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Yıldız M, Sarpdağı Y, Okuyar M, Yildiz M, Çiftci N, Elkoca A, Yildirim MS, Aydin MA, Parlak M, Bingöl B. Segmentation and classification of skin burn images with artificial intelligence: Development of a mobile application. Burns 2024; 50:966-979. [PMID: 38331663 DOI: 10.1016/j.burns.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/26/2023] [Accepted: 01/10/2024] [Indexed: 02/10/2024]
Abstract
AIM This study was conducted to determine the segmentation, classification, object detection, and accuracy of skin burn images using artificial intelligence and a mobile application. With this study, individuals were able to determine the degree of burns and see how to intervene through the mobile application. METHODS This research was conducted between 26.10.2021-01.09.2023. In this study, the dataset was handled in two stages. In the first stage, the open-access dataset was taken from https://universe.roboflow.com/, and the burn images dataset was created. In the second stage, in order to determine the accuracy of the developed system and artificial intelligence model, the patients admitted to the hospital were identified with our own design Burn Wound Detection Android application. RESULTS In our study, YOLO V7 architecture was used for segmentation, classification, and object detection. There are 21018 data in this study, and 80% of them are used as training data, and 20% of them are used as test data. The YOLO V7 model achieved a success rate of 75.12% on the test data. The Burn Wound Detection Android mobile application that we developed in the study was used to accurately detect images of individuals. CONCLUSION In this study, skin burn images were segmented, classified, object detected, and a mobile application was developed using artificial intelligence. First aid is crucial in burn cases, and it is an important development for public health that people living in the periphery can quickly determine the degree of burn through the mobile application and provide first aid according to the instructions of the mobile application.
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Affiliation(s)
- Metin Yıldız
- Department of Nursing, Sakarya University, Sakarya, Turkey.
| | - Yakup Sarpdağı
- Department of Nursing Van Yuzuncu Yil University, Turkey
| | - Mehmet Okuyar
- Sakarya University of Applied Sciences Biomedical Engineering, Sakarya, Turkey
| | - Mehmet Yildiz
- Sakarya University of Applied Sciences, Distance Education Research and Application Center, Sakarya, Turkey
| | - Necmettin Çiftci
- Muş Alparslan University, Faculty of Health Sciences, Department of Nursing, 49100 Muş, Turkey
| | - Ayşe Elkoca
- Gaziantep Islamic University of Science and Technology Faculty of Health Sciences, Midwifery, Turkey
| | - Mehmet Salih Yildirim
- Vocational School of Health Services, Agri Ibrahim Cecen University School of Health, Agri, Turkey
| | | | - Mehmet Parlak
- Ataturk University, Department of Nursing, Erzurum, Turkey
| | - Bünyamin Bingöl
- Sakarya University, Electrical and Electronics Engineering, Sakarya, Turkey
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Tapking C, Panayi A, Haug V, Palackic A, Houschyar KS, Claes KEY, Kuepper S, Vollbach F, Kneser U, Hundeshagen G. Use of the modified meek technique for the coverage of extensive burn wounds. Burns 2024; 50:1003-1010. [PMID: 38383170 DOI: 10.1016/j.burns.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 12/26/2023] [Accepted: 01/10/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Autologous split thickness skin grafting using meshing technique remains the preferred option for the management of deep dermal and full thickness burns. The limited donor site availability seen in patients with extensive burns, however, restricts use of the mesh grafting technique for skin expansion. Meek micrografting was developed to allow for greater expansion, and, therefore, more reliable treatment of extensive burns. This study aimed to present our outcomes using the Meek micrografting technique and identify risk factors for graft failure. METHODS A retrospective review of patients admitted to our large academic hospital who were treated with the Meek micrografting technique from 2013 to 2022 was conducted. Patient demographics, surgical characteristics and outcomes were reported. Regression analyses were performed to identify factors that influence graft take and reoperation rate. RESULTS A total of 73 patients with a mean age of 45.7 ± 19.9 years and mean burn size of 60.0 ± 17.8%TBSA, with 45.3 ± 14.9% TBSA being third degree burns, received Meek transplantation. The mean graft take after removal of the pre-folded polyamide gauze at the tenth post-operative day was 75.8 ± 14.7%. Pre-treatment with use of an allograft, longer waiting time between admission and Meek grafting and transplantation over a dermal matrix were identified as positive predictors for graft take, while age was established as a negative predictor. CONCLUSION By examining the outcomes of the Meek micrografting technique in extensive burn wounds we identified that preconditioning of the wound bed, through allograft or negative pressure wound therapy application, positively correlates with improved outcomes, including higher graft take. At the same time, older age was seen to negatively correlate with graft take. Overall, Meek transplantation displays a favorable safety profile with promising outcomes. Future prospective studies and clinical trials can optimize the procedure and help establish it as the golden standard for extensive and complex burns.
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Affiliation(s)
- C Tapking
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, Heidelberg University, Ludwigshafen, Germany
| | - A Panayi
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, Heidelberg University, Ludwigshafen, Germany
| | - V Haug
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, Heidelberg University, Ludwigshafen, Germany
| | - A Palackic
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, Heidelberg University, Ludwigshafen, Germany
| | - K S Houschyar
- Department of Dermatology and Allergology, University Hospital Aachen, Germany
| | - K E Y Claes
- Burn Center, Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
| | - S Kuepper
- Burns Center and Plastic Surgery, Unfallkrankenhaus Berlin, Berlin, Germany
| | - F Vollbach
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, Heidelberg University, Ludwigshafen, Germany
| | - U Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, Heidelberg University, Ludwigshafen, Germany
| | - G Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, Heidelberg University, Ludwigshafen, Germany.
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Vanaclocha N, Miranda Gómez L, Pérez Del Caz MD, Vanaclocha Vanaclocha V, Miranda Alonso FJ. Higher serum prealbumin levels are associated with higher graft take and wound healing in adult burn patients: A prospective observational trial. Burns 2024; 50:903-912. [PMID: 38302393 DOI: 10.1016/j.burns.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/24/2023] [Accepted: 12/26/2023] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Nutritional support is essential in burn care. There are few studies investigating the effect of nutrition on burn healing. The purpose of this study was to determine the relationship between perioperative serum prealbumin levels and the probability of autologous skin graft take in burned patients. MATERIALS AND METHODS A prospective observational study was carried out with burned adults recruited consecutively from April 2019 until September 2021. Serum prealbumin was determined perioperatively. The percentage of graft take was evaluated over the first 5 postoperative dressing changes. Time until full epithelialization (absence of wounds) was also registered. RESULTS A total of 60 patients were recruited, mostly middle-aged people with moderate flame burns. Serum prealbumin levels and graft take had a weak-moderate, nonlinear, statistically significant correlation. They were also an independent predictor of full epithelialization on the fifth dressing change, together with burn depth. Higher perioperative serum prealbumin levels were significantly associated with a reduction in time until full epithelialization. CONCLUSIONS Perioperative serum prealbumin levels are significantly correlated with the probability of split-thickness skin autograft take in burned patients and with a reduced time to achieve complete epithelialization. They were an independent predictor of full graft take.
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Affiliation(s)
- Nieves Vanaclocha
- Department of Plastic Surgery and Burns, University and Polytechnic Hospital La Fe, Valencia, Spain.
| | - Luis Miranda Gómez
- Department of Plastic Surgery, University General Hospital, Valencia, Spain
| | - Maria Dolores Pérez Del Caz
- Department of Plastic Surgery and Burns, University and Polytechnic Hospital La Fe, Valencia, Spain; Department of Surgery, University of Valencia, Valencia, Spain
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Bai D, Cheng H, Mei J, Tian G, Wang Q, Yu S, Gao J, Zhong Y, Xin H, Wang X. Rapid formed temperature-sensitive hydrogel for the multi-effective wound healing of deep second-degree burn with shikonin based scar prevention. Biomater Adv 2024; 160:213851. [PMID: 38642517 DOI: 10.1016/j.bioadv.2024.213851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/03/2024] [Accepted: 04/06/2024] [Indexed: 04/22/2024]
Abstract
Burns are a significant public health issue worldwide, resulting in prolonged hospitalization, disfigurement, disability and, in severe cases, death. Among them, deep second-degree burns are often accompanied by bacterial infections, insufficient blood flow, excessive skin fibroblasts proliferation and collagen deposition, all of which contribute to poor wound healing and scarring following recovery. In this study, SNP/MCNs-SKN-chitosan-β-glycerophosphate hydrogel (MSSH), a hydrogel composed of a temperature-sensitive chitosan-β-glycerophosphate hydrogel matrix (CGH), mesoporous carbon nanospheres (MCNs), nitric oxide (NO) donor sodium nitroprusside (SNP) and anti-scarring substance shikonin (SKN), is intended for use as a biomedical material. In vitro tests have revealed that MSSH has broad-spectrum antibacterial abilities and releases NO in response to near-infrared (NIR) laser to promote angiogenesis. Notably, MSSH can inhibit excessive proliferation of fibroblasts and effectively reduce scarring caused by deep second-degree burns, as demonstrated by in vitro and in vivo tests.
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Affiliation(s)
- Danmeng Bai
- The National Engineering Research Center for Bioengineering Drugs and the Technologies, Institute of Translational Medicine, Nanchang University, Nanchang, Jiangxi 330088, PR China
| | - Haoxin Cheng
- School of Chemistry and Chemical Engineering, Nanchang University, Nanchang, Jiangxi 330088, PR China
| | - Junmin Mei
- The National Engineering Research Center for Bioengineering Drugs and the Technologies, Institute of Translational Medicine, Nanchang University, Nanchang, Jiangxi 330088, PR China
| | - Guangqi Tian
- The National Engineering Research Center for Bioengineering Drugs and the Technologies, Institute of Translational Medicine, Nanchang University, Nanchang, Jiangxi 330088, PR China
| | - Qingqing Wang
- School of Pharmacy, Nanchang University, Nanchang, Jiangxi 330006, PR China
| | - Simin Yu
- School of Chemistry and Chemical Engineering, Nanchang University, Nanchang, Jiangxi 330088, PR China
| | - Jie Gao
- The National Engineering Research Center for Bioengineering Drugs and the Technologies, Institute of Translational Medicine, Nanchang University, Nanchang, Jiangxi 330088, PR China
| | - Yanhua Zhong
- School of Chemistry and Chemical Engineering, Nanchang University, Nanchang, Jiangxi 330088, PR China
| | - Hongbo Xin
- The National Engineering Research Center for Bioengineering Drugs and the Technologies, Institute of Translational Medicine, Nanchang University, Nanchang, Jiangxi 330088, PR China
| | - Xiaolei Wang
- The National Engineering Research Center for Bioengineering Drugs and the Technologies, Institute of Translational Medicine, Nanchang University, Nanchang, Jiangxi 330088, PR China; School of Chemistry and Chemical Engineering, Nanchang University, Nanchang, Jiangxi 330088, PR China.
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Foppiani JA, Weidman A, Hernandez Alvarez A, Valentine L, Bustos VP, Galinaud C, Hrdina R, Hrdina R, Musil Z, Lee BT, Lin SJ. A Meta-Analysis of the Mortality and the Prevalence of Burn Complications in Western Populations. J Burn Care Res 2024:irae064. [PMID: 38619135 DOI: 10.1093/jbcr/irae064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Indexed: 04/16/2024]
Abstract
Management of burn injuries is complex, with highly variable outcomes occurring among different populations. This meta-analysis aims to assess the outcomes of burn therapy in North American (NA) and European adults, specifically, mortality and complications, to guide further therapeutic advances. A systematic review of PubMed, Web of Science, and Cochrane was performed. Random-effect meta-analysis of proportions was conducted to assess the overall prevalence of the defined outcomes. Fifty-four studies were included, pooling 60,269 adult patients. A total of 53,896 patients were in North America (NA, 89.4%), and 6,373 were in Europe (10.6%). Both populations experienced similar outcomes. The overall pooled prevalence of mortality was 13% (95% CI 8-19%) for moderate burns and 20% (95% CI 12-29%) for severe burns in the NA region, and 22% (95% CI 16-28%) for severe burns in Europe. Infectious complications were the most common across both regions. European studies showed an infection rate for moderate and severe burn patients at 8% and 76%, respectively, while NA studies had rates of 35% and 54%. Acute kidney injury (39% vs. 37%) and shock (29% vs. 35%), were the next most common complications in European and NA studies, respectively. The length of stay was 27.52 days for severe burn patients in Europe and 31.02 days for severe burn patients in NA. Burn outcomes are similar between Western populations. While outcomes are reasonably good overall, infectious complications remain high. These findings encourage the development of further therapeutic strategies disclosing respective costs to enable cost/efficiency evaluations in burn management.
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Affiliation(s)
- Jose A Foppiani
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Allan Weidman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Angelica Hernandez Alvarez
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Lauren Valentine
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Valeria P Bustos
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Cécilia Galinaud
- Charles University, Faculty of Science, Department of Organic Chemistry, Praha, Czech Republic
| | - Radim Hrdina
- University of Pardubice, Faculty of Chemical Technology, Pardubice, Czech Republic
| | - Radim Hrdina
- Charles University, Faculty of Science, Department of Organic Chemistry, Praha, Czech Republic
| | - Zdenek Musil
- Charles University, Faculty of Medicine, Institute of Biology and Medical Genetics, Praha, Czech Republic
| | - Bernard T Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Huang YN, Chen KC, Wang JH, Lin YK. Effects of aloe vera on burn injuries: A systematic review and meta-analysis of randomized controlled trials. J Burn Care Res 2024:irae061. [PMID: 38605441 DOI: 10.1093/jbcr/irae061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Indexed: 04/13/2024]
Abstract
Burn injuries cause severe pain, infection risks, psychological distress, financial burdens, and mortality, necessitating effective care. Aloe vera, a traditional burn remedy, shows wound healing potential, but its analgesic effects and efficacy with varying burn severity are uncertain. This study aims to investigate aloe vera's impact on wound healing, pain management, and infection prevention in burn patients. A systematic search on PubMed, Embase, and CENTRAL was performed on 9th October 2023 for randomized controlled trials (RCTs). The risk of bias was examined using the Cochrane risk-of-bias tool (version 2), and the meta-analysis was carried out using a random-effects model. The primary outcome was wound healing time, with secondary outcomes examining pain severity and wound infection. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence for each outcome. Nine RCTs were included in the current study, of which six provided data on the primary outcome. Aloe vera significantly reduced mean wound healing time compared to other topicals [mean difference (MD) -3.76 days; 95% confidence interval (CI) -5.69 to -1.84]. Additionally, the meta-analysis of the secondary outcomes found no significant differences in pain reduction (MD -0.76 points; 95% CI -1.53 to 0.01) and wound infection risk (risk ratio 1.10; 95% CI 0.34 to 3.59) between aloe vera and control groups. In conclusion, aloe vera expedites wound healing in second-degree burn patients without increased infection risk compared to other antimicrobial agents. The analgesic effects on burn injuries remain uncertain.
