Transplanted artificial amnion membrane enhanced wound healing in third-degree burn injury diabetic mouse model

Introduction

Wound healing is severely compromised in patients with diabetes owing to factors such poor blood circulation, delayed immune response, elevated blood sugar levels, and neuropathy. Although the development of new wound healing products and prevention of serious complications such as infections in wounds have received substantial interest, wound healing remains a challenge in regenerative medicine. Burn wounds, especially third-degree burns, are difficult to treat because they are associated with immune and inflammatory reactions and distributive shock. Wound care and treatment that protects the burn site from infection and allows wound healing can be achieved with bioengineered wound dressings. However, few studies have reported effective dressings for third-degree burn wounds, making it important to develop new dressing materials.

Methods

In this study, we developed an artificial amniotic membrane (AM) using epithelial and mesenchymal cells derived from human amnion as a novel dressing material. The artificial AM was applied to the wound of a diabetic third-degree burn model and its wound healing ability was evaluated.

Results

This artificial amnion produced multiple growth factors associated with angiogenesis, fibroblast proliferation, and anti-inflammation. In addition, angiogenesis and granulation tissue formation were promoted in the artificial AM-treated mouse group compared with the control group. Furthermore, the inflammatory phase was prolonged in the control group.

Conclusions

Our preliminary results indicate that the artificial AM might be useful as a new dressing for refractory ulcers and third-degree burns. This artificial AM-based material represents great potential for downstream clinical research and treatment of diabetes patients with third-degree burns.

Burn Care at the National Orthopaedic Hospital, Enugu: A Comparison of Two 5-Year Periods: January 2012-December 2016 and January 2017-December 2021

Background and Objectives

The survival rate of patients with burn injuries has increased remarkably owing to the advancements in burn management which has resulted in improved survival rates, shorter hospital stays and decreases in morbidity and mortality rates due to the development of fluid resuscitation protocols, improved respiratory support, infection control etc. This study compares the parameters of burn patients admitted in a tertiary hospital from January 2012 to December 2016 and January 2017 to December 2021.

Materials and Methods

This study was at the National Orthopaedic Hospital Enugu, NOHE. It was a retrospective study of patients who presented with burn injuries to the burn unit between the period of January 2012 and December 2021.

Results

A total of 771 cases were analysed. Three hundred and twenty-three were seen between January 2012 to December 2016, 448 were seen between January 2017 and December 2021. Flame remained the major cause of burn injuries with 62% occurring in the first 5-year period while 72% occurred in the second 5 years. Adults had more injuries from flames than children, while children had more scald injuries than adults. The highest percentage of Total Burn Surface Area (TBSA) salvaged was 79% in the first 5-year period while 86% was salvaged in the second. Mortality rate in the first and second 5-year periods were 12% and 19%, respectively.

Conclusions

Flame burn injuries are the most common cause of burn injuries in adults and children. Mortality was lower in the first 5-year period. A higher TBSA was salvaged in the second 5-year period.

Burn contracture risk factors and measurement in low-middle income countries: A clinical perspective

We find a lack of high-quality published evidence on risk factors for burn contracture formation. The vast majority of research is from High Income Countries (HICs), where many potential risk factors are controlled for by standardised and high-quality healthcare systems. To augment the published literature, burn care professionals with Low Middle Income Countries (LMICs) experience were interviewed for their opinion on risk factors for burn contracture formation. Participants were also asked for their views on identification and measurement of contracture. Seventeen semi-structured interviews were conducted (13 burn surgeons and 4 therapists). The average length of experience in burn-care was 13 years. Participants represented Ghana, Ethiopia, Malawi, Nigeria, South Africa, Nepal, and India. Participants reported ninety risk factors. Risk factors were later collated according to topic: Non burn individual factors (n = 13), Burn injury factors (n = 14), Family and community factors (n = 9), Treatment factors (n = 18), Complications (n = 2), Healthcare capacity factors (n = 19) and Societal and environmental factors (n = 12). The top five most frequently cited risk factors were lack of splinting, lack of physiotherapy, lack of early excision and skin grafting, low socioeconomic status and presence of infection. Although participants had no doubts that they could recognise a contracture, none provided a standardised system of measurement or an operational definition of contracture. Burn care professionals have a wealth of experience and untapped knowledge of risk factors for burn contracture formation in their own population base, but many of the risk factors highlighted by participants have not yet been explored in the literature. Variations in clinicians' diagnosis and measurement of a burn contracture underscores the need for an agreed, standardised, simple and easily reproducible method of diagnosing and classifying burn contractures.

The gut microbiota regulates the depressive-type behaviors and inflammatory processes after severe burn injuries in mice

An emerging number of studies have recently revealed the correlation between burn injuries and psychological disorders. Gut microbiota and inflammatory factors may play a vital role in this process. Nevertheless, there are few studies conducted to disclose the potential mechanism of the gut microbiota between depression and burn injuries. In this study, we constructed a burn model of C57BL/6 mice, which showed that the symptom of depression became more and more severe with the burn of mice lasted longer. Meanwhile, there are significant differences of composition of gut microbiota among mice before and after burn. Then, we tested the inflammatory factors in the brain and peripheral blood, which showed an increased expression of Iba1, VWF, TNF-α and IL-6, and a decreased expression of IL-10 in burn mice. In addition, the expression of zonula occludens-1 (ZO-1) in cecum showed a down-regulation in burn mice, which indicated impaired intestinal barrier function. Lastly, the crossing fecal microbiota transplantation (FMT) and cohousing experiment were conducted to determine the functions of cross-transplantation of fecal microbiota on the depressive-type behaviours in burned mice. According to the score of Tail suspension test (TST), the burn mice were divided into two groups: Resilient mice (no-depressed mice) and Abnormal mice (depressed mice). After abnormal mice were transplanted with fecal microbiota of resilient mice, the symptom of depression was improved, and the expression of TNF-α, IL-6 and IL-10 return to normal levels (P < 0.05). On the contrary, after resilient mice were transplanted with fecal microbiota of abnormal mice both the TST scores and inflammatory factor developed depressive-type changes. In conclusion, our study demonstrated the changes of gut microbiota and inflammatory factors in depressed burn mice and non-depressed burn mice. The gut microbiota dysbiosis could impaired intestinal barrier function and lead to neuroinflammation, and this phenomenon could be significantly mitigated by FMT.

Pediatric Facial Soft Tissue Repair and Reconstruction

There are unique considerations for the management, repair, and reconstruction of pediatric facial soft tissue injuries. Conventional methods for the repair and reconstruction of facial soft tissue injuries can be successfully applied in children with considerations for anatomic and physiologic differences and the growth potential of a child. Attention to correct form, framework, and esthetics guides the proper reconstruction of individual regions on the face. Choice of approach ultimately depends on and the size, severity, location of injury, and surgeon's preferences.

