Potential efficacy of sensorimotor exercise program on pain,proprioception, mobility,and quality of life in diabetic patients with foot burns: A 12-week randomized control study

BackgroundBoth diabetes mellitus (DM) and burn injuries lead to physical and psychological impairments. Foot burns are still a challenging health condition because of its important sensory role. No previous studies have assessed the physical therapy intervention on diabetic patients with foot burns. Therefore, this study aimed to assess the potential efficacy of sensorimotor exercise on pain, proprioception, mobility, balance, and quality of life in diabetic patients with foot burns.MethodsBetween July 2019 and February 2020, thirty-three diabetic patients with foot burns, aged 32 to 46 yrs, were enrolled in this randomized control study, and randomized consecutively into two groups, study group (n = 16) and control group (n = 17). The study group underwent a sensorimotor exercise program thrice a week for 12 consecutive weeks, however the control group did not undergo the exercise intervention. Both groups were instructed to conduct home exercises. Visual analogue scale (VAS), proprioceptive responses, time-up and go (TUG) values, and short form-36 (SF-36) have been assessed prior and subsequent to the study intervention.ResultsNo significant differences were observed between groups regarding baseline data (p ? 0.05). Subsequent to 12 wk intervention, the study group showed significant improvements in outcome measures (proprioceptive responses, p ? 0.05, VAS, p ? 0.001, TUG, p = 0.003, and SF-36, p ? 0.001) and the control group exhibited significant changes in VAS and SF-36 (p = 0.004, p = 0.043 respectively) however, no significant changes were found in proprioceptive responses and TUG values (p ? 0.05). Between groups, the post-intervention comparison demonstrated statistical differences with tending toward the study group (proprioceptive responses, p ? 0.05, VAS, p ? 0.001, TUG, p = 0.013, and SF-36, p = 0.046).ConclusionsSensorimotor exercise training may improve, pain, proprioceptive responses, mobility, balance, and quality of life in diabetic patients with foot burns. Physiotherapists and rehabilitation providers should include the sensorimotor exercise in their protocols in the treatment of diabetic patients with foot burns.     

Female patients display poorer burn-specific quality of life 12 months after a burn injury

IntroductionAlthough gender differences in morbidity and mortality have been measured in patients with moderate to severe burn injury, little attention has been directed at gender effects on health-related quality of life (HRQoL) following burn injury. The current study was therefore conducted to prospectively measure changes in HRQoL for males and females in a sample of burn patients.MethodsA total of 114 adults who received treatment at a statewide burns service for a sustained burns injury participated in this study. Instruments measuring generic health status (Short Form 36 Medical Outcomes Survey version 2), burn-specific HRQoL (Burns Specific Health Scale-Brief), psychological distress (Kessler Psychological Distress Scale) and alcohol use (Alcohol Use Disorders Identification Tool) were prospectively measured at 3, 6 and 12 months post-burn.ResultsIn the 12 months post-injury, female patients showed overall poorer physical (p = 0.01) and mental health status (p < 0.001), greater psychological distress (p < 0.001), and greater difficulty with aspects of burn-specific HRQoL: body image (p < 0.001), affect (p < 0.001), interpersonal functioning (p = 0.005), heat sensitivity (p = 0.01) and treatment regime (p = 0.01). While significant interaction effects suggested that female patients had more improvement in difficulties with treatment regime (p = 0.007), female patients continued to report greater difficulty with multiple aspects of physical and psychosocial health status 12 months post-injury.ConclusionEven though demographic variables, injury characteristics and burn care interventions were similar across genders, following burn injury female patients reported greater impairments in generic and burn-specific HRQoL along with psychological morbidity, when compared to male patients. Urgent clinical and research attention utilising an evidence-based research framework, which incorporates the use of larger sample sizes, the use of validated instruments to measure appropriate outcomes, and a commitment to monitoring long-term care, can only improve burn-care.     