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Affiliation(s)
- Yu-Ning Huang
- Department of Anesthesiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, No. 707, Sec. 3, Zhongyang Rd., Hualien City, Hualien County 970473, Taiwan
| | - Kun-Chuan Chen
- Department of Emergency Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, No. 707, Sec. 3, Zhongyang Rd., Hualien City, Hualien County 970473, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan, No. 701, Sec. 3, Zhongyang Rd., Hualien City, Hualien County 970374, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, No. 707, Sec. 3, Zhongyang Rd., Hualien City, Hualien County 970473, Taiwan
| | - Yun-Kuan Lin
- Department of Emergency Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, No. 707, Sec. 3, Zhongyang Rd., Hualien City, Hualien County 970473, Taiwan
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Boccara D, Chaouat M, Serror K, Mimoun M, Vairinho A. Specificities of the Management of perineal burns. J Burn Care Res 2024:irae054. [PMID: 38594952 DOI: 10.1093/jbcr/irae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Indexed: 04/11/2024]
Abstract
There is a paucity of articles addressing the management strategy for perineal burns. Pelvic floor burns present a multitude of problems. These relate to the management of stool, urine, areas of maceration, significant strain, and the risk of infection. The objective of this study was to analyze a consecutive series of perineal burns by studying their characteristics, treatment, and the management of urine and feces. This was a retrospective study including 100 patients between January 2018 and December 2022. The patients had all been hospitalized after suffering burns to the perineum. In 28% of the patients, the perineal burn was complicated by infection. In 61% of cases, a cutaneous infection, in 32% of cases, a urinary tract infection, in 25% of cases, a respiratory tract infection, and in 7% of cases, an infection of the digestive tract. Superinfection is associated with an increased risk of poor engraftment. 100% of the patients with poor or average engraftment had an infection in the aftermath of the burn, compared with 20% of the patients with excellent engraftment and 61% of the patients with good engraftment. In our series, the analysis revealed that, in 95% of cases, no specific procedures were implemented for stool management. Perianal involvement was associated with a risk of sub-excellent engraftment. The results were statistically significant, with p=0.005 and an OR=8.72 after multivariate analysis. We favor the least invasive approach to stool management. Indications for a rectal catheter arise in patients with the following characteristics: the patient must be sedated, the burns must be deep and close to the anal opening, and the stools must be watery and abundant. In 95% of cases, we do not install a stool management device. Colostomies should remain exceptional.
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Affiliation(s)
- David Boccara
- Plastic, Reconstructive and Cosmetic and Burn Surgery unit, Hôpital Saint Louis, Paris, France
| | - Marc Chaouat
- Plastic, Reconstructive and Cosmetic and Burn Surgery unit, Hôpital Saint Louis, Paris, France
| | - Kevin Serror
- Plastic, Reconstructive and Cosmetic and Burn Surgery unit, Hôpital Saint Louis, Paris, France
| | - Maurice Mimoun
- Plastic, Reconstructive and Cosmetic and Burn Surgery unit, Hôpital Saint Louis, Paris, France
| | - Alexandre Vairinho
- Plastic, Reconstructive and Cosmetic and Burn Surgery unit, Hôpital Saint Louis, Paris, France
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Hassan A, Ali S, Farooq MA, Suleyman R, Liaqat I, Shahzad H, Mumtaz S, Summer M, Akbar Mughal T. Synergetic effects of sericin and turmeric on burn wound healing in mice. J Burn Care Res 2024:irae062. [PMID: 38596864 DOI: 10.1093/jbcr/irae062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Indexed: 04/11/2024]
Abstract
Burn wounds are one of the most hazardous issues globally. Silkworm produces a protein called sericin. Sericin assists in wound healing by facilitating the proliferation of keratinocytes and fibroblasts while turmeric is potentially helpful in wound healing because of its antioxidant, anti-inflammatory, and anti-infectious activities. The current study aimed to investigate the synergetic and individual effects of turmeric, sericin, and their nanoparticles on burn wounds in mice. The female mice of 2 months of age (each weighing 29-30 g) were arbitrarily distributed in seven groups. Five mice were added to each group. Burn wounds were induced in mice by using a hot metal rod. Burn wounds were evaluated histologically and morphologically. Turmeric nanoparticles substantially improved the wound contraction area as compared to the negative control group and other treatment groups. The serum level of Glutathione (4.9±0.1umol/L), Catalase (6.0±0.2mmol/ml), Glutathione Peroxidase (183.4±5.1U/L), Superoxide dismutase (194.6±5.1 U/ml) were significantly increased in the turmeric nanoparticles (TNPs) group as compared to the negative control (2.8±0.1umol/L, 3.5±0.1mmol/ml, 87.8±3.0U/L, and 92.0±4.8U/ml respectively). The minimum levels of Malondialdehyde (3.8±0.2mmol/L) were noticed in TNPs group contrary to the negative control (7.4±0.2mmol/L). The restoration of the epidermis was also observed to be faster in TNPs group as compared to all other treatment groups. The histopathological analysis also demonstrated the effectiveness of turmeric, sericin, and their nanoparticles. In conclusion, turmeric, sericin, and their nanoparticles are effective in improving the healing process of burn wounds, but TNPs showed the most effective results as compared to all other treatment groups.
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Affiliation(s)
- Ali Hassan
- Medical Toxicology Laboratory, Department of Zoology, Government College University, Lahore, Pakistan
| | - Shaukat Ali
- Medical Toxicology Laboratory, Department of Zoology, Government College University, Lahore, Pakistan
| | - Muhammad A Farooq
- Medical Toxicology Laboratory, Department of Zoology, Government College University, Lahore, Pakistan
| | - Rida Suleyman
- Medical Toxicology Laboratory, Department of Zoology, Government College University, Lahore, Pakistan
| | - Irfana Liaqat
- Medical Toxicology Laboratory, Department of Zoology, Government College University, Lahore, Pakistan
| | - Hafsa Shahzad
- Medical Toxicology Laboratory, Department of Zoology, Government College University, Lahore, Pakistan
| | - Samaira Mumtaz
- Medical Toxicology Laboratory, Department of Zoology, Government College University, Lahore, Pakistan
| | - Muhmmad Summer
- Medical Toxicology Laboratory, Department of Zoology, Government College University, Lahore, Pakistan
| | - Tafail Akbar Mughal
- Medical Toxicology and nano biotechnology laboratory, Department of Zoology, Women University of Azad Jammu and Kashmir, Bagh, Pakistan
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Druery M, Das A, Warren J, Newcombe PA, Lipman J, Cameron CM. Early predictors of health-related quality of life outcomes at 12 months post- burn: ABLE study. Injury 2024:111545. [PMID: 38584078 DOI: 10.1016/j.injury.2024.111545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/21/2024] [Accepted: 04/01/2024] [Indexed: 04/09/2024]
Abstract
There remains a paucity of evidence on the early predictors of long-term Health-Related Quality of Life (HRQoL) outcomes post-burn in hospitalised adults. The overall aim of this study was to identify the factors (personal, environmental, burn injury and burn treatment factors) that may predict long-term HRQoL outcomes among adult survivors of hospitalised burn injuries at 12 months post-burn. A total of 274 participants, aged 18 years or over, admitted to a single state-wide burn centre with a burn injury were recruited. Injury and burn treatment information were collected from medical records or the hospital database and surveys collected demographic and social data. HRQoL outcome data were collected at 3-, 6- and 12-months using the 12-Item Short Form Survey (SF-12 v1) and Burns Specific Health Scale-Brief (BSHS-B). Personal, environmental, burn injury and burn treatment factors were also recorded at baseline. Analyses were performed using linear and logistic regression. Among 274 participants, 71.5 % (N=196) remained enrolled in the study at 12 months post-burn. The majority of participants reported HRQoL outcomes comparable with population norms and statistically significant improvements in generic (SF-12 v1) and condition-specific (BSHS-B) outcomes over time. However, for participants with poor HRQoL outcomes at 12-months post-burn, Univariable predictors included longer hospital length of stay, unemployment at the time of injury, a diagnosed pre-injury mental health condition, inadequate pre-burn social support, intentional injury, recreational drug use pre-injury and female gender. The early multivariable predictors of insufficient HRQoL outcomes were female gender, a previously diagnosed mental health condition, unemployment, inadequate social support, intentional injury, and prolonged hospital length of stay. These results suggest potential factors that could be used to screen and burns patients for psychosocial intervention and long-term follow up.
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Affiliation(s)
| | - Arpita Das
- Jamieson Trauma Institute, Australia; Queensland University of Technology, Australia.
| | - Jacelle Warren
- Jamieson Trauma Institute, Australia; Queensland University of Technology, Australia
| | | | - Jeffrey Lipman
- The University of Queensland, Australia; Jamieson Trauma Institute, Australia
| | - Cate M Cameron
- Jamieson Trauma Institute, Australia; Queensland University of Technology, Australia
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Al Sulaiman KA, Al-Ramahi G, Aljuhani O, Al-Joudi K, Alhujayri AK, Al-Shomer F, Silas J, Al Dabbagh T, Al Harbi S, AlDekhayel S, Eldali A, Alqahtani R, Vishwakarma R, Al-Dorzi HM. Comparison of the safety and efficacy for different regimens of pharmaco-prophylaxis among severely burned patients: a randomized controlled trial. Eur J Trauma Emerg Surg 2024; 50:567-579. [PMID: 38240791 DOI: 10.1007/s00068-024-02443-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/31/2023] [Indexed: 04/23/2024]
Abstract
PURPOSE Venous thromboembolism (VTE) is a common complication in critically ill patients, including severe burn cases. Burn patients respond differently to medications due to pharmacokinetic changes. This study aims to assess the feasibility and safety of different VTE pharmaco-prophylaxis in patients admitted to the ICU with severe burns. METHODS A pilot, open-label randomized controlled trial was conducted on ICU patients with severe burns (BSA ≥ 20%). By using block randomization, patients were allocated to receive high-dose enoxaparin 30 mg q12hours (E30q12), standard-dose enoxaparin 40 mg q24hours (E40q24), or unfractionated heparin (UFH) 5000 Units q8hours. In this study, the primary outcomes assessed were the recruitment and consent rates, as well as bleeding or hematoma at both the donor and graft site. Additionally, secondary measures were evaluated to provide further insights. RESULTS Twenty adult patients out of 114 screened were enrolled and received E30q12 (40%), E40q24 (30%), and UFH (30%). The recruitment rate was one patient per month with a 100% consent rate. Donor site bleeding occurred in one patient (16.7%) in the UFH group. On the other hand, graft site bleeding was only reported in one patient (12.5%) who received E30q12. Major bleeding happened in two patients, one in E30q12 and one in the UFH group. Five patients (25.0%) had minor bleeding; two patients (25.0%) received E30q12, two patients E40q24, and one patient UFH. RBC transfusion was needed in four patients, two on E30q12 and two on UFH. Only one patient had VTE, while four patients died in the hospital. CONCLUSION The study observed a low recruitment rate but a high consent rate. Furthermore, there were no major safety concerns identified with any of the three pharmacologic prophylaxis regimens that were evaluated. TRIAL REGISTRATION NUMBER NCT05237726.
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Affiliation(s)
- Khalid A Al Sulaiman
- Pharmaceutical Care Department, King Abdulaziz Medical City (KAMC) - Ministry of National Guard Health Affairs (MNGHA), King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, PO Box 22490, 11426, Riyadh, Saudi Arabia.
- College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
- King Abdullah International Medical Research Center-King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.
- Saudi Critical Care Pharmacy Research (SCAPE) Platform, Riyadh, Saudi Arabia.
| | - Ghassan Al-Ramahi
- Plastic Surgery Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ohoud Aljuhani
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Khuloud Al-Joudi
- Pharmaceutical Care Department, King Abdulaziz Medical City (KAMC) - Ministry of National Guard Health Affairs (MNGHA), King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, PO Box 22490, 11426, Riyadh, Saudi Arabia
- College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center-King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Abdulaziz K Alhujayri
- King Abdullah International Medical Research Center-King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
- Plastic Surgery Division, Department of Surgery, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Feras Al-Shomer
- King Abdullah International Medical Research Center-King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
- Plastic Surgery Division, Department of Surgery, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Johanna Silas
- King Abdullah International Medical Research Center-King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
- Nursing Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Tarek Al Dabbagh
- King Abdullah International Medical Research Center-King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Shmeylan Al Harbi
- Pharmaceutical Care Department, King Abdulaziz Medical City (KAMC) - Ministry of National Guard Health Affairs (MNGHA), King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, PO Box 22490, 11426, Riyadh, Saudi Arabia
- College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center-King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Salah AlDekhayel
- Plastic Surgery Division, Department of Surgery, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Ahmed Eldali
- Plastic Surgery Division, Department of Surgery, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Rahaf Alqahtani
- Pharmaceutical Care Department, King Abdulaziz Medical City (KAMC) - Ministry of National Guard Health Affairs (MNGHA), King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, PO Box 22490, 11426, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center-King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | | | - Hasan M Al-Dorzi
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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11
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Thomas R, Wicks S, Dale M, Toose C, Pacey V. Cutaneous functional units prediction in outcomes of early and intensive splinting following palmar burn injury in young children: a prospective study. Burns 2024; 50:717-729. [PMID: 38184424 DOI: 10.1016/j.burns.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/06/2023] [Accepted: 12/17/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Palmar burn injuries are common in young children and can result in contracture. METHODS A prospective longitudinal study describes outcomes of palm and digit extension splint use following burn in 75 children (83 hands) aged < 5 years and determines whether specific cutaneous functional units (CFUs) are associated with early signs of contracture (ESC). Outcomes were assessed up to 9-18 months following burn. Routine clinical data was collected at therapy reviews. RESULTS Children were splinted > 12 h/day for a mean of 158 days following burn. The mean time to splint cessation was 264 days following burn. Fourteen hands developed ESC (17%): 12 hands had full ROM restored following conservative management, 2 hands (3%) progressed to contracture. Hands that developed ESC had greater healing time (p = 0.002), greater number of CFUs affected (p < 0.001), and greater number of immediate first webspace and extended first webspace CFUs affected (p = 0.002, p < 0.001 respectively). ESC risk increases for each day to heal (odds ratio [OR] 1.1, 95% CI 1.0-1.2) and each CFU in extended first webspace (OR 2.8, 95% CI 1.5-5.0). CONCLUSION Early and intensive splinting following palmar burn results in excellent ROM. Burns involving more CFUs or the first webspace are associated with ESC.
