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Amaris-Acuña JS, Mendoza-Toro B, Camacho-Obando D, Gómez-Ortega V. Customized Negative Pressure Wound Therapy: Innovative Design in Polyurethane Foam for Complex Burn Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6028. [PMID: 39114795 PMCID: PMC11302936 DOI: 10.1097/gox.0000000000006028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 05/31/2024] [Indexed: 08/10/2024]
Abstract
The use of negative pressure wound therapy (NPWT) throughout the entire treatment of a burn patient boosts wound healing and recovery. Hand burns require specialized management that enhances wound healing and facilitates early physical rehabilitation. Thus, this article showcases a novel idea of NPWT foam customization that boosts recovery and rehabilitation in patients with hand burns. We present two patients with hand burns treated with NPWT using a customized foam design that allowed for early rehabilitation while providing and optimized recovery. In the two cases presented, the patients required two surgical stages; in the first surgery, debridement of the burns was performed and customized NPWT with instillation was applied, and in the second surgical stage, the bed was reconstructed with partial-thickness skin grafts, which were bolstered with customized conventional NPWT. The management, reconstruction, and rehabilitation were accomplished in under 2 weeks, achieving a remarkable 100% success rate in graft integration during the acute phase on the first attempt. This highlights the effectiveness of incorporating NPWT across all burn treatment phases, expediting recovery and ensuring optimal functional outcomes for patients. Surgeons can customize different NPWT foam shapes that facilitate its use on difficult-to-treat areas, allowing for a faster recovery and better rehabilitation outcomes.
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Affiliation(s)
| | - Bibiana Mendoza-Toro
- Burn Unit and Plastic and Reconstructive Surgery Department, Fundación Santa Fé de Bogotá, Bogotá, Colombia
| | - David Camacho-Obando
- Burn Unit and Plastic and Reconstructive Surgery Department, Fundación Santa Fé de Bogotá, Bogotá, Colombia
| | - Viviana Gómez-Ortega
- Burn Unit and Plastic and Reconstructive Surgery Department, Fundación Santa Fé de Bogotá, Bogotá, Colombia
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Aryee G, Aborbi VM, Essuman R, Pereko J, Djagbletey R, Darkwa EO. Predictors of household direct cost of burn injury in adult patients at a tertiary healthcare facility in Ghana: an analytical cross-sectional study in Korle-Bu Teaching Hospital. Pan Afr Med J 2024; 48:9. [PMID: 38946741 PMCID: PMC11214145 DOI: 10.11604/pamj.2024.48.9.38266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/11/2024] [Indexed: 07/02/2024] Open
Abstract
Introduction treatment of severe burn injury generally requires enormous human and material resources including specialized intensive care, staged surgery, and continued restoration. This contributes to the enormous burden on patients and their families. The cost of burn treatment is influenced by many factors including the demographic and clinical characteristics of the patient. This study aimed to determine the costs of burn care and its associated predictive factors in Korle-Bu Teaching Hospital, Ghana. Methods an analytical cross-sectional study was conducted among 65 consenting adult patients on admission at the Burns Centre of the Korle-Bu Teaching Hospital. Demographic and clinical characteristics of patients as well as the direct cost of burns treatment were obtained. Multiple regression analysis was done to determine the predictors of the direct cost of burn care. Results a total of sixty-five (65) participants were enrolled in the study with a male-to-female ratio of 1.4: 1 and a mean age of 35.9 ± 14.6 years. Nearly 85% sustained between 10-30% total body surface area burns whilst only 6.2% (4) had burns more than 30% of total body surface area. The mean total cost of burns treatment was GHS 22,333.15 (USD 3,897.58). Surgical treatment, wound dressing and medication charges accounted for 45.6%, 27.5% and 9.8% of the total cost of burn respectively. Conclusion the direct costs of burn treatment were substantially high and were predicted by the percentage of total body surface area burn and length of hospital stay.
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Affiliation(s)
- George Aryee
- Department of Anaesthesia, University of Ghana Medical School, Korle-Bu, Accra, Ghana
| | - Veronica Mamle Aborbi
- Reconstructive Plastic Surgery and Burns Centre, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Raymond Essuman
- Department of Anaesthesia, University of Ghana Medical School, Korle-Bu, Accra, Ghana
| | - Janet Pereko
- Reconstructive Plastic Surgery and Burns Centre, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Robert Djagbletey
- Department of Anaesthesia, University of Ghana Medical School, Korle-Bu, Accra, Ghana
| | - Ebenezer Owusu Darkwa
- Department of Anaesthesia, University of Ghana Medical School, Korle-Bu, Accra, Ghana
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Ghadimi T, Naderi Gharahgheshlagh S, Latifi N, Hivechi A, Hosseinpour Sarmadi V, Farokh Forghani S, Amini N, B Milan P, Latifi F, Hamidi M, Larijani G, Haramshahi SMA, Abdollahi M, Ghadimi F, Nezari S. The Effect of Rainbow Trout (Oncorhynchus mykiss) Collagen Incorporated with Exo-Polysaccharides Derived from Rhodotorula mucilaginosa sp. on Burn Healing. Macromol Biosci 2023; 23:e2300033. [PMID: 37120148 DOI: 10.1002/mabi.202300033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/03/2023] [Indexed: 05/01/2023]
Abstract
Burn is one of the physically debilitating injuries that can be potentially fatal; therefore, providing appropriate coverage in order to reduce possible mortality risk and accelerate wound healing is mandatory. In this study, collagen/exo-polysaccharide (Col/EPS 1-3%) scaffolds are synthesized from rainbow trout (Oncorhynchus mykiss) skins incorporated with Rhodotorula mucilaginosa sp. GUMS16, respectively, for promoting Grade 3 burn wound healing. Physicochemical characterizations and, consequently, biological properties of the Col/EPS scaffolds are tested. The results show that the presence of EPS does not affect the minimum porosity dimensions, while raising the EPS amount significantly reduces the maximum porosity dimensions. Thermogravimetric analysis (TGA), FTIR, and tensile property results confirm the successful incorporation of the EPS into Col scaffolds. Furthermore,the biological results show that the increasing EPS does not affect Col biodegradability and cell viability, and the use of Col/EPS 1% on rat models displays a faster healing rate. Finally, histopathological examination reveals that the Col/EPS 1% treatment accelerates wound healing, through greater re-epithelialization and dermal remodeling, more abundant fibroblast cells and Col accumulation. These findings suggest that Col/EPS 1% promotes dermal wound healing via antioxidant and anti-inflammatory activities, which can be a potential medical process in the treatment of burn wounds.
