The effect of diabetes on burn patients: a retrospective cohort study

Impact of pre-existing cancer diagnoses on burn injury survival and morbidity

OBJECTIVES

Severe burns place patients in a compromised state, especially those with pre-existing chronic diseases such as malignancy. Due to improvements in detection and treatment, cancer mortality has declined significantly, leaving a growing population of cancer survivors. Therefore, we wondered whether pre-existing cancer diagnoses influence patient outcomes following burn injury.

METHODS

46,275 patients with a neoplasm diagnosis prior to experiencing a burn injury were identified using the TriNetX research network. Two control groups were organized: 1) cancer patients without burns and 2) burn patients with no history of cancer. The test group included patients with a pre-existing cancer diagnosis who received a subsequent burn injury. Outcomes included death, sepsis, nutritional deficiency, eating disorder, immunodeficiency, and depression. Odds ratios were calculated with 95 % confidence intervals.

RESULTS

Of the nearly 10 million cancer patients, 0.45 % experienced a burn injury after diagnosis. Compared to propensity-matched burned patients without cancer, burned patients with a previous cancer diagnosis had increased odds of developing sepsis (2.013, 1.895-2.138), nutritional deficiency (1.874, 1.58-2.221), immunodeficiency (5.584, 4.85-7.06), eating disorder (2.384, 1.947-2.918), and depression (1.772, 1.695-1.853). The odds ratios of sepsis (1.718, 1.612-1.83), nutritional deficiency (1.963, 1.593-2.418), immunodeficiency (1.265, 1.098-1.459), eating disorder (2.569, 2.077-3.177), and depression (1.538, 1.468-1.611) were increased when compared to cancer patients without burn injury. Burned patients with a previous neoplasm of hematologic origin fared worse in the odds of developing the mentioned outcomes compared to those with solid neoplasms. Lastly, burned patients with any previous neoplasm who later received chemotherapy and/or radiation suffered worse outcomes than those who never received such treatment.

CONCLUSION

Patients who developed neoplasms before receiving a burn injury demonstrated considerable increases in odds of poor outcomes. Increased odds of developing poor outcomes were greater in those with hematologic neoplasms and those who received chemotherapy or radiation treatment.

The use of smartphone thermography to evaluate wound healing in second-degree burns

BACKGROUND

Burn injuries can significantly affect a person's ability to function and reduce their quality of life. This study used thermal imaging to investigate the relationship between blood flow changes and healing in second-degree burns. The researchers hypothesized that improved blood flow to the burn site, as indicated by infrared thermography assessments, may be associated with better wound healing outcomes in patients with second-degree burns.

PATIENTS AND METHODS

This prospective, non-randomized study included 47 adults with second-degree burns who underwent a structured program of range of motion (ROM) exercises during the healing process. Wound healing progression was assessed by infrared thermography (FLIR imaging) to measure temperature differences (ΔT) between burn wounds (T2) and normal skin (T1) as an indirect marker of perfusion; the modified Abbreviated Burn Severity Index (mABSI) to classify burn severity levels; and the Bates-Jensen Wound Assessment Tool (BWAT). Measurements were taken at baseline, week one, week two, and week three following the initiation of ROM exercises.

RESULTS

The ABSI levels showed that 46.8 % of patients had moderate severity burns, 38.3 % had very low severity, and 14.9 % had moderately severe burns. BWAT scores showed a decreasing trend over a three-week period. They began at 28.9 ± 4.6 SD, rose slightly to 30.1 ± 4.7 SD after one week indicating inflammation and wound changes, and then dropped to 19.2 ± 6.5 SD and 17.1 ± 4.3 SD in the second and third weeks respectively showing substantial healing. FLIR thermal imaging was also used to monitor the healing process by measuring the temperature difference (ΔT) between the burn wound (T2) and normal skin (T1). Larger ΔT values suggest better blood flow (perfusion) and potentially improved healing. The median ΔT values decreased over the three weeks, starting at 0.60 (IQR 1.65) and falling to 0.01 (IQR 0.20) by week three. These changes in ΔT over time were statistically significant (p < 0.001, Kruskal-Wallis test).

CONCLUSIONS

This study successfully used FLIR thermal imaging in patients undergoing a rehabilitation program focused on ROM exercises, showing a positive link with healing progress. The findings highlight the potential of FLIR thermal imaging to optimize burn management and improve patient outcomes. Further research is needed to validate these findings and develop standardized protocols for both ROM exercises and thermal imaging to enhance burn care.