Efficacy of Maitland joint mobilization technique on pain intensity,mouth opening,functional limitation,kinesiophobia, sleep quality and quality of life in temporomandibular joint dysfunction following bilateral cervicofacial burns

BackgroundBilateral cervicofacial burn contracture initially affects facial expressions and later affects tempero mandibular joint (TMJ) function of the patient. It further tightens the ligaments and capsules around the TMJ and leads to tempero mandibular dysfunction. The consequences of temporomandibular joint dysfunction will be pain, limitation of mouth opening, functional disability and poor quality of life (Qol). However, studies examining the efficacy of Maitland joint mobilization technique in this population are lacking.ObjectivesTo find the short term effects of Maitland joint mobilization technique on pain, mouth opening, functional limitation, kinesiophobia, sleep quality and Quality of life in tempero mandibular joint dysfunction following bilateral cervicofacial burns.MethodsThirty subjects with temporomandibular joint dysfunction following cervicofacial burn (N = 30) were allocated to Maitland joint mobilization group (n = 15) and home based training group (n = 15) randomly to receive Maitland joint mobilization technique and home based training for 4 weeks. All the participants received ultrasound therapy as common treatment. Primary (Numeric Pain Rating Scale – NPRS, maximal mouth opening – MMO & Tempero mandibular disability index – TDI) and secondary (Tampa Scale of Kinesiophobia – TSK-17, Sleep quality questionnaire – SSQ & Global Rating of Change – GRC) outcome measures were measured at baseline, after four weeks and three months follow up. Repeated measures of ANOVA and independent t test were performed for analyzing the dependent variables in both groups.ResultsBaseline demographic characters and study variables show homogenous distribution between the groups (p > 0.05). Four weeks following different training protocols Maitland joint mobilization group shows more significant changes in pain intensity, mouth opening, functional limitation, kinesiophobia, sleep quality and Qol than home based training group (p ≤ 0.05). Also Maitland joint mobilization group show significant improvement in study variables than home based training group (p ≤ 0.05) at three months follow up.ConclusionBoth groups improved over time, however, differences between the groups were noticed small. However, physiotherapy management which includes Maitland joint mobilization technique and therapeutic exercise program has an effective strategy in the treatment of tempero mandibular joint dysfunction following cervicofacial burns.     

Comparison of prognostic models for burn patients: A retrospective nationwide registry study

BackgroundPrognostic burn index (PBI) is a unique model utilized to predict mortality of burn patients in Japan. In contrast, other prediction models are rarely used in Japan, and their accuracy and predictive value are unknown. The present study aimed to compare commonly used burn prediction models and determine the appropriate model for mortality prediction in Japanese burn patients.MethodsJapanese burn patients registered in the nationwide burn registry of Japanese Society for Burn Injury between April 1, 2011 and March 31, 2019 were reviewed retrospectively. The prognostic performance of PBI was compared with Baux score, revised Baux score, abbreviated burn severity index (ABSI), Ryan score and Belgian outcome in burn injury score (BOBI). The primary outcome was in-hospital mortality.ResultsThe study included 7911 acute burn patients. The overall mortality rate was 10.7%, the median age was 52 (interquartile range, 26–72) years, and the median % total body surface area was 7% (interquartile range, 3%–17%). The areas under the receiver operating characteristic curve for PBI, Baux score, ABSI, revised Baux score, Ryan score, and BOBI were 0.940 (95% confidence interval [CI]: 0.931–0.948), 0.943 (95% CI: 0.934–0.951; p = 0.002), 0.945 (95% CI: 0.937–0.953; p = 0.058), 0.946 (95% CI: 0.937–0.953; p = 0.002), 0.859 (95% CI: 0.846–0.870; p < 0.001), and 0.896 (95% CI: 0.885–0.905; p < 0.001), respectively.ConclusionAlthough the performance of PBI was good, it was not superior to the Baux score, revised Baux score, and ABSI. These three scores have a high prognostic accuracy. Hence, they are considered as alternative burn prognostic scores in Japan. The Baux score was an optimal prognostic model for patients with burns in Japan.     

