Active immunization using exotoxin A confers protection against Pseudomonas aeruginosa infection in a mouse burn model

Antimicrobial efficacy of aloe-emodin mediated photodynamic therapy against antibiotic-resistant Pseudomonas aeruginosa in vitro

Multidrug-resistant Pseudomonas aeruginosa is a common pathogen that causes topical infections following burn injuries. Antimicrobial photodynamic therapy (aPDT) has emerged as a promising approach for treating antibiotic-resistant bacterial infections. The objective of this study was to evaluate the aPDT efficacy of aloe-emodin (AE), which is a photosensitizer extracted from traditional Chinese herbs, on antibiotic-sensitive and antibiotic-resistant P. aeruginosa in vitro. In this study, we confirmed the effectiveness of AE-mediated aPDT against both standard and MDR P. aeruginosa, explored the effects of irradiation time and AE concentration on bacterial survival in AE-mediated aPDT, and observed the structural damage of P. aeruginosa by using transmission electron microscope. Our results showed that neither AE nor light irradiation alone caused cytotoxic effects on P. aeruginosa. However, AE-mediated aPDT effectively inactivated both antibiotic-sensitive and antibiotic-resistant P. aeruginosa. The transmission electron microscope investigation showed that aPDT mediated by AE primarily caused damage to the cytoplasm and cell membrane. Our findings suggest that AE is a photosensitizer in the aPDT of MDR P. aeruginosa-caused topical infections following burn injuries. Future investigations will concentrate on the safety and efficacy of AE-mediated aPDT in animal models and clinical trials.

Relation between CarS expression and activation of carotenogenesis by stress in Fusarium fujikuroi

Fusarium fujikuroi, a model organism for secondary metabolism in fungi, produces carotenoids, terpenoid pigments with antioxidant activity. Previous results indicate that carotenoid synthesis in F. fujikuroi is stimulated by light or by different stress conditions and downregulated by a RING finger protein encoded by carS gene. Here, we have analyzed the effects of three stressors, nitrogen scarcity, heat shock, and oxidative stress. We compared them with the effect of light in the wild type, a carS mutant that overproduces carotenoids, and its complemented strain. The assayed stressors increase the synthesis of carotenoids in the three strains, but mRNA levels of structural genes of carotenogenesis, carRA and carB, are only enhanced in the presence of a functional carS gene. In the wild-type strain, the four conditions affect in different manners the mRNA levels of carS: greater in the presence of light, without significant changes in nitrogen starvation, and with patent decreases after heat shock or oxidative stress, suggesting different activation mechanisms. The spores of the carS mutant are more resistant to H₂O₂ than those of the wild type; however, the mutant shows a greater H₂O₂ sensitivity at the growth level, which may be due to the participation of CarS in the regulation of genes with catalase domains, formerly described. A possible mechanism of regulation by heat stress has been found in the alternative splicing of the intron of the carS gene, located close to its 3′ end, giving rise to the formation of a shorter protein. This action could explain the inducing effect of the heat shock, but not of the other inducing conditions, which may involve other mechanisms of action on the CarS regulator, either transcriptionally or post-transcriptionally.

Enhanced Healing Activity of Manuka Honey and Nitrofurazone Composite in Full-Thickness Burn Wounds in the Rabbit Model

Burns cause many significant changes in metabolism and inflammatory reactions, leading to poor regeneration in animals and humans. A list of medicines to treat burns is available in the market. But due to the high cost of these medicines, these are unaffordable, especially for farmers of middle-class families of Africa and Asia. Therefore, a low-cost complementary treatment has always been a topic of many researchers, and there is a dire need of time for the welfare of animals to save them. The current study was planned to scrutinize the therapeutic effects of Manuka honey and Nitrofurazone ointments on full-thickness burn wounds in the rabbit model. The healing efficacy was performed through wound contraction rate, hematological analysis, the thickness of dermis and epidermis, and collagen content percentage. Histopathology was performed after taking biopsy samples at the end of the research. Based on statistical analysis using wound healing time (days, D), the combination (MO + NT) resulted in a shorter period (27 D ± 1) than the average healing time of controlled (36 ± 2), Manuka ointment (31.33 D ± 1.52), and Nitrofurazone ointment (32 ± 1). A significant decrease in the count of red blood cell (RBC), mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH) in all treatments was noticed mainly in MO + NT. Furthermore, burns induced a significant difference (p < 0.05) in the white blood cells (WBCs) count levels in the MO-treated group. While the level of platelets (PLTs) was not significantly different from the healthy control group. Histopathological assessment (epithelialization, fibrosis, and angiogenesis) of skin showed burn healing to be better in MO and MO + NT groups. In conclusion, the composite of Manuka honey with Nitrofurazone led to the faster recovery than other treatments.

Bio-Evaluation of the Wound Healing Activity of Artemisia judaica L. as Part of the Plant’s Use in Traditional Medicine; Phytochemical, Antioxidant, Anti-Inflammatory, and Antibiofilm Properties of the Plant’s Essential Oils

Artemisia judaica (ArJ) is a Mediterranean aromatic plant used traditionally to treat gastrointestinal ailments, skin diseases, atherosclerosis, and as an immuno-stimulant. This study describes ArJ essential oil constituents and investigates their wound healing activity. The in vitro antioxidant and antibiofilm activities of ArJ essential oil were investigated. The in vivo pro/anti-inflammatory and oxidative/antioxidant markers were compared with standard silver sulfadiazine (SS) in a second-degree skin burn experimental rat model. The gas chromatography-equipped flame ionization detector (GC-FID) analysis of ArJ essential oil revealed the major classes of compounds as oxygenated monoterpenes (>57%) and cinnamic acid derivatives (18.03%). The antimicrobial tests of ArJ essential oil revealed that Bacillus cereus, Candida albicans, and Aspergillus niger were the most susceptible test organisms. Two second-degree burns (each 1 inch square in diameter) were created on the dorsum of rats using an aluminum cylinder heated to 120 °C for 10 s. The wounds were treated either with ArJ or SS ointments for 21 days, while the negative control remained untreated, and biopsies were obtained for histological and biochemical analysis. The ArJ group demonstrated a significant increase in antioxidant superoxide dismutase (SOD) and catalase (CAT) enzymatic activities, while lipid peroxide (LP) levels remained insignificant compared to the negative control group. Additionally, ArJ and SS groups demonstrated a significant decrease in inflammatory levels of tumor necrosis factor α (TNF-α) compared to the negative group, while interleukin 1 beta (IL-1b) and IL-6 were comparable to the negative group. At the same time, anti-inflammatory IL-10 and transforming growth factor beta 1 (TGF-b1) markers increased significantly in the ArJ group compared to the negative control. The ArJ results demonstrated potent wound healing effects, comparable to SS, attributable to antioxidant and anti-inflammatory effects as well as a high proportion of oxygenated monoterpenes and cinnamate derivatives.

