1
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Çelik E, Akelma H. Hydrogel burn dressing effectiveness in burn pain. Burns 2024; 50:190-196. [PMID: 37827940 DOI: 10.1016/j.burns.2023.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 08/07/2023] [Accepted: 08/15/2023] [Indexed: 10/14/2023]
Abstract
Severe burns are painful and dramatic injuries. Studies show that pain is underestimated and often not adequately treated. This study aims to evaluate the analgesic efficacy of hydrogel burn dressing and silver sulfadiazine, which are two agents commonly used in first-aid dressings for burn patients. This study, designed as a prospective, observational, and cross-sectional study. Study included 64 pediatric patients admitted to our burn center between 01.03.2020 and 01.09.2020 who were examined by our burn service after their first treatment in the emergency dressing room. Two groups of patients were included in the study. Pain level was assessed in the dressing room before and 10 min after the procedure using the Visual Analog Scale and FLACC (Face, Legs, Activity, Cry, Consolability) pain assessment scales.During the study period, Burnaid® was applied to 62.5% of patients (40 patients) and silver sulfadiazine to 37.5% (24 patients). In terms of pain scores, pre-dressing FLACC values were higher in Group B (p = 0.039); post-dressing VAS and FLACC values were significantly lower in group B (p 0.001; p 0.001). In terms of additional analgesia, we found more patients in Group S received analgesics (p 0.001).We believe that its effect on burn wound pain is superior to that of silver sulfadiazine.
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Affiliation(s)
- Enes Çelik
- Mardin Artuklu Faculty of Medicine Department of Anesthesiology and Reanimation, Turkey
| | - Hakan Akelma
- Mardin Artuklu Faculty of Medicine Department of Anesthesiology and Reanimation, Turkey.
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2
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Yousefian F, Hesari R, Jensen T, Obagi S, Rgeai A, Damiani G, Bunick CG, Grada A. Antimicrobial Wound Dressings: A Concise Review for Clinicians. Antibiotics (Basel) 2023; 12:1434. [PMID: 37760730 PMCID: PMC10526066 DOI: 10.3390/antibiotics12091434] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Wound management represents a substantial clinical challenge due to the growing incidence of chronic skin wounds resulting from venous insufficiency, diabetes, and obesity, along with acute injuries and surgical wounds. The risk of infection, a key impediment to healing and a driver of increased morbidity and mortality, is a primary concern in wound care. Recently, antimicrobial dressings have emerged as a promising approach for bioburden control and wound healing. The selection of a suitable antimicrobial dressing depends on various parameters, including cost, wound type, local microbial burden and the location and condition of the wound. This review covers the different types of antimicrobial dressings, their modes of action, advantages, and drawbacks, thereby providing clinicians with the knowledge to optimize wound management.
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Affiliation(s)
| | - Roksana Hesari
- Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA
| | - Taylor Jensen
- St. George’s University School of Medicine, West Indies P.O. Box 7, Grenada
| | - Sabine Obagi
- College of Medicine, University of Arizona, Tucson, AZ 85724, USA
| | - Ala Rgeai
- Hai Al-Andalus Primary Healthcare Center, Tripoli 13555, Libya
| | - Giovanni Damiani
- Italian Center of Precision Medicine and Chronic Inflammation, 20122 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, 35131 Padua, Italy
| | - Christopher G. Bunick
- Department of Dermatology, Yale University School of Medicine, New Haven, CT 06510, USA
- Program in Translational Biomedicine, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Ayman Grada
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
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3
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Griffin B, Cabilan C, Ayoub B, Xu H(G, Palmieri T, Kimble R, Singer Y. The effect of 20 minutes of cool running water first aid within three hours of thermal burn injury on patient outcomes: A systematic review and meta-analysis. Australas Emerg Care 2022; 25:367-376. [DOI: 10.1016/j.auec.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
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4
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Derwin R, Patton D, Avsar P, Strapp H, Moore Z. The impact of topical agents and dressing on pH and temperature on wound healing: A systematic, narrative review. Int Wound J 2021; 19:1397-1408. [PMID: 34931445 PMCID: PMC9493238 DOI: 10.1111/iwj.13733] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/14/2021] [Accepted: 12/01/2021] [Indexed: 11/27/2022] Open
Abstract
To assess the impact of topical agents and dressings on surface wound pH, temperature, and subsequent wound healing. This was a systematic, narrative review of the literature, following the PRISMA (2020) guidelines. The databases searched were Medline PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Embase, Web of Science, and Scopus. Data synthesis and analysis were conducted using a structured narrative synthesis. The quality of the included clinical studies was appraised using the Evidence-Based Literature (EBL) Critical Appraisal Tool. A total of six clinical studies were assessed as eligible for inclusion, A total of six dressings/topical agents were assessed and the types of wounds included non-healing chronic wounds. Of the studies, five explored pH and one explored temperature. The EBL validity of the clinical studies was low (mean quality score was 51.3%). The five clinical studies that explored pH investigated different dressings and topical agents reporting an associated reduction in pH and improved wound outcomes. One clinical study investigated the impact of topical sodium nitrite on temperature and found that sodium nitrite increased peri-wound skin temperature and improved wound outcomes with a reduction in leg ulcer size. Given the low certainty of the evidence, we cannot confidently recommend the use of any particular topical agent or dressing to manipulate pH, or temperature to improve wound outcomes. Thus, there is a need for further research to develop a greater understanding of this topic. Irish Research Council, Enterprise Partnership Scheme.
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Affiliation(s)
- Rosemarie Derwin
- School of Nursing and Midwifery, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Declan Patton
- Wounds and Trauma Research Centre, School of Nursing and Midwifery, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.,Department of Nursing, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia.,Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Pinar Avsar
- Skin Wounds and Trauma Research Centre, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Helen Strapp
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Zena Moore
- Department of Nursing, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia.,Head of School of Nursing and Midwifery and Director of the Skin Wounds and Trauma Research Centre, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.,Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Nursing, Lida Institute, Shanghai, China.,School of Nursing and Midwifery, University of Wales, Cardiff, UK
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5
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Mehra L, Mehra S, Tiwari N, Singh T, Rawat H, Belagavi S, Jaimini A, Mittal G. Fabrication, characterization and evaluation of the efficacy of gelatin/hyaluronic acid microporous scaffolds suffused with aloe-vera in a rat burn model. J Biomater Appl 2021; 36:1346-1358. [PMID: 34873947 DOI: 10.1177/08853282211061821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Burn induced injuries are commonly encountered in civilian and military settings, leading to severe morbidity and mortality. Objective of this study was to construct microporous bioactive scaffolds of gelatin-hyaluronic acid suffused with aloe-vera gel (Gela/HA/AvG), and to evaluate their efficacy in healing partial-thickness burn wounds. Scaffolds were characterized using Fourier transform-infrared spectroscopy, Scanning electron microscopy, and Thermo-gravimetric analysis to understand intermolecular interactions and morphological characteristics. In-vitro fluid uptake ability and hemolytic index of test scaffolds were also determined. In-vitro collagenase digestion was done to assess biodegradability of scaffolds. Wound retraction studies were carried out in Sprague Dawley rats inflicted with partial-thickness burn wounds to assess and compare efficacy of optimized scaffolds with respect to negative and positive control groups. In-vivo gamma scintigraphy using Technetium-99m labeled Immunoglobulin-G (99mTc-IgG) as imaging agent was also performed to validate efficacy results. Histological and immunohistochemical comparison between groups was also made. Scaffolds exhibited mircoporous structure, with pore size getting reduced from 41.3 ± 4.3 µm to 30.49 ± 5.7 µm when gelatin conc. was varied from 1% to 5%. Optimized test scaffolds showed sustained in-vitro swelling behavior, were biodegradable and showed hemolytic index in range of 2.4-4.3%. Wound retraction study along with in-vivo gamma scintigraphy indicated that Gela/HA/AvG scaffolds were not only able to reduce local inflammation faster but also accelerated dermis regeneration. Immunohistochemical analysis, in terms of expression levels of epidermal growth factor and fibroblast growth factor-2 also corroborated in-vivo efficacy findings. Gela/HA/AvG scaffolds, therefore, can potentially be developed into an effective dermal regeneration template for partial-thickness burn wounds.
