RESUMEN
This paper describes a randomized, controlled, parallel-group, single-center clinical trial designed to compare non surgical treatment methods of deep partial thickness skin burns of the hand. All patients were scanned with the Laser Doppler Imaging device to determine the depth of the burn wound. Viable keratinocytes sites were determined according to the established Perfusion Units (PU) measurement system. The trial enrolled 87 patients with hand burn wounds in the section of 260-600PU. Hand burn patients were divided into the following four groups: treated with hydrocolloid dressings; treated with mechanical debridement of monofilament polyester fibers pad and then applying silver sulfadiazine; treated with gauze dressings containing enzymatic collagenase preparation. The fourth group of patients was treated with silver sulfadiazine and gauze dressings. This group was considered as the control group. The wound healing status was assessed after 3, 7, 14 and 21 days. Burn scars and injured extremity function were assessed after six months according to the Vancouver Scar Scale and Disabilities of the Arm, Shoulder and Hand Outcome Measure. The fastest epithelialization of hand burn wounds was observed in the patients group treated with hydrocolloid dressings (15, 7 days, p<0,05). The patients of this group also had less scars and a better hand function.
Asunto(s)
Antiinfecciosos Locales/uso terapéutico , Vendas Hidrocoloidales , Quemaduras/terapia , Traumatismos de la Mano/terapia , Péptido Hidrolasas/uso terapéutico , Sulfadiazina de Plata/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Vendajes , Quemaduras/complicaciones , Quemaduras/diagnóstico por imagen , Quemaduras/patología , Cicatriz/etiología , Desbridamiento , Femenino , Traumatismos de la Mano/complicaciones , Traumatismos de la Mano/diagnóstico por imagen , Traumatismos de la Mano/patología , Humanos , Flujometría por Láser-Doppler , Masculino , Persona de Mediana Edad , Repitelización , Piel/irrigación sanguínea , Piel/diagnóstico por imagen , Piel/patología , Adulto JovenRESUMEN
OBJECTIVE: To describe the epidemiology of paediatric burns in Lithuania, identify the trends of burn occurrence, the vulnerable population and aetiology. METHODS: This study was based on all inclusive national information obtained from the National Health Insurance database for the period of 2001-2010. Information on the burns aetiology was collected in the Hospital of Lithuanian University of Heath Sciences Kauno Klinikos. FINDINGS: 7146 children in the age group of 0-14 were hospitalized in Lithuania and constituted 44% of all admissions due to burns. The incidence among boys was 149.8 and among girls 99.9 per 100,000. The highest risk of burns was observed from 11 to 15 months of age. Scalding in 0-1 years age group composed 96% of all burns in this age group. CONCLUSION: Children younger than 2 years of age are a vulnerable population of burns in Lithuania. Scalding was main cause of their burns. The aetiological subgroups of scalding were scalding with hot drinks/food and scalding with hot water meant for household. The major part of scalding with hot drinks was due to scalding with parents' drinks. Scalding with hot water meant for household is associated with the lack of hot water supply.
