The emergency management and treatment of severe burns

Tissue Inhibitors of Metalloproteinase 1 (TIMP-1) and 3 (TIMP-3) as New Markers of Acute Kidney Injury After Massive Burns

BACKGROUND Acute kidney injury (AKI) is a common and serious complication after massive burn injury. One of the postulated etiologies is destruction of the extracellular matrix of nephrons, caused by a local imbalance between matrix metalloproteinases (MMPs) and specific inhibitors. The aim of this study was to analyze the dynamics of tissue inhibitors of metalloproteinases (TIMPs) during the first 5 days after massive thermal injury and the relationship with the risk of AKI. MATERIAL AND METHODS Thirty-three adults (22 men, 11 women) with severe burns were enrolled in the study. The values of TIMPs 1 to 4 were measured in blood serum and urine using the multiplex Luminex system. The associations between TIMPs and the risk of AKI were analyzed by using the generalized linear mixed models for repeated measurements. RESULTS Significant changes in serum and urine activities of TIMPs were confirmed, especially during the first 2 days after burn injury. Almost half of patients presented renal problems during the study. Significant differences between values of TIMPs in AKI and non-AKI status were also observed. However, a significant relationship between concentration of TIMPs and risk of AKI was confirmed only for urine TIMP-1 and serum TIMP-3. CONCLUSIONS The evaluation of TIMPs in the early stage after burn injury has potential benefits. The important roles of urine TIMP-1 and serum TIMP-3, as novel markers of the risk of AKI development, were confirmed. Other parameters require further analysis.

The Combination of Stromal Vascular Fraction Cells and Platelet-Rich Plasma Reduces Malondialdehyde and Nitric Oxide Levels in Deep Dermal Burn Injury

Introduction

Thermal burns release reactive oxygen species, which cause profound systemic and local changes. Stromal vascular fraction cells (SVFs) combined with platelet-rich plasma accelerate burn wound healing. This study investigated the effect of a combination of locally injected SVFs and PRP on malondialdehyde (MDA) and nitric oxide (NO) serum and tissue levels in a deep dermal burn model in Wistar rats.

Methods

Thirty-six adult Wistar rats weighing between 150 and 250 grams were used in this study to establish a deep dermal degree burn wound model. They were randomly divided into 4 groups: locally injected the combination SVFs and PRP, the Vaseline group, the placebo group, and healthy Wistar rats (the normal control group). MDA and NO levels in blood serum and burn wound tissue were measured at 8, 24, and 48 hours. Data were analyzed with one-way ANOVA followed by multiple comparisons tests and regression tests.

Results

Local injection of SVFs and PRP in combination affected blood MDA, tissue MDA, blood NO and tissue NO levels, with reductions of 0.257µmol/L, 0.427 µmol/L, 21.78nmol/mg, and 23.777nmol/mg, respectively. Injection of SVFs and PRP in combination reduced tissue MDA levels by 1.282 times, NO blood levels by 2.305, and NO tissue levels by 2.377 times compared to Vaseline application.

Conclusion

The combination of SVFs and PRP undeniably reduced the MDA and NO levels in blood and tissue compared to those in the Vaseline and placebo groups. The injection of these two preparations in combination inhibited the local and systemic stress oxidative response, as illustrated by the decreased MDA and NO levels in blood serum and tissue.

Physicians based emergency medical services for the management of burn injuries in trauma centers of the center region of Saudi Arabia: evaluation of physicians' knowledge and experience

BACKGROUND

Medical services at trauma centers regularly encounter severe burn patients but prehospital care of these patients in Saudi Arabia is comparatively unexplored. This study evaluates the knowledge and experience of physicians working in trauma centers of Qassim province of Saudi Arabia for the management of patients with burn injuries.

METHODS

This is a cross sectional study performed on 204 physicians working in the trauma centers of Qassim province. Physicians' knowledge and experience were assessed via administration of validated questionnaires and the data were analyzed using SPSS software.

RESULTS

Among total studied physicians, only 35.3% and 24.0% gave the right answer to the question on the diagnosis of burn skin in depth/extent for adults and pediatric patients, respectively. Importantly, 93.6% physicians responded correctly for first aid treatment. For the parkland concept, 62.2% responded correctly, however, only 22.5% understand the colloid fluid concept. The 74% physicians knew the methods of fluid revival for mass burn injuries and about half of studied physicians showed right knowledge for intubation for breathing for mass burn injuries. Only 47.5% physicians understand the concept of electrolyte disorder.

CONCLUSIONS

This is the first study from the central region of Saudi Arabia that analyzed the knowledge and experience of physicians working in trauma centers for the management of patients with burn injuries. Overall data showed that ~60% physicians working in trauma centers have knowledge for handling the patients with burn injuries but the rest needed counseling, therefore proper training sessions for them are needed for management of burn patients.

