Epidemiology and Etiology of Burns in Iran Through the Examination of the Economic, Social and Educational Situation

Burn accidents continue to cause severe physical, psychological and economic damage to individuals and communities, especially in low- and middle-income countries. The present study was designed and conducted to investigate the epidemiology and identify the causes/mechanisms of burns in Iran, focusing on the economic, social and educational status of patients. This is a survey study that was performed from August 2016 to October 2017 on patients referred to Shahid Motahari University Hospital in Tehran. Samples included all patients whose parents or children were able to answer the questions. The data was extracted and analysed with SPSS Statistics v. 21. A total 1708 patients participated. Most of the patients were 19 to 39 years old. 70.6% had achieved a high school diploma or lower, and 11.5% patients were illiterate. Most of the patients lived in urban areas (91.7%) and in most cases, 4 people or less lived in a common space. Heat burns, chemical (acid) burns, and electrical burns account for the majority of cases. Most patients were unfamiliar with safety standards for burn prevention, safely stopping a fire, and fire safety equipment (alarms and extinguishers). The most common burn mechanisms were hot liquids inside the kitchen (12.6%) and gas explosion (11.9%). Based on these findings, the implementation of codified training programs, continuous control and monitoring of the safety standards in home and work environments, and the establishment of laws to standardize cooking and heating equipment will play an important role in reducing burn injuries in our country.

Effectiveness of incorporating occupational therapy in rehabilitation of hand burn patients

One of the main goals in the rehabilitation process of patients with burn to their hands is their return to society and their professional occupation, which has a direct positive influence on these patients' quality of life. The goal of this research project was to investigate the effect of early intervention with occupational therapy in patients with burns to their hands. The study included 30 patients with second or third degree hand burns. Patients were added to the study 12 days after their burn wounds and grafted areas had healed. They had 3 sessions of occupational therapy per week for 8 weeks. These sessions included active and passive range of motion exercises, active resistive exercises, stretching exercises and practicing activities of daily living. Functionality of the hand was assessed before and after the 8 weeks of occupational therapy using the DASH questionnaire. The average initial DASH score before intervention with occupational therapy was 60.9, and after 8 weeks of occupational therapy it was 33.9 (average difference between the pre-intervention and post-intervention DASH scores is 27 points, p < 0.001). After 8 weeks of occupational therapy, patients performed activities of daily living with a lot less difficulty, and an increase in functionality of the hands was observed. This study suggests that early intervention with rehabilitative therapies is advantageous and may result in improved hand function.

Comparing the effect of colactive plus ag dressing versus nitrofurazone and vaseline gauze dressing in the treatment of second-degree burns

Wound care quality and speed of burn healing are important factors that affect the treatment, prognosis and complications of burns. Burn care is challenging, and the ideal method controversial. The aim of this study was to compare the effects of a new dressing (ColActive dressing) in the treatment of superficial second-degree burns versus traditional dressing including Vaseline and Nitrofurazone. This was a randomized clinical trial study involving 25 cases. A superficial second-degree burn area was divided into two parts in each patient; randomly, traditional dressing was used on one area, and ColActive plus Ag dressing on the other. Every 3 days, after removing the dressings and washing the wounds, wound surface area was evaluated by medical photographic records and J image software. Wound surface area in the two groups was compared before dressing and on the 3rd, 6th, 9th and 12th day afterwards. The difference was not significant before dressing, but significant on the 3rd, 6th, 9th and 12th post-operative day. The difference was significant in both groups, but it was more prominent in the ColActive group (p<0.001) than in the traditional group (p<0.05). Considering the results of this study and good results in previous case reports, ColActive may be more effective than traditional dressing. We suggest a more comprehensive study for a longer period with a larger number of cases to compare other important variables such as scar quality, cost, and pain in the two dressings.

