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Wildfires and climate change increasingly are transforming vegetation composition and structure, and postfire management may have long-lasting effects on ecosystem reorganization. Postfire aerial seeding treatments are commonly used to reduce runoff and soil erosion, but little is known about how seeding treatments affect native vegetation recovery over long periods of time, particularly in type-converted forests that have been dramatically transformed by the effects of repeated, high-severity fire. In this study, we analyze and report on a rare long-term (23-year) dataset that documents vegetation dynamics following a 1996 post-fire aerial seeding treatment and a subsequent 2011 high-severity reburn in a dry conifer landscape of northern New Mexico, USA. Repeated surveys between 1997 and 2019 of 49 permanent transects were analyzed for differences in vegetation cover, richness, and diversity between seeded and unseeded areas, and to characterize the development of seeded and unseeded vegetation communities through time and across gradients of burn severity, elevation, and soil-available water capacity. Seeded plots showed no significant difference in bare ground cover during the initial years postfire relative to unseeded plots. Postfire seeding led to a clear and sustained divergence in herbaceous community composition. Seeded plots had a much higher cover of non-native graminoids, primarily Bromus inermis, a likely contaminant in the seed mix. High-severity reburning of all plots in 2011 reduced native graminoid cover by half at seeded plots compared with both prefire levels and with plots that were unseeded following the initial 1996 fire. In addition, higher fire severity was associated with increased non-native graminoid cover and reduced native graminoid cover. This study documents fire-driven ecosystem transformation from conifer forest into a shrub-and-grass-dominated system, reinforced by aerial seeding of grasses and high-severity reburning. This unique long-term dataset illustrates that post-fire seeding carries significant risks of unwanted non-native species invasions that persist through subsequent fires-thus alternative postfire management actions merit consideration to better support native ecosystem resilience given emergent climate change and increasing disturbance. This study also highlights the importance of long-term monitoring of postfire vegetation dynamics, as short-term assessments miss key elements of complex ecosystem responses to fire and postfire management actions.

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SUMMARY: The objective of this study was to investigate the therapeutic wound healing potential and molecular mechanisms of shikonin as small molecules in vitro. A mouse burn model was used to explore the potential therapeutic effect of shikonin; we traced proliferating cells in vivo to locate the active area of skin cell proliferation. Through the results of conventional pathological staining, we found that shikonin has a good effect on the treatment of burned skin and promoted the normal distribution of skin keratin at the damaged site. At the same time, shikonin also promoted the proliferation of skin cells at the damaged site; importantly, we found a significant increase in the number of fibroblasts at the damaged site treated with shikonin. Most importantly, shikonin promotes fibroblasts to repair skin wounds by regulating the PI3K/AKT signaling pathway. This study shows that shikonin can effectively promote the proliferation of skin cell, and local injection of fibroblasts in burned skin can play a certain therapeutic role.

El objetivo de este trabajo fue investigar el potencial terapéutico de cicatrización de heridas y los mecanismos moleculares de la shikonina como moléculas pequeñas in vitro. Se utilizó un modelo de quemaduras en ratones para explorar el posible efecto terapéutico de la shikonina; Rastreamos las células en proliferación in vivo para localizar el área activa de proliferación de células de la piel. A través de los resultados de la tinción para patología convencional, encontramos que la shikonina tiene un buen efecto en el tratamiento de la piel quemada y promueve la distribución normal de la queratina de la piel en el sitio dañado. Al mismo tiempo, la shikonina también promovió la proliferación de células de la piel en el sitio dañado. Es importante destacar que encontramos un aumento significativo en la cantidad de fibroblastos en el sitio dañado tratado con shikonina. Lo más importante es que la shikonina promueve la función reparadora de fibroblastos en las heridas de la piel regulando la vía de señalización PI3K/ AKT. Este estudio muestra que la shikonina puede promover eficazmente la proliferación de células de la piel y que la inyección local de fibroblastos en la piel quemada puede desempeñar un cierto papel terapéutico.

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Global burned area has declined by nearly one quarter between 1998 and 2015. Drylands contain a large proportion of these global fires but there are important differences within the drylands, for example, savannas and tropical dry forests (TDF). Savannas, a biome fire-prone and fire-adapted, have reduced the burned area, while the fire in the TDF is one of the most critical factors impacting biodiversity and carbon emissions. Moreover, under climate change scenarios TDF is expected to increase its current extent and raise the risk of fires. Despite regional and global scale effects, and the influence of this ecosystem on the global carbon cycle, little effort has been dedicated to studying the influence of climate (seasonality and extreme events) and socioeconomic conditions of fire regimen in TDF. Here we use the Global Fire Emissions Database and, climate and socioeconomic metrics to better understand long-term factors explaining the variation in burned area and biomass in TDF at Pantropical scale. On average, fires affected 1.4% of the total TDF' area (60,208 km2 ) and burned 24.4% (259.6 Tg) of the global burned biomass annually at Pantropical scales. Climate modulators largely influence local and regional fire regimes. Inter-annual variation in fire regime is shaped by El Niño and La Niña. During the El Niño and the forthcoming year of La Niña, there is an increment in extension (35.2% and 10.3%) and carbon emissions (42.9% and 10.6%). Socioeconomic indicators such as land-management and population were modulators of the size of both, burned area and carbon emissions. Moreover, fires may reduce the capability to reach the target of "half protected species" in the globe, that is, high-severity fires are recorded in ecoregions classified as nature could reach half protected. These observations may contribute to improving fire-management.