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Affiliation(s)
- Tayyeb Ghadimi
- Burn Research Center, Iran University of Medical Sciences, Shahid Motahari Hospital, Shahid Yasemi Street, Valiasr Street, Tehran, 1996714353, Iran
- Department of Plastic and Reconstructive Surgery, School of Medicine, Iran University of Medical Sciences, Hazrat-e Fatemeh Hospital, 21th Alley, Seyed Jamaloddin Asad Abadi Street, Tehran, 1433933111, Iran
| | - Soheila Naderi Gharahgheshlagh
- Burn Research Center, Iran University of Medical Sciences, Shahid Motahari Hospital, Shahid Yasemi Street, Valiasr Street, Tehran, 1996714353, Iran
- Department of Plastic and Reconstructive Surgery, School of Medicine, Iran University of Medical Sciences, Hazrat-e Fatemeh Hospital, 21th Alley, Seyed Jamaloddin Asad Abadi Street, Tehran, 1433933111, Iran
| | - Noorahmad Latifi
- Department of Plastic and Reconstructive Surgery, School of Medicine, Iran University of Medical Sciences, Hazrat-e Fatemeh Hospital, 21th Alley, Seyed Jamaloddin Asad Abadi Street, Tehran, 1433933111, Iran
| | - Ahmad Hivechi
- Department of Plastic and Reconstructive Surgery, School of Medicine, Iran University of Medical Sciences, Hazrat-e Fatemeh Hospital, 21th Alley, Seyed Jamaloddin Asad Abadi Street, Tehran, 1433933111, Iran
- Martin-Luther-University Halle-Wittenberg, Institute of Pharmacy, 6099, Halle (Saale), Germany
- Faculty of Advanced Technologies in Medicine, Institutes of Regenerative Medicine, Iran University of Medical Sciences, Tehran, 1449614535, Iran
| | - Vahid Hosseinpour Sarmadi
- Faculty of Advanced Technologies in Medicine, Institutes of Regenerative Medicine, Iran University of Medical Sciences, Tehran, 1449614535, Iran
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, 1996714353, Iran
| | - Siamak Farokh Forghani
- Burn Research Center, Iran University of Medical Sciences, Shahid Motahari Hospital, Shahid Yasemi Street, Valiasr Street, Tehran, 1996714353, Iran
- Department of Plastic and Reconstructive Surgery, School of Medicine, Iran University of Medical Sciences, Hazrat-e Fatemeh Hospital, 21th Alley, Seyed Jamaloddin Asad Abadi Street, Tehran, 1433933111, Iran
| | - Naser Amini
- Faculty of Advanced Technologies in Medicine, Institutes of Regenerative Medicine, Iran University of Medical Sciences, Tehran, 1449614535, Iran
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, 1996714353, Iran
| | - Peiman B Milan
- Faculty of Advanced Technologies in Medicine, Institutes of Regenerative Medicine, Iran University of Medical Sciences, Tehran, 1449614535, Iran
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, 1996714353, Iran
| | - Fatemeh Latifi
- Department of Oral and Maxillofacial Surgery, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, 1983969411, Iran
| | - Masoud Hamidi
- Faculty of Paramedicine, Department of Medical Biotechnology, Guilan University of Medical Sciences, Rasht, 4188794755, Iran
| | - Ghazaleh Larijani
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, 1477893855, Iran
| | - Seyed Mohammad Amin Haramshahi
- Faculty of Advanced Technologies in Medicine, Institutes of Regenerative Medicine, Iran University of Medical Sciences, Tehran, 1449614535, Iran
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, 1996714353, Iran
| | - Motahareh Abdollahi
- Department of Plastic and Reconstructive Surgery, School of Medicine, Iran University of Medical Sciences, Hazrat-e Fatemeh Hospital, 21th Alley, Seyed Jamaloddin Asad Abadi Street, Tehran, 1433933111, Iran
| | - Fatemeh Ghadimi
- Department of Plastic and Reconstructive Surgery, School of Medicine, Iran University of Medical Sciences, Hazrat-e Fatemeh Hospital, 21th Alley, Seyed Jamaloddin Asad Abadi Street, Tehran, 1433933111, Iran
| | - Saeed Nezari
- Department of Plastic and Reconstructive Surgery, School of Medicine, Iran University of Medical Sciences, Hazrat-e Fatemeh Hospital, 21th Alley, Seyed Jamaloddin Asad Abadi Street, Tehran, 1433933111, Iran
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Hsu KC. Impact of long-term outcomes on the caregivers of burn survivors. Burns 2023; 49:317-328. [PMID: 36195483 DOI: 10.1016/j.burns.2022.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/21/2022] [Accepted: 08/30/2022] [Indexed: 11/02/2022]
Abstract
This prospective longitudinal study investigated the changes in caregiving burden, post-traumatic stress disorder (PTSD), and quality of life (QoL) of primary caregivers of burn survivors 48 h, 3 months, 6 months, and 12 months after the burn event. We also explored and identified relevant factors associated with these metrics. We collected data regarding the sociodemographic and injury characteristics of 69 caregivers and their survivors. Their responses were recorded to the Caregiver Burden Scale (CBS), Impact of Events Scale for Burn (IESB), and Short Form-36 questionnaires. Temporal changes in the CBS, IESB, and SF-36 scores and their differences were analyzed using the generalized estimating equation. Among the caregivers of children, QoL decreased with increasing children's total burn surface area (TBSA) and length of hospital stays, caregivers being female, decreasing caregivers' age, increasing the time required to travel to and from the hospital, and increasing global and subjective burdens. Among the caregivers of adults, QoL decreased with increasing survivors' TBSA and caregivers' PTSD. Based on these results, several recommendations for implementation in clinical practice include integrating caregivers into care plans and encouraging active participation, providing learning and consultation channels, and encouraging caregivers to schedule breaks from caregiving activities.
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Affiliation(s)
- Kuo-Cheng Hsu
- Linkou Chang Gung Memorial Hospital Burn Center, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan, ROC; School of Nursing, College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 33302, Taiwan, ROC.