Identification and validation of the diagnostic biomarker MFAP5 for CAVD with type 2 diabetes by bioinformatics analysis

Introduction

Calcific aortic valve disease (CAVD) is increasingly prevalent among the aging population, and there is a notable lack of drug therapies. Consequently, identifying novel drug targets will be of utmost importance. Given that type 2 diabetes is an important risk factor for CAVD, we identified key genes associated with diabetes - related CAVD via various bioinformatics methods, which provide further potential molecular targets for CAVD with diabetes.

Methods

Three transcriptome datasets related to CAVD and two related to diabetes were retrieved from the Gene Expression Omnibus (GEO) database. To distinguish key genes, differential expression analysis with the "Limma" package and WGCNA was applied. Machine learning (ML) algorithms were employed to screen potential biomarkers. The receiver operating characteristic curve (ROC) and nomogram were then constructed. The CIBERSORT algorithm was utilized to investigate immune cell infiltration in CAVD. Lastly, the association between the hub genes and 22 types of infiltrating immune cells was evaluated.

Results

By intersecting the results of the "Limma" and WGCNA analyses, 727 and 190 CAVD - related genes identified from the GSE76717 and GSE153555 datasets were obtained. Then, through differential analysis and interaction, 619 genes shared by the two diabetes mellitus datasets were acquired. Next, we intersected the differential genes and module genes of CAVD with the differential genes of diabetes, and the obtained genes were used for subsequent analysis. ML algorithms and the PPI network yielded a total of 12 genes, 10 of which showed a higher diagnostic value. Immune cell infiltration analysis revealed that immune dysregulation was closely linked to CAVD progression. Experimentally, we have verified the gene expression differences of MFAP5, which has the potential to serve as a diagnostic biomarker for CAVD.

Conclusion

In this study, a multi-omics approach was used to identify 10 CAVD-related biomarkers (COL5A1, COL5A2, THBS2, MFAP5, BTG2, COL1A1, COL1A2, MXRA5, LUM, CD34) and to develop an exploratory risk model. Western blot (WB) and immunofluorescence experiments revealed that MFAP5 plays a crucial role in the progression of CAVD in the context of diabetes, offering new insights into the disease mechanism.

The Effect of Diabetes Mellitus Severity on Foot & Ankle Burn Recovery

BACKGROUND

Diabetic patients often present with complex limb pathology, resulting in impaired sensation in the distal extremities making tactile injuries such as burns difficult to notice. We posit that poorly controlled diabetes mellitus, evidenced by increasing elevations in hemoglobin A1c, is associated with delayed wound healing and increased complications in burn patients.

METHODS

The TriNetX Network, a database of 89 million patients across the U.S., was queried for diabetic patients with foot and ankle burns. Patients were divided into four groups based on A1c: properly controlled (<7%), moderately controlled (7-9%), poorly controlled (>9%), and propensity-matched non-diabetic controls. Evaluated outcomes included split-thickness skin grafting, infections, amputations, acute kidney failure (AKF), and mortality within one month of the burn.

RESULTS

When comparing the poorly controlled A1c cohort with the properly controlled and moderately controlled A1c cohorts, we found a significant increase in amputations (p = 0.042) and cutaneous infections (p = 0.0438), respectively. When evaluating non-diabetics to diabetic patients, significantly increased rates of amputations (p < 0.0001), cutaneous infections (p = 0.0485), systemic infections (p = 0.0066), and AKF (p = 0.0005) were noted in the latter.

CONCLUSIONS

Poorly controlled diabetes shows a significant correlation with increased complications following foot and ankle burns, including amputations, infections, and AKF.

The association between body mass index and physical function in adult burn survivors: A Burn Model System National Database study

INTRODUCTION

An area of rehabilitation research in burns is the impact of co-morbidities on disease trajectory. Obesity is a comorbidity of increasing public health concern, but its role remains controversial regarding burn injury and physical recovery. Our aim was to evaluate the association between body mass index (BMI) categories as a measure of obesity at discharge and self-reported physical function (PF) during recovery of adult burn survivors.

