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Goh M, Du M, Peng WR, Saw PE, Chen Z. Advancing burn wound treatment: exploring hydrogel as a transdermal drug delivery system. Drug Deliv 2024; 31:2300945. [PMID: 38366562 PMCID: PMC10878343 DOI: 10.1080/10717544.2023.2300945] [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: 08/16/2023] [Accepted: 12/05/2023] [Indexed: 02/18/2024] Open
Abstract
Burn injuries are prevalent and life-threatening forms that contribute significantly to mortality rates due to associated wound infections. The management of burn wounds presents substantial challenges. Hydrogel exhibits tremendous potential as an ideal alternative to traditional wound dressings such as gauze. This is primarily attributed to its three-dimensional (3D) crosslinked polymer network, which possesses a high water content, fostering a moist environment that supports effective burn wound healing. Additionally, hydrogel facilitates the penetration of loaded therapeutic agents throughout the wound surface, combating burn wound pathogens through the hydration effect and thereby enhancing the healing process. However, the presence of eschar formation on burn wounds obstructs the passive diffusion of therapeutics, impairing the efficacy of hydrogel as a wound dressing, particularly in cases of severe burns involving deeper tissue damage. This review focuses on exploring the potential of hydrogel as a carrier for transdermal drug delivery in burn wound treatment. Furthermore, strategies aimed at enhancing the transdermal delivery of therapeutic agents from hydrogel to optimize burn wound healing are also discussed.
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Affiliation(s)
- MeeiChyn Goh
- Institute of Medical Imaging, Hengyang Medical School, University of South China, Hengyang, China
| | - Meng Du
- Institute of Medical Imaging, Hengyang Medical School, University of South China, Hengyang, China
| | - Wang Rui Peng
- Institute of Medical Imaging, Hengyang Medical School, University of South China, Hengyang, China
- The Seventh Affiliated Hospital, Hunan Veterans Administration Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Phei Er Saw
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Nanhai Translational Innovation Center of Precision Immunology, Sun Yat-Sen Memorial Hospital, Foshan, China
| | - Zhiyi Chen
- Institute of Medical Imaging, Hengyang Medical School, University of South China, Hengyang, China
- The Seventh Affiliated Hospital, Hunan Veterans Administration Hospital, Hengyang Medical School, University of South China, Changsha, China
- The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
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McGovern C, McKinley G, McConnachie A, Arkoulis N, Paton L, Shaw M, Quasim T, Puxty K. Long term mortality in burn injury survivors: A matched cohort study. Injury 2024; 55:111793. [PMID: 39111270 DOI: 10.1016/j.injury.2024.111793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 08/03/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND Survivors of burn injuries may be at risk of early death. This study describes the mortality of burn survivors in comparison with two matched cohorts. METHODS This retrospective cohort study compared adults admitted with a burn injury from 2009 to 2019 with two matched cohorts; one from the general population and one with a diagnosis of acute pancreatitis. Patients were excluded from analysis if they died during hospital admission or within 90 days of hospital discharge. Cox proportional hazards models were used to explore differences between cohorts and variables associated with mortality. RESULTS 7,147 burns patients were matched with 6,810 pancreatitis patients and 28,184 individuals from the general population. Patients with a burn injury had an increased risk of death when compared to the general population (HR 2.46, 95 % CI 2.28,2.66, p < 0.001) and those with acute pancreatitis (HR 1.28, 95 % CI 1.17,1.40, p < 0.001). Socioeconomic deprivation, increasing comorbidity and specific comorbidities such as alcohol, drug abuse and depression were also associated with increased mortality. CONCLUSION Survivors of burn injury are at increased risk of mortality compared to individuals matched on sex, age and socioeconomic deprivation in both the general population and with a hospital admission due to acute pancreatitis.
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Affiliation(s)
- Christopher McGovern
- Intensive Care Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, Scotland, UK.
| | - Gemma McKinley
- Robertson Centre for Biostatistics, Clarice Pears Building, University of Glasgow, 90 Byres Road, Glasgow, Scotland, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Clarice Pears Building, University of Glasgow, 90 Byres Road, Glasgow, Scotland, UK
| | - Nicolaos Arkoulis
- Burn and Plastic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, Scotland, UK
| | - Lia Paton
- Intensive Care Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, Scotland, UK
| | - Martin Shaw
- Department of Anaesthesia, Critical Care and Perioperative Medicine, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - Tara Quasim
- Intensive Care Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, Scotland, UK; Department of Anaesthesia, Critical Care and Perioperative Medicine, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - Kathryn Puxty
- Intensive Care Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, Scotland, UK; Department of Anaesthesia, Critical Care and Perioperative Medicine, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, Scotland, UK
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Khalaf F, Ricciuti Z, Barayan D, Wojtowicz-Piotrowski S, Jeschke MG. Post-burn endocrine-immune dynamics and ageing considerations. Nat Rev Endocrinol 2024; 20:567-568. [PMID: 38982289 DOI: 10.1038/s41574-024-01018-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Affiliation(s)
- Fadi Khalaf
- Department of Biochemistry, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- David Braley Research Institute, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Zachary Ricciuti
- David Braley Research Institute, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Medical Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Dalia Barayan
- David Braley Research Institute, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie Wojtowicz-Piotrowski
- David Braley Research Institute, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Marc G Jeschke
- Department of Biochemistry, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
- David Braley Research Institute, Hamilton, Ontario, Canada.
- Hamilton Health Sciences, Hamilton, Ontario, Canada.
- Department of Medical Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
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Panayi AC, Heyland DK, Stoppe C, Jeschke MG, Knoedler S, Tapking C, Didzun O, Haug V, Bigdeli AK, Kneser U, Orgill DP, Hundeshagen G. Frailty as a sequela of burn injury: a post hoc analysis of the "RE-ENERGIZE" multicenter randomized-controlled trial and the National Health Interview Survey. Mil Med Res 2024; 11:63. [PMID: 39267196 PMCID: PMC11391741 DOI: 10.1186/s40779-024-00568-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 08/19/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND With advancements in burn treatment and intensive care leading to decreased mortality rates, a growing cohort of burn survivors is emerging. These individuals may be susceptible to frailty, characterized by reduced physiological reserve and increased vulnerability to stressors commonly associated with aging, which significantly complicates their recovery process. To date, no study has investigated burns as a potential risk factor for frailty. This study aimed to determine the short-term prevalence of frailty among burn survivors' months after injury and compare it with that of the general population. METHODS A post hoc analysis was conducted on the Randomized Trial of Enteral Glutamine to Minimize the Effects of Burn Injury (RE-ENERGIZE) trial, an international randomized-controlled trial involving 1200 burn injury patients with partial- or full-thickness burns. Participants who did not complete the 36-Item Short Form Health Survey (SF-36) questionnaire were excluded. Data for the general population were obtained from the 2022 National Health Interview Survey (NHIS). Frailty was assessed using the FRAIL (Fatigue, Resistance, Ambulation, Illness, Loss of weight) scale. Due to lack of data on loss of weight, for the purposes of this study, malnutrition was used as the fifth variable. Illness and malnutrition were based on admission data, while fatigue, resistance, and ambulation were determined from post-discharge responses to the SF-36. The burn cohort and general population groups were matched using propensity score matching and compared in terms of frailty status. Within the burn group, patients were divided into different subgroups based on their frailty status, and the differences in their (instrumental) activities of daily living (iADL and ADL) were compared. A multivariable analysis was performed within the burn cohort to identify factors predisposing to frailty as well as compromised iADL and ADL. RESULTS Out of the 1200 burn patients involved in the study, 600 completed the required questionnaires [follow-up time: (5.5 ± 2.3) months] and were matched to 1200 adults from the general population in the U.S. In comparison to the general population, burn patients exhibited a significantly higher likelihood of being pre-frail (42.3% vs. 19.8%, P < 0.0001), or frail (13.0% vs. 1.0%, P < 0.0001). When focusing on specific components, burn patients were more prone to experiencing fatigue (25.8% vs. 13.5%, P < 0.0001), limited resistance (34.0% vs. 2.7%, P < 0.0001), and restricted ambulation (41.8% vs. 3.8%, P < 0.0001). Conversely, the incidence rate of illness was observed to be higher in the general population (1.2% vs. 2.8%, P = 0.03), while no significant difference was detected regarding malnutrition (2.3% vs. 2.6%, P = 0.75). Furthermore, in comparison with robust burn patients, it was significantly more likely for pre-frail and frail patients to disclose compromise in ADL and iADL. The frail cohort reported the most pronounced limitation. CONCLUSIONS Our findings suggest a higher incidence of post-discharge frailty among burn survivors in the short-term following injury. Burn survivors experience compromised fatigue, resistance, and ambulation, while rates of illness and malnutrition were lower or unchanged, respectively. These results underscore the critical need for early identification of frailty after a burn injury, with timely and comprehensive involvement of a multidisciplinary team including burn and pain specialists, community physicians, physiotherapists, nutritionists, and social workers. This collaborative effort can ensure holistic care to address and mitigate frailty in this patient population.
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Affiliation(s)
- Adriana C Panayi
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071, Ludwigshafen, Germany
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Department of Critical Care Medicine, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Christian Stoppe
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, 97080, Würzburg, Germany
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité Berlin, 10117, Berlin, Germany
| | - Marc G Jeschke
- Hamilton Health Sciences Research, Department of Surgery, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - Samuel Knoedler
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Christian Tapking
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071, Ludwigshafen, Germany
| | - Oliver Didzun
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071, Ludwigshafen, Germany
| | - Valentin Haug
- Burns Center and Plastic Surgery, Unfallkrankenhaus Berlin, 12683, Berlin, Germany
| | - Amir K Bigdeli
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071, Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071, Ludwigshafen, Germany
| | - Dennis P Orgill
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Gabriel Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071, Ludwigshafen, Germany.
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Kumar R, Sharma AK, Kirti, Kalonia A, Shaw P, Yashvarddhan MH, Vibhuti A, Shukla SK. Understanding innate and adaptive responses during radiation combined burn injuries. Int Rev Immunol 2024:1-14. [PMID: 39262163 DOI: 10.1080/08830185.2024.2402023] [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: 04/04/2024] [Revised: 06/28/2024] [Accepted: 09/03/2024] [Indexed: 09/13/2024]
Abstract
The occurrence of incidents involving radiation-combined burn injuries (RCBI) poses a significant risk to public health. Understanding the immunological and physiological responses associated with such injuries is crucial for developing care triage to counter the mortality that occurs due to the synergistic effects of radiation and burn injuries. The core focus of this narrative review lies in unraveling the immune response against RCBI. Langerhans cells, mast cells, keratinocytes, and fibroblasts, which induce innate immunity, have been explored for their response to radiation, burns, and combined injuries. In the case of adaptive immune response, exploring behavioral changes in T regulatory (Treg) cells, T helper cells (Th1, Th2, and Th17), and immunoglobulin results in delayed healing compared to burn and radiation injury. The review also includes the function of complement system components such as neutrophils, acute phase proteins (CRP, C3, and C5), and cytokines for their role in RCBI. Combined insults resulting in a reduction in the cell population of immune cells display variation in response based on radiation doses, burn injury types, and their intrinsic radiosensitivity. The lack of approved countermeasures against RCBI poses a significant challenge. Drug repurposing might help to balance immune cell alteration, resulting in fast recovery and decreasing mortality, which gives it clinical significance for its implication on the site of such incidence. However, the exact immune response in RCBI remains insufficiently explored in pre-clinical and clinical stages, which might be due to the non-availability of in vitro models, standard animal models, or human subjects, warranting further research.
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Affiliation(s)
- Rishav Kumar
- Radiation Combined Injuries Research Department, Institute of Nuclear Medicine and Allied Sciences, Defence Research Development Organization, Timarpur, Delhi, India
- Department of Biotechnology, SRM University, Sonepat, India
| | - Ajay Kumar Sharma
- Radiation Combined Injuries Research Department, Institute of Nuclear Medicine and Allied Sciences, Defence Research Development Organization, Timarpur, Delhi, India
| | - Kirti
- Radiation Combined Injuries Research Department, Institute of Nuclear Medicine and Allied Sciences, Defence Research Development Organization, Timarpur, Delhi, India
| | - Aman Kalonia
- Radiation Combined Injuries Research Department, Institute of Nuclear Medicine and Allied Sciences, Defence Research Development Organization, Timarpur, Delhi, India
| | - Priyanka Shaw
- Radiation Combined Injuries Research Department, Institute of Nuclear Medicine and Allied Sciences, Defence Research Development Organization, Timarpur, Delhi, India
| | - M H Yashvarddhan
- Radiation Combined Injuries Research Department, Institute of Nuclear Medicine and Allied Sciences, Defence Research Development Organization, Timarpur, Delhi, India
| | - Arpana Vibhuti
- Department of Biotechnology, SRM University, Sonepat, India
| | - Sandeep Kumar Shukla
- Radiation Combined Injuries Research Department, Institute of Nuclear Medicine and Allied Sciences, Defence Research Development Organization, Timarpur, Delhi, India
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Chen J, Zhang JF, Xiao X, Tang YJ, Huang HJ, Xi WW, Liu LN, Shen ZZ, Tan JH, Yang F. Nomogram for predicting the risk of anxiety and depression in patients with non-mild burns. World J Psychiatry 2024; 14:1233-1243. [PMID: 39165551 PMCID: PMC11331381 DOI: 10.5498/wjp.v14.i8.1233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/02/2024] [Accepted: 07/08/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Post-burn anxiety and depression affect considerably the quality of life and recovery of patients; however, limited research has demonstrated risk factors associated with the development of these conditions. AIM To predict the risk of developing post-burn anxiety and depression in patients with non-mild burns using a nomogram model. METHODS We enrolled 675 patients with burns who were admitted to The Second Affiliated Hospital, Hengyang Medical School, University of South China between January 2019 and January 2023 and met the inclusion criteria. These patients were randomly divided into development (n = 450) and validation (n = 225) sets in a 2:1 ratio. Univariate and multivariate logistic regression analyses were conducted to identify the risk factors associated with post-burn anxiety and depression diagnoses, and a nomogram model was constructed. RESULTS Female sex, age < 33 years, unmarried status, burn area ≥ 30%, and burns on the head, face, and neck were independent risk factors for developing post-burn anxiety and depression in patients with non-mild burns. The nomogram model demonstrated predictive accuracies of 0.937 and 0.984 for anxiety and 0.884 and 0.923 for depression in the development and validation sets, respectively, and good predictive performance. Calibration and decision curve analyses confirmed the clinical utility of the nomogram. CONCLUSION The nomogram model predicted the risk of post-burn anxiety and depression in patients with non-mild burns, facilitating the early identification of high-risk patients for intervention and treatment.