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Zeng Z, Li N, Yang L, Feng X, Zuo F, Luo G, Peng Y, Yuan Z. Cost analysis of severe burn victims in Southwest China: A 7-year retrospective study. Front Public Health 2023; 10:1052293. [PMID: 36699890 PMCID: PMC9868295 DOI: 10.3389/fpubh.2022.1052293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/06/2022] [Indexed: 01/11/2023] Open
Abstract
Background Severe burn injury can be a life-threatening experience and can also lead to financial issues for suffers. The purpose of the current study was to analyze the direct hospitalization costs of severe burn inpatients in Southwest China. Methods Data related to all inpatients admitted with severe burns [total body surface area (TBSA) ≥30%] pooled from 2015 to 2021 were reviewed retrospectively at the Institute of Burn Research of Army Medical University. Demographic parameters, medical economics, and clinical data were obtained from medical records. Results A total of 668 cases were identified. The average age was 37.49 ± 21.00 years, and 72.3% were men. The average TBSA was 51.35 ± 19.49%. The median length of stay of inpatients in the burn intensive care unit was 14 [interquartile range (IQR): 5.0-34.8] days, and the median length of stay (LOS) was 41 (IQR: 22.0-73.8) days. The mortality rate was 1.6%. The median total cost was 212,755.45 CNY (IQR: 83,908.80-551,621.57 CNY) per patient varying from 3,521.30 to 4,822,357.19 CNY. The direct cost of scald burns was dramatically lower compared with that of other types of burns, with 11,213.43 to 2,819,019.14 CNY. Medical consumables presented the largest portion of total costs, with a median cost of 65,942.64 CNY (IQR: 18,771.86-171,197.97 CNY). The crucial risk factors for medical cost in our study were TBSA, surgical frequency, LOS, depth of burn, and outcome. Conclusion We conclude that an effective burn prevention program, shorter hospital stays, and facilitating the healing of wounds should be focused on with tailored precautionary protocols to reduce the medical costs of inpatients with severe burns.
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Salendo J, Ximenes J, Soares A, Guest G, Hagander L. Acute burn care and outcomes at the Hospital Nacional Guido Valadares (HNGV), Timor-Leste: A 7-year retrospective study. Medicine (Baltimore) 2022; 101:e32113. [PMID: 36550901 PMCID: PMC9771211 DOI: 10.1097/md.0000000000032113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The purpose of this study was to describe the epidemiology of patients presenting with acute burns and undergoing admission at Hospital Nacional Guido Valadares (HNGV) in Dili, Timor-Leste in the period 2013 to 2019. HNGV is the only tertiary referral hospital in Timor-Leste. This was a retrospective study involving all acute burn patients admitted to the surgical wards of HNGV from 2013 to 2019. The data was collected from patient charts and hospital medical archives. Data were reviewed and analyzed statistically in terms of age, gender, residence, cause, total body surface area (TBSA), burns depth, length of stay (LOS), and mortality. The outcomes were analyzed using logistic regression. Over the 7-year period, there were 288 acute burn patients admitted to the surgical wards of HNGV. Most patients were children (55%), male (65%) and from the capital city of Dili or surrounding areas (59%). The most common cause of burns in children was scalds and the most common cause among adults was flames. Of the admitted patients 59% had burns affecting >10% of the TBSA and 41% had full thickness burns. The median LOS was 17 days (1-143) and the average mortality for admitted burn patients in HNGV was 5.6% (annual mortality 0-17%). The odds ratio for extended LOS was 1.9 (95% confidence interval 1.1-3.2) in female compared with male patients. The odds ratio for mortality was 14.6 (95% confidence interval 2.7-80.6) in the older adults when compared with younger adults. Higher TBSA, full thickness burns, and flame burns were also significantly associated with longer LOS and higher mortality. Children and male patients were disproportionately overrepresented among patients admitted to HNGV, while female patients had longer LOS and older adults had more severe injury and a higher risk of mortality. Establishment of a national program for the prevention of burns is essential.
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Affiliation(s)
- Junius Salendo
- Institute of Tropical Medicine and International Health Charité, Universitätsmedizin Berlin, Berlin, Germany
- Global Health, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
| | - Joao Ximenes
- Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Alito Soares
- Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Glenn Guest
- Epworth Geelong Hospital and Department of Clinical and Biomedical Sciences, Deakin University, Geelong, Victoria, Australia
| | - Lars Hagander
- Department of Clinical Sciences in Lund, Pediatric Surgery, Skåne University Hospital in Lund, Faculty of Medicine, Lund University, Lund, Sweden
- * Correspondence: Lars Hagander, Department of Clinical Sciences in Lund, Pediatric Surgery, Skåne University Hospital in Lund, Faculty of Medicine, Lund University, Lund, Sweden (e-mail: )
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7
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Soltani S, Akhbari K, Phuruangrat A. Improved Antibacterial Activity by Incorporation of Silver sulfadiazine on Nanoporous Cu-BTC Metal-Organic-Framework. Inorganica Chim Acta 2022. [DOI: 10.1016/j.ica.2022.121182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cohen-Manheim I, Harats M, Goldman S, Beylin D, Haik J, Bodas M, Givon A, Kornhaber R, Hayun Y, Cleary M, Hilewitz D, Tessone A. Burns in Israel: Etiologic, Demographic, and Clinical trends—A 9-Year Updated Comprehensive Study, 2004–2010 versus 2011–2019. Semin Plast Surg 2022; 36:66-74. [PMID: 36172009 PMCID: PMC9512588 DOI: 10.1055/s-0042-1749094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AbstractBased on the Israeli National Trauma Registry (INTR) data, this study reports etiological, demographic, and clinical trends and includes all admissions to burn and trauma centers across Israel from 2011 to 2019 and compares these with 2004 to 2010 rates. From 2011 to 2019, 5,710 patients were admitted to burn centers across Israel. Children aged 0 to 1 years (25.9%), non-Jews (40.7%), and males (67.2%) remain the main groups of the burn casualties. Most of the casualties sustained 1 to 9% total body surface area (TBSA) burns with various depths. Scalds were less fatal than fire/flame-related casualties (<1 vs. 11.5%). Fewer surgical procedures were conducted for burns under 9% TBSA compared with greater TBSA. The percentage of TBSA and burn depth were found to be the most significant predictor of mortality among all age groups (>200 times increased risk with full-thickness burns >30% TBSA burn) and correlated with prolonged length of stay (>7 days).