Common mistakes in the choice of topical agents for emergency care of burns: Experimental study

The aim of the research was a histological study of the tissue structure of experimental animals with burns in dynamics using various topical agents after the injury. Experimental simulation of burn injuries was performed on 40 rats, which were divided into the main and control groups. Depending on the nature of care provided, the animals of the main group were divided into subgroups: in the 1st subgroup a uniform layer of sunflower oil was applied, in the 2nd subgroup dexpanthenol was sprayed, in the 3rd subgroup prompt neutralization of traumatic action was performed with a gauze napkin soaked in water. Animals from the control group were not treated. The examination involved a histological study. The results confirmed the negative impact of applying oil to the burnt area as a means of first aid, which caused more pronounced degenerative changes of the dermis and its structures with the involvement of hypodermis in the pathological process, prolonging the duration of healing. As for the use of dexpanthenol spray for burn injuries, the histological changes of tissues did not differ much from those in animals of the control group, which did not receive any care. At the same time, histological findings of the tissues of animals treated with moistened wipes was characterized by less pronounced pathological changes. Histological analysis of tissue changes of the burnt area in dynamics objectively proved the effectiveness of water as the main pathogenetic element of emergency care in an experiment.

Knowledge and Practice of Burn First Aid Among Saudi Arabian Medical and Non-Medical University Students

Burns are serious injuries, resulting in high morbidity and healthcare costs. Effective first aid improves outcomes. The aim of this study was to assess the knowledge and practice of first aid for burn injuries among medical and non-medical students in Saudi Arabia. A cross-sectional study (N = 408) was conducted, in which a questionnaire was administered assessing students' experience with burns, as well as their hypothetical responses to vignettes involving patients with burn injuries. Although most students reported having personal experience with burns, and had received some information regarding burn first aid, only about half were able to provide correct responses regarding first aid techniques, and medical students were no more accurate than non-medical students in their responses. Results suggest that members of the Saudi Arabian population may lack appropriate knowledge about burn first aid, and education and public information resources may help to remedy this problem.

A concept analysis of burn care in nursing

BACKGROUND

Burn is a life-threatening injury that requires long-term treatment and concomitant hospital stay. Relevant clinical studies in burns have been accomplished and published in the literature. However, none of these studies reported the concept analysis of burn care in nursing. Therefore, analysing the concept of burn care acts as an imperative strategy to provide comprehensive management of burn injury.

OBJECTIVE

The study aims to describe the concept of burn care in nursing.

METHOD

Walker and Avant's method (2013) was used to achieve the objective of the study.

FINDINGS

A model of burn care in nursing was generated that consists of assessment and diagnosis, intervention and evaluation. In addition, the biopsychosocial model developed by George L. Engel (1977) was also integrated to examine how these aspects play a significant role in burn care.

CONCLUSION

Implementing the concept of burn care will improve the quality of nursing care, cosmetic outcomes and vice versa, reduce the comorbidities on burn injury.

Review of school fires in Iran: the causes, consequences and lessons learned

Fire in Iranian schools has led to death, serious injury and disability for dozens of students and teachers. The aim of this study was to explore the causes, consequences and lessons learned from school fires in Iran. The available literature, including scientific texts, previous research and media reports, was searched using English and Persian keywords. The keywords were: "students, school, Iran, fire, burn and incidents". No time limitation was imposed. Results showed that 62 school and student dormitory fires have been reported in Iran, of which 14 school fires and 2 student dormitory fires led to human injuries or casualties (25.8%). In these incidents, thirty students (19 girls and 11 boys) and one teacher died. More than 60 students, 8 teachers, and 2 staff suffered burn injuries or disabilities. The main causes of the fire incidents were use of non-standard kerosene heaters (38.7%) and faulty electrical wiring (35.4%). Lack of knowledge about dealing with accidents, inappropriate physical conditions of the school building, lack of fire extinguishers in the building, and carelessness were the main reasons for the deaths and injuries. In conclusion, it is essential to reduce the incidence of fire and prevent its casualties with proper management and standardization of school buildings.

Teleconsultation Using Mobile Phones for Diagnosis and Acute Care of Burn Injuries Among Emergency Physicians: Mixed-Methods Study

Background

The referral process in acute care remains challenging in many areas including burn care. Mobile phone apps designed explicitly for medical referrals and consultations could streamline the referral process by using structured templates and integrating features specific to different specialties. However, as these apps are competing with commercial chat services, usability becomes a crucial factor for successful uptake.

Objective

The aim of this study was to assess the usability of a mobile phone app for remote consultations and referrals of burn injuries.

Methods

A total of 24 emergency doctors and 4 burns consultants were recruited for the study. A mixed-methods approach was used including a usability questionnaire and a think-aloud interview. Think-aloud sessions were video-recorded, and content analysis was undertaken with predefined codes relating to the following 3 themes: ease of use, usefulness of content, and technology-induced errors.

Results

The users perceived the app to be easy to use and useful, but some problems were identified. Issues relating to usability were associated with navigation, such as scrolling and zooming. Users also had problems in understanding the meaning of some icons and terminologies. Sometimes, some users felt limited by predefined options, and they wanted to be able to freely express their clinical findings.