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Affiliation(s)
- Jie Chen
- Department of Burns and Plastic Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang 421001, Hunan Province, China
| | - Jian-Fei Zhang
- Department of Burns and Plastic Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang 421001, Hunan Province, China
| | - Xia Xiao
- Department of Burns and Plastic Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang 421001, Hunan Province, China
| | - Yu-Jun Tang
- Department of Burns and Plastic Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang 421001, Hunan Province, China
| | - He-Jin Huang
- Department of Burns and Plastic Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang 421001, Hunan Province, China
| | - Wen-Wen Xi
- Department of Burns and Plastic Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang 421001, Hunan Province, China
| | - Li-Na Liu
- Department of Burns and Plastic Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang 421001, Hunan Province, China
| | - Zheng-Zhou Shen
- Department of Beauty Surgery, Nantong Shenmei Medical Beauty Clinic, Nantong 226001, Jiangsu Province, China
| | - Jian-Hua Tan
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang 421001, Hunan Province, China
| | - Feng Yang
- Department of Burns and Plastic Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang 421001, Hunan Province, China
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Turan TL, Klein HJ, Graf TR, Chillon TS, Plock JA, Schomburg L. New-onset autoantibodies to selenoprotein P following severe burn injury. Front Immunol 2024; 15:1422781. [PMID: 39176084 PMCID: PMC11338932 DOI: 10.3389/fimmu.2024.1422781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/22/2024] [Indexed: 08/24/2024] Open
Abstract
The liver-derived selenium (Se) transporter selenoprotein P (SELENOP) declines in critical illness as a negative acute phase reactant and has recently been identified as an autoantigen. Hepatic selenoprotein biosynthesis and cotranslational selenocysteine insertion are sensitive to inflammation, therapeutic drugs, Se deficiency, and other modifiers. As severe burn injury induces a heavy inflammatory burden with concomitant Se depletion, we hypothesized an impairment of selenoprotein biosynthesis in the acute post-burn phase, potentially triggering the development of autoantibodies to SELENOP (SELENOP-aAb). To test this hypothesis, longitudinal serum samples from severely burned patients were analyzed over a period of six months. Newly occurring SELENOP-aAb were detected in 8.4% (7/83) of the burn patients, with onset not earlier than two weeks after injury. Prevalence of SELENOP-aAb was associated with injury severity, as aAb-positive patients have suffered more severe burns than their aAb-negative counterparts (median [IQR] ABSI: 11 [7-12] vs. 7 [5.8-8], p = 0.023). Autoimmunity to SELENOP was not associated with differences in total serum Se or SELENOP concentrations. A positive correlation of kidney-derived glutathione peroxidase (GPx3) with serum SELENOP was not present in the patients with SELENOP-aAb, who showed delayed normalization of GPx3 activity post-burn. Overall, the data suggest that SELENOP-aAb emerge after severe injury in a subset of patients and have antagonistic effects on Se transport. The nature of burn injury as a sudden event allowed a time-resolved analysis of a direct trigger for new-onset SELENOP-aAb, which may be relevant for severely affected patients requiring intensified acute and long-term care.
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Affiliation(s)
- Tabael L. Turan
- Institute for Experimental Endocrinology, Max Rubner Center for Cardiovascular Metabolic Renal Research, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Holger J. Klein
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
- Department of Plastic Surgery and Hand Surgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Theresia Reding Graf
- Department of Visceral Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Thilo Samson Chillon
- Institute for Experimental Endocrinology, Max Rubner Center for Cardiovascular Metabolic Renal Research, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jan A. Plock
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
- Department of Plastic Surgery and Hand Surgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Lutz Schomburg
- Institute for Experimental Endocrinology, Max Rubner Center for Cardiovascular Metabolic Renal Research, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Chouinard NH, Ndongo Sonfack DJ, Chang SL, Bergeron F, Beaudoin Cloutier C, Guertin JR. Exploring the Prevalence of Post-traumatic Stress Disorder and Post-traumatic Stress Symptoms in Parents Within 12 Months of Child Burn Injury: A Systematic Review. J Burn Care Res 2024; 45:1051-1059. [PMID: 38421036 PMCID: PMC11303126 DOI: 10.1093/jbcr/irae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Indexed: 03/02/2024]
Abstract
Our systematic review aimed to investigate the prevalence of post-traumatic stress symptoms (PTSS) and post-traumatic stress disorder (PTSD) among parents within 12 months of their child's burn injury. A literature search was conducted in PubMed, Embase, Web of Science, Psychinfo, and CINAHL on January 6, 2023, for quantitative studies reporting the prevalence of PTSD and/or PTSS in parents within 12 months following their child's burn injury. The risk of bias was assessed using the Mixed Methods Appraisal Tool version 2018. A narrative synthesis of prevalence was presented. We identified 15 articles that met our inclusion criteria. The prevalence of PTSS within 12 months following the burn injury ranged from 6% to 49%. Prevalence estimates of PTSD within the 12 months following a burn injury were limited, ranging from 4.4% to 22%. Our findings highlight the significant impact of burn injuries on parental mental health, with a considerable proportion of parents experiencing PTSS within 12 months following their child's burn injury. Prevalence estimates for PTSD were limited and warrant further investigation. Our review also underscores the need for standardization of PTSS/PTSD terminology. Timely and targeted psychological support is needed for parents in the aftermath of their child's burn injury.
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Affiliation(s)
- Naomi Hope Chouinard
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, G1V 5C3, Canada
- Centre de recherche du CHU de Québec-Université Laval, Québec, G1S 4L8, Canada
- Centre de recherche en organogénèse expérimentale de l’Université Laval/LOEX, Québec, G1J 5B3, Canada
| | - Davaine Joel Ndongo Sonfack
- Centre de recherche du CHU de Québec-Université Laval, Québec, G1S 4L8, Canada
- Centre de recherche en organogénèse expérimentale de l’Université Laval/LOEX, Québec, G1J 5B3, Canada
- Département de chirurgie, Faculté de médecine, Université Laval, Québec, G1V 5C3, Canada
| | - Sue-Ling Chang
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, G1V 5C3, Canada
- CHU de Québec-Université Laval, Québec, G1S 4L8, Canada
| | - Frédéric Bergeron
- Bibliothèque-Direction des services-conseils, Université Laval, Québec, G1V 5C3, Canada
| | - Chanel Beaudoin Cloutier
- Centre de recherche du CHU de Québec-Université Laval, Québec, G1S 4L8, Canada
- Centre de recherche en organogénèse expérimentale de l’Université Laval/LOEX, Québec, G1J 5B3, Canada
- Département de chirurgie, Faculté de médecine, Université Laval, Québec, G1V 5C3, Canada
| | - Jason Robert Guertin
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, G1V 5C3, Canada
- Centre de recherche du CHU de Québec-Université Laval, Québec, G1S 4L8, Canada
- Centre de recherche en organogénèse expérimentale de l’Université Laval/LOEX, Québec, G1J 5B3, Canada
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Ryan M, Raby E, Whiley L, Masuda R, Lodge S, Nitschke P, Maker GL, Wist J, Holmes E, Wood FM, Nicholson JK, Fear MW, Gray N. Nonsevere Burn Induces a Prolonged Systemic Metabolic Phenotype Indicative of a Persistent Inflammatory Response Postinjury. J Proteome Res 2024; 23:2893-2907. [PMID: 38104259 PMCID: PMC11302432 DOI: 10.1021/acs.jproteome.3c00516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Indexed: 12/19/2023]
Abstract
Globally, burns are a significant cause of injury that can cause substantial acute trauma as well as lead to increased incidence of chronic comorbidity and disease. To date, research has primarily focused on the systemic response to severe injury, with little in the literature reported on the impact of nonsevere injuries (<15% total burn surface area; TBSA). To elucidate the metabolic consequences of a nonsevere burn injury, longitudinal plasma was collected from adults (n = 35) who presented at hospital with a nonsevere burn injury at admission, and at 6 week follow up. A cross-sectional baseline sample was also collected from nonburn control participants (n = 14). Samples underwent multiplatform metabolic phenotyping using 1H nuclear magnetic resonance spectroscopy and liquid chromatography-mass spectrometry to quantify 112 lipoprotein and glycoprotein signatures and 852 lipid species from across 20 subclasses. Multivariate data modeling (orthogonal projections to latent structures-discriminate analysis; OPLS-DA) revealed alterations in lipoprotein and lipid metabolism when comparing the baseline control to hospital admission samples, with the phenotypic signature found to be sustained at follow up. Univariate (Mann-Whitney U) testing and OPLS-DA indicated specific increases in GlycB (p-value < 1.0e-4), low density lipoprotein-2 subfractions (variable importance in projection score; VIP > 6.83e-1) and monoacyglyceride (20:4) (p-value < 1.0e-4) and decreases in circulating anti-inflammatory high-density lipoprotein-4 subfractions (VIP > 7.75e-1), phosphatidylcholines, phosphatidylglycerols, phosphatidylinositols, and phosphatidylserines. The results indicate a persistent systemic metabolic phenotype that occurs even in cases of a nonsevere burn injury. The phenotype is indicative of an acute inflammatory profile that continues to be sustained postinjury, suggesting an impact on systems health beyond the site of injury. The phenotypes contained metabolic signatures consistent with chronic inflammatory states reported to have an elevated incidence postburn injury. Such phenotypic signatures may provide patient stratification opportunities, to identify individual responses to injury, personalize intervention strategies, and improve acute care, reducing the risk of chronic comorbidity.
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Affiliation(s)
- Monique
J. Ryan
- Australian
National Phenome Centre, Health Futures Institute, Harry Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, Western Australia 6150, Australia
- Centre
for Computational and Systems Medicine, Health Futures Institute,
Harry Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, Western Australia 6150, Australia
| | - Edward Raby
- Burns
Service of Western Australia, WA Department
of Health, Murdoch, Western Australia 6150, Australia
- Department
of Microbiology, PathWest Laboratory Medicine, Perth, Western Australia 6009, Australia
- Department
of Infectious Diseases, Fiona Stanley Hospital, Perth, Western Australia 6150, Australia
| | - Luke Whiley
- Australian
National Phenome Centre, Health Futures Institute, Harry Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, Western Australia 6150, Australia
- Centre
for Computational and Systems Medicine, Health Futures Institute,
Harry Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, Western Australia 6150, Australia
| | - Reika Masuda
- Australian
National Phenome Centre, Health Futures Institute, Harry Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, Western Australia 6150, Australia
| | - Samantha Lodge
- Australian
National Phenome Centre, Health Futures Institute, Harry Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, Western Australia 6150, Australia
- Centre
for Computational and Systems Medicine, Health Futures Institute,
Harry Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, Western Australia 6150, Australia
| | - Philipp Nitschke
- Australian
National Phenome Centre, Health Futures Institute, Harry Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, Western Australia 6150, Australia
| | - Garth L. Maker
- Australian
National Phenome Centre, Health Futures Institute, Harry Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, Western Australia 6150, Australia
| | - Julien Wist
- Australian
National Phenome Centre, Health Futures Institute, Harry Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, Western Australia 6150, Australia
- Centre
for Computational and Systems Medicine, Health Futures Institute,
Harry Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, Western Australia 6150, Australia
- Chemistry
Department, Universidad del Valle, Cali 76001, Colombia
| | - Elaine Holmes
- Centre
for Computational and Systems Medicine, Health Futures Institute,
Harry Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, Western Australia 6150, Australia
- Department
of Metabolism Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2AZ, United Kingdom
| | - Fiona M. Wood
- Burns
Service of Western Australia, WA Department
of Health, Murdoch, Western Australia 6150, Australia
- Burn
Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Perth, Western Australia 6009, Australia
- Fiona
Wood Foundation, Perth, Western Australia 6150, Australia
| | - Jeremy K. Nicholson
- Australian
National Phenome Centre, Health Futures Institute, Harry Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, Western Australia 6150, Australia
- Institute
of Global Health Innovation, Imperial College
London, London SW7 2AZ, United Kingdom
| | - Mark W. Fear
- Burn
Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Perth, Western Australia 6009, Australia
- Fiona
Wood Foundation, Perth, Western Australia 6150, Australia
| | - Nicola Gray
- Australian
National Phenome Centre, Health Futures Institute, Harry Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, Western Australia 6150, Australia
- Centre
for Computational and Systems Medicine, Health Futures Institute,
Harry Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, Western Australia 6150, Australia
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Mai L, Boardman G, Robinson K, Edgar DW, Wood FM. Postoperative hypothermia is associated with reduced length of stay in adult acute burn survivors. Burns 2024; 50:1536-1543. [PMID: 38705776 DOI: 10.1016/j.burns.2024.02.033] [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: 06/04/2023] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND The hypermetabolic response after a burn predisposes patients to hypothermia due to dysfunction of thermoregulation. Traditionally, hypothermia is avoided actively in burn care due to reported complications associated with low body temperature. The likelihood of hypothermia with acute burn surgery is compounded by general anesthesia, exposure of wound areas and prolonged operation times. However, we find limited studies exploring the effects of perioperative hypothermia on length of stay in the adult burn population. OBJECTIVE To determine associations between postoperative hypothermia and hospital length of stay in adult burns patients. METHOD This retrospective cohort study involved patients admitted to the State Adult Burn Unit in Western Australia between 1st January 2015 to 28th February 2021. All adults who underwent surgery for acute burn, and had postoperative recovery room body temperature recorded, were included in the study. In this study, we defined normothermia as >36.5C and hypothermia as < 36.0 °C with mild, moderate, and severe hypothermia being 35.0-35.9 °C, 34.0-34.9 °C and < 34.0 °C, respectively. Patients with hyperthermia were excluded. Multivariable general linear models explored if hypothermia was independently associated with length of stay. RESULTS Among 1486 adult patients, 1338 (90%) were normothermic postoperatively, with temperatures >36.0C. We included 148 (10%) patients with hypothermia (temperature <36.0 °C) postoperatively. Most burns in the study population were minor: 96% had burns < 15% TBSA. Data modelling demonstrated that hypothermia was associated with a shorter length of hospital stay (coefficient = -0.129, p = 0.041). CONCLUSION In adult acute burn patients, postoperative hypothermia was associated with reduced length of stay after surgery. The positive results of this study indicate that a review of the core temperature targets with acute burn surgery, and timing of burn patient cooling practices in general is warranted.