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Affiliation(s)
- Lalita Mehra
- Department of Combat Sciences, 93048DRDO Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Smritee Mehra
- Department of Biotechnology, RinggoldID:231547Manav Rachna International Institute of Research and Studies, Faridabad, Haryana, India
| | - Nidhi Tiwari
- Department of Combat Sciences, 93048DRDO Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Thakuri Singh
- Department of Combat Sciences, 93048DRDO Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Harish Rawat
- Department of Nuclear Medicine, 93048DRDO Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Shreeshail Belagavi
- Department of Cytopathology, 93048DRDO Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Abhinav Jaimini
- Department of Nuclear Medicine, 93048DRDO Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Gaurav Mittal
- Department of Combat Sciences, 93048DRDO Institute of Nuclear Medicine and Allied Sciences, Delhi, India
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Wang M, Xu X, Lei X, Tan J, Xie H. Mesenchymal stem cell-based therapy for burn wound healing. BURNS & TRAUMA 2021; 9:tkab002. [PMID: 34212055 PMCID: PMC8240555 DOI: 10.1093/burnst/tkab002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/14/2020] [Indexed: 02/05/2023]
Abstract
Burns, with their high incidence and mortality rates, have a devastating effect on patients. There are still huge challenges in the management of burns. Mesenchymal stem cells (MSCs), which have multidirectional differentiation potential, have aroused interest in exploring the capacity for treating different intractable diseases due to their strong proliferation, tissue repair, immune tolerance and paracrine abilities, among other features. Currently, several animal studies have shown that MSCs play various roles and have beneficial effects in promoting wound healing, inhibiting burn inflammation and preventing the formation of pathological scars during burn healing process. The substances MSCs secrete can act on peripheral cells and promote burn repair. According to preclinical research, MSC-based treatments can effectively improve burn wound healing and reduce pain. However, due to the small number of patients and the lack of controls, treatment plans and evaluation criteria vary widely, thus limiting the value of these clinical studies. Therefore, to better evaluate the safety and effectiveness of MSC-based burn treatments, standardization of the application scheme and evaluation criteria of MSC therapy in burn treatment is required in the future. In addition, the combination of MSC pretreatment and dressing materials are also conducive to improving the therapeutic effect of MSCs on burns. In this article, we review current animal research and clinical trials based on the use of stem cell therapy for treating burns and discuss the main challenges and coping strategies facing future clinical applications.
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Affiliation(s)
- Mingyao Wang
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Keyuan Road 4, Gaopeng Street, Chengdu, Sichuan 610041, China
| | - Xinxuan Xu
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Keyuan Road 4, Gaopeng Street, Chengdu, Sichuan 610041, China
| | - Xiongxin Lei
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Keyuan Road 4, Gaopeng Street, Chengdu, Sichuan 610041, China
| | - Jie Tan
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Keyuan Road 4, Gaopeng Street, Chengdu, Sichuan 610041, China
| | - Huiqi Xie
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Keyuan Road 4, Gaopeng Street, Chengdu, Sichuan 610041, China
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7
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He JJ, McCarthy C, Camci-Unal G. Development of Hydrogel‐Based Sprayable Wound Dressings for Second‐ and Third‐Degree Burns. ADVANCED NANOBIOMED RESEARCH 2021. [DOI: 10.1002/anbr.202100004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Jacqueline Jialu He
- Department of Chemical Engineering University of Massachusetts Lowell One University Avenue Lowell MA 01854 USA
- Biomedical Engineering and Biotechnology Program University of Massachusetts Lowell One University Avenue Lowell MA 01854 USA
| | - Colleen McCarthy
- Department of Chemical Engineering University of Massachusetts Lowell One University Avenue Lowell MA 01854 USA
| | - Gulden Camci-Unal
- Department of Chemical Engineering University of Massachusetts Lowell One University Avenue Lowell MA 01854 USA
- Department of Surgery University of Massachusetts Medical School 55 Lake Avenue Worcester MA 01655 USA
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8
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Goodwin NS. Burn first aid issues again-"Not seeing the forest for the trees". Burns 2021; 47:970-972. [PMID: 33531185 PMCID: PMC7813503 DOI: 10.1016/j.burns.2020.12.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 12/31/2020] [Indexed: 11/03/2022]
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9
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Holbert MD, Kimble RM, Chatfield M, Griffin BR. Effectiveness of a hydrogel dressing as an analgesic adjunct to first aid for the treatment of acute paediatric burn injuries: a prospective randomised controlled trial. BMJ Open 2021; 11:e039981. [PMID: 33402404 PMCID: PMC7786810 DOI: 10.1136/bmjopen-2020-039981] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To compare the effectiveness of two acute burn dressings, Burnaid hydrogel dressing and plasticised polyvinylchloride film, on reducing acute pain scores in paediatric burn patients following appropriate first aid. DESIGN Single-centre, superiority, two-arm, parallel-group, prospective randomised controlled trial. PARTICIPANTS AND SETTING Paediatric patients (aged ≤16) presenting to the Emergency Department at the Queensland Children's Hospital, Brisbane, Australia, with an acute thermal burn were approached for participation in the trial from September 2017-September 2018. INTERVENTIONS Patients were randomised to receive either (1) Burnaid hydrogel dressing (intervention) or (2) plasticised polyvinylchloride film (Control) as an acute burn dressing. PRIMARY AND SECONDARY OUTCOMES Observational pain scores from nursing staff assessed 5 min post application of the randomised dressing, measured using the Face Legs Activity Cry and Consolability Scale was the primary outcome. Repeated measures of pain, stress and re-epithelialisation were also collected at follow-up dressing changes until 95% wound re-epithelialisation occurred. RESULTS Seventy-two children were recruited and randomised (n=37 intervention; n=35 control). No significant between-group differences in nursing (mean difference: -0.1, 95% CI -0.7 to 0.5, p=0.72) or caregiver (MD: 1, 95% CI -8 to 11, p=0.78) observational pain scores were identified. Moreover, no significant differences in child self-report pain (MD: 0.3, 95% CI -1.7 to 2.2, p=0.78), heart rate (MD: -3, 95% CI -11 to 5, p=0.41), temperature (MD: 0.6, 95% CI -0.13 to 0.24, p=0.53), stress (geometric mean ratio: 1.53, 95% CI 0.93 to 2.53, p=0.10), or re-epithelialisation rates (MD: -1, 95% CI -3 to 1, p=0.26) were identified between the two groups. CONCLUSIONS A clear benefit of Burnaid hydrogel dressing as an analgesic adjunct to first aid for the treatment of acute paediatric burns was not identified in this investigation. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12617001274369).