The relationship between kinesiophobia and health-related quality of life in patients with rheumatoid arthritis: A controlled cross-sectional study

ObjectivesTo evaluate the kinesiophobia and kinesiophobia-related factors in patients with rheumatoid arthritis (RA) and provide a better perspective on the relationship between kinesiophobia and patients’ health-related quality of life (HRQoL).MethodsA total of 88 patients (67 females, 21 males) with RA and 93 healthy volunteers (67 females, 26 males) were included in the study between March 2020 and July 2020. Kinesiophobia was evaluated using the Tampa Scale of Kinesiophobia (TSK) and HRQoL was evaluated using the 36-item Short-Form Health Survey (SF-36). The Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), Health Assessment Questionnaire Disability Index (HAQ-DI), International Physical Activity Questionnaire (IPAQ) (Short Form) were completed by all participants.ResultsThe median age was 52.0 (IQR, 45.0-58.0) years in the RA group and 50.0 (IQR, 41.5-56.0) years in the control group. Age and sex were not significantly different between the groups. The median TSK score was 45.0 (IQR, 39.0-49.75) in the RA group, 39.0 (IQR, 37.0-43.0) in the control group (P < 0.001). The median FSS, BDI, and HAQ-DI scores were higher and the median HRQoL domains were lower in the RA group than in the control group (P < 0.05). Multivariate linear regression analysis including age, sex, education level, body mass index (BMI), morning stiffness duration, Disease Activity Score in 28 joints, FSS, BDI, visual analog scale and IPAQ scores variables showed that FSS scores (B = 1.07, P < 0.05), BDI scores (B = 0.24, P < 0.05), and BMI (B = 0.22, P < 0.05) were independent variables for kinesiophobia in patients with RA (R² = 0.32). TSK was a predictive variable for HAQ-DI (B = 0.03, P < 0.001), the physical functioning domain of the HRQoL (B = -1.18, P < 0.001), the bodily pain domain of the HRQoL (B = -0.78, P < 0.05), respectively.ConclusionPhysicians should have awareness of kinesiophobia in patients with RA. Educating patients about kinesiophobia, developing strategies for avoiding kinesiophobia, and specific treatment strategies with a multidisciplinary approach may improve HRQoL and disability.     

Long term sensory function after minor partial thickness burn: A pilot study to determine if recovery is complete or incomplete

BackgroundAcute burn damages skin architecture, including nerve endings, altering sensation and influencing recovery of quality of life and participation. It is established that sensation is reduced in scars after deep burn. However, it is unclear if sensory deficits exist in mild scars. The aim of this trial was to determine if sensory deficits persist in mature scars after minor partial thickness burn.MethodsThis observational pilot involved 30 patients with ‘good quality’ scars (defined as VSS ≤5 at ≥6 months post-burn). Sensory function was compared in scars and site matched uninjured skin using von Frey filaments and two-point discrimination (2-PD). Multivariable regression was used to predict the influence of burn and confounders on sensory outcomes.ResultsBoth pressure and 2-PD distance were significantly greater in scar compared to uninjured sites, indicating reduced sensory function. For von Frey filaments, the median was 3.84 (IQR = 1) in scars and 3.22 (IQR = 1) for uninjured (p = 0.001). For 2-PD, the median was 3.9 cm (IQR = 1.8) for scars and 2.6 cm (IQR = 1.6) for control sites (p = 0.001).ConclusionMeasureable sensory deficits persist in mature, good quality burn scars. These deficits may influence long-term recovery after minor partial thickness burn.     

Lethal triad in severe burns

IntroductionHypothermia, acidaemia and coagulopathy in trauma is associated with significant mortality. This study aimed to identify the incidence of the lethal triad in major burns, and describe demographics and outcomes.MethodsPatients admitted during a 71 month period with a total body surface area burn (TBSA) ≥ 30% were identified. A structured review of a prospective database was conducted. The lethal triad was defined as a combination of coagulopathy (International normalised ratio > 1.2), hypothermia (temperature ≤ 35.5 °C) and acidaemia (pH ≤ 7.25).ResultsFifteen of 117 patients fulfilled the criteria for the lethal triad on admission. Lethal triad patients had a higher median (IQR) abbreviated burn severity index (ABSI) (12 (9–13) vs. 8.5 (6–10), p = 0.001), mean (SD) TBSA burn (59.2% (18.7) vs. 47.9% (18.1), p = 0.027), mean (SD) age (46 (22.6) vs. 33 (28.3) years, p = 0.033), and had a higher incidence of inhalational injury (p < 0.0001) and full-thickness burns (p = 0.021). Both groups received similar volumes of fluid (p > 0.05).The lethal triad was associated with increased mortality (66.7% vs. 13.7%, p < 0.0001). With logistic regression analysis and adjustment for ABSI, the lethal triad was not shown to be a predictor of mortality (p > 0.05).ConclusionBurn patients with the lethal triad have a high mortality rate which reflects the severity of the injury sustained.     