Massive scar contractures in unique presentation: Case report

INTRODUCTION

Scar contractures are a common complication of burn injuries, especially in the head and neck region. This paper presents a case of a middle-aged female who suffered severe scar contracture after a burn injury during the war in Syria.

PRESENTATION OF CASE

A 33-year-old woman with a severe neck scar contracture resulting from a neglected burn injury presented to a plastic surgery department. The contractures extended to the chin, mandible, chest, and upper limbs. The patient underwent contracture release and reconstruction surgery, which involved the removal of the platysma and the placement of split-thickness skin grafts. The patient was discharged after one month of hospitalization. However, burn injuries require immediate and deliberate treatment, which may include reconstructive surgery.

DISCUSSION

Despite various efforts have been made to prevent the development of contractures, the contraction ratio of burn scars is still a badly controlled process, and reconstructive surgery is often indicated. There are many options to achieving the surgery, which vary in complexity. However, there is no preferable strategy and each option has advantages and disadvantages.

CONCLUSION

Reconstructive is complete and technically demanded surgery, which needs special centers and professionals, this leads to poor results, especially in development countries like Syria.

Enhanced skin burn assessment through transfer learning: a novel framework for human tissue analysis

Visual inspection is the typical way for evaluating burns, due to the rising occurrence of burns globally, visual inspection may not be sufficient to detect skin burns because the severity of burns can vary and some burns may not be immediately apparent to the naked eye. Burns can have catastrophic and incapacitating effects and if they are not treated on time can cause scarring, organ failure, and even death. Burns are a prominent cause of considerable morbidity, but for a variety of reasons, traditional clinical approaches may struggle to effectively predict the severity of burn wounds at an early stage. Since computer-aided diagnosis is growing in popularity, our proposed study tackles the gap in artificial intelligence research, where machine learning has received a lot of attention but transfer learning has received less attention. In this paper, we describe a method that makes use of transfer learning to improve the performance of ML models, showcasing its usefulness in diverse applications. The transfer learning approach estimates the severity of skin burn damage using the image data of skin burns and uses the results to improve future methods. The DL technique consists of a basic CNN and seven distinct transfer learning model types. The photos are separated into those displaying first, second, and third-degree burns as well as those showing healthy skin using a fully connected feed-forward neural network. The results demonstrate that the accuracy of 93.87% for the basic CNN model which is significantly lower, with the VGG-16 model achieving the greatest accuracy at 97.43% and being followed by the DenseNet121 model at 96.66%. The proposed approach based on CNN and transfer learning techniques are tested on datasets from Kaggle 2022 and Maharashtra Institute of Technology open-school medical repository datasets that are clubbed together. The suggested CNN-based approach can assist healthcare professionals in promptly and precisely assessing burn damage, resulting in appropriate therapies and greatly minimising the detrimental effects of burn injuries.

Thermal Injuries Occurring to the Foot: A Review

Thermal injuries are one of the most common injuries in both civilian and combat scenarios. The importance of clinical determination of burn and frostbite injuries and treatment involves understanding the pathophysiology and mechanisms of these injuries while continually reviewing literature and studying new treatment modalities. This present review examines the (1) epidemiology, (2) etiology, (3) pathophysiology and classification, and (4) treatment of thermal injuries occurring to the foot. In addition to the paucity of new literature and studies on thermal injury, this is the first review, to the best of our knowledge, to examine the management of thermal injuries occurring to the foot.

Quality of life in paediatric burn patients with non-severe burns

BACKGROUND

Burns are common worldwide, and the vast majority are non-severe burns of less than 20% of the total body surface area (TBSA). In Australia, paediatric burns account for a third of all burn admissions, thus understanding the quality-of-life outcomes after a non-severe burn in children is important.

METHODS

This retrospective cohort study describes a paediatric cohort from Western Australia with non-severe burns occurring between 2018 and 2020 and characterises the child's quality-of-life outcomes which is measured using the Paediatric quality of life survey (PedsQL). The PedsQL included a parent-report and child-report assessment, each with a physical function domain and a psychosocial function domain which comprised of an emotional, a social and a school category.

RESULTS

Data collected from 249 patients; 50.6% were male, 45.6% were toddlers. The most common cause was scald (48.19%), the majority had burns smaller than 5% TBSA (91.97%), and most included visible areas such as head, neck or hands (77.51%). The parent-report PedsQL scores were significantly different for both physical and psychosocial domains between the different age groups (p = 0.002, p = 0.001, respectively) and for burn cause (p = 0.004, p = 0.005, respectively). For child-reported scores we found evidence of an effect of burn cause across both domains that did not reach a statistical significance (p = 0.076, p = 0.078, respectively). The psychosocial functions in both the parent-report and the self-report were significantly different for the socioeconomic status groups (p = 0.015, p = 0.032, respectively). Quality of life scores were critically low in 16.46% of paediatric burn patients at three months after burn.

CONCLUSION

Parent-reported and child-reported psychosocial function was significantly poorer in higher socioeconomic groups, for older children and for those with flame burns. About 16% of patients had scores below the critical cut off. These data provide insight into the quality-of-life outcomes of paediatric patients with non-severe burns, allowing future studies to investigate burn prevention strategies and services to help paediatric burn patients in their recovery.

The epidemiology of in-hospital burn patients in a tertiary hospital in Damascus, Syria. A retrospective cohort study

BACKGROUND

Syria has been facing a dreadful crisis for the past 11 years, which has had a significant toll on the healthcare system of the country, and its ability to adequately manage acute injuries. In this research, we study the epidemiology and outcomes of burn patients admitted to the burn center of Al-Mouwasat Hospital in Damascus, Syria.

METHODS

A retrospective cohort research was conducted from January 2017 to December 2021. All accessible paper-based medical records of burn injury patients admitted to the hospital were evaluated. ABSI score was used to classify injury degrees. Chi-square test and logistic regression model were used to study the association between demographic variables and outcomes.

RESULTS

Of the 641 patients, 367 (57.3%) were males and 274 (42.7%) were females. Children represented more than half of our sample 377 (58.8%). The most common cause of burns was flame 393 (61.3%), followed by scalding 199 (31.0%). Most of the patients had a more than 10% TBSA of burns 511 (79.7%). 209 (32.6%) patients had a moderate ABSI score, followed by moderately severe in 149 (23.2%) patients. Children, patients who had high ABSI scores, and those who needed respiratory support were more likely to die than others 2.545 (1.079-6.004), 9.208 (4.061-20.879), respectively.

CONCLUSION

Death was the outcome of third of the hospitalized patients. Furthermore, Children made up more than half of the sample, and had the highest rates of leaving the hospital against medical advice. These results underline the importance of an updated nationally uniformed protocol for the management of burn patients.

The burden of disease of fatal and non-fatal burn injuries for the full spectrum of care in the Netherlands

BACKGROUND

A comprehensive overview of the burden of disease of burns for the full spectrum of care is not available. Therefore, we estimated the burden of disease of burns for the full spectrum in the Netherlands in 2018, and explored whether the burden of disease changed over the past 5 years (2014-2018).

