Jefferson Lessa Soares de Macedo

Bacterial and fungal colonization of burn wounds

A prospective study of fungal and bacterial flora of burn wounds was carried out from February 2004 to February 2005 at the Burns Unit of Hospital Regional da Asa Norte, Brasília, Brazil. During the period of the study, 203 patients were treated at the Burns Unit. Wound swab cultures were assessed at weekly intervals for four weeks. Three hundred and fifty four sampling procedures (surface swabs) were performed from the burn wounds. The study revealed that bacterial colonization reached 86.6% within the first week. Although the gram-negative organisms, as a group, were more predominant, Staphylococcus aureus (28.4%) was the most prevalent organism in the first week. It was however surpassed by Pseudomonas aeruginosa form third week onwards. For S. aureus and P. aeruginosa vancomycin and polymyxin were found to be the most effective drugs. Most of the isolates showed high level resistance to antimicrobial agents. Fungi were found to colonize the burn wound late during the second week postburn, with a peak incidence during the third and fourth weeks. Species identification of fungi revealed that Candida tropicalis was the most predominant, followed by Candida parapsilosis. It is crucial for every burn institution to determine the specific pattern of burn wound microbial colonization, the time-related changes in the dominant flora, and the antimicrobial sensitivity profiles. This would enable early treatment of imminent septic episodes with proper empirical systemic antibiotics, without waiting for culture results, thus improving the overall infection-related morbidity and mortality.

Sepsis in burned patients

A prospective study was conducted from June 2001 to May 2002 at the Burns Unit of Hospital Regional da Asa Norte, Brasília, Brazil. During the period of the study, 252 patients were treated at the Burns Unit, 49 (19.4%) developed clinically and microbiologically proven sepsis. Twenty-six (53.1%) were males and 23 (46.9%) females with a mean age of 22 years (range one to 89 years) and mean burned body surface area of 37.7 +/- 18.4% (range 7 to 84%). Forty-three patients had flame burns, five a scald and one an electric burn. These 49 patients had a total of 62 septic episodes. Forty (81.6%) patients had only one and nine (18.4%) had up to three episodes of sepsis. Thirty (61.2%) patients had their first septicemic episode either earlier or by one week postburn. Out of 62 septic episodes, 58 were due to bacteria and four due to Candida sp. The most common bacteria isolated from blood culture were Staphylococccus aureus, coagulase-negative Staphylococcus, Acinetobacter baumannii, Enterobacter cloacae and Klebsiella pneumoniae. Eleven (18.9%) episodes were due to oxacillin resistant Staphylococcus aureus. Acinetobacter baumannii was sensitive to ampicillin/sulbactam in 71.4% and to imipenem in 85.7% of the cases. The primary foci of sepsis were the burn wound in 15 (24.2%) episodes. The most common clinical findings of sepsis in these patients were fever, dyspnea, hypotension and oliguria. The most common laboratory findings of these patients were anemia, leukocytosis, hypoalbuminemia and thrombocytopenia. Twelve (24.5%) patients died. The appropriate knowledge of clinical, epidemiological, laboratorial and microbiological aspects of sepsis in burned patients permits an adequate diagnosis and treatment of this complication.

Predictive factors of mortality in burn patients

Burn mortality statistics may be misleading unless they account properly for the many factors that can influence outcome. Such estimates are useful for patients and others making medical and financial decisions concerning their care. This study aimed to define the clinical, microbiological and laboratorial predictors of mortality with a view to focus on better burn care. Data were collected using independent variables, which were analyzed sequentially and cumulatively, employing univariate statistics and a pooled, cross-sectional, multivariate logistic regression to establish which variables better predict the probability of mortality. Survivors and non-survivors among burn patients were compared to define the predictive factors of mortality. Mortality rate was 5.0%. Higher age, larger burn area, presence of fungi in the wound, shorter length of stay and the presence of multi-resistant bacteria in the wound significantly predicted increased mortality. The authors conclude that those patients who are most apt to die are those with age > 50 years, with limited skin donor sites and those with multi-resistant bacteria and fungi in the wound.As estatisticas de mortalidade em queimaduras podem ser incompletas se nao levarem em consideracao varios fatores que podem influenciar o obito. Tradicionalmente, apenas a extensao da queimadura e a idade do paciente tem sido usadas como preditores de mortalidade em vitimas de queimaduras. Estas estimativas sao uteis na assistencia aos pacientes, interferindo em decisoes medicas e financeiras no cuidado desses doentes. O objetivo desse estudo foi definir os preditores clinicos, microbiologicos e laboratoriais de mortalidade em pacientes queimados. Os autores realizaram uma analise univariada e multivariada de varias variaveis independentes para determinar os fatores preditivos de mortalidade em queimados. A taxa de mortalidade foi de 5,0%. A idade mais avancada, a extensao das queimaduras, a presenca de fungo na ferida queimada e a presenca de bacteria multiresistente na ferida foram os fatores que mais aumentaram significativamente a mortalidade em pacientes queimados. Os autores concluem que os pacientes com maior probabilidade de obito sao os pacientes com idade superior a 50 anos, com queimaduras extensas, presenca de fungo e bacteria multiresistente na ferida.