El área global quemada se redujo en casi una cuarta parte entre 1998 y 2015. Los bosques secos contienen una gran proporción de esos incendios globales, pero existen diferencias importantes dentro de ellos, por ejemplo, las sabanas y los bosques secos tropicales (SBC). Las sabanas, son un bioma propenso y adaptado al fuego, y que en los últimos años han reducido su área quemada. Mientras que el fuego en la SBC es uno de los factores más críticos que impactan la biodiversidad y las emisiones de carbono. Además, bajo escenarios de cambio climático, se espera que la SBC aumente su extensión actual y aumente el riesgo de incendios. A pesar de los efectos a escala regional y global, y la influencia de este ecosistema en el ciclo global del carbono, se le ha dedicado poco esfuerzo a estudiar la influencia del clima (estacionalidad y eventos extremos) y las condiciones socioeconómicas del régimen de incendios. Aquí usamos la base de datos global de emisiones de incendios y métricas climáticas y socioeconómicas para comprender mejor los factores a largo plazo que explican la variación en el área quemada y la biomasa a escala Pantropical. En promedio, los incendios afectaron el 1,4% del área total de la SBC (60 208 km2 ) y quemaron el 24,4% (259,6 Tg) de la biomasa global quemada anualmente a escala Pantropical. Los moduladores climáticos influyen en gran medida en los regímenes de incendios locales y regionales. La variación interanual del régimen de incendios está determinada por El Niño y La Niña. Durante El Niño y el año subsecuente de La Niña, se produce un incremento en la extensión (35,2% y 10,3%) y en las emisiones de carbono (42,9% y 10,6%). Los indicadores socioeconómicos como la gestión de la tierra y la población fueron moduladores del tamaño tanto del área quemada como de las emisiones de carbono. Además, los incendios pueden reducir la capacidad de alcanzar el objetivo de "protección de la mitad de las especies" en el mundo, es decir, los incendios de alta gravedad se registran en ecorregiones clasificadas como naturaleza que podría alcanzar la protección de la mitad de su biodiversidad. Estas observaciones pueden contribuir a mejorar la gestión de incendios.

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Resumen: El conocimiento de la fisiopatología de las quemaduras son base del manejo perioperatorio. Todos los órganos y sistemas resultan alterados y los cambios hemodinámicos en la fase aguda se caracterizan por una disminución del gasto cardíaco. Después de seis días de la lesión, ocurre un nuevo cambio hemodinámico, esta fase es conocida como estado hipermetabólico y su duración está en relación con la extensión y profundidad de la lesión. La lesión por inhalación es un factor importante a considerar como mal pronóstico y, de igual manera, el número de comorbilidades y/o trauma asociado. Durante este segundo período, los anestesiólogos tienen una participación continua y estrecha. Los problemas farmacológicos, manejo de vía aérea, accesos vasculares, hipotermia, monitoreo y control del dolor, entre otros, se hacen muy marcados. Por último, la fase de secuelas acompaña al paciente para toda su vida y la magnitud de los daños, costos y discapacidad serán directamente relacionados con la atención administrada durante las primeras dos fases.

Abstract: Knowledge of the pathophysiology of burns is the basis of perioperative management. All organs and systems are altered and hemodynamic changes in the acute phase are characterized by a decrease in cardiac output. After six days of injury a new hemodynamic change occurs, this phase is known as hypermetabolic state and its duration is in relation to the extent and depth of the injury. Inhalation injury is an important factor to consider as a poor prognosis and also the number of associated comorbidities and/or trauma. During this second period the Anesthesiologists have a continuous and close participation. Pharmacological problems, airway management, vascular access, hypothermia, monitoring and pain control among others become very marked. Finally, the phase of sequelae is for life and the magnitude of damages, costs and disability will be directly related to the care administered during the first two phases.

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OBJECTIVE: To have a scale for pain assessment in the critical burned adult patient. METHOD: A literature review was carried out, and an assessment scale was built with 24 items grouped into 8 categories or dimensions: burn extension, depth, airway burn and/or inhalation injury, facial expression, mechanical ventilation, limb movement, heart rate and painful procedures, and 4 evaluation criteria were applied: sufficiency, clarity, coherence and relevance, on a scale of 1 to 4, from non-compliance with the criterion to full compliance with the criterion. RESULTS: The Scale was revised and validated by expert judgement, reaching an overall content validity ratio of 0.96 (Lawshe) and 0.98 (Tristan-Lopez), an Aiken V of 0.96, which shows an agreement between judges over 96% and an adequate validity of the instrument. The Cronbach index was 0.74, demonstrating acceptable internal reliability and consistency. CONCLUSIONS: In the experts' opinion, it is an instrument with a high reliability rate and is recommended for application in a sample of critical burned patients for a second validation and its subsequent use and dissemination.