METHODS

Data were collected at four levels: general practice, emergency department, hospital, and mortality data. For each level, years lived with disability (YLD), years of life lost (YLL), and disability-adjusted life-years (DALY) were estimated using a tailored methodology.

RESULTS

Burns resulted in a total of 9278 DALYs in the Netherlands in 2018, comprising of 7385 YLDs (80%) and 1892 YLLs (20%). Burn patients who visited the general practice contributed most DALYs (64%), followed by deceased burn patients (20%), burn patients admitted to hospital (14%) and those treated at the emergency department (2%). The burden of disease was comparable in both sexes (4734 DALYs (51%) for females; 4544 DALYs (49%) for males), though the distribution of DALYs by level of care varied; females contributed more DALYs at the general practice level, and males at all other levels of care. Among children boys 0-4 years had the highest burden of disease (784 DALYs (9%)), and among adults, females 18-34 years old (1319 DALYs (14.2%)) had the highest burden of disease. Between 2014 and 2018 there was a marginal increase of 0.8% in the number of DALYs.

CONCLUSIONS

Burns cause a substantial burden of disease, with burns requiring care at the general practice level contributing most DALYs. Information on burden of burns by the full level of care as well as by subgroup is important for the development of tailored burn prevention strategies, and the updated figures are recommended to be used for priority setting and resource allocation.

Outcome of burn injury and associated factor among patient visited at Addis Ababa burn, emergency and trauma hospital: a two years hospital-based cross-sectional study

BACKGROUND

Burn is one of the critical health problems worldwide. Developing countries with sub-Saharan and Asian populations are affected more. Its mortality and non-fatal complications depend on several factors including age, sex, residency, cause, the extent of the burn, and time and level of care given.

OBJECTIVE

The purpose of this study was to assess the outcome of burn injury and its associated factor among patients who visited Addis Ababa burn emergency and trauma hospital.

METHODS

The institutional-based, retrospective cross-sectional study design was conducted from April 1, 2019, to March 30, 2021. After checking the data for its consistency the data were entered and analyzed by using SPSS version 25. A total of 241 patients who had visited Addis Ababa burn, emergency and trauma Hospitals after sustained burn injury were recruited through convenience sampling method for final analysis. Model goodness-of-fit was checked by Hosmer and Lemeshow test (0.272). After checking multi-collinearity both the bi-variable and multivariable logistic regression model was fitted and variables having a p-value less than or equal to 0.05 at 95% CI in the multivariable analysis were considered statistically significant.

RESULT

Adults (age 15 to 60 years) are the most affected groups accounting for 55.2% followed by pediatric age groups (age <15 years) (43.6%) and the elderly (age > 60 years) (1.2%). Scald burn was the major cause accounting for 39 % followed by Flame burn (33.6%), Electrical burn (26.6%), and chemical burn (0.8%). The mean TBSA% was 15.49%, ranging from1% to 64%. Adult males are more affected by electrical burns while adult females and the elderly encounter flame burn. 78.4% of patients were discharged without complications, 14.9% were discharged with complications and 6.6% died. The commonest long-term complication is the amputation of the extremity (19, 7.9%). Age greater than 60 years and TBSA% greater than 30% is a strong predictors of mortality with odds of 2.2 at 95% CI of [1.32, 3.69] and 8.7 at 95% CI of [1.33, 57.32] respectively.

CONCLUSION AND RECOMMENDATION

The mortality rate show decrement from previous studies. Overall scald burn is common in all age groups but electrical burns and flame burns affected more adult and elderly age groups. Extremities were by far, the commonest affected body parts. The extent of burn injury and the age of the patient independently predict mortality. Early intervention will reduce mortality and complications.

Assault burn injuries in adolescents and adults in South Africa: risk factors and characteristics

Assault burns comprise a significant subset of burns, with a greater risk of severe injuries. This South African study used a national dataset from major hospitals to identify risks and injury characteristics of assault burns. The analysis sample comprised 2658 adolescent and adult cases and employed logistic regression with bootstrapping to examine the risk of assault compared to unintentional burns. The study indicates that 17.4% of burns were due to assault. Males were 1.5 times more likely than females to be burn assault victims. Compared to adults 55 years and older, young adults 22-39 years were at greatest risk, followed by youth 13-21 years. Assault injuries were five times more likely due to chemical attacks and three times more likely to scalds than to flame burns. The head, neck and trunk were most affected. Where alcohol was indicated, assault burns were five times more likely than unintentional burns. The findings may indicate the need for targeted prevention strategies such as conflict resolution, alcohol use management and the control of corrosive chemicals.

An empirical investigation of firefighting personal protective equipment and burn injuries in Korea

This study aimed to investigate the current situation of firefighting burn injuries and personal protective equipment (PPE) in Korea using a questionnaire. A questionnaire was constructed and then distributed to fire stations via the Fire & Disaster Headquarters of Korea. Responses from a total of 536 firefighters who were currently responsible for suppressing fire or doing rescue work were analysed (39.2 ± 8.58 y in age, 173.8 ± 5.0 cm in height, 73.4 ± 8.9 kg in body weight). The results showed that 22% of firefighters had experienced burns but of these 93% of were burns of less than 1% of total body surface area. The most common body site of burn injury was the hands (37%) and the head (face and neck) (34%). There were significant relationships between PPE non-compliance and career years, especially for the hood and boots. According to firefighters their gloves were the most vulnerable part of their PPE. We also elucidated relationships between the body sites most vulnerable to burn injuries and PPE wear compliance by item. The present results suggest that officially-undisclosed minor burn injuries but prevailing among firefighters can be reduced through improving firefighters' protective helmet, hoods and gloves.

Magnitude of mortality and its associated factors among Burn victim children admitted to South Gondar zone government hospitals, Ethiopia, from 2015 to 2019

BACKGROUND

Burn is one of the leading causes of preventable death and disability every year in low and middle-income countries, which mainly affects those aged less than 15 years. Death from burn injuries carries the most significant losses, which often have grave consequences for the countries. Even though data from different settings are necessary to tackle it, pieces of evidence in this area are limited. Thus, this study was aimed to answer the question, what is the Magnitude of Mortality? And what are the factors associated with mortality among burn victim children admitted to South Gondar Zone Government Hospitals, Ethiopia, from 2015 to 2019?

METHODS

Institutional-based cross-sectional study design was used to study 348 hospitalized burn victim pediatrics', from 2015 to 2019. A simple random sampling method was used. Data were exported from Epidata to SPSS version 23 for analysis. Significant of the variables were declared when a p-value is < 0.05.

