and most (122; 88.4%) had second degree burns. The most common topic treatment (93; 67.4%) was silver sulfadiazine. Forty-seven (34.0%) patients had indwelling catheters; 30 (21.7%) underwent tissue transplantation, and 28 (20.3%) underwent debridement; the lesions in 14 (10.1%) patients became infected.

Desgaste da equipe de enfermagem no centro de tratamento de queimados

OBJETIVO: Descrever como as percepções sensoriais da equipe de enfermagem apontam para compreensão do desgaste amplo dos sentidos durante os cuidados prestados. MÉTODOS: Estudo qualitativo, baseado nos princípios da sociopoética e no dispositivo do grupo pesquisador, a partir de dinâmicas de criatividade e sensibilidade. No primeiro período de 2008, participaram do estudo11 profissionais de enfermagem de um hospital municipal do Rio de Janeiro. RESULTADOS: A partir dos conceitos de desgaste mental, de Seligmann-Silva, e dos sentidos corporais de Araújo, observou-se que os efeitos da visão e da audição desgastam emocionalmente a equipe. O tato, durante o desbridamento, sinalizou cansaço físico/psíquico. O maior desgaste é gerado pela mazela social, relacionada com as causas das queimaduras. CONCLUSÕES: A equipe de enfermagem, utilizando estratégias defensivas, reduz o desgaste psíquico e o sofrimento durante o cuidado prestado. A pesquisa proporcionou repensar o cuidado através de subjetividades da equipe.

Processo de cuidar da criança queimada: vivência de familiares

Este estudo teve o objetivo de descrever a vivência de familiares no cuidado da criança que sofreu queimadura. Foi realizado um estudo exploratório, em um hospital de emergência na cidade de João Pessoa - PB, com dez acompanhantes de crianças hospitalizadas, vítimas de queimadura. Os resultados mostraram que os agentes térmicos foram os maiores causadores das queimaduras nas crianças. O discurso dos participantes revela que a maioria dos acidentes ocorreu na presença do cuidador, menciona algumas condutas erradas após a ocorrência do acidente e alguns consideram a experiência de cuidar da criança queimada como negativa, o que evidencia a necessidade de orientação da população em geral e a participação no cuidar da criança queimada.

The use of light photobiomodulation on the treatment of second-degree burns: a histological study of a rodent model

OBJECTIVE

The aim of this investigation was to compare, by light microscopy, the effects of the use of laser photobiomodulation (LPBM) and polarized light (PL) on second-degree burns on rodents.

BACKGROUND DATA

Burns are severe injuries that result in the loss of tissue fluids, destruction of tissues, infection, and shock. With severe and widespread third-degree burns death may occur. Several light sources have been suggested as being effective for improving wound healing.

MATERIALS AND METHODS

Forty five rats were used in this study. A second-degree burn was created on the dorsum of each animal, and the animals were divided into four groups: PL (400-2000 nm, 40 mW, 2.4 J/cm(2)/min); LPBM-1 (780 nm, 35/40 mW, theta approximately 2 mm, 4 x 5 J/cm(2)); LPBM-2 (660 nm, 35/40 mW, theta approximately 2 mm, 4 x 5 J/cm(2)); and untreated animals acted as controls. The treatment was started immediately post-burn at four points around the burned area (laser: 5 J/cm(2) per site). The illumination with PL was performed according to the manufacturer's instructions. Treatments were repeated at 24-h intervals for 7 d. The animals were sacrifice at 3, 5, and 7 d post-burn. The specimens were routinely cut and stained and analyzed by light microscopy using hematoxylin and eosin and Sirius red.

RESULTS

The analysis of the results demonstrated that the damaged tissue was able to efficiently absorb and process the light at all tested wavelengths. LPBM at 660 nm showed better results at early stages of wound healing. However, the use of 780-nm laser light had beneficial effects throughout the experimental period, with the animals growing newly-formed tissue similar to normal dermis.

CONCLUSION

Despite our findings that the use of both types of light energy improved the healing of second-degree burns at the early stages, long-term assessment is needed to verify if this improvement will influence the final results of treatment.