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Affiliation(s)
- Linda Mai
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Anaesthesia Department, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Australia; Fiona Wood Foundation, Perth, WA, Australia
| | - Glenn Boardman
- Research Support and Development Unit, South Metropolitan Health Service, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Kieran Robinson
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Anaesthesia Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Dale W Edgar
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Fiona Wood Foundation, Perth, WA, Australia; The Institute for Health Research, The University of Notre Dame, Fremantle, Australia; Armadale Kalamunda Group Health Service, Safety and Quality Unit, East Metropolitan Health Service, Mt Nasura, Western Australia, Australia; Burn Injury Research Unit, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Fiona M Wood
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Fiona Wood Foundation, Perth, WA, Australia; Burn Injury Research Unit, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia.
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11
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Espinoza-Moya ME, Laberge M, Bélanger L, Chang SL, Poder TG, Moulin VJ, Germain L, Beaudoin Cloutier C, Guertin JR. Adaptation of a standardized self-reported cost questionnaire specific for the severe burn injury population (BI-CoPaQ). Burns 2024:S0305-4179(24)00207-9. [PMID: 39322506 DOI: 10.1016/j.burns.2024.07.008] [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: 12/24/2023] [Revised: 06/03/2024] [Accepted: 07/08/2024] [Indexed: 09/27/2024]
Abstract
Severe burn injuries (SBIs) are known to pose a significant burden on patients, caregivers, and the healthcare system. Yet, scarce data on the short and long-term clinical and economic impacts of these injuries limit the development of evidence-informed strategies and policies to better care for these patients. To fill in this gap, we adapted a previously validated self-reported out-of-pocket cost measurement questionnaire, the Cost for Patients Questionnaire (CoPaQ), to the severe burn injury survivor context. We conducted one-on-one cognitive semi-structured interviews with burn injury survivors, their caregivers, and healthcare providers to identify elements of the CoPaQ's structure and content that needed to be revised to adapt to the specific health care trajectory, service utilization, needs and expenses incurred by adult severe burn injury survivors and their caregivers. Summative content analysis was used to identify items needing to be modified, deleted, or added. Based on this information, a preliminary version of a Burn Injury Cost for Patients Questionnaire (BI-CoPaQ) was developed and subsequently pre-tested on a small sample of SBIs survivors. Further validation of this tool will be required before BI-CoPaQ can be used as the standard for the estimation of the financial burden of SBIs in this population.
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Affiliation(s)
- Maria-Eugenia Espinoza-Moya
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, Université Laval, Québec, QC G1V 0A6, Canada; Centre de Recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada
| | - Maude Laberge
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, Université Laval, Québec, QC G1V 0A6, Canada; Centre de Recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada; Vitam, Centre de recherche en santé durable, Université Laval. 2525, Chemin de la Canardière, Québec, QC G1J 0A4, Canada
| | - Laurianne Bélanger
- Centre de Recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada
| | - Sue-Ling Chang
- Centre de Recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada
| | - Thomas G Poder
- Département de Gestion, Évaluation et Politique de Santé, École de Santé Publique de l'Université de Montréal, 7101 Av du Parc, Montréal QC H3N 1×9, Canada; Centre de recherche de l'IUSMM, CIUSSS de l'Est de l'Île de Montréal, 7331 Rue Hochelaga, Montréal, QC H1N 3J4, Canada
| | - Véronique J Moulin
- Department of Surgery, Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, Université Laval, Québec, QC G1V 0A6, Canada; Centre de Recherche du CHU de Québec-Université Laval, Hôpital de l'Enfant-Jésus, 1401 18e Rue, Québec, QC G1J 1Z4, Canada; Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX, 1401 18e Rue, Québec, QC G1J 1Z4, Canada
| | - Lucie Germain
- Department of Surgery, Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, Université Laval, Québec, QC G1V 0A6, Canada; Centre de Recherche du CHU de Québec-Université Laval, Hôpital de l'Enfant-Jésus, 1401 18e Rue, Québec, QC G1J 1Z4, Canada; Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX, 1401 18e Rue, Québec, QC G1J 1Z4, Canada
| | - Chanel Beaudoin Cloutier
- Department of Surgery, Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, Université Laval, Québec, QC G1V 0A6, Canada; Centre de Recherche du CHU de Québec-Université Laval, Hôpital de l'Enfant-Jésus, 1401 18e Rue, Québec, QC G1J 1Z4, Canada; Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX, 1401 18e Rue, Québec, QC G1J 1Z4, Canada
| | - Jason Robert Guertin
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, Université Laval, Québec, QC G1V 0A6, Canada; Centre de Recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada; Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX, 1401 18e Rue, Québec, QC G1J 1Z4, Canada.
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12
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Adhikari S, Gurung R, Bastakoti S, Alrasheedy AA, KC B. Burn pain management in a female patient with severe burn injuries in Nepal: a case study and review. Pain Manag 2024; 14:323-329. [PMID: 39101437 PMCID: PMC11340753 DOI: 10.1080/17581869.2024.2382072] [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: 04/24/2024] [Accepted: 07/16/2024] [Indexed: 08/06/2024] Open
Abstract
Burn injuries in low-resource settings like Nepal present significant public health challenges, leading to substantial morbidity, mortality and severe pain. This paper assesses burn pain management in Nepal, emphasizing the need for enhanced strategies. A case study of a female patient with severe burn injuries from a rural village in Western Nepal illustrates current challenges. Reviewing studies on burn pain management in Nepal shows limited access to specialized facilities, inadequate palliative care, medication shortages and insufficient healthcare professionals. Pharmacological interventions are impacted by financial constraints and a lack of protocols, while nonpharmacological approaches have not been explored and contextualized for the Nepalese context due to similar financial issues. Comprehensive burn pain management requires addressing resource constraints through collaborative health-aid partnerships.
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Affiliation(s)
- Sundar Adhikari
- Department of Pharmacy, Fishtail Hospital and Research Center, Pvt. Ltd., Gairapatan-4, Pokhara, Nepal
| | | | - Suresh Bastakoti
- Nepalese Army Institute of Health Sciences, Shree Birendra Hospital, Kathmandu, Nepal
| | | | - Bhuvan KC
- Discipline of Pharmacy, School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
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13
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Maddipatla SP, McLoone P, Puxty K, McGovern C. The incidence of cancer following hospitalisation for a burn injury in Scotland 2009-2019: A retrospective cohort study. Burns 2024; 50:866-873. [PMID: 38494397 DOI: 10.1016/j.burns.2024.02.029] [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: 06/22/2023] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Studies suggest increased occurrence of cancer in persons who have experienced a burn injury with hospital admission. OBJECTIVE To determine the incidence of cancer among those hospitalised for burn injuries in Scotland compared with a similar group without a history of burn injury hospitalisation. METHOD A retrospective cohort design was used to compare cancer (ICD10 C00-97, excluding C44) incidence in two groups: 6805 burn injury patients discharged from Scottish hospitals between 2009 and 2019, and 25,946 subjects from the general population who were matched to burn patients by sex, year of birth, and degree of social deprivation. Cancer incidence was identified from the Scottish cancer registry. Cox proportional hazard regression was used to model time to cancer incidence adjusting for age, sex, degree of deprivation and presence of a comorbidity. Cancer risk was presented as standardised incidence ratios (SIRs) and hazard ratios (HR). RESULTS We found a higher prevalence of pre-existing conditions, particularly alcohol abuse among patients with burns. Pre-existing cancers were more common in the burn cohort (3.5%) than the comparison group (1.7%) and were excluded from further analysis. Over a median follow-up of 4-5 years, a total of 236 (3.5%) burn patients and 969 (3.7%) persons in the comparison group were diagnosed with cancer. At 0-6 months the cancer SIR for burn patients was 1.88 95% CI (1.40-2.52). After excluding the first six months of follow-up, the overall incidence of cancer was marginally elevated in burn patients (SIR 1.04, 95% CI 0.90-1.19, p = 0.62) and not statistically different from the incidence in comparison subjects (adjusted HR 1.03, 95% CI 0.88-1.21, p = 0.71). CONCLUSIONS Patients that suffer burn injury have a higher incidence of cancer than the general population and a group matched by age, sex and degree of deprivation. A higher incidence of adverse health-related behaviours such as smoking, alcohol use and pre-existing health conditions among many patients that suffer a burn most likely explain this observed increase. Any persisting inflammatory or immune dysfunction following burn injury is unlikely to account for the increase in cancers in this study.
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Affiliation(s)
- Sai Phani Maddipatla
- Public Health, School of Health & Wellbeing, University of Glasgow, United Kingdom
| | - Philip McLoone
- Public Health, School of Health & Wellbeing, University of Glasgow, United Kingdom.
| | - Kathryn Puxty
- Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, United Kingdom
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14
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Katsu A, Mackenzie L, Elliott JM, Mackey M, Tyack Z. Return-to-employment for working-aged adults after burn injury: A mixed methods scoping review. Work 2024:WOR230148. [PMID: 38578910 DOI: 10.3233/wor-230148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND This scoping review aimed to identify the barriers, facilitators and benefits of returning to work following burn injury, outcome measures used, management strategies, and models of care. OBJECTIVE To provide a comprehensive overview about working-aged adults returning to their preinjury employment after burn injury. METHODS We followed a pre-determined scoping review protocol to search MEDLINE, CINAHL, Embase, PsycINFO, PubMed, Scopus, CCRCT and CDSR databases between 2000 to December 2023. Papers reporting primary data from previously employed adults with cutaneous burn injuries were included. RESULTS In all, 90 articles met the review criteria. Return-to-work was both an outcome goal and process of recovery from burn injury. Physical and psychological impairments were identified barriers. Job accommodations and modifications were important for supporting the transition from hospital to workplace. Employment status and quality of life sub-scales were used to measure return-to-work. CONCLUSIONS Consistent definitions of work and measurements of return-to-employment after burn injury are priorities for future research. Longitudinal studies are more likely to capture the complexity of the return-to-employment process, its impact on work participation and changes in employment over time. The social context of work may assist or hinder return-to-work more than physical environmental constraints. Equitable vocational support systems would help address disparities in vocational rehabilitation services available after burn injury.
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Affiliation(s)
- Akane Katsu
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - James M Elliott
- The Kolling Institute, Northern Sydney Local Health District, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Martin Mackey
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Zephanie Tyack
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation and School of Public Health and Social Work, Queensland University of Technology, Australia
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15
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Ohm E, Madsen C, Gravseth HM, Brage S, Grøholt EK, Alver K, Holvik K. Post-injury long-term sickness absence and risk of disability pension: The role of socioeconomic status. Injury 2024; 55:111480. [PMID: 38452702 DOI: 10.1016/j.injury.2024.111480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/02/2024] [Accepted: 02/25/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Previous research has identified low socioeconomic status (SES) as a risk factor for long-term sickness absence (LTSA) and disability pension (DP) following trauma. However, most studies lack information on medical diagnoses, limiting our understanding of the underlying factors. To address this gap, we retrieved information about diagnostic causes for receipt of welfare benefits to explore the role of SES in the transition from post-injury LTSA to permanent DP among the working population in Norway. MATERIALS AND METHODS We conducted a population-based cohort study of all Norwegian residents aged 25-59 years registered with a spell of LTSA due to injury commencing in the period 2000-2003. This cohort was followed through 2014 by linking information on receipt of welfare benefits with sociodemographic data from administrative registers. SES was defined as a composite measure of educational attainment and income level. We used flexible parametric survival models to estimate hazard ratios (HR) with 95 % confidence intervals (CI) for all-cause and diagnosis-specific DP according to SES, adjusting for sex, age, marital status, immigrant status and healthcare region of residence. RESULTS Of 53,937 adults with post-injury LTSA, 9,665 (18 %) transferred to DP during follow-up. The crude risk of DP was highest for LTSA spells due to poisoning and head injuries. Overall, individuals in the lowest SES category had twice the risk of DP compared to those in the highest SES category (HR = 2.25, 95 % CI 2.13-2.38). The difference by SES was greatest for LTSA due to poisoning and smallest for LTSA due to head injuries. A majority (75 %) of DP recipients had a non-injury diagnosis as the primary cause of DP. The socioeconomic gradient was more pronounced for non-injury causes of DP (HR = 2.47, 95 % CI 2.31-2.63) than for injury causes (HR = 1.73, 95 % CI 1.56-1.92) and was especially steep for DP due to musculoskeletal diseases and mental and behavioural disorders. CONCLUSIONS The relationship between SES and DP varied by both the type of injury that caused LTSA and the diagnosis used to grant DP, highlighting the importance of taking diagnostic information into account when investigating long-term consequences of injuries.
