The year in burns 2013

Prescripción del ejercicio físico y sus implicaciones en adultos que han sufrido quemaduras

Introducción. La prescripción del ejercicio físico y sus implicaciones en pacientes que han sufrido quemaduras es objeto de estudio en diferentes investigaciones debido al impacto físico, psicológico y social que tiene en las personas.Objetivo. Describir la prescripción de ejercicio físico y sus implicaciones en la población adulta que ha sufrido quemaduras.Materiales y métodos. Se realizó una revisión de tema por medio de exploración de artículos de manera electrónica con filtros de búsqueda en distintas bases de datos con términos DeCS y MeSH.Resultados. Se seleccionaron 11 artículos con intervención de ejercicio físico en fases aguda y crónica. Se incluyeron estrategias sobre la fuerza muscular en cinco de los artículos: tres de resistencia cardiovascular; dos de rango de movimiento, flexibilidad y características tróficas de la piel, y uno de dolor.Conclusiones. Las variables de la prescripción se determinan de acuerdo a las características propias que presenta la persona con quemadura, las cuales se resumen en esta revisión.

Multidrug resistant Pseudomonas aeruginosa in Estonian hospitals

Background

We aimed to identify the main spreading clones, describe the resistance mechanisms associated with carbapenem- and/or multidrug-resistant P. aeruginosa and characterize patients at risk of acquiring these strains in Estonian hospitals.

Methods

Ninety-two non-duplicated carbapenem- and/or multidrug-resistant P. aeruginosa strains were collected between 27th March 2012 and 30th April 2013. Clinical data of the patients was obtained retrospectively from the medical charts. Clonal relationships of the strains were determined by whole genome sequencing and analyzed by multi-locus sequence typing. The presence of resistance genes and beta-lactamases and their origin was determined. Combined-disk method and PCR was used to evaluate carbapenemase and metallo-beta-lactamase production.

Results

Forty-three strains were carbapenem-resistant, 11 were multidrug-resistant and 38 were both carbapenem- and multidrug-resistant. Most strains (54%) were isolated from respiratory secretions and caused an infection (74%). Over half of the patients (57%) were ≥ 65 years old and 85% had ≥1 co-morbidity; 96% had contacts with healthcare and/or had received antimicrobial treatment in the previous 90 days.

Clinically relevant beta-lactamases (OXA-101, OXA-2 and GES-5) were found in 12% of strains, 27% of which were located in plasmids. No Ambler class B beta-lactamases were detected. Aminoglycoside modifying enzymes were found in 15% of the strains. OprD was defective in 13% of the strains (all with CR phenotype); carbapenem resistance triggering mutations (F170 L, W277X, S403P) were present in 29% of the strains. Ciprofloxacin resistance correlated well with mutations in topoisomerase genes gyrA (T83I, D87N) and parC (S87 L). Almost all strains (97%) with these mutations showed ciprofloxacin-resistant phenotype.

Multi-locus sequence type analysis indicated high diversity at the strain level – 36 different sequence types being detected. Two sequence types (ST108 (n = 23) and ST260 (n = 18)) predominated. Whereas ST108 was associated with localized spread in one hospital and mostly carbapenem-resistant phenotype, ST260 strains occurred in all hospitals, mostly with multi-resistant phenotype and carried different resistance genotype/machinery.

Conclusions

Diverse spread of local rather than international P. aeruginosa strains harboring multiple chromosomal mutations, but not plasmid-mediated Ambler class B beta-lactamases, were found in Estonian hospitals.

Trial registration

This trial was registered retrospectively in ClinicalTrials.gov (NCT03343119).

Electronic supplementary material

The online version of this article (10.1186/s12879-018-3421-1) contains supplementary material, which is available to authorized users.

Use of Essential Oils Following Traumatic Burn Injury: A Case Study

Hospital admissions related to burn injury reach 40,000 annually. Patients who experience extensive burns require longer hospital stays and are at increased risk for infection and hospital acquired conditions. This comparative case study is a two patient matched case control design that follows the hospital course of two children who experienced burn injuries. For one of these patients, with the consent of the child's parents, the grandmother treated her granddaughter with essential oils. Essential oils have the potential to inhibit microbial growth, support treatment of wounds, and facilitate healing. However, there have been no large scale studies on essential oils. Data for the two cases were retrieved from the electronic medical record at a Midwestern Pediatric Hospital. Retrieved data included burn site description, treatment for burns, number of days on the ventilator, white blood cell count, length of hospital stay, number of ICU days, infections diagnosed by positive culture and pain ratings. While the goals for treatment were the same for both children, the child who received only standard care was diagnosed with two blood stream infections and four hospital acquired conditions while the child who received supplemental treatment with essential oils did not develop any blood stream infections, was diagnosed with one hospital acquired condition, was in the PICU one day less, and had a four day shorter length of hospital stay. While these case findings are intriguing, research is needed to expand understanding of the role of essential oils in the treatment of burns.

Wound Healing Effects of Prunus yedoensis Matsumura Bark in Scalded Rats

Pruni Cortex has been used to treat asthma, measles, cough, urticaria, pruritus, and dermatitis in traditional Korean medicine. The objective of this study was to investigate the effects of Prunus yedoensis Matsumura bark methanol extract (PYE) on scald-induced dorsal skin wounds in rats. Scalds were produced in Sprague-Dawley rats with 100°C water and treated with 5% and 20% PYE (using Vaseline as a base), silver sulfadiazine (SSD), and Vaseline once a day for 21 days, beginning 24 hours after scald by treatment group allocation. The PYE-treated groups showed accelerated healing from 12 days after scald, demonstrated by rapid eschar exfoliation compared to the control and SSD groups. PYE-treated groups showed higher wound contraction rates and better tissue regeneration in comparison with the control group. Serum analysis showed that transforming growth factor beta 1 and vascular endothelial growth factor levels remained high or gradually increased up to day 14 in both PYE groups and then showed a sharp decline by day 21, implying successful completion of the inflammatory phase and initiation of tissue regeneration. These findings suggested that PYE is effective in promoting scald wound healing in the inflammation and tissue proliferation stages.