RESULT

The mortality rate of burn victim children in this study was 8.5% (95% CI = 5.5-11.4). Medical insurance none users burn victim children were more likely (AOR 3.700; 95% CI =1.2-11.5) to die as compared with medical insurance users, burn victim children with malnutrition were more risk (AOR 3.9; 95% CI = 1.3-12.2) of mortality as compared with well-nourished child. Moreover, electrical (AOR 7.7; 95% CI = 1.8-32.5.2) and flame burn (AOR 3.3; 95% CI = 1.2-9.0), total body surface area greater than 20% of burn were more likely (AOR 4.6; 95% CI 1.8-11.8) to die compared to less than 20% burn area and burn victim children admitted with poor clinical condition at admission were four times (AOR 4.1, 95% CI = 1.3-12.0) of mortality compared to a good clinical condition.

CONCLUSION

The mortality among burn victim children was higher than most of the studies conducted all over the world. Medical insurance none users, being malnourished, burned by electrical and flame burn, having total body surface area burnt greater than 20%, and having poor clinical condition at addition were significantly associated with mortality of burn victim pediatrics. Therefore, timely identification and monitoring of burn injury should be necessary to prevent mortality of burn victim pediatrics.

Most prominent factors contributing to burn injury-related amputations: an analysis of a referral Burn Center

Amputations are un-common surgical procedures in patients with severe burn injuries. However, these patients often face extreme physical and psychological challenges that result in social stigmatization and inadequate rehabilitation facilities. A retrospective cohort study was designed for the patients admitted to the Burn Center of Adana City Training and Research Hospital (ACTRH). During the study period, a total of 2007 patients aged 0.5 to 92 years were hospitalized and treated at the burn center from January 2016 to June 2020. The incidence of amputation observed among inpatient burn injuries regardless of the etiology was 1.9%, and 87.2% were male. The univariate and multivariate logistic regression analysis was performed to detect the most prominent factors contributing to burn injury-related amputations. The cause of burns appears to be one of the main factors in the past research, and in this context, the electrical burns stand out, likewise, the fire-flame-related burns, full-thickness burns, the existence of infection, male gender, patients aged within the 18 to 64 age group, and the burn extent within the total body surface area (TBSA) range of 10 to <50% were found to be the most leading factors of amputations among patients having severe burns. Although they are rare, amputations related to burns commonly cause a decrease in quality of life. Therefore, besides increasing occupational health and safety methods for these risk groups, especially for adults of working age; also, it is essential to increase the importance and awareness of the precautions to be taken in daily life.

Designing effective virtual reality environments for pain management in burn-injured patients

Burn patients engage in repetitive painful therapeutic treatments, such as wound debridement, dressing changes, and other medical processes high in procedural pain. Pharmacological analgesics have been used for managing pain, but with ineffective results and negative side effects. Studies on pain management for burn patients suggested that Virtual Reality can treat procedural pain. This paper describes the process of designing, testing, and deploying a Virtual Reality system into a hospital setting. Firstly, a workshop was conducted to identify the most suitable types of Virtual Reality contents for the needs of burn-injured patients. Then, an experimental study, with 15 healthy adults, explored the analgesic impact of the Virtual Reality contents. The pain was induced through a cold pressor. Finally, we deployed the Virtual Reality system into the hospital to examine its efficiency on burn-injured inpatients. This study presents factors for the effective design and deployment of Virtual Reality for burn-injured patients residing in a hospital. Those factors refer to the use of cartoonish features and a choice of content based on each patient's interests to increase the positive emotions and the use of interactive features, portable equipment to reduce pain and increase the feasibility of the technology in clinical settings. Finally, our results indicated that the extension of the VR use after the therapeutic session could support more effective pain treatment. Trial registration number Protocol ID: AA8434.

Activity impairment, work status, and work productivity loss in adults 5-7 years after burn injuries

An important aspect of the rehabilitation of burn patients is social participation, including daily activities and work. Detailed information on long-term activity impairment and employment is scarce. Therefore, we investigated activity impairment, work status, and work productivity loss in adults 5–7 years following burn injuries, and investigated associations with burn-specific health-related quality of life (HRQL) domains. Adult participants completed the Work Productivity and Activity Impairment General Health questionnaire and the Burn Specific Health Scale-brief (BSHS-B) 5–7 years post-burn. Outcomes were compared between participants with mild/intermediate and severe burns (>20% total body surface area burned). Seventy-six (36%) of the 213 participants experienced some degree of activity impairment due to burn-related problems 5–7 years post-burn. Seventy percent of the population was employed; 12% of them experienced work productivity loss due to burn-related problems. Nineteen percent reported changes in their work situation (partly) because of the burn injury. A higher proportion of participants with severe burns had activity impairments (56% vs 29%; P = .001) and work productivity loss (26% vs 8%; P < .001) compared to participants with mild/intermediate burns. Activity impairment and work productivity loss were both associated with burn-related work problems and lower mood, measured with the BSHS-B. In conclusion, a substantial part of the study population experienced activity impairment and work productivity loss, was unemployed, and/or reported changes in their work situation due to their injury. Particularly patients with severe burns reported productivity loss and had lower employment rates. This subscribes the importance of addressing work-related functioning in the rehabilitation of burn patients.

Reliability and structural validity of the Dutch version of Perceived Stigmatization Questionnaire in adults with burns

OBJECTIVE

Burn scars can attract attention from others which can be perceived as stigmatizing behavior with negative psychological consequences. The Perceived Stigmatization Questionnaire (PSQ) is a validated instrument measuring the perception of stigmatization in burn survivors. The objective of this study was to examine the psychometric properties of the Dutch version of the PSQ, specifically its factor structure, reliability, and associations with other relevant constructs.

METHOD

Patients (N = 220) completed the PSQ at 3 months after burn. The factor structure was examined with explorative (EFA) and confirmatory (CFA) factor analyses at 3 and 12 months after burn, and reliability was examined using Cronbach's alpha. Three months measurements were used to examine associations of the PSQ with 'depressive mood' (Beck Depression Inventory, BDI-II), 'interpersonal relations' and 'body image' (Burn Specific Health Scale-Brief, BSHS-B), and two scales of the Illness Invalidation Inventory (3*I).

RESULTS

A four factor model showed the best fit to the data. Two factors, 'confused/staring behavior' and 'hostile behavior', were identical to the original PSQ. The third original factor, 'absence of friendly behavior', was now divided into two factors separating absence of friendly behavior of strangers and other people. Internal consistency ranged from .60 to .88. Especially the 'confused/staring behavior' factor was related to the other questionnaire scores.

CONCLUSION

The current study shows acceptable reliability and structural validity of the Dutch version of the PSQ in a 4-factor solution. Further research into measurement invariance across languages is recommended to establish a uniform multicultural instrument.

The added value of extending the EQ-5D-5L with an itching item for the assessment of health-related quality of life of burn patients: an explorative study

INTRODUCTION

Health-related quality of life (HRQL) is an important outcome in burn care and research. An advantage of a generic HRQL instrument, like the EQ-5D, is that it enables comparison of outcomes with other conditions and the general population. However, the downside is that it does not include burn specific domains, like scar issues or itching. Adding extra items to a generic instrument might overcome this issue. This study explored the potential and added value of extending the EQ-5D-5L with a burn-specific item, using a itching item as an example.