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Affiliation(s)
- Maleea Denise Holbert
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane, Queensland, Australia
- Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane, Queensland, Australia
- Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Mark Chatfield
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Bronwyn R Griffin
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane, Queensland, Australia
- Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, Herston, Queensland, Australia
- Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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10
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Ashman H, Rigg D, Moore F. The assessment and management of thermal burn injuries in a UK ambulance service: a clinical audit. Br Paramed J 2020; 5:52-58. [PMID: 33456397 PMCID: PMC7783961 DOI: 10.29045/14784726.2020.12.5.3.52] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Although burn emergencies are infrequently encountered, the ambulance service is often the first point of contact for patients in these situations. It is therefore important that these potentially devastating injuries are managed in accordance with the evidence base. Appropriate assessment and management of these patients in the pre-hospital phase will have a significant impact upon their long-term outcomes, such as scarring cosmesis and functionality. Aim and objectives: This audit was conducted to determine if patients presenting to one UK ambulance service with thermal burn injuries were managed safely, effectively and in a timely manner. Areas highlighted for improvement will assist in directing future pre-hospital research and educational requirements. Epidemiological data will also be provided. Results: 278 thermal burn incidents occurring from June 2017 to May 2018 (inclusive) were included in this audit. A larger proportion of burn patients were paediatrics who fell into the 0–10 age category, most burn patients were injured at a home address and only nine of the overall sample were major burns. Only 35% of patients received adequate cooling of their burns, an essential first aid intervention. The assessment of pain (87%) and provision of analgesia (75%) showed a higher compliance rate. However, only 54% had pain reassessed after analgesia. There was a near 100% compliance rate for patients being managed without hydrogel dressings and topical medicines. Conclusion: The results indicate several areas for improvement within the ambulance trust. Of importance is the application of basic first aid, such as cooling. It is important not only to improve education among staff but also to understand non-compliance. It should be acknowledged that assessment of pain and provision of analgesia demonstrated far higher compliance compared to current pre-hospital evidence. Several points for education and research have been identified.
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Affiliation(s)
- Harriet Ashman
- South East Coast Ambulance Service ORCID iD: https://orcid.org/0000-0003-0628-5492
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11
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Frear CC, Griffin B, Kimble R. Adequacy of cool running water first aid by healthcare professionals in the treatment of paediatric burns: A cross-sectional study of 4537 children. Emerg Med Australas 2020; 33:615-622. [PMID: 33191592 PMCID: PMC9292905 DOI: 10.1111/1742-6723.13686] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 10/23/2020] [Accepted: 10/28/2020] [Indexed: 11/27/2022]
Abstract
Objective To determine the adequacy of cool running water first aid provided by healthcare professionals in the early management of children with thermal burn injuries. Methods A cross‐sectional study was undertaken using a prospectively collected registry of children who presented with a thermal burn to the only major paediatric burns centre in Queensland, Australia, from January 2013 to December 2018. Main outcome measures included the type and duration of first aid administered by paramedics, general practitioners and emergency providers at local general hospitals and a children's hospital. In accordance with current Australian guidelines, adequate cooling was defined as 20 min of cool running water within 3 h of the injury. Results Of the 4537 children who presented to the paediatric burns centre, 3261 (71.9%) received adequate first aid, including 1502 (33.1%) at the scene of injury. Paramedics and general practitioners administered adequate cooling to 184 (25.0%) and 52 (24.2%) of their patients, respectively. ED clinicians adhered to guidelines in the treatment of 1019 (56.3%) children at general hospitals and 411 (76.0%) at the children's hospital. Among ED patients who presented with incomplete prior first aid, the risk of inadequate cooling was significantly greater for those transported via ambulance (P < 0.001). Conclusion Deficiencies remain in the cooling of paediatric burns patients at all levels of initial management. There is a need in the healthcare community for improved education regarding the parameters and clinical benefits of cool running water first aid.
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Affiliation(s)
- Cody C Frear
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Bronwyn Griffin
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, Brisbane, Queensland, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Paediatric Surgery, Urology, Burns and Trauma, Queensland Children's Hospital, Brisbane, Queensland, Australia
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12
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Samdavid Thanapaul RJR, Ranjan A, Manikandan SK, Nadar MSAM. Efficacy of Lobelia alsinoides Lam ethanolic extract on a third-degree burn: An experimental study on rats. Dermatol Ther 2020; 33:e14242. [PMID: 32860351 DOI: 10.1111/dth.14242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/11/2020] [Accepted: 08/21/2020] [Indexed: 02/02/2023]
Abstract
This is the first study to evaluate the topical application of Lobelia alsinoides Lam (LT) ethanolic extract on burns in rats. A deep third-degree burn wound was inflicted in adult male Wistar rats and the burns were dressed daily with a topical ointment formulation (Patent filed) comprising of Lobelia alsinoides Lam (5% and 10% w/w). The wound had noteworthy contraction and quicker eschar removal in 10% w/w LT-treated groups followed by 5% w/w treated groups on comparing with the commonly prescribed ointment (SilverexTM containing 1% w/w Silver sulfadiazine). Histopathological analysis showed that ointment containing 10% w/w LT ethanolic extract significantly increased fibroblast growth, which plays a major role in anatomic integrity, collagen synthesis, and accelerated the rate of the healing process. This study shows that the ethanolic extract of Lobelia alsinoides Lam, a previously pharmacologically unreported traditional medicinal plant, possesses wound contraction and eschar removal properties on burn wounds.
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Affiliation(s)
- Rex Jeya Rajkumar Samdavid Thanapaul
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Biotechnology, Karunya Institute of Technology and Sciences (Deemed to be University), Coimbatore, Tamil Nadu, India
| | - Abraham Ranjan
- Department of Biotechnology, Karunya Institute of Technology and Sciences (Deemed to be University), Coimbatore, Tamil Nadu, India
| | - Sreeraj K Manikandan
- Department of Biotechnology, Karunya Institute of Technology and Sciences (Deemed to be University), Coimbatore, Tamil Nadu, India
| | - M S A Muthukumar Nadar
- Department of Biotechnology, Karunya Institute of Technology and Sciences (Deemed to be University), Coimbatore, Tamil Nadu, India
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13
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Svitina H, Swanepoel R, Rossouw J, Netshimbupfe H, Gouws C, Hamman J. Treatment of Skin Disorders with Aloe Materials. Curr Pharm Des 2020; 25:2208-2240. [PMID: 31269881 DOI: 10.2174/1381612825666190703154244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 06/20/2019] [Indexed: 01/09/2023]
Abstract
The skin is the largest organ and functions as a barrier to protect the underlying tissues against the elements and pathogens, while also fulfilling many physiological roles and biochemical functions such as preventing excessive water loss. Skin disorders vary greatly in terms of origin, severity, symptoms and affect persons of all ages. Many plants have been used for medicinal purposes since ancient times including the treatment of skin disorders and diseases. Aloe represents one of the earliest medicinal plant species mentioned in antique scriptures and even in rock art dating back thousands of years. Different Aloe species and materials have been used in the prevention and treatment of skin related disorders. Aloe vera is the most commonly used Aloe species for medicinal purposes. Some of the most prominent skin related applications and disorders that Aloe materials have been investigated for are discussed in this paper, which include cosmetic, radiation, cancer, wound and antimicrobial applications. Both in vitro and in vivo studies are included in the discussions of this paper and comprehensive summaries of all these studies are given in tables in each section. Although some contradictory results were obtained among studies, certain Aloe materials have shown excellent efficacy and exhibited potential for the treatment of skin related disorders and cosmetic applications.