OBJETIVO: Disponer de una escala para la evaluación del dolor en el paciente adulto quemado en estado crítico. MÉTODO: Se realizó una revisión bibliográfica y se construyó una escala de valoración con 24 ítems agrupados en ocho categorías o dimensiones: extensión de la quemadura, profundidad, quemadura de vía aérea o lesión por inhalación, expresión facial, ventilación mecánica, movimiento de las extremidades, frecuencia cardíaca y procedimientos dolorosos. Se aplicaron cuatro criterios de evaluación: suficiencia, claridad, coherencia y relevancia, en una escala de 1 a 4, desde no cumplimiento del criterio hasta cumplimiento total. RESULTADOS: La escala fue revisada y validada por juicio de expertos, alcanzando un coeficiente de razón de validez global de 0.96 (Lawshe) y 0.98 (Tristán-López), y una V de Aiken de 0.96, lo que evidencia un acuerdo entre jueces superior al 96% y una validez adecuada del instrumento. El índice de Cronbach fue de 0,74, demostrando confiabilidad y consistencia interna aceptables. CONCLUSIONES: A juicio de los expertos, es un instrumento con un alto índice de confiabilidad y se recomienda su aplicación en una muestra amplia de pacientes quemados críticos para una segunda validación y su posterior uso y difusión.

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Wildfires are behaving differently now compared to other time in history in relation to frequency, intensity and affected ecosystems. In Brazil, unprecedented fires are being experienced in the last decade. Thus, to prevent and minimize similar disasters, we must better understand the natural and human drivers of such extreme events. The Brazilian Pantanal is the largest contiguous wetland in the world and a complex environmental system. In 2020, Pantanal experienced catastrophic wildfires due to the synergy between climate, inadequate fire management strategies and weak environmental regulations. In this study, we analyzed recent patterns and changes in fire behavior across the Pantanal based on land use and cover (LULC) classes. The inter-annual variability of the fire and land cover changes between 2000 and 2021 was assessed using BA from MCD64A1 V.6 product and LULC data from Landsat satellite. Our work reveals that fires in the Pantanal over the last two decades tended to occur more frequently in grassland than in others land cover types, but the 2020 fires have preferentially burned forest regions. Large fire patches are more frequent in forest and grasslands; in contrast, croplands exhibit small patches. The results highlight that a broad scale analysis does not reflect distinct localized patterns, thus stratified and refined studies are required. Our work contributes as a first step to disentangling the role of anthropogenic-related drivers, namely LULC changes, in shaping the fire regime in the Pantanal biome. This is crucial not only to predict future fire activity but also to guide appropriated fire management in the region.

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The identification of fire causes and characteristics is of fundamental importance to better understand fire regimes and drivers. Particularly for Brazil, there is a gap in the quantification of lightning-caused fires. Accordingly, this work is a novel probabilistic assessment of the spatial-temporal patterns of lightning-ignited wildfires in the Pantanal wetland. Here, remote sensing information such as VIIRS active fires, MODIS burned area (BA) and STARNET lightning observations from 2012 to 2017, were combined to estimate the location, number of scars and amount of BA associated with atmospheric discharges on a seasonal basis. The highest lightning activity occurs during summer (December-February), and the lowest during winter (June-August). Conversely, the highest fire activity occurred during spring (September-November) and the lowest during autumn (March-May). Our analysis revealed low evidence of an association between fires and lightning, suggesting that human-related activities are the main source of ignitions. Weak evidence of natural-caused fire occurrence is conveyed by the low spatial-temporal match of lightning and fire throughout the studied period. Natural-caused fires accounted for only 5% of the annual total scars and 83.8% of the BA was human-caused. Most of the fires with extension larger than 1000 ha were not related to lighting. Lightning-fires seem an important element of the summer fire regime given that around half of the total BA during this season may be originated by lightning. By contrast, in the rest of the year the lightning-fires represent a minor percentage of the fire activity in the region. The density of lightning-ignited fires varies considerably, being higher in the north part of the Pantanal. This work provides a basis for a better understanding of lightning-related fire outbreaks in tropical ecosystems, particularly wetlands, which is fundamental to improve region-based strategies for land management actions, ecological studies and modeling climatic and anthropogenic drivers of wildfires.

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The Brazilian savanna (Cerrado) is considered the most floristically diverse savanna in the world, home to more than seven thousand species. The region is a mosaic of savannas, grasslands and forests whose unique biophysical and landscape attributes are on the basis of a recent ecoregional map, paving the way to improved region-based strategies for land management actions. However, as a fire-prone ecosystem, Cerrado owes much of its distribution and ecological properties to the fire regime and contributes to an important parcel of South America burned area. Accordingly, any attempt to use ecoregion geography as a guide for management strategies should take fire into account, as an essential variable. The main aim of this study is to complement the ecoregional map of the Cerrado with information related to the fire component. Using remotely sensed information, we identify patterns and trends of fire frequency, intensity, seasonality, extent and scar size, and combine this information for each ecoregion, relying on a simple classification that summarizes the main fire characteristics over the last two decades. Results show a marked north-south fire activity gradient, with increased contributions from MATOPIBA, the latest agricultural frontier. Five ecoregions alone account for two thirds of yearly burned area. More intense fires are found in the Arc of Deforestation and eastern ecoregions, while ecoregions in MATOPIBA display decreasing fire intensity. An innovative analysis of fire scars stratified by size class shows that infrequent large fires are responsible for the majority of burned area. These large fires display positive trends over many ecoregions, whereas smaller fires, albeit more frequent, have been decreasing in number. The final fire classification scheme shows well defined spatially-aggregated groups, where trends are found to be the key factor to evaluate fire within their regional contexts. Results presented here provide new insights to improve fire management strategies under a changing climate.