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Affiliation(s)
- Irit Cohen-Manheim
- Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
- School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv-Yafo, Israel
| | - Moti Harats
- School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv-Yafo, Israel
- The Division of Plastic & Reconstructive Surgery, The National Burn Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Institute for Health Research, University of Notre Dame, Notre Dame, Australia
- The Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel
| | - Sharon Goldman
- Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
- School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv-Yafo, Israel
| | - Dmitry Beylin
- The Division of Plastic & Reconstructive Surgery, The National Burn Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Josef Haik
- School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv-Yafo, Israel
- The Division of Plastic & Reconstructive Surgery, The National Burn Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- College of Health and Medicine, School of Nursing, University of Tasmania, Sydney, NSW, Australia
- Institute for Health Research, University of Notre Dame, Notre Dame, Australia
- The Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel
| | - Moran Bodas
- Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
- School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv-Yafo, Israel
| | - Adi Givon
- Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Rachel Kornhaber
- The Division of Plastic & Reconstructive Surgery, The National Burn Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- College of Health and Medicine, School of Nursing, University of Tasmania, Sydney, NSW, Australia
| | - Yehiel Hayun
- Department of Plastic Surgery and Burns, Rabin Medical Center, Petach Tikva, Israel
| | - Michelle Cleary
- School of Nursing, Midwifery and Social Sciences, CQ University, Sydney, NSW, Australia
| | - Daniel Hilewitz
- School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv-Yafo, Israel
| | - Ariel Tessone
- School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv-Yafo, Israel
- The Division of Plastic & Reconstructive Surgery, The National Burn Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- The Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel
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Keshavarzi A, Montaseri H, Akrami R, Moradi Sarvestani H, Khosravi F, Foolad S, Zardosht M, Zareie S, Saharkhiz MJ, Shahriarirad R. Therapeutic Efficacy of Great Plantain ( Plantago major L.) in the Treatment of Second-Degree Burn Wounds: A Case-Control Study. Int J Clin Pract 2022; 2022:4923277. [PMID: 35966146 PMCID: PMC9359829 DOI: 10.1155/2022/4923277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/13/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Great plantain (Plantago major L. or P.major) is a medicinal plant that is available all around the world. The whole plant has several bioactive compounds including terpenoids, flavonoids, phenolic compounds, alkaloids, fatty acids, iridoid glycosides, polysaccharides, and vitamins. Scientific studies have recognized several medical benefits like wound healing, anti-inflammatory, antimicrobial, antiulcerative, and antioxidative agents. The wound-healing capacity of this plant has been investigated under in vivo and ex vivo conditions. In the current study, we aim to compare the therapeutic effect of the P.major extract with 1% sulfadiazine on the healing of second-degree burn wounds. METHOD Second-degree burn victims were included in our study. The investigation and control group, respectively, received P. major ointment 10% and silver sulfadiazine ointment 1%. The bacterial culture from the wound site was taken on days 3, 7, 10, 13, and last day of hospitalization. Patients' subjective complaints were obtained through the visual analog scale (VAS). All patients were treated and evaluated in the hospital. RESULT Among the 15 patients, 11 were male, and the mean age was 33.3 years. The average complete healing duration was 11.73 vs. 13 days in the P. major and control group, respectively (P=0.166). On the third day, infection control was similar between the two groups, and on the seventh day, all bacterial cultures were negative. Although there was a significant reduction in pain scores during the recovery time, no significant differences in pain reduction were noted between the two groups (P=0.849). CONCLUSION We showed that P.major ointment is a safe and suitable herbal compound in the treatment of second-degree burn wounds that not only has wound-healing properties but also is an analgesic and antimicrobial compound.
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Affiliation(s)
| | - Hashem Montaseri
- Department of Quality Control, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rahimeh Akrami
- Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Fateme Khosravi
- MPH Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Foolad
- College of Agricultural Sciences, Shiraz Branch, Islamic Azad University, Shiraz, Iran
| | - Mitra Zardosht
- Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeid Zareie
- Bachelor of Nursing, Nurse of Intensive Care Unit (ICU) of Amir Al-Momenin Burn Injury Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Reza Shahriarirad
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Karimi H, Latifi NA, Mehrjerdi AZ, Jafarnejad B, Karimi AM. Histopathological Changes of Organs (Lungs, Liver, Kidney, and Brain) After Using Two Types of AgiCoat and Acticoat Nanosilver Dressings on Deep Second-Degree Burn in Rat. J Burn Care Res 2021; 41:141-150. [PMID: 31400763 DOI: 10.1093/jbcr/irz137] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Prevention of infections is a very important issue in treating the burn wounds. The nanosilver dressings have many promising advantages, but absorption of silver ions and its adverse effects to the body were always a question. The aim of this study was to compare Silver serum levels and acute toxic effects of nanosilver on histopathology of organs (lungs, liver, kidney, spleen, and brain) in two types of AgiCoat and Acticoat (nanosilver) dressings on second-degree deep burn in rat. This is an experimental study conducted in our animal laboratory. We divided 24 Sprague-Dawley male rats weighing 300 to 350 randomly into two groups. After anesthesia, a second deep-degree burn was made over dorsal skins of rats by standard method. For group A, Agicoat and, for group B, Acticoat dressings were used. The dressings were changed every 3 days with AgiCoat and Acticoat, respectively. After 14 days, we got blood samples and tissue samples taken from heart, liver, kidneys, spleen, lungs, and brain and a sample from dorsal skin of the rat for histopathological examinations. The results showed that the levels of serum silver in both groups were significantly higher than the standard level (1.22 part per million (PM); AgiCoat, P = .017; Acticoat, P = .000), but there was no significant difference between the groups (P = .551). Examination of the relationship between the level of serum silver and histopathological changes in liver showed that hepatotoxicity of AgiCoat was higher compared with Acticoat and the difference was significant (P = .002). There were no pathological changes in brain, kidneys, spleen, heart, and lungs. Wound healing was faster in Acticoat group. The nanosilver dressings can cause toxicity in liver but not in kidney, brain, spleen, heart, and lungs. Liver pathology and hepatotoxicity were more prominent in AgiCoat group. Wound healing was faster in Acticoat group.