A comparative study on antibacterial activity of carvacrol and glutaraldehyde on Pseudomonas aeruginosa and Staphylococcus aureus isolates: an in vitro study

The resistance of hospital bacterial isolates against traditional germicides, which used frequently, is one of the important factors contributing to emerging nosocomial infections. Moreover, due to having the side effects of chemical substances, the development of novel low-risk natural compounds seems necessary for control the spread of resistant pathogens in hospital environments. The aim of this study was to compare the effect of carvacrol and glutaraldehyde against two common hospital acquired pathogens, including Pseudomonas aeruginosa and Staphylococcus aureus. In this study 365 samples were collected from different wards of hospitals of Khorramabad, Iran. One hundred and sixty samples were identified as P. aeruginosa and S. aureus by using standard microbiological methods. Then the antibacterial effects of four combinations including carvacrol+ethanol, carvacrol+dimethyl sulfoxide (DMSO), glutaraldehyde 2%, and pure glutaraldehyde (50%) were evaluated and determined using dilution broth and disk diffusion methods. Our results showed that the carvacrol had more antibacterial effects against selected bacteria compared to glutaraldehyde. Moreover, the optimal time and concentration of carvacrol+ethanol against hospital isolates of P. aeruginosa and S. aureus was determined after 1 h at concentration of 64 μl/ml and 8 μl/ml, respectively. In conclusion by comparing the results of carvacrol and glutaraldehyde, seem that carvacrol, as an herbal and natural agent, may be a suitable alternative to glutaraldehyde in hospital equipment's' sterilization.

Understanding Pseudomonas aeruginosa-Host Interactions: The Ongoing Quest for an Efficacious Vaccine

Pseudomonas aeruginosa is a leading cause of chronic respiratory infections in people with cystic fibrosis (CF), bronchiectasis or chronic obstructive pulmonary disease (COPD), and acute infections in immunocompromised individuals. The adaptability of this opportunistic pathogen has hampered the development of antimicrobial therapies, and consequently, it remains a major threat to public health. Due to its antimicrobial resistance, vaccines represent an alternative strategy to tackle the pathogen, yet despite over 50 years of research on anti-Pseudomonas vaccines, no vaccine has been licensed. Nevertheless, there have been many advances in this field, including a better understanding of the host immune response and the biology of P. aeruginosa. Multiple antigens and adjuvants have been investigated with varying results. Although the most effective protective response remains to be established, it is clear that a polarised Th2 response is sub-optimal, and a mixed Th1/Th2 or Th1/Th17 response appears beneficial. This comprehensive review collates the current understanding of the complexities of P. aeruginosa-host interactions and its implication in vaccine design, with a view to understanding the current state of Pseudomonal vaccine development and the direction of future efforts. It highlights the importance of the incorporation of appropriate adjuvants to the protective antigen to yield optimal protection.

Contamination of wounds with fecal bacteria in immuno-suppressed mice

Immunocompromised patients are predisposed to chronically infected wounds. Especially ulcers in the dorsal region often experience secondary polymicrobial infections. However, current wound infection models mostly use single-strain bacteria. To mimic clinically occurring infections caused by fecal contamination in immunocompromised/immobile patients, which differ significantly from single-strain infections, the present study aimed at the establishment of a new mouse model using infection by fecal bacteria. Dorsal circular excision wounds in immunosuppressed mice were infected with fecal slurry solution in several dilutions up to 1:8,000. Impact of immunosuppressor, bacterial load and timing on development of wound infections was investigated. Wounds were analyzed by scoring, 3D imaging and swab analyses. Autofluorescence imaging was not successful. Dose-finding of cyclophosphamide-induced immunosuppression was necessary for establishment of bacterial wound infections. Infection with fecal slurry diluted 1:166 to 1:400 induced significantly delayed wound healing (p < 0.05) without systemic reactions. Swab analyses post-infection matched the initial polymicrobial suspension. The customized wound score confirmed significant differences between the groups (p < 0.05). Here we report the establishment of a simple, new mouse model for clinically occurring wound infections by fecal bacteria and the evaluation of appropriate wound analysis methods. In the future, this model will provide a suitable tool for the investigation of complex microbiological interactions and evaluation of new therapeutic approaches.

Treatment of Second to Third-Degree Burns in A 2-Day-Old Infant: A Case Report

Burn injuries in newborns are particularly complex cases. Since these patients are rare, there is little experience and no existing standardized treatment. This report examines a case of accidental second to third-degree burning of the heel and toes on the left foot in a new-born girl. The burns covered an estimated 1% of the total body surface area (TBSA). After an initial debridement and 32 days of non-surgical wound therapy with Adaptic® fat gauze dressings, we were able to achieve an aesthetically and functionally satisfactory result including the complete preservation of all toes. Modern wound treatment following the principle of less frequent dressing changes allows the burn wound to have better re-epithelialization. New findings in stem cell research indicate that the high proportion of mesenchymal stem cells (MSC) in postnatal blood is also involved in the regeneration and healing of burns. To our knowledge, this is the first case report dealing with initial non-surgical combustion therapy in a newborn. In order to eliminate a scar contracture, we carried out a Z-plasty one year later.

Prophylactic Tracheostomy for Inhalational Burns

BACKGROUND

Various studies have reported different conclusions over the safety and benefits of early tracheostomy in burns. Our study aimed to assess the role of prophylactic tracheostomy in treatment and improvement of outcomes in inhalational burns in India.

METHODS

In a retrospective descriptive analysis of burns admitted over 1 year in Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Tertiary Burns Center in India, patients with thermal burns of TBSA less than 60% and those with indirect evidence of airway burns were enrolled and divided into two groups who underwent prophylactic tracheostomy vs. patients for whom prophylactic tracheostomy was not done. Mortality was the final point and primary variable measurement.

RESULTS

Totally, 10 patients with inhalational burns were admitted. Out of the 4 patients for whom prophylactic tracheostomy was undertaken, three patients survived, while one died. Out of the 6 patients for which prophylactic tracheostomy were not performed, 4 patients died; while 2 survived. The average percentage of burns TBSA in the prophylactic tracheostomy group was 34%. Average age of patients in the prophylactic tracheostomy group was 31.3 years. The average percentage burns TBSA in the group, where prophylactic tracheostomy was not carried out was 42%. Average age of patients in the prophylactic tracheostomy group was 36.2 years.

CONCLUSION

Our study is a pilot study to investigate the possibility and a way to improve outcomes in patients with inhalational injuries. Larger trials may be needed to facilitate or disprove the same.

Design of a gold nanoprobe for the detection of Pseudomonas aeruginosa elastase gene (lasB)

In this study, a gold nanoparticle-based DNA diagnostic sensor that is sensitive to the aggregation states of gold nanoparticles was used to identify the amplified and non-amplified lasB gene.

Inhibitory effects of Cinnamaldehyde, Carvacrol, and honey on the expression of exoS and ampC genes in multidrug-resistant Pseudomonas aeruginosa isolated from burn wound infections

This study aimed to evaluate the effects of Cinnamaldehyde, Carvacrol, and honey either alone or in combinations on the expression of exoS and ampC genes in multidrug-resistant (MDR) P. aeruginosa isolates. Thirty-five P. aeruginosa isolates were recovered from burn wound infections of patients admitted to the burn ward of Besat hospital of Hamadan, Iran, during 2018. Antibiotic susceptibility testing was performed using the Kirby-Bauer disk diffusion method to identify MDR isolates. The antibacterial effects of Cinnamaldehyde, Carvacrol, and honey either alone or in combinations with each other were compared to Imipenem (as the control group) using the broth dilution method. The expressions of exoS and ampC genes were determined in bacteria treated with sub-minimum inhibitory concentration (MIC) of the ternary combination of Cinnamaldehyde, Carvacrol, and honey by Real-Time-PCR. The data were analyzed using SPSS software applying student t-test, Kruskal-Wallis, and Mann-Whitney U tests. The P-value less than 0.05 was considered as statistically significant. The average MICs of Cinnamaldehyde, Carvacrol, and honey were 0.82-0.01, 0.01-0.6, and 62.5-250 μg/mL, respectively. The average MIC of the mentioned compounds was 430 times lower than that of Imipenem. A synergistic effect was detected between these drugs against 70% of the isolates. At sub-MIC concentration, the triple combination of Cinnamaldehyde, Carvacrol, and honey reduced the expressions of exoS and ampC genes by 6.12 and 2.85 folds, respectively. The combination of Cinnamaldehyde, Carvacrol, and honey showed a higher antibacterial effect than Imipenem. However, it needs confirmation with more isolates.