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Biomass burning is one of the most critical factors impacting vegetation and atmospheric trends, with important societal implications, particularly when extreme weather conditions occur. Trends and factors of burned area (BA) have been analysed at regional and global scales, but little effort has been dedicated to study the interannual variability. This paper aimed to better understand factors explaining this variation, under the assumption that the more human control of fires the more frequently they occur, as burnings will be less dependent of weather cycles. Interannual variability of BA was estimated from the coefficient of variation of the annual BA (BA_CV) estimated from satellite data at 250 m, covering the period from 2001 to 2018. These data and the explanatory variables were resampled at 0.25-degree resolution for global analysis. Relations between this variable and explanatory factors, including human and climate drivers, were estimated using Random Forest (RF) and generalized additive models (GAM). BA_CV was negatively related to BA_Mean, implying that areas with higher average BA have lower variability as well. Interannual BA variability decreased when maximum temperature (TMAX) and actual and potential evapotranspiration (AET, PET) increased, cropland and livestock density increased and the human development index (HDI) values decreased. GAM models indicated interesting links with AET, PET and precipitation, with negative relation with BA_CV for the lower ranges and positive for the higher ones, the former indicating fuel limitations of fire activity, and the latter climate constrains. For the global RF model, TMAX, AET and HDI were the main drivers of interannual variability. As originally hypothesised, BA_CV was more dependent on human factors (HDI) in those areas with medium to large BA occurrence, particularly in tropical Africa and Central Asia, while climatic factors were more important in boreal regions, but also in the tropical regions of Australia and South America.

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Resumen: La atención y manejo del paciente quemado en México representa un reto para el personal médico, la estancia intrahospitalaria del quemado generalmente es prolongada, por lo que los pacientes pueden desarrollar complicaciones psicológicas derivadas del cambio en su aspecto físico y los tratamientos que este tipo de patología requiere, por lo que la aparición de ansiedad es común. El propósito de este trabajo es plantear una propuesta de terapia audiovisual como tratamiento alternativo y/o complementario en el control de la ansiedad en el paciente durante su estancia en la unidad de cuidados intensivos.

Abstract: The care and management of the burn patient in Mexico represents a challenge for the medical staff, the hospital stay of the burn is generally prolonged so that patients can develop psychological complications derived from the change in their physical appearance and the treatments that this type of pathology requires, so the appearance of anxiety is common. The purpose of this work is to propose a proposal of audiovisual therapy as an alternative and/or complementary treatment in the control of anxiety in the patient during his stay in the intensive care unit.

Resumo: O cuidado e o manejo do paciente queimado no México representam um desafio para a equipe médica, a internação do paciente queimado é geralmente prolongada para que os pacientes possam desenvolver complicações psicológicas derivadas da mudança em sua aparência física e dos tratamentos que este tipo de a patologia exige, então o aparecimento de ansiedade é comum. O objetivo deste trabalho é propor uma proposta de terapia audiovisual como alternativa e/ou tratamento complementar no controle da ansiedade do paciente durante sua permanência em unidade de terapia intensiva.

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This study evaluated the space-time variability of fire foci via environmental satellites for the State of Rio de Janeiro (SRJ) based on statistical procedures. The fire foci in the period of 2000 to 2015 were obtained from the BDQueimadas fire database. Descriptive, exploratory, and multivariate statistical analyses were performed in the software environment R i386 version 3.2.5. The north region had 6760 foci (21.11%), the south-central region had 3020 foci (9.43%), the Middle Paraíba had 6,352 foci (19.84%), the Metropolitan areas had 6671 foci (20.83%), and the Green Coast region had 292 foci (0.91%). The cluster analysis identified three homogeneous groups of fire foci (G1, G2, and G3) but did not include the municipality of Campos dos Goytacazes (NA). The G1 group (6.21 ± 0.01 foci, 57.61%) included areas throughout the state and covered the coastal region and lowlands towards the north. The G2 group (6.21 ± 0.01 foci, 34.81%) included the northern, south-central, and coastal shallows regions. The G3 group (6.21 ± 0.01 foci, 9.78%) included the mountain ranges of the state. Environmental characteristics and socioeconomic are crucial in the dynamics of fire foci in Rio de Janeiro.

Este estudo avaliou a variabilidade espaço-temporal de focos de calor via satélites ambientais para o Estado do Rio de Janeiro (SRJ) com base em procedimentos estatísticos. Os focos de calor no período de 2000 a 2015 foram obtidos a partir do banco de dados de focos do BDQueimadas. Análises estatísticas descritivas, exploratórias e multivariadas foram realizadas no ambiente de software R i386 versão 3.2.5. A região Norte tinha 6760 focos (21,11%), a região Centro-Sul tinha 3020 focos (9,43%), o Médio Paraíba tinha 6,352 focos (19,84%), as áreas metropolitanas tinham 6671 focos (20,83%) e a Costa Verde região teve 292 focos (0,91%). A análise de agrupamento identificou três grupos homogêneos de focos de calor (G1, G2 e G3), mas não incluiu o município de Campos dos Goytacazes (NA). Em que se observa no grupo G1 uma forte presença de outliers com valores atípicos, em todos os anos da série temporal, sendo destaque para os anos de 2014 e 2015 que apresentam os maiores números de outliers seguidos dos valores das médias (20.46 e 18.85 focos) acima das medianas (14.00 e 12.50 focos). Comportamentos semelhantes foram observados nos grupos G2 e G3, sendo o grupo G2 com média (81.43 mm e 66.00 focos) e medianas (49.07 e 35.50 focos) com um DP de 27.89 focos de fogo. O grupo G3 com média (314.13 e 361.33 mm) e mediana (204.50 e 76.00 focos) e o maior DP (196,75 focos) em comparação aos demais grupos. Características ambientais e socioeconômicas são cruciais na dinâmica dos focos de calor no Rio de Janeiro.