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Affiliation(s)
- Hanna Svitina
- Centre of Excellence for Pharmaceutical Sciences (Pharmacen™), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Roan Swanepoel
- Centre of Excellence for Pharmaceutical Sciences (Pharmacen™), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Jacques Rossouw
- Centre of Excellence for Pharmaceutical Sciences (Pharmacen™), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Happiness Netshimbupfe
- Centre of Excellence for Pharmaceutical Sciences (Pharmacen™), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Chrisna Gouws
- Centre of Excellence for Pharmaceutical Sciences (Pharmacen™), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Josias Hamman
- Centre of Excellence for Pharmaceutical Sciences (Pharmacen™), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
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First aid management of paediatric burn and scald injuries in Southern Malawi: A mixed methods study. Burns 2019; 46:727-736. [PMID: 31732221 DOI: 10.1016/j.burns.2019.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/06/2019] [Accepted: 08/29/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND In sub-Saharan Africa, burn and scald injuries occur more commonly in children aged less than five years, than in any other age group, and carry a high lifetime morbidity. The optimal first aid at the time of injury includes the use of cool running water, which can reduce pain, scarring, and skin grafting. Data on the types of first aid used in Malawi is lacking, as is an in-depth understanding of the underlying factors which may influence this health behaviour. This study sought to: (a) document the types of first aid after paediatric burn and scald injuries in Southern Malawi; and (b) explore factors affecting the choice of first aid used. METHODS ANDFINDINGS We conducted a sequential explanatory mixed methods study. Quantitative analysis of a prospectively collected database of all patients aged less than 17 years admitted to the only burn unit in Southern Malawi was followed by thematic analysis of semi-structured interviews with 15 adults who had witnessed a paediatric burn or scald injury. 1326 patients aged less than 17 years were admitted to the Queen Elizabeth Central Hospital between July 2009 and December 2016. Median age was 3.0 years (IQR 1.9-5.0) and male to female ratio 1:0.9. The commonest cause of injury was hot liquid (45%), followed by open fire (31%) and porridge (12%). First aid was applied in 829 patients (69%), the commonest applications used were water (31%) and egg (21%). There was a statistically significant association between the type of first aid and secondary education of the father (p = 0.009) or mother (p = 0.036); however, the type of first aid used was more likely to be egg rather than water. Analysis of qualitative interviews identified four main themes: perceived roles and responsibilities within the community, drivers of individual behaviours, availability, and trust. Participants reported using eggs as a first aid treatment, as these were readily available and were seen to reduce the occurrence of blisters and prevent peeling of the skin. By comparison, there was a strong underlying fear of using water on burn injuries due to its association with peeling of the skin. Intergenerational learning appeared to play a strong role in influencing what is used at the time of injury, and mothers were the key source of this information. CONCLUSIONS This study provides the largest description of first aid use in sub-Saharan Africa, strengthening the evidence that remedies aside from water are commonly used and that higher parental education levels do not translate to increased use of water, but rather use of alternative treatments. Our qualitative findings allow improved understanding of how first aid for paediatric burns is perceived in rural Malawi communities, providing insight as to why certain first aid choices are made and the possible barriers and facilitators to the adoption of water as a first aid treatment.
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Griffin BR, Frear CC, Babl F, Oakley E, Kimble RM. Cool Running Water First Aid Decreases Skin Grafting Requirements in Pediatric Burns: A Cohort Study of Two Thousand Four Hundred Ninety-five Children. Ann Emerg Med 2019; 75:75-85. [PMID: 31474480 DOI: 10.1016/j.annemergmed.2019.06.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 06/11/2019] [Accepted: 06/27/2019] [Indexed: 10/26/2022]
Abstract
STUDY OBJECTIVE First-aid guidelines recommend the administration of cool running water in the early management of thermal injury. Our objective is to analyze the associations between first aid and skin-grafting requirements in children with burns. METHODS This cohort study used a prospectively collected registry of patients managed at a tertiary children's hospital. Multivariate logistic regression models were used to evaluate the relationship between first aid and the requirement for skin grafting. Secondary outcomes included time to re-epithelialization, wound depth, hospital admission and length of stay, and operating room interventions. Adequate first aid was defined as 20 minutes of cool running water within 3 hours of injury. RESULTS In our cohort of 2,495 children, 2,259 (90.6%) received first aid involving running water, but only 1,780 (71.3%) were given the adequate duration. A total of 236 children (9.5%) required grafting. The odds of grafting were decreased in the adequate first aid group (odds ratio [OR] 0.6; 95% confidence interval [CI] 0.4 to 0.8). The provision of adequate running water was further associated with reductions in full-thickness depth (OR 0.4; 95% CI 0.2 to 0.6), hospital admission (OR 0.7; 95% CI 0.3 to 0.9), and operating room interventions (OR 0.7; 95% CI 0.5 to 0.9), but not hospital length of stay (hazard ratio=0.9; 95% CI 0.7 to 1.2; P=.48). CONCLUSION Burn severity and clinical outcomes improved with the administration of cool running water. Adequate first aid must be prioritized by out-of-hospital and emergency medical services in the preliminary management of pediatric burns.
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Affiliation(s)
- Bronwyn R Griffin
- Queensland University of Technology Faculty of Health, Centre for Children's Burns and Trauma Research, South Brisbane, Queensland, Australia.
| | - Cody C Frear
- Queensland University of Technology Faculty of Health, Centre for Children's Burns and Trauma Research, South Brisbane, Queensland, Australia.
| | - Franz Babl
- Murdoch Children's Research Institute, Royal Children's Hospital, and Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Ed Oakley
- Murdoch Children's Research Institute, Royal Children's Hospital, and Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Roy M Kimble
- Queensland University of Technology Faculty of Health, Centre for Children's Burns and Trauma Research, South Brisbane, Queensland, Australia
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16
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Goodwin N. "Mixed messages" - Ongoing confusion with hydrogel dressings in burn 1st aid. Commentary on the trial report from Holbert et al. 2018/19. Burns 2019; 45:1727-1729. [PMID: 31351818 DOI: 10.1016/j.burns.2019.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 07/03/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Nicholas Goodwin
- Ambulance Victoria 375 Manningham Road, Doncaster, Victoria, 3108, Australia.
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17
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Orchard A, van Vuuren SF. Carrier oils in dermatology. Arch Dermatol Res 2019; 311:653-672. [PMID: 31321504 DOI: 10.1007/s00403-019-01951-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/24/2019] [Accepted: 07/04/2019] [Indexed: 10/26/2022]
Abstract
Wounds are a common medical infliction. With the increase in microbial resistance and a shift of interest towards complementary medicines, essential oils have been shown to be beneficial in suppressing microbial growth. However, in practice, essential oils are more often diluted into a base due to the risk of topical adverse effects, such as dermatitis. There is a lack of collated evidence-based information on toxicity and efficacy of carrier oils. The current information on the subject matter is restricted to generic, aroma-therapeutic books and pamphlets, based on anecdotal evidence rather than an experimental approach. Therefore, this review aimed at identifying the recommended carrier oils used in dermatology and thereafter collating the scientific evidence to support the use of carrier oils together with essential oils recommended for dermatological use. Aloe vera gel had multiple studies demonstrating the ability to enhance wound healing; however, several other carrier oils have been largely neglected. It was observed that the extracts for certain plant species had been used to justify the use of the carrier oils of the same plant species. This is an inaccurate cross assumption due to the difference in chemical composition and biological activities. Lastly, despite these carrier oils being recommended as a base for essential oils, very little data was found on the interactive profile of the carrier oil with the essential oil. This review provides a platform for further studies, especially if essential oils are to receive credence in the scientific field.