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Affiliation(s)
- Rhianydd Thomas
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, New South Wales, Australia; Burns Unit, The Children's Hospital at Westmead, New South Wales, Australia.
| | - Stephanie Wicks
- Burns Unit, The Children's Hospital at Westmead, New South Wales, Australia
| | - Marita Dale
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Claire Toose
- Burns Unit, The Children's Hospital at Westmead, New South Wales, Australia
| | - Verity Pacey
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, New South Wales, Australia
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12
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Wang Z, Chen L, Rong X, Wang X. Upregulation of MAOA in the hippocampus results in delayed depressive-like behaviors in burn mice. Burns 2024; 50:789-795. [PMID: 28413107 DOI: 10.1016/j.burns.2017.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 02/03/2017] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To observe depressive-like behavior and hippocampus monoamine oxidase A (MAOA) changes in burned mice. METHODS We tested depression and anxiety like behaviors of burn C57 mice with the sucrose preference test, forced swimming test (FST), open field test and elevated plus maze test and then detected the MAOA content and MAOA gene transcriptional levels in the hippocampus with western blot analysis and real-time quantitative PCR analysis. We then sought to reverse depressive-like behavior of burned mice with an MAOA inhibitor. RESULTS (1) Mice showed depressive and anxiety like behaviors one week after they were burned; (2) The content of MAOA in the hippocampus of burned mice was significantly higher than that in control mice (P<0.05); (3) MAOA gene transcription in the hippocampus of burned mice was significantly increased (MAOA mRNA was increased, P<0.05); (4) treatment with a MAOA inhibitor (phenelzine) significantly increased the sucrose preference rate and decreased FST immobility time in burned mice, and also decreased elevated expression of MAOA in the hippocampus of burned mice. CONCLUSION Burned mice showed "delayed" depressive-like behavior combined with a degree of anxiety; this phenomenon is likely associated with the increase in MAOA expression in the hippocampus.
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Affiliation(s)
- Zhen Wang
- Key Laboratory of Psychiatric Disorders of Guangdong Province, Department of Neurobiology, School of Basic Medical Science, Southern Medical University, Guangzhou City, Guangdong Province, 510000, People's Republic of China.
| | - Lu Chen
- Pathology Department of The Second Affiliated Hospital of South China University of Technology, Guangzhou City, Guangdong Province, 510180, People's Republic of China.
| | - Xinzhou Rong
- Burn Department of The Second Affiliated Hospital of South China University of Technology, Guangzhou City, Guangdong Province, 510180, People's Republic of China.
| | - Xuemin Wang
- Key Laboratory of Psychiatric Disorders of Guangdong Province, Department of Neurobiology, School of Basic Medical Science, Southern Medical University, Guangzhou City, Guangdong Province, 510000, People's Republic of China.
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13
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Powell LE, Knutson A, Meyer AJ, McCormick M, Lacey AM. A 15-year review of characteristics and outcomes of patients leaving against medical advice. Burns 2024; 50:616-622. [PMID: 37980269 DOI: 10.1016/j.burns.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/24/2023] [Accepted: 10/06/2023] [Indexed: 11/20/2023]
Abstract
PURPOSE Discharging against medical advice can have significant, detrimental effects on burn patient outcomes as well as higher hospital readmission rates and healthcare expenditures. The goal of this study is to identify characteristics of patients who left against medical advice and suggest solutions to mitigate these factors. Data were collected at our American Burn Association verified Burn Unit over a 15-year period. RESULTS Between 2007 and 2022, 37 patients were identified as having left against medical advice from the burn unit. The average patient age was 37 years old with 64.9% being male, and 70.2% were identified as having a substance abuse history. The majority (51.4%) had Medicaid or State health insurance, 29.7% had no insurance, and 18.9% had private insurance. The mechanism of injury was most commonly frostbite (43.2%). The majority sustained < 1% total body surface area injuries. Most (83.7%) had social work and/or case management involved during their admission, and all (100%) had their involvement if the length of admission was greater than one day. Over half (59.5%) returned to the ED within 2 weeks with complications. CONCLUSIONS This study found that patients discharging against medical advice from the burn unit suffered from smaller injuries, often due to cold related injuries. These patients had comorbid substance abuse or psychiatric histories, and the majority had Medicaid or state health insurance. Recruiting interdisciplinary care members, including social work, psychiatry, and addiction medicine, early may help these patients by encouraging completion of their hospital care and setting up crucial follow-up care.
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Affiliation(s)
- Lauren E Powell
- University of Minnesota, Division of Plastic and Reconstructive Surgery, Minneapolis, MN, USA.
| | - Alexis Knutson
- University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Alyssa J Meyer
- University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Melanie McCormick
- University of Minnesota, Department of Surgery, Minneapolis, MN, USA
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14
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Di Via Ioschpe A, Brozynski M, Oleru OO, Seyidova N, Rew C, Henderson PW. Scalding saline injuries: Preventing a rare but serious event in medical litigation. Burns 2024; 50:730-732. [PMID: 38216374 PMCID: PMC10999320 DOI: 10.1016/j.burns.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/04/2023] [Accepted: 12/16/2023] [Indexed: 01/14/2024]
Abstract
This study aimed to investigate the causes, outcomes, and compensation amounts of saline-induced perioperative burns, a rare but entirely preventable event. Saline-induced burns pose a significant risk to patients, and understanding the factors associated with such incidents is crucial for improving patient safety. Previous studies highlighted the use of hot saline bags and solution during medical procedures as a potential cause of these burns. A retrospective analysis of cases involving perioperative saline-induced burns was conducted using the Westlaw and Lexis Nexis legal databases. Eight relevant cases were identified and analyzed to determine the causes, outcomes, and compensation amounts. Hot saline bags used for positioning and hot saline solution were identified as the primary causes of saline-induced burns. Out of the eight cases analyzed, four resulted in a favorable verdict for the plaintiff, three cases were settled, and one case was in favor of the defense. Compensation amounts ranged from no monetary compensation to over one million dollars. This study highlights the need for increased awareness among medical professionals regarding the risks associated with saline-induced burns, and the importance of implementing guidelines for the safe use of hot saline bags and solution. Together these measures can hopefully mitigate the occurrence of these preventable incidents, improve patient safety, and reduce medicolegal exposure.
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Affiliation(s)
- Anaïs Di Via Ioschpe
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, USA
| | - Martina Brozynski
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, USA
| | - Olachi O Oleru
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, USA
| | - Nargiz Seyidova
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, USA
| | - Curtis Rew
- University of Connecticut School of Law, USA
| | - Peter W Henderson
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, USA.
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15
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Chen H, Wu X, Zou L, Zhang Y, Deng R, Jiang Z, Xin G. A comparative study of the predictive value of four models for death in patients with severe burns. Burns 2024; 50:550-560. [PMID: 38008701 DOI: 10.1016/j.burns.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/02/2023] [Accepted: 10/29/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE To assess the prognostic value of the Ryan score, Belgian Outcome of Burn Injury (BOBI) score,revised Baux (rBaux) score, and a new model (a Logit(P)-based scoring method created in 2020) for predicting mortality risk in patients with extremely severe burns and to conduct a comparative analysis. METHODS A retrospective analysis was conducted on 599 burn patients who met the inclusion criteria and were admitted to the burn unit of the First Affiliated Hospital of Nanchang University from 2017 to 2022. Relevant information was collected, and receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were plotted for each of the four models in assessing mortality in these burn patients using both age-stratified and unstratified forms. The ROC curve section was further compared with the area under the curve (AUC), optimal cutoff value, as well as its sensitivity and specificity. Additionally, the quality of the AUC was assessed using the Delong test. RESULT Among the patients who met the inclusion criteria, 532 were in the survival group and 67 in the death group. Irrespective of age stratification, the novel model exhibited superior performance with an AUC of 0.868 (95% CI: 0.838-0.894) among all four models predicting mortality risk in included patients, and also demonstrated better AUC quality than other models; the calibration curves showed that the accuracy of all four models was good; the DCA curves showed that the clinical utility of the novel model and rBuax score were better. In the comparison of four scoring models across different age groups, the new model demonstrated the largest AUC in both 0-19 years (0.954, 95% CI 0.914-0.979) and 20-59 years groups (0.838, 95% CI 0.793-0.877), while rBuax score exhibited the highest AUC in ≥ 60 years group (0.708, 95% CI of 0.602-0.800). The calibration curves showed that the four models exhibited greater accuracy within the age range of 20-59 years, while the DCA curves indicated that both the novel model and rBuax score scale displayed better prediction in both the 20-59 and ≥ 60 years groups. CONCLUSIONS All four models demonstrate accurate and effective prognostication for patients with severe burns. Both the novel model and rBaux score exhibit enhanced prediction utility. In terms of the model itself alone, the new model is not simpler than, for example, the rBaux score, and whether it can be applied clinicallyinvolves further study.
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Affiliation(s)
- Huayong Chen
- No.17, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi, 330006, China; The First Affiliated Hospital of Nanchang University, China; Master of Medicine, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi 330006, China
| | - Xingwang Wu
- No.17, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi, 330006, China; The First Affiliated Hospital of Nanchang University, China; Master of Medicine, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi 330006, China
| | - Lijin Zou
- No.17, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi, 330006, China; The First Affiliated Hospital of Nanchang University, China; Doctor of Medicine, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi 330006, China
| | - Youlai Zhang
- No.17, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi, 330006, China; The First Affiliated Hospital of Nanchang University, China; Doctor of Medicine, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi 330006, China
| | - Rufei Deng
- No.17, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi, 330006, China; The First Affiliated Hospital of Nanchang University, China; Master of Medicine, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi 330006, China
| | - Zhenyu Jiang
- No.17, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi, 330006, China; The First Affiliated Hospital of Nanchang University, China; Master of Medicine, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi 330006, China
| | - Guohua Xin
- No.17, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi, 330006, China; The First Affiliated Hospital of Nanchang University, China; Master of Medicine, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi 330006, China.
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16
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Klifto KM, Hultman CS. Pain Management in Burn Patients: Pharmacologic Management of Acute and Chronic Pain. Clin Plast Surg 2024; 51:267-301. [PMID: 38429049 DOI: 10.1016/j.cps.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
Burn-related pain can contribute to decreased quality of life and long-term morbidity, limiting functional recovery. Burn-related pain should be assessed first by chronicity (acute or chronic), followed by type (nociceptive, neuropathic, nociplastic), to guide multimodal pharmacologic management in a stepwise algorithm approach. Combination therapies increase the efficacy and reduce toxicity by offering a multimodal approach that targets different receptors in the peripheral nervous system and central nervous system. When multimodal pharmacologic management is ineffective, etiologies of burn-related pain amenable to surgical interventions must be considered. It is important to know when to refer a patient to pain management.
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Affiliation(s)
- Kevin M Klifto
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Missouri Health Care, 1 Hospital Drive, Columbia, MO 65212, USA.
| | - C Scott Hultman
- Department of Plastic and Reconstructive Surgery, WPP Plastic and Reconstructive Surgery, WakeMed Health and Hospitals, 3000 New Bern Avenue, Raleigh, NC 27610, USA
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17
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Rahmanian E, Tanideh N, Karbalay-Doust S, Mehrabani D, Rezazadeh D, Ketabchi D, EskandariRoozbahani N, Hamidizadeh N, Rahmanian F, Namazi MR. The effect of topical magnesium on healing of pre-clinical burn wounds. Burns 2024; 50:630-640. [PMID: 37980271 DOI: 10.1016/j.burns.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 09/26/2023] [Accepted: 10/26/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Magnesium (Mg) is an essential factor in the healing process. This study aimed to evaluate the effect of Mg creams on healing burn wounds in the rat model. METHODS To induce burns under general anaesthesia, a 2 × 2 cm2, 100 °C plate was placed for 12 s between the scapulas in 100 male adult Sprague Dawley rats. Animals were divided into five groups (n = 20); positive control (induced burn without treatment); vehicle control (received daily Eucerin cream base topically); comparative control (induced burn and treated daily with Alpha burn cream topically); Treatment 1 and 2 (received daily Mg cream 2% and 4% topically, respectively). All animals were bled for hematological assessment of malondialdehyde (MDA) and TNF-α and sacrificed on days 0, 1, 7, 14, and 21 after interventions for biomechanical, histological, and stereological studies. RESULTS Stereologically speaking, in treatment groups an increase in dermal collagen volume and fibroblasts was noticed. In treatment groups, the length of vessels, angiogenesis, and skin stretch increased, but the wound area, MDA, and TNF-α level decreased. CONCLUSION Mg cream was effective in healing burns.
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Affiliation(s)
- Elham Rahmanian
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran, And Department of Anatomy, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nader Tanideh
- Stem cells technology research center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saied Karbalay-Doust
- Histomorphometry and Stereology research Center, Shiraz University of Medical Sciences, Shiraz, iran
| | - Davood Mehrabani
- Stem Cell Technology Research Center, Shiraz, Iran. and Li Ka Shing Center for Health Research and Innovation, University of Alberta, Edmonton, AB, Canada
| | - Davood Rezazadeh
- Molecular Medicine Department, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Deniz Ketabchi
- Haj Daei Clinic, Kermanshah University of Medical Science, Kermanshah, Iran
| | - Narges EskandariRoozbahani
- Clinical research development center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nasrin Hamidizadeh
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzad Rahmanian
- Paramedic of Jahrom University of Medical Sciences, Jahrom, Iran
| | - Mohammad Reza Namazi
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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18
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Angle PJ, Ashok V, Liu G, Trenholm M, Montbriand J. Severe back labor pain masks a scald caused by shower hydrotherapy: a case report. Int J Obstet Anesth 2024:103992. [PMID: 38632014 DOI: 10.1016/j.ijoa.2024.103992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/17/2024] [Indexed: 04/19/2024]
Abstract
Shower hydrotherapy is generally considered benign during labor. We report a case of extensive scalds in a primigravida who used shower hydrotherapy to treat severe back labor pain from fetal malposition. Interestingly, her back pain was so severe that she felt no pain as her scald developed, describing the hot water from the showerhead as the only measure which "soothed" her pain. Her scald was diagnosed presumptively during assessment for epidural analgesia. The nature of her back labor pain, associated with occiput posterior fetal head position and her management are described. Severe pain from persistent fetal malposition may alter somatic pain perception during labor, increasing burn risks during shower hydrotherapy. These women are also at increased risk of operative delivery and infection risks from inadvertent neuraxial blockade after burns. Improved prevention strategies and vigilance for scalds are warranted in women with severe back labor undergoing shower hydrotherapy, including by anesthesiologists assessing them for neuraxial blockade.