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Affiliation(s)
- Hamid Karimi
- Hazrat Fatemeh Hospital, School of Medicine, Burn Research Center, Iran University of Medical Sciences
| | - Noor-Ahmad Latifi
- Hazrat Fatemeh Hospital, School of Medicine, Burn Research Center, Iran University of Medical Sciences
| | - Ali Zare Mehrjerdi
- Pathology Department, School of medicine, Iran University of Medical Sciences
| | - Babak Jafarnejad
- Plastic surgery Department, School of medicine, Hazrat Fatemeh Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali-Mohammad Karimi
- Pathology Department, School of medicine, Iran University of Medical Sciences
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11
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The Relationship of Orofacial Pain and Dental Health Status and Oral Health Behaviours in Facial Burn Patients. Pain Res Manag 2021; 2021:5512755. [PMID: 34055118 PMCID: PMC8123994 DOI: 10.1155/2021/5512755] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/24/2021] [Accepted: 05/03/2021] [Indexed: 12/02/2022]
Abstract
This study aims to examine the association of orofacial pain and oral health status and oral health behaviours in facial burn patients. The participants in this cross-sectional study were randomly recruited from the Burn Care Center, Institute of Medical Sciences, Islamabad, Pakistan. An intraoral evaluation was carried out to record the DMFT and OHI-S. A self-administered questionnaire was used to collect information on sociodemographic status, brushing frequency, and dental visits. Orofacial pain during mandibular movement was assessed using the Visual Analogue Scale (VAS). Psychological status was assessed using the Generalized Anxiety Disorder Scale and Impact of Events Scale. ANOVA and simple and multiple linear regression tests were used to analyse the data. From the 90 facial burn patients included, the majority were below 34 years of age, female, single or divorced, and unemployed. The mean DMFT was 10.7, and 71% had poor oral hygiene. 56% of the participants had moderate-to-severe anxiety, and 68% had posttraumatic stress disorder. 53% of the participants had moderate-to-severe pain during mouth opening or moving the mandible with a mean score of 41.5. Analyses showed that orofacial pain was associated with less frequent brushing, irregular dental visits, greater DMFT score, and more plaque accumulation (OHI-S). It was also associated with employment status, the severity of a burn, anxiety, and stress. The treatment and management of dental and oral conditions in burn patients need judicious balance in controlling and accurate assessment of the pain and improving psychological problems in burn patients.
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12
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Saavedra PAE, De Oliveira Leal JV, Areda CA, Galato D. The Costs of Burn Victim Hospital Care around the World: A Systematic Review. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:866-878. [PMID: 34183945 PMCID: PMC8223566 DOI: 10.18502/ijph.v50i5.6104] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/22/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND Burn injuries are very common and fire-related burns account for over 300,000 deaths per year globally. The costs of the treatment of these patients change around the world. The aim of the present study was to conduct a systematic literature review to identify the costs related to hospital stays of burn victims in countries with different Human Development Index (HDIs). METHODS PubMed, CINAHL and BVIS databases were searched using the following terms: "burn," treatment" and "costs". The review included articles that presented cost studies or economic assessments of burn victims in which the costs were reported, and published between 2012 and 2019. The quality of the evidence was assessed using the Consensus on Health Economic Criteria. This review presents register in Prospero (CRD42019137580). RESULTS The review included 19 economic studies conducted in 13 countries, most with a very high HDIs. Most studies estimated direct acute burn care costs through bottom-up costing and institutional data. Total hospital care costs ranged from US$ 10.58 to US$ 125,597.86 per patient, the cost of 1% of total body surface area burned ranged from US$ 2.65 to US$ 11,245.04, and the cost of hospital care per day, from US$ 24.23 to US$ 4,125.50. CONCLUSION The costs are high and show wide discrepancies among countries. Medical costs and other losses caused by fatal and non-fatal burn injuries differ considerably among demographic groups, care protocols, and country HDIs.
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Affiliation(s)
- Pamela Alejandra Escalante Saavedra
- Health Sciences and Technology Post-Graduate Program, University of Brasilia, Brasília, Distrito Federal, Brazil
- Research Group on Access to and Responsible Use of Medications, University of Brasilia, Brasília, Distrito Federal, Brazil
| | | | - Camila Alves Areda
- Research Group on Access to and Responsible Use of Medications, University of Brasilia, Brasília, Distrito Federal, Brazil
- Pharmacy Graduate, University of Brasilia, Brasília, Distrito Federal, Brazil
| | - Dayani Galato
- Health Sciences and Technology Post-Graduate Program, University of Brasilia, Brasília, Distrito Federal, Brazil
- Research Group on Access to and Responsible Use of Medications, University of Brasilia, Brasília, Distrito Federal, Brazil
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13
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Chinweuba AU, Chinweuba IS, Diorgu FC, Ubochi NE, Ezeruigbo CS, Wasini KB, Nnabuenyi AI. Economic burden of moderate to severe burns and its association with health-related quality of life of Nigerian women. BMC WOMENS HEALTH 2021; 21:85. [PMID: 33639915 PMCID: PMC7916273 DOI: 10.1186/s12905-021-01232-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 02/21/2021] [Indexed: 11/25/2022]
Abstract
Background Burns cases are frequent in Nigeria hospitals, however, literature on its economic burden and the association with health-related quality of life (HRQOL) of women in Nigeria is scarce. This study determined the burden of hospitalization after burns on women’s economic status and its associated HRQOL. Methods This was a three-month cross-sectional study of female patients ≥ 25 years, treated of mixed or full thickness burns in four teaching hospitals in south-east Nigeria, discharged between September–November, 2018. Study instruments were participants’ case notes for socio-demographic and disease history, interviewer-administered questionnaires, namely-economic-burden-of-burns questionnaire and English version of the EuroQol Five-Dimensions-Three-Level Health Questionnaire for Nigeria. Data were collected on second- or third-day post-discharge through home visits or phone calls. This lasted for 13 weeks. Results A total of seventy-three female patients with burn were successfully enrolled. Most participants were married, fairly educated, mainly traders or housewives. Thirty-four (46.6%) had subjective estimated family monthly income below NGN 50,000 (low economic status). Participants’ average monthly income reduced drastically after hospitalization. Their average family monthly income was NGN110,439 (USD307), while their average total expenses incurred during hospitalization was NGN691,093 (USD1,920). Almost all (93.2%) had at least one surgical intervention during management. Their average length of hospital stay was 35.4 days; eleven consequently lost their job. Many had moderate to severe economic burden of treatment; only eleven could bear all the treatment expenses independently. Anxiety/depression and pain/discomfort were common problems reported, However, these Euroqol dimensions varied according to their SES, education and occupation. Women in the low economic class were more inclined to poor HRQOL (Mean ± SD VAS = 53.33 ± 17.619) than women in high economic class (Mean ± SD VAS = 76.67 ± 21.794). Conclusion Burns places high level of economic burden on women and unfortunately, Nigerian government’s commitment to healthcare of burns patients is low. The long course of hospitalization and economic depletion impact negatively on the women’s HRQOL. Based on these findings, we recommend that government parastatals create special trust fund for burns treatment and the National Health Insurance Scheme be restructured for more accessibility.