Mortality and Body Mass Index in Burn Patients: Experience from a Tertiary Referral Burn Center in Southern Iran

BACKGROUND

The role of obesity has been widely studied as a determinant factor of increasing mortality in surgical patients. In this study we aimed to investigate the association of mortality determinants with obesity classification and BMI score in burn patients admitted to a tertiary referral center in Southern Iran.

METHODS

In this retrospective cross-sectional study, medical profiles of burn patients admitted from 2016 to 2017 were obtained from Amiralmomenin Burn Hospital, a tertiary referral burn center affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. Demographic, and clinical characteristics as well as patient outcomes were recorded to determine prognostic factors in fatal burns based on anthropometric measurements.

RESULTS

Among 101 patients who were enrolled in this study including 73 males and 28 females, mean age was 34.85±12.04 years, total burn surface area (TBSA) was 37.37 (10.50%), BMI was 25.46±5.33 kg/m² and hospital stay was 22.28±13.62 days. Overall mortality rate was 24.7% with 25 expired cases. Logistic regression demonstrated significant association of older age, male gender, and greater TBSA with mortality. However, difference in mortality rate in patients with BMI of 25 kg/m2 (27.4%) in comparison to patients with BMI<25 kg/m2 (18%) did not reach statistical significance.

CONCLUSION

Although patients with higher BMI had increased mortality rate following burn injury, this finding showed no significant association. Further studies with larger samples may be necessary to conclude a causal association between BMI and mortality in burn patients.

Anti-PcrV IgY antibodies protect against Pseudomonas aeruginosa infection in both acute pneumonia and burn wound models

Pseudomonas aeruginosa is a common nosocomial pathogen in burn patients, and rapidly acquires antibiotic resistance; thus, developing an effective therapeutic approach is the most promising strategy for combating infection. Type III secretion system (T3SS) translocates bacterial toxins into the cytosol of the targeted eukaryotic cells, which plays important roles in the virulence of P. aeruginosa infections in both acute pneumonia and burn wound models. The PcrV protein, a T3SS translocating protein, is required for T3SS function and is a well-validated target in animal models of immunoprophylactic strategies targeting P. aeruginosa. In the present study, we evaluated the protective efficacy of chicken egg yolk antibodies (IgY) raised against recombinant PcrV (r-PcrV) in both acute pneumonia and burn wound models. R-PcrV protein was generated by expressing the pcrV gene (cloned in pET-28a vector) in E. coli BL-21. Anti-PcrV IgY was obtained by immunization of hen. Anti-PcrV IgY induced greater protection in P. aeruginosamurine acute pneumonia and burn wound models than control IgY (C-IgY) and PBS groups. Anti-PcrV IgY improved opsonophagocytic killing and inhibition of bacterial invasion of host cells. Taken together, our data provide evidence that anti-PcrV IgY can be a promising therapeutic candidate for combating P. aeruginosa infections.

A Six-Year Study on Epidemiology of Electrical Burns in Northern Iran: Is It Time to Pay Attention?

BACKGROUND

Although electrical burns are less prevalent than other types, they put socioeconomic burden on communities, yielding higher mortalities. Therefore, the frequency and causes of electrical burns in the largest burn center in northern Iran were studied.

METHODS

All patients with electrical burn injuries admitted to Velayat Hospital, Rasht, Iran participated in this descriptive cross-sectional study. The data collection tool was a checklist including demographic data, damage mechanism, voltage classification (high or low), injured organ, ICU need, length of stay (LOC), electrical burn severity (degree and area of burns based on TBSA), surgical interventions, and return to work. All data were gathered through HIS system and analyzed.

RESULTS

Most electrical burns occurred in men (99.4%) and most of whom had electricity-related jobs (26%). The majority of victims had third-degree burns (63%), and electrical current-induced burns in entry points occurred in the upper and lower extremities, head and other organs ranked the first to fourth, respectively. Most burns happened due to abrupt contact with electrical current (83.33%) in routine home activities (52.78%). The mean LOC was 8.73 days, suggesting that LOC increased significantly, if the electrical current entered the body through lower extremities, while it decreased significantly, if the electrical current exited through lower extremities.

CONCLUSION

The majority of electrical burn victims were men. Most burns occurred in urban communities in summer. Most people were affected by high voltage electricity.

An Observational Study on Clothing Characteristics Involved as Major Contributors in Sustaining Domestic Burns Injuries

BACKGROUND

Fire and burn-related injuries are a leading cause of morbidity and mortality worldwide, and is a serious public health problem in developing countries. Several studies showed causes such as low socioeconomic status, poor living conditions, illiteracy, and floor level cooking, however, very few studies stated severity of the burn injuries to be dependent on ignition of type clothing garment and fabric wore at the time of incident.

METHODS

A cross sectional observational study done on burn injury patients admitted from February 2014 to August 2016. Data were collected from the patients or their relatives and analysed.

RESULTS

Among 224 burn injury patients, majority were females (59.3%) sustained burn injuries in the study population (p=0.005). Victims wearing long loose flowing garments such as sarees (41.1%), salwar (22.3%), and dupatta (9.8%) were caught fire easily and sustained more burn injuries, compared to clothes reaching down to the knee and short fitting dresses (p=0.004). Percentage of burn was higher among wearers of synthetic fabrics (50.89%) than that of cottons (20.53%, p=0.028].

CONCLUSION

Every year, thousands of people are injured when their clothing catches fire. The findings reported herein documented that public knowledge about clothing related fire risks was lacking. This can be reduced by bringing about stronger regulations by government and to educate about the magnitude of the problems inflicted by burn injuries and to oversight and to promote less inflammable fabrics to be worn at home, especially in kitchen.

The Effect of Short-Term Training Course by Nurses on Body Image in Patients with Burn Injuries

BACKGROUND

Burn is the fourth most common cause of trauma worldwide and is the fourth among the injuries and surgeries requiring medical care. This study was designed to determine the effect of a short-term training course by nurses on body image in patients with burn injuries.

METHODS

This study was a semi-experimental single-group survey assessing before and after interventions. Totally, 130 subjects (65 women and 65 men) were enrolled. The training course was held in 3 sessions of two hours. The contents of the group training course (a group of 5 people) were in relation to the body image and the factors affecting it, and the ways to improve the body image. The data collection instrument was the satisfaction with appearance scale (SWAP).

RESULTS

The mean scores of the body image of patients before and after the intervention were 49.44±11.39 and 41.63±11.89, respectively. There was a significant difference between the mean scores of body image before and after educational interventions (T=6.013, P≤0.001). The mean score of body image in women before and after intervention was 49.2±10.9 and 41.2±11.65, respectively (T=4.51, P≤0.000). The mean score of body image in men before and after intervention was 49.6±11.89 and 42.07±12.19, respectively (T=4.51, P≤0.000).

CONCLUSION

Short-term courses held by nurses were shown to have a significant role in improving the body image of burn patients.

Fusarium Solani Infection Following Burn Injury: A Case Report

Fungal infections are becoming increasingly recognized among burn patients. Infection with Fusarium, a filamentous mold, is rarely encountered and mainly seen in immunocompromised patients. High mortality and morbidity were reported with these virulent infections. We present a rare case of refractory septic shock from upper extremity fungal infection with Fusarium solani in a burn patient. Multiple operative debridements and below elbow amputation caused resolution of septic shock. Closure was achieved with a split thickness skin graft. Aggressive approach should be adopted in managing burn patients with Fusarium infection. Serial debridements and extremity amputation should be considered in attempts to improve survival.