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Affiliation(s)
- P J Angle
- Department of Anesthesia, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada; Institute for Health Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Obstetrical Anesthesia Research Unit (OARU), Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
| | - V Ashok
- Department of Anesthesia, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - G Liu
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - M Trenholm
- Labor & Delivery Unit, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - J Montbriand
- Obstetrical Anesthesia Research Unit (OARU), Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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19
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Blome-Eberwein SA, Schwartz A, Ferdock M, Starner S, Gogal C. Minimally invasive burn reconstruction with subcutaneous scar contracture release. Burns 2024:S0305-4179(24)00094-9. [PMID: 38609745 DOI: 10.1016/j.burns.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Scar contracture bands after burns are frequent problems that cause discomfort and physical limitation. This study investigates the efficacy of a minimally invasive contracture band release technique (MICBR) inspired by closed platysmotomy. METHODS Patients with burn scars treated with MICBR in our center were included retrospectively. Our routine scar and contracture treatments (non-invasive and invasive) were utilized prior to undergoing MICBR. Range of motion (ROM) and Vancouver Scar Scale was measured before and after the procedure when feasible. RESULTS Forty-five patients were included, with 97 total contracture sites treated all over the body. An average of 1.6 sites were treated per patient, with a maximum of six. Patients age was 6-68 years; total burn surface area ranged from 0.5% to 85%. 24% were performed under local anesthesia. 84% were in originally skin grafted areas. We found significant improvements in ROM and VSS. 84% of patients surveyed were "satisfied" or "very satisfied". 95% reported improved mobility. No significant adverse events occurred. CONCLUSION This MICBR technique is a versatile, safe, and well-tolerated adjunct procedure that can help patients regain mobility after a burn injury.
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Affiliation(s)
- Sigrid A Blome-Eberwein
- Department of Surgery, Division of Burn Surgery, Lehigh Valley Health Network, Allentown, PA, USA.
| | - Adam Schwartz
- Department of Surgery, Division of Burn Surgery, Lehigh Valley Health Network, Allentown, PA, USA
| | | | - Sophia Starner
- Department of Surgery, Division of Burn Surgery, Lehigh Valley Health Network, Allentown, PA, USA
| | - Christina Gogal
- Network Office of Research and Innovation, Lehigh Valley Health Network, Allentown, PA, USA
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Kahramanlar D, Özlü SG, Demirci P, Erten EE, Şenel E, Bayrakçi US. Acute kidney injury in pediatric burn patients. Pediatr Nephrol 2024:10.1007/s00467-024-06341-5. [PMID: 38519599 DOI: 10.1007/s00467-024-06341-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Acute kidney injury (AKI) is a common and important complication of burn injury. Although there are numerous adult studies, data regarding AKI in pediatric burn patients are scarce. Here, we aimed to evaluate the frequency, clinical features, and prognosis of AKI among pediatric burn injury patients. METHODS This is a retrospective cohort study. Patients aged between 1 month and 18 years who had been followed up between the years 2011 and 2017 were included, and patients with previous kidney disease were excluded. Demographic data, laboratory and clinical variables, management strategies, and outcome data were obtained from the hospital records. Factors associated with AKI were determined by logistic regression analysis. RESULTS A total of 697 patients had been followed up, and 87 (12.5%) had AKI. Older age, refugee status, prolonged duration between the incident and time of hospitalization, presence of sepsis, severity and type of burn, volume of fluid administration, intubation status, and accompanying organ failure were all associated with the development of AKI. According to multivariate logistic regression analysis, the most statistically significant factors associated with the development of AKI were older age and increased serum hemoglobin values. In terms of outcomes, length of stay and mortality increased in patients with AKI when compared with patients without AKI. CONCLUSION Similar to adults, AKI is an important and common complication of burn injury in pediatric burn patients and is associated with increased length of stay, morbidity, and mortality. Early recognition and prompt and appropriate management are crucial to avoid morbidity and mortality.
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Affiliation(s)
| | - Sare Gülfem Özlü
- Department of Pediatric Nephrology, Faculty of Medicine, Ankara Bilkent City Hospital, Ankara Yıldırım Beyazıt University, University District 1604, Street No: 9, Çankaya, Ankara, Turkey.
| | - Pervin Demirci
- Department of Biostatistics, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Elif Emel Erten
- Department of Pediatric Surgery, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Emrah Şenel
- Department of Pediatric Surgery, Faculty of Medicine, Ankara Bilkent City Hospital, Ankara Yıldırım Beyazıt University, Ankara, Turkey
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Saldanha U, Aldwinkle R, Chen A, Raut S, Penta D, Valazquez YA, Sen S. Fascia iliaca catheters for donor site pain after split-thickness skin grafting for acute burn injury: a retrospective review. J Burn Care Res 2024:irae052. [PMID: 38512052 DOI: 10.1093/jbcr/irae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Indexed: 03/22/2024]
Abstract
The management of acute burn pain poses significant challenges. Regional techniques have become increasingly popular in perioperative burn pain management. Continuous nerve block catheters are particularly useful for split thickness skin grafts where donor site pain can exceed that of the burn-injured site. Donor skin is frequently harvested from the anterolateral thigh. The fascia iliaca (FI) compartment block provides blockade of both the lateral femoral cutaneous nerve and the femoral nerve and thus, it is a useful modality for burn donor pain. Our institution initiated a protocol in which continuous fascia iliaca catheters were placed in patients undergoing split-thickness skin grafting of the anterolateral thigh. This retrospective review seeks to assess the impact of this modality on post-operative pain scores and opioid requirements. Oral morphine equivalent administration was significantly lower in the FI group than the control group starting with POD 0, which is the day of the FI catheter insertion (188 vs 327mg, p<0.001). Over the next 4 postoperative days, OME administration remained lower in the FI group compared to control patients, although not statistically significant on POD 3-4. There was a significant difference in OME administered between the FI group and the control group on POD 5 (159.5 vs 209.2mg, p<0.05). Our retrospective study evaluating the role of fascia iliaca catheters in burn patients undergoing split thickness skin grafting surgery showed significantly lower opioid consumption on postoperative days 1-5 compared to patients without a fascia iliaca catheter.
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Affiliation(s)
- Usha Saldanha
- Department of Anesthesiology and Pain Medicine, University of California, Davis Medical Center, 4150 V Street Suite 1200 PSSB, Sacramento, CA 95817, United States of America
| | - Robin Aldwinkle
- Department of Anesthesiology and Pain Medicine, University of California, Davis Medical Center, 4150 V Street Suite 1200 PSSB, Sacramento, CA 95817, United States of America
| | - Amy Chen
- Department of Anesthesiology and Pain Medicine, University of California, Davis Medical Center, 4150 V Street Suite 1200 PSSB, Sacramento, CA 95817, United States of America
| | - Snehal Raut
- Department of Anesthesiology and Pain Medicine, University of California, Davis Medical Center, 4150 V Street Suite 1200 PSSB, Sacramento, CA 95817, United States of America
| | - Deepthi Penta
- Department of Anesthesiology and Pain Medicine, University of California, Davis Medical Center, 4150 V Street Suite 1200 PSSB, Sacramento, CA 95817, United States of America
| | - Yakelin Arroyo Valazquez
- University of California, Davis School of Medicine, 4610 X Street Sacramento , CA 95817, United States of America
| | - Soman Sen
- Department of Surgery, University of California Medical Center, 2315 Stockton Blvd. Sacramento, CA 95817, United States of America
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Blears E, Kuo SCE, Tiongco RFP, Suresh R, Cooney CM, Caffrey J. Associations of urban versus rural patient residence on outcomes after burn: A national inpatient sample database study. Burns 2024:S0305-4179(24)00091-3. [PMID: 38584006 DOI: 10.1016/j.burns.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/06/2024] [Accepted: 03/13/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Burn patients in rural areas may encounter poorer outcomes associated with barriers to care; however, residence has not been studied in a large sample. The association between rural-versus-urban residence and outcomes after burn was examined using the National Inpatient Sample (NIS) database. METHODS Using the 2019 NIS database, patients over 18 years with a primary diagnosis of burn or corrosive injury were included. Level of urbanization was categorized into six groups. Outcomes after burn such as in-hospital mortality, multifactorial shock, prolonged mechanical ventilation, length of stay, and total costs were analyzed after adjusting for demographic factors and hospital characteristics. RESULTS We included 4671 records, which represented a weighted population of 23,085 patients. Rural residence was associated with higher percentage of prior transfer but not in-hospital mortality. Compared to the most urbanized counties, encounters from the most rural counties were associated with higher odds of shock (aOR:2.62, 99% CI: 1.04-6.56, p = 0.007). CONCLUSION Burn encounters from less urbanized counties did not experience differences in mortality, rates of skin grafting, prolonged mechanical ventilation, length of stay, or overall costs. However, odds of shock were higher among the least urbanized counties. Despite improved triage and transportation systems across the US, disparities and challenges exist for burn patients from rural residence.
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Affiliation(s)
- Elizabeth Blears
- Bayview Burn Center, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Shih-Chiang Edward Kuo
- Bayview Burn Center, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Rafael Felix P Tiongco
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Rachana Suresh
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Carisa M Cooney
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Julie Caffrey
- Bayview Burn Center, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Song HT, Zhang XH. The need for innovation in burn pain management. Burns 2024:S0305-4179(24)00079-2. [PMID: 38641501 DOI: 10.1016/j.burns.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 03/05/2024] [Indexed: 04/21/2024]
Affiliation(s)
- Hai-Tao Song
- Department of Burns, The First Hospital of Jilin University, Changchun 130021, China.
| | - Xiu-Hang Zhang
- Department of Burns, The First Hospital of Jilin University, Changchun 130021, China.
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Zhou P, Jiang Y, Liu AY, Chen XL, Wang F. Patients with hypertrophic scars following severe burn injury express different long noncoding RNAs. Burns 2024:S0305-4179(24)00059-7. [PMID: 38503573 DOI: 10.1016/j.burns.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 01/19/2024] [Accepted: 02/26/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE Research indicates that long noncoding RNAs (lncRNAs) contribute significantly to fibrotic diseases. Although lncRNAs may play a role in hypertrophic scars after burns, its mechanisms remain poorly understood. METHODS Using chip technology, we compared the lncRNA expression profiles of burn patients and healthy controls (HCs). Microarray results were examined by quantitative reverse-transcription polymerase chain reaction (RT-PCR) to verify their reliability. The biological functions of differentially expressed mRNAs and the relationships between genes and signaling pathways were investigated by Gene Ontology (GO) and pathway analyses, respectively. RESULTS In contrast with HCs, it was found that 2738 lncRNAs (1628 upregulated) and 2166 mRNAs (1395 upregulated) were differentially expressed in hypertrophic scars after burn. Results from RT-PCR were consistent with those from microarray. GO and pathway analyses revealed that the differentially expressed mRNAs are mainly associated with processes related to cytokine secretion in the immune system, notch signaling, and MAPK signaling. CONCLUSION The lncRNA expression profiles of hypertrophic scars after burn changed significantly compared with HCs. It was believed that the transcripts could be used as potential targets for inhibiting abnormal scar formation in burn patients.
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Affiliation(s)
- Ping Zhou
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China
| | - Yan Jiang
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China
| | - Ao-Ya Liu
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China
| | - Xu-Lin Chen
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China
| | - Fei Wang
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China.
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Song Y, Li Y, Hu W, Li F, Sheng H, Huang C, Gou X, Hou J, Zheng J, Xiao Y. Luminol-conjugated cyclodextrin biological nanoparticles for the treatment of severe burn-induced intestinal barrier disruption. Burns Trauma 2024; 12:tkad054. [PMID: 38444636 PMCID: PMC10910847 DOI: 10.1093/burnst/tkad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 10/14/2023] [Accepted: 10/14/2023] [Indexed: 03/07/2024]
Abstract
Background The breakdown of intestinal barrier integrity occurs after severe burn injury and is responsible for the subsequent reactions of inflammation and oxidative stress. A new protective strategy for the intestinal barrier is urgently needed due to the limitations of the traditional methods. Recently, the application of nanoparticles has become one of the promising therapies for many inflammation-related diseases or oxidative damage. Herein, we developed a new anti-inflammatory and antioxidant nanoparticle named luminol-conjugated cyclodextrin (LCD) and aimed to evaluate its protective effects in severe burn-induced intestinal injury. Methods First, LCD nanoparticles, engineered with covalent conjugation between luminol and β-cyclodextrin (β-CD), were synthesized and examined. Then a mouse burn model was successfully established before the mouse body weight, intestinal histopathological manifestation, permeability, tight junction (TJ) expression and pro-inflammatory cytokines were determined in different groups. The proliferation, apoptosis, migration and reactive oxygen species (ROS) of intestinal epithelial cells (IECs) were assessed. Intraepithelial lymphocytes (IELs) were isolated and cultured for analysis by flow cytometry. Results LCD nanoparticle treatment significantly relieved the symptoms of burn-induced intestinal injury in the mouse model, including body weight loss and intestinal permeability abnormalities. Moreover, LCD nanoparticles remarkably recovered the mechanical barrier of the intestine after severe burn, renewed TJ structures, promoted IEC proliferation and migration, and inhibited IEC apoptosis. Mechanistically, LCD nanoparticles dramatically alleviated pro-inflammation factors (tumor necrosis factor-α, IL-17A) and ROS accumulation, which could be highly involved in intestinal barrier disruption. Furthermore, an increase in IL-17A and the proportion of IL-17A+Vγ4+ γδ T subtype cells was also observed in vitro in LPS-treated Vγ4+ γδ T cells, but the use of LCD nanoparticles suppressed this increase. Conclusions Taken together, these findings demonstrate that LCD nanoparticles have the protective ability to ameliorate intestinal barrier disruption and provide a therapeutic intervention for burn-induced intestinal injury.