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Affiliation(s)
- Ané Orchard
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, 2193, South Africa
| | - Sandy F van Vuuren
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, 2193, South Africa.
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Abstract
Purpose of Review Botanicals have long played a crucial role in the management of chronic and infected wounds, yet the mechanistic basis of these therapies remains largely poorly understood by modern science. Recent Findings Studies have begun to unveil the mechanistic bases of botanical therapies for wound healing, but more work is necessary. Most notably, investigation into the growing conditions, postharvest treatment and pharmacological preparation of these botanicals has demonstrated their importance in terms of the chemical makeup and pharmacological activity of the final product used in pre-clinical and clinical studies. Summary This work evaluates the potential safety, efficacy and mechanistic basis of some key botanical ingredients used in traditional medicine for wound care: aloe, marigold and St. John's wort. Furthermore, perspectives on the future role that botanical natural products may play in anti-infective and wound care innovations are explored.
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Negut I, Grumezescu V, Grumezescu AM. Treatment Strategies for Infected Wounds. Molecules 2018; 23:E2392. [PMID: 30231567 PMCID: PMC6225154 DOI: 10.3390/molecules23092392] [Citation(s) in RCA: 313] [Impact Index Per Article: 52.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/12/2018] [Accepted: 09/14/2018] [Indexed: 12/22/2022] Open
Abstract
The treatment of skin wounds is a key research domain owing to the important functional and aesthetic role of this tissue. When the skin is impaired, bacteria can soon infiltrate into underlying tissues which can lead to life-threatening infections. Consequently, effective treatments are necessary to deal with such pathological conditions. Recently, wound dressings loaded with antimicrobial agents have emerged as viable options to reduce wound bacterial colonization and infection, in order to improve the healing process. In this paper, we present an overview of the most prominent antibiotic-embedded wound dressings, as well as the limitations of their use. A promising, but still an underrated group of potential antibacterial agents that can be integrated into wound dressings are natural products, especially essential oils. Some of the most commonly used essential oils against multidrug-resistant microorganisms, such as tea tree, St. John's Wort, lavender and oregano, together with their incorporation into wound dressings are presented. In addition, another natural product that exhibits encouraging antibacterial activity is honey. We highlight recent results of several studies carried out by researchers from different regions of the world on wound dressings impregnated with honey, with a special emphasis on Manuka honey. Finally, we highlight recent advances in using nanoparticles as platforms to increase the effect of pharmaceutical formulations aimed at wound healing. Silver, gold, and zinc nanoparticles alone or functionalized with diverse antimicrobial compounds have been integrated into wound dressings and demonstrated therapeutic effects on wounds.
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Affiliation(s)
- Irina Negut
- National Institute for Lasers, Plasma and Radiation Physics, Magurele RO-77125, Romania.
- Faculty of Physics, University of Bucharest, Magurele 077125, Romania.
| | - Valentina Grumezescu
- National Institute for Lasers, Plasma and Radiation Physics, Magurele RO-77125, Romania.
- Faculty of Applied Chemistry and Materials Science, Politehnica University of Bucharest, Bucharest 011061, Romania.
| | - Alexandru Mihai Grumezescu
- Faculty of Applied Chemistry and Materials Science, Politehnica University of Bucharest, Bucharest 011061, Romania.
- Research Institute of University of Bucharest, ICUB, Bucharest 050107, Romania.
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Burusapat C, Supawan M, Pruksapong C, Pitiseree A, Suwantemee C. Topical Aloe Vera Gel for Accelerated Wound Healing of Split-Thickness Skin Graft Donor Sites: A Double-Blind, Randomized, Controlled Trial and Systematic Review. Plast Reconstr Surg 2018; 142:217-226. [PMID: 29649056 DOI: 10.1097/prs.0000000000004515] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aloe vera has been used to treat wounds since ancient times. However, data regarding the efficacy of aloe vera for burns and split-thickness skin graft donor sites are inconclusive. METHODS A double-blind, randomized, controlled trial was conducted. Patients who underwent split-thickness skin graft harvesting from the thigh were included. Split-thickness skin graft donor sites were divided into two groups: the aloe vera group and the placebo group. The visual analogue scale score was used to evaluate pain, and complete epithelialization was assessed. The authors searched electronic databases and included only international clinical trials published in the English language. RESULTS Twelve patients with 24 donor sites participated. Times to complete epithelization for the aloe vera and placebo groups were 11.5 ± 1.45 and 13.67 ± 1.61 days, respectively (p < 0.05). Visual analogue scale scores after wound dressing for the aloe vera and placebo groups were 17.18 ± 13.17 and 18.63 ± 11.20, respectively. No statistical significance was found between groups. Five articles met the inclusion criteria: four involved burns and one involved split-thickness skin graft donor sites. Three studies of burn wounds demonstrated improved epithelization and one did not. The split-thickness skin graft donor-site study indicated that wound healing time for the control group was significantly different from that of the aloe vera and placebo groups. The healing rate was not statistically different between groups. CONCLUSION Topical aloe vera gel significantly demonstrated accelerated split-thickness skin graft donor-site healing but did not show significant pain relief. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, I.
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Affiliation(s)
- Chairat Burusapat
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Phramongkutklao Hospital and Phramongkutklao College of Medicine
| | - Monlada Supawan
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Phramongkutklao Hospital and Phramongkutklao College of Medicine
| | - Chatchai Pruksapong
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Phramongkutklao Hospital and Phramongkutklao College of Medicine
| | - Anont Pitiseree
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Phramongkutklao Hospital and Phramongkutklao College of Medicine
| | - Chaichoompol Suwantemee
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Phramongkutklao Hospital and Phramongkutklao College of Medicine
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Simpson MJ, McInerney S, Carr EJ, Cuttle L. Quantifying the efficacy of first aid treatments for burn injuries using mathematical modelling and in vivo porcine experiments. Sci Rep 2017; 7:10925. [PMID: 28883527 PMCID: PMC5589934 DOI: 10.1038/s41598-017-11390-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 08/23/2017] [Indexed: 01/19/2023] Open
Abstract
First aid treatment of burns reduces scarring and improves healing. We quantify the efficacy of first aid treatments using a mathematical model to describe data from a series of in vivo porcine experiments. We study burn injuries that are subject to various first aid treatments. The treatments vary in the temperature and duration. Calibrating the mathematical model to the experimental data provides estimates of the thermal diffusivity, the rate at which thermal energy is lost to the blood, and the heat transfer coefficient controlling the loss of thermal energy at the interface of the fat and muscle. A limitation of working with in vivo experiments is the difficulty of measuring variations in temperature across the tissue layers. This limitation motivates us to use a simple, single layer mathematical model. Using the solution of the calibrated mathematical model we visualise the temperature distribution across the thickness of the tissue. With this information we propose a novel measure of the potential for tissue damage. This measure quantifies two important factors: (i) the volume of tissue that rises above the threshold temperature associated with the accumulation of tissue damage; and (ii) the duration of time that the tissue remains above this threshold temperature.