Conclusions

We found that users faced problems mainly with navigation when the app did not work in the same way as the other apps that were frequently used. Our study also resonates with previous findings that when using standardized templates, the systems should also allow the user to express their clinical findings in their own words.

Prehospital treatment of burns in Tanzania: a mini-meta-analysis

The present study describes initial burn injury care in Tanzania-materials applied, sources of information, reasons for applying the materials, and time to a health centre-in order to suggest ways to optimize initial care. Eight small studies were conducted in which burn-injured patients were interviewed who had been admitted to referral hospitals in four regions in Tanzania. Most burn injuries in Tanzania occur in the home cooking area, and it was found that the first responders were family members, friends, and neighbours. A total of 710 burn victims were interviewed. Twenty-four different materials were applied to the patients' wounds. The most common application was honey. Only 14.3% of the victims received the recommended form of care: application of cool water. It was also found that nothing was applied to the wounds of 17.5% of these patients by first responders. Sources of information on burn treatment were family, friends and neighbours, and, less often, health workers or the media. Most of the burn victims' households had enough water to enable administration of recommended initial care. The main impediment to the provision of appropriate initial treatment of a burn appears to be lack of correct and useful knowledge about what to do immediately after the injury. A two-pronged educational approach should be used to improve care. A national mass media campaign should start immediately to inform ordinary citizens about proper initial treatment of burns. In addition, curricula of all schools that train health workers need to be reviewed for accuracy, and appropriate knowledge about initial care of burn victims should be added if necessary. Measures to improve burn first aid, are relatively easy, even in a low-income country such as Tanzania.

The effect of Quercus brantii gall extract on burn wound healing in rat

OBJECTIVES

The aim of the present study was to evaluate the effect of Quercus brantii galls extract on the rat skin burn wound healing.

MATERIALS AND METHODS

Ethanol extract of the galls of Q. brantii was used to treat the induced burn wounds on the back of 32 Wistar rats divided into 4 groups. The groups were treated by placebo, 1%, 2% and 4% concentration gall extract gels for 14 days and the efficacy of treatment was assessed based on reduction of burn wound area, as well as histological and molecular characteristics.

RESULTS

The mean wound surface in the 14^th day, in all groups treated by Q. brantii gall extracts were larger than control group and the differences were statistically significant (P=0.043). The mean histological wound healing scores were not statistically different. Analysis of nitric oxide and platelet derived growth factor concentration in wound fluids in the 5^th day of study showed that there was not any significant difference between groups (P=0.468 and 0.312 respectively). Fibroblast growth factor (bFGF) concentration in the wound fluids, was significantly higher in group treated with 1% gall extract gel in comparison to the control group (P=0.026).

CONCLUSION

Our results could not prove the significant positive effect of Q. brantii galls extract on the burning wound healing. More studies with more groups treated with different doses of the Q. brantii extract are recommended.

Human Dental Pulp Stem Cells. A promising epithelial-like cell source

Several models of tissue-engineered human skin based on three-dimensional (3D) co-culture techniques have been proposed to the date. However, normal skin biopsies are not always available, especially in patients with a high percentage of skin affected by deep burning, and the generation of large amounts of cultured keratinocytes may take very long time, with an associated risk for the patients' survival. For those reasons, the search of alternative cell sources for tissue reconstruction is a clinical need. In this context, Human Dental Pulp Stem Cells (HDPSC) have the potential to differentiate into multiple cell lineages by the appropriate differentiation conditions, but skin epidermis differentiation has not been demonstrated so far. Here, we hypothesize that HDPSC may have pluripotent differentiation capability, and may be able to differentiate into skin epithelial keratinocytes in culture using organotypic 3D models based on the interaction with the subjacent dermal fibroblasts. By using HDPSC, the problems associated to the donor site availability and the proliferation capability of the epithelial cells could be solved. The rapid accessibility to these cells could be translated to a more immediate generation of a bioengineered human skin substitute for the future clinical treatment.

Treatment of burns in the first 24 hours: simple and practical guide by answering 10 questions in a step-by-step form

Residents in training, medical students and other staff in surgical sector, emergency room (ER) and intensive care unit (ICU) or Burn Unit face a multitude of questions regarding burn care. Treatment of burns is not always straightforward. Furthermore, National and International guidelines differ from one region to another. On one hand, it is important to understand pathophysiology, classification of burns, surgical treatment, and the latest updates in burn science. On the other hand, the clinical situation for treating these cases needs clear guidelines to cover every single aspect during the treatment procedure. Thus, 10 questions have been organised and discussed in a step-by-step form in order to achieve the excellence of education and the optimal treatment of burn injuries in the first 24 hours. These 10 questions will clearly discuss referral criteria to the burn unit, primary and secondary survey, estimation of the total burned surface area (%TBSA) and the degree of burns as well as resuscitation process, routine interventions, laboratory tests, indications of Bronchoscopy and special considerations for Inhalation trauma, immediate consultations and referrals, emergency surgery and admission orders. Understanding and answering the 10 questions will not only cover the management process of Burns during the first 24 hours but also seems to be an interactive clear guide for education purpose.