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Affiliation(s)
- Eyvind Ohm
- Department of Health and Inequality, Norwegian Institute of Public Health, PO Box 222 Skøyen 0213 Oslo, Norway.
| | - Christian Madsen
- Department of Disease Burden, Norwegian Institute of Public Health, Zander Kaaesgt. 7 5015 Bergen, Norway
| | - Hans Magne Gravseth
- Department of Occupational Health Surveillance, National Institute of Occupational Health, PO Box 5330 Majorstuen 0304 Oslo, Norway
| | - Søren Brage
- Retired medical doctor with a PhD in epidemiology/social medicine. Before retirement SB held a position in the Norwegian Labour and Welfare Administration, leading the unit responsible for medical coding of welfare benefits from 1998 to 2015
| | - Else Karin Grøholt
- Department of Health and Inequality, Norwegian Institute of Public Health, PO Box 222 Skøyen 0213 Oslo, Norway
| | - Kari Alver
- Department of Health and Inequality, Norwegian Institute of Public Health, PO Box 222 Skøyen 0213 Oslo, Norway
| | - Kristin Holvik
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, PO Box 222 Skøyen 0213 Oslo, Norway
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16
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Katsu A, Mackenzie L, Tyack Z, Mackey M. Understanding return-to-employment experiences after burns: Qualitative scoping review findings. Aust Occup Ther J 2024; 71:113-131. [PMID: 37990624 DOI: 10.1111/1440-1630.12915] [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: 09/13/2023] [Revised: 10/21/2023] [Accepted: 10/25/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION Participation in work and employment is a milestone of adulthood. People returning to work after burn injury may have physical, psychological, social, and environmental barriers to overcome in order to resume their pre-injury employment. The aim of this paper is to evaluate qualitative findings regarding return-to-employment after burn injury. METHODS A qualitative synthesis was conducted based on the qualitative findings of an earlier mixed methods review. A pre-determined scoping review protocol was used in the earlier review to search MEDLINE, CINAHL, Embase, PsycINFO, PubMed, Scopus, CCRCT, and CDSR databases between 2000 and Aug 2021. Any papers presenting qualitative data from previously employed adults with cutaneous burn injuries were included. FINDINGS A total of 20 papers with qualitative data on return-to-employment after burn injury were found. Only six included studies focused on return-to-employment outcomes and the remaining studies reporting on quality of life and life experiences after burn injury. Common themes included impairments that develop and change over time; occupational identity and meaning; temporal aspects of burn recovery; burn rehabilitation services and interventions; attitudes, knowledge and support of service providers; workplace environments supporting work re-engagement after burn injury; usefulness of work accommodations; family and social supports, individuals attributes that influence re-engaging in employment; and accepting and rebuilding. CONCLUSION Resumption of work after burn injury is regarded as a key marker of recovery for working-aged adults by burn survivors and burn care professionals. Support at transition points during the burn recovery process and peer-led programmes were important. However, limited information currently exists regarding clinical practices, service gaps, and understanding of return-to-employment outcomes after burn injury.
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Affiliation(s)
- Akane Katsu
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Zephanie Tyack
- Australian Centre for Health Services Research, Faculty of Health, Queensland University of Technology, QLD, Australia
| | - Martin Mackey
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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17
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Shokre ES, Mohammed SEM, Elhapashy HMM, Elsharkawy NB, Ramadan OME, Abdelaziz EM. The effectiveness of the psychosocial empowerment program in early adjustment among adult burn survivors. BMC Nurs 2024; 23:45. [PMID: 38225570 PMCID: PMC10790373 DOI: 10.1186/s12912-024-01700-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/01/2024] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Burns constitute a major global health challenge, causing not only physical trauma, but also significant psychosocial and emotional disturbances. The complexity of these injuries requires comprehensive rehabilitation programs that address both the physical and psychosocial aspects of recovery. Despite advances in medical care, there is a lack of standardized, accessible, and sustainable psychosocial interventions for burn survivors, particularly in the transition from hospital to home. This study aimed to develop and evaluate a nurse-led psychosocial empowerment intervention for early adjustment among burn survivors after hospital discharge. METHODS The study adopted a quasi-experimental framework. A convenient sample of 80 adult burn survivors was randomly divided into an intervention group, receiving the psychosocial empowerment program, and a control group, continuing standard care from November 2022 to May 2023. The effectiveness of the program was evaluated using various tools that measure satisfaction with appearance, coping abilities, and symptoms of post-traumatic stress disorder (PTSD). The intervention focused on enhancing resilience, self-efficacy, and adaptive coping, through targeted skill building in stress management, adaptability to coping, social reintegration, emotion regulation, and problem-solving. RESULTS Participants in the intervention group demonstrated significant improvements in body image satisfaction, coping abilities, and symptoms of PTSD compared to the control group. CONCLUSIONS The psychosocial empowerment program effectively addressed the psychosocial needs of burn survivors and enhanced their early adjustment after hospital discharge. The findings highlight the critical role of psychosocial support in the rehabilitation of burn survivors and underscore the need to integrate such interventions into standard post-discharge care. Future research should focus on the long-term effects of these interventions and their applicability in diverse settings.
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Affiliation(s)
- Evon S Shokre
- Department of Psychiatric Mental Health Nursing, Faculty of Nursing, Fayoum University, Fayoum, Egypt.
| | | | | | - Nadia Bassuoni Elsharkawy
- College of Nursing, Jouf University, Sakaka, 72388, Saudi Arabia
- Department of Maternal and New-born Health Nursing, Faculty of Nursing, Cairo University, Cairo, 11562, Egypt
| | - Osama Mohamed Elsayed Ramadan
- College of Nursing, Jouf University, Sakaka, 72388, Saudi Arabia
- Department of Paediatric Nursing, Faculty of Nursing, Cairo University, Cairo, 11562, Egypt
| | - Enas Mahrous Abdelaziz
- College of Nursing, Jouf University, Sakaka, 72388, Saudi Arabia
- Department of Psychiatric Mental Health Nursing, Faculty of Nursing, Cairo University, Cairo, 11562, Egypt
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Ivanko A, DeWitt A, Schoen JE, Phelan HA, Hill D, Carter JE. Scientific Opinion on the Risks of Drug Shortages on Burn Care. J Burn Care Res 2024; 45:253-255. [PMID: 37971431 PMCID: PMC11023253 DOI: 10.1093/jbcr/irad174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Indexed: 11/19/2023]
Abstract
Introduction Autologous skin cell suspensions (ASCS) minimize the donor site required for addressing partial and full thickness burns. ASCS is currently FDA approved for use in combination with meshed split thickness skin grafts (STSGs) for full-thickness thermal burns in pediatric and adult patients. Besides the initial clinical trials of ASCS and STSG use for burn wounds, there are minimal studies reporting outcomes of their use. Here, we present our experience using ASCS in the past six years. We hypothesized that ASCS and STSG would result in a low reoperation and infection rate. Methods Retrospective review of patients seen at an American Burn Association verified burn center between 2017 and 2023 identified 15 patients treated with ASCS overlying STSG. Data collected included patient demographics, burn characteristics, surface area of ASCS usage, and patient outcomes. The primary outcome of interest was the requirement for reoperation following ASCS use. Secondary outcomes included hospital length of stay (LOS), ICU LOS, infection, and the necessity for scar revision via surgery or laser treatment. Data was analyzed using descriptive statistics with categorical variables presented as frequencies and percentages and continuous variables reported as medians and ranges. Results The median age of patients treated with ASCS was 36 years (13-67 years). The median BMI was 27.4 (17.7-35.4) and median total body surface area (TBSA) affected by burn was 18% (5.75-69.5%). Six patients (40%) had full thickness in addition to partial thickness burns. Most burns, 11 (73%) were the result of flames, although there were three grease burns and one friction burn. The median time to ASCS application was 10 days (1-39 days) and the median number of ASCS application sites was 2 (1-6). Most ASCS sites were on the upper or lower extremities or the torso; however, two patients had ASCS applied to their feet while another patient had it applied to their genitalia. Median ASCS surface area was 2,464 cm2 (289-20,000 cm2). Median LOS was 23 days (8-125 days) and median ICU LOS was 3 days (0-94 days). Four patients (26.7%) required reoperation on sites of ASCS application with the median time to reoperation being 40.5 days (28-66 days). Three patients (20%) required scar contracture surgery and three (20%) received laser treatments. There were no cutaneous infections in our cohort. Conclusions ASCS was effectively used to treat both partial thickness and full thickness burns and burns due to flame, grease, and friction. There did not seem to be any relationship between the necessity for reoperation after ASCS and the burn depth, etiology, surface area, or location. Applicability of Research to Practice Clinicians can look to our study for potential outcomes when using ASCS with STSG in a variety of situations.
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Affiliation(s)
- Anastasiya Ivanko
- Louisiana State University Health and Sciences Center, New Orleans, LA, USA
| | | | - Jonathan E Schoen
- Louisiana State University Health and Sciences Center, New Orleans, LA, USA
- University Medical Center (LSU Health), New Orleans, LA, USA
| | - Herb A Phelan
- Louisiana State University Health and Sciences Center, New Orleans, LA, USA
- University Medical Center (LSU Health), New Orleans, LA, USA
| | | | - Jeffrey E Carter
- Louisiana State University Health and Sciences Center, New Orleans, LA, USA
- University Medical Center (LSU Health), New Orleans, LA, USA
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19
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Rowe G, Allahham A, Edgar DW, Rurak BK, Fear MW, Wood FM, Vallence AM. Functional Brain Changes Following Burn Injury: A Narrative Review. Neurorehabil Neural Repair 2024; 38:62-72. [PMID: 38044625 PMCID: PMC10798013 DOI: 10.1177/15459683231215331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
BACKGROUND Burn injuries cause significant motor and sensory dysfunctions that can negatively impact burn survivors' quality of life. The underlying mechanisms of these burn-induced dysfunctions have primarily been associated with damage to the peripheral neural architecture, however, evidence points to a systemic influence of burn injury. Central nervous system (CNS) reorganizations due to inflammation, afferent dysfunction, and pain could contribute to persistent motor and sensory dysfunction in burn survivors. Recent evidence shows that the capacity for neuroplasticity is associated with self-reported functional recovery in burn survivors. OBJECTIVE This review first outlines motor and sensory dysfunctions following burn injury and critically examines recent literature investigating the mechanisms mediating CNS reorganization following burn injury. The review then provides recommendations for future research and interventions targeting the CNS such as non-invasive brain stimulation to improve functional recovery. CONCLUSIONS Directing focus to the CNS following burn injury, alongside the development of non-invasive methods to induce functionally beneficial neuroplasticity in the CNS, could advance treatments and transform clinical practice to improve quality of life in burn survivors.
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Affiliation(s)
- Grant Rowe
- School of Psychology, College of Health and Education, Murdoch University, Murdoch, WA, Australia
| | - Amira Allahham
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Crawley, WA, Australia
| | - Dale W. Edgar
- Fiona Wood Foundation, Murdoch, WA, Australia
- Burn Service of Western Australia, Fiona Stanley Hospital, MNH (B) Main Hospital, Level 4, Burns Unit, Murdoch, WA, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Brittany K. Rurak
- School of Psychology, College of Health and Education, Murdoch University, Murdoch, WA, Australia
| | - Mark W. Fear
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Crawley, WA, Australia
- Fiona Wood Foundation, Murdoch, WA, Australia
| | - Fiona M. Wood
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Crawley, WA, Australia
- Fiona Wood Foundation, Murdoch, WA, Australia
- Burn Service of Western Australia, Fiona Stanley Hospital, MNH (B) Main Hospital, Level 4, Burns Unit, Murdoch, WA, Australia
| | - Ann-Maree Vallence
- School of Psychology, College of Health and Education, Murdoch University, Murdoch, WA, Australia
- Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Murdoch, WA, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Health Futures Institute, Murdoch University, Murdoch, WA, Australia
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20
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Halim N, Holland AJA, McMaugh A, Cameron CM, Lystad RP, Badgery-Parker T, Mitchell R. Impact of childhood burns on academic performance: a matched population-based cohort study. Arch Dis Child 2023; 108:808-814. [PMID: 37423641 PMCID: PMC10511986 DOI: 10.1136/archdischild-2023-325769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE This study aimed to compare academic performance and high school completion of young people hospitalised for a burn compared with young people not hospitalised for an injury. DESIGN A retrospective population-based matched case-comparison cohort study. PARTICIPANTS Young people aged ≤18 years hospitalised for a burn during 2005-2018 in New South Wales, Australia, with age, sex and residential postcode-matched peers not hospitalised for any injury during 1 July 2001 and 31 December 2018. MAIN OUTCOME MEASURES Performance below the national minimum standard (NMS) on the National Assessment Plan for Literacy and Numeracy assessments and not completing high school. RESULTS Young females hospitalised for a burn had a 72% higher risk of poorer reading compared with their peers (adjusted relative risk (ARR) 1.72; 95% CI 1.33 to 2.23), while young males hospitalised with a burn showed no higher risk (ARR 1.14; 95% CI 0.91 to 1.43). Young males (ARR 1.05; 95% CI 0.81 to 1.35) and females (ARR 1.34; 95% CI 0.93 to 1.94) hospitalised with a burn had no higher risk of not reaching the NMS for numeracy compared with peers. Young people hospitalised with a burn had at least twice the risk of not completing year 10 (ARR 3.86; 95% CI 1.68 to 8.86), year 11 (ARR 2.45; 95% CI 1.89 to 3.18) and year 12 (ARR 2.09; 95% CI 1.63 to 2.67) compared with matched counterparts. CONCLUSIONS Young females hospitalised with a burn displayed poorer academic performance for reading compared with matched peers, while males and females were more likely to leave school earlier. Identifying unmet learning support needs of young burn survivors should be investigated.
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Affiliation(s)
- Nicole Halim
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Andrew J A Holland
- Department of Pediatric Surgery, Children's Hospital Westmead, Westmead, New South Wales, Australia
| | - Anne McMaugh
- The Macquarie School of Education, Macquarie University, Sydney, New South Wales, Australia
| | - Cate M Cameron
- Jamieson Trauma Institute, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
- Australian Centre for Health Services Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Reidar P Lystad
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Tim Badgery-Parker
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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21
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Li M, Gao J, Wang L, Liu J, Fu C, Yang X, Zhang S, Li X, Luo S, Yang C. Basic research and clinical exploration of cold atmospheric plasma for skin wounds. Bioeng Transl Med 2023; 8:e10550. [PMID: 37693064 PMCID: PMC10487309 DOI: 10.1002/btm2.10550] [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: 12/07/2022] [Revised: 04/18/2023] [Accepted: 04/30/2023] [Indexed: 09/12/2023] Open
Abstract
Skin wounds, such as burns, diabetic foot ulcers, pressure sores, and wounds formed after laser or surgical treatment, comprise a very high proportion of dermatological disorders. Wounds are treated in a variety of ways; however, some wounds are greatly resistant, resulting in delayed healing and an urgent need to introduce new alternatives. Our previous studies have shown that cold atmospheric plasma (CAP) has antibacterial activity and promotes cell proliferation, differentiation, and migration in vitro. To further advance the role of CAP in wound healing, we evaluated the safety and efficacy of CAP in vitro by irradiation of common refractory bacteria on the skin, irradiation of normal skin of rats and observing reactions, treatment of scald wounds in rats, and treating clinically common acute wounds. Our findings revealed that CAP can eliminate refractory skin bacteria in vitro; CAP positively affected wound healing in a rat scalding wound model; and direct CAP irradiation of low intensity and short duration did not lead to skin erythema or edema. CAP promises to be a new, economical, and safe means of wound treatment.