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Affiliation(s)
- Matthew J Simpson
- School of Mathematical Sciences, Queensland University of Technology (QUT), Brisbane, Australia.
| | - Sean McInerney
- School of Mathematical Sciences, Queensland University of Technology (QUT), Brisbane, Australia
| | - Elliot J Carr
- School of Mathematical Sciences, Queensland University of Technology (QUT), Brisbane, Australia
| | - Leila Cuttle
- Centre for Children's Burns and Trauma Research, QUT, Institute of Health and Biomedical Innovation at the Centre for Children's Health Research, South Brisbane, Australia
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23
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Comparison of three cooling methods for burn patients: A randomized clinical trial. Burns 2016; 43:502-508. [PMID: 27707640 DOI: 10.1016/j.burns.2016.09.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 09/08/2016] [Accepted: 09/11/2016] [Indexed: 11/22/2022]
Abstract
Tap water may not be readily available in numerous places as a first aid for burns and, therefore, tea tree oil products are recommended alternatives. Our aim in this study was to compare the cooling effects of three burn-cooling methodologies, running tap water, Burnshield®, and Burn Cool Spray®, and suggest indications for each cooling method. This randomized, controlled, study enrolled patients with burns who used the emergency service of Seoul Bestian Hospital from June 2015 to October 2015. The allocation of the cooling methods was randomly generated using a computer. We cooled the burn wounds by applying one of the three methods and measured the skin surface temperature and pain level using a visual analog scale (VAS) scoring. Ninety-six patients were enrolled in this study. The variability in the median(IQR) skin temperatures of the three groups was from 33.5°C (31.5-35.0) to 28.7°C (25.9-30.9), 33.8°C (32.0-35.4) to 33.2°C (30.5-35.0), and 34.0°C (32.0-35.1) to 34.4°C (32.7-35.6) for the tap water, Burn Cool Spray®, and Burnshield®, respectively. The variability of the mean VAS pain scores was 6.9 to 4.8 (tap water), 5.6 to 4.5 (Burn Cool Spray®), and 5.5 to 3.3 (Burnshield®). The reduction of skin surface temperature by tap water was significantly greater than that by the other two methods. All three methods reduced the VAS pain score after 20min of treatment (p<0.001). The tap water had a similar effect to that of the Burn Cool Spray® but significantly better than that of Burnshield®. There was a significant difference in the skin surface temperature and VAS pain score reduction (p=0.014 and p=0.007, respectively) between the groups cooled by tap water below and above 24°C. The patients who visited the center within 30min showed a significantly higher skin temperature than those who came after 30min did (p=0.033). Tap water and Burn Cool Spray® reduced the skin surface temperature, but the Burnshield® slightly increased it. All three cooling methods were effective in relieving pain. The temperature of the tap water used was related to the reduction in skin surface temperature and VAS pain score. The patients who visited the hospital within 30min of their burn accident needed a longer cooling time to attain a comparable skin surface temperature to those who visited after 30min.
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López-Mata MA, García-González G, Valbuena-Gregorio E, Ruiz-Cruz S, Zamudio-Flores PB, Burruel-Ibarra SE, Morales-Figueroa GG, Quihui-Cota L. Development and characteristics of biodegradable Aloe-gel/egg white films. J Appl Polym Sci 2016. [DOI: 10.1002/app.44067] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Marco Antonio López-Mata
- Departamento de Ciencias de La Salud; Universidad de Sonora, Campus Cajeme. Blvd. Bordo Nuevo S/N, Antiguo Providencia; Apdo. Postal 85040. Tel 01(644) 410 52 70. Cd. Obregón Sonora México
| | - Gerardo García-González
- Departamento de Ciencias de La Salud; Universidad de Sonora, Campus Cajeme. Blvd. Bordo Nuevo S/N, Antiguo Providencia; Apdo. Postal 85040. Tel 01(644) 410 52 70. Cd. Obregón Sonora México
| | - Edith Valbuena-Gregorio
- Departamento de Ciencias de La Salud; Universidad de Sonora, Campus Cajeme. Blvd. Bordo Nuevo S/N, Antiguo Providencia; Apdo. Postal 85040. Tel 01(644) 410 52 70. Cd. Obregón Sonora México
| | - Saúl Ruiz-Cruz
- Departamento de Biotecnología y Ciencias Alimentarias; Instituto Tecnológico de Sonora; 5 De Febrero 818 Sur, Apdo. Postal 85000, Cd. Obregón Sonora México
| | - Paul Baruk Zamudio-Flores
- Centro de Investigación en Alimentación y Desarrollo A.C; Av. Río Conchos S/N Parque Industrial, Apdo. Postal 31570 Cuauhtémoc Chihuahua México
| | - Silvia Elena Burruel-Ibarra
- Departamento de Investigación en Polímeros y Materiales; Universidad de Sonora, Unidad Centro; Apdo. Postal 83000 Hermosillo Sonora México
| | - Gloria Guadalupe Morales-Figueroa
- Departamento de Nutrición Pública y Salud, Coordinación de Nutrición; Centro de Investigación en Alimentación y Desarrollo; A.C. Carretera al Ejido La Victoria Km 0.6, Apdo. Postal 83304 Hermosillo Sonora México
| | - Luis Quihui-Cota
- Departamento de Nutrición Pública y Salud, Coordinación de Nutrición; Centro de Investigación en Alimentación y Desarrollo; A.C. Carretera al Ejido La Victoria Km 0.6, Apdo. Postal 83304 Hermosillo Sonora México
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Low WL, Kenward K, Britland ST, Amin MC, Martin C. Essential oils and metal ions as alternative antimicrobial agents: a focus on tea tree oil and silver. Int Wound J 2016; 14:369-384. [PMID: 27146784 DOI: 10.1111/iwj.12611] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 04/04/2016] [Accepted: 04/06/2016] [Indexed: 01/22/2023] Open
Abstract
The increasing occurrence of hospital-acquired infections and the emerging problems posed by antibiotic-resistant microbial strains have both contributed to the escalating cost of treatment. The presence of infection at the wound site can potentially stall the healing process at the inflammatory stage, leading to the development of a chronic wound. Traditional wound treatment regimes can no longer cope with the complications posed by antibiotic-resistant strains; hence, there is a need to explore the use of alternative antimicrobial agents. Pre-antibiotic compounds, including heavy metal ions and essential oils, have been re-investigated for their potential use as effective antimicrobial agents. Essential oils have potent antimicrobial, antifungal, antiviral, anti-inflammatory, antioxidant and other beneficial therapeutic properties. Similarly, heavy metal ions have also been used as disinfecting agents because of their broad spectrum activities. Both of these alternative antimicrobials interact with many different intracellular components, thereby resulting in the disruption of vital cell functions and eventually cell death. This review will discuss the application of essential oils and heavy metal ions, particularly tea tree oil and silver ions, as alternative antimicrobial agents for the treatment of chronic, infected wounds.