The effect of foot reflexology massage on burn-specific pain anxiety and sleep quality and quantity of patients hospitalized in the burn intensive care unit (ICU)

BackgroundBurn-specific pain anxiety and sleep disorders are common factors in burned patients that affect wound healing process, as well as the severity of burn pain. This study aimed to investigate the effect of foot reflexology massage on burn-specific pain anxiety and sleep condition of patients hospitalized in the burn ICU.MethodIn this randomized controlled clinical trial, 52 patients were assigned by permuted block randomization 1:1 to the intervention (n = 26) and control (n = 26) groups. The intervention group received 20 min of foot reflexology massage during 3 days on their third, fourth and fifth days of hospitalization and 15 min before changing wound dressings. Patients in the control group merely received routine care. The Burn-Specific Pain Anxiety Scale (BSPAS) was completed for three consecutive days before and after changing wound dressings, and St. Mary's Hospital Sleep Questionnaire (SMHSQ) was filled out for four consecutive days before changing wound dressings for patients in both groups. The data were analyzed by IBM SPSS 16 software, Chicago, independent t, Chi-square, Friedman, Mann–Whitney and Wilcoxon tests.FindingsWe found no significant difference between pain-anxiety in the two groups before the intervention. The trend of different days in each groups were compared with Friedman test and showed that pain anxiety (p < 0.001), sleep latency (p < 0.001), duration of the last day's sleep (p < 0.001) and satisfaction of the last night sleep (p < 0.001) had a significant difference. In addition, Mann–Whitney test results showed that there were significant differences between the two groups at different times in terms of the above variables (p < 0.05). The effect size was = 0.82 for pain anxiety between group after the intervention.ConclusionBased on the results, foot reflexology massage can effectively reduce pain anxiety levels and improve sleep quality and quantity of patients with burn injuries; therefore, this non- pharmacological therapeutic method is recommended to be used in the burn ICUs. (Clinical trial’s registration code: IRCT20110906007494N27)     

Pediatric burn-trauma patients have increased length of stay compared to trauma-only patients: A propensity matched analysis

BackgroundTrauma is the leading cause of mortality in children. Burn injury involves intensive resources, especially in pediatric patients. We hypothesized that among pediatric trauma patients, combined burn-trauma (BT) patients have increased length of stay (LOS) and mortality compared to trauma-only (T) patients.MethodsThe Pediatric Trauma Quality Improvement Program (2014–2016) was queried and BT patients were 1:2 propensity-score-matched to T patients based on age, gender, hypotension on admission, injury type and severity.Results93 BT patients were matched to 186 T patients. There were no differences in matched characteristics. BT patients had a longer median LOS (4 vs 2 days, p < 0.001) with no difference in mortality (1.1% vs 1.1%, p = 1.00), intensive care unit (ICU) LOS (3 vs 3 days, p = 0.55), or complications including decubitus ulcer (0% vs 1.1%, p = 0.32), deep vein thrombosis (0% vs 0.5%, p = 0.48), extremity compartment syndrome (1.1% vs 0%, p = 0.16), and urinary tract infection (1.1% vs 1.1%, p = 1.00).ConclusionPediatric BT patients had twice the LOS compared to a matched group of pediatric T patients. There was no difference between the cohorts in ICU LOS, complications or mortality rate. When evaluating risk-stratified quality metrics such as LOS, concomitant burn injury should be incorporated.     

Repetitive extracorporeal shock wave applications are superior in inducing angiogenesis after full thickness burn compared to single application