A trivalent vaccine consisting of "flagellin A+B and pilin" protects against Pseudomonas aeruginosa infection in a murine burn model

Pseudomonas aeruginosa is a common nosocomial pathogen in burn patients, and rapidly achieves antibiotic resistance, and thus, developing an effective vaccine is critically important for combating P. aeruginosa infection. Flagella and pili play important roles in colonization of P. aeruginosa at the burn wound site and its subsequent dissemination to deeper tissue and organs. In the present study, we evaluated protective efficacy of a trivalent vaccine containing flagellins A and B (FlaA + FlaB) + pilin (PilA) in a murine burn model of infection. "FlaA + FlaB + PilA" induced greater protection in P. aeruginosa murine burn model than the single components alone, and it showed broad immune protection against P. aeruginosa strains. Immunization with "FlaA + FlaB + PilA" induced strong opsonophagocytic antibodies and resulted in reduced bacterial loads, systemic IL-12/IL-10 cytokine expression, and increased survival after challenge with three times lethal dose fifty (LD50) of P. eruginosa strains. Moreover, the protective efficacy of "FlaA + FlaB + PilA" vaccination was largely attributed to specific antibodies. Taken together, these data further confirm that the protective effects of "FlaA + FlaB + PilA" vaccine significantly enhance efficacy compared with antibodies against either mono or divalent antigen, and that the former broadens the coverage against P. eruginosa strains that express two of the three antigens.

Evaluation of 'green' synthesis and biological activity of gold nanoparticles using Tragopogon dubius leaf extract as an antibacterial agent

Currently, the use of 'green' synthesised nanoparticles with environmentally friendly properties is considered a novel therapeutic approach in medicine. Here, the authors evaluated gold nanoparticles (AuNPs) conjugated with Tragopogon dubius leaf extract and their antibacterial activity in vitro and in vivo. Colour changes from yellow to dark brown and a peak at 560 nm on ultraviolet-visible spectroscopy confirmed the formation of nanoparticles. Additionally, transmission electron microscopy, X-ray diffraction, and Fourier transform infrared spectroscopy analyses were performed to determine particle sizes and functional groups involved in gold reduction. Moreover, using standard micro-dilution and disc-diffusion assays against Klebsiella pneumoniae, Bacillus cereus, Escherichia coli, and Staphylococcus aureus, the antimicrobial properties of synthesised AuNPs were investigated. To confirm antibacterial activity, synthesised AuNPs were applied in a rat model on burn wounds infected with S. aureus, and the nanoparticles were as effective as tetracycline in bacterial reduction and wound healing. In conclusion, the synthesis of AuNPs with aqueous T. dubius extract was rapid, simple, and inexpensive, and the synthesised nanoparticles had significant antibacterial activity in vitro and in vivo.

Prophylactic and therapeutic protection of human IgG purified from sera containing anti-exotoxin A titers against pneumonia caused by Pseudomonas aeruginosa

Antibodies are effective alternative tools to combat infections caused by Pseudomonas aeruginosa (PA), especially multi-drug-resistant PA. Thus, to solve the urgent need for an anti-PA antibody drug, we hypothesized that anti-PA intravenous immunoglobulins could be a practical attempt. Exotoxin A (ETA) is one of the most important factors for PA infection and is also a critical target for the development of immune interventions. In this study, a total of 320 sera were collected from healthy volunteers. The concentration of ETA-specific antibodies was determined by a Luminex-based assay and then purified by affinity chromatography. The purified IgGs were able to neutralize the cytotoxicity of ETA in vitro. We showed they had a prophylactic and therapeutic protective effect in PA pneumonia and ETA toxemia models. In addition, administration of nonspecific IgGs also provided partial protection. Collectively, our results provide additional evidence for IVIG-based treatment of infections caused by multi-drug-resistant PA and suggest that patients at high risk of PA pneumonia could be prophylactically treated with anti-ETA IgGs or even with nonspecific IgGs.

Novel pharmacotherapy for burn wounds: what are the advancements

INTRODUCTION

The prognosis for severe burns has improved significantly over the past 50 years. Meanwhile, burns have become an affliction mainly affecting the less well-developed regions of the world. Early excision and skin grafting has led to major improvements in therapeutic outcomes.

AREAS COVERED

The purpose of this article is to survey the use of pharmacotherapy to treat different pathophysiological complications of burn injury. The author, herein, discusses the use of drug treatments for a number of systemic metabolic disturbances including hyperglycemia, elevated catabolism, and gluconeogenesis.

EXPERT OPINION

Advancements in personalized and molecular medicine will make an impact on burn therapy. Similarities between severe burns and other critically ill patients will lead to cross-fertilization between different medical specialties. Furthermore, advances in stem cells and tissue regeneration will lead to improved healing and less lifelong disability. Indeed, research in new drug therapy for burns is actively progressing for many different complications.

Invasive Fungal Infection with Absidia Corymbifera in Immunocompetent Patient with Electrical Scalp Burn

Invasive fungal infection in burn injury is caused by inoculation of fungal spore from patient skin, respiratory tract or from care giver. The risk factors for acquiring fungal infection in burns include age of burns, total burn size, full thickness burns, inhalational injury, prolonged hospital stay, late surgical excision, open dressing, central venous catheters, antibiotics, steroid treatment, long-term artificial ventilation, fungal wound colonization, hyperglycemic episodes and other immunosuppressive disorders. Invasive fungal infection with Absidia corymbifera is rare opportunistic infection encountered in patient with burn injury. The key for treatment is early clinical diagnosis, wide and repeated debridement and systemic and local antifungal treatment. We describe a case of invasive fungal infection with A. corymbifera in a patient with post-electrical scalp burn with late presentation after 10 days of injury in an immunocompetent patient.

The Healing Effect of N-Hexan- Dichloromethane Extract Root Onosma Bulbotrichum in Second Degree Burns

BACKGROUND

Wound healing is the process of repair following an injury to the skin and other soft tissues. In this study, the effect of n-hexane d-chloromethane extract (1: 1) of root Onosma bulbotrichum DC on the second degree burn in rabbit model was investigated.

METHODS

Thirty-six adult rabbits of both sexes were randomly divided into six groups, control (without treatment), negative control (treatment with cold cream), positive control (treatment with silver sulfadiazine), and treatment groups with 5%, 1% and 2% O. bulbotrichum cream and assessed histologically.

RESULTS

The best result was shown in 5% O. bulbotrichum group similar to silver sulfadiazine group. The maximum amount of collagen and the tensile strength of tissue were observed in 5% O. bulbotrichum and silver sulfadiazine groups. Histopathological examination showed that burn healing in treatment group with 5% O. bulbotrichum was faster than other groups.

CONCLUSION

The 5% O. bulbotrichum cream was shown to have healing, and anti-inflammatory effects when used in treatment of second degree burns.

The Healing Effect of Sesame Oil, Camphor and Honey on Second Degree Burn Wounds in Rat

BACKGROUND

Many studies were carried out to improve sophisticated dressings to accelerate healing processes and reduce the microbial burden in burn wounds. This study evaluated the healing effect of herbal ointment containing extract of sesame oil, camphor and honey on second degree burn wounds in rats in comparison with daily dressing oil vaseline.