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Affiliation(s)
- Yajun Song
- Department of Urology, Xinqiao Hospital, The Army Medical University, No. 184, Xinqiao Street, Shapingba District, Chongqing, 400037, China
| | - Yang Li
- Department of Urology, Xinqiao Hospital, The Army Medical University, No. 184, Xinqiao Street, Shapingba District, Chongqing, 400037, China
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1, Yuanjiagang Road, Yuzhong District, Chongqing, 400016, China
| | - Wengang Hu
- Department of Urology, Xinqiao Hospital, The Army Medical University, No. 184, Xinqiao Street, Shapingba District, Chongqing, 400037, China
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burn and Combined Injury, Chongqing Key Laboratory for Disease Proteomics, Army Military Medical University, No. 30, Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Feng Li
- Department of Urology, Chongqing University Three Gorges Hospital, No. 165, Xincheng Road, Wanzhou District, Chongqing, 404031, China
| | - Hao Sheng
- Department of Urology, Xinqiao Hospital, The Army Medical University, No. 184, Xinqiao Street, Shapingba District, Chongqing, 400037, China
| | - Chibing Huang
- Department of Urology, Xinqiao Hospital, The Army Medical University, No. 184, Xinqiao Street, Shapingba District, Chongqing, 400037, China
| | - Xin Gou
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1, Yuanjiagang Road, Yuzhong District, Chongqing, 400016, China
| | - Jingming Hou
- Department of Rehabilitation, Southwest Hospital, The Army Medical University, No. 30, Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Ji Zheng
- Department of Urology, Xinqiao Hospital, The Army Medical University, No. 184, Xinqiao Street, Shapingba District, Chongqing, 400037, China
| | - Ya Xiao
- Department of Urology, Xinqiao Hospital, The Army Medical University, No. 184, Xinqiao Street, Shapingba District, Chongqing, 400037, China
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Kiani Z, Khorsand N, Beigi F, Askari G, Sharma M, Bagherniya M. Coenzyme Q10 supplementation in burn patients: a double-blind placebo-controlled randomized clinical trial. Trials 2024; 25:160. [PMID: 38431600 PMCID: PMC10908042 DOI: 10.1186/s13063-024-08006-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 02/22/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Burn injuries are important medical problems that, aside from skin damage, cause a systemic response including inflammation, oxidative stress, endocrine disorders, immune response, and hypermetabolic and catabolic responses which affect all the organs in the body. The aim of this study was to determine the effect of coenzyme Q10 (CoQ10) supplementation on inflammation, oxidative stress, and clinical outcomes in burn patients. METHODS In a double-blind placebo-controlled randomized clinical trial, 60 burn patients were randomly assigned to receive 100 mg CoQ10 three times a day (total 300 mg/day) or a placebo for 10 days. Inflammatory markers including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), oxidative stress markers including total antioxidant capacity (TAC), malondialdehyde (MDA) and superoxide dismutase (SOD) activity, fasting blood glucose (FBG), blood urea nitrogen (BUN), creatinine, white blood cells (WBC), and body temperature were assessed as primary outcomes and albumin, prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR), other hematological parameters, blood pressure, O2 saturation, ICU duration, and 28-mortality rate were assessed as secondary outcomes. RESULTS Fifty-two participants completed the trial. CRP and ESR levels were not significantly different between CoQ10 and placebo groups at the end of the study (P = 0.550 and P = 0.306, respectively). No significant differences between groups were observed for TAC (P = 0.865), MDA (P = 0.692), and SOD activity (P = 0.633) as well. Administration of CoQ10 resulted in a significant increase in albumin levels compared to placebo (P = 0.031). There was no statistically significant difference between the two groups in other measured outcomes (P > 0.05). CONCLUSION Results showed that in patients with burn injury, CoQ10 administration had no effect on inflammatory markers and oxidative stress, although serum albumin levels were improved after supplementation. Further studies with albumin as the primary outcome are needed to confirm this finding.
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Affiliation(s)
- Zahra Kiani
- Nutrition and Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nadereh Khorsand
- Department of Internal Medicine, Imam Musa Kazem Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fahimeh Beigi
- Pharmaceutical Biotechnology Department, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Science, Isfahan, Iran
- Research and Development Unit, Imam Muss Kazim Hospital, Isfahan University of Medical Science, Isfahan, Iran
| | - Gholamreza Askari
- Nutrition and Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
- Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Manoj Sharma
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Mohammad Bagherniya
- Nutrition and Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
- Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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Salehi S, Hosseinzadeh-Attar MJ, Alipoor E, Dahmardehei M, Yaseri M, Emami MR, Siadat SD. Effects of hydrolyzed collagen alone or in combination with fish oil on the gut microbiome in patients with major burns. Burns 2024; 50:444-453. [PMID: 38114377 DOI: 10.1016/j.burns.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/08/2023] [Accepted: 08/20/2023] [Indexed: 12/21/2023]
Abstract
Burns are associated with gut dysbiosis. Collagen peptides and omega-3 fatty acids (FAs) are suggested to improve wound healing and the inflammatory response. These are also correlated with microbiome colonization. Therefore, the present study aimed to investigate the effect of hydrolyzed collagen alone or in combination with fish oil on specific species of the gut microbiome in patients with major burns. In this randomized double-blind clinical trial, 57 adults (aged 18-60 years) with 20-45% total body surface area burns were randomised into three groups to receive either 40 gr hydrolyzed collagen +10 ml sunflower oil, 40 g hydrolyzed collagen +10 ml fish oil or placebo, divided into two daily drinks, for two weeks. Gut bacteria were measured using the real-time quantitative polymerase chain reaction (qPCR) method. The mean concentration of Bifidobacterium was significantly reduced in the control (P = 0.002) and collagen (P = 0.005) groups compared with the baseline values, whereas no significant change was observed in the collagen omega-3 group. The Firmicutes to Bacteroidetes ratio decreased significantly in the collagen group (p = 0.002) after supplementation compared to baseline . No significant changes in concentration of Lactobacillus, Enterobacteriaceae, and F.prausnitzii were observed between or within the study groups. Two weeks of supplementation with collagen and omega-3 FAs in patients with major burns did not result in a significant difference in the concentration of bacteria measured between the study groups. However, the addition of omega-3 FAs prevented a significant reduction in gut Bifidobacterium. Future studies are suggested to investigate the potential efficacy of these nutrients in improving the gut microbiota and clinical outcomes in major burns. REGISTRATION NUMBER: IRCT20131125015536N9.
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Affiliation(s)
- Shiva Salehi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Hosseinzadeh-Attar
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran; Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Elham Alipoor
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran; Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Dahmardehei
- Department of Plastic Surgery, Burn Research Center, Motahari Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Emami
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Davar Siadat
- Mycobacteriology and Pulmonary Research Department, Pasteur Institute of Iran, Tehran, Iran
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Elks W, McNickle AG, Kelecy M, Batra K, Wong S, Wang S, Angotti L, Kuhls DA, St Hill C, Saquib SF, Chestovich PJ, Fraser DR. Early Versus Late Feeding After Percutaneous Endoscopic Gastrostomy Placement in Trauma and Burn. J Surg Res 2024; 295:112-121. [PMID: 38006778 DOI: 10.1016/j.jss.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/13/2023] [Accepted: 10/28/2023] [Indexed: 11/27/2023]
Abstract
INTRODUCTION Timing to resume feeds after percutaneous endoscopic gastrostomy (PEG) placement continues to vary among US trauma surgeons. The purpose of this study was to assess differences in meeting nutritional therapy goals and adverse outcomes with early versus late enteral feeding after PEG placement. METHODS This retrospective review included 364 trauma and burn patients who underwent PEG placement. Data included patient characteristics, time to initiate feeds, rate feeds were resumed, % feed volume goals on postoperative days 0-7, and complications. Statistical analysis was performed comparing two groups (feeds ≤ 6 h versus > 6 h) and three subgroups (< 4 h, 4-6 h, ≥ 6 h) based on data quartiles. Chi-square/Fisher's exact test, independent-samples t-test, and one-way analysis of variance were used to analyze the data. RESULTS Mean time to initiate feeds after PEG was 5.48 ± 4.79 h. Burn patients received early feeds in a larger proportion. A larger proportion of trauma patients received late feeds. The mean % of goal feed volume met on postoperative day 0 was higher in the early feeding group versus the late (P < 0.001). There were no differences in adverse events, even after subgroup analysis of those who received feeds < 4 h after PEG placement. CONCLUSIONS Patients with early initiation of feeds after PEG placement achieve a higher percentage of goals on day 0 without an increased rate of adverse events. Unfortunately, patients routinely fall short of their target tube feeding goals.
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Affiliation(s)
- Whitney Elks
- Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada.
| | - Allison G McNickle
- Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada
| | - Matthew Kelecy
- Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada
| | - Kavita Batra
- Department of Medical Education, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada
| | - Shirley Wong
- Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada
| | - Shawn Wang
- Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada
| | - Lisa Angotti
- Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada
| | - Deborah A Kuhls
- Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada
| | - Charles St Hill
- Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada
| | - Syed F Saquib
- Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada
| | - Paul J Chestovich
- Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada
| | - Douglas R Fraser
- Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada
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Bebbington E, Kakola M, Nagaraj S, Guruswamy S, McPhillips R, Majgi SM, Rajendra R, Krishna M, Poole R, Robinson C. Development of an electronic burns register: Digitisation of routinely collected hospital data for global burns surveillance. Burns 2024; 50:395-404. [PMID: 38172021 DOI: 10.1016/j.burns.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/05/2023] [Accepted: 08/10/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Burn registers provide important data that can track injury trends and evaluate services. Burn registers are concentrated in high-income countries, but most burn injuries occur in low- and middle-income countries where surveillance data are limited. Injury surveillance guidance recommends utilisation of existing routinely collected data where data quality is adequate, but there is a lack of guidance on how to achieve this. Our aim was to develop a rigorous and reproducible method to establish an electronic burn register from existing routinely collected data that can be implemented in low resource settings. METHODS Data quality of handwritten routinely collected records (register books) from a tertiary government hospital burn unit in Mysore, India was assessed prior to digitisation. Process mapping was conducted for burn patient presentations. Register and casualty records were compared to assess the case ascertainment rate. Register books from February 2016 to February 2022 were scanned and anonymised. Scans were quality checked and stored securely. An online data entry form was developed. All data underwent double verification. RESULTS Process mapping suggested data were reliable, and case ascertainment was 95%. 1930 presentations were recorded in the registers, representing 0.84% of hospital all-cause admissions. 388 pages were scanned with 4.4% requiring rescanning due to quality problems. Two-step verification estimated there to be errors remaining in 0.06% of fields following data entry. CONCLUSION We have described, using the example of a newly established electronic register in India, methods to assess the suitability and reliability of existing routinely collected data for surveillance purposes, to digitise handwritten data, and to quantify error during the digitisation process. The methods are likely to be of particular interest to burn units in countries with no active national burns register. We strongly recommend mobilisation of resources for digitisation of existing high quality routinely collected data as an important step towards developing burn surveillance systems in low resource settings.
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Affiliation(s)
- Emily Bebbington
- Centre for Mental Health and Society, School of Medical and Health Sciences, Bangor University, Wrexham, LL13 7YP, UK.
| | - Mohan Kakola
- Department of Plastic Surgery and Burns, Mysore Medical College and Research Institute, KR hospital, Irwin Road, Mysuru, Karnataka 570001, India
| | - Santhosh Nagaraj
- South Asia Self-harm Initiative, JSS Hospital, Mahatma Gandhi Road, Mysuru, Karnataka 570004, India
| | - Sathish Guruswamy
- South Asia Self-harm Initiative, JSS Hospital, Mahatma Gandhi Road, Mysuru, Karnataka 570004, India
| | - Rebecca McPhillips
- Social Care and Society, School of Health Sciences, Faculty of Biology, Medicine and Health, Ellen Wilkinson Building, Oxford Road, Manchester M13 9PL, UK
| | - Sumanth Mallikarjuna Majgi
- Department of Community Medicine, Mysore Medical College and Research Institute, Mysuru, Karnataka 570001, India
| | - Rajagopal Rajendra
- Department of Psychiatry, Mysore Medical College and Research Institute, Mysuru, Karnataka 570001, India
| | - Murali Krishna
- Centre for Mental Health and Society, School of Medical and Health Sciences, Bangor University, Wrexham, LL13 7YP, UK
| | - Rob Poole
- Centre for Mental Health and Society, School of Medical and Health Sciences, Bangor University, Wrexham, LL13 7YP, UK
| | - Catherine Robinson
- Social Care and Society, School of Health Sciences, Faculty of Biology, Medicine and Health, Ellen Wilkinson Building, Oxford Road, Manchester M13 9PL, UK
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Ash A, Brune M, Willson TD, Colbert SH, Klifto KM. Tumescent technique for split-thickness skin graft donor sites: A systematic review of randomized controlled trials. J Plast Reconstr Aesthet Surg 2024; 90:292-304. [PMID: 38394837 DOI: 10.1016/j.bjps.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 12/06/2023] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Split-thickness skin grafting (STSG) is widely used for reconstructive wound management. This review aimed to use level I evidence to determine if tumescent techniques were safe and effective compared to other interventions for STSG donor sites. It was hypothesized that tumescent techniques were safe and effective for STSG donor sites. METHODS Five databases (MEDLINE via PubMed, Embase, Cochrane Library, Web of Science, and Scopus) were searched to identify studies concerning the use of tumescent solutions for STSG. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and Cochrane's guidelines were strictly followed. RESULTS Nine randomized controlled trials met the criteria. Included studies were published from 2001 to 2021, with results from 40 of 121 possible queried outcomes and complications. Outcomes included patient demographics, formulations of tumescent solutions, tumescent technique, hemodynamics, pain, perfusion, graft take, healing time, and postoperative complications. The tumescent technique reduced estimated blood loss (standard mean differences [SMD]: -2.68, 95%CI: -3.41 to -1.94; participants = 72; studies = 2; I2 = 96%; p < 0.001), and postoperative analgesic use within 24 hours (SMD: -1.75, 95%CI: -2.09 to -1.41; participants = 202; studies = 2; I2 = 96%; p < 0.001), without increasing graft loss/take (SMD: 0.29, 95%CI: -0.02 to 0.61; participants = 158; studies = 3; I2 = 41%; p = 0.07) and infection (risk ratios [RR]: 0.52, 95%CI: 0.08 to 3.54; participants = 87; studies = 3; I2 = 0%; p = 0.58) complications compared to other interventions. CONCLUSIONS Level I evidence demonstrated tumescent techniques were safe and effective for STSG donor sites. Tumescent techniques reduced blood loss and postoperative analgesic use within 24 hours without increasing graft loss/take and infection complications compared to other interventions. Inconsistencies between studies limit conclusions and emphasize the need for standardized protocols regarding tumescent solution formulations, techniques, and reported outcomes.