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Affiliation(s)
- Wan-Li Low
- School of Pharmacy, University of Wolverhampton, Wolverhampton, UK
| | - Ken Kenward
- School of Pharmacy, University of Wolverhampton, Wolverhampton, UK
| | - Stephen T Britland
- School of Pharmacy, University of Wolverhampton, Wolverhampton, UK.,Research Institute in Healthcare Science, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK
| | - Mohd Cim Amin
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Claire Martin
- School of Pharmacy, University of Wolverhampton, Wolverhampton, UK.,Research Institute in Healthcare Science, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK
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Ionically Crosslinked Chitosan Hydrogels for the Controlled Release of Antimicrobial Essential Oils and Metal Ions for Wound Management Applications. MEDICINES 2016; 3:medicines3010008. [PMID: 28930118 PMCID: PMC5456230 DOI: 10.3390/medicines3010008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 02/01/2016] [Accepted: 02/17/2016] [Indexed: 12/23/2022]
Abstract
The emerging problems posed by antibiotic resistance complicate the treatment regime required for wound infections and are driving the need to develop more effective methods of wound management. There is growing interest in the use of alternative, broad spectrum, pre-antibiotic antimicrobial agents such as essential oils (e.g., tea tree oil, TTO) and metal ions (e.g., silver, Ag+). Both TTO and Ag+ have broad spectrum antimicrobial activity and act on multiple target sites, hence reducing the likelihood of developing resistance. Combining such agents with responsive, controlled release delivery systems such as hydrogels may enhance microbiocidal activity and promote wound healing. The advantages of using chitosan to formulate the hydrogels include its biocompatible, mucoadhesive and controlled release properties. In this study, hydrogels loaded with TTO and Ag+ exhibited antimicrobial activity against P. aeruginosa, S. aureus and C. albicans. Combining TTO and Ag+ into the hydrogel further improved antimicrobial activity by lowering the effective concentrations required, respectively. This has obvious advantages for reducing the potential toxic effects on the healthy tissues surrounding the wound. These studies highlight the feasibility of delivering lower effective concentrations of antimicrobial agents such as TTO and Ag+ in ionically crosslinked chitosan hydrogels to treat common wound-infecting pathogens.
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Walsh K, Stiles K, Dheansa B. Letter in Response to: European Resuscitation Council's guidelines for resuscitation 2015. Resuscitation 2016; 99:e13. [DOI: 10.1016/j.resuscitation.2015.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 11/15/2015] [Indexed: 11/28/2022]
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28
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Concerns relating to the European resuscitation guidelines for the first aid management of burns. Burns 2016; 42:240-241. [DOI: 10.1016/j.burns.2015.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 11/16/2015] [Indexed: 11/22/2022]
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Homeyer DC, Sanchez CJ, Mende K, Beckius ML, Murray CK, Wenke JC, Akers KS. In vitro activity of Melaleuca alternifolia (tea tree) oil on filamentous fungi and toxicity to human cells. Med Mycol 2015; 53:285-94. [PMID: 25631479 DOI: 10.1093/mmy/myu072] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Invasive fungal wound infections (IFIs) are increasingly reported in trauma patients and cause considerable morbidity and mortality despite standard of care treatment in trauma centers by experienced medical personnel. Topical agents such as oil of melaleuca, also known as tea tree oil (TTO), have been proposed for adjunctive treatment of IFIs. We evaluated the activity of TTO against filamentous fungi associated with IFIs by testing 13 clinical isolates representing nine species via time-kill assay with seven concentrations of TTO (100%, 75%, 50%, 25%, 10%, 5%, and 1%). To ascertain the safety of topical application to wounds, cell viability assays were performed in vitro using human fibroblasts, keratinocytes, osteoblasts, and umbilical vein endothelial cells with 10 concentrations of TTO (75%, 50%, 25%, 10%, 5%, and 10-fold serial dilutions from 1 to 0.0001%) at five time points (5, 15, 30, 60, and 180 min). Compatibility of TTO with explanted porcine tissues was also assessed with eight concentrations of TTO (100%, 75%, 50%, 25%, 10%, 5%, 1%, and 0.1%) at the time points used for cellular assays and at 24 h. The time-kill studies showed that fungicidal activity was variable between isolates. The effect of TTO on cell viability was primarily concentration dependent with significant cytotoxicity at concentrations of ≥ 10% and ≥ 50% for cells lines and whole tissue, respectively. Our findings demonstrate that TTO possesses antifungal activity against filamentous fungi associated with IFIs; furthermore that negligible effects on whole tissues, in contrast to individual cells, were observed following exposure to TTO. Collectively, these findings indicate a potential use of TTO as topical treatment of IFIs.
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Affiliation(s)
- Diane C Homeyer
- Department of Medicine, Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, TX, USA
| | - Carlos J Sanchez
- Extremity Trauma & Regenerative Medicine Task Area, United States Army Institute of Surgical Research, Fort Sam Houston, TX, USA
| | - Katrin Mende
- Department of Medicine, Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, TX, USA Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Miriam L Beckius
- Department of Clinical Investigation, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Clinton K Murray
- Department of Medicine, Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, TX, USA
| | - Joseph C Wenke
- Extremity Trauma & Regenerative Medicine Task Area, United States Army Institute of Surgical Research, Fort Sam Houston, TX, USA
| | - Kevin S Akers
- Department of Medicine, Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, TX, USA Extremity Trauma & Regenerative Medicine Task Area, United States Army Institute of Surgical Research, Fort Sam Houston, TX, USA
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Fein M, Quinn J, Watt K, Nichols T, Kimble R, Cuttle L. Prehospital paediatric burn care: New priorities in paramedic reporting. Emerg Med Australas 2014; 26:609-15. [PMID: 25348749 DOI: 10.1111/1742-6723.12313] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The present study evaluates the prehospital care of paediatric burn patients in Queensland (QLD). As first aid (FA) treatment has been shown to affect burn progression and outcome, the FA treatment and the risk of associated hypothermia in paediatric patients were specifically examined in the context of paramedic management of burn patients. METHODS Data were retrospectively collected from electronic ambulance response forms (eARFs) for paediatric burn patients (0-5 years) who were attended by Queensland Ambulance Service (QAS) from 2008 to 2010. Data were collected from 117 eARFs of incidents occurring within the Brisbane, Townsville and Cairns regions. RESULTS Initial FA measures were recorded in 77.8% of cases, with cool running water FA administered in 56.4% of cases. The duration of FA was recorded in 29.9% of reports. The duration of FA was significantly shorter for patients in Northern QLD (median = 10 min, n = 10) compared with Brisbane (median = 15 min, n = 18), P = 0.005. Patient temperatures were recorded significantly more often in Brisbane than in other regions (P = 0.041); however, in total, only 24.8% of all patients had documented temperature readings. Of these, six (5%) were recorded as having temperatures ≤ 36.0°C. Burnaid(TM) was the most commonly used dressing and was applied to 55.6% of all patients; however, it was applied with a variety of different outer dressings. Brisbane paramedics applied Burnaid significantly less often (44.3%) compared with paramedics from Northern QLD (72.7%) and Far Northern QLD (60.9%), P = 0.025. CONCLUSIONS Despite FA and patient temperatures being important prognostic factors for burn patients, paramedic documentation of these was often incomplete, and there was no consistent use of burns dressings.