METHODS

Forty rats were randomly assigned to two equal groups. A deep second degree burn was formed on the back of each rat with using a standard burning technique. The burns were dressed daily with herbal ointment containing extract of sesame oil, camphor and honey in group 1, dressing oil vaseline in group 2. The response to treatment was evaluated by digital photography during the treatment on 0, 7, 14, 21, 28 days. Histological scoring was undertaken for scar tissue samples on 0, 7, 14, 21, 28 days.

RESULTS

Considerable epithelization in the herbal ointment group vs. the control group over the study period was noted. Neovascularization was significantly higher in herbal ointment treated rats as well. In terms of difference of wound surface area, maximal healing was noticed in herbal ointment extract of sesame oil, camphor and honey group and the minimal repair in the control group.

CONCLUSION

The greatest rate of healing was in the herbal ointment group containing sesame oil, camphor and honey, so the herbal ointment as a suitable substitute for dressing and healing of burn wound injuries is recommended.

Role of Square Flap in Post Burn Axillary Contractures

BACKGROUND

Post-burn contractures are a commonly encountered problem and many techniques have been described in their treatment. Z-plasties are the commonest local flap procedure done for linear bands with adjacent healthy tissue. Our aim was to assess the use of square flap technique in axillary contractures.

METHODS

Ten patients with type I and II axillary contractures underwent release by the square flap technique. All cases were followed up for at least one year and analysed for range of motion and aesthetic outcome.

RESULTS

All cases achieved full range of movement postoperatively with no recurrence during follow up period and a good cosmetic outcome.

CONCLUSION

Square flap was shown to be a reliable technique for mild to moderate axillary contractures of the anterior or posterior axillary folds even when there is significant adjacent scarring of chest wall or back of types I and II.

The Effect of Lithospermum officinale, Silver Sulfadiazine and Alpha Ointments in Healing of Burn Wound Injuries in Rat

BACKGROUND

Burn is the most devastating condition in emergency medicine leading to chronic disabilities. This study aimed to compare the effect of Lithospermum officinale, silver sulfadiazine and alpha ointments on healing of burn wounds in rat.

METHODS

Ninety-five rats were divided into 5 groups. Group 1 just underwent burn injury, and groups 2-5 received alpha ointment, silver sulfadiazine (SSD), gel base and L. officinale extract, respectively. A hot plate was used for induction of a standard 3^rd degree burn wound. Burn wounds were macroscopically and microscopically evaluated on days 7^th, 14^th and 21^st after burn induction.

RESULTS

A decrease in the number of inflammatory cells was noted when L. officinale and SSD were applied while the most inflammatory response was seen after administration of alpha ointment. The number of macrophages alone decreased after burn injury, while the frequency was the most when L. officinale and alpha ointment were applied. Re-epithelialization, angiogenesis and formation of granulation tissue were the best in relation to L. officinale and alpha ointment while, the worst results belonged to burn injury group and SSD regarding granulation tissue formation. Considering histological assessment, the best results were observed for scoring of inflammation, re-epithelialization, angiogenesis, formation of granulation tissue and number of macrophage when L. officinale and alpha ointment were used after burn injury.

CONCLUSION

It can be concluded that topical application of L. officinale as a non-toxic, inexpensive and easy to produce herbal can lead to a rapid epithelialization and wound healing and these findings can be added to the literature on burn wound healing.

Epidemiology of Acid-Burns in a Major Referral Hospital in Tehran, Iran

BACKGROUND

Most of the acid- burns are due to assault or accidental. The epidemiology of burns is diverse across the world and within a country. We evaluated the epidemiology and outcome of acid-burns in tertiary health care center in Tehran, Iran.

METHODS

This study was retrospective descriptive among patients referred for acid-burn injury that was done in a referral Burn Care Center in Tehran, Iran, during a ten-year period since 2005 to 2014. Patient's data collected by a specially designed check list. The subjects included 37 consecutive patients with various causes of acid burn injury. Descriptive statistics (means with standard deviations or frequency distribution) of sociodemographic variables were computed.

RESULTS

The patients' mean age was 31.97±11.02 years. The mean hospitalization period was 18.08±15.25 days. The grade of burn was III in 75.7% patients. Among the acid-burn patients, 64.8% suffered from <20% of total body surface area burn. Most affected part of the body was Head /face/neck 17 (45.9%). Most of the acid-burn occurred from attack (67.6%). Burns mortality rate for this study was identified 8.1% (N=3).

CONCLUSION

The results of this study showed high acid attacks rates. Prevention strategies must be coordinated at national level. So acid-burn patients have to receive the best medical care possible, first locally and then in a specialized center.

Management of Chronic Non-healing Wounds by Hirudotherapy

A chronic wound is a wound that does not heal in an orderly set of stages and in a predictable amount of time or wounds that do not heal within three months are often considered chronic. Chronic wounds often remain in the inflammatory stage for too long and may never heal or may take years. Chronic wound patients often report pain as dominant in their lives. Persistent pain is the main problem for patients with chronic ulcers. Many wounds pose no challenge to the body's innate ability to heal; some wounds, however, may not heal easily either because of the severity of the wounds themselves or because of the poor state of health of the individual. Any wound that does not heal within a few weeks should be examined by a healthcare professional because it might be infected, might reflect an underlying disease.

The Effect of Massage on Anticipatory Anxiety and Procedural Pain in Patients with Burn Injury

BACKGROUND

Pain related to burn injuries is one of the most troublesome pain intensity. This study aimed to investigate the effect of massage on anticipatory anxiety, procedural pain intensity, vital signs and relaxation level of patients with burn injury.

METHODS

In this quasi-experimental study, through convenience sampling, 60 hospitalized adult burn patients were selected from a specialized burn and reconstructive hospital. Subjects were assigned to massage and control groups through simple randomization. Massage was offered by using non aromatic oil about 10-15 minutes before wound care on intact part of the body once a day for 20 minutes on patients' bedside for 3 consecutive days. In the 3 days, the control group did not received any massage and were asked to stay at bed. Demographic and clinical characteristics and vital signs, Visual Analogue Scale and the Persian version of Burn Specific Pain Anxiety Scale were used to determine baseline and procedural pain, anxiety and relaxation levels and anticipatory anxiety.

RESULTS

No significant difference was noted between mean score of pain intensity, anxiety and relaxation level, and vital signs in massage and control groups after intervention following wound care. In massage and control groups, there was no significant differences between mean scores of anticipatory anxiety before and after intervention. There was no significant difference between the mean scores of anticipatory anxiety in massage and control groups after intervention prior wound care.

CONCLUSION

Massage was shown not to have any effect on anticipatory anxiety and procedural pain.

Fibroblast Growth Factor-1 vs. Fibroblast Growth Factor-2 in Ischemic Skin Flap Survival in a Rat Animal Model

BACKGROUND

One of the main challenges in skin flap surgery is tissue ischemia and following necrosis. The present study compares the effects of fibroblast growth factors 1 and 2 on increasing cutaneous vasculature, improving ischemia, and preventing distal necrosis in ischemic skin flaps in rat model.

METHODS

Thirty rats were allocated into 3 groups (n=10) and 2×8 cm dorsal random-pattern skin flaps were raised after four daily subdermal injections of normal saline (control group), fibroblast growth factor 1 (FGF-1 group; 2.5 µg/day), or fibroblast growth factor 2 (FGF-2 group; 2.5 µg/day) at designated flap areas. Skin flap viability and number of blood vessels were evaluated on day 10 after elevation by planimetric analysis and histological examination.

RESULTS

It was shown that administrations of FGF-1 and FGF-2 significantly decreased the percentage of flap necrosis and improved the percentage of ischemic survivable area, compared to the control samples. Meanwhile, the differences between these factors in terms of preventing skin flap necrosis and improving ischemia were also significant. The number of visible blood vessel sections was also higher in FGF-1 and FGF-2 groups than in the control group.