Asunto(s)
Accidentes Domésticos/estadística & datos numéricos , Quemaduras/epidemiología , Abastecimiento de Agua/estadística & datos numéricos , Adolescente , Distribución por Edad , Bebidas/estadística & datos numéricos , Niño , Preescolar , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Lituania/epidemiología , Masculino , Factores de Riesgo , Distribución por Sexo , Poblaciones VulnerablesRESUMEN
SUMMARY OBJECTIVE: The main goal of this study was to evaluate the variation of antibiotic consumption and relation between antibiotic consumption and microorganism resistance. MATERIAL AND METHODS: This analysis was performed in one of Lithuanian tertiary hospitals. The defined daily dose (DDD) analysis was performed to express drug consumption per every 100 occupied bed days (OBDs) for single units in clinical departments. Average of DDD/100 OBDs was estimated for 2004-2007, and mean values were compared among all four years. The relation between the number of surgical operations and antibiotic consumption in surgery departments was analysed. E. coli and K. pneumoniae resistance for four years (2004-2007) was determined. Moreover, the relation between microorganism resistance and variation of antibiotic consumption was determined. Data were analysed by descriptive and comparative statistics (by Mann-Whitney test for nonparametric criteria and Spearman correlation). RESULTS: Comparing the DDD/100 OBD data during 2004-2007 revealed a statistically significant increase in piperacillin and tazobactam (877.50%), metronidazole (114.00%), cefuroxime (77.31%), meropenem (47.55%), cefoperazone and sulbactam (173.11%) consumption. The increased usage of these antibiotics was determined in surgery department too. However, the increased number of surgical operations cannot be the only reason of the growing antibiotic consumption. Results revealed a statistically significant decrease in ofloxacin use from 2006 to 2007 (93.94%). E. coli resistance to ampicillin (from 49.80% to 56.60%), ampicillin and sulbactam (from 25.50% to 39.20%), cefuroxime (from 7.40% to 10.10%), ciprofloxacin (from 4.20% to 12.50%), gentamicin (from 11.40% to 13.20%) and K. pneumoniae resistance to ampicillin and sulbactam (from 45.40% to 56.40%), cefuroxime (from 34.00% to 39.10%), ciprofloxacin (from 5.50% to 10.50%), gentamicin (from 32.00% to 35.80%) increased. A statistically significant positive correlation between quinolone consumption and K. pneumoniae resistance to ciprofloxacin was determined (r=1, P<0.05). CONCLUSIONS: In 2004-2007, the usage of piperacillin and tazobactam, metronidazole, cefuroxime, meropenem, cefoperazone, and sulbactam increased. In 2006-2007, ofloxacin consumption decreased. The changes in other antibiotic usage were statistically insignificant. In 2004-2007, E. coli and K. pneumoniae resistance to ampicillin and sulbactam, cefuroxime, ciprofloxacin, gentamicin and E. coli resistance to ampicillin increased. A statistically significant positive correlation between quinolone consumption and K. pneumoniae resistance to ciprofloxacin was determined.
Asunto(s)
Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Farmacorresistencia Bacteriana/efectos de los fármacos , Escherichia coli/efectos de los fármacos , Klebsiella pneumoniae/efectos de los fármacos , Aminoglicósidos/farmacología , Aminoglicósidos/uso terapéutico , Antibacterianos/administración & dosificación , Utilización de Medicamentos , Electroforesis en Gel de Agar , Hospitalización , Humanos , Inmunodifusión , Tiempo de Internación , Pruebas de Sensibilidad Microbiana , Estadísticas no Paramétricas , Factores de Tiempo , Inhibidores de beta-LactamasasRESUMEN
UNLABELLED: The objective of this article is to overview and present the burn incidence and burn care in Lithuania. MATERIALS AND METHODS: In this study, data from the period of 1991-2004 were collected from the Lithuanian Department of Statistics, Department of Fire and Rescue, Lithuanian Health Information Center, State Patient Fund, health care institutions, burn care facilities. RESULTS: In the 14-year period, 9459 persons per year (2.6/1000 population) in average sustained burn injuries. The majority of burned patients (74.8%) were adults and 25.2% were children; 21.5% of all burned patients were hospitalized (2013 inpatients per year). The number of hospitalizations per 100 000 individuals has decreased from 65.6 to 39.5, but it is still very high and worrying. Among all the patients admitted to hospitals, 67% were males and 33% females, with a male-to-female ratio of 2:1. The length of hospitalization decreased from 16.2 to 12.7 days. The number of fire-related deaths for the 14-year period was 289 deaths per year (8 per 100 000 persons). The number of deaths among inpatients was 63.6 deaths per year, the age being an important factor in mortality rates. Although the mortality of inpatients has increased in recent years, the mortality in the age group up to 14 years has decreased to 0. Children made up 24.6% of burn patients; among those admitted to hospital, they accounted for 41.1%. Mortality rates for males and females were almost the same. CONCLUSIONS: The number of burns is decreasing. The hospitalization rate and hospitalization time are becoming shorter. In the last few years, patients suffer from more severe burns, while children sustain more severe burns requiring hospitalization. Children and working-age persons make up 91.9% of hospitalized burn patients. Number of deaths in fire accidents is increasing.