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Affiliation(s)
- Angela Ash
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Madison Brune
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Thomas D Willson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Stephen H Colbert
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Kevin M Klifto
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA.
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Owings CG, McKee-Zech HS, Orebaugh JA, Devlin JL, Vidoli GM. The utility of blow fly (Diptera: Calliphoridae) evidence from burned human remains. Forensic Sci Int 2024; 356:111962. [PMID: 38359753 DOI: 10.1016/j.forsciint.2024.111962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
Burning of human remains is a common method to conceal or destroy evidence associated with homicides and illegal activities. However, data regarding blow fly colonization of burned remains are scarce, with all previously published empirical studies focusing only on non-human animals. It is critically important to obtain basic data on blow fly colonization patterns of burned human remains as such evidence may represent the only feasible method for PMI estimation in cases of burning. In this study, we thermally altered six human donors to a Crow-Glassman Scale Level 3 (CGS-3) and placed them at the Anthropology Research Facility at the University of Tennessee in Summer 2021, Spring 2022, and Summer 2022. Six unburned human donors were used as controls. Observations for insect activity began within 24 h of placement and continued twice weekly through decomposition. Age estimations were performed with immature blow flies to estimate the time of colonization (TOC), and accuracy was assessed against the time of placement for each donor. All burned donors examined in this study were colonized by blow flies. No significant difference in species composition was determined between treatments, though TOC estimations from burned donors were slightly (but significantly) less accurate than TOC estimations from unburned donors (80% vs. 83% accuracy; χ2 = 0.041, df = 1, P = 0.840). These results indicate that blow flies can successfully colonize human remains burned to CGS-3 and that accurate TOC estimations can still be generated from larval specimens. Though several limitations to this study exist (e.g., inconsistent donor BMI, lack of donor temperature data), our results underscore the utility of entomological evidence in cases of burned human remains.
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Affiliation(s)
- Charity G Owings
- Department of Entomology and Plant Pathology, University of Tennessee, 2505 EJ Chapman Dr., 370 Plant Biotechnology Building, Knoxville, TN 37996, United States.
| | - Hayden S McKee-Zech
- Department of Anthropology, University of Tennessee, 1621 Cumberland Ave., Knoxville, TN 37996, United States
| | - Jack A Orebaugh
- Department of Anthropology, University of Tennessee, 1621 Cumberland Ave., Knoxville, TN 37996, United States
| | - Joanne L Devlin
- Department of Anthropology, University of Tennessee, 1621 Cumberland Ave., Knoxville, TN 37996, United States
| | - Giovanna M Vidoli
- Department of Anthropology, University of Tennessee, 1621 Cumberland Ave., Knoxville, TN 37996, United States
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Yen JS, Chang SY, Sun PL. Extensive primary cutaneous fusariosis in a patient with burns: A case report and review of the literature. J Mycol Med 2024; 34:101450. [PMID: 38042017 DOI: 10.1016/j.mycmed.2023.101450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/25/2023] [Accepted: 11/06/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Fusarium species can cause a broad spectrum of human infections, ranging from superficial and locally invasive to disseminated, depending on the immune status of the host and portal of entry. Although several cases of cutaneous fusariosis in burn victims have been reported, molecular identification for pathogen recognition has been used only in a few cases. CASE DESCRIPTION In this report, we describe an uncommon case of extensive primary cutaneous fusariosis caused by Fusarium keratoplasticum in a patient who sustained injuries during stubble burning. FINDINGS A review of cases of cutaneous fusariosis in burn victims revealed that this uncommon infection could be lethal, and treatment strategies should focus on both surgical debridement and the initiation of systemic antifungal therapy. Furthermore, because skin defects can serve as a portal of entry for Fusarium species in burn victims, early and aggressive treatment is crucial to prevent serious consequences.
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Affiliation(s)
- Ju-Shao Yen
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Shu-Ying Chang
- Department of Plastic and Reconstructive Surgery, The Burn Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Pei-Lun Sun
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan; Research Laboratory of Medical Mycology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
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Tsai AJ. Is diabetes mellitus an independent contributor towards burns mortality? Burns 2024; 50:526-527. [PMID: 38092604 DOI: 10.1016/j.burns.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/29/2023] [Indexed: 02/24/2024]
Affiliation(s)
- Allen J Tsai
- Department of Surgery, Western Reserve Health Education Inc., College of Medicine, Northeast Ohio Medical University, OH, USA.
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Sangha MS, Baker M, Baldwin AJ, Murray A. Assessing the effect of the cost-of-living crisis on hot water bottle-related burns in the United Kingdom, a single-centre retrospective observational study. JPRAS Open 2024; 39:313-320. [PMID: 38380183 PMCID: PMC10878842 DOI: 10.1016/j.jpra.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/17/2024] [Indexed: 02/22/2024] Open
Abstract
Background The cost-of-living crisis (CoLC) is an economic climate that the United Kingdom (UK) has been experiencing since late 2021, characterized by an increase in the price of essential goods faster than real-term incomes. Food and fuel poverty has ensued. This study aimed to assess whether the CoLC is associated with an increase in hot water bottle (HWB)-related burns as patients seek alternative heating sources to keep warm. Methods Records of patients treated for HWB burns between December 2019 and March 2023 were reviewed for patient demographics, burn depth and surface area, patient comorbidities, and patient index of multiple deprivation (IMD). The incidence of admissions, IMD, and severity of injury were compared prior to and during the CoLC using either independent t-test or Kruskal-Wallis H test. Results Between December 2019 and March 2023, 177 patients were treated for HWB burns, 79 prior to the CoLC, and 98 during. Of the patients, 55 patients were male and 122 females. An independent t-test comparing average monthly admissions prior and during the CoLC identified a significant difference (p = 0.042), with a mean increase of 1.85 cases (95% CI: 0.71-3.63). Additionally, a Kruskal-Wallis H test showed statistically significant difference in the number of patients treated for HWB burns between the seasons (p = 0.001). An independent t-test comparing average patient IMD prior and during the CoLC identified no difference (p = 0.33). Conclusion The increase in HWB burns coincides with the increase in energy costs and general cost of living that has occurred in the UK since October 2021.
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Affiliation(s)
- Mahaveer S. Sangha
- Corresponding author at: Foundation Year 2 Doctor, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK.
| | - Michelle Baker
- Department of Plastic & Reconstructive Surgery, Stoke Mandeville Hospital, Aylesbury, UK
| | - Alexander J. Baldwin
- Department of Plastic & Reconstructive Surgery, Stoke Mandeville Hospital, Aylesbury, UK
| | - Alexandra Murray
- Department of Plastic & Reconstructive Surgery, Stoke Mandeville Hospital, Aylesbury, UK
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Baldwin AJ, Bhojwani D, Murray A. Cold burn injuries in the United Kingdom: retain-->A 5-year cohort study of patients presenting to a regional burn unit. J Plast Reconstr Aesthet Surg 2024; 90:315-322. [PMID: 38394839 DOI: 10.1016/j.bjps.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/20/2023] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
AIMS To assess the aetiology, management and outcomes of cold burn injuries presenting to a regional burn unit in the United Kingdom. METHODS Retrospective cohort study of consecutive patients over a 5-year period (2018-2022). RESULTS Sixty-two patients (M:F 34:38; median age 23.5 years) were identified. The most common aetiology was aerosol (n = 28, 45.2%). Seven (11.5%) injuries were sustained during a social media or peer 'challenge' and 19 (31.2%) were self-harm, of whom 5 (26.3%) were inpatients on a mental health ward at the time of injury. All 'challenge' and self-harm injuries were caused by aerosol. Patients with 'challenge' injury were younger than those with self-harm (p = .007) and non-intentional injuries (p < .001). A greater proportion of self-harm injuries were in female patients compared with non-intentional injuries (p < .001). Median total body surface area (TBSA) was 0.35% (IQR: 0.3). Most burns were superficial partial thickness (n = 35, 56.5%), followed by deep dermal (n = 18, 29.0%), full-thickness (n = 8, 12.9%), and superficial (n = 1, 1.6%). The upper limb was most frequently affected (n = 35, 56.5%). Aetiology and a non-intentional, 'challenge' or self-harm injury did not affect TBSA (p = 0.776 and p = 0.364) or depth (p = 0.353 and p = 0.381). Five (8.1%) patients underwent autografting. The median time to healing was 17 days (range: 7-45, IQR: 22.75). Follow-up ranged from 1 to 173 weeks. CONCLUSIONS The incidence of cold burns has increased when compared with previous literature. A disproportionate number of cold burns are self-inflicted using aerosols, either as self-harm or because of social media or peer 'challenges'. Other emerging aetiologies include non-intentional skin contact with nitrous oxide containers during its recreational use.
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Affiliation(s)
- Alexander J Baldwin
- Department of Burns and Plastic Surgery, Buckinghamshire Healthcare NHS Trust, Buckinghamshire, UK.
| | - Deepika Bhojwani
- Department of Burns and Plastic Surgery, Buckinghamshire Healthcare NHS Trust, Buckinghamshire, UK
| | - Alexandra Murray
- Department of Burns and Plastic Surgery, Buckinghamshire Healthcare NHS Trust, Buckinghamshire, UK
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Hans N, Fauville JP, Peeters R, Isacu C, Saïdane G, Nizet JL. [Serious burns associated with a fracture : how to react in emergency]. Rev Med Liege 2024; 79:131-136. [PMID: 38487905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
The incidence of burns associated with one or even several fractures is rare and linked to high-energy mechanisms (traffic accidents, terrorist attacks, etc.). Treatment requires a multidisciplinary approach both at the medical and paramedical levels. The various stages of treatment require a systematic reassessment of the situation according to the patient's evolution. Detailed understanding of treatment strategies and outcomes is vital when managing these patients with multiple trauma. We will discuss about our experience with a focus on the management of burns, fractures and associated pathologies.
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Affiliation(s)
| | | | | | | | | | - Jean-Luc Nizet
- Service de Chirurgie maxillo-faciale, CHU Liège, Belgique
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Hagiga A, Dheansa B. Multi-resistant organisms in burn patients: an end or a new beginning. Burns 2024:S0305-4179(24)00057-3. [PMID: 38472000 DOI: 10.1016/j.burns.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/16/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
Infections are a major cause of morbidity and mortality in burn patients, and the rise of multidrug-resistant organisms (MDROs) has made it more challenging to manage and prevent infections. This review examines the available treatment options for MDROs in burn patients and anticipates the future challenges posed by their increasing prevalence. The review covers new antibiotics, such as Eravacycline and Plazomicin, as well as non-antibiotic therapies, such as bacteriophages and nanoparticles. Future research should focus on examining the long-term efficacy, cost-effectiveness, and in vivo efficacy of different treatment modalities. The potential of alternative therapies, such as probiotics and low-frequency magnetic fields, should also be explored. Accurate and rapid diagnostic and monitoring tools for detecting MDROs in burn patients should be developed. The emergence of MDROs in burn care is a challenge and a new beginning in infection innovation and novel treatments.
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Affiliation(s)
- Ahmed Hagiga
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom.
| | - Baljit Dheansa
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom
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Zang T, Fear MW, Parker TJ, Holland AJA, Martin L, Langley D, Kimble R, Wood FM, Cuttle L. Inflammatory proteins and neutrophil extracellular traps increase in burn blister fluid 24h after burn. Burns 2024:S0305-4179(24)00064-0. [PMID: 38490838 DOI: 10.1016/j.burns.2024.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 02/15/2024] [Accepted: 02/27/2024] [Indexed: 03/17/2024]
Abstract
Burn wound blister fluid is a valuable matrix for understanding the biological pathways associated with burn injury. In this study, 152 blister fluid samples collected from paediatric burn wounds at three different hospitals were analysed using mass spectrometry proteomic techniques. The protein abundance profile at different days after burn indicated more proteins were associated with cellular damage/repair in the first 24 h, whereas after this point more proteins were associated with antimicrobial defence. The inflammatory proteins persisted at a high level in the blister fluid for more than 7 days. This may indicate that removal of burn blisters prior to two days after burn is optimal to prevent excessive or prolonged inflammation in the wound environment. Additionally, many proteins associated with the neutrophil extracellular trap (NET) pathway were increased after burn, further implicating NETs in the post-burn inflammatory response. NET inhibitors may therefore be a potential treatment to reduce post-burn inflammation and coagulation pathology and enhance burn wound healing outcomes.
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Affiliation(s)
- Tuo Zang
- Queensland University of Technology (QUT), Faculty of Health, School of Biomedical Sciences, Centre for Children's Health Research, South Brisbane, Queensland, Australia
| | - Mark W Fear
- Burn Injury Research Unit, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Tony J Parker
- Queensland University of Technology (QUT), School of Biomedical Sciences, Faculty of Health, Kelvin Grove, Queensland, Australia
| | - Andrew J A Holland
- The Children's Hospital at Westmead Burns Unit, Kids Research Institute, Department of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, New South Wales, Australia
| | - Lisa Martin
- Burn Injury Research Unit, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Donna Langley
- Queensland University of Technology (QUT), Faculty of Health, School of Biomedical Sciences, Centre for Children's Health Research, South Brisbane, Queensland, Australia
| | - Roy Kimble
- Children's Health Queensland, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Fiona M Wood
- Burn Injury Research Unit, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia; Burns Service of Western Australia, Perth Children's Hospital and Fiona Stanley Hospital, Perth, WA, Australia
| | - Leila Cuttle
- Queensland University of Technology (QUT), Faculty of Health, School of Biomedical Sciences, Centre for Children's Health Research, South Brisbane, Queensland, Australia.