METHODS

The EQ-5D-5L and the Patient and Observer Scar Assessment Scale (POSAS) was completed by adult patients 5-7 years after injury. A separate POSAS itching item was used to study the added value of an itching item for the EQ-5D-5L. The EQ-5D-5L + Itching was created by adding the POSAS itching item to the EQ-5D-5L. Five psychometric properties were compared between EQ-5D-5L and EQ-5D-5L + Itching: distribution (e.g. ceiling), informativity cf. Shannon's indices, convergent validity, dimension dependency, and explanatory power respectively.

RESULTS

A total of 243 patients were included, of whom 49% reported any itching on the POSAS. Adding an itching item to the EQ-5D-5L decreased the ceiling effect, and resulted in increased absolute informativity (H' = 4.76 vs. H' = 3.64) and relative informativity (J' = 0.34 vs. J' = 0.31). The extra itching item decreased the convergent validity (Spearman's rank correlation coefficient = -0.51 vs. -0.59). Mutual dependency of dimensions existed, showing that all other items were dominant over the itching item. Adding the itching item to the standard EQ-5D-5L barely improved explanatory power (49.3% vs. 49.0%).

CONCLUSIONS

PThe present study showed adding a burn-specific item to the EQ-5D-5L is possible and has potential. However, 5 to 7 years after injury, adding an itching item to the EQ-5D-5L provides little additional information; the gain in terms of added value is relatively small. Apart from instances where itching information is specifically needed, a strong case is not present for adding an itching item to the EQ-5D-5L for long-term (>5 yr after burns) HRQL assessment in burn patients. In early time periods after burn, the added value might be greater and we recommend exploring this potential in future studies, ideally on multiple timepoints after burn.

The Japanese Experience with Basic Fibroblast Growth Factor in Cutaneous Wound Management and Scar Prevention: A Systematic Review of Clinical and Biological Aspects

INTRODUCTION

Basic fibroblast growth factor (bFGF) plays several key roles in wound healing. Over the last 2 decades, clinical and basic research on bFGF has been actively conducted in Japan with reports on its potent efficacy in accelerating the healing of chronic ulcers and burn wounds by stimulating key cellular players in the skin. However, its efficacy remains unrecognized internationally. Thus, this study reviews current knowledge about the therapeutic value of bFGF in wound management and scar prevention accumulated in Japan over the last 2 decades.

METHODS

We review the Japanese literature that demonstrates the anti-scarring effects of bFGF and exhaustively assess how these effects are exerted. Using the search terms "bFGF OR growth factors AND wound healing in Japan" and "bFGF AND scar prevention in Japan," we conducted a search of the PubMed database for publications on the role of bFGF in wound and scar management in Japan. All eligible papers published between 1988 and December 2019 were retrieved and reviewed.

RESULTS

Our search yielded 208 articles; 82 were related to the application of bFGF for dermal wound healing in Japan. Of these, 27 fulfilled all inclusion criteria; 11 were laboratory studies, 7 were case reports, 4 were clinical studies, and 5 were randomized controlled trials.

CONCLUSION

Further research, with recognition of the therapeutic value of bFGF in wound and scar management and its clinical applications, is needed to provide additional clinical advantages while improving wound healing and reducing the risk of post-surgical scar formation.

Comparison of three different methods to estimate the burden of disease of burn injuries in Western Australia in 2011-2018

BACKGROUND

Priority setting and resource allocation in health care, surveillance and interventions is based increasingly on burden of disease. Several methods exist to calculate the non-fatal burden of disease of burns expressed in years lived with disability (YLDs). The aim of this study was to assess the burden of disease due to burns in Western Australia 2011-2018 and compare YLD outcomes between three existing methods.

METHODS

Data from the Burns Service of Western Australia was used. Three existing methods to assess YLDs were compared: the Global Burden of Disease (GBD) method, a method dedicated to assess injury YLDs (Injury-VIBES), and a method dedicated to assess burns YLDs (INTEGRIS-burns).

RESULTS

Incidence data from 2,866 burn patients were used. Non-fatal burden of disease estimates differed substantially between the different methods. Estimates for 2011-2018 ranged between 610 and 1,085 YLDs per 100.000 based on the Injury-VIBES method; between 209 and 324 YLDs based on the INTEGRIS-burns method; and between 89 and 120 YLDs based on the GBD method. YLDs per case were three to nine times higher when the Injury-VIBES method was applied compared to the other methods. Also trends in time differed widely through application of the different methods. There was a strong increase in YLDs over the years when the Injury-VIBES method was applied, a slight increase when the INTEGRIS-burns method was applied and a stable pattern when the GBD method was applied.

CONCLUSION

This study showed that the choice for a specific method heavily influences the non-fatal burden of disease expressed in YLDs, both in terms of annual estimates as well as in trends over time. By addressing the methodological limitations evident in previously published calculations of the non-fatal burden of disease, the INTEGRIS-burns seems to present a method to provide the most robust estimates to date, as it is the only method adapted to the nature of burn injuries and their recovery.

Predictors of generic and burn-specific quality of life among adult burn patients admitted to a Lebanese burn care center: a cross-sectional single-center study

Burn injuries carry significant implications on short- and long-term quality of health. The present study undertook the first attempt to characterize generic and burn-specific quality of life and their predictors among adult burn patients admitted to a Lebanese burn care center. 130 adult patients admitted to the Lebanese Geitaoui Hospital burn center between 2013 and 2019 willingly answered Arabic versions of RAND's 36-Item Short Form Survey (SF-36), and the Burn-Specific Health Scale-Brief (BSHS-B). Results showed that burn patients continue to exhibit impairments on various generic and burn-specific quality of life subdomains. Education, pain and total body surface area (TBSA) burned were consistently and significantly correlated with both BSHS-B and SF-36 component scores, while inhalation injury exhibited an association with total BSHS-B score. Education and pain emerged as independent predictors of SF-36 components as well as total BSHS-B score. The latter was additionally associated with BMI and burn degree, while TBSA burned negatively correlated with SF-36 physical component scores. Correlates of impaired quality of life among Lebanese adult burn patients should therefore be taken into account and existing burn management practices and rehabilitation programs should be revised accordingly in order to ensure optimal long-term patient outcomes.

Improved and standardized method for assessing years lived with disability after burns and its application to estimate the non-fatal burden of disease of burn injuries in Australia, New Zealand and the Netherlands

Background

Burden of disease estimates are an important resource in public health. Currently, robust estimates are not available for the burn population. Our objectives are to adapt a refined methodology (INTEGRIS method) to burns and to apply this new INTEGRIS-burns method to estimate, and compare, the burden of disease of burn injuries in Australia, New Zealand and the Netherlands.