CONCLUSION

These findings suggest that, while FGF-2 is still much more potent than FGF-1, treatment with either of these drugs could be very effective in increasing the survival of surgical flaps at risk (length to width ratio>3) in situations that other therapeutic options could not be considered.

Superficial Burn Wound Healing with Intermittent Negative Pressure Wound Therapy Under Limited Access and Conventional Dressings

BACKGROUND

Thermal injury is associated with several biochemical and histopathological alteration in tissue. Analysis of these objective parameters in research and clinical field are common to determine healing rate of burn wound. Negative pressure wound therapy has been achieved wide success in treating chronic wounds. This study determines superficial burn wound healing with intermittent negative pressure wound therapy under limited access and conventional dressings.

METHODS

A total 50 patients were randomised into two equal groups: limited access and conventional dressing groups. Selective biochemical parameters such as hydroxyproline, hexosamine, total protein, and antioxidants, malondialdhyde (MDA), wound surface pH, matrix metalloproteinase-2 (MMP-2), and nitric oxide (NO) were measured in the granulation tissue. Histopathologically, necrotic tissue, amount of inflammatory infiltrate, angiogenesis and extracellular matrix deposition (ECM) were studied to determine wound healing under intermittent negative pressure.

RESULTS

Patients treated with limited access have shown significant increase in the mean hydroxyproline, hexosamine, total protein, reduced glutathione (GSH), glutathione peroxidase (GPx), and decrease in MDA, MMP-2, wound surface pH, and NO. Histopathologic study showed that there was a significant difference after 10 days of treatment between limited access vs conventional dressing group, Median (Q₁, Q₃)=3 (2, 4.25) vs 2 (1.75, 4).

CONCLUSION

Limited access was shown to exert its beneficial effects on wound healing by increasing ground substance, antioxidants and reducing MMP-2 activity, MDA, NO and providing optimal pH, decreasing necrotic tissue, amount of inflammatory infiltrate, increasing ECM deposition and angiogenesis.

Chronic Wounds in Burn Injury: A Case Report on Importance of Biofilms

According to the National Institutes of Health and the Center for Disease and Prevention, it is estimated that 65 to 80 percent of the human infectious are caused by biofilms. Antibiotics and drainage of purulent discharge are the main treatment measures. But in chronic infections sometimes these findings are not easy to recognize. Biofilm is an extracellular polymeric conglomeration generally composed of extracellular DNA, proteins, and polysaccharides, which help bacteria to survive into the host. The following case is the example of chronic wound in burn patient, where biofilm gets involved and special attention is given to the relationship biofilm-chronic wound injury in a burn patient.

The Healing Effect of Amniotic Membrane in Burn Patients

BACKGROUND

Different methods for dressing of donor site of skin graft in burn patients have similarly pain, limitation of mobility of donor site and local complications such as infection and scar. Amniotic membrane has used for improvement of healing in some wounds. Accordingly in this study amnion was used as biologic dressing for donor site of skin graft to evaluate it's efficacy in improvement of pain, move score and the risk of local infection.

METHODS

Study was done as clinical trial over 32 admitted patients in burn department of Beasat hospital. Amnion was prepared in elective caesarean section after rule out any placental site for risk of torch and viral infection. Skin graft was taken from two sites in every patient. One site dressed with amnion and another with routine dressing. Then two sites were compared about severity of pain, move score, infection and time of dressing sloughing.

RESULTS

Fourteen patients were women and 18 men. Mean score of pain and movement up to fourth and fifth post operative day respectively was less than control site. No difference is seen about infection and dressing slough in two sites.

CONCLUSION

It seems use of amnion for dressing of donor site probably cause rapid epithelialisation and wound healing and can improve pain and move score in early post operative days. Accordingly it is expected to need less analgesia and low rate of immobilization and following complications and earlier discharge of patients.

Protective efficacy of recombinant exotoxin A--flagellin fusion protein against Pseudomonas aeruginosa infection

Pseudomonas aeruginosa is an opportunistic bacterium that causes serious nosocomial infection in immunocompromised patients. The aim of this study was to prepare a fusion protein consisting of exotoxin A (ExoA) and flagellin (Fla) from P. aeruginosa and to evaluate its potential as a vaccine candidate against P. aeruginosa infection. The genes encoding for ExoA and Fla proteins were cloned in-frame and expressed in Escherichia coli. The recombinant ExoA-Fla fusion protein was purified by Ni-NTA affinity chromatography. Mice were immunized subcutaneously with ExoA, Fla, and ExoA-Fla fusion proteins, and the humoral immune response was evaluated by ELISA method. The immunized and control group mice were challenged with a 2× LD50 (7.5 × 10(7) CFU) of P. aeruginosa for the protection assay. The results indicated that vaccination with Fla, ExoA, and ExoA-Fla fusion proteins produced a significant amount of specific immunoglobulin G antibodies. Immunization of mice with ExoA-Fla fusion protein showed significant protection against intraperitoneal challenge with 7.5 × 10(7) CFU (2× LD50) P. aeruginosa. Results of this study suggest that recombinant ExoA-Fla fusion protein is a highly immunogenic protective protein showing promise as a vaccine candidate against P. aeruginosa.

The Role of CHI3L1 (Chitinase-3-Like-1) in the Pathogenesis of Infections in Burns in a Mouse Model

In severe burn injury the unique setting of a depleted, dysfunctional immune system along with a loss of barrier function commonly results in opportunistic infections that eventually proof fatal. Unfortunately, the dynamic sequence of bacterial contamination, colonization and eventually septic invasion with bacteria such as Pseudomonas species is still poorly understood although a limiting factor in clinical decision making. Increasing evidence supports the notion that inhibition of bacterial translocation into the wound site may be an effective alternative to prevent infection. In this context we investigated the role of the mammalian Chitinase-3-Like-1 (CHI3L1) non-enyzmatic protein predominately expressed on epithelial as well as innate immune cells as a potential bacterial-translocation-mediating factor. We show a strong trend that a modulation of chitinase expression is likely to be effective in reducing mortality rates in a mouse model of burn injury with superinfection with the opportunistic PA14 Pseudomonas strain, thus demonstrating possible clinical leverage.

The Healing Effect of Arnebia Euchroma Ointment versus Silver Sulfadiazine on Burn Wounds in Rat

BACKGROUND

Burn is still a majordevastating condition in emergency medicine departments among both genders and all age groups in all developed and developing countries, leading to physical, psychological scars and economical burden. The present study aimed to determine the healing effect of topical treatment with Arnebia euchroma on second-degree burn wound in rats.

METHODS

Fifty rats were divided into 4 equal groups receiving the ointment base, normal saline (NS), standard 1% silver sulfadiazine (SSD), and 5% and 10% Arnebia euchroma ointments (AEO). The mean of burn area, percentage of wound contraction, histopathological and bacteriological assessments in the injured area were dtermined during the study.

RESULTS

Average area of wound on the 10(th) day was 10.2±2.3, 8.4±2.6, 12.4±2.5, 5.9±2.2 and 5.7±2 cm(2) for ointment base, NS, 1% SSD, and 5% and 10% AEO, respectively. Wound size was significantly lower in 10% AEO than 1% SSD and control groups on the 10(th) day post-burn injury. On day 11, the percentage of wound contraction in 5% and 10% AEO was 53.9%±14.7% and 55.9±10.5% which was more than 1% SSD (15.3±10.8%). The collagen fibers were well formed and horizontally-oriented in 5% and 10% AEO groups when compared with other groups.