METHODS

This is a retrospective study on data collected by four major US burn centers, which contribute to the Burn Model System National Database. The data included BMI obtained at hospital discharge and self-reported PF-mobility, using the PROMIS measures assessed at 6, 12, and 24 months after burn. Subjects were classified into weight status categories based on BMI: underweight (BMI <18.5), normal weight (18.5 ≤ BMI <25), overweight (25 ≤ BMI <30), obesity class 1 (30 ≤ BMI <35), obesity class 2 (35 ≤ BMI <40), and obesity class 3 (BMI ≥40). Mixed-effects linear regression models were used to assess the association between BMI categories and PF scores over time, adjusted for patient and injury characteristics.

RESULTS

A total of 496 adult burn patients aged 47 ± 16 years were included, with mean total body surface area (TBSA) burned of 18 ± 19 % and mean BMI at discharge of 28 ± 7 kg/m2. PROMIS PF scores significantly improved over time in the recovery phase after burn (time effect, p < 0.001). Compared to overweight burn patients, normal-underweights exhibited lower PF score by an average of 4.06 units (p = 0.001) but scores increased linearly by an estimated 0.17 units per month (p = 0.01) over the 24 months after discharge. Similarly, compared to overweight burn patients, class 1 obese reported lower PF score by a mean 2.67 units (p = 0.07) but PF increased linearly by 0.15 units per month (p = 0.07) over the 24 months after discharge. These findings were independent of the effects of age at discharge, sex, TBSA burned, and hand and leg burn.

CONCLUSION

Being overweight was associated with improved and faster recovery of PF scores compared to normal, underweight, and obese burn patients during long-term recovery. Hence, our data suggests that long-term recovery and restoration of PF in adult burn survivors is not compromised by a small excess in body weight.

Evaluating the association between time to skin grafting for truncal burn patients and complications: a comparative cohort study using the National Trauma Data Bank

BACKGROUND

The split-thickness skin graft (STSG) procedure is frequently used in the reconstruction of burn-injured patients. This study assessed the impact of graft timing on associated skin complications in patients with torso burns using a comprehensive national database.

METHODS

Truncal burn (2nd-degree and 3rd-degree burns covering 20-89% TBSA) patients who underwent STSG in the National Trauma Data Bank from 2011 to 2015 were studied. The outcomes examined were graft-related complications (superficial surgical site infections, deep surgical site infections, and graft failure), overall mortality and hospital length of stay (LOS). Patients were compared based on the presence or absence of grafting complications. A linear regression model was used to assess the relationship between hospital LOS and graft timing, considering other variables.

RESULTS

Among the 853 studied patients, the cohort with graft complications exhibited a significantly prolonged time to STSG (413.0 h compared to 264.6 h, P<0.001) and a higher percentage of patients with pre-existing diabetes (18.5 vs. 8.0%, P=0.008). The multiple logistic regression analysis revealed that both the extended time to STSG (odds=1.001, P=0.003) and pre-existing diabetes (odds=2.790, P=0.010) significantly elevated the likelihood of complications associated with STSG. Notably, this delay did not elevate mortality risks. A positive relationship was found between grafting delay and LOS.

CONCLUSION

The findings underscore that a prolonged duration to skin grafting contributes to extended hospital stays and increased graft-related complications. However, the role of grafting delay in influencing the mortality of truncal burn patients appeared inconsequential, indicating that mortality may be influenced by various factors.

Excess Risk of Injury in Individuals With Type 1 or Type 2 Diabetes Compared With the General Population

OBJECTIVE

To estimate the relative risk (RR) and excess hospitalization rate for injury in individuals with diabetes compared with the general population.

RESEARCH DESIGN AND METHODS

Data were obtained from the Australian National Diabetes Services Scheme, hospitalization data sets, the Australian Pharmaceutical Benefits Scheme, the National Death Index, and the census spanning from 2011 to 2017. Hospitalizations for injury were coded as head and neck, lower-extremity, upper-extremity, or abdominal and thoracic injury; burns; or other injury. Poisson regression was used to estimate the age- and sex-adjusted RR of hospitalization for injury.

RESULTS

The total number of hospitalizations for any injury was 117,705 in people with diabetes and 3,463,173 in the general population. Compared with that in the general population, an elevated adjusted risk of admission was observed for any injury (RR 1.22; 95% CI 1.21, 1.22), head and neck (1.28; 1.26, 1.30), lower extremity (1.24; 1.23, 1.26), abdominal and thoracic (1.29; 1.27, 1.30), upper extremity (1.03; 1.02, 1.05), burns (1.52; 1.44, 1.61), and other injury (1.37; 1.33, 1.40). The adjusted RR of any injury was 1.62 (1.58, 1.66) in individuals with type 1 diabetes, 1.65 (1.63, 1.66) in those with type 2 diabetes who were taking insulin, and 1.07 (1.06, 1.08) in individuals with type 2 diabetes not using insulin. Falls were the primary cause of injury in individuals with diabetes.

