RESUMEN
This study has developed a learning kit for the prevention of domestic burns in childhood. The main objective was to trial an educational package for children (nursery and primary classes), for the prevention of burns, to be implemented through education in schools. The educational kit comprises posters, information leaflets, comic books, and pre and post education evaluation materials for school children, parents and teachers. Recipients of the preliminary study were the students of nine schools in the eight Italian cities where Burn Centers are located. In order to reach the target groups of children, it was necessary to identify the most effective communication strategy to convey the burn prevention message. For nursery school children, it was not possible to use tools with written texts alone, as they were not yet literate. Moreover, even for older children, it was necessary to find an attractive tool to catch their attention and interest, promoting the understanding and memorization of lessons learned. The most suitable means was found to be comic strips, allowing the messages to be conveyed through images as well as words. A total of 370 children (195 from nurseries and 175 from primary schools) participated in the trial of the educational kit. Overall, for every environment represented in the evaluation table, the ability to recognize the dangers among both the pre-school and primary school children increased significantly after the training activity. In conclusion, the educational kit has been positively assessed.
Cette étude a permis de mettre au point un kit d'apprentissage pour la prévention des brûlures domestiques chez les enfants. L'objectif principal était d'expérimenter un ensemble éducatif pour enfants (crèches et écoles primaires), pour la prévention des brûlures, à mettre en oeuvre à travers des actions d'éducation dans les écoles. Le kit éducatif est composé de posters, de brochures d'information, de bandes dessinées, et d'un matériel d'évaluation pré et post enseignements, pour enfants, parents et enseignants. Cette'étude préliminaire a rassemblé les élèves de 9 écoles, appartenant aux 8 villes des Centres de grands brûles en Italie. Concernant l'éducation des enfants, il était nécessaire d'identifier la stratégie de communication la plus efficace pour leur transmettre les messages de prévention. Pour les élèves de maternelle, il n'a pas été possible d'utiliser des outils avec textes, puisqu'ils n'étaient pas encore capables de lire et écrire; en outre, même pour les enfants plus âgés, il était nécessaire de trouver un outil attrayant pour attirer leur attention et susciter leur intérêt, promouvoir la compréhension et la mémorisation des leçons apprises. La bande dessinée a été jugée l'outil le plus approprié (langage complexe qui utilise l'outil verbal et les codes iconiques).Au total, 195 enfants de maternelle et 175 d'écoles primaires ont participé à l'évaluation du kit pédagogique. Nos résultats démontrent que, pour chaque environnement représenté dans le tableau d'évaluation, la capacité à reconnaître les dangers a augmenté d'une manière significative après la formation aussi bien dans le groupe des élèves de maternelle que dans celui des élèves d'écoles primaires. En conclusion, le kit pédagogique a été évalué positivement.
RESUMEN
Systematic education based on internationally standardized programs is a well-established practice in Italy, especially in the emergency health care system. However, until recently, a specific program to treat burns was not available to guide emergency physicians, nurses, or volunteers acting as first responders. In 2010, two national faculty members, acting as ABA observers, and one Italian course coordinator, trained and certified in the United States, conducted a week-long training program which fully certified 10 Italian instructors. Authorized ABLS provider courses were conducted in Italy between 2010 and 2012, including one organized prior to the 20th annual meeting of the Italian Society of Burns (SIUst). In order to increase the effectiveness and diffusion of the course in Italy, changes were approved by the ABA to accommodate societal differences, including the translation of the manual into Italian. The ABA has also approved the creation and publication of a bilingual ABLS Italian website for the purpose of promoting the ABLS course in Italy. In response to high demand, a second ABLS Instructor course was organized in 2012 and has been attended by physicians and nurses from several Italian burn centers. In the following discourse the experiences of the first 15 Italian ABLS courses will be discussed.