Introduction to a case of orf disease in a burn wound at Motahari Hospital

Orf disease is caused by a double-stranded DNA virus of the Parapox family. Human infection is mostly due to occupational hazard and handling infected animals. Our patient was an 18-year-old woman who suffered burns in 2015. Total Burn Surface Area (TBSA) was 22% and cause of burn was flame. One week after hospital admission, she underwent skin grafts of her upper extremities. However, vegetative granulomatous ulcerations developed on the wound, resulting in the grafts failing to take. After careful investigation into the patient's history, we discovered that the water used to douse the flames was from a drinking trough for sheep. Suspecting Orf disease, we disinfected the wounds and dressing tools with Dakin's solution. We waited about 12 days to perform a new skin graft, and most of the grafted skin took. PCR test for Parapox virus was positive. Orf disease should be considered a distinct possibility in burn patients with a history of probable contamination. Manipulation of the disease in the early stages of burn wound could potentially spread it and change the degree of the wound, therefore being aware of this possibility can save the patient unnecessary pain and time. To prevent a nosocomial outbreak of Orf, wound care and wound disinfection should be scrupulously carried out. Isolation and disinfection of the entire dressing tool should be considered. Educating wound care providers in burn hospitals and scrupulous wound disinfection would protect the patient from cross contamination and allow skin grafts to take with ease, without the formation of ulcerations associated with Orf.

Abstract P5-13-07: An investigator-initiated registry trial of simple oral therapy for low risk breast cancer

Background: Across multiple studies performed in several countries with widely instituted screening mammography programs at different intervals between exams, up to 19% of breast cancer identified is in patients whose disease would otherwise go undetected and not have caused any ill effect if left untreated. Recent advances in pathologic and multigene assays have demonstrated promise to better identify low risk breast cancer and appropriately tailor treatments. Nonetheless, most women who may have such low-risk, estrogen receptor expressing lesions continue to be offered only an aggressive treatment paradigm. This most commonly includes surgery and lymph node evaluation and, in the case of breast conservation, breast irradiation following surgery, with the option of endocrine therapy for 5-10 years.

Trial design: We propose a multi-center US registry study of post-menopausal, female breast cancer patients age 60 and older who will be managed 5 years with oral endocrine therapy for mammographically screen-detected, node-negative, unifocal invasive disease with low clinical grade, high estrogen/progesterone receptor expression, negative Her2 expression, Ki67 rate &lt;20%, and low-risk multigene expression analysis with Mammaprint Breast Cancer Recurrence Assay. Target lesions will be confirmed with a pre-treatment bilateral breast MRI and imaged routinely with standard mammography or ultrasound at 3-month intervals during months 1-36 and at 6-month intervals during months 37-60 to assess for disease response. Enrolled patients will have an ECOG performance status of 0-2. Medication history will be documented at routine follow-up visits.

Our primary objective will be to determine the frequency of conversion from a low-toxicity approach with oral endocrine therapy to conventional care with surgery +/- radiation therapy as a result of progression of disease or patient/provider choice. Progression of disease will be quantified objectively as &gt;20% growth of the target lesion as compared to baseline in imaging measurements. After 5 years of endocrine therapy sans disease progression, patients may elect to continue or stop treatment or convert to standard care.

Statistical methods: We will determine the conversion rate from oral therapy for any cause to conventional management (compliance). Compared to the most pessimistic assumed true-rate for compliance of 0.5, we predict &gt;90% power to detect a decrease of 0.1 in outcomes with an alpha of 5% (corresponds to a 95% Confidence Interval). Using descriptive statistics, we will also quantify for disease responses and progression-free survival. Our sample size will be ample for multiple sub-analyses including measurement of differences emanating from tertiary care versus local oncologic management, advanced imaging outcomes (if performed on any subset of patients), effect of type of endocrine therapy type (SERM vs AI), and effect of age and/or comorbidity severity interaction.

Accrual: Clinic sites with large patient cohorts are now being selected nationwide to enroll and manage patients' disease with endocrine treatment only. We will select up to 20 sites and enroll 300 patients with low-risk disease.

Citation Format: Gadi VK, Preusse C, Calhoun KE, Kim J, Linden HM, Rendi M, Etzioni RB, Gooley T, Lyman G, Stork L, van der Baan B, Barth N, Rahbar H. An investigator-initiated registry trial of simple oral therapy for low risk breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-13-07.