ObjectiveBurn wounds remain a challenge due to subsequent wound infection and septicemia, which can be prevented by acceleration of wound healing. The aim of the study was to analyze microcirculation and leukocyte endothelium interaction with particular focus on angiogenesis after full-thickness burn using three different repetitions of low energy shock waves.MethodsFull-thickness burns were inflicted to the ears of hairless mice (n = 44; area: 1.6 ± 0.05 mm² (mean ± SEM)). Mice were randomized into four groups: the control group received a burn injury but no shock waves; group A received ESWA (0.03 mJ/mm²) on day one after burn injury; group B received shock waves on day one and day three after burn injury; group C ESWA on day one, three and seven after burn injury. Intravital fluorescent microscopy was used to assess microcirculatory parameters, angiogenesis and leukocyte interaction. Values were obtained before burn (baseline value) immediately after and on days 1, 3, 7 and 12 after burn.ResultsShock-wave treated groups showed significantly accelerated angiogenesis compared to the control group. The non-perfused area (NPA) is regarded as a parameter for angiogenesis and showed the following data on day 12 2.7 ± 0.4% (group A, p = 0.001), 1.4 ± 0.5% (group B, p < 0.001), 1.0 ± 0.3% (group C, p < 0.001), 6.1 ± 0.9% (control group). Edema formation is positively correlated with the number of shock wave applications: day 12: group A: 173.2 ± 9.8%, group B: 184.2 ± 6.6%, group C: 201.1 ± 6.9%, p = 0.009 vs. control: 162.3 ± 8.7% (all data: mean ± SEM).ConclusionAccording to our data shock waves positively impact the wound healing process following burn injury. Angiogenesis showed significantly improved activity after shock wave application. In all three treatment groups angiogenesis was higher compared to the control group. Within the ESWA groups, double applications showed better results than single application and three applications showed better results than single or double applications.     

Changes in total body surface area and the distribution of skin surfaces in relation to body mass index

BackgroundA correct estimation of total burn surface area is important since it is used for determining fluid resuscitation volumes, nutritional estimates and hospital admission criteria. Wallace’s rule of nines is the most commonly used methods for this purpose. However, fat distribution is non-uniform and the total body surface area changes with obesity. The aim of this study was to determine if the rule of nines applies to all body mass index groups.MethodsA total of 217 individuals were included in the study. The patients were divided into 4 groups according to their BMI (18.5–25 kg/m² (60 persons)), 25–29.9 kg/m² (61 individuals)), 30–34.9 kg/m² (55 persons)), >35 kg/m² (41 persons)). Each patient underwent a complete duel-energy X-ray absorptiometry body scan to determine the surface area (cm²) of the various regions of the body.ResultsWe found no statistically significant variations between the Wallace body percentage distributions and our results in the men for all BMI ranges (head p = 0.331, arms p = 0.861, legs p = 0.282, trunk p = 0.696). In contrast, among women we found a statistically significant change in body surface area percentage distribution between the BMI groups and specific body regions (head p = 0.000, legs p = 0.000 and trunk p = 0.001).ConclusionThe Wallace rule of nines is a quick and acceptable method for estimating the total burn surface area percentage in men of all BMI ranges. However, for women, a more accurate method of burn area estimation is required as proposed by our BMI adjusted charts.     

The association between pain catastrophising and kinesiophobia with pain and function in people with plantar heel pain

BackgroundPsychological variables, including catastrophic thoughts and kinesiophobia, are common in people with chronic musculoskeletal pain and are associated with pain and function. However, the role of each factor has not been evaluated in people with plantar heel pain (plantar fasciitis).MethodsThirty-six participants diagnosed with plantar heel pain were recruited. Main outcome measures included the Pain Catastrophising Scale, Tampa Scale of Kinesiophobia, the Foot Health Status Questionnaire and a Visual Analogue Scale. Hierarchical regression models were developed to evaluate the association between each psychological variable with variations in foot pain, first step pain and foot function.ResultsIn a full model with age, sex and BMI, kinesiophobia contributed to 21% of the variability in foot function and was a significant predictor in this model (Beta = −0.49, P = 0.006). In a separate model, catastrophising explained 39% of the variability in foot function and was a significant predictor in this model (Beta = −0.65, P < 0.001). Finally, pain catastrophising accounted for 18% of the variability in first step pain and was a significant predictor in a model that also included age, sex and BMI (Beta = 0.44, P = 0.008).ConclusionsAfter controlling for age, sex and BMI, kinesiophobia and catastrophising were significantly associated with foot function, while catastrophising was associated with first step pain in people with plantar heel pain. In addition to addressing biological factors in the management of plantar heel pain, clinicians should consider the potential role of pain catastrophising and kinesiophobia in this population.     