CONCLUSIONS

Individuals with diabetes, especially those using insulin, had a higher risk of hospitalization for injury compared with the general population.

Whey protein-loaded 3D-printed poly (lactic) acid scaffolds for wound dressing applications

Chronic skin wounds pose a global clinical challenge, necessitating effective treatment strategies. This study explores the potential of 3D printed Poly Lactic Acid (PLA) scaffolds, enhanced with Whey Protein Concentrate (WPC) at varying concentrations (25, 35, and 50% wt), for wound healing applications. PLA's biocompatibility, biodegradability, and thermal stability make it an ideal material for medical applications. The addition of WPC aims to mimic the skin's extracellular matrix and enhance the bioactivity of the PLA scaffolds. Fourier Transform Infrared Spectroscopy results confirmed the successful loading of WPC into the 3D printed PLA-based scaffolds. Scanning Electron Microscopy (SEM) images revealed no significant differences in pore size between PLA/WPC scaffolds and pure PLA scaffolds. Mechanical strength tests showed similar tensile strength between pure PLA and PLA with 50% WPC scaffolds. However, scaffolds with lower WPC concentrations displayed reduced tensile strength. Notably, all PLA/WPC scaffolds exhibited increased strain at break compared to pure PLA. Swelling capacity was highest in PLA with 25% WPC, approximately 130% higher than pure PLA. Scaffolds with higher WPC concentrations also showed increased swelling and degradation rates. Drug release was found to be prolonged with increasing WPC concentration. After seven days of incubation, cell viability significantly increased in PLA with 50% WPC scaffolds compared to pure PLA scaffolds. This innovative approach could pave the way for personalized wound care strategies, offering tailored treatments and targeted drug delivery. However, further studies are needed to optimize the properties of these scaffolds and validate their effectiveness in clinical settings.

Associations of Diabetes and Hyperglycaemia with Extent and Outcomes of Acute Burn Injuries

BACKGROUND

Severe burns may induce hyperglycaemia in the absence of diabetes, but how glucose trajectories relate to burns outcomes is unclear.

AIM

To assess incidence of hyperglycaemia following acute burn injury, and associations with diabetes history and length of stay (LOS).

METHODS

Retrospective cohort study of adults admitted with acute burns to tertiary centres. Blood glucose level (BGL), hyperglycaemic episodes (BGL ≥ 11.1 mmol/L) and hyperglycaemic days were recorded. Stress hyperglycaemia was defined as BGL ≥ 11.1 mmol/L without a diabetes history.

RESULTS

A total of 30 participants had a diabetes history and 260 did not. Participants with known diabetes had higher mean BGLs (9.7 vs. 9.0 mmol/L, p < 0.001), more hyperglycaemic episodes (28.0 vs. 17.2%, p < 0.001) and hyperglycaemic days (51 vs. 21%, p < 0.001), compared to those without diabetes, despite smaller burns (total body surface area 1.0 vs. 14.8%, p < 0.001). Fourteen participants with stress hyperglycaemia had similar BGLs (at admission 10.3 vs. 11.5 mmol/L; during inpatient stay 9.9 vs. 9.8 mmol/L), more severe burns (15.6% vs. 1.0% TBSA) and longer LOS (18 vs. 7 days, p < 0.001) compared to participants with known diabetes. Extent of burns, having NGT nutrition, age, having inpatient BGL monitoring in the setting of diabetes, or having inpatient BGL monitoring in the absence of diabetes were associated with longer LOS.

CONCLUSIONS

In participants with known diabetes, small burn injuries were associated with hyperglycaemia. Stress hyperglycaemia can be triggered by major burn injuries, with early and sustained elevation of BGLs. Further research is warranted to improve inpatient management of BGL in patients with acute burn injury.

Impact of elevated body mass index on burn injury-associated mortality in a representative US sample

BACKGROUND

The impact of obesity on burn-related mortality is inconsistent and incongruent; despite being a risk factor for numerous comorbidities that would be expected to increase complications and worsen outcomes, there is evidence of a survival advantage for patients with high body mass index-the so-called obesity paradox. We used a national data set to explore further the relationship between body mass index and burn-related mortality.