Methods

Existing European and Western-Australian health-related quality of life (HRQL) datasets were combined to derive disability weights for three homogenous burn injury groups based on percentage total body surface area (%TBSA) burned. Subsequently, incidence data from Australia, New Zealand, and the Netherlands from 2010 to 2017 were used to compute annual non-fatal burden of disease estimates for each of these three countries. Non-fatal burden of disease was measured by years lived with disability (YLD).

Results

The combined dataset included 7159 HRQL (EQ-5D-3 L) outcomes from 3401 patients. Disability weights ranged from 0.046 (subgroup < 5% TBSA burned > 24 months post-burn) to 0.497 (subgroup > 20% TBSA burned 0–1 months post-burn). In 2017 the non-fatal burden of disease of burns for the three countries (YLDs/100,000 inhabitants) was 281 for Australia, 279 for New Zealand and 133 for the Netherlands.

Conclusions

This project established a method for more precise estimates of the YLDs of burns, as it is the only method adapted to the nature of burn injuries and their recovery. Compared to previous used methods, the INTEGRIS-burns method includes improved disability weights based on severity categorization of burn patients; a better substantiated proportion of patients with lifelong disability based; and, the application of burn specific recovery timeframes. Information derived from the adapted method can be used as input for health decision making at both the national and international level. Future studies should investigate whether the application is valid in low- and middle- income countries.

Evaluation of an International Classification of Functioning, Disability and Health-based rehabilitation for thermal burn injuries: a prospective non-randomized design

Background

Severe burn injuries result in relevant restrictions of physical capacity as well as psychological and social integrity and require a specialized rehabilitation. There is a common agreement, among national as well as international burn associations, that burn rehabilitation is a complex, dynamic process which needs an interdisciplinary and specialized treatment team. There is wide agreement that more research is needed in this field.

Methods/design

The aim of the study is to examine the effectiveness and efficiency of our new ICF (International Classification of Functioning, Disability and Health)-based rehabilitation for thermal injuries. Because of ethical reasons, we have chosen a prospective non-randomized design, which takes place at two different rehabilitation centers. At center A, a newly developed ICF-based rehabilitation program was established; at rehabilitation center B, a well-established rehabilitation program has existed for 20 years and is used as reference. The primary research question addresses the “Pre-post comparison of the physical and psychological outcome measurements,” secondary question I looks at the “Examination of the non-inferiority of the new treatment concept with the established concept,” and secondary question II is the “Analysis of the rehabilitation process based on the rehabilitation cycle.”

Only patients of the two burn rehabilitation centers who are insured by workers’ compensation will be asked to participate in this study to avoid outcome bias by insurance status. A physical examination (physical working capacity testing, grip strength, range of motion, and scar evaluation by Cutometer and Vancouver Scar Scale) and a standardized questionnaire battery (Burn Specific Health Scale-Brief , Short Form 36, Impact of Event Scale-Revised, the German version of the Symptom Checklist, the Freiburg Social Support Questionnaire, Patient/Client Satisfaction Questionnaire, Disabilities of the Arm, Shoulder and Hand, and Lower Extremity Functional Scale ) measure physical and psychological conditions. Data will be taken on admission, during stay, and on discharge of the rehabilitation program and at follow-up 3 and 12 months after discharge. A minimum of 162 participants will be enrolled in this clinical longitudinal, prospective, observational study.

Discussion

The proof of the effectiveness of the ICF-based rehabilitation program for thermal injuries will give evidence in a comprehensive way for the first time in this field. As result, a standardized rehabilitation concept will be introduced, which can be provided to other rehabilitation institutions treating thermal injuries.

Trial registration

German Clinical Trials Register, DRKS00017702. Registered on 2 September 2019.

The role of concomitant alcohol and drug use in increased risk for burn mortality outcomes

BACKGROUND

Burn injuries are a major cause of mortality and morbidity in low- and middle-income countries, with high rates in Sub-Saharan Africa. The risks may be heightened for persons who present with concomitant use of alcohol and illicit substances, which increase the risk for injury and severely compromise prognosis following injury.

METHODS

This study utilised a national dataset on hospitalised burns in South Africa to explore the risk for mortality relative to morbidity. To assess the influence of alcohol and drugs in mortality outcomes, the analysis was restricted to adult cases, 18 years and older (N = 918). The primary statistical procedures used in the analysis were logistic regression models.

FINDINGS

The results indicate that burn victims with full thickness and partial thickness burn degree and more than 30% TBSA had a significantly increased risk of mortality. In addition, the risk for mortality was increased ten times when concomitant alcohol and drugs were indicated compared to cases where these were absent. The length of stay in hospital diminished the risk for mortality by about 10%.

INTERPRETATION

The findings may be explained by the role of skin as the main barrier against infections and the concurrent increase in risk of infection based on the degree and extent of any damage. The combined presence of both alcohol and drugs may predispose towards more severe burns and greatly compromise liver function with heightened risk for sepsis and death.

Applying quality improvement methods to neglected conditions: development of the South Asia Burn Registry (SABR)

OBJECTIVE

South Asia has the highest mortality rate from burns in the world. Application of quality improvement methods to burn care can help identify health system gaps. Our overall aim is to introduce a sustainable hospital-based burn registry for resource-constrained settings to assess health outcomes of burn injury patients presenting to dedicated burn injury centers in South Asia.

RESULTS

The South Asia Burn Registry (SABR) is implemented through collaborative approach in selected burn centers in Bangladesh and Pakistan. Th registry collects data on burn injury events, the care provided, and the functional status of patients at discharge from burn centers. It covers the entire spectrum of care provision for burn injury patients from the actual event through their discharge from the healthcare system. SABR investigates locally relevant contextual factors associated with burn injury and health-system requirements for burn patients receiving emergency and inpatient care in resource-constrained settings. It also explores factors associated with burn injury and care provision. SABR will inform better prevention and management efforts in South Asia and help to address healthcare needs of burn injury patients.

Epidemiological characteristics of burn injuries in Iraq: A burn hospital-based study

This study was conducted to determine the epidemiological and clinical characteristics of burn injuries, estimate the case fatality rate for burn patients, and determine the main determinants of the associated death among burn patients who were admitted to Baghdad Burn Hospital, Medical City Teaching Hospitals, Baghdad, Iraq during 2015. This study involved a retrospective review of medical records of all burn patients who were admitted to Baghdad Burn Hospital in 2015. Data were collected using a special form and included information on demographic characteristics and burn characteristics and outcomes. A total of 676 patients with burn were included in this study, who constituted 75% of admitted patients. The remaining was admitted for treatment of old scars. About one third of patients (37.0%) aged 21-30 years, 67.1% were males, 34.8% were military personnel, and 60.7% of the patients had primary school education. About 71.6% of patients were burned by flame and 23.4% were burned by hot fluid. Half of patients had a second degree burns. Almost half of patients had 11-20% of their body surface area affected. About 13% of patients died, mainly due to multiple organs failure (53.3%), septicemia (44.4%), and shock (2.2%). In conclusion, young adults and children, males, and low educated patients represent the majority of admitted burn cases in Iraq. Flame and scalds were the most important causes of burn. More than one tenth of patients died mostly due to septicemia and multi-organ failure.