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Affiliation(s)
- Miaomiao Li
- Department of Dermatology and Venereologythe Second Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Jing Gao
- Department of Dermatology and Venereologythe Second Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
- Anhui Provincial Institute of Translational MedicineHefeiAnhuiChina
| | - Liyun Wang
- Department of Dermatology and Venereologythe Second Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Jia Liu
- Department of Dermatology and Venereologythe Second Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Chuyu Fu
- Department of Dermatology and Venereologythe Second Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Xingyu Yang
- Department of Dermatology and Venereologythe Second Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Shengquan Zhang
- Anhui Provincial Institute of Translational MedicineHefeiAnhuiChina
- Department of Biochemistry and Molecular Biology, School of Basic Medical SciencesAnhui Medical UniversityHefeiAnhuiChina
| | - Xinwei Li
- Anhui Academy of Medical SciencesHefeiAnhuiChina
| | | | - Chunjun Yang
- Department of Dermatology and Venereologythe Second Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
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22
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Raipure A, Patil S, Pathan H. Effectiveness of Early Physiotherapy Rehabilitation Approach for Split Skin Grafting Post-burn in a Pediatric Patient. Cureus 2023; 15:e44083. [PMID: 37750141 PMCID: PMC10518060 DOI: 10.7759/cureus.44083] [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: 01/19/2023] [Accepted: 08/24/2023] [Indexed: 09/27/2023] Open
Abstract
Childhood is critical for developing social, physical, and cognitive functioning. Burns in children are very different from burns in adults because it is difficult for them to save themselves. Their skin is more sensitive and less heat-resistant; their exposure may last longer, worsening the burn. When neglected, severe disabling and deforming contractures caused by burns in children can result in substantial impairment. Therefore, burn rehabilitation should not be carried out by one person but rather by a multidisciplinary team to ensure that all of the patients' physical, psychological, and social requirements are met while the child is in the hospital and after discharge. The treatment of young burn victims requires a multidisciplinary approach that begins the day of the accident and lasts for several years. To reduce the consequences of the patient's post-traumatic stress and increase functional independence, a thorough rehabilitation programme is needed. The burn team members' dedication, commitment to the patient's care, and encouragement of patient participation and full engagement in rehabilitation can make a difference to juvenile burn patients' long-term quality of life (QOL). We present a seven-year-old female who suffered from a superficial burn over the lateral aspect of her right thigh. Exercise prescriptions should be thoroughly customized to provide the best possible success in rehabilitation, considering the degree of burns and physical limitations. This case report is intended to serve as a practical manual for the necessary clinical knowledge and therapy intervention approaches for managing burn patients successfully.
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Affiliation(s)
- Anushka Raipure
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Shubhangi Patil
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Heena Pathan
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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23
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Chiang LJ, Lai PC, Huang YT. Effectiveness and Adverse Events of Gabapentinoids as Analgesics for Patients with Burn Injuries: A Systematic Review with Meta-Analysis and Trial Sequential Analysis. J Clin Med 2023; 12:5042. [PMID: 37568444 PMCID: PMC10420087 DOI: 10.3390/jcm12155042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/10/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
(1) Background: Pain after a burn injury is difficult to endure, and emerging studies aim to ascertain the effects of gabapentin and pregabalin as non-opioid treatment options. (2) Methods: We searched for randomised controlled trials (RCTs) in six databases. The risk of bias was assessed using the RoB 2.0 tool. We performed meta-analysis and trial sequential analysis and used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology for judging the certainty of evidence (CoE). (3) Results: Five RCTs were included. Compared with placebo, gabapentinoids significantly decreased the pain intensity within 24 h (mean difference (MD) = -1.06, 95% confidence interval (CI): -1.47--0.65) and from 72 h to 9 days (MD = -0.82, 95% CI: -1.16--0.48), but not after 3 weeks (MD = -0.44, 95% CI: -1.31-0.42). Opioid consumption (mg/day) was reduced within 24 h (MD = -13.34, 95% CI: -22.16--4.52) and from 72 h to 9 days (MD = -7.87, 95% CI: -14.82--0.91). Increased risks of drowsiness (risk ratio (RR) = 3.255, 95% CI: 1.135-9.335) and dizziness (RR = 3.034, 95% CI: 1.006-9.147) were observed, but sensitivity analysis using the Bayesian method showed no increased risk. All endpoints were judged as low to very low CoE. (4) Conclusions: Gabapentinoids offer modest analgesic benefits as a component of multimodal pain management for burn injuries of less than 3 weeks. The adverse effects should be carefully monitored. Large-scale RCTs are warranted for the reinforcement of CoE in clinical use.
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Affiliation(s)
- Liang-Jui Chiang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
| | - Pei-Chun Lai
- Education Centre, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
| | - Yen-Ta Huang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
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24
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Begum S, Lodge S, Hall D, Johnson BZ, Bong SH, Whiley L, Gray N, Fear VS, Fear MW, Holmes E, Wood FM, Nicholson JK. Cardiometabolic disease risk markers are increased following burn injury in children. Front Public Health 2023; 11:1105163. [PMID: 37333522 PMCID: PMC10275366 DOI: 10.3389/fpubh.2023.1105163] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/11/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Burn injury in children causes prolonged systemic effects on physiology and metabolism leading to increased morbidity and mortality, yet much remains undefined regarding the metabolic trajectory towards specific health outcomes. Methods A multi-platform strategy was implemented to evaluate the long-term immuno-metabolic consequences of burn injury combining metabolite, lipoprotein, and cytokine panels. Plasma samples from 36 children aged 4-8 years were collected 3 years after a burn injury together with 21 samples from non-injured age and sex matched controls. Three different 1H Nuclear Magnetic Resonance spectroscopic experiments were applied to capture information on plasma low molecular weight metabolites, lipoproteins, and α-1-acid glycoprotein. Results Burn injury was characterized by underlying signatures of hyperglycaemia, hypermetabolism and inflammation, suggesting disruption of multiple pathways relating to glycolysis, tricarboxylic acid cycle, amino acid metabolism and the urea cycle. In addition, very low-density lipoprotein sub-components were significantly reduced in participants with burn injury whereas small-dense low density lipoprotein particles were significantly elevated in the burn injured patient plasma compared to uninjured controls, potentially indicative of modified cardiometabolic risk after a burn. Weighted-node Metabolite Correlation Network Analysis was restricted to the significantly differential features (q <0.05) between the children with and without burn injury and demonstrated a striking disparity in the number of statistical correlations between cytokines, lipoproteins, and small molecular metabolites in the injured groups, with increased correlations between these groups. Discussion These findings suggest a 'metabolic memory' of burn defined by a signature of interlinked and perturbed immune and metabolic function. Burn injury is associated with a series of adverse metabolic changes that persist chronically and are independent of burn severity and this study demonstrates increased risk of cardiovascular disease in the long-term. These findings highlight a crucial need for improved longer term monitoring of cardiometabolic health in a vulnerable population of children that have undergone burn injury.
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Affiliation(s)
- Sofina Begum
- Harvard Medical School, Harvard University, Boston, MA, United States
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, United States
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
- Australian National Phenome Centre, Computational and Systems Medicine, Health Futures Institute, Perth, WA, Australia
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Samantha Lodge
- Australian National Phenome Centre, Computational and Systems Medicine, Health Futures Institute, Perth, WA, Australia
| | - Drew Hall
- Australian National Phenome Centre, Computational and Systems Medicine, Health Futures Institute, Perth, WA, Australia
| | - Blair Z. Johnson
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Sze How Bong
- Australian National Phenome Centre, Computational and Systems Medicine, Health Futures Institute, Perth, WA, Australia
| | - Luke Whiley
- Australian National Phenome Centre, Computational and Systems Medicine, Health Futures Institute, Perth, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- Centre for Computational and Systems Medicine, Health Futures Institute, Murdoch University, Perth, WA, Australia
| | - Nicola Gray
- Australian National Phenome Centre, Computational and Systems Medicine, Health Futures Institute, Perth, WA, Australia
- Centre for Computational and Systems Medicine, Health Futures Institute, Murdoch University, Perth, WA, Australia
| | - Vanessa S. Fear
- Translational Genetics, Telethon Kids Institute, Perth, WA, Australia
| | - Mark W. Fear
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Elaine Holmes
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
- Australian National Phenome Centre, Computational and Systems Medicine, Health Futures Institute, Perth, WA, Australia
- Centre for Computational and Systems Medicine, Health Futures Institute, Murdoch University, Perth, WA, Australia
| | - Fiona M. Wood
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
- WA Department of Health, Burns Service of Western Australia, Perth, WA, Australia
| | - Jeremy K. Nicholson
- Australian National Phenome Centre, Computational and Systems Medicine, Health Futures Institute, Perth, WA, Australia
- Centre for Computational and Systems Medicine, Health Futures Institute, Murdoch University, Perth, WA, Australia
- Faculty of Medicine, Institute of Global Health Innovation, London, United Kingdom
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25
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Bryarly J, Kowalske K. Long-Term Outcomes in Burn Patients. Surg Clin North Am 2023; 103:505-513. [PMID: 37149386 DOI: 10.1016/j.suc.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Better understanding of long-term outcomes after burn injury is essential for the burn clinician. Contractures are present in almost half of patients at discharge. Although less common, neuropathy and heterotopic ossification may be missed or go unaddressed. Close attention to psychological distress and to challenges with community reentry is essential. Obviously long-term problems with skin issues occur but other issues must be attended to maximize health and quality of life after injury. Facilitating access to community resources and providing long-term medical follow-up should be the standard of care.
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Affiliation(s)
- Julia Bryarly
- Physical Medicine and Rehabilitation, University of Texas, Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235-9055, USA
| | - Karen Kowalske
- Physical Medicine and Rehabilitation, University of Texas, Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235-9055, USA.
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26
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Tejiram S, Tranchina SP, Travis TE, Shupp JW. The First 24 Hours: Burn Shock Resuscitation and Early Complications. Surg Clin North Am 2023; 103:403-413. [PMID: 37149377 DOI: 10.1016/j.suc.2023.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Resuscitation is required for the management of patients with severe thermal injury. Some of the initial pathophysiologic events following burn injury include an exaggerated inflammatory state, injury to the endothelium, and increased capillary permeability, which all culminate in shock. Understanding these processes is critical to the effective management of patients with burn injuries. Formulas predicting fluid requirements during burn resuscitation have evolved over the past century in response to clinical experience and research efforts. Modern resuscitation features individualized fluid titration and monitoring along with colloid-based adjuncts. Despite these developments, complications from over-resuscitation still occur.
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Affiliation(s)
- Shawn Tejiram
- The Burn Center, MedStar Washington Hospital Center, 110 Irving Street, Northwest Suite 3B-55, Washington, DC 20010, USA; Department of Surgery, Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC 20007, USA
| | - Stephen P Tranchina
- Georgetown University School, 3900 Reservoir Road NW, Washington, DC 20007, USA
| | - Taryn E Travis
- The Burn Center, MedStar Washington Hospital Center, 110 Irving Street, Northwest Suite 3B-55, Washington, DC 20010, USA; Department of Surgery, Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC 20007, USA; Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC 20007, USA
| | - Jeffrey W Shupp
- The Burn Center, MedStar Washington Hospital Center, 110 Irving Street, Northwest Suite 3B-55, Washington, DC 20010, USA; Department of Surgery, Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC 20007, USA; Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC 20007, USA; Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, 37th and O Street, Northwest, Washington, DC 20057, USA.
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27
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Kairuz C, Hunter K, Bennett-Brook K, Ryder C, Holland AJA, Mackean T, Jacques M, Maze D, Scarcella M, Briscoe K, Coombes J. Codesigning informative resources for families of Aboriginal and Torres Strait Islander children who sustained a burn injury: a protocol for a participatory action research study. BMJ Open 2023; 13:e068530. [PMID: 37192809 PMCID: PMC10193058 DOI: 10.1136/bmjopen-2022-068530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 05/09/2023] [Indexed: 05/18/2023] Open
Abstract
INTRODUCTION Parents of children hospitalised in a burn unit experience psychological trauma and later post-traumatic stress. Aboriginal and Torres Strait Islander families whose child has been admitted to a burn unit encounter additional burdens through a culturally unsafe healthcare system. Psychosocial interventions can help reduce anxiety, distress and trauma among children and parents. There remains a lack of interventions or resources that reflect Aboriginal and Torres Strait Islander people's perspective of health. The objective of this study is to codevelop a culturally appropriate informative resource to assist Aboriginal and Torres Strait Islander parents whose child has been hospitalised in a burn unit. METHODS In this participatory research study, the development of a culturally safe resource will build on Aboriginal and Torres Strait Islander families' experiences and voices, complemented by the knowledge and expertise of an Aboriginal Health Worker (AHW) and burn care experts. Data will be collected through recorded yarning sessions with families whose child has been admitted to a burn unit, the AHW and burn care experts. Audiotapes will be transcribed and data will be analysed thematically. Analysis of yarning sessions and resource development will follow a cyclical approach. ETHICS AND DISSEMINATION This study has been approved by the Aboriginal Health and Medical Research Council (AH&MRC) (1690/20) and the Sydney Children's Hospitals Network ethics committee (2020/ETH02103). Findings will be reported to all participants and will be disseminated with the broader community, the funding body and health workers at the hospital. Dissemination with the academic community will be through peer-reviewed publications and presentations in relevant conferences.