METHODS

Deidentified data from patients with second and third-degree burns between 2014 and 2018 were obtained from the Cerner Health Facts Database. Univariate and multivariate regression models were created to identify potential factors related to burn-related mortality. A restricted cubic spline model was built to assess the nonlinear association between body mass index and burn-related mortality. All statistical analyses were conducted using R (R Foundation for Statistical Computing).

RESULTS

The study included 9,405 adult burn patients. Univariate and multivariate analyses revealed that age (odds ratio = 2.189 [1.771, 2.706], P < .001), total burn surface area (odds ratio = 1.824 [1.605, 2.074], P < .001), full-thickness burns (odds ratio = 1.992 [1.322, 3.001], P < .001), and comorbidities (odds ratio = 2.03 [1.367, 3.014], P < .001) were associated with increased mortality. Sensitivity analysis showed similar results. However, a restricted cubic spline indicated a U-shaped relation between body mass index and burn-related mortality. The nadir of body mass index was 28.92 kg/m², with the lowest mortality. This association persisted even after controlling for age, total burn surface area, full-thickness burns, and comorbidities, which all remained significant.

CONCLUSION

This study confirms a U-shaped association between body mass index and burn-related mortality along with age, total burn surface area, full-thickness burns, and comorbidities as risk factors.

Oxidative Stress and Lipid Peroxidation: Prospective Associations Between Ferroptosis and Delayed Wound Healing in Diabetic Ulcers

Diabetic ulcers are one of the major complications of diabetes, and patients usually suffer from amputation and death due to delayed ulcer wound healing. Persistent inflammation and oxidative stress at the wound site are the main manifestations of delayed wound healing in diabetic ulcers. In addition, chronic hyperglycemia in patients can lead to circulatory accumulation of lipid peroxidation products and impaired iron metabolism pathways leading to the presence of multiple free irons in plasma. Ferroptosis, a newly discovered form of cell death, is characterized by intracellular iron overload and accumulation of iron-dependent lipid peroxides. These indicate that ferroptosis is one of the potential mechanisms of delayed wound healing in diabetic ulcers and will hopefully be a novel therapeutic target for delayed wound healing in diabetic patients. This review explored the pathogenesis of diabetic ulcer wound healing, reveals that oxidative stress and lipid peroxidation are common pathological mechanisms of ferroptosis and delayed wound healing in diabetic ulcers. Based on strong evidence, it is speculated that ferroptosis and diabetic ulcers are closely related, and have value of in-depth research. We attempted to clarify prospective associations between ferroptosis and diabetic ulcers in terms of GPX4, iron overload, ferroptosis inhibitors, AGEs, and HO-1, to provide new ideas for exploring the clinical treatment of diabetic ulcers.

Clinical outcomes in 'diabese' burn patients: A systematic review and meta-analysis

OBJECTIVE

The objective of this study was to update the current status of clinical outcomes in diabetic (type II) and obese (BMI: 30-39.9 kg/m²) burn patients.

METHODS

We adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We searched MEDLINE (PubMed), Google Scholar, Scopus, and Embase for studies related to a number of comorbidities and burn outcomes. Search terms for each of these databases are listed in the Appendix. From this search, we screened 6923 articles. Through our selection criteria, 12 articles focusing on either diabetes or obesity were selected for systematic review and meta-analysis. Data was analyzed using the "meta" package in R software to produce pooled odds ratios from the random effect model.

RESULTS

Diabetic patients had 2.38 times higher odds of mortality [OR: 2.38, 95% CI:1.66, 3.41], however no statistically significant difference was found in mortality in obese patients [OR: 2.49, 95% CI: 0.36, 17.19]. Obese patients had 2.18 times higher odds of inhalation injury [95%CI: 1.23, 3.88], whereas diabetic patients did not show a difference in odds of inhalation injury [OR:1.02, 95% CI: 0.57, 1.81]. Diabetic patients had higher odds of complications resulting from infection: 5.47 times higher odds of wound, skin, or soft tissue infections [95% CI:1.97, 15.18]; 2.28 times higher odds of UTI or CAUTI [95% CI:1.50, 3.46]; and 1.78 times higher odds of pneumonia or respiratory tract infections [95% CI:1.15, 2.77]. Obese patients also had similar complications related to infection: 2.15 times higher odds of wound infection [95% CI: 1.04, 4.42] and 1.96 times higher odds of pneumonia [95% CI: 1.08, 3.56]. Other notable complications in diabetic patients were higher odds of amputation [OR: 37, 95% CI: 1.76, 779.34], respiratory failure [OR: 4.39, 95% CI: 1.85, 10.42], heart failure [OR: 6.22, 95% CI: 1.93, 20.06], and renal failure [OR: 2.95, 95% CI: 1.1, 7.86].