CONCLUSION

Arnebia euchroma ointment was an effective treatment for healing of burn wounds in comparison with SSD and can be regarded as an alternative topical treatment for burn wounds.

Clindamycin Phosphate Absorption from Nanoliposomal Formulations through Third-Degree Burn Eschar

BACKGROUND

It has been shown that topical nanoliposomal formulations improve burn healing process. On the other hand, it has been shown that liposomal formulations increase drug deposition in the normal skin while decrease their systemic absorption; there is not such data available for burn eschar. Present investigation studies permeation of clindamycin phosphate (CP) through burn eschar from liposomal formulations to answer this question. In this investigation, permeation of CP through fully hydrated third-degree burn eschar was evaluated using solution, normal nanoliposomes and ultradeformable nanoliposomes.

METHODS

Liposomal CP were prepared by thin-film hydration and characterized in terms of size, size distribution, zeta potential, encapsulation efficiency and short-time stability. Then the effect of liposomal lipid concentration on CP absorption was investigated.

RESULTS

The permeability coefficient ratio (liposome/solution) and permeation lag-time ratio (liposome/solution) of CP through burn eschar at 20 Mm lipid concentration were 0.81±0.21 and 1.19±1.30 respectively, indicating the retardation effects of liposomes. Data also showed that increasing liposomal lipid concentration from 20 to 100 mM, clindamycin permeation decreased by about 2 times. There was no difference between normal liposome and ultradeformable liposome in terms of clindamycin absorption.

CONCLUSION

Nanoliposomes could decrease trans-eschar absorption of CP, in good agreement with normal skin data, and might indicate CP deposition in the eschar tissue.

The healing effect of scrophularia striata on experimental burn wounds infected to pseudomonas aeruginosa in rat

BACKGROUND

The cause of death in burn patients after 48 hours of hospitalization has been reported to be bacterial infections. Recently, due to the compounds accelerating the healing process and the intense reduction of treatment side effects, medicinal plants are used to cure burn wound infections. This study aims to investigate the medicinal effect of the ethanolic extract of Scrophularia striata on burn wound infection in in-vivo and in-vitro in comparison with silver sulfadiazine (SSD).

METHODS

One hundred and fifty male Sprague Dawley rats were divided into 3 equal groups. A hot plate of 1×1cm was used to create second degree burn wounds. The ethanolic extract of S. striata was provided through percolation method. Group 1 was treated with SSD, group 2 with S. striata, and group 3 was considered as control group. All animals were infected to Pseudomonas aeruginosa. On days 3, 7, 10, 14, and 21 after burn wound injury, the animals were euthanized and were evaluated histologically. The MIC and MBC were determined using the micro dilution method.

RESULTS

The rate of wound healing was significantly greater in S. striata group in comparison to SSD and control groups.

CONCLUSION

S. striata contains was shown to have anti-bacterial and wound healing effects while this effect was significantly more than SSD denoting to its use when needed for burn wounds infected to P. aeruginosa.

The healing effect of curcumin on burn wounds in rat

BACKGROUND

Burns are still considered one of the most devastating conditions in emergency medicine affecting both genders and all age groups in developed and developing countries, resulting into physical and psychological scars and cause chronic disabilities. This study was performed to determine the healing effect of curcumin on burn wounds in rat.

METHODS

Seventy female Sprague-Dawley 180-220 g rats were randomly divided into 5 equal groups. Groups of A-C received 0.1, 0.5 and 2% curcumin respectively and Group D, silver sulfadiazine ointment. Group E was considered as control group and received eucerin. After 7, 14 and 21 days of therapy, the animals were sacrificed and burn areas were macroscopically examined and histologically were scored.

RESULTS

Administration of curcumin resulted into a decrease in size of the burn wounds and a reduction in inflammation after 14(th) days. Reepithelialization was prominent in groups A-C while more distinguishable in group C. In group C, epidermis exhibited well structured layers without any crusting. There were spindle shaped fibroblasts in fascicular pattern, oriented parallel to the epithelial surface with eosinophilic collagen matrix.

CONCLUSION

Curcumin as an available and inexpensive herbal was shown be a suitable substitute in healing of burn wounds especially when 2% concentration was applied.

Burn wound infections and antibiotic susceptibility patterns at pakistan institute of medical sciences, islamabad, pakistan

BACKGROND

Burn wound infections carry considerable mortality and morbidity amongst burn injury victims who have been successfully rescued through the initial resuscitation. This study assessed the prevalent microrganisms causing burn wound infections among hospitalized patients; their susceptibility pattern to commonly used antibiotics; and the frequency of infections with respect to the duration of the burn wounds.

METHODS

This study was carried out at Burn Care Centre, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan over a period of two years (i.e. from June 2010 to May 2012). The study included all wound-culture-positive patients of either gender and all ages, who had sustained deep burns and underwent definitive management with wound excisions and skin auto-grafting. Patients with negative cultures of the wounds were excluded. Tissue specimens for culture and sensitivity were collected from burn wounds using standard collection techniques and analyzed at microbiological laboratory.

RESULTS

Out of a total of 95 positive microbial growths, 36 were Pseudomonas aeruginosa (35.29%) as the most frequent isolate found, followed by 21 Klebsiella pneumoniae (20.58%), 19 Staphylococcus aureaus (18.62%), 10 Proteus (9.80%), 7 E. coli (6.86%), 7 Acinetobacter (6.86%), and 4 Candida (3.92%). A variable antibiotic susceptibility pattern was observed among the grown microbes. Positive cultures were significantly more frequent among patients with over two weeks duration of burn wounds.

CONCLUSION

P. aeruginosa, K. pneumoniae and S. aureus constituted the most common bacterial microbes of burn wounds in our in-patients cases. Positive cultures were more frequent among patients with over two weeks duration of burn wounds. Early excision and skin grafting of deep burns and adherence to infection control measures can help to effectively reduce the burden of these infections.

Reconstructive surgery of extensive face and neck burn scars using tissue expanders

BACKGROUND

Neck reconstruction is considered as one of the most important surgeries in cosmetic and reconstructive surgery. The present study aimed to assess the results of reconstructive surgery of extensive face and neck burning scars using tissue expanders.

METHODS

This descriptive prospective study was conducted on 36 patients with extensive burning scars on the neck and face. Operation for tissue expander insertion was performed and tissue distension started two or three weeks later, depending on the patients' incisions. After sufficient time for tissue expansion, while removing the expander and excision of the lesion, the expanded flap was used to cover the lesion. Overall, 43 cosmetic surgeries were done.

RESULTS

Rectangular expanders were employed in most patients (73.81%) and were located in the neck in most of them (60.78%). Complications were detected in five patients (13.89%), with exposure of the prosthesis being the most common one. Scar tissues at the reconstruction site and the flap donor site were acceptable in 94.44% and 98.18% of the cases, respectively. Overall, most of the patients (77.78%) were satisfied with the operation results. 

CONCLUSION

Using tissue expanders in tissue reconstruction of extensive neck and facial burning scars results in highly desirable outcomes.

The healing effect of nettle extract on second degree burn wounds

BACKGROUND

Numerous studies were carried out to develop more sophisticated dressings to expedite healing processes and diminish the bacterial burden in burn wounds. This study assessed the healing effect of nettle extract on second degree burns wound in rats in comparison with silver sulfadiazine and vaseline.

METHODS

Forty rats were randomly assigned to four equal groups. A deep second-degree burn was created on the back of each rat using a standard burning procedure. The burns were dressed daily with nettle extract in group 1, silver sulfadiazine in group 2, vaseline in group 3 and without any medication in group 4 as control group. The response to treatment was assessed by digital photography during the treatment until day 42. Histological scoring was undertaken for scar tissue samples on days 10 and 42.