Perfil epidemiológico do trauma de face dos pacientes atendidos no pronto socorro de um hospital público

RESUMO: Objetivo: Avaliar os dados epidemiologicos e a localizacao dos traumas de face de pacientes atendidos no Hospital Regional da Asa Norte (HRAN), Brasilia, Distrito Federal. Metodo: Trata-se de um estudo retrospectivo, realizado no pronto socorro do HRANDF, visando avaliar o perfil epidemiologico dos pacientes atendidos pela equipe da Unidade de Cirur gia Plastica vitimas de trauma de face no periodo de 1 de janeiro a 31 dezembro de 2004. Resultados: O estudo compreendeu 711 pacientes, destacando-se o sexo masculino (72,8%). Quanto a causa, predominou a agressao fisica, seguida por acidente com veiculos/motos. As quedas foram a causa predominante das lesoes em criancas, mas verificou-se a participacao cada vez maior da agressao fisica como mecanismo de trauma facial com o aumento da idade. A relacao de homem:mulher foi de 3:1. A faixa etaria mais atingida foi de 21 a 30 anos, representando 35,3% dos pacientes. As fraturas foram encontradas em 24,9% das lesoes faciais. O nariz foi o local mais acometido nas fraturas de face (76,8%). Conclusao: A violencia interpessoal foi a principal causa de trauma de face. A queda da propria altura mostrou-se como importante mecanismo de trauma nos extremos de idade (Rev. Col. Bras. Cir. 2008; 35(1): 009-013). Descritores: Face; Traumatismos maxilofaciais; Ossos da face; Traumatismos faciais; Ferimentos e lesoes; Violencia; Cirurgia.

Fatores de risco da sepse em pacientes queimados

BACKGROUND: The advances of the treatment of burns have decreased the mortality rate and improved the quality of life of burned patients. Our objective is to analyse, through a case-control study, the risk factors of sepsis in burned patients. METHODS: This case-control study included cases which were treated as in-patients at the Burn Unit of Hospital Regional da Asa Norte, Brasilia, Brazil, during an one year period. RESULTS: Forty-nine (19.4%) patients had sepsis amongst 252 cases admitted to the Burn Unit during the period of study. They had one to three septic episodes amounting to a total of 62. Twenty-six (53.1%) were males and the mean age was 22 years (range one year old to 89 years old). The total body surface area burned from the cases of sepsis varied from seven to 84% with a mean of 37.7 ± 18.4%, was significantly higher than controls. The most common bacteria isolated from the blood culture of the cases of sepsis were Staphylococcus aureus (46.5%), Staphylococcus coagulase negative (20.7%), Acinetobacter baumannii (12.1%) and Enterobacter cloacae (12.1%). Thirty (61.2%) patients had their first septic episode either earlier or by one week postburn. The risk factors for sepsis were the use of three or more catheters, the presence of two or more complications, total body surface area burned > 30%, flame as cause of the burn and female sex. In general, the letality rate of sepsis was 24.5%. CONCLUSION: The appropriate knowledge of risk factors of sepsis in burned patients permit early treatment of this complication, with an adequate systemic antibiotics, thus contributing to decrease the morbidity and letality of these patients.

