martes, 30 de diciembre de 2014

Quemaduras / Burns

Heparina tópica versus tratamiento convencional en las quemaduras agudas. estudio comparativo 

Topical heparin versus conventional treatment in acute burns: A comparative study.
Masoud M, Wani AH, Darzi MA.
Indian J Burns [serial online] 2014 [cited 2014 Dec 15];22:43-50.

Background: In order to alleviate pain, reduce scarring, and to improve the overall outcome in burn patients multitude of novel agents are being utilized. In this regard, heparin has been introduced because of its research proven role in burn wound management. Objective:The objective was to evaluate, whether the addition of heparin, administered only topically, could improve burn treatment. Materials and Methods: The subjects in this study were 40 consecutive burn patients with 10-20% burns, randomly allocated to heparin group (H-group) (20) and control group (C-group) (20). Results: All patients in the H-group were receiving analgesics on demand only from the 2 nd week onwards. This was in contrast to the C-group wherein 35% patients received twice daily dosage of analgesics in the 2 nd week of their treatment. When compared to the average hospital stay of 18.3 days in the C-group, patients belonging to the H-group had an average hospital stay of 12.3 days (P < 0.05). Conclusions: The current comparative study demonstrates that heparin significantly decreases the requirement of analgesics and the time required to prepare a burn wound for grafting. Besides as compared to silver sulfadiazine dressings, heparin appears to be cost-effective.
Keywords: Burn, conventional burn treatment, topical heparin;year=2014;volume=22;issue=1;spage=43;epage=50;aulast=Masoud;type=2

Prutito post quemaduras

Postburn pruritus: A practical review.
Ahuja RB, Chatterjee P.
Indian J Burns [serial online] 2014 [cited 2014 Dec 15];22:13-21.
The incidence of postburn pruritus is reported to vary between 80% and 100% and the persistence of itching leads to disabling symptoms such as sleep disturbance, anxiety, and disruption of daily activities. Recently, a few small randomized controlled trials by investigators have focused our attention to the neurobiology and molecular mechanisms of the postburn pruritus and the role of centrally acting agents in its treatment. It is now recognized that the central nervous system develops aberrant autonomous activity that causes maintenance of pruritic symptoms into a chronic state. This practical review on the topic aims to rationalize and simplify the current treatment options, through emerging and available evidence, to enable the physician to make an even better informed choice. While antihistamines and massage therapy will continue to be effective first-line strategy for most clinicians, the promising results in controlled studies obtained with gabapentin/pregabalin to ameliorate pruritic symptoms in a predictable fashion in burns patients have caused a paradigm shift in the therapeutic approach. Tailoring the drug therapy to the severity of symptoms leads to more successful therapy of this vexing malady and current evidence supports the use of gabapentin/pregabalin in patients with moderate to severe postburn pruritus (visual analog scale score >5) as the first line, even if as an "off label" indication. Other treatment modalities like doxepin, ondansetron, or transcutaneous electrical nerve stimulation may have applications on a case to case basis. However, massage therapy should continue to be an adjunct with all other modalities.
Keywords: Antihistamines, early itch, gabapentin, late itch, post burn itch, post burn pruritis, pregabalin;year=2014;volume=22;issue=1;spage=13;epage=21;aulast=Ahuja;type=2

Anestesiología y Medicina del Dolor
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