Asunto(s)
Atención de Apoyo Vital Avanzado en Trauma/métodos , Quemaduras/terapia , Educación Médica Continua/métodos , Educación Continua en Enfermería/métodos , Medicina de Emergencia/educación , Enfermería de Urgencia/educación , Unidades de Quemados , Primeros Auxilios , Humanos , Italia , Cuidados para Prolongación de la Vida/métodosRESUMEN
The activities of the Bambino Gesù Paediatric Clinical and Surgical Centre Takeo in Cambodia started in May 2006, after the signature of a formal agreement between the Royal Government of Cambodia and the hospital. The paediatric centre is currently composed of an out-patients section with diagnostic ultrasound facilities and an obstetrics and gynaecology section, 3 consulting rooms, 20 beds for clinical activities, 13 beds for surgery, 7 beds for the paediatric intensive care unit, 2 dressing rooms, 1 out-patients sterile section, a library for off- and on-line consultation, a playroom and laundry facilities, and an administration office. For the last five years its activity has neen steadily on the increase, and the local population are beginning to look on the Centre as a full-scale local and regional referral hospital. From the 190 cases handled in 2006, the Centre increased to 669 surgical procedures in 2010 and 341 in the first four months of 2011, with good prospects of exceeding 1000 operations before the end of 2012. Takeo Centre also developed a Mobile Clinic Project to assist children directly in rural areas lacking health facilities. Today the Centre is a new reality in Cambodia's healthcare system.
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The present review of the literature aims at analysing the challenges facing burn management in low- and middleincome countries and exploring probable modalities to optimize burn management in these countries. In Part I, epidemiology of burns injuries and the formidable challenges for proper management due to limited resources and inaccessibility to sophisticated skills and technologies in low- and middle income countries (LMICs) were presented. Part II discussed the actual state of burn injuries management in LMICs. In Part III of this review strategies for proper prevention and burn care in LMICs will be presented.
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In developing countries burn injuries are much more common than in the USA and Europe or other affluent developed countries, due to poverty, overcrowding, and illiteracy, and are associated with higher mortality rates. The high incidence makes burns an endemic health hazard in these countries. Over 90% of burn-related fatalities occur in developing or low- and middle-income countries (LMICs), with south-east Asia alone accounting for over half of fire-related deaths. Management of burns and their sequelae even in the well-equipped, modern burn units of advanced affluent societies remains demanding despite advances in surgical techniques and development of tissue-engineered biomaterials available to these burn centres. Undoubtedly, in a developing country with limited resources and inaccessibility to sophisticated skills and technologies, management of burns constitutes a major challenge. The present review of the literature analyses the challenges facing burn management in LMICs and explores probable modalities to optimize burn management in these countries. The review will be published in three parts. Part I will present the epidemiology of burn injuries and challenges for management in LMICs. Part II will be about management of burn injuries in LMICs and Part III will discuss strategies for proper prevention and burn care in LMICs.
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The BurNet project, a pilot project of the Eumedis initiative, has become true. The Eumedis (EUro MEDiterranean Information Society) initiative is part of the MEDA programme of the EU to develop the Information Society in the Mediterranean area. In the health care sector, the objective of Eumedis is: the deployment of network-based solutions to interconnect - using userfriendly and affordable solutions - the actors at all levels of the "health care system" of the Euro-Mediterranean region. The Bur Net project interconnects 17 Burn Centres (BC) in the Mediterranean Area through an information network both to standardize courses of action in the field of prevention, treatment, and functional and psychological rehabilitation of burn patients and to coordinate interactions between BC and emergency rooms in peripheral hospitals using training/information activities and telemedicine to optimize first aid provided to burn patients before referral to a BC. Shared procedure protocols for prevention and the care and rehabilitation of patients, both at individual and mass level, will help to create an international specialized database and a Webbased teleconsultation system.
RESUMEN
The present review of the literature aims at analysing the challenges facing burn management in low- and middleincome countries (LMICs) and exploring probable modalities to optimize burn management in these countries. In Part 1, the epidemiology of burn injuries and the formidable challenges for proper management due to limited resources and inaccessibility to sophisticated skills and technologies in LMICs were presented. Part II will discuss the actual state of burn injuries management in LMICs.
RESUMEN
Burn injury induces a suppression of the Th1 response, which is associated with an increased susceptibility to conditions of infection, morbidity, and mortality. It is well established that cytokines modulate the pathogenesis of burn injury. In this study, plasma levels of interleukin-6 (IL-6) and interleukin-10 (IL-10) were determined in burn patients and correlated with the severity of sepsis. Sixty adult burn patients (total body surface area burned, 8-80%) were included in the study, of whom 34 developed sepsis and 14 died. The nonseptic group consisted of 26 patients. Thirty-one healthy blood donors served as controls. Patients were not treated with antibiotics until sepsis occurred. Plasma samples were collected immediately post-burn and after several days, and cytokine concentrations were determined by ELISA. Within three days, all the patients presented high levels of circulating IL-6, which were significantly higher in septic patients than in nonseptic patients (349 ± 278 vs 63 ± 56 pg/ml, p < 0.001).IL-10 levels were higher in septic patients than in nonseptic patients at all times in our study. The value of 60 pg/ml shows a sensitivity of 92% and a specificity of 93% in the differentiation of survivor from nonsurvivor septic patients. In this study the high value of circulating IL-10 on day 3 suggests that cytokine may discriminate between nonsurvivor septic and survivor septic patients.