Resiliency in burn recovery: a qualitative analysis

This phenomenological study engaged an availability sample of eight, long-term, adult burn survivors living a primarily rural burn center catchment area of the U.S. in face-to-face interviews focused on their holistic health since their burn injuries occurred. Criteria for the primary study involved females (n = 1) and males (n = 7) with an age range of 18 to 65 years and a minimum of 20% total body surface area (TBSA) injuries that required hospitalization in a specialized burn center. The mean age of participants at the time of interviews was 54.38 years. Burns ranged between 20% and 98% TBSA and one to 22 years since burn injuries occurred. Thematic data analysis revealed resilient protective factors as contributing to participants' post-burn health and recoveries. Resilient factors included resourcefulness, achievement motivation, optimism, spirituality, and empathy. Increased understanding of resilient protective factors and how they impacted long-term burn recovery in this sample may aid social workers in development and implementation community-based interventions in rural communities that promote resilience, health/mental health and long-term recovery for this population and others who have experienced trauma.

Epidemiology of burn at a military hospital in Bahrain: initial experience of patient outcomes and quality indicators

Burn injuries are one of the most common causes of morbidity and mortality in the world. We undertook a retrospective study to analyze the epidemiology and etiology of burn injuries at the burn unit of Bahrain Defence Force-Royal Medical Services from 2015 to 2016. The epidemiological and medical information were retrieved from the burn unit's (burn ward and burn intensive care unit (BICU)) medical records. The data were analyzed in Microsoft Excel. We observed that civilians were most affected by burn injuries and men were more affected than women. The age group of the maximally burnt patients differed between the burn ward and BICU. The age group of 21-30 years and 51-60 years were maximally affected by burn injuries among patients admitted in the BICU, whereas the 1-10 years age group dominated cases in the burn ward. Flame and scald burns contributed maximally to the burn cases in both years. TBSA 0-10% was the most commonly observed burn size. The length of hospital stay decreased from 2015 to 2016, possibly because of improvements in medical infrastructure and nursing care and opening of a burn dressing room. Wound dressing, surgical debridement and skin grafting of wounds were the predominant modes of treatment. Our results show that burn injuries remain an important public health issue and increase in public awareness about burn prevention and first aid should be emphasized for reducing the frequency of burn-associated mortalities.

Predictors of health-related quality of life after burn injuries: a systematic review

Background

Identifying predictors of health-related quality of life (HRQL) following burns is essential for optimization of rehabilitation for burn survivors. This study aimed to systematically review predictors of HRQL in burn patients.

Methods

Medline, Embase, Web of Science, Cochrane, CINAHL, and Google Scholar were reviewed from inception to October 2016 for studies that investigated at least one predictor of HRQL after burns. The Quality in Prognostic Studies tool was used to assess risk of bias of included studies.

Results

Thirty-two studies were included. Severity of burns, postburn depression, post-traumatic stress symptoms, avoidance coping, less emotional or social support, higher levels of neuroticism, and unemployment postburn were found to predict a poorer HRQL after burns in multivariable analyses. In addition, weaker predictors included female gender, pain, and a postburn substance use disorder. Risk of bias was generally low in outcome measurement and high in study attrition and study confounding.

Conclusions

HRQL after burns is affected by the severity of burns and the psychological response to the trauma. Both constructs provide unique information and knowledge that are necessary for optimized rehabilitation. Therefore, both physical and psychological problems require attention months to years after the burn trauma.

Electronic supplementary material

The online version of this article (10.1186/s13054-018-2071-4) contains supplementary material, which is available to authorized users.

Cell therapy for severe burn wound healing

Cell therapy has emerged as an important component of life-saving procedures in treating burns. Over past decades, advances in stem cells and regenerative medicine have offered exciting opportunities of developing cell-based alternatives and demonstrated the potential and feasibility of various stem cells for burn wound healing. However, there are still scientific and technical issues that should be resolved to facilitate the full potential of the cellular devices. More evidence from large, randomly controlled trials is also needed to understand the clinical impact of cell therapy in burns. This article aims to provide an up-to-date review of the research development and clinical applications of cell therapies in burn wound healing and skin regeneration.

Effect of aquatic versus land based exercise programs on physical performance in severely burned patients: a randomized controlled trial

[Purpose] To compare the effect of an aquatic-based versus a land-based exercise regimen on the physical performance of severely burned patients. [Subjects and Methods] Forty patients suffering from severe burn (total body surface area more than 30%) were recruited from several outpatient clinics in Greater Cairo. Their ages ranged between 20 to 40 years and were randomly assigned into two equal groups: group (A), which received an aquatic based exercise program, and group (B), which received a land-based exercise program. The exercise program, which took place in 12 consecutive weeks, consisted of flexibility, endurance, and lower and upper body training. Physical performance was assessed using 30 seconds chair stand test, stair climb test, 30 meter fast paced walk test, time up and go test, 6-minute walk test and a VO2max evaluation. [Results] Significantly increase in the 30 second chair stand, 6-minute walk, 30 meter fast paced walk, stair climb, and VO2 max tests and significantly decrease in the time up and go test in group A (aquatic based exercise) compared with group B (a land-based exercise) at the post treatment. [Conclusion] Twelve-week program of an aquatic program yields improvement in both physical performance and VO2 max in patients with severe burns.

Pediatric burns in Israeli natives versus asylum seekers living in Israel: Lessons learned

BACKGROUND

Burn injuries are one of the leading causes of morbidity and mortality in the pediatric population. In early childhood, burns have a wide range of adverse long-term consequences ranging from functional impairment to psychological implications. Children from low-income and middle-income countries are at a higher risk of suffering from burn injuries. In the last 10 years the population of asylum seekers from low-income countries in Israel has increased dramatically. About 25,000 or 60% of asylum seekers are living in the Tel Aviv area, making up roughly 6% of the city's total population (about 405,000).

AIM

A retrospective study aimed to profile the pediatric burn injuries treated at the Tel Aviv Sourasky Medical Center over the last 9 years in an effort to examine the distinct characteristics of African asylum seekers who suffer burn injuries in comparison with Israeli nationals.

PATIENTS & METHODS

Medical records of 876 patients under the age of 18 years presenting between 2007-2015 were retrospectively reviewed. The parameters collected included gender, causality, total body surface area (TBSA), burn depth and patient outcome.

CONCLUSIONS

There was no significant difference regarding: age; male-female ratio; scald-types burns; limb involvement. However, hospitalization and length of hospital stay were significantly higher among asylum seekers, as was family burden. Questions may be raised regarding prevention, education & social support. Our research provides a small glimpse into the world of asylum seekers in Israel. We hope it will serve as a window into the much grander problems that this population faces on a daily basis.