Self-inflicted burns: attempted suicide

OBJECTIVE To analyze the incidence, characteristics, behavior and mortality rate of patients with self-injury by burns admitted to the Burns Centre of Brasilia, Federal District, Brazil. METHODS The study population consisted of burned patients consecutively admitted to the Burns Unit of Hospital Regional da Asa Norte, Brasília, Federal District, Brazil, during the period from February 2008 to February 2009. Data were obtained on admission and were prospectively recorded during hospitalization. Patients were followed until discharge or death. RESULTS During the study period, 15 cases were admitted due to self-injury burns in the Unit. The mean age was 38.0 ± 20.6 years, 66.7% of cases of self-injury burning were women. In most cases they were married, home providers and poor. The biggest reason was marital conflict. The mortality rate was 40%. The average burned body surface was 38.7 ± 26.1%. Alcohol was used by 66.7% of patients to cause the burns. The average duration of treatment was 20.1 ± 14.8 days. Self-injury burned patients had more extensive lesions, remained in hospital for longer periods and had worse prognosis. CONCLUSION Patients with self-inflicted burns had a mean higher age, higher burned body surface, longer hospitalization, more infectious complications and higher mortality rate than patients with accidental burns. These patients need constant psychiatric support, which can be helpful in preventing future episodes of self-harm.

An experimental study of tissue reaction to polymethyl methacrylate (PMMA) microspheres (Artecoll) and dimethylsiloxane (DMS) in the mouse.

Various methods are available for the treatment of scars, wrinkles, and other cutaneous defects, and the material used must be as biocompatible as possible. This study analyzes the biological behavior of polymethyl methacrylate/bovine collagen (Artecoll) and of polydimethylsiloxane (DMS), using a histopathological study in mice. A prospective study was performed using 40 mice for each substance: polymethyl methacrylate/bovine collagen or polydimethylsiloxane was injected into the right ear, the left ear being used as a control. Histopathological analyses of the right ear, liver, and kidney were performed at intervals during the study and revealed the development of an intense granulomatous reaction of the foreign body type in the right ear, periportal and intralobular infiltrates in the liver, and interstitial nephritis and chronic pyelonephritis in the kidney for polymethyl methacrylate/bovine collagen. A variable reaction with less intense fibrosis and a reduced foreign body reaction were seen in the mice injected with polydimethylsiloxane.

Entomoftoromicose intestinal: relato de caso

Os autores relatam um caso de entomoftoromicose intestinal causada por Entomophthorales, em individuo de 19 anos, agricultor e sem doenca associada. O paciente foi submetido a resseccao intestinal e o diagnostico foi feito apos analise da peca cirurgica. Apos revisao da literatura, sao discutidos a evolucao clinica, as caracteristicas clinicopatologicas, as dificuldades no diagnostico e o tratamento dessa entidade rara.

Sensibilidade antimicrobiana de bactérias aeróbicas isoladas de úlceras leishmanióticas, em Corte de Pedra, BA

A prospective study regarding aspects of antimicrobial susceptibility aspects was realized among patients with tegumentary leishmaniasis in Corte de Pedra, Bahia. Cases were composed mainly of adolescent and adult farmer patients with single lesions. Staphylococcus aureus predominated (83%) in the cultures with susceptibility to the majority of antibiotics. A mixed bacterial flora in ulcers was encountered in 37 (44.1%) patients. Among the gram-negative bacteria isolated, Enterobacter sp (13.1%), Proteus sp (8.3%), Pseudomonas aeruginosa (7.1%) and Klebsiella sp (7.1%) were mainly found with susceptibility to ciprofloxacin, aminoglycosides, third generation cephalosporin and carbapenems.

An experimental study of tissue reaction to hyaluronic acid (Restylane) and polymethylmethacrylate (Metacrill) in the mouse.

Abstract:The aging skin is a challenge for medical science. Plastic surgeons and dermatologists are called every day to solve problems like filling wrinkles or folds. The material used must be biocompatible because abnormal reactions may cause catastrophic results. This study analyzes the biological behavior of polymethylmethacrylate (Metacrill) and hyaluronic acid (Restylane), using a histopathologic study in mice. A prospective study was performed using 40 mice for each substance: polymethylmethacrylate or hyaluronic acid was injected into the right ear, the left ear been used as a control. Histopathologic analyses of the right ear, liver, and kidney were performed at intervals during the study and revealed the development of a granulomatous reaction with fibrosis and absorption of spheres and signs of liver and kidney sistematization for polymethylmethacrylate. A discrete cellular reaction, with less formation of fibrosis, and no giant cells were seen in the mice injected with hyaluronic acid.