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RESUMEN Fundamento: La quemadura grave representa el tipo de agresión biológica más severo que puede sufrir el organismo y ponen en peligro la vida del paciente por el permanente riesgo de sepsis y falla multisistémica progresiva. La anemia incide en la morbilidad y mortalidad del quemado en estado grave; su tratamiento ha pasado por diversos momentos en la historia y su corrección depende de las transfusiones sanguíneas que aumentan el riesgo de complicaciones y reacciones adversas. Objetivo: Actualizar los conocimientos sobre la utilidad de la eritropoyetina en el tratamiento de la anemia en el quemado grave. Desarrollo: La gravedad de la quemadura está determinada por la intensidad de la temperatura y la duración de la exposición. La anemia es una de las complicaciones más frecuentes en los quemados graves y su tratamiento en ocasiones se limita al uso de transfusiones de sangre, sin embrago la eritropoyetina es una alternativa terapéutica; pertenece a la familia de las citoquinas, alcanza la médula ósea, donde estimula células progenitoras cuyo objetivo es lograr su transformación en eritrocitos. La administración de eritropoyetina humana recombinante en el paciente quemado grave con anemia se considera eficaz, ya que al estimular los mecanismos de la eritropoyesis, produce una elevación paulatina pero mantenida del hematocrito acompañándose de otros efectos beneficiosos. Conclusiones: La eritropoyetina humana por sus características farmacológicas, se muestra como una opción de tratamiento para el paciente quemado grave con anemia al permitir la recuperación de manera sostenida de los valores de hemoglobina con un mínimo de complicaciones, disminuye el uso de transfusiones de sangre que pueden aumentar la morbilidad de estos enfermos.

ABSTRACT Background: The serious burn represents the most severe type of biological aggression the body can suffer and endangers the patient's life due to the permanent risk of sepsis and progressive multisystem failure. Anemia affects the morbidity and mortality of seriously burned patient in serious condition; its treatment has gone through different moments in history and its correction depends on blood transfusions that increase the risk of complications and adverse reactions. Objective: To update knowledge about the usefulness of erythropoietin in the treatment of anemia in seriously burned patient. Development: The severity of the burn is determined by the intensity of the temperature and the duration of the exposure. Anemia is one of the most frequent complications in seriously burned patient and its treatment is sometimes limited to the use of blood transfusions. However, erythropoietin is a therapeutic alternative; it belongs to the family of cytokines, reaches the spinal cord, where it stimulates progenitor cells with the objective of achieving their transformation into erythrocytes. The administration of recombinant human erythropoietin in seriously burned patient with anemia is considered effective, since by stimulating the mechanisms of erythropoiesis, it produces a gradual but sustained elevation of the hematocrit accompanied by other beneficial effects. Conclusions: Human erythropoietin, due to its pharmacological characteristics, is shown as a treatment option for seriously burned patient with anemia by allowing the sustained recovery of hemoglobin values with a minimum of complications, reducing the use of blood transfusions that can increase the morbidity of these patients.

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RESUMEN Fundamento: La quemadura grave representa el tipo de agresión biológica más severo que puede sufrir el organismo y ponen en peligro la vida del paciente por el permanente riesgo de sepsis y falla multisistémica progresiva. La anemia incide en la morbilidad y mortalidad del quemado en estado grave; su tratamiento ha pasado por diversos momentos en la historia y su corrección depende de las transfusiones sanguíneas que aumentan el riesgo de complicaciones y reacciones adversas. Objetivo: Actualizar los conocimientos sobre la utilidad de la eritropoyetina en el tratamiento de la anemia en el quemado grave. Desarrollo: La gravedad de la quemadura está determinada por la intensidad de la temperatura y la duración de la exposición. La anemia es una de las complicaciones más frecuentes en los quemados graves y su tratamiento en ocasiones se limita al uso de transfusiones de sangre, sin embrago la eritropoyetina es una alternativa terapéutica; pertenece a la familia de las citoquinas, alcanza la médula ósea, donde estimula células progenitoras cuyo objetivo es lograr su transformación en eritrocitos. La administración de eritropoyetina humana recombinante en el paciente quemado grave con anemia se considera eficaz, ya que al estimular los mecanismos de la eritropoyesis, produce una elevación paulatina pero mantenida del hematocrito acompañándose de otros efectos beneficiosos. Conclusiones: La eritropoyetina humana por sus características farmacológicas, se muestra como una opción de tratamiento para el paciente quemado grave con anemia al permitir la recuperación de manera sostenida de los valores de hemoglobina con un mínimo de complicaciones, disminuye el uso de transfusiones de sangre que pueden aumentar la morbilidad de estos enfermos.