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Affiliation(s)
- Anthonia U Chinweuba
- Department of Nursing Sciences, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria.
| | - Ifunanya S Chinweuba
- Department of Medicine and Surgery, College of Medicine, Chukwuemeka Odumegwu Ojukwu University, Awka, Anambra State, Nigeria
| | - Faith C Diorgu
- Department of Nursing Sciences, University of Port Harcourt, Rivers State, Port Harcourt, Nigeria
| | - Nneka E Ubochi
- Department of Nursing Sciences, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Chinwe S Ezeruigbo
- Department of Nursing Science, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| | - Kenneth B Wasini
- Faculty of Nursing Sciences, College of Health Sciences, Niger Delta University, Wilberforce Island, Bayelsa State, Nigeria
| | - Anthonia I Nnabuenyi
- School of Nursing, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria
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Morsalivachin Z, Salehi H, Dahmardehei M, Mousavipour M, Karimi H, Jafarian A, Momeni M. A comparison on the scar development when done through overlapping versus approximating seams techniques - A clinical trial. Burns 2021; 47:1602-1607. [PMID: 33933305 DOI: 10.1016/j.burns.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 01/04/2021] [Accepted: 01/15/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Skin autografting is performed widely for deep burn wounds as an ideal coverage. Scaring at the site of grafting has been always a challenge for surgeons. Many methods have been proposed to lessen the probability of scaring, but conflicting results have been obtained. It is said that the suture type is important in the development of scaring. Seams technique has also been introduced to decrease scar after autografting. OBJECTIVE We sought to compare two approximating (AP) and overlapping (OV) Seams technique to compare the development of scars. METHODS AND MATERIALS Patients with deep burns of 10% to 50% TBSA who were candidates for grafting entered this double-blind randomized trial. One side of the graft was fixed with a stapler using the "approximating" technique and the other side was fixed by the "overlapping" technique with a 1-2 mm margin overlap. The Vancouver Scar Scale (VSS) standard was used to evaluate scar formation at the graft edges at six months. Data entered SPSS 16 and analyzed. A P-value below 0.05 was considered as statistically significant. RESULTS Thirty-six patients entered. Two (5.6%) were females and 34 (94.4%) males. The mean age of patients was 39.14 ± 8.53 years. The mean burn surface area percentage was 15.2 ± 2.84. Vascularity Scar index had no statistically significant difference between the overlapping and approximating techniques (P = 0.564). However, pigmentation (P = 0.014), pliability (P = 0.008) and the height indices (P < 0.001) were statistically significantly better in the approximating technique. The mean of total score of Vancouver was better in the approximating technique as well (P < 0.001). CONCLUSION We compared two techniques of Seams between the normal skin and the graft edge for the first time. We showed that the AP method had a better Vancouver score compared to the OV regarding pigmentation, height, and pliability indices.
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Affiliation(s)
- Zeinab Morsalivachin
- Department of Surgery School of Medicine, Iran University of Medical Sciences, Iran
| | - Hamid Salehi
- Department of General Surgery, School of Medicine, Burn Research Center, Shahid Motahari Burns Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Dahmardehei
- Department of Plastic Surgery, School of Medicine, Burn Research Center, Shahid Motahari Burns Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Mousavipour
- Department of Psychiatry School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Karimi
- Department of Plastic Surgery, School of Medicine, Burn Research Center, Shahid Motahari Burns Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Jafarian
- Iran University of Medical Sciences, Tehran, Iran
| | - Mahnoush Momeni
- Department of General Surgery, School of Medicine, Burn Research Center, Shahid Motahari Burns Hospital, Iran University of Medical Sciences, Tehran, Iran.
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Ben C, Liu X, Shen T, Song Y, Li H, Pan B, Hou W, Liu T, Luo P, Ma B, Sun Y, Xiao S, Xia Z, Cheng D, Zhu S. A recombinant human collagen hydrogel for the treatment of partial-thickness burns: A prospective, self-controlled clinical study. Burns 2021; 47:634-642. [PMID: 33402311 DOI: 10.1016/j.burns.2020.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/10/2019] [Accepted: 01/16/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Allogeneic and xenogeneic skin are recognized as the best coverings for skin burn wounds, but currently face a supply shortage. To solve this problem, our research group developed a standardized manufactured hydrogel dressing based on a new type of highly bioactive recombinant human collagen. STUDY DESIGN Prospective self-controlled trial. OBJECTIVE To evaluate the efficacy and safety of recombinant human collagen hydrogel in the treatment of partial burn wounds to the skin compared to those of xenogeneic skin. METHODS This study included twenty-one patients admitted to Shanghai Changhai Hospital within 48 h after receiving partial-thickness skin burns. The wounds were symmetrically separated along the axis and treated with recombinant human collagen hydrogel (RHCH) or a human-CTLA4-Ig gene-transferred pig skin xenotransplant. The condition of the wound surfaces was recorded on days 0 (of enrollment), 5, 10, 15, and 20, and bacterial drug sensitivity testing, hematuria examination, and electrocardiographic tests were conducted on days 0, 10, 20, or on the day of wound healing. RESULTS There were no statistically significant differences in wound healing time between the two groups. The median number of days to healing was 11.00 ± 0.56 for xenogeneic skin vs. 11.00 ± 1.72 for RHCH. CONCLUSION During the observation period, the therapeutic effect of the RHCH developed by our group on partial-thickness burn wounds was not significantly different from that of gene-transferred xenogeneic skin. Thus, our designed RHCH shows potential for clinical use to treat burn wounds on the skin.