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Affiliation(s)
- Mikaela Fein
- Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, University of Queensland, Brisbane, Queensland, Australia
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Akhoondinasab MR, Khodarahmi A, Akhoondinasab M, Saberi M, Iranpour M. Assessing effect of three herbal medicines in second and third degree burns in rats and comparison with silver sulfadiazine ointment. Burns 2014; 41:125-31. [PMID: 24907191 DOI: 10.1016/j.burns.2014.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 03/13/2014] [Accepted: 04/02/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Assessing effect of three herbal medicines on healing of deep second and third degree burns in rats and their comparison with silver sulfadiazine group. METHODS AND MATERIALS 40 rats were randomly assigned to one of the four groups, each group 10 rats. A deep second degree burn and a third degree burn were induced on the lower back and upper back of each rat under standard burning procedure, respectively. The burns were daily dressed with Robacin in group 1, silver sulfadiazine in group 2, aloe vera extract in group 3, and Rimojen in group 4. Responses to the treatment were assessed by digital photography during the treatment until day 32. Histological parameters (PMN, epithelialization, fibrosis, and angiogenesis) were assessed after the scar biopsy at the end of the research. RESULTS On the basis of the taken photos, the wound had better healing in Robacin group. Also, speed of healing was better in aloe vera group than silver sulfadiazine and Rimojen groups. In terms of wound surface area maximal improvement was observed at the same time in the second and third degree burn wounds in Robacin group, in the second degree wound of aloe vera and Rimojen groups, and in the third degree wound of aloe vera and silver sulfadiazine groups. In pathological respects, epithelialization was more evident in both wounds of aloe vera group and third degree burn of Robacin group. In both wounds of Robacin group (second and third degree), the extend of angiogenesis and fibrosis was significantly less than other groups; but, inflammation was at a less level in third degree of silver, second degree of Rimogen and aloe vera, and third degree of aloe vera groups. CONCLUSION In histological survey, minimal rate of angiogenesis and fibrosis was seen in Robacin group, which indicated less wound scar in this group. Healing speed of the burn wound was also higher in Robacin group.
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Affiliation(s)
- Mohammad Reza Akhoondinasab
- Faculty of Plastic and Reconstructive Surgery, Burn Research Centre, Iran University of Medical Sciences, Tehran, Iran.
| | - Ali Khodarahmi
- Burn Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mohsen Saberi
- Medicine, Quran and Hadith Research Center and Department of Community Medicine, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Polymeric films loaded with vitamin E and aloe vera for topical application in the treatment of burn wounds. BIOMED RESEARCH INTERNATIONAL 2014; 2014:641590. [PMID: 24524083 PMCID: PMC3912760 DOI: 10.1155/2014/641590] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 12/07/2013] [Indexed: 11/18/2022]
Abstract
Burns are serious traumas related to skin damage, causing extreme pain and possibly death. Natural drugs such as Aloe vera and vitamin E have been demonstrated to be beneficial in formulations for wound healing. The aim of this work is to develop and evaluate polymeric films containing Aloe vera and vitamin E to treat wounds caused by burns. Polymeric films containing different quantities of sodium alginate and polyvinyl alcohol (PVA) were characterized for their mechanical properties and drug release. The polymeric films, which were produced, were thin, flexible, resistant, and suitable for application on damaged skin, such as in burn wounds. Around 30% of vitamin E acetate was released from the polymeric films within 12 hours. The in vivo experiments with tape stripping indicated an effective accumulation in the stratum corneum when compared to a commercial cream containing the same quantity of vitamin E acetate. Vitamin E acetate was found in higher quantities in the deep layers of the stratum corneum when the film formulation was applied. The results obtained show that the bioadhesive films containing vitamin E acetate and Aloe vera could be an innovative therapeutic system for the treatment of burns.
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Are parents in the UK equipped to provide adequate burns first aid? Burns 2012; 38:438-43. [DOI: 10.1016/j.burns.2011.08.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 08/25/2011] [Accepted: 08/25/2011] [Indexed: 11/22/2022]
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Abstract
Burns commonly occur in children and their first aid remains inadequate despite burn prevention programmes. While scald injuries predominate, contact and flame burns remain common. Although typically less severe injuries overall than those in adults, hypertrophic scarring complicating both the burn wound and even donor sites occur more frequently in children. The heterogeneous nature of burn wounds, coupled with the difficulties associated with the early clinical assessment of burn depth, has stimulated the application of novel technologies to predict burn wound outcome. This review explores current best practice in the management of paediatric burns, with a focus on prevention, optimal first aid, resuscitation, burn wound prediction and wound management strategies.
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Affiliation(s)
- Leo K P Kim
- The Children's Hospital at Westmead Burns Research Institute, Sydney Medical School, The University of Sydney, New South Wales, Australia
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Seoighe DM, Baker JF, Conroy F. Licking as an out-of-hospital burns treatment-An isolated cultural phenomenon? Burns 2010; 37:348-50. [PMID: 21074331 DOI: 10.1016/j.burns.2010.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 08/14/2010] [Accepted: 08/20/2010] [Indexed: 11/30/2022]
Abstract
Wound management in burns is a potentially complex issue. Salivary constituents have been shown experimentally to be of benefit in the treatment of thermal injuries. In our clinical experience we have encountered patients who have saliva directly applied to the burn wound prior to presenting to the national burns service. The practice is known as "Licking". We report two cases to illustrate the presentations we have encountered. We believe that these illustrate an isolated phenomenon unique to the Republic of Ireland.
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Affiliation(s)
- Deirdre M Seoighe
- Department of Plastic Surgery, Our Ladys Hospital for Sick Children, Crumlin, Dublin 12, Ireland.
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The optimal duration and delay of first aid treatment for deep partial thickness burn injuries. Burns 2010; 36:673-9. [DOI: 10.1016/j.burns.2009.08.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Revised: 07/23/2009] [Accepted: 08/10/2009] [Indexed: 11/20/2022]
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Cuttle L, Pearn J, McMillan JR, Kimble RM. A review of first aid treatments for burn injuries. Burns 2009; 35:768-75. [DOI: 10.1016/j.burns.2008.10.011] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 10/31/2008] [Indexed: 11/26/2022]
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Design of a cervical collar device to facilitate and accelerate implementation of first aid. J Med Syst 2009; 34:573-8. [PMID: 20703911 DOI: 10.1007/s10916-009-9270-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 02/23/2009] [Indexed: 10/21/2022]
Abstract
Frequently there are disasters all over the world-fires, earthquakes, or even some unexpected shocking catastrophes. Hence people injured, or even died. Lifesaving actions begin with the initiation of the chain of survival. With every minute that passes without medical action being taken, the probability of being able to save the patients life decreases by ten percent. After 10 min there is normally no chance of resuscitation being successful. First aid is emergency treatment given before regular medical aid can be obtained. And it is a concept of first hands-on measures performed in a medical emergency by laypersons. The major aim of this study is to develop an easy-feasible cervical collar, for facilitating and accelerating implementation of first aid especially in case of collective injuries. The developed device is different from the cervical collars which are used to treat the neck pain. In the present study, the heartbeat is obtained by detecting pulse with the stethoscope that is a part of the developed device and fixed on the carorid artery. The obtained heartbeat signal has been processed by the electronic control circuit and the used LED has given light according to the patient's life signal. Although there are some disadvantages of the developed system, the precautions for these cases have been taken and the system has been tried to design in order to operate sensibly.
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