ABSTRACT Background: The serious burn represents the most severe type of biological aggression the body can suffer and endangers the patient's life due to the permanent risk of sepsis and progressive multisystem failure. Anemia affects the morbidity and mortality of seriously burned patient in serious condition; its treatment has gone through different moments in history and its correction depends on blood transfusions that increase the risk of complications and adverse reactions. Objective: To update knowledge about the usefulness of erythropoietin in the treatment of anemia in seriously burned patient. Development: The severity of the burn is determined by the intensity of the temperature and the duration of the exposure. Anemia is one of the most frequent complications in seriously burned patient and its treatment is sometimes limited to the use of blood transfusions. However, erythropoietin is a therapeutic alternative; it belongs to the family of cytokines, reaches the spinal cord, where it stimulates progenitor cells with the objective of achieving their transformation into erythrocytes. The administration of recombinant human erythropoietin in seriously burned patient with anemia is considered effective, since by stimulating the mechanisms of erythropoiesis, it produces a gradual but sustained elevation of the hematocrit accompanied by other beneficial effects. Conclusions: Human erythropoietin, due to its pharmacological characteristics, is shown as a treatment option for seriously burned patient with anemia by allowing the sustained recovery of hemoglobin values with a minimum of complications, reducing the use of blood transfusions that can increase the morbidity of these patients.

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OBJECTIVES: To compare perceived stigmatization, symptoms of depression and self-esteem of adults from Brazilian general population with Brazilian burns survivors and to verify the possible correlations between these populations. METHOD: The general population and burn survivors administered the adapted Brazilian versions of the Perceived Stigmatization Questionnaire (BR-PSQ-R), Beck Depression Inventory (BDI) and Rosenberg Self-Esteem Scale (RSES). The Student's t-test for independent samples was employed to identify significant differences between the means of the results from the BR-PSQ-R, BDI and RSES instruments, and the Pearson correlation was used to detect correlations between constructs. The significance level was set at 0.05. RESULTS: Participants of this study included: 102 individuals from the general population and 240 burn survivors. The difference between the BR-PSQ-R mean scores of the two groups was not statistically significant (p = 0.077). The mean scores for the BDI (p = 0.001) and RSES (p = 0.001) where found to be lower in the general population, when compared to burn survivors. Moderate correlations were identified between the perceived stigmatization and depression (r = 0.43; p < 0.001) and perceived stigmatization and self-esteem (r = -0.35; p < 0.001). CONCLUSIONS: Participants from the general population and burn survivors exhibit similar levels of perception of stigmatization; the general population presented fewer symptoms of depression and a higher self-esteem when compared to burn survivors.

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Pseudomonas aeruginosa is an opportunistic bacterium associated with healthcare infections in intensive care units (ICUs), ventilator-associated pneumonia (VAP), surgical site infections, and burns. This bacterium causes 75% of death in burned patients, since it can develop a persistent biofilm associated with infections, express several virulence factors, and antibiotic-resistance mechanisms. Some of these virulence factors are proteases such as elastase and alkaline protease, or toxic metabolites such as pyocyanin and is one of the few microorganisms able to produce cyanide, which inhibits the cytochrome oxidase of host cells. These virulence factors are controlled by quorum sensing (QS). In this work, 30 P. aeruginosa clinical strains isolated from burned patients from a tertiary hospital in Mexico City were studied. Antibiotic susceptibility tests were done, and virulence factors (elastase, alkaline protease, HCN, and pyocyanin) were determined in presence of an N-acylhomoserine lactonase, AiiM able to hydrolyze a wide range of acyl homoserine lactones. The treatment reduced significantly the activities of elastase and alkaline protease, and the production of pyocyanin and HCN in all producer strains but not the secretion of toxins through the type III secretion system. Our work suggests that AiiM treatment may be an effective therapy to combat P. aeruginosa infection in burn patients.

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Resumen: Introducción: En las unidades pediátricas de quemados se atienden pacientes de urgencias y cuidados intensivos. La aplicación del ultrasonido como herramienta básica en el cuidado de pacientes gravemente enfermos en tiempo real, ha permitido responder a preguntas específicas sobre su condición clínica y se utiliza como una herramienta que guía diferentes procedimientos necesarios para el cuidado adecuado de este tipo de pacientes. Con estos antecedentes, y además del hecho de que el entorno de cuidados críticos está integrando las aplicaciones básicas del ultrasonido al monitoreo no invasivo, consideramos importante revisar los usos de la ecografía en una unidad pediátrica de quemados. Objetivo: Presentar los aspectos más importantes de los protocolos de ultrasonido más comunes en una unidad pediátrica de quemados. Material y métodos: Se realizó un estudio retrospectivo, observacional, descriptivo, longitudinal y homodémico sobre protocolos de ultrasonido en la Unidad de Quemados de los Servicios de Salud del Estado de Puebla anexa al Hospital para el Niño Poblano, especificando su importancia en la toma de decisiones en el manejo integral de pacientes pediátricos quemados. Resultados: Se encontró que cuatro protocolos eran los más utilizados en los pediátricos quemados: Focus Assessment Sonography in Trauma, Rapid Ultrasound In Shock, ecocardiografía enfocada y diámetro de la vaina del nervio óptico. Conclusión: La ecografía está cubriendo un campo más amplio en unidades de cuidados intensivos pediátricos. En la Unidad de Quemados de los Servicios de Salud del Estado de Puebla consideramos que es una herramienta de diagnóstico que no se puede posponer.