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Grossoehme DH, Friebert S, Brown C, Brown M, Lou R, Teo E, Khandelwal A. Refining the referral criteria of persons who have been burned to palliative care: A modified Delphi approach. Burns 2024; 50:507-516. [PMID: 37833145 DOI: 10.1016/j.burns.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/25/2023] [Accepted: 07/04/2023] [Indexed: 10/15/2023]
Abstract
A paucity of evidence is available to guide integration of specialist palliative care into burn care. This study's purpose was to develop consensus on referral criteria using a modified Delphi process. Content experts were defined as burn or palliative care providers in locations where the teams have collaborative history; published at least one manuscript or presented nationally on burn and palliative care collaboration; or nomination as having equivalent expertise. N = 202 eligible persons were identified; n = 43 participated in Iteration 1 and Iteration 3 retained 79%. Iteration 1 invited participants to rank published referral criteria on a 9-point Likert-style scale. Consensus was defined as an interquartile range ≤ 2. Consensus items with median scores ≤ 3 were dropped from further consideration. Consensus items with median scores ≥ 7 were considered to be important and excluded in Iteration 2. Iteration 2 which presented non-consensus items with their associated median (interquartile range) and the participant's own ranking from Iteration 1. Iteration 3 presented three models; participants ranked in order of preference and suggested revisions. Consensus was achieved on a final set of criteria for specialist palliative care for persons who sustain burn injuries. Future research should prospectively evaluate the criteria against meaningful outcomes.
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Affiliation(s)
- Daniel H Grossoehme
- Haslinger Family Pediatric Palliative Care Center, 215 West Bowery St, Akron Children's Hospital, Akron, OH 44308-1062 USA; Rebecca D. Considine Research Institute, Akron Children's Hospital, One Perkins Square, Akron, OH 44308-1062, USA.
| | - Sarah Friebert
- Haslinger Family Pediatric Palliative Care Center, 215 West Bowery St, Akron Children's Hospital, Akron, OH 44308-1062 USA; Rebecca D. Considine Research Institute, Akron Children's Hospital, One Perkins Square, Akron, OH 44308-1062, USA
| | - Carrie Brown
- Department of Pediatrics, University of Arkansas for Medical Sciences, 1 Children's Way, Little Rock, AR 72202, USA
| | - Miraides Brown
- Rebecca D. Considine Research Institute, Akron Children's Hospital, One Perkins Square, Akron, OH 44308-1062, USA
| | - Richard Lou
- Regional Burn Center, Akron Children's Hospital, One Perkins Square, Akron, OH 44308-1062, USA
| | - Esther Teo
- Department of Surgery, University of Arkansas for Medical Sciences, 1 Children's Way, Little Rock, AR 72202, USA
| | - Anjay Khandelwal
- Regional Burn Center, Akron Children's Hospital, One Perkins Square, Akron, OH 44308-1062, USA
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Andrade LF, Abdi P, Kooner A, Eldaboush AM, Dhami RK, Natarelli N, Yosipovitch G. Treatment of post- burn pruritus - A systematic review and meta-analysis. Burns 2024; 50:293-301. [PMID: 38097439 DOI: 10.1016/j.burns.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/22/2023] [Accepted: 09/22/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Post-burn pruritus is one of the most common complaints reported by patients with limited evidence for a gold-standard treatment. OBJECTIVE To review the literature and assess the efficacy of various interventions in treating post-burn pruritus. METHODS PubMed, MEDLINE, CINAHL, Web of Sciences, Ovid Databases, and ClinicalTrials.Gov were searched. The articles were scored by two assessors for inclusion with a third independent assessor resolving conflicting scores. RESULTS The present systematic review and meta-analysis synthesised findings from a total of nine studies, representing a pool of 323 patients. The standardized mean effect size for the various categories of interventions was: naltrexone at 1.47 (95 % CI of 0.75-2.20, p < 0.0000), coverings at 0.94 (95 % CI of 0.40-1.48, p = 0.006), topical ozonated oil at 2.64 (95 % CI of 1.94-3.34, p < 0.00001), lasers at 2.34 (95 % CI of 1.60-3.09, p < 0.00001), current stimulation at 1.03 (95 % CI of -0.04 to 2.10, p = 0.06), and lemon balm tea at 0.54 (95% CI of 0.12-0.96, p = 0.01). CONCLUSIONS Current evidence suggests that current modalities have a statistically significant, but not clinically significant, reduction in pruritus. This review highlights the limited quality of evidence in the literature and the poor quality of reporting among excluded studies.
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Affiliation(s)
- Luis F Andrade
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Parsa Abdi
- Memorial University Faculty of Medicine, St. Johns, NL, Canada
| | - Amritpal Kooner
- Chicago College of Osteopathic Medicine, Downers Grove, IL, USA
| | | | - Ramneek K Dhami
- University of Nevada, Reno School of Medicine, Reno, NV, USA
| | | | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Shah JK, Liu F, Cevallos P, Amakiri UO, Johnstone T, Nazerali R, Sheckter CC. A national analysis of burn injuries among homeless persons presenting to emergency departments. Burns 2024:S0305-4179(24)00068-8. [PMID: 38492979 DOI: 10.1016/j.burns.2024.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 01/31/2024] [Accepted: 02/27/2024] [Indexed: 03/18/2024]
Abstract
INTRODUCTION Burn injuries among the homeless are increasing as record numbers of people are unsheltered and resort to unsafe heating practices. This study characterizes burns in homeless encounters presenting to US emergency departments (EDs). METHODS Burn encounters in the 2019 Nationwide Emergency Department Sample (NEDS) were queried. ICD-10 and CPT codes identified homelessness, injury regions, depths, total body surface area (TBSA %), and treatment plans. Demographics, comorbidities, and charges were analyzed. Discharge weights generated national estimates. Statistical analysis included univariate testing and multivariate modeling. RESULTS Of 316,344 weighted ED visits meeting criteria, 1919 (0.6%) were homeless. Homeless encounters were older (mean age 44.83 vs. 32.39 years), male-predominant (71% vs. 52%), and had more comorbidities, and were more often White or Black race (p < 0.001). They more commonly presented to EDs in the West and were covered by Medicaid (51% vs. 33%) (p < 0.001). 12% and 5% of homeless burn injuries were related to self-harm and assault, respectively (p < 0.001). Homeless encounters experienced more third-degree burns (13% vs. 4%; p < 0.001), though TBSA % deciles were not significantly different (34% vs. 33% had TBSA % of ten or lower; p = 0.516). Homeless encounters were more often admitted (49% vs. 7%; p < 0.001), and homelessness increased odds of admission (OR 4.779; p < 0.001). Odds of transfer were significantly lower (OR 0.405; p = 0.021). CONCLUSION Homeless burn ED encounters were more likely due to assault and self-inflicted injuries, and more severe. ED practitioners should be aware of these patients' unique presentation and triage to burn centers accordingly.
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Affiliation(s)
- Jennifer K Shah
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Farrah Liu
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | - Rahim Nazerali
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Clifford C Sheckter
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA; Regional Burn Center, Santa Clara Valley Medical Center, USA.
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Marcus JE, Townsend LC, Rizzo JA, James KA, Markelz AE, Blyth DM. Epidemiology and clinical significance of persistent bacteremia in severely burned patients. Burns 2024; 50:375-380. [PMID: 38042626 DOI: 10.1016/j.burns.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 11/09/2023] [Accepted: 11/17/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND The utility of follow-up blood cultures (FUBC) for gram-negative bloodstream infections (BSIs) are controversial due to low rates of positivity. However, recent studies suggest higher rates of positivity in critically ill patients. The utility of FUBC in gram-negative BSI in patients with severe burn injuries is unknown. METHODS Patients ≥ 18 years old admitted to the US Army Institute of Surgical Research Burn Center for combat-related thermal burns from 1/2003-6/2014 with a monomicrobial BSI were included. FUBC were defined as repeat cultures 1-5 days from index BSI. Persistent BSI (pBSI) was defined as isolation of the same organism from initial and FUBC. The primary endpoint was all-cause in-hospital mortality in patients with gram-negative pBSI. RESULTS Of 126 patients meeting inclusion criteria with BSI, 53 (42%) had pBSI. Compared to patients without persistence, patients with pBSI had more severe burns with median total body surface area (TBSA) burns of 47% ([IQR 34-63] vs. 35.3% [IQR 23.3-56.6], p = 0.02), increased mortality (38 vs. 11%, p = 0.001) compared to those with non-persistent BSI. On multivariate analysis, pBSI was associated with an odds ratio for mortality of 5.3 [95% CI 1.8-15.8, p = 0.003). Amongst gram-negative pathogens, persistence rates were high and associated with increased mortality (41% vs. 11%, p = 0.001) compared to patients without pBSI. CONCLUSION In this cohort of military patients with combat-related severe burns, pBSI was more common than in other hospitalized populations and associated with increased mortality. Given this high frequency of persistence in patients with burn injuries and associated mortality, FUBC are an important diagnostic and prognostic study in this population.
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Affiliation(s)
- Joseph E Marcus
- Infectious Diseases Service, Department of Medicine, Brooke Army Medical Center, Joint Base San Antonio, TX, USA; Department of Medicine, Uniformed Services University, Bethesda, MD, USA.
| | - Lisa C Townsend
- Infectious Diseases Service, Department of Medicine, Brooke Army Medical Center, Joint Base San Antonio, TX, USA; Department of Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Julie A Rizzo
- Department of Trauma, Brooke Army Medical Center, Joint Base San Antonio, TX, USA; Department of Surgery, Uniformed Services University, Bethesda, MD, USA
| | - K Aden James
- Biostatistics, Brooke Army Medical Center, Joint Base San Antonio, TX, USA
| | - Ana E Markelz
- Infectious Diseases Service, Department of Medicine, Brooke Army Medical Center, Joint Base San Antonio, TX, USA; Department of Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Dana M Blyth
- Department of Medicine, Uniformed Services University, Bethesda, MD, USA; Infectious Diseases Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA
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Labanian S, Faghihi H, Montazeri H, Jafarian A. Freeze-drying of bupivacaine lipospheres: preparation, characterization, and evaluation of anti-microbial properties. Daru 2024:10.1007/s40199-024-00506-1. [PMID: 38421501 DOI: 10.1007/s40199-024-00506-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 02/08/2024] [Indexed: 03/02/2024] Open
Abstract
PURPOSE To prepare freeze-dried bupivacaine lipospheres intended for topical application in burn injuries. The aim was improving the storage stability and developing a prolonged release pattern to tackle the adverse reactions resulting from the frequent administration of bupivacaine. METHODS The lipospheres were prepared by hot-melt dispersion method employing bupivacaine base at 1.5 and 3%w/w, tristearin 6% w/w as the core while dipalmitoyl phosphatidylcholine (DPPC) and soy phosphatidylcholine (SPC) as the coat at 0.75, 1.5 and 3% w/w. The lotion was then freeze-dried and cryoprotected by sucrose 3% w/w. Evaluation was carried out through loading and release analysis, storage study, particle characterization including morphology, zeta potential and particle size as well as anti-microbial assessment. RESULTS The highest loading, (87.6 ± 0.1%), was achieved using bupivacaine 3% and SPC 0.75%. After 6 months of storage at 4 ͦC, the loading in the lotion and the freeze-dried samples were 17.4 ± 0.2 and 87.2 ± 0.3%, respectively. In vitro dissolution test demonstrated 94.5% and 95% of bupivacaine release from lotion and freeze-dried samples, after 24 h. The respective zeta potential of -1.30 and 26 mV was recorded for lotion and solid-state bupivacaine. Micromeritic evaluation of freeze-dried powder exhibited particle size of 35.23 ± 2.02 μm and highly-wrinkled-irregular morphology without detectable needle structures related to drug free crystals. The powder had rapid reconstitution property and antibacterial activity. CONCLUSION Freeze- drying holds a promising potential to improve the storage stability of bupivacaine lipospheres with well- preserved release pattern and particle properties for further topical application.
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Affiliation(s)
- Sepehr Labanian
- Department of Pharmaceutics and Pharmaceutical Nanotechnology, School of Pharmacy, Iran University of Medical Sciences, Tehran, Iran
| | - Homa Faghihi
- Department of Pharmaceutics and Pharmaceutical Nanotechnology, School of Pharmacy, Iran University of Medical Sciences, Tehran, Iran.
| | - Hamed Montazeri
- Department of Pharmacognosy and Pharmaceutical Biotechnology, School of Pharmacy, Iran University of Medical Sciences, Tehran, Iran
| | - Aliakbar Jafarian
- Department of Anesthesiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Mondor E, Barnabe J, Laguan EMR, Malic C. Virtual burn care - Friend or foe? A systematic review. Burns 2024:S0305-4179(24)00047-0. [PMID: 38490837 DOI: 10.1016/j.burns.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 01/16/2024] [Accepted: 02/21/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION Evidence on the impact of virtual care for patients with burn injuries is variable. This review aims to evaluate its use in remote assessment, rounding, and follow-up through outcomes of efficacy, usability, costs, satisfaction, clinical outcomes, impacts on triage and other benefits/drawbacks. METHODS A PRISMA-compliant qualitative systematic review (PROSPERO CRD42021267787) was conducted in four databases and the grey literature for primary research published between 01/01/2010 and 12/31/2020. Study quality was appraised using three established tools. Evidence was graded by the Oxford classification. RESULTS The search provided 481 studies, of which 37 were included. Most studies (n = 30, 81%) were Oxford Level 4 (low-level descriptive/observational) designs and had low appraised risk-of-bias (n = 20, 54%). Most applications were for the acute phase (n = 26, 70%). High patient compliance, enhanced specialist access, and new educational/networking opportunities were beneficial. Concerns pertained to IT/connection, virtual communication barriers, privacy/data-security and logistical/language considerations. Low-to-moderate-level (Oxford Grade C) evidence supported virtual burn care's cost-effectiveness, ability to improve patient assessment and triage, and efficiency/effectiveness for remote routine follow-up. CONCLUSION We find growing evidence that virtual burn care has a place in acute-phase specialist assistance and routine outpatient follow-up. Low-to-moderate-level evidence supports its effectiveness, cost-effectiveness, usability, satisfactoriness, and capacity to improve triage.
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Affiliation(s)
- Eli Mondor
- Carleton University, Department of Health Sciences, 1125 Colonel By Drive, Ottawa, Ontario K1S 5B6, Canada.
| | - Jaymie Barnabe
- Carleton University, Department of Health Sciences, 1125 Colonel By Drive, Ottawa, Ontario K1S 5B6, Canada
| | | | - Claudia Malic
- Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1, Canada.