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Advances in our understanding of the Toll-like receptors (TLRs) have led to the identification of several agonists that are suitable for clinical development. Chronic lymphocytic leukemia (CLL) may be especially amenable to TLR agonists because it is an immunologically susceptible tumor with strong expression of several TLRs, particularly TLR-7 and TLR-9. TLR agonists may indirectly clear CLL cells by enhancing the activity of natural killer and tumor-reactive T cells, or by altering the tumor microenvironment and inhibiting angiogenesis. However, signaling pathways can be activated directly in CLL cells by TLR-7 and TLR-9 agonists, leading to the production of cytokines and costimulatory molecules in a manner that is dependent on the underlying cytogenetic abnormalities, but rendering the tumor cells more sensitive to killing by cytotoxic T cells, immunotoxins and some chemotherapeutic drugs. Imidazoquinolines are TLR-7 agonists with strong local activity against CLL, and phase I trials of systemically administered imidazoquinolines (and also cytosine-phosphate-guanosine oligonucleotides that are TLR-9 agonists) are currently ongoing at different centers. The potential importance of these TLR agonists in the treatment of CLL is suggested by their ability to sensitize tumor cells to cytotoxic agents, and their future probably lies in combination with radiotherapies, chemotherapies, monoclonal antibodies and cancer vaccines.
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Antineoplásicos/farmacología , Leucemia Linfocítica Crónica de Células B/tratamiento farmacológico , Receptor Toll-Like 7/agonistas , Receptor Toll-Like 9/agonistas , Antineoplásicos/uso terapéutico , Muerte Celular/efectos de los fármacos , Ensayos Clínicos como Asunto , Humanos , Leucemia Linfocítica Crónica de Células B/inmunología , Leucemia Linfocítica Crónica de Células B/metabolismo , Leucemia Linfocítica Crónica de Células B/patología , Oligonucleótidos/farmacología , Oligonucleótidos/uso terapéutico , Quinolonas/farmacología , Quinolonas/uso terapéutico , Linfocitos T Citotóxicos/inmunologíaRESUMEN
Four cases are presented of severe face burn sequelae with mutilation of one or both pinnae, treated using osseointegrated epistheses. In the light of over 10 years' use of this technique, applied in other forms of anatomical deficits in the head such as congenital malformations, demolition owing to extensive neoplasias, and serious traumatic sequelae, it is recommended that burn patients should be carefully considered from both the psychological and the technical point of view. It is suggested that such patients should be analysed by a specific team consisting of a plastic surgeon, a psychologist, and a prosthetist who assess their expectations, analyse their actual reactions, and above all judge their degree of acceptance of an episthesis. A description is provided of the advantages of the technique, which is mainly indicated when the mutilated area presents a deficit of tissues capable of being reconstructed using traditional surgical techniques.
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After presenting an analysis of the principal antiseptics used for the local treatment of burns, highlighting their toxicity and the limitations of their antibacterial effectiveness, we describe the therapeutic protocol used in our burns centre (where antibacterial treatment consists exclusively of antibiotics for both local and systemic use). We review the data regarding actual and predicted mortality, and mortality due to septicaemia during the years 2000-2003.
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BACKGROUND: The importance of the bone marrow microenvironment in multiple myeloma is receiving increasing attention. Recent studies have suggested the importance of cytokine production and cell-cell contact by bone marrow stromal cells in the survival of myeloma cells. METHODS: In the current study, the authors examined bone marrow mesenchymal progenitor cell (MPC) cultures derived from eight multiple myeloma patients (mean age, 58 years) and nine normal donors (mean age, 61 years), with emphasis on cell surface antigens, cytokine, and growth factor expression. RESULTS: The authors have found, based on analysis of cellular receptors, growth factors, and cytokine expression, that myeloma MPCs are phenotypically and functionally distinguishable from normal donor MPCs. Immunofluorescence analysis of MPC monolayers shows that myeloma MPC cultures expressed reduced cell surface vascular cell adhesion molecule-1 and fibronectin, in contrast with the strong expression found on normal donor MPCs. Furthermore, a subset of myeloma MPCs strongly express intracellular receptor for hyaluronan-mediated motility, whereas normal MPCs do not. Cytokine expression in bone marrow MPC cultures was examined by reverse transcription-polymerase chain reaction and enzyme linked immunosorbent assay. Bone marrow MPCs constitutively express interleukin (IL)-1beta, IL-6, granulocyte colony-stimulating factor (G-CSF), granulocyte macrophage (GM)-CSF, stem cell factor (SCF), and tumor necrosis factor (TNF)-alpha. In comparison to normal MPCs, multiple myeloma MPCs express increased basal levels of IL-1beta and TNF-alpha. In vitro exposure of MPC cultures to dexamethasone resulted in the down-regulation of IL-6, G-CSF, and GM-CSF in both normal and myeloma MPC cultures. However, dexamethasone treatment significantly increased expression of SCF-1 in myeloma MPCs. CONCLUSIONS: In myeloma, bone marrow stromal cells provide paracrine factors, through cytokine production and cell-cell contact, which play a role in plasma cell growth and survival. The authors' data indicate differences in bone marrow MPCs, which may be biologically relevant to the growth and survival of myeloma plasma cells.