CONCLUSIONS

Diabetic patients have higher odds of mortality, whereas no statistically significant difference of mortality was found in obese patients. Obese patients had higher odds of inhalation injury, whereas odds of inhalation injury was unchanged in diabetic patients. Diabetic patients had higher odds of failure in multiple organs, whereas such failure in obese patients was not reported. Both diabetic and obese patients had multiple complications related to infection.

The effect of nursing intervention based on the staged behaviour change on recovery, quality of life, and self-efficacy of diabetic patients with scalds

This study aimed to explore the impact of nursing intervention based on staged behaviour change (SBC) on the quality of life (QoL) and self-efficacy of diabetic patients with scalds. From January 2020 to January 2021, a total of 82 consecutive cases with diabetes and scalds were prospectively enrolled in this study. They were divided into the SBC group (41 cases were given SBC-based nursing intervention) and the control group (41 cases were given routine intervention) using the random number table method. The granulation tissue growth time and wound healing time were compared between the two groups. Pain intensity, QoL, self-efficacy, and score of wound exudation at 3, 7, and 15 days after intervention were observed. The granulation tissue growth time and wound healing time of the SBC group were lower than those of the control group with statistical difference (P < 0.05). The 3-, 5-, and 7-day pain intensity of the SBC group were all lower than those of the control group, with statistical difference (P < 0.05, respectively). Before intervention, there were no significant differences in mental health, role emotional, social function, vitality status, physical pain, role physical, physical function, and general health between the two groups (P > 0.05, respectively). After intervention, the above indicators of the SBC group were significantly higher than those of the control group (P < 0.05, respectively). Before intervention, there were no significant differences between the two groups in communication with doctors, emotional communication, role function, symptom management, medication as prescribed, and control of water and salt intake and nutrition (P > 0.05, respectively). After intervention, the above indicators in the SBC group were all significantly higher than those in the control group (P < 0.05, respectively). The score of wound exudation of the SBC group was lower than that of the control group after intervention (P < 0.05). SBC-based nursing intervention can effectively improve the QoL and self-efficacy of diabetic patients with scalds and can effectively promote wound healing, and can be recommended for clinical use.

A review of the most impactful published pharmacotherapy-pertinent literature of 2019 and 2020 for clinicians caring for patients with thermal or inhalation injury

Keeping abreast with current literature can be challenging, especially for practitioners caring for patients sustaining thermal or inhalation injury. Practitioners caring for patients with thermal injuries publish in a wide variety of journals, which further increases the complexity for those with resource limitations. Pharmacotherapy research continues to be a minority focus in primary literature. This review is a renewal of previous years' work to facilitate extraction and review of the most recent pharmacotherapy-centric studies in patients with thermal and inhalation injury. Sixteen geographically dispersed, board-certified pharmacists participated in the review. A MeSH-based, filtered search returned 1,536 manuscripts over the previous 2-year period. After manual review and exclusions, only 98 (6.4%) manuscripts were determined to have a potential impact on current pharmacotherapy practices and included in the review. A summary of the 10 articles that scored highest are included in the review. Nearly half of the reviewed manuscripts were assessed to lack a significant impact on current practice. Despite an increase in published literature over the previous 2-year review, the focus and quality remain unchanged. There remains a need for investment in well-designed, high impact, pharmacotherapy-pertinent research for patients sustaining thermal or inhalation injuries.

The effect of vacuum sealing drainage after early woundabrasion on wound healing in diabetic patients with deep second degree burn and its influence on the inflammatory response

OBJECTIVE

To investigate the effect of vacuum sealing drainage (VSD) after early woundabrasion (WA) in diabetic patients with deep second degree burn (DSDB).

METHODS

This prospective study selected 89 diabetic patients with DSDB treated in our hospital. Using the random number table method, the patients were divided into the control group (44 cases with conventional treatment after early WA) and observation group (45 cases with VSD treatment after WA). Wound healing, fungal infection rate, serum levels of inflammatory factors and vascular endothelial growth factor (VEGF), and adverse reactions in both groups were compared.