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Affiliation(s)
- Camila Kairuz
- Guunu-maana (Heal), Aboriginal and Torres Strait Islander Health, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Kate Hunter
- Guunu-maana (Heal), Aboriginal and Torres Strait Islander Health, The George Institute for Global Health, Newtown, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Keziah Bennett-Brook
- Guunu-maana (Heal), Aboriginal and Torres Strait Islander Health, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Courtney Ryder
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Andrew J A Holland
- Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Tamara Mackean
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Madeleine Jacques
- Burn Services, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Deborah Maze
- Burn Services, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Michele Scarcella
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Karl Briscoe
- National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners, Phillip, ACT, Australia
| | - Julieann Coombes
- Guunu-maana (Heal), Aboriginal and Torres Strait Islander Health, The George Institute for Global Health, Newtown, New South Wales, Australia
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McKenna ZJ, Moralez G, Romero SA, Hieda M, Huang M, Cramer MN, Sarma S, MacNamara JP, Jaffery MF, Atkins WC, Foster J, Crandall CG. Cardiac remodeling in well-healed burn survivors after 6 months of unsupervised progressive exercise training. J Appl Physiol (1985) 2023; 134:405-414. [PMID: 36633867 PMCID: PMC9902219 DOI: 10.1152/japplphysiol.00630.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 01/13/2023] Open
Abstract
Aerobic exercise is important in the rehabilitation of individuals with prior burn injuries, but no studies have examined whether adult burn survivors demonstrate cardiac remodeling to long-term aerobic exercise training. In this study, we tested the hypothesis that 6 months of progressive exercise training improves cardiac magnetic resonance imaging-based measures of cardiac structure and function in well-healed burn survivors. Secondary analyses explored relations between burn surface area and changes in cardiac structure in the cohort of burn survivors. V̇o2peak assessments and cardiac magnetic resonance imaging were performed at baseline and following 6 months of progressive exercise training from 19 well-healed burn survivors and 10 nonburned control participants. V̇o2peak increased following 6 months of training in both groups (Control: Δ5.5 ± 5.8 mL/kg/min; Burn Survivors: Δ3.2 ± 3.6 mL/kg/min, main effect of training, P < 0.001). Left ventricle (LV) mass (Control: Δ1.7 ± 3.1 g/m2; Burn survivors: Δ1.8 ± 2.7 g/m2), stroke volume (Control: Δ5.8 ± 5.2 mL/m2; Burn Survivors: Δ2.8 ± 4.2 mL/m2), and ejection fraction (Control: Δ2.4 ± 4.0%; Burn Survivors: Δ2.2 ± 4.3%) similarly increased following 6 months of exercise training in both cohorts (main effect of training P < 0.05 for all indexes). LV end-diastolic volume increased in the control group (Δ6.5 ± 4.5 mL/m2) but not in the cohort of burn survivors (Δ1.9 ± 2.7 mL/m2, interaction, P = 0.040). Multiple linear regression analyses revealed that burn surface area had little to no effect on changes in ventricular mass or end-diastolic volumes in response to exercise training. Our findings provide initial evidence of physiological cardiac remodeling, which is not impacted by burn size, in response to exercise training in individuals with well-healed burn injuries.NEW & NOTEWORTHY Aerobic exercise is important in the rehabilitation of individuals with prior burn injuries, but no studies have examined whether adult burn survivors demonstrate cardiac remodeling to long-term aerobic exercise training. In this study, we tested the hypothesis that 6 months of progressive exercise training would improve cardiac magnetic resonance imaging-based measures of cardiac structure and function in well-healed burn survivors. Our findings highlight the ability of exercise training to modify cardiac structure and function in well-healed burn survivors and nonburned sedentary controls alike.
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Affiliation(s)
- Zachary J McKenna
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Gilbert Moralez
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Steven A Romero
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas
| | | | - Mu Huang
- Office of Science, Medicine, and Health, American Heart Association, Dallas, Texas
| | - Matthew N Cramer
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Satyam Sarma
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - James P MacNamara
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Manall F Jaffery
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Whitley C Atkins
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Josh Foster
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Craig G Crandall
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
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Korkmaz HI, Flokstra G, Waasdorp M, Pijpe A, Papendorp SG, de Jong E, Rustemeyer T, Gibbs S, van Zuijlen PPM. The Complexity of the Post-Burn Immune Response: An Overview of the Associated Local and Systemic Complications. Cells 2023; 12:345. [PMID: 36766687 PMCID: PMC9913402 DOI: 10.3390/cells12030345] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/22/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023] Open
Abstract
Burn injury induces a complex inflammatory response, both locally and systemically, and is not yet completely unravelled and understood. In order to enable the development of accurate treatment options, it is of paramount importance to fully understand post-burn immunology. Research in the last decades describes insights into the prolonged and excessive inflammatory response that could exist after both severe and milder burn trauma and that this response differs from that of none-burn acute trauma. Persistent activity of complement, acute phase proteins and pro- and anti-inflammatory mediators, changes in lymphocyte activity, activation of the stress response and infiltration of immune cells have all been related to post-burn local and systemic pathology. This "narrative" review explores the current state of knowledge, focusing on both the local and systemic immunology post-burn, and further questions how it is linked to the clinical outcome. Moreover, it illustrates the complexity of post-burn immunology and the existing gaps in knowledge on underlying mechanisms of burn pathology.
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Affiliation(s)
- H. Ibrahim Korkmaz
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Location VUmc, 1081 HZ Amsterdam, The Netherlands
- Department of Molecular Cell Biology and Immunology, Amsterdam Infection and Immunity (AII) Institute, Amsterdam UMC, Location VUmc, 1081 HZ Amsterdam, The Netherlands
- Burn Center and Department of Plastic and Reconstructive Surgery, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands
- Association of Dutch Burn Centres (ADBC), 1941 AJ Beverwijk, The Netherlands
| | - Gwendolien Flokstra
- Department of Molecular Cell Biology and Immunology, Amsterdam Infection and Immunity (AII) Institute, Amsterdam UMC, Location VUmc, 1081 HZ Amsterdam, The Netherlands
| | - Maaike Waasdorp
- Department of Molecular Cell Biology and Immunology, Amsterdam Infection and Immunity (AII) Institute, Amsterdam UMC, Location VUmc, 1081 HZ Amsterdam, The Netherlands
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
| | - Anouk Pijpe
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Location VUmc, 1081 HZ Amsterdam, The Netherlands
- Burn Center and Department of Plastic and Reconstructive Surgery, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands
- Association of Dutch Burn Centres (ADBC), 1941 AJ Beverwijk, The Netherlands
| | - Stephan G. Papendorp
- Burn Center and Department of Plastic and Reconstructive Surgery, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands
- Intensive Care Unit, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands
| | - Evelien de Jong
- Burn Center and Department of Plastic and Reconstructive Surgery, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands
- Intensive Care Unit, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands
| | - Thomas Rustemeyer
- Department of Dermatology, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Susan Gibbs
- Department of Molecular Cell Biology and Immunology, Amsterdam Infection and Immunity (AII) Institute, Amsterdam UMC, Location VUmc, 1081 HZ Amsterdam, The Netherlands
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
| | - Paul P. M. van Zuijlen
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Location VUmc, 1081 HZ Amsterdam, The Netherlands
- Burn Center and Department of Plastic and Reconstructive Surgery, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands
- Association of Dutch Burn Centres (ADBC), 1941 AJ Beverwijk, The Netherlands
- Paediatric Surgical Centre, Emma Children’s Hospital, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands
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30
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Wood FM. The Role of Cell-Based Therapies in Acute Burn Wound Skin Repair: A Review. J Burn Care Res 2023; 44:S42-S47. [PMID: 36567469 DOI: 10.1093/jbcr/irac146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Tissue engineering solutions for skin have been developed over the last few decades with a focus initially on a two-layered structure with epithelial and dermal repair. An essential element of skin restoration is a source of cells capable of differentiating into the appropriate phenotype. The need to repair areas of skin when traditional techniques were not adequate addressed led to cell based therapies being developed initially as a laboratory-based tissue expansion opportunity, both as sheets of cultured epithelial autograft and in composite laboratory-based skin substitutes. The time to availability of the cell-based therapies has been solved in a number of ways, from using allograft cell-based solutions to the use of point of care skin cell harvesting for immediate clinical use. More recently pluripotential cells have been explored providing a readily available source of cells and cells which can express the broad range of phenotypes seen in the mature skin construct. The lessons learnt from the use of cell based techniques has driven the exploration of the use of 3D printing technology, with controlled accurate placement of the cells within a specific printed construct to optimise the phenotypic expression and tissue generation.
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Affiliation(s)
- Fiona M Wood
- University of Western Australia, Fiona Stanley Hospital, Perth Children's Hospital, Burns Service of WA, Level 4 Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch Western, Australia 6150
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31
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Osborne T, Wall B, Edgar DW, Fairchild T, Wood F. Current understanding of the chronic stress response to burn injury from human studies. BURNS & TRAUMA 2023; 11:tkad007. [PMID: 36926636 PMCID: PMC10013650 DOI: 10.1093/burnst/tkad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 12/26/2022] [Accepted: 01/17/2023] [Indexed: 03/15/2023]
Abstract
There is a marked inflammatory and hypermetabolic response following a burn injury. The interlinked responses are more pronounced than for other forms of trauma and can persist for ≥3 years post-injury in burned patients. After a burn, patients have an increased risk of diseases of ageing including cancer, diabetes and cardiovascular disease, highlighting the need for effective long-term strategies to ameliorate the stress response post-burn. Current therapeutic strategies for post-burn recovery include removal of damaged tissue with surgical excision and wound repair, nutritional supplementation and rehabilitative exercise. These strategies aim to minimize the hypermetabolic and inflammatory responses, as well as reducing the loss of lean body mass. This review briefly summarises the inflammatory and hypermetabolic responses and provides an update on the current therapeutic strategies for burned patients. The review examines the persistent nutritional challenge of ensuring sufficient energy intake of each macronutrient to fuel the hypermetabolic and counteract the catabolic response of burn injury, whilst reducing periods of hyperglycaemia and hypertriglyceridemia. Patients require individualized treatment options tailored to unique systemic responses following a burn, facilitated by a precision medicine approach to improve clinical and physiological outcomes in burned patients. Thus, this review discusses the utility of metabolic flexibility assessment to aid clinical decision making and prescription relating to nutritional supplementation and rehabilitative exercise in the burned patient.
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Affiliation(s)
- Tyler Osborne
- Discipline of Exercise Science, Murdoch University, Murdoch 6150, Western Australia.,Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Murdoch 6150, Western Australia
| | - Bradley Wall
- Discipline of Exercise Science, Murdoch University, Murdoch 6150, Western Australia.,Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Murdoch 6150, Western Australia
| | - Dale W Edgar
- State Adult Burns Unit, Government of Western Australia South Metropolitan Health Service, Fiona Stanley Hospital, Murdoch 6150, Western Australia.,Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch 6150, Western Australia.,Burn Injury Research Node, Institute for Health Research, The University of Notre Dame Australia, Murdoch 6160, Western Australia.,Burn Injury Research Unit, University of Western Australia, Murdoch 6009, Western Australia
| | - Timothy Fairchild
- Discipline of Exercise Science, Murdoch University, Murdoch 6150, Western Australia.,The Centre for Molecular Medicine and Innovative Therapeutics, Health Futures Institute, Murdoch University, Murdoch 6150, Western Australia
| | - Fiona Wood
- State Adult Burns Unit, Government of Western Australia South Metropolitan Health Service, Fiona Stanley Hospital, Murdoch 6150, Western Australia.,Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch 6150, Western Australia.,Burn Injury Research Unit, University of Western Australia, Murdoch 6009, Western Australia
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32
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Bayuo J, Wong FKY, Lin R, Su JJ, Abu-Odah H. A meta-ethnography of developing and living with post-burn scars. J Nurs Scholarsh 2023; 55:319-328. [PMID: 36161474 DOI: 10.1111/jnu.12811] [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: 02/17/2022] [Revised: 07/07/2022] [Accepted: 08/19/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Post-burn scarring is often cosmetically unappealing and create discomfort. This makes it crucial to understand the experience of individuals living with scars which can offer insights into their recovery. This review sought to develop an in-depth understanding of living with post-burn scars. DESIGN A systematic review and meta-ethnography approach were employed. We utilized an interpretive approach to inductively generate codes. These codes were examined iteratively using a constant comparison strategy following which they were re-interpreted to formulate themes which formed the basis of undertaking a narrative synthesis. RESULTS Twenty-five studies were retained. The analytical process yielded two themes: emergence of a new identity and living with the redefined self. The experience of living with scars is entwined with the initial trauma as the scars served as a permanent reminder of the injury. Emergence of a new identity involved a process of meaning making, mourning the loss of the old self, confronting the new self, reconciling the remains of the old self with the new, rebuilding a new identity, and navigating through functional restrictions. These processes were particularly challenging for persons involved in self-immolation. Positive coping and changing one's perspective emerged as strategies to facilitate living with the redefined self. CONCLUSION Living with scars is a challenging process which is more difficult for persons whose injuries are due to self-immolation (act of burning oneself). The findings highlight a latent yet ongoing process towards subjective recovery. Clinicians need to be aware of the processes and incorporate these into rehabilitation programmes. CLINICAL RELEVANCE Burn survivors need ongoing professional support to adjust to and live with the scars. Victims of self-immolation should be considered for early psychosocial support.
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Affiliation(s)
- Jonathan Bayuo
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | | | - Rose Lin
- School of Nursing, The University of Hong Kong, Hong Kong
| | - Jing Jing Su
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | - Hammoda Abu-Odah
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
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Bazaid AS, Punjabi AA, Aldarhami A, Qanash H, Alsaif G, Gattan H, Barnawi H, Alharbi B, Alrashidi A, Alqadi A. Bacterial Infections among Patients with Chronic Diseases at a Tertiary Care Hospital in Saudi Arabia. Microorganisms 2022; 10:microorganisms10101907. [PMID: 36296184 PMCID: PMC9609889 DOI: 10.3390/microorganisms10101907] [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: 09/05/2022] [Revised: 09/18/2022] [Accepted: 09/23/2022] [Indexed: 11/30/2022] Open
Abstract
Infections caused by multi-drug-resistant bacteria in patients with chronic diseases have been associated with high mortality and morbidity. While few reports have evaluated bacterial infections in multiple chronic disease patients, the focus of the current study was to investigate the prevalence of bacterial infections and the susceptibility profiles of causative strains among various groups of patients suffering from chronic diseases. Microbiological reports of patients suffering from cancer, diabetes mellitus, cardiovascular diseases, kidney diseases, and skin burns were retrospectively collected from a tertiary hospital in Saudi Arabia. Approximately 54.2% of recruited patients were males, and positive urine was the most prevalent specimen associated with kidney disease patients (25%). Escherichia coli isolates were predominant among cardiovascular, kidney, and cancer patients. Staphylococcus aureus was commonly detected in diabetics and those with burns. Although resistance patterns varied based on the type of specimens and underlying diseases, Escherichia coli showed limited resistance to colistin, carbapenems, and tigecycline, while S. aureus demonstrated susceptibility to ciprofloxacin, gentamicin, and rifampin. These observations are crucial for clinicians and policymakers to ensure effective treatment plans and improve outcomes in these patients with comorbidity.