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45
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Jawad AM, Kadhum M, Evans J, Cubitt JJ, Martin N. Recovery of functional independence following major burn: A systematic review. Burns 2024:S0305-4179(24)00049-4. [PMID: 38492981 DOI: 10.1016/j.burns.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/07/2024] [Accepted: 02/21/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Major burn injury, despite advancements in care and prevention, can have a profound impact on long-term morbidity, affecting quality of life and socioeconomic standing. We aim to explore factors predicting recovery of independence, the expected rate and time in majorly burned patients, and the measures of progress used. METHOD A systematic search of four databases (MEDLINE, EMBASE, COCHRANE, CINAHL) was conducted for studies reporting outcomes pertaining to physical ability indicative of independent function in adult (>15 y) cohorts who had suffered a major burn (>20% TBSA) up to 30 years after treatment in a developed specialised burn service. Data extracted included factors affecting rate of and time to achievement of function in five independence domains, as well as the outcome measures used. RESULTS 21 eligible studies were included comprising 1298 major burns survivors with a combined mean age of 39.6 y and a mean TBSA of 25.8%. The most significant recurring factors impacting recovery of independent function were older age, female gender, burn severity, prolonged ICU and hospital admission, preceding mental health conditions, and post-acute psychological issues. Exercise-based rehabilitation conferred benefits on major burn patients even over 2 years following injury. Discharge to independent living from hospital occurred in 27% to 97% of patients, while reported return to work rates varied from 52% to 80%. Burns Specific Health Scale-Brief, Functional Independence Measure, and Physical Composite Score (SF-36) were the most widely used outcome scoring systems. CONCLUSION Major burn survivors have protracted recovery with potential for persistent chronic impairments, remaining consistently below baseline levels of function. Non-modifiable factors such as age and gender, and disease characteristics such as burn size with associated physical, physiological and psychosocial sequelae are contributory. Further research is required to explore achievement of specific milestones of major burn and polytrauma critical care patients, while early targeted rehabilitation addressing physical, psychological, and vocational needs has promising potential benefit.
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Affiliation(s)
- Ali M Jawad
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, UK; Welsh Centre for Burns and Plastic Surgery, Swansea, Wales, UK.
| | - Murtaza Kadhum
- Welsh Centre for Burns and Plastic Surgery, Swansea, Wales, UK
| | - Janine Evans
- Welsh Centre for Burns and Plastic Surgery, Swansea, Wales, UK
| | | | - Niall Martin
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, UK
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Gus E, Wang SM, Malic C, Zuccaro J. Routinely collected burn clinical data in Canada: Determining the knowledge gap. Burns 2024:S0305-4179(24)00036-6. [PMID: 38429127 DOI: 10.1016/j.burns.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/17/2024] [Accepted: 02/08/2024] [Indexed: 03/03/2024]
Abstract
Unlike other developed countries that hold national burn registries to monitor burn injury and care, Canada relies on single-centre secondary datasets and administrative databases as surveillance mechanisms. The objective of this study was to determine the knowledge gap faced in Canada for not having a dedicated burn registry. A comprehensive scoping review was conducted to identify the burn literature that has arisen from secondary datasets in Canada. Literature of all study designs was included with the exception of case reports and cases series. Once data extraction was concluded, a thematic framework was constructed based on the information that arose from nations that hold national burn registries. Eighty-eight studies were included. Twelve studies arose from national datasets, and 18 from provincial databases, most of which were from Ontario and British Columbia. Only seven studies were conducted using a combination of Canadian units' single-centre datasets. The majority of included studies (58%) resulted from non-collaborative use of single-centre secondary datasets. Research efforts were predominantly conducted by burn units in Ontario, British Columbia, Manitoba and Alberta. A significant number of the included studies were outdated and several provinces/territories had no published burn data whatsoever. Efforts should be made towards the development of systems to surveil burn injury and care in Canada. This study supports the development of a nation-wide burn registry to bridge this knowledge gap.
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Affiliation(s)
- Eduardo Gus
- Division of Plastic, Reconstructive & Aesthetic Surgery, The Hospital for Sick Children, Toronto, Canada; Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Canada.
| | - Sabrina M Wang
- Temerty Faculty of Medicine, University of Toronto, Canada
| | - Claudia Malic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jennifer Zuccaro
- Division of Plastic, Reconstructive & Aesthetic Surgery, The Hospital for Sick Children, Toronto, Canada
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Francalancia S, Mehta K, Shrestha R, Phuyal D, Bikash D, Yadav M, Nakarmi K, Rai S, Sharar S, Stewart BT, Fudem G. Consumer focus group testing with stakeholders to generate an enteral resuscitation training flipbook for primary health center and first-level hospital providers in Nepal. Burns 2024:S0305-4179(24)00037-8. [PMID: 38472005 DOI: 10.1016/j.burns.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/30/2024] [Accepted: 02/08/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Enteral resuscitation (EResus) is operationally advantageous to intravenous resuscitation for burn-injured patients in some low-resource settings. However, there is minimal guidance and no training materials for EResus tailored to non-burn care providers. We aimed to develop and consumer-test a training flipbook with doctors and nurses in Nepal to aid broader dissemination of this life-saving technique. MATERIALS AND METHODS We used individual cognitive interviews with Nepali (n = 12) and international (n = 4) burn care experts to define key elements of EResus and specific concepts for its operationalization at primary health centers and first-level hospitals in Nepal. Content, prototype illustrations, and wireframe layouts were developed and revised with the burn care experts. Subsequently, eight consumer testing focus groups with Nepali stakeholders (5-10 people each) were facilitated. Prompts were generated using the Questionnaire Appraisal System (QAS) framework. The flipbook was iteratively revised and tested based on consumer feedback organized according to the domains of clarity, assumptions, knowledge/memory, and sensitivity/bias. RESULTS AND DISCUSSION The flipbook elements were iterated until consumers made no additional requests for changes. Examples of consumer inputs included: clarity-minimize medical jargon, add shrunken organs and wilted plants to represent burn shock; assumptions-use locally representative figures, depict oral rehydration salts sachet instead of a graduated bottle; knowledge/memory-clarify complex topics, use Rule-of-9 s and depict approximately 20% total body surface area to indicate the threshold for resuscitation; sensitivity/bias-reduce anatomic illustration details (e.g. urinary catheter placement, body contours). CONCLUSION Stakeholder engagement, consumer testing, and iterative revision can generate knowledge translation products that reflect contextually appropriate education materials for inexperienced burn providers. The EResus Training Flipbook can be used in Nepal and adapted to other contexts to facilitate the implementation of EResus globally.
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Affiliation(s)
| | - Kajal Mehta
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Raslina Shrestha
- Kirtipur Hospital Phect Nepal Cleft and Burn Center, Kathmandu, Nepal
| | - Diwakar Phuyal
- Kirtipur Hospital Phect Nepal Cleft and Burn Center, Kathmandu, Nepal
| | - Das Bikash
- Kirtipur Hospital Phect Nepal Cleft and Burn Center, Kathmandu, Nepal
| | - Manish Yadav
- Kirtipur Hospital Phect Nepal Cleft and Burn Center, Kathmandu, Nepal
| | - Kiran Nakarmi
- Kirtipur Hospital Phect Nepal Cleft and Burn Center, Kathmandu, Nepal
| | - Shankar Rai
- Kirtipur Hospital Phect Nepal Cleft and Burn Center, Kathmandu, Nepal
| | - Sam Sharar
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Barclay T Stewart
- Department of Surgery, University of Washington, Seattle, WA, USA; Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
| | - Gary Fudem
- Department of Surgery, University of Washington, Seattle, WA, USA
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Presser E, Farhat M, Michael M, El Asmar K, Jaber L, Moustafa M, Mowafi H, Al-Hajj S. Epidemiology of burns in a humanitarian setting: A national study among refugees in Lebanon. Burns 2024:S0305-4179(24)00034-2. [PMID: 38402117 DOI: 10.1016/j.burns.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 01/16/2024] [Accepted: 02/08/2024] [Indexed: 02/26/2024]
Abstract
INTRODUCTION Burns represent one of the leading causes of morbidity worldwide and disproportionately impact women, children, and socioeconomically disadvantaged individuals. Syrian refugees who fled conflict to land in overcrowded informal settlements across Lebanon are a particularly vulnerable population. This study aims to assess the etiology and risk factors for burns in this population. METHODS This cross-sectional, cluster-based population study adopted the Surgeons Overseas Assessment of Surgical Need (SOSAS) version 3.0 to capture data from refugees residing in informal settlements in multiple regions across Lebanon. The tool was contextualized and used to collect detailed information on burn cases sustained by refugees during the last 12 months prior to data collection. Univariate logistic regression models were performed to assess the relationship between burns and associated risk factors. RESULTS From the 1468 households surveyed, a total of 223 households experienced a burn in the last 12 months. Over 63% of burns occurred in children under the age of ten years and almost 57% of burns occurred in females. More than 70% of burns resulted from hot liquid, while 17% were caused by direct heat contact. Over 3/4ths of burns occurred while preparing food (77.4%). Approximately 32% of those burned did not seek healthcare, of which almost 85% noted the cause was mainly due to financial limitations. CONCLUSION Burns are a common injury in the Syrian refugee population living in Lebanon. Children and women are particularly impacted, often during cooking. Multi-level interventions are necessary to reduce burn injuries and improve care for those affected by burns. Community kitchens can be used to separate cooking and living environments and get stoves and hot liquids off the floor. Importantly, policies should allow for refugees to receive medical care when necessary without a major financial burden.
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Affiliation(s)
- Elise Presser
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - May Farhat
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Marc Michael
- Department of Sociology, American University of Beirut, Beirut, Lebanon
| | - Khalil El Asmar
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Lubna Jaber
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Moustafa Moustafa
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Hani Mowafi
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Samar Al-Hajj
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
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Basaran A, Özlü Ö, Gürbüz K, Daş K. Analysis of Inpatient Burn Patients Treated After the February 2023 Kahramanmaras Turkiye Earthquake and Examination of the Burn Profile According to Injury Time. J Burn Care Res 2024:irae019. [PMID: 38334440 DOI: 10.1093/jbcr/irae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Indexed: 02/10/2024]
Abstract
On February 6, 2023, a 7.7 and about 9 hours later, a 7.6 Richter's scale earthquake struck south of Turkiye, affecting more than 9 million people in 11 cities. This study aims to assess injury mechanisms, patient characteristics, and the outcome related to the earthquakes and the newly emerging living conditions. This study was conducted between February 6, 2023, and May 6, 2023, in a referral burn center. Patients who experienced burns either during the earthquakes or within three months in the region were included. The patient characteristics, time and place of burn injury, etiology, latency time to hospital admittance, outcome, and mortality were evaluated retrospectively. Sixty-three patients were included in our study cohort with a mean age of 21.84±20.3 years. The burned total body surface area was 15.56±20.3%. The burns that occurred during the earthquakes were mainly minor scalds, but the median time to hospital admission was 55 hours. The burns after the first week to the end of day forty-five were mainly flame burns that occurred in tents. The following burns up to the end of the third month included flame burns resulting in high mortality, and electrical burns mainly occurred during the restoration of the destroyed environment. In major disasters like earthquakes, burns during catastrophes are inevitable. Accommodating survivors in fireproof tents will be essential for avoiding fatalities from fires. In the restoration period of the settlements, the workers should be adequately informed about precautions when dealing with electric transmission lines.
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Affiliation(s)
- Abdulkadir Basaran
- Burn Center, Department of General Surgery, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Özer Özlü
- Burn Center, Department of General Surgery, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Kayhan Gürbüz
- Burn Center, Department of General Surgery, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Koray Daş
- Burn Center, Department of General Surgery, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
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50
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Allahham A, Rowe G, Stevenson A, Fear MW, Vallence AM, Wood FM. The impact of burn injury on the central nervous system. Burns Trauma 2024; 12:tkad037. [PMID: 38312739 PMCID: PMC10835674 DOI: 10.1093/burnst/tkad037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/31/2023] [Accepted: 06/21/2023] [Indexed: 02/06/2024]
Abstract
Burn injuries can be devastating, with life-long impacts including an increased risk of hospitalization for a wide range of secondary morbidities. One area that remains not fully understood is the impact of burn trauma on the central nervous system (CNS). This review will outline the current findings on the physiological impact that burns have on the CNS and how this may contribute to the development of neural comorbidities including mental health conditions. This review highlights the damaging effects caused by burn injuries on the CNS, characterized by changes to metabolism, molecular damage to cells and their organelles, and disturbance to sensory, motor and cognitive functions in the CNS. This damage is likely initiated by the inflammatory response that accompanies burn injury, and it is often long-lasting. Treatments used to relieve the symptoms of damage to the CNS due to burn injury often target inflammatory pathways. However, there are non-invasive treatments for burn patients that target the functional and cognitive damage caused by the burn, including transcranial magnetic stimulation and virtual reality. Future research should focus on understanding the mechanisms that underpin the impact of a burn injury on the CNS, burn severity thresholds required to inflict damage to the CNS, and acute and long-term therapies to ameliorate deleterious CNS changes after a burn.
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Affiliation(s)
- Amira Allahham
- Burn injury research unit, School of Biomedical Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia
- Fiona Wood Foundation, 11 Robin Warren Dr, Murdoch WA 6150, Australia
| | - Grant Rowe
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, 90 South Street, Murdoch, Perth 6150, Australia
| | - Andrew Stevenson
- Burn injury research unit, School of Biomedical Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia
- Fiona Wood Foundation, 11 Robin Warren Dr, Murdoch WA 6150, Australia
| | - Mark W Fear
- Burn injury research unit, School of Biomedical Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia
- Fiona Wood Foundation, 11 Robin Warren Dr, Murdoch WA 6150, Australia
| | - Ann-Maree Vallence
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, 90 South Street, Murdoch, Perth 6150, Australia
- Centre for Healthy Ageing, Health Futures Institute, Murdoch University, 90 South Street, Murdoch Perth 6150, Australia
- Burn Service of Western Australia, Fiona Stanley Hospital, MNH (B), Level 4, 102-118 Murdoch Drive, Murdoch, Perth, WA 6150, Australia
| | - Fiona M Wood
- Burn injury research unit, School of Biomedical Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia
- Fiona Wood Foundation, 11 Robin Warren Dr, Murdoch WA 6150, Australia
- School of Psychology, College of Health and Education, Murdoch University, 90 South Street, Murdoch, Perth 6150, Australia
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