RESULTS

After 2 weeks of treatment, the total effective rate of observation group was higher than that of control group, and the incidence of adverse reactions showed an opposite trend (both P<0.05). Compared with the control group, the wound healing time was shortened, the wound healing rate was increased, and the fungal infection rate was decreased in the observation group (all P<0.05). Compared with before treatment, serum TNF-α levels in both groups were decreased, while serum levels of IL-10, IL-4 and VEGF were increased after treatment, and the changes in the observation group were more obvious (all P<0.05).

CONCLUSIONS

In diabetic patients with DSDB, VSD after early WA can effectively reduce the incidence of fungal infection, reduce inflammation, improve VEGF level, and facilitate wound healing.

Comparison of clinical outcomes of lower extremity burns in diabetic and non-diabetic patients: a retrospective analysis

Diabetes mellitus is an increasingly prevalent chronic disease that leads to long-term health consequences. Some long-term clinical sequelae of diabetes include coronary artery disease, peripheral vascular disease, peripheral neuropathy, and impaired wound healing. These can increase hospital stay and complications such as wound infections and amputations among patients with lower extremity burns. A retrospective analysis was performed of all isolated lower extremity burns from a single tertiary burn care centre from 2006-2017. Patients were stratified by diabetic status and the incidence of lower extremity amputations was the primary outcome. Multivariable regression was used to model the association between diabetes and amputations, adjusting for patient and injury characteristics. A total of 198 patients were identified as meeting inclusion criteria, 160 were non-diabetic and 38 were diabetic. Age was significantly different between non-diabetic and diabetic patients; mean age was 46 ± 18 years versus 62 ± 17 years (p<0.0001). Length of stay was also significantly different, median length of stay was 11 (IQR 7-15) versus 18 (IQR 12-24) (p<0.001), with diabetic patients staying longer. There was a significantly greater proportion of diabetic patients that had an amputation (control 4% versus diabetic 29%; p<0.0001). After adjustment for patient and injury characteristics, there was a significant association between diabetes and amputation (p=0.002). Among patients with isolated lower extremity burns, those with a pre-existing condition of diabetes had a longer hospitalization and increased amputations, despite similar size of burn. Diabetes is an important risk factor to acknowledge in patients with these injuries to optimize care.

In Patients with Lower Extremity Burns and Osteomyelitis, Diabetes Mellitus Increases Amputation Rate

In this retrospective analysis, we investigated the rate of radiologically confirmed osteomyelitis, extremity amputation and healthcare utilization in both the diabetic and non-diabetic lower extremity burn populations to determine the impact of diabetes mellitus on these outcomes. The burn registry was used to identify all patients admitted to our tertiary burn center from 2014 to 2018. Only patients with lower extremity burns (foot and/or ankle) were included. Statistical analysis was performed using Student's t test, chi-squared test, and Fischer's exact test. Of the 315 patients identified, 103 had a known diagnosis of diabetes mellitus and 212 did not. Seventeen patients were found to have osteomyelitis within three months of the burn injury. Fifteen of these patients had a history of diabetes. Notably, when non-diabetics were diagnosed with osteomyelitis, significant differences were observed in both length of stay and cost in comparison to their counterparts without osteomyelitis (36 vs 9 days; p=0.0003; $226,289 vs $48,818, p=0.0001). Eleven patients required an amputation and 10 (90.9%) of these patients had comorbid diabetes and documented diabetic neuropathy. Compared to non-diabetics, the diabetic cohort demonstrated both a higher average length of stay (13.7 vs 9.2 days, p-value=0.0016) and hospitalization cost ($72,883 vs $50,500, p-value=0.0058). Our findings highlight that diabetic patients with lower extremity burns are more likely to develop osteomyelitis than their non-diabetic counterparts and when osteomyelitis is present, diabetic patients have an increased amputation rate. Further study is required to develop protocols to treat this population, with the specific goal of minimizing patient morbidity and optimizing healthcare utilization.

Low Vibrational Training as an Additional Intervention for Postural Balance, Balance Confidence and Functional Mobility in Type 2 Diabetic Patients with Lower Limb Burn Injury: A Randomized Clinical Trial

PURPOSE

Burn injury with pre-existing diabetes has poorer outcomes and complications. Balance and functional mobility are disturbed in diabetic patients with burn injury which increase the risk of total morbidity. The aim of the current study was to evaluate the impact of vibrational training as an additional intervention on postural balance, balance confidence and functional mobility in type 2 diabetic patients with lower limb burn injury.