Abstract: Introduction: In pediatric burn units, emergency and intensive care patients are attended. The application of ultrasound as a basic tool in the care of seriously ill patients in real time, has allowed responding to specific questions about their clinical condition and used as a tool that guides different procedures necessary in the proper care of this type of patients. With this background and in addition to the fact that the critical care environment is integrating the basic applications of ultrasound in non-invasive monitoring, we consider it important to review the uses of ultrasonography in a pediatric burn unit. Objective: To present the most important aspects of the most common ultrasound protocols in a pediatric burn unit. Material and methods: A retrospective, observational, descriptive, longitudinal and homodemic study was conducted on ultrasound protocols in the Unidad de Quemados de los Servicios de Salud del Estado de Puebla anexa al Hospital para el Niño Poblano, specifying its importance in the decision making in the integral management of burned pediatric patients. Results: Four protocols were found to be the most used in the burned pediatric patients: FAST, RUSH, focused echocardiography and DVNO. Conclusion: Ultrasound is covering a wider field in pediatric intensive care units. In the Unidad de Quemados de los Servicios de Salud del Estado de Puebla we consider that it is a diagnostic tool that can not be postponed.

Resumo: Introdução: Nas unidades de queimados pediátrica são atendidos pacientes de emergência e terapia intensiva. A aplicação do ultrassom como ferramenta básica no atendimento de pacientes graves em tempo real, permitiu-nos responder a perguntas específicas sobre sua condição clínica e é utilizada como ferramenta que orienta os diferentes procedimentos necessários para o atendimento adequado desse tipo de paciente. Com esse pano de fundo e além do fato de o ambiente de cuidados intensivos integrar as aplicações básicas do ultrassom ao monitoramento não invasivo, consideramos importante revisar os usos do ultrassom em uma unidade de queimados pediátrica. Objetivo: Apresentar os aspectos mais importantes dos protocolos de ultrassom mais comuns em uma unidade de queimados pediátrica. Material e métodos: Foi realizado um estudo retrospectivo, observacional, descritivo, longitudinal e homodêmico dos protocolos de ultrassom no UQSSEP-HNP, especificando sua importância na tomada de decisão no manejo integral de pacientes pediátricos queimados. Resultados: Verificou-se que quatro protocolos foram os mais utilizados em pacientes pediátricos queimados: FAST, RUSH, ecocardiografia focada e DVNO. Conclusão: O ultrassom está cobrindo um campo mais amplo nas unidades de terapia intensiva pediátrica. No UQSSEP, consideramos uma ferramenta de diagnóstico que não pode ser posposta.

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RESUMEN El cambio en el uso del suelo y el fuego como mecanismo utilizado para el mismo han creado perturbaciones ecológicas a grandes escalas, como lo son la fragmentación y aislamiento de ecosistemas importantes en paisajes tropicales. En el presente estudio, analizamos los cambios de uso del suelo entre los años 2012-2016 y los eventos de fuego entre los años 2016-2018, para identificar la dinámica de cambio espaciotemporal en la Serranía de la Lindosa, Guaviare, a partir de información oficial y sensores remotos. Para 2016 la cobertura boscosa se redujo en un 17 % correspondiendo con el aumento de vegetación secundaria y pastizales en el área. Los focos de fuego detectados estuvieron concentrados en el noroeste y sureste de la serranía, puntos coincidentes en zonas de bosque primario y zonas de pastizal consolidadas. Estos resultados indican que existe un proceso activo de deforestación en la serranía, que fragmenta la matriz boscosa dejando parches de bosque aislados, lo cual tendría repercusiones sobre la biodiversidad allí presente. Asimismo, la sinergia entre dicho proceso y el uso de fuego se muestra como amenaza constante, a diferentes escalas, sobre los diferentes ecosistemas. Esta información se presenta como herramienta para elaborar estrategias puntuales para evitar mayores repercusiones negativas sobre la serranía, que actualmente se encuentra en estado vulnerable.

ABSTRACT The change in land use and fire as a mechanism used for this change, have created ecological disturbances at large scales, such as the fragmentation and isolation of essential ecosystems within tropical landscapes. In the present study, we analyze the land-use changes along 2012-2016 and fire events between 2016-2018, to identify the dynamics of spatial-temporal change in the Serranía La Lindosa, Guaviare using official information and remote sensors. Forest cover was reduced by 17 %, during 2012-2016, corresponding to an increase in secondary vegetation and pastures in the area. The fire-hotspots detected were concentrated on the northwest and southeast of the mountain range, coinciding with areas of primary forest and consolidated pasture areas. These results show that there is an active process of deforestation in La Lindosa, leaving a fragmented matrix and isolated forest patches, which would have repercussions on the local biodiversity. Besides, the synergy between this process and the use of fire, represent a constant threat, at different scales, on the different ecosystems. This information is presented as a resource to elaborate punctual strategies in order to avoid greater negative repercussions on the mountain range area, which is currently in a vulnerable state.