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Affiliation(s)
- Abdulrahman S. Bazaid
- Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Ha’il, Hail 55476, Saudi Arabia
- Correspondence: (A.S.B.); (H.Q.); Tel.: +966-16-5358200 (ext. 1713) (A.S.B.); +966-16-5351752 (H.Q.)
| | - Ahmed A. Punjabi
- Microbiology Unit, Department of Laboratory Medicine and Pathology BB, International Medical Center, Jeddah 21451, Saudi Arabia
| | - Abdu Aldarhami
- Department of Medical Microbiology, Qunfudah Faculty of Medicine, Umm Al-Qura University, Al-Qunfudah 21961, Saudi Arabia
| | - Husam Qanash
- Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Ha’il, Hail 55476, Saudi Arabia
- Molecular Diagnostics and Personalized Therapeutics Unit, University of Ha’il, Hail 55476, Saudi Arabia
- Correspondence: (A.S.B.); (H.Q.); Tel.: +966-16-5358200 (ext. 1713) (A.S.B.); +966-16-5351752 (H.Q.)
| | - Ghaida Alsaif
- Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Ha’il, Hail 55476, Saudi Arabia
| | - Hattan Gattan
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Special Infectious Agents Unit, King Fahad Medical Research Center, Jeddah 22252, Saudi Arabia
| | - Heba Barnawi
- Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Ha’il, Hail 55476, Saudi Arabia
| | - Bandar Alharbi
- Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Ha’il, Hail 55476, Saudi Arabia
| | - Abdulaziz Alrashidi
- Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Ha’il, Hail 55476, Saudi Arabia
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Enhanced Antimicrobial Activity of Silver Sulfadiazine Cosmetotherapeutic Nanolotion for Burn Infections. COSMETICS 2022. [DOI: 10.3390/cosmetics9050093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Burns are highly traumatizing injuries that can be complicated by various microbial infections, leading to morbidity and mortality. The ultimate goal of burn therapy is to prevent any microbial infection and rapid wound healing with epithelization. The current study aimed to develop and investigate the potential of nanoemulsion-based cosmetotherapeutic lotion of silver sulfadiazine (SSD) for increased antimicrobial activity to treat burn injuries. Silver sulfadiazine is the standard topical treatment for burn patients, but is allied with major limitations of poor solubility, low bioavailability, and other hematologic effects, hindering its pharmaceutical applications. The nanoformulation was fabricated through the ultrasonication technique and optimized by selecting various parameters and concentrations for the formation of water-in-oil (w/o) emulsion. The optimized formulation depicts a smaller particle size of 213 nm with an encapsulation efficiency of approx. 80%. Further, nanoemulsion-based SSD lotion by utilizing argan oil as a cosmetotherapeutic agent was prepared for scar massaging with improved permeation properties. The designed cosmeceutical formulation was characterized in terms of physical appearance, refractive index, particle size, encapsulation efficiency, and biocompatibility. The compatibility of the formulation ingredients were determined through FTIR (Fourier Transform Infrared Spectroscopy). The formulated nanolotion containing SSD demonstrated superior antimicrobial activities against different bacterial strains in comparison to commercialized burn creams.
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35
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Ngoepe MP, Battison A, Mufamadi S. Nano-Enabled Chronic Wound Healing Strategies: Burn and Diabetic Ulcer Wounds. J Biomed Nanotechnol 2022. [DOI: 10.1166/jbn.2022.3427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The human skin serves as the body’s first line of defense against the environment. Diabetes mellitus (DM) and 2nd–4th degree burns, on the other hand, affect the skin’s protective barrier features. Burn wounds, hypermetabolic state, and hyperglycemia compromise the
immune system leading to chronic wound healing. Unlike acute wound healing processes, chronic wounds are affected by reinfections which can lead to limb amputation or death. The conventional wound dressing techniques used to protect the wound and provide an optimal environment for repair have
their limitations. Various nanomaterials have been produced that exhibit distinct features to tackle issues affecting wound repair mechanisms. This review discusses the emerging technologies that have been designed to improve wound care upon skin injury. To ensure rapid healing and possibly
prevent scarring, different nanomaterials can be applied at different stages of healing (hemostasis, inflammation, proliferation, remodeling).
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Affiliation(s)
- Mpho Phehello Ngoepe
- DSI-Mandela Nanomedicine Platform, Nelson Mandela University, Gqeberha, 6001, Eastern Cape, South Africa
| | - Aidan Battison
- DSI-Mandela Nanomedicine Platform, Nelson Mandela University, Gqeberha, 6001, Eastern Cape, South Africa
| | - Steven Mufamadi
- DSI-Mandela Nanomedicine Platform, Nelson Mandela University, Gqeberha, 6001, Eastern Cape, South Africa
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36
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Watso JC, Romero SA, Moralez G, Huang M, Cramer MN, Johnson E, Crandall CG. Six months of unsupervised exercise training lowers blood pressure during moderate, but not vigorous, aerobic exercise in adults with well-healed burn injuries. J Appl Physiol (1985) 2022; 133:742-754. [PMID: 35952345 PMCID: PMC9484988 DOI: 10.1152/japplphysiol.00181.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/18/2022] [Accepted: 08/08/2022] [Indexed: 11/22/2022] Open
Abstract
Exercise training reduces cardiovascular disease risk, partly due to arterial blood pressure (BP) lowering at rest and during fixed-load exercise. However, it is unclear whether exercise training can reduce BP at rest and during exercise in adults with well-healed burn injuries. Therefore, the purpose of this investigation was to test the hypothesis that 6 mo of unsupervised exercise training reduces BP at rest and during lower-body cycle ergometry in adults with well-healed burn injuries. Thirty-nine adults (28 with well-healed burn injuries and 11 controls) completed 6 mo of unsupervised, progressive exercise training including endurance, resistance, and high-intensity interval components. Before and after exercise training, we measured BP at rest, during fixed-load submaximal exercise (50 and 75 W), during fixed-intensity submaximal exercise (40% and 70% of V̇o2peak), and during maximal exercise on a lower-body cycle ergometer. We compared cardiovascular variables using two-way ANOVA (group × pre/postexercise training [repeated factor]). Adults with well-healed burn injuries had higher diastolic BP at rest (P = 0.04), which was unchanged by exercise training (P = 0.26). Exercise training reduced systolic, mean, and diastolic BP during fixed-load cycling exercise at 75 W in adults with well-healed burn injuries (P ≤ 0.03 for all), but not controls (P ≥ 0.67 for all). Exercise training also reduced mean and diastolic BP during exercise at 40% (P ≤ 0.02 for both), but not at 70% (P ≥ 0.18 for both), of V̇o2peak. These data suggest that a 6-mo unsupervised exercise training program lowers BP during moderate, but not vigorous, aerobic exercise in adults with well-healed burn injuries.NEW & NOTEWORTHY Adults with well-healed burn injuries have greater cardiovascular disease morbidity and all-cause mortality compared with nonburn-injured adults. We found that exercise training reduced blood pressure (BP) during fixed-load cycling at 75 W and during moderate, but not vigorous, intensity cycling exercise in adults with well-healed burn injuries. These data suggest that 6 mo of unsupervised exercise training provides some degree of cardioprotection by reducing BP responses during submaximal exercise in well-healed burn-injured adults.
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Affiliation(s)
- Joseph C Watso
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Nutrition & Integrative Physiology, Florida State University, Tallahassee, Florida
| | - Steven A Romero
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Physiology & Anatomy, University of North Texas Health Science Center, Fort Worth, Texas
| | - Gilbert Moralez
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mu Huang
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, Texas
- Office of Science, Medicine, and Health, American Heart Association, Dallas, Texas
| | - Matthew N Cramer
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Elias Johnson
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Craig G Crandall
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, Texas
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A comparison of parent-reported and self-reported psychosocial function scores of the PedsQL for children with non-severe burn. Burns 2022:S0305-4179(22)00237-6. [DOI: 10.1016/j.burns.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/04/2022] [Accepted: 09/04/2022] [Indexed: 11/19/2022]
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Young AE, Staruch RMT, Dziewulski P. Why is priority setting important for global burn care research? Burns 2022; 48:1035-1039. [PMID: 35525771 DOI: 10.1016/j.burns.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/12/2022] [Indexed: 12/15/2022]
Abstract
The use of robust evidence is a key component of providing high quality care to patients. Synthesised evidence to support clinical decision-making is lacking for many aspects of clinical burn care. Identifying the most important areas of care that lack high quality evidence and requires research is necessary, as funding for primary research is limited. Priority setting research studies are a joint endeavour between patients, carers and clinicians to identify and rank topics for research in a healthcare area in order to reduce research waste. Such an exercise has yet to be undertaken in burns. The aim of this paper is to outline the importance of research prioritisation in burn care, to discuss how it facilitates the maximum benefit from limited research funding and to explain the methodologies used.
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Affiliation(s)
- A E Young
- Population Health Sciences, Bristol Medical School, University of Bristol, UK.
| | - R M T Staruch
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - P Dziewulski
- St Andrews Centre for Burns & Plastic Surgery, Chelmsford, UK
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Kankam HK, Lee KC, Sardeli AV, Dretzke J, Lord JM, Moiemen N. Are acute burn injuries associated with long-term mortality? A systematic review and meta-analysis. Burns 2022; 48:1783-1793. [DOI: 10.1016/j.burns.2022.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/25/2022] [Accepted: 06/15/2022] [Indexed: 11/02/2022]
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Monsalve-Duarte S, Betancourt-Zapata W, Suarez-Cañon N, Maya R, Salgado-Vasco A, Prieto-Garces S, Marín-Sánchez J, Gómez-Ortega V, Valderrama M, Ettenberger M. Music therapy and music medicine interventions with adult burn patients: A systematic review and meta-analysis. Burns 2022; 48:510-521. [PMID: 34906387 DOI: 10.1016/j.burns.2021.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/08/2021] [Accepted: 11/04/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pain is one of the most common and most difficult symptoms to manage in adult burn patients in the Intensive Care Unit (ICU). Insufficient or unsuccessful pain management can negatively affect physiological, psychological, and social health in burn patients, both during and after hospitalization. Music therapy and music medicine interventions have been shown to positively affect pain and mental health in this population. This systematic review and meta-analysis provide an update of Randomized Controlled Trials (RCTs) using music therapy or music medicine interventions in adult burn patients. METHODS A variety of databases were searched from their beginning to June 2020, including PsycINFO and PsycArticles (via APAsycNET), PubMed and MEDLINE (via OvidSP), Scopus, Web of Science, and the Cochrane Library. Data of all articles meeting the inclusion criteria were extracted, organized, and processed according to the PRISMA guidelines. Statistical analysis was performed using Q-test and I2 statistics. RESULTS 10 RCTs with a total of 1061 participants were included. The results of the meta-analysis showed a statistically significant reduction of pain (I2 = 96.03%, P < 0.001), anxiety (I2 = 98.85%, P < 0.002), and improved relaxation (I2 = 87.19%, P < 0.001) favoring music interventions compared to control groups. CONCLUSIONS This review provides preliminary evidence for the effectiveness of music interventions for adult burn patients. However, more high-quality RCTs are needed to safely establish guidelines for music therapists and other health care professionals in using music for health purposes with this population.
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Affiliation(s)
| | | | - Nicolas Suarez-Cañon
- Department of Critical Care, University Hospital Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Rafael Maya
- Department of Music Therapy, University Hospital Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Andrés Salgado-Vasco
- Department of Music Therapy, University Hospital Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Sergio Prieto-Garces
- Department of Critical Care, University Hospital Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | | | | | - Mario Valderrama
- Department of Biomedical Engineering, University Los Andes, Bogotá, Colombia
| | - Mark Ettenberger
- Department of Music Therapy, University Hospital Fundación Santa Fe de Bogotá, Bogotá, Colombia..
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McGovern C, Puxty K, Paton L. Major burns: part 2. Anaesthesia, intensive care and pain management. BJA Educ 2022; 22:138-145. [PMID: 35531075 PMCID: PMC9073309 DOI: 10.1016/j.bjae.2022.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- C. McGovern
- Glasgow Royal Infirmary, Glasgow, UK
- University of Glasgow, Glasgow, UK
| | - K. Puxty
- Glasgow Royal Infirmary, Glasgow, UK
- University of Glasgow, Glasgow, UK
| | - L. Paton
- Glasgow Royal Infirmary, Glasgow, UK
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42
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Cuttle L, Fear M, Wood FM, Kimble RM, Holland AJA. Management of non-severe burn wounds in children and adolescents: optimising outcomes through all stages of the patient journey. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:269-278. [PMID: 35051408 DOI: 10.1016/s2352-4642(21)00350-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 12/11/2022]
Abstract
Paediatric burn injuries are common, especially in children younger than 5 years, and can lead to poor physical and psychosocial outcomes in the long term. In this Review, we aim to summarise the key factors and interventions before hospital admission and following discharge that can improve the long-term outcomes of paediatric burns. Care can be optimised through first aid treatment, correct initial assessment of burn severity, and appropriate patient referral to a burns centre. Scar prevention or treatment and patient follow-up after discharge are also essential. As most burn injuries in children are comparatively small and readily survivable, this Review does not cover the perioperative management associated with severe burns that require fluid resuscitation, or inhalational injury. Burns disproportionately affect children from low socioeconomic backgrounds and those living in low-income and middle-income countries, with ample evidence to suggest that there remains scope for low-cost interventions to improve care for those patients with the greatest burden of burn injury. Current knowledge gaps and future research directions are discussed.