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Affiliation(s)
- Chi Ben
- Department of Burns Surgery, Changhai Hospital, Naval Medical University, PR China
| | - Xiaobin Liu
- Department of Burns Surgery, Changhai Hospital, Naval Medical University, PR China
| | - Tuo Shen
- Department of Burns Surgery, Changhai Hospital, Naval Medical University, PR China
| | - Yanling Song
- Department of Burns Surgery, Changhai Hospital, Naval Medical University, PR China
| | - Haihang Li
- Department of Burns Surgery, Changhai Hospital, Naval Medical University, PR China
| | - Bohan Pan
- Department of Burns Surgery, Changhai Hospital, Naval Medical University, PR China
| | - Wenjia Hou
- Department of Burns Surgery, Changhai Hospital, Naval Medical University, PR China
| | - Tong Liu
- Department of Burns Surgery, Changhai Hospital, Naval Medical University, PR China
| | - Pengfei Luo
- Department of Burns Surgery, Changhai Hospital, Naval Medical University, PR China
| | - Bing Ma
- Department of Burns Surgery, Changhai Hospital, Naval Medical University, PR China
| | - Yu Sun
- Department of Burns Surgery, Changhai Hospital, Naval Medical University, PR China
| | - Shichu Xiao
- Department of Burns Surgery, Changhai Hospital, Naval Medical University, PR China
| | - Zhaofan Xia
- Department of Burns Surgery, Changhai Hospital, Naval Medical University, PR China
| | - Dasheng Cheng
- Department of Burns Surgery, Changhai Hospital, Naval Medical University, PR China.
| | - Shihui Zhu
- Department of Burns Surgery, Changhai Hospital, Naval Medical University, PR China.
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'Poverty's scar: A qualitative inquiry of financing shortcomings in specialized burn hospitals. Burns 2020; 47:1191-1202. [PMID: 33293154 DOI: 10.1016/j.burns.2020.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/12/2020] [Accepted: 10/21/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Victims of burn have particular characteristics such as high vulnerability, expensive treatment, and cost of burn services. Thus, the financing of burn services is crucially important. The purpose of the present work is to recognize the financing challenges in Iranian specialized burn hospitals (SBHs). METHODS In the present qualitative descriptive research, purposive sampling was used for selecting key informants with maximum variation at local, provincial, and national levels. Semi-structured interviews were used for data collection. Interviews were continued as long as the saturation point was achieved at the 21 st interview. We employed conventional content analysis using an inductive data-driven coding process and theme development for the analysis of the transcribed documents by MAXQDA Analytics Pro 2018 (VERBI GmbH Release 18.2.0 Berlin). RESULTS We extracted 3 themes and 12 sub-themes, including resource mobilization (the poor burnt victims, unique feature of the single- SBH, high direct and indirect costs, and poor intra-sectoral advocacy), insurance coverage for burn care (incomplete breadth of population coverage, inadequate depth of benefits package and coverage of costs, and reimbursements of burn care) and mechanism of financial resource allocation (unsuitable payment system, less sustainable budgeting, inappropriate tariffing for burning services, top-down budgeting approach, and politicized budget process). CONCLUSIONS We suggest that health policy-makers in Iran could modify the SBHs financing system by improving resource mobilization, scaling up insurance coverage for burns, and optimizing the allocation of financial resources. Besides, we propose several points for policy entry to address SBHs financial difficulties. These points are serious attention to vulnerable and the poor burn patients, provision of burn care in multi-specialized hospitals, strengthening intra-collaboration, revision of tariffs, and payments for burn services, and preservation and realization of burn budgeting.
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Lowin JL, Poudel AN, Price PE, Potokar TS. A Structured Review to Assess the Current Status of Cost-Based Burns Research in Nepal. J Burn Care Res 2020; 42:93-97. [PMID: 32780811 PMCID: PMC7856442 DOI: 10.1093/jbcr/iraa125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The management of burns is costly and complex. The problem is compounded in low and middle income countries (LMICs) where the incidence of burn injuries is high but infrastructure and funding for management and prevention is limited. Cost of illness studies allows for quantification of the costs associated with public health problems. Without cost quantification, focus and allocation of funding is challenging. The authors explored the availability of cost-focused burns research data in a target LMIC. The focus of their research was Nepal. A structured literature review including published papers, Ministry of Health (MOH) and World Health Organization (WHO) statistics was conducted to identify cost of illness studies or evidence relating to burn-related resource and costs. Gaps in the evidence base were highlighted. Research methodologies from other LMICs were reviewed. We found 32 papers related to burn injury in Nepal, one key MOH document and one relevant WHO data source. Most research focused on the epidemiology and etiology of burns in Nepal. Of the papers, only 14 reported any type of burn-related resource use and only 1 paper directly reported (limited) cost data. No studies attempted an overall quantification of the cost of burns. MOH statistics provided no additional insight into costs. Our study found an almost complete lack of cost-focused burns research in Nepal. Primary research is needed to quantify the cost of burns in Nepal. Initial focus could usefully be on the cost of care in tertiary hospitals. A full cost of burns for Nepal remains some way off.