PATIENTS AND METHODS

Thirty-eight type 2 diabetic patients of both sexes with healed lower limb burn were randomly assigned into two equal groups: the vibration group and the control group. The vibration group received whole body vibration (WBV), 3 sessions a week for 8 weeks, in addition to the selected exercise program (balance exercises and resisted exercises), while the control group only received the selected exercise program. Biodex Balance System was used to assess the dynamic balance score, the Activities-specific Balance Scale to assess balance confidence and the timed up and go test to assess the functional mobility. All measurements were obtained before and at the end of the study after 8 weeks of treatment.

RESULTS

Marked improvement in all dynamic balance indices; overall stability index, antero-posterior stability index and medio-lateral stability index, balance confidence and the functional mobility were obtained in both the vibration and the control groups (P< 0.05), whereas post-treatment comparison between groups revealed a statistically significant difference in favor of the vibration group in all measured variables.

CONCLUSION

Based on the results of the current study, it is possible to conclude that adding WBV training for an 8-week duration to a selected exercise program (balancing and resisted exercises) seems to be effective; in improving postural balance, balance confidence, as well as improving the functional mobility in type 2 diabetic patients with lower limb burn injury.

Clinical outcomes following burn injury across the continuum of chronic glycemic control

Diabetes has been associated with poor outcomes following burn injury. There is limited data related to prediabetes in burn injury, and no studies to date have compared clinical outcomes inpatients without diabetes, with prediabetes, and with diabetes. Therefore, this study aimed to compare clinical outcomes after burn injury across the continuum of pre-injury glucose control. A propensity score weighted cohort study of adult patients admitted for initial management of burn injury was performed. Patients were categorized as no diabetes, prediabetes or diabetes based on their admission hemoglobin A1c and past medical history. The primary outcome was length of stay per percent Total Body Surface Area (TBSA) burn. Secondary outcome measures included length of stay, all-cause hospital mortality, disposition at discharge, re-grafting of same site, and amputations. A total of 2450 patients were screened; 1137 patients were included for evaluation (236 diabetes, 191 prediabetes, 710 no diabetes). After inverse probability weighing to adjust for potentially confounding factors, patients in the diabetes group had longer length of stay/%TBSA burn than both the no diabetes group (ratio of geometric means (95% CI) = 1.65 (1.25, 2.18), p < 0.001) and the prediabetes group (ratio (95% CI) = 1.49 (1.10, 2.02), p = 0.01). No statistically significant differences in secondary outcomes were observed between groups other than a higher rate of amputations in the diabetes group (2.7%) compared to the no diabetes (0.7%, p = 0.047) and prediabetes (0%, p = 0.04) groups. Further studies are needed to delineate the differences across the continuum of pre-injury glucose control in order to identify mechanisms to optimize burn-related outcomes.

Osteomyelitis Increases the Rate of Amputation in Patients With Type 2 Diabetes and Lower Extremity Burns

In patients with diabetes mellitus (DM), amputation rates exceed 30% when lower extremity osteomyelitis is present. We sought to determine the rate of osteomyelitis and any subsequent amputation in our patients with DM and lower extremity burns. We performed a single-site, retrospective review at our burn center using the institutional burn center registry, linked to clinical and administrative data. Adults (≥18 years old) with DM admitted from January 1, 2014 to December 31, 2018 for isolated lower extremity burns were eligible for inclusion. We evaluated demographics, burn characteristics, comorbidities, presence of radiologically confirmed osteomyelitis, length of stay (LOS), inpatient hospitalization costs, and amputation rate at 3 months and 12 months after injury. We identified 103 patients with DM and isolated lower extremity burns. Of these, 88 patients did not have osteomyelitis, while 15 patients had radiologically confirmed osteomyelitis within 3 months of the burn injury. Compared to patients without osteomyelitis, patients with osteomyelitis had significantly increased LOS (average LOS 22.7 days vs 12.1 days, P = .0042), inpatient hospitalization costs (average $135,345 vs $62,237, P = .0008), amputation rate within 3 months (66.7% vs 5.70%, P &lt; .00001), and amputation rate within 12 months (66.7% vs 9.1%, P &lt; .0001). The two groups were otherwise similar in demographics, burn injury characteristics, access to healthcare, and preexisting comorbidities. Patients with DM and lower extremity burns incurred increased LOS, higher inpatient hospitalization costs, and increased amputation rates if radiologically confirmed osteomyelitis was present within 3 months of the burn injury.