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Affiliation(s)
- Leila Cuttle
- Centre for Children's Health Research, Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Mark Fear
- Burn Injury Research Unit, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Fiona M Wood
- Burn Injury Research Unit, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia; Burns Service of Western Australia, Perth Children's Hospital and Fiona Stanley Hospital, Perth, WA, Australia
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, The University of Queensland, South Brisbane, QLD, Australia; Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Andrew J A Holland
- The Children's Hospital Burns Research Institute, The Children's Hospital at Westmead, The University of Sydney, NSW, Westmead, Australia
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43
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van Niekerk A, Kimemia D, Seedat M, Annegarn H. Energy impoverishment and burns: The case for an expedited, safe and inclusive energy transition in South Africa. S AFR J SCI 2022. [DOI: 10.17159/sajs.2022/13148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Ashley van Niekerk
- Institute for Social and Health Sciences, University of South Africa, Johannesburg, South Africa
- Masculinity and Health Research Unit, University of South Africa and South African Medical Research Council, Cape Town, South Africa
| | - David Kimemia
- Institute for Social and Health Sciences, University of South Africa, Johannesburg, South Africa
- Masculinity and Health Research Unit, University of South Africa and South African Medical Research Council, Cape Town, South Africa
| | - Mohamed Seedat
- Institute for Social and Health Sciences, University of South Africa, Johannesburg, South Africa
- Masculinity and Health Research Unit, University of South Africa and South African Medical Research Council, Cape Town, South Africa
| | - Harold Annegarn
- Unit for Environmental Science and Management, North-West University, Potchefstroom, South Africa
- Bioenergy and Environmental Science and Technology Laboratory, College of Engineering, China Agricultural University, Beijing, China
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Kelter BM, Shepler LJ, Ni P, Slavin MD, Acton A, Kazis LE, Ryan CM, Schneider JC. Developing trajectories of social recovery after burn injury: Preliminary results from the LIBRE Journey Study. Burns 2022; 48:460-462. [PMID: 34924225 PMCID: PMC9275732 DOI: 10.1016/j.burns.2021.11.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Brian M. Kelter
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA; Spaulding Research Institute, Boston, MA, USA
| | - Lauren J. Shepler
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA; Spaulding Research Institute, Boston, MA, USA
| | - Pengsheng Ni
- Boston University School of Public Health, Boston, MA, USA
| | - Mary D. Slavin
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA; Spaulding Research Institute, Boston, MA, USA; Boston University School of Public Health, Boston, MA, USA
| | - Amy Acton
- Phoenix Society for Burn Survivors, Grand Rapids, MI, USA
| | - Lewis E. Kazis
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA; Spaulding Research Institute, Boston, MA, USA; Boston University School of Public Health, Boston, MA, USA
| | - Colleen M. Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Shriners Hospitals for Children - Boston®, Boston, MA, USA
| | - Jeffrey C. Schneider
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA; Spaulding Research Institute, Boston, MA, USA
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45
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Rescuing the negative effects of aging in burn wounds using tacrolimus applied via microcapillary hydrogel dressing. Burns 2022; 48:1885-1892. [DOI: 10.1016/j.burns.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/25/2022] [Accepted: 02/03/2022] [Indexed: 11/19/2022]
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46
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Innate Immune System Response to Burn Damage-Focus on Cytokine Alteration. Int J Mol Sci 2022; 23:ijms23020716. [PMID: 35054900 PMCID: PMC8775698 DOI: 10.3390/ijms23020716] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 02/04/2023] Open
Abstract
In the literature, burns are understood as traumatic events accompanied by increased morbidity and mortality among affected patients. Their characteristic feature is the formation of swelling and redness at the site of the burn, which indicates the development of inflammation. This reaction is not only important in the healing process of wounds but is also responsible for stimulating the patient’s innate immune system. As a result of the loss of the protective ability of the epidermis, microbes which include bacteria, fungi, and viruses have easier access to the system, which can result in infections. However, the patient is still able to overcome the infections that occur through a cascade of cytokines and growth factors stimulated by inflammation. Long-term inflammation also has negative consequences for the body, which may result in multi-organ failure or lead to fibrosis and scarring of the skin. The innate immune response to burns is not only immediate, but also severe and prolonged, and some people with burn shock may also experience immunosuppression accompanied by an increased susceptibility to fatal infections. This immunosuppression includes apoptosis-induced lymphopenia, decreased interleukin 2 (IL-2) secretion, neutrophil storm, impaired phagocytosis, and decreased monocyte human leukocyte antigen-DR. This is why it is important to understand how the immune system works in people with burns and during infections of wounds by microorganisms. The aim of this study was to characterize the molecular pathways of cell signaling of the immune system of people affected by burns, taking into account the role of microbial infections.
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47
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Kelter BM, Wolfe AE, Kazis LE, Ryan CM, Acton A, Slavin MD, Schneider JC. Trajectory Curves for Purposes of Benchmarking and Predicting Clinical Outcomes: A Scoping Review. J Burn Care Res 2022; 43:1095-1104. [PMID: 34986488 PMCID: PMC9255662 DOI: 10.1093/jbcr/irab245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Trajectory curves are valuable tools to benchmark patient health status and predict future outcomes. A longitudinal study is underway to examine social participation after burn injury using the Life Impact Burn Recovery Evaluation (LIBRE) Profile with the goal of developing trajectory curves for specific domains that focus on social reintegration. We conducted a scoping review to inform and understand trajectory curves applied in clinical settings to compare outcomes for an individual to a matched cohort of comparable patients or predicted expected outcomes over time. This scoping review utilized a PubMed search from January 2014 to August 2019 for the following terms: "trajectory curves" or "trajectory models" and "clinic" or "clinical." Only articles that specifically referenced longitudinal and clinical research designs were included in the scoping review. Articles were assessed using standard scoping review methods and categorized based on clinical application of trajectory curves for either benchmarking or prediction. The initial literature review identified 141 manuscripts and 34 met initial inclusion criteria. The reviewed articles support the clinical use of trajectory curves. Findings provide insight into several key determinants involved with the successful development and implementation of trajectory curves in clinical settings. These findings will inform efforts to use the LIBRE Profile to model social participation recovery and assist in developing effective strategies using trajectory curves to promote social reintegration after burn injury.
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Affiliation(s)
- Brian M Kelter
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA,Department of Physical Medicine & Rehabilitation, Spaulding Research Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Audrey E Wolfe
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA,Department of Physical Medicine & Rehabilitation, Spaulding Research Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Lewis E Kazis
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA,Department of Physical Medicine & Rehabilitation, Spaulding Research Institute, Harvard Medical School, Boston, Massachusetts, USA,Department of Health Law, Policy and Management, Boston University School of Public Health, Massachusetts, USA
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA,Department of Surgery, Shriners Hospitals for Children—Boston®, Massachusetts, USA
| | - Amy Acton
- Phoenix Society for Burn Survivors, Grand Rapids, Michigan, USA
| | | | - Jeffrey C Schneider
- Address correspondence to Jeffrey C. Schneider, MD, 300 1st Avenue, Boston, MA 02129, USA.
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48
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Barrett LW, Fear VS, Foley B, Audsley K, Barnes S, Newnes H, McDonnell A, Wood FM, Fear MW, Waithman J. Non-severe burn injury increases cancer incidence in mice and has long-term impacts on the activation and function of T cells. BURNS & TRAUMA 2022; 10:tkac016. [PMID: 35505970 PMCID: PMC9054911 DOI: 10.1093/burnst/tkac016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/13/2022] [Indexed: 11/30/2022]
Abstract
Background Recent evidence suggests that burn patients are at increased risk of hospital admission for infection, mental health conditions, cardiovascular disease and cancer for many years after discharge for the burn injury itself. Burn injury has also been shown to induce sustained immune system dysfunction. This change to immune function may contribute to the increased risk of chronic disease observed. However, the mechanisms that disrupt long-term immune function in response to burn trauma, and their link to long-term morbidity, remain unknown. In this study we investigated changes to immune function after burn injury using a murine model of non-severe injury. Methods An established mouse model of non-severe burn injury (full thickness burn equivalent to 8% total body surface area) was used in combination with an orthotopic model of B16 melanoma to investigate the link between burns and cancer. Considering that CD8+ T cells are important drivers of effective tumour suppression in this model, we also investigated potential dysregulation of this immune population using mouse models of burn injury in combination with herpes simplex virus infection. Flow cytometry was used to detect and quantify cell populations of interest and changes in immune function. Results We demonstrate that 4 weeks after a non-severe burn injury, mice were significantly more susceptible to tumour development than controls using an orthotopic model of B16 melanoma. In addition, our results reveal that CD8+ T cell expansion, differentiation and memory potential is significantly impaired at 1 month post-burn. Conclusions Our data suggests that CD8+ T cell-mediated immunity may be dysfunctional for a sustained period after even non-severe burn injury. Further studies in patients to validate these findings may support clinical intervention to restore or protect immunity in patients after burn injury and reduce the increased risk of secondary morbidities observed.
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Affiliation(s)
- Lucy W Barrett
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Crawley, WA, 6009, Australia
- Telethon Kids Institute, University of Western Australia, Northern Entrance, Perth Children’s Hospital, 15 Hospital Ave, Nedlands, WA, 6009, Australia
- Fiona Wood Foundation, Fiona Stanley Hospital, MNH (B), Main Hospital, CD 15, Level 4, Burns Unit, 102-118 Murdoch Drive, Murdoch, WA, 6150, Australia
| | - Vanessa S Fear
- Telethon Kids Institute, University of Western Australia, Northern Entrance, Perth Children’s Hospital, 15 Hospital Ave, Nedlands, WA, 6009, Australia
| | - Bree Foley
- Telethon Kids Institute, University of Western Australia, Northern Entrance, Perth Children’s Hospital, 15 Hospital Ave, Nedlands, WA, 6009, Australia
| | - Katherine Audsley
- Telethon Kids Institute, University of Western Australia, Northern Entrance, Perth Children’s Hospital, 15 Hospital Ave, Nedlands, WA, 6009, Australia
| | - Samantha Barnes
- Telethon Kids Institute, University of Western Australia, Northern Entrance, Perth Children’s Hospital, 15 Hospital Ave, Nedlands, WA, 6009, Australia
| | - Hannah Newnes
- Telethon Kids Institute, University of Western Australia, Northern Entrance, Perth Children’s Hospital, 15 Hospital Ave, Nedlands, WA, 6009, Australia
| | - Alison McDonnell
- Telethon Kids Institute, University of Western Australia, Northern Entrance, Perth Children’s Hospital, 15 Hospital Ave, Nedlands, WA, 6009, Australia
| | - Fiona M Wood
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Crawley, WA, 6009, Australia
- Fiona Wood Foundation, Fiona Stanley Hospital, MNH (B), Main Hospital, CD 15, Level 4, Burns Unit, 102-118 Murdoch Drive, Murdoch, WA, 6150, Australia
- Burns Service of Western Australia, WA Department of Health, Nedlands, WA, 6009, Australia
| | - Mark W Fear
- Fiona Wood Foundation, Fiona Stanley Hospital, MNH (B), Main Hospital, CD 15, Level 4, Burns Unit, 102-118 Murdoch Drive, Murdoch, WA, 6150, Australia
- Burns Service of Western Australia, WA Department of Health, Nedlands, WA, 6009, Australia
| | - Jason Waithman
- Telethon Kids Institute, University of Western Australia, Northern Entrance, Perth Children’s Hospital, 15 Hospital Ave, Nedlands, WA, 6009, Australia
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49
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Chronic physical health conditions following injury: a comparison of prevalence and risk in people with orthopaedic major trauma and other types of injury. Arch Phys Med Rehabil 2022; 103:1738-1748. [DOI: 10.1016/j.apmr.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 11/17/2021] [Accepted: 12/13/2021] [Indexed: 11/19/2022]
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50
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Keyloun JW, Campbell R, Carney BC, Yang R, Miller SA, Detwiler L, Gautam A, Moffatt LT, Hammamieh R, Jett M, Shupp JW. Early Transcriptomic Response to Burn Injury: Severe Burns Are Associated With Immune Pathway Shutdown. J Burn Care Res 2021; 43:306-314. [PMID: 34791339 PMCID: PMC9890902 DOI: 10.1093/jbcr/irab217] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Burn injury induces a systemic hyperinflammatory response with detrimental side effects. Studies have described the biochemical changes induced by severe burns, but the transcriptome response is not well characterized. The goal of this work is to characterize the blood transcriptome after burn injury. Burn patients presenting to a regional center between 2012 and 2017 were prospectively enrolled. Blood was collected on admission and at predetermined time points (hours 2, 4, 8, 12, and 24). RNA was isolated and transcript levels were measured with a gene expression microarray. To identify differentially regulated genes (false-discovery rate ≤0.1) by burn injury severity, patients were grouped by TBSA above or below 20% and statistically enriched pathways were identified. Sixty-eight patients were analyzed, most patients were male with a median age of 41 (interquartile range, 30.5-58.5) years, and TBSA of 20% (11%-34%). Thirty-five patients had % TBSA injury ≥20%, and this group experienced greater mortality (26% vs 3%, P = .008). Comparative analysis of genes from patients with </≥20% TBSA revealed 1505, 613, 380, 63, 1357, and 954 differentially expressed genes at hours 0, 2, 4, 8, 12, and 24, respectively. Pathway analysis revealed an initial up-regulation in several immune/inflammatory pathways within the ≥20% TBSA groups followed by shutdown. Severe burn injury is associated with an early proinflammatory immune response followed by shutdown of these pathways. Examination of the immunoinflammatory response to burn injury through differential gene regulation and associated immune pathways by injury severity may identify mechanistic targets for future intervention.
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Affiliation(s)
| | | | - Bonnie C Carney
- Firefighters’ Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA,Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA,Department of Biochemistry, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Ruoting Yang
- Medical Readiness Systems Biology, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Stacy-Ann Miller
- Medical Readiness Systems Biology, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA,Oak Ridge Institute for Science and Education, Silver Spring, Maryland, USA
| | - Leanne Detwiler
- The Geneva Foundation, Silver Spring, Maryland, USA,Medical Readiness Systems Biology, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Aarti Gautam
- Medical Readiness Systems Biology, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Lauren T Moffatt
- Firefighters’ Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA,Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA,Department of Biochemistry, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Rasha Hammamieh
- Medical Readiness Systems Biology, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Marti Jett
- Headquarters Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Jeffrey W Shupp
- Address correspondence to Jeffrey W. Shupp, MD, The Burn Center, 110 Irving Street, NW, Suite 3B-55, Washington, DC 20010, USA.
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