A prospective pilot study of the energy balance profiles in acute non-severe burn patients

BackgroundMajor burn patients have been shown to exhibit a hyper-metabolic state of activity which can persist for up to two years after burn. The relationship between total body surface area (TBSA) and resting metabolic rate (RMR) has been investigated in larger burns (≥20% TBSA), however not in non-severe burns (≤15% TBSA). The primary aim of this observational study was to examine the association between the acute effects of burns <15% TBSA with RMR in patients using indirect calorimetry, as well as any potential covariates. The secondary aim was to determine 24-h energy balance.MethodsThe study included data from 39 participants (82% male), all admitted to the State Adult Burn Unit at Fiona Stanley Hospital. Each patient was recruited upon admission and RMR data was collected on day four (± one day) after burn.ResultsThe pooled data bivariate correlation showed a significant relationship between RMR and TBSA (r = 0.435, p = 0.009). A stronger relationship was also found between RMR and TBSA in males (r = 0.634, p = 0.001). Patients recorded a caloric deficit of 116 kcal/day.ConclusionThis study demonstrated that a moderately strong linear association exists between RMR and TBSA in males for burns of ≤15% TBSA. The energy balance data indicated that supplementation of calorific intake for non-severe burns suggests careful consideration.     

Awareness and attitude of doctors and nurses at a teaching hospital to skin donation and banking

IntroductionThis study sought to determine the awareness and attitude of doctors and nurses in a teaching hospital to skin donation and banking, and to identify needs for personnel educational programmes.MethodsA cross sectional survey on doctors and nurses was carried out using a 44-item questionnaire that included a Likert scale on attitudes. Predictors of favourable attitudes were determined.ResultsEighty (49.7%) doctors and 81 (50.3%) nurses participated in the study. Many participants, 126 (78.3%), knew that skin could be donated, but only 96 (59.6%) participants were aware of skin banking. The main source of information was during professional training (17.4%). Only 41 (25.5%) participants were willing to donate skin after death. Body disfigurement was the major reason (20.5%) against skin donation. Participants who were doctors, were aware of skin banking, and who were previous blood donors had higher attitudes scores (p < 0.001, p = 0.004, p = 0.007 respectively). Being a doctor and having heard of skin banking were predictors of favourable attitudes to skin donation and banking.ConclusionKnowledge transfer during health professional training on the usefulness of banked skin in patients with major burns may lead to improved attitude of health professionals and acceptance of this modality of burn management.     

The effect of thoracic spine high-velocity low-amplitude thrust manipulation on myoelectric activity of the lower trapezius and posterior deltoid muscles during treadmill walking

ObjectivesTo investigate the effect of thoracic spine thrust manipulation on the EMG activity of posterior deltoid and lower trapezius during treadmill walking.MethodsVolunteers (n = 40; 19 males and 21 females) were randomly assigned to a ‘sham ultrasound’ control group (n = 20) or a thoracic spine high-velocity thrust (HVLAT) manipulation group (n = 20). Surface EMG recordings were collected from the right posterior deltoid and lower trapezius muscles whilst participants walked on a treadmill for 2 min, at 2.8 mph, both prior to and immediately post-intervention. EMG recordings were analysed by evaluating the difference of integral values for pre and post data using repeated measures ANOVA.ResultsBoth control (sham ultrasound) and experimental groups (HVLAT) exhibited small non-significant reductions in post-intervention EMG activity of lower trapezius (p = 0.201) and a significant reduction in posterior deltoid (p = 0.003) during treadmill walking. No significant difference was found in the integrated EMG (IEMG) power between control and experimental group in either the ‘before’ or ‘after’ measurements for both target muscles.ConclusionsManipulation of the thoracic spine does not significantly alter the myoelectric activity of lower trapezius and posterior deltoid muscles during treadmill walking.     