P2-08-03: Quantitative MRI for Noninvasive Prediction of Prognostic Markers in Breast Cancer

Background: Magnetic resonance imaging (MRI) is a valuable tool for assessing extent of breast cancer and monitoring treatment response. Quantitative measures by diffusion-weighted MRI (DWI) and dynamic contrast-enhanced (DCE) MRI reflect tumor cellularity and vascularity. Tumor grade and some histopathological markers, such as ER, PR, HER-2, Ki67 and P53, are prognostic factors that can also be associated with tumor cellularity and vascularity. DWI and DCE measures may therefore provide a noninvasive means for predicting disease prognosis and stratifying patients to appropriate therapies. The purpose of this study was to investigate the correlation between quantitative MRI features and prognostic pathological factors in patients with invasive breast cancer.

Methods: This IRB-approved retrospective study included patients with biopsy-proven invasive cancer who underwent 1.5T breast MRI (including DCE and DWI) from October 2005 to May 2006 prior to treatment. Pathology data was obtained from pre-treatment biopsy and intrinsic subtype classification was approximated by standard immunohistochemistry characteristics. After excluding cases with missing MRI or pathology data, the final study cohort included 41 invasive cancers (36 ductal and 5 lobular carcinomas) in 36 patients. MRI measures included lesion DCE kinetic features: peak initial enhancement (PE), percent rapid enhancement (RE), and percent washout (WO), and DWI normalized apparent diffusion coefficient values (nADC). Associations between imaging features and pathology markers, cancer grades and intrinsic subtypes were evaluated by Mann-Whitney U test and multivariate logistic regression.

Results: Results of univariate comparisons are summarized in Table 1. One or more DCE-MRI kinetic parameters were significantly predictive (p&lt;0.05) of each of the histopathological markers with the exception of ER, which was marginally associated with WO (p=0.05). Each of the DCE kinetics parameters significantly discriminated grade III tumors from grades I and II and luminal A from luminal B and basal-like intrinsic subtypes. In multivariate regression, both PE and WO were significant independent predictors of tumor grade (p=0.0094, p=0.0005, respectively). WO and nADC were significant independent predictors of PR status (p=0.0054, p=0.0027), while PE was the only significant independent predictor of both Ki67 (p=0.014) and intrinsic subtype (p=0.015).

Conclusion: This preliminary study suggests that quantitative MRI measures are associated with prognostic tumor markers and may provide valuable noninvasive characterization of tumor biology. Larger prospective studies are needed to validate our findings.

Improved diagnostic accuracy of breast MRI through combined apparent diffusion coefficients and dynamic contrast-enhanced kinetics

This study investigated the relationship between apparent diffusion coefficient (ADC) measures and dynamic contrast-enhanced magnetic resonance imaging (MRI) kinetics in breast lesions and evaluated the relative diagnostic value of each quantitative parameter. Seventy-seven women with 100 breast lesions (27 malignant and 73 benign) underwent both dynamic contrast-enhanced MRI and diffusion weighted MRI. Dynamic contrast-enhanced MRI kinetic parameters included peak initial enhancement, predominant delayed kinetic curve type (persistent, plateau, or washout), and worst delayed kinetic curve type (washout > plateau > persistent). Associations between ADC and dynamic contrast-enhanced MRI kinetic parameters and predictions of malignancy were evaluated. Results showed that ADC was significantly associated with predominant curve type (ADC was higher for lesions exhibiting predominantly persistent enhancement compared with those exhibiting predominantly washout or plateau, P = 0.006), but was not significantly associated with peak initial enhancement or worst curve type (P > 0.05). Univariate analysis showed significant differences between benign and malignant lesions in both ADC (P < 0.001) and worst curve (P = 0.003). In multivariate analysis, worst curve type and ADC were significant independent predictors of benign versus malignant outcome and in combination produced the highest area under the receiver operating characteristic curve (0.85 and 0.78 with 5-fold cross validation).