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Antecedentes. Son múltiples los recursos utilizados en el manejo de niñosquemados,debido a la respuesta inflamatoria secundaria a quemadurases necesario determinar la ausencia o presencia de infecciones asociadas, ya que constituyen la principal causa de muerte en pacientes quemados pediátricos. El uso de la procalcitonina y proteína C reactivasirven de apoyo en el seguimiento y diagnóstico de infecciones. Objetivo. Determinarla utilidad de procalcitonina y proteína C reactivacomo reactantes agudos en niños quemados. Métodos. Se revisaron 74 pacientes pediátricos quemados en el hospital Dr. Francisco de Icaza Bustamante, del año 2015. Fue undiseño no experimental, de tipo descriptivo, de corte trasversal. Resultados.Los niños atendidos por quemaduras fueron masculinos con 56,75% y femenino del 43,25%. Con mayor frecuencia estuvieron los pacientes entre 0-3 años de edad con 56,75%; y de este el masculino tuvo el 33,78% comparado con el femenino del 22,97%, la mayoría de quemaduras fue secundaria a líquidos calientes (68,92%). La afectación de superficie corporal quemada estuvo entre 10 a <20% (64,86%) y fueron del grado II de profundidad (66,21%). El índice de gravedad tuvo un 51,35% como grave. Conclusiones.Las pruebas de PCR y PCT como reactantes de fase aguda no mostraron un valor significativo de utilidad que pudiera relacionar u orientar dicho resultado con el Índice de Gravedad, evidenciando que en este grupo de pacientes no influyó en el manejo terapéutico en las diferentes fases descritas.

Background.There are multiple resources used in the management of burned children; due to the inflammatory response secondary to burns, it is necessary to determine the absence or presence of associated infections, since they are the main cause of death in burned pediatric patients. The use of procalcitonin and C-reactive protein, support the follow-up and diagnosis of infections. Objective.To determine the utility of procalcitonin and C reactive protein as acute reactants in burned children. Methods.We reviewed 74pediatric patients burned at the hospital Dr. Francisco de Icaza Bustamante, January 1-December 31, 2015. It was a non-experimental, descriptive, cross-cut design. Result.The children treated for burns were male with 56.75% and female with 43,25%. Morefrequent were patients between 0-3 years of age with 56,75%; and of this the masculine had 33,78%compared to the feminine of 22,97%, the majority of burns was secondary to hot liquids (68,92%). The affectation of burned corporal surface was between 10 to <20% (64,86%) and theywere of degree II of depth (66,21%). The severity index had 51,35% as serious.Conclusions. PCR and PCT tests as acute phase reactants did not show a significant value of utility that could relate or guide the result with the Severity Index, evidencing that in this group of patients it did not influence the therapeutic management in the different phases described.

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Abstract Background and objectives: Major burn surgery causes large hemorrhage and coagulation dysfunction. Treatment algorithms guided by ROTEM® and factor VIIa reduce the need for blood products, but there is no evidence regarding factor XIII. Factor XIII deficiency changes clot stability and decreases wound healing. This study evaluates the efficacy and safety of factor XIII correction and its repercussion on transfusion requirements in burn surgery. Methods: Randomized retrospective study with 40 patients undergoing surgery at the Burn Unit, allocated into Group A those with factor XIII assessment (n = 20), and Group B, those without assessment (n = 20). Erythrocyte transfusion was guided by a hemoglobin trigger of 10 g.dL-1 and the other blood products by routine coagulation and ROTEM® tests. Analysis of blood product consumption included units of erythrocytes, fresh frozen plasma, platelets, and fibrinogen. The coagulation biomarker analysis compared the pre- and post-operative values. Results and conclusions: Group A (with factor XIII study) and Group B had identical total body surface area burned. All patients in Group A had a preoperative factor XIII deficiency, whose correction significantly reduced units of erythrocyte concentrate transfusion (1.95 vs. 4.05, p = 0.001). Pre- and post-operative coagulation biomarkers were similar between groups, revealing that routine coagulation tests did not identify factor XIII deficiency. There were no recorded thromboembolic events. Correction of factor XIII deficiency in burn surgery proved to be safe and effective for reducing perioperative transfusion of erythrocyte units.

Resumo Justificativa e objetivos: A cirurgia no grande queimado causa hemorragia de grande porte e disfunção da coagulação. Os algoritmos de tratamento guiados por ROTEM® e fator VIIa reduzem as necessidades de hemoderivados, mas falta evidência em relação ao fator XIII. A deficiência do fator XIII altera a estabilidade do coágulo e diminui a cicatrização. Este estudo avalia a eficácia e a segurança da correção do fator XIII e sua repercussão nas necessidades transfusionais na cirurgia do queimado. Métodos: Estudo retrospectivo randomizado de 40 doentes submetidos à cirurgia na Unidade de Queimados alocados em grupo A com estudo do fator XIII (n = 20) e grupo B sem estudo (n = 20). A transfusão eritrocitária foi guiada por gatilho de hemoglobina de 10 g.dL-1 e os outros hemoderivados por testes de coagulação de rotina e ROTEM®. A análise do consumo de hemoderivados incluiu unidades de eritrócitos, plasma fresco congelado, plaquetas e fibrinogênio. A análise dos biomarcadores da coagulação comparou os valores pré e pós-operatórios. Resultados e conclusões: O grupo A (com estudo de fator XIII) e o grupo B apresentaram área de superfície corporal total queimada idêntica. Todos os doentes do grupo A revelaram déficit pré-operatório de fator XIII, cuja correção reduziu significativamente a transfusão de unidades de concentrado eritrocitário (1,95 vs. 4,05, p = 0,001). Os biomarcadores de coagulação pré e pós-operatórios foram semelhantes entre os grupos, revelaram que os testes de coagulação de rotina não identificam o déficit de fator XIII. Sem eventos tromboembólicos registrados. A correção do fator XIII na cirurgia do queimado revelou-se segura e eficaz na redução da transfusão perioperatória de unidades de eritrócitos.

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