Epidemiología de las quemaduras pediátricas: seis años de experiencia en una unidad especializada de alta complejidad

Introducción: Las lesiones por quemaduras son una patología grave, que pueden conducir a una gran morbilidad y una mortalidad significativa, pero también tienen un impacto sanitario-económico considerable. El objetivo de este estudio fue describir epidemiológicamente la población hospitalizada en la Unidad de Quemados del Hospital de Pediatría “Prof. Dr. Juan P. Garrahan” entre los años 2015 y 2020. Material y métodos: Estudio observacional, descriptivo- analítico, transversal, con evaluación y análisis de datos registrados en base de datos de historias clínicas digitalizadas. Resultados: La serie incluyó 214 pacientes, 60,3% sexo masculino, mediana de edad 4.6 años (0-16,6), 63% provenientes de la provincia de Buenos Aires, 78% de traslados se hicieron por vía terrestre con tiempo promedio de 55,6 minutos (DS 81,9), 52,8% ingresaron en los meses de otoño-invierno, 80% carecían de cobertura social. La etiología lesional fue fuego y variantes (69,2%) y escaldaduras (25,7%). El 49% reunieron criterios de lesión inhalatoria. La mediana de superficie corporal quemada (SCQ) fue 30% (0-100%), lesiones tipo B (profundas) 16,2% (0-100%) y gravedad crítica (37,4%) y grave (19,2%), requiriendo una mediana de 5 actos quirúrgicos (0-55). El 87,3% de los ingresos fue en Cuidados Intensivos, con mediana de estancia hospitalaria de 33 días (1-243) y relación promedio %SCQ/días internación 1,9 (DS 2,1). El uso de Asistencia Respiratoria Mecánica (ARM) fue 68,7% con una mediana de 7.5 días (1-100). La mortalidad de la serie fue 9,8% y estuvo asociada estadísticamente a lesión inhalatoria (p=0,0001), profundidad lesional B (p=0,00001) y uso de ARM (p=0,0011). Conclusion: Los resultados de este estudio concluyen que el sexo masculino, la franja etaria < 5 años, los ingresos en otoño-invierno, las lesiones por fuego, el grupo de gravedad crítico y la utilización de ARM son datos epidemiológicos predominantes correspondientes a una Unidad de Quemados de Alta Complejidad y deben ser tenidos en cuenta para la planificación y adecuación de los recursos asistenciales.Burn injuries are a serious pathology, which can lead to high morbidity and significant mortality, but also have a considerable health-economic impact. The objective of this study was to epidemiologically describe the population hospitalized in the Burn Unit of the Pediatric Hospital “Prof. Dr. Juan P. Garrahan” between 2015 and 2020. Material and method: Observational, descriptive-analytical, cross-sectional study, with evaluation and analysis of data recorded in a database of digitized medical records. Results: The series included 214 patients, 60,3% male, median age 4,6 years (0-16,6), 63% from the province of Buenos Aires, 78% of transfers were made by land with an average time of 55,6 minutes (DS 81,9), 52,8% entered in the fall-winter months, 80% lacked social coverage. The lesional etiology was fire and variants (69,2%) and scalds (25,7%). 49% met criteria for inhalation injury. The median body surface area burned (SCQ) was 30% (0-100%), type B (deep) injuries 16,2% (0-100%) and critical (37,4%) and severe (19,2%) severity, requiring a median of 5 surgical acts (0-55). 87,3% of the admissions were in Intensive Care, with a median hospital stay of 33 days (1-243) and average ratio %SCQ/days hospitalization 1,9 (DS 2,1). The use of Mechanical Respiratory Assistance (MRA) was 68,7% with a median of 7,5 days (1-100). Mortality in the series was 9,8% and was statistically associated with inhalation injury (p=0,0001), injury depth B (p=0,00001) and use of MRA (p=0,0011). Conclusion: The results of this study conclude that male sex, the age group <5 years, admissions in autumn-winter, fire injuries, the critical severity group and the use of MRA are predominant epidemiological data corresponding to a Unit of High Complexity Burns and must be taken into account for the planning and adaptation of care resources

cytotoxicity and genotoxicity of size-fractionated iron oxide (magnetite) in a549 human lung epithelial cells: role of ROS, JNK, and NF-κB

Airborne particulate matter (PM) of varying size and composition is known to cause health problems in humans. The iron oxide Fe₃O₄ (magnetite) may be a major anthropogenic component in ambient PM and is derived mainly from industrial sources. In the present study, we have investigated the effects of four different size fractions of magnetite on signaling pathways, free radical generation, cytotoxicity, and genotoxicity in human alveolar epithelial-like type-II cells (A549). The magnetite particles used in the exposure experiments were characterized by mineralogical and chemical techniques. Four size fractions were investigated: bulk magnetite (0.2–10 μm), respirable fraction (2–3 μm), alveolar fraction (0.5–1.0 μm), and nanoparticles (20–60 nm). After 24 h of exposure, the A549 cells were investigated by transmission electron microscopy (TEM) to study particle uptake. TEM images showed an incorporation of magnetite particles in A549 cells by endocytosis. Particles were found as agglomerates in cytoplasm-bound vesicles, and few particles were detected in the cytoplasm but none in the nucleus. Increased production of reactive oxygen species (ROS), as determined by the 2′,7′-dichlorfluorescein-diacetate assay (DCFH-DA), as well as genotoxic effects, as measured by the cytokinesis block-micronucleus test and the Comet assay, were observed for all of the studied fractions after 24 h of exposure. Moreover, activation of c-Jun N-terminal kinases (JNK) without increased nuclear factor kappa-B (NF-κB)-binding activity but delayed IκB-degradation was observed. Interestingly, pretreatment of cells with magnetite and subsequent stimulation with the pro-inflammatory cytokine tumor necrosis factor-alpha (TNFα) led to a reduction of NF-κB DNA binding compared to that in stimulation with TNFα alone. Altogether, these experiments suggest that ROS formation may play an important role in the genotoxicity of magnetite in A549 cells but that activation of JNK seems to be ROS- independent