Asunto(s)
Células de la Médula Ósea/metabolismo , Mesodermo/metabolismo , Mieloma Múltiple/metabolismo , Células Madre/metabolismo , Adulto , Anciano , Antígenos CD/análisis , Antineoplásicos Hormonales/farmacología , Células de la Médula Ósea/efectos de los fármacos , Células de la Médula Ósea/patología , Ciclo Celular , División Celular , Células Cultivadas , Citocinas/metabolismo , Dexametasona/farmacología , Ensayo de Inmunoadsorción Enzimática , Técnica del Anticuerpo Fluorescente Indirecta , Sustancias de Crecimiento/metabolismo , Humanos , Inmunohistoquímica , Integrinas/análisis , Mesodermo/efectos de los fármacos , Mesodermo/patología , Persona de Mediana Edad , Mieloma Múltiple/patología , Fenotipo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Células Madre/efectos de los fármacos , Células Madre/patología , Células del Estroma/efectos de los fármacos , Células del Estroma/metabolismo , Células del Estroma/patologíaRESUMEN
DNA aneuploidy characterizes a proportion of malignant bone marrow (BM)-localized plasma cells in multiple myeloma (MM). This analysis shows that for most MM patients, circulating clonotypic B cells in MM are also hyperdiploid. Although all normal B cells and some malignant B cells are diploid, hyperdiploidy is likely to be exclusive to those that are malignant. Hyperdiploid MM B cells express CD34 and have clonotypic IgH transcripts, confirming them as part of the malignant clone. For MM, 92% (70/76) of patients had a DNA hyperdiploid subset [5-30% of peripheral blood mononuclear cells (PBMCs)] of CD19+ B cells. All CD19+ PBMCs in MM expressed CD19 and IgH variable diversity joining (VDJ) transcripts, confirming them as B cells. DNA aneuploid cells were undetectable in T or B lymphocytes from normal blood, spleen or thymus, or in blood from patients with B chronic lymphocytic leukemia. In MM, untreated patients had the highest DNA index (1.12). DNA hyperdiploid PBMCs were most frequent among untreated patients and were significantly reduced after chemotherapy. Diploid B cells were significantly more frequent after chemotherapy than at diagnosis. Of the hyperdiploid PBMCs, 81 +/- 3% expressed CD34 and CD19. In contrast to circulating CD34+ B cells, CD34- B cells in MM are diploid. In MM, unlike hyperdiploid PBMC B cells, hyperdiploid BM plasma cells lack both CD34 and CD19, suggesting that loss of CD34 correlates with differentiation and BM anchoring. In situ reverse transcription-PCR of the CD34+ (hyperdiploid) and CD34- (diploid) PBMC B-cell subsets was performed using patient-specific primers to amplify clonotypic IgH VDJ transcripts. Confirming previous work, CD34+ hyperdiploid MM PBMCs were clonotypic (86 +/- 5%). In contrast, CD34- diploid MM PBMCs had few monoclonal cells (4.8 +/- 2%). The lack of hyperdiploidy, together with the relative absence of cells having clonotypic transcripts, suggests these polyclonal CD34- B cells are normal. After culture in colchicine to arrest mitosis, hyperdiploid B cells were reduced and MM B cells accumulated in a diploid G2-M, suggesting that hyperdiploid in MM may represent a transient S-phase arrest rather than an aneuploid G0 phase. The DNA hyperdiploidy of CD34+ clonotypic B cells suggests these cells may be clinically important constituents of the myeloma clone and that they may play a direct role in the spread of myeloma.