Detection of Pseudomonas aeruginosa biomarkers from thermally injured mice in situ using imaging mass spectrometry

Monitoring patients with burn wounds for infection is standard practice because failure to rapidly and specifically identify a pathogen can result in poor clinical outcomes, including death. Therefore, a method that facilitates detection and identification of pathogens in situ within minutes of biopsy would be a significant benefit to clinicians. Mass spectrometry is rapidly becoming a standard tool in clinical settings, capable of identifying specific pathogens from complex samples. Imaging mass spectrometry (IMS) expands the information content by enabling spatial resolution of biomarkers in tissue samples as in histology, without the need for specific stains/antibodies. Herein, a murine model of thermal injury was used to study infection of burn tissue by Pseudomonas aeruginosa. This is the first use of IMS to detect P. aeruginosa infection in situ from thermally injured tissue. Multiple molecular features could be spatially resolved to infected or uninfected tissue. This demonstrates the potential use of IMS in a clinical setting to aid doctors in identifying both presence and species of pathogens in tissue.

Burns in South Korea: An analysis of nationwide data from the Health Insurance Review and Assessment Service

INTRODUCTION

The purpose of the study was to identify and describe the incidence of burn injuries in patients seen and treated in South Korea. Characteristics of inpatients and outpatients with burns were analyzed according to gender, age, burn site, and burn severity.

METHODS

This retrospective study examined the characteristics of a stratified sample of burn patients seen and treated in South Korea during the calendar year 2011. The sample was drawn from the national patient database Health Insurance Review and Assessment (HIRA).

RESULTS

Approximately 1.71% of the total patients in the Patient Sample of HIRA for 2011 were burn-injured patients. The numbers of patients treated for burns were 913/10(5) males (n=8009) and 1454/10(5) females (n=11,881). Nearly all of these patients (94.1%) were covered by national health insurance and the majority of these patients (80.6%) were treated as outpatients. Nearly half of the burn injuries were of the upper extremities (43.5%), and most of these injuries (71.5%) were rated as second-degree burns.

CONCLUSION

A review of the national data on patients seen and treated for burns in 2011 revealed that people in South Korea may experience higher numbers and more severe cases of burns and burn-related injuries than found in other countries. General burn prevention programs as well as gender- and age-specific prevention strategies are needed to reduce the risk of burns in this population.

Biobrane™ and skin staples: beware of necrotic ulceration

Biobrane™ is a product used for temporary wound coverage post major paediatric burn wound debridement. We report two cases of necrotic ulceration associated with the use of Biobrane™ with skin staples. We suggest securing Biobrane™ with alternatives such as adhesive tapes and glue to prevent the occurrence of this adverse outcome.

Which factors influence the development of post-traumatic stress disorder in patients with burn injuries? A systematic review of the literature

INTRODUCTION

This article aims to discover which variables influence the development of post-traumatic stress disorder in patients with burn injuries. It will also consider whether it is possible to predict which burns patients will develop PTSD.

BACKGROUND

Post-traumatic stress disorder is an important psychopathology for burned patients as it can affect both physical outcomes and quality of life for those affected. Research states that PTSD may be identified in up to 30% of burns patients, making it relatively common.

METHODS

A systematic review of the literature was carried out using four databases. Eleven articles were identified from these searches, and were then analysed thematically to draw out common ideas.

RESULTS

Gender, extraversion and neuroticism, attribution of blame, capacity for forgiveness, the event as a disaster or non-disaster, alcohol consumption and peri-traumatic emotional response were all found to influence burns patients' risk of developing PTSD.

CONCLUSION

While it is possible to identify the factors that put burns patients are greater risk of developing PTSD, it is not possible to accurately predict who will go on to develop PTSD due to the interplay between variables and individual differences. Focus should instead be on screening for PTSD and timely recognition of intrusive symptoms.

Honey: A Skin Graft Fixator Convenient for Both Patient and Surgeon

Skin grafts can be used effectively to cover burn injuries. A critical element of this treatment is the adherence of the graft to the wound bed. Honey has been shown to increase the adherence of skin grafts to wound beds and have antibacterial and anti-inflammatory effects and increase healing rate of wounds. We therefore devised a clinical trial to determine the effect of honey on skin graft fixation in burn injuries. Sixty patients were included in this study (in 30 patients, graft was fixed with medical honey, and in 30 patients, it was fixed with dressing or suturing). All patients in two groups were evaluated for infection, graft loss, graft contraction, severity of pain, and need for re-operation. The most common cause of burn was kerosene. Honey significantly decreased infection rate on fifth day and reduced the patient pain. The mean hospital stay was shorter in honey group. Contraction of graft was significantly less in honey group. Honey has strong adhesive properties for skin graft fixation. Medical honey is a natural material, not synthetic. For this reason, we can advise the application of medical honey for the fixation of split thickness skin graft.

Special considerations in paediatric burn patients

Burn injuries are a major cause of morbidity and mortality in children. In India, the figure constitutes about one-fourth of the total burn accidents. The management of paediatric burns can be a major challenge for the treating unit. One has to keep in mind that “children are not merely small adults”; there are certain features in this age group that warrant special attention. The peculiarities in the physiology of fluid and electrolyte handling, the uniqueness of the energy requirement and the differences in the various body proportions in children dictate that the paediatric burn management should be taken with a different perspective than for adults. This review article would deal with the special situations that need to be addressed while treating this special class of thermal injuries. We must ensure that not only the children survive the initial injury, but also the morbidity and complications are minimized. If special care is taken during the initial management of paediatric burn injuries, these children can be effectively integrated into the society as very useful and productive members.

Prevalence burn injuries and risk factors in persons older the 15 years in Urmia burn center in Iran

BACKGROUND

Burn injuries in many respects is the most tragic that a person may experience. The purpose of this study was to know the burn casualties prevalence in people over 15 years old to identify the risk and predisposing factors in the province of west Azarbaijan of Iran.

METHODS

This cross-sectional study was performed from March 2008 to March 2010. The demographic and epidemiologic information about burn and its complications were extracted from the data banks and records. Data were collected and analyzed.

RESULTS

Four hundred twenty eight patients (44.9% female and 56.1% male) were studied. Most of the admissions were in 16 to 25 years age bracket. Burning with fire accounted (39.2%) of admission in males and (53.2%) in females which was the most common cause of burning. Percentage patients who had more than 40% body surface area (BSA) burned was 42.0% in males, and 30.1% in females. Patients with >40% BSA burn had a mortality of 73.8%. The mean body surface area burned was 33.8% in males and 25.2% in females. The mean duration of hospitalization was 6.19 days.

CONCLUSION

The results of this study show that the prevalence of burn injuries is relatively high with high mortality rate in those with BSA> 40%. The commonest cause of burn was fire.