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Affiliation(s)
- Julia L Lowin
- Swansea Centre for Health Economics (SCHE), Swansea University
| | | | - Patricia E Price
- Interburns, Welsh Centre for Burns and Plastic Surgery.,Centre for Global Burn injury Policy and Research, Swansea University, Swansea, UK
| | - Tom S Potokar
- Interburns, Welsh Centre for Burns and Plastic Surgery.,Centre for Global Burn injury Policy and Research, Swansea University, Swansea, UK
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Karimi H, Sedigh-Maroufi S, Akbari H, Latifi NA, Momeni M, Karimi AM, Safari R. Pregnancy and burns: Guidelines for safe management. Burns 2020; 46:1620-1631. [PMID: 32690332 DOI: 10.1016/j.burns.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 03/31/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND IThe incidence of burns in pregnancy is very low, therefore little is confirmed in the specific management of pregnant women who are burned. PURPOSE We conducted a study to survey the frequency of pregnancy in our patients and evaluate the risk factors of mortality for mother and foetus. Finally we provide recommendations about management of mother and child. MATERIALS AND METHODS Retrospectively, we surveyed data of our pregnant patients for an 18 year period. All demographic data, gestational age, history of previous pregnancy or miscarriage, diabetes, suicide, number of operations, presence of inhalation injury, TBSA, percentage of burn in abdomen and lower extremity, early excision and outcome of mother and foetus were gathered in a special questionnaire. Uni-variate regression and multi-variate regression were done for mortality of mother and child. RESULTS We treated 89 pregnant patients. Mean (SD) of mother's age and their pregnancy age were 24.08±5.56 years and 19.18±9.24 weeks, respectively. Mean TBSA (SD) was 36 (18%). Median of TBSA was 38 (IQR: 25, 70). Median of TBSA in Abdomen was 8 (IQR: 7, 9). Median of TBSA in lower extremities was 18 (IQR: 9, 34). Nine cases were due to attempted suicide. For 34 patients skin grafting was done. The main cause of death of the mothers was sepsis. The infections were due to Pseudomonas aeruginosa, Acinetobacter, E. coli, Klebsiella and Staphylococcus. In uni-variate regression model, TBSA, gestational week, and burns involving the abdomenwere related to maternal mortality. In multi-variate regression model, TBSA had high influence on maternal mortality, with every percent of burn surface area, the risk of mortality increased by 3.4% (p-value <0.005). In a uni-variate regression, TBSA and abdominal burn was associated with foetal mortality. However, in the multi-variate regression, only inhalation injury and TBSA had association with foetal mortality. Inhalation injury increased foetal mortality up to 16 times (p-value <0.05). CONCLUSION TBSA burned is the only major risk factor of maternal mortality. TBSA burned and inhalation injury are the main risk factors of foetal mortality.
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Affiliation(s)
- Hamid Karimi
- Plastic and Reconstructive Surgery, Hazrat Fatemeh Hospital, School of Medicine, Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Hossein Akbari
- Plastic and Reconstructive Surgery, Hazrat Fatemeh Hospital, School of Medicine, Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Noor-Ahmad Latifi
- Plastic and Reconstructive Surgery, Hazrat Fatemeh Hospital, School of Medicine, Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahnoush Momeni
- General Surgery, Motahary Burn Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Roya Safari
- Department of Epidemiology, Research Center for Environmental Determinants of Health, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Momeni M, Sediegh-Marufi S, Safari-Faramani R, Akhoondinasab MR, Karimi H, Karimi AM. Lower Extremity Burns, Complications, and Outcome. J Burn Care Res 2019; 41:409-415. [DOI: 10.1093/jbcr/irz182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
We have encountered many burn cases with lower extremity burn with adverse outcome. The study was a retrospective cohort study in 2 years, mean (SD) of follow up was 12(7) months. All demographic data, cause burn, time, total burn surface area (TBSA), presence lower extremity burn and its burn surface area (BSA), foot burn, delay in treatment, smoking, infection, morbidity, co-morbid diseases, length of stay (LOS), amputation, mortality, and outcome were gathered from patients’ files. Statistical analysis was done with SPSS 21software. We had 14,215 burn patients, of them 995 were admitted according to criteria of ABA. Six hundred and ten (61.3%) were male and 358 (37%) female. Male to female ratio was 1.58:1. The mean age ± SD was 33.64 ±23.45. Mean (SD) of lower extremity BSA was 12.09 ± 9.18%. The patients who had 10 to 19% burn, had 3 times more risk of mortality than patients with 0 to 9% burn (P < .018). And those with 20 to 29% burn had 35 times more risk of mortality comparing to patients with 0 to 9% burn. The difference was significant too. (P < .000). Delay in treatment, presence of co-morbid diseases and diabetes would not do any increase in mortality. The sex, weight, cause of burn, diabetes, and delay in treatment have not any influence on the death risk. But age and lower extremity BSA have influence on the risk of death. According to statistical study: with every 1-year increase in age, death rate increased by 4% (P < .0001). With every 1% increase in lower extremity BSA, death rate increase by 9% (P < .0005) and with every 1 day increase in LOS, the death rate increase by 4%. Statistical study shows lower extremity burn, TBSA, age, and LOS have great influence on the outcome of these patients. Sex, weight, cause of burn, and delay in treatment have not affected the risk of mortality.
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Affiliation(s)
- Mahnoush Momeni
- General Surgery, Motahary Hospital, School of Medicine, Burn Research Center
| | | | - Roya Safari-Faramani
- Department of Epidemiology, Research Center for Environmental Determinants of Health, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Hamid Karimi
- Plastic and Reconstructive Surgery, Hazrat Fatemeh Hospital, School of Medicine, Burn Research Center
| | - Ali-Mohammad Karimi
- Surgery Department, Medical School, Iran University of Medical Sciences, Tehran, Iran
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Karimi H, Latifi NA, Momeni M, Sedigh-Maroufi S, Karimi AM, Akhoondinasab MR. Tissue expanders; review of indications, results and outcome during 15 years' experience. Burns 2019; 45:990-1004. [PMID: 30685190 DOI: 10.1016/j.burns.2018.11.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/20/2018] [Accepted: 11/30/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Tissue expanders (TE) are frequently used worldwide. In this study we surveyed outcome of our patients retrospectively during 15 years. MATERIALS AND METHODS We had 1105 patients for whom 3059 TEs have been used. Demographic data, age, sex, indications, type of tissue expander devices, volume of devices, site of scar and site TE insertion, our technique for tissue expander insertion and flap design, complications and outcome were gathered. A complete and through technical points and tips will be discussed. RESULTS In 91% of patients overexpansion was done. (Expansion ratio=2.1-4.5). Re-expansion has been done in about 12% of patients. Complications were perforation of skin of pocket (11%) or exposure, infection (6%), dehiscence of the wound (1.5%), perforation of the port or disconnection of the tubes (2.1%), expansion of the scar itself (1%), saggy flap (3%), dog ear (5%), lack of adhesions of flap to its new site (4%). OUTCOME In 93% of the patients we could totally remove the scar. Around 9.1% of our patients had two sessions of expansion in the same area and 2.9% had three sessions of expansion. 51% of our patients were highly satisfied and 42% were satisfied of the results of expansion. CONCLUSION Our patients were satisfied with the results. In 12% cases we have done re-expansion. Re-expansion is possible as long as you have enough thickness of dermis in the skin. More than 50% of our patients were optimistic for 2nd or 3rd session of re-expansion.
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Affiliation(s)
- Hamid Karimi
- Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Noor-Ahmad Latifi
- Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahnoush Momeni
- Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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