A remarkable point for evaluating the severity of burns: Thiol–disulfide profile

AimThe objective of this study was to examine the thiol–disulfide profile tests in patients suffering from burn injuries.MethodsThis case–control study comprised 48 patients with thermal burn injuries and 61 healthy individuals. Thiol–disulfide tests were conducted in both groups, and also, the changes of thiol–disulfide parameters were analyzed at zero time and on days 3, 7, 15, and 30 of the admission in patients with burn injuries.ResultsThe patients had significantly decreased native and total thiol levels and native thiol/total thiol ratios, and significantly increased disulfide/native thiol and disulfide/total thiol ratios compared to control individuals (p < 0.001 for all). The variations of native thiol levels, total thiol levels, and disulfide/native thiol ratios were significantly different over time in patients with burn injuries (p < 0.001, p < 0.001, p < 0.05, respectively). There were strong associations with the clinical parameters and thiol–disulfide profile tests (p < 0.05 for all).ConclusionThere was a metabolic disturbance of the thiol–disulfide system among patients with burn injuries. The courses of thiol–disulfide variables in time overlapped with the burn mechanism. Strong associations provide that thiol–disulfide homeostasis might be a notable key for evaluating the severity of burns and predicting the survival.     

Perfil epidemiológico da espondiloartrite de início juvenil comparada com a espondiloartrite de início na vida adulta em uma grande coorte brasileira

ObjectiveTo analyze the clinical and epidemiologic characteristics of juvenile‐onset spondyloarthritis (SpA) (< 16 years) and compare them with a group of adult‐onset (≥ 16 years) SpA patients.Patients and methodsProspective, observational and multicentric cohort with 1,424 patients with the diagnosis of SpA according to the European Spondyloarthropathy Study Group (ESSG) submitted to a common protocol of investigation and recruited in 29 reference centers participants of the Brazilian Registry of Spondyloarthritis (RBE – Registro Brasileiro de Espondiloartrites). Patients were divided in two groups: age at onset < 16 years (JOSpA group) and age at onset ≥ 16 years (AOSpA group).ResultsAmong the 1,424 patients, 235 presented disease onset before 16 years (16.5%). The clinical and epidemiologic variables associated with JOSpA were male gender (p < 0.001), lower limb arthritis (p = 0.001), enthesitis (p = 0.008), anterior uveitis (p = 0.041) and positive HLA‐B27 (p = 0.017), associated with lower scores of disease activity (Bath Ankylosing Spondylitis Disease Activity Index – BASDAI; p = 0.007) and functionality (Bath Ankylosing Spondylitis Functional Index – BASFI; p = 0.036). Cutaneous psoriasis (p < 0.001), inflammatory bowel disease (p = 0.023), dactylitis (p = 0.024) and nail involvement (p = 0.004) were more frequent in patients with adult‐onset SpA.ConclusionsPatients with JOSpA in this large Brazilian cohort were characterized predominantly by male gender, peripheral involvement (arthritis and enthesitis), positive HLA‐B27 and lower disease scores.     

Efeitos da musicoterapia sobre dor e estresse oxidativo na aspiração folicular: estudo clínico randomizado

Background and objectiveThe aim was to investigate the effects of Turkish classical music on pain and oxidative stress in patients undergoing oocyte pick‐up.MethodsThe study was a randomized, controlled trial. The groups included were Group NM (Non‐Music), control group; Group PM, which comprised patients who listened to music before the operation; and Group CM, which comprised patients who listened to music both before and during the operation. Blood was drawn prior to the operation to measure the oxidative stress values. Pain, hemodynamic parameters, oxidative stress values were assessed postoperatively.ResultsThe number of patients requiring additional propofol was higher in Group PM than in Groups NM and CM (p = 0.003). The postoperative Visual Analog Scale (VAS) score were lower in Groups PM and CM than in Group NM (p = 0.001, p = 0.007) in the 1^st and 60^th minutes. The postoperative VAS score was lower in Group CM than in Group NM (p = 0.045) in the 5^th minute. The postoperative additional analgesic requirements were lower in Groups PM and CM than in Group NM (p = 0.045). The postoperative blood glutathione peroxidase values were significantly higher in Groups PM and CM than in Group NM (p = 0.001). The postoperative catalase values were significantly higher in Groups PM and CM than in Group NM (p = 0.008 and p ≤ 0.001). The preoperative malondialdehyde values were significantly lower in Groups PM and CM than in Group NM. The preoperative nitric oxide values were higher in Groups PM and CM than in Group NM (p ≤ 0.001), whereas the postoperative nitric oxide values were lower in Groups PM and CM than in Group NM (p ≤ 0.001).ConclusionTurkish classical music has beneficial effects on pain and oxidative stress in oocyte pick‐up patients.