RESULTS

A statistically significant difference was observed in group 1 compared with other groups regarding 4 scoring parameters after 10 days. A statistically significant difference was seen for fibrosis parameter after 42 days. In terms of difference of wound surface area, maximal healing was noticed at the same time in nettle group and minimal repair in the control group.

CONCLUSION

Our findings showed maximal rate of healing in the nettle group. So it may be a suitable substitute for silver sulfadiazine and vaseline when available.

The effect of shiatsu massage on pain reduction in burn patients

BACKGROUND

Burn is a tragedy that follows multiple problems in a patient including pain, anxiety and lack of confidence into medical team. This study evaluated the effect of shiatsu massage on pain intensity of burn patients.

METHODS

A total of 120 burn patients from Motahhari Burn Hospital and of both genders were randomly divided into 4 groups of undergoing hand massage, leg massage, both hand and leg massages, and the control group. The effect of shiatsu massage in pain relief of burned patients was evaluated. The visual analog scale (VAS) was used to assess pain in burn patients.

RESULTS

Pain intensity in the control group before and after the intervention was not statistically significant (p=1). In all massage groups, the difference for pain intensity before and after the intervention was statistically significant.

CONCLUSION

According to our data, shiatsu method over both hands and legs were effective in pain reduction and can be recommended together with analgesics to decrease the dose.

The Healing Effect of Licorice on Pseudomonas aeruginosa Infected Burn Wounds in Experimental Rat Model

BACKGROUND

Burn is still one of the most devastating injuries in emergency medicine while improvements in wound healing knowledge and technology have resulted into development of new dressings. This study was undertaken to evaluate the healing effect of licorice in Pseudomonas aeruginosa infected burn wounds of experimental rat model.

METHODS

One hundred and twenty female Sprague-Dawley rats were randomly allocated to 4 equal groups. Group A received silver sulfadiazine ointment, Group B received 10% licorice extract and Group C was considered as control group and received gel base as the base of medication. Group D did not receive any medication and just underwent burn injury. A standard 3rd degree burn wound was produced by a hot plate with similar size about 20% of total body surface area (TBSA) and at identical temperature. After 24 h of burn production, 10(8) colony forming units (CFU) of toxigenic strains of P. aeruginosa (PA 103) were inoculated subcutaneously into the burnt area. After 3, 7, 14, 21 and 28 days of therapy, the animals were sacrificed and burn areas were macroscopically examined and histologically evaluated.

RESULTS

Decrease in size of the burn wounds, in inflammation and re-epithelialization were poor in groups B-D. Infection to P. aeruginosa was still visible in groups B-D but was absent in Group A. The mean histological score, tensile strength, maximum stress, yield strength and stiffness in groups B-D were lower compared with Group A.

CONCLUSION

Licorice extract in 10% concentration was shown not to be effective in healing of P. aeruginosa infected burn wounds.

Epidemiology and outcome of self-inflicted burns at pakistan institute of medical sciences, islamabad

BACKGROUND

Self-inflicted burn injuries carry considerable mortality and morbidity among otherwise fit young individuals. This study assessed the epidemiologic pattern and outcome of these injuries in a burn care facility in Pakistan.

METHODS

The study was carried out at Pakistan Institute of Medical Sciences (PIMS) Burn Care Centre in Islamabad over a period of 2 years. It included all adult patients of either gender, aged over 14 years who presented as cases of burn suicides and attempted burn suicides during the study period. Convenience sampling technique was employed. The sociodemographic profile of the patients, motives underlying the act of self-immolation, any underlying psychiatric illness, alcohol abuse, total body surface area (TBSA) burnt, depth of burn injury, associated inhalation injury, duration of hospital stay, and mortality were all recorded.

RESULTS

Seventy five patients (80.64%) were female while 18 patients (19.35%) were male. The overall mean age was 26.89±6.1 years (range=15-52 years). The affected TBSA ranged from 15%-100% with an overall mean of 69.30±25.42%. The hospital stay ranged from 1-37 days with a mean of 7.16±6.60 days. Marital conflicts constituted the most frequent motive underlying the suicidal attempts (n=57; 61.29%) followed by failed love affairs (n=9; 9.67%). There was an overall mortality of 84.95%. The most common sufferers of self inflicted burn injuries were young, married, illiterate housewives who were resident of rural area. Getting marriage was the most common triggering cause for such injuries.

CONCLUSION

There is need to institute appropriate preventive measures to address the issue in a national perspective.

Comparison of healing effect of aloe vera extract and silver sulfadiazine in burn injuries in experimental rat model

BACKGROUND

Wound healing is widely discussed in the medical literature. This study compared the healing effect of aloe vera extract and silver sulfadiazine in burn injuries in experimental rat model.

METHODS

Sixteen rats were randomly assigned to one of two groups, each group 8 rats. A deep second-degree burn on the lower back and 3(rd) degree burn on upper back of each rat were created with a standard burning procedure. Burns were dressed daily with aloe vera extract in group 2 and silver sulfadiazine in group 1. Response to treatment was assessed by digital photography during treatment until day 32. Histological parameters (PMN, epithelialization, fibrosis and angiogenesis) were assessed after biopsy of scar at the end of research.

RESULTS

Wound healing was more visible in aloe vera group. Also the speed of healing in aloe vera group was better than silver sulfadiazine group.

CONCLUSIONS

Based on our findings, aloe vera can be a therapy of choice for burn injuries.

Cloning, expression and characterization of recombinant exotoxin A-flagellin fusion protein as a new vaccine candidate against Pseudomonas aeruginosa infections

BACKGROUND

Infections due to Pseudomonas aeruginosa are among the leading causes of morbidity and mortality in patients who suffer from impaired immune responses and chronic diseases such as cystic fibrosis. At present, aggressive antibiotic therapy is the only choice for management of P. aeruginosa infections, but emergence of highly resistant strains necessitated the development of novel alternative therapeutics including an effective vaccine. Several P. aeruginosa antigens have been tested for vaccine development, including lipopolysaccharide alone, polysaccharides alginate, extracellular proteins, exotoxin A (exo A) and killed whole cell. However, none of them are currently available clinically.

METHODS

In this research, recombinant exoA-flagellin (fliC) fusion protein as a cocktail antigen was expressed and purified and its antigenic characteristics were evaluated.

RESULTS

Expression of recombinant fusion protein by E. coli using pET22b vector resulted in production of exoA-fliC fusion protein in high concentration. Based on Western-blotting results, recombinant fusion protein showed a good antigenic interaction with sera from patients with various P. aeruginosa infections.

CONCLUSION

These results suggested that recombinant exoA-fliC fusion protein can be produced in the laboratory, and tested as a candidate vaccine in P. aeruginosa infections.

Novel approaches to the treatment of Pseudomonas aeruginosa infections in cystic fibrosis

Pseudomonas aeruginosa chronically infects patients with cystic fibrosis and is associated with greater morbidity. There has been limited progress on the clinical development of new antibiotics with novel modes of action. This review addresses some of the latest research developments on the exploitation of candidate adjuvant therapeutic agents that may act alongside conventional antibiotics as an alternative therapeutic strategy. After considering key mechanisms this opportunistic pathogen employs to control virulence, the progress of various strategies including the inhibition of quorum sensing, efflux pumps and lectins, and the use of iron chelators, bacteriophages, immunisation and immunotherapy is reviewed. Both therapeutic approaches in early development and clinical phase are discussed.