Oral glutamine dipeptide or oral glutamine free amino acid reduces burned injury progression in rats

This study was carried out to evaluate the effect of Glutamine, as a dipeptide or a free amino acid form, on the progression of burn injuries in rats. Thirty male Wistar rats were burned with a comb metal plate heated in boiling water (98 °C) for three minutes, creating four rectangular full-thickness burn areas separated by three unburned interspaces (zone of stasis) in both dorsum sides. The animals were randomized into three groups (n=10): saline solution (G1-Control) and treated groups that orally received Glutamine as dipeptide (G2-Dip) or free amino acid (G3-FreeAA). Two and seven days after burn injury, lesions were photographed for unburned interspaces necrosis evolution assessment. Seven days after injury, glutathione seric was measured and histopathological analysis was performed. By photographs, there was a significant reduction in necrosis progression in G3-Free-AA between days two and seven. Histopathological analysis at day 7 showed a significantly higher stasis zone without necrosis and a higher number of fibroblasts in G2-Dip and G3-FreeAA compared with G1-Control. Also, glutathione serum dosage was higher in G2-Dip. The plasmatic glutathione levels were higher in the G2-Dip than the G1-Control, and there was a trend to higher levels in G3-FreeAA. The reduction in histological lesions, greater production of fibroblasts, and greater amounts of glutathione may have benefited the evolution of burn necrosis, which showed greater preservation of interspaces.

Burn Injuries in People Who Used Drug, 2009-2017: A Case-Control Study in Shiraz, Southern Iran

Background Burn injury is a critical health issue, which is associated with several morbidities and mortalities. Substance abuse, which is an important public health problem in Iran, can affect burn injury outcomes and etiologies in victims. This study was aimed to evaluate different aspects of burn injuries in people who used drug (PWUD) in two referral centers in the south of Iran. Methods This Case-Control Study was conducted on burn victims referred to Amir-al Momenin Hospital and Ghotb-al-din Hospital from 2009 to 2017. Patients with a history of drug consumption were selected from the database and compared to randomly selected burn victims with no history of drug use. Demographics, burn etiology, underlying disease, total body surface area, hospitalization duration, and also the outcomes were collected and recorded in both groups. Data analysis was done by SPSS software. Results A total of 5,912 inpatients were included in this study, which 2,397 of them (40.54%) were female. The mean age of the patients was 26.12 ± 19.18. Drug history was positive in 659 patients (11.15%). Familial issues and mental disorders were significantly higher in the PWUD group compared to the control group (P<0.001). Explosion etiology was significantly higher in the PWUD group (P<0.001). Psychiatric disorders (P<0.001), total body surface area (P=0.023), and hospital stay (P<0.001) were significantly higher in PWUD; however, the mortality rate had no statistically significant differences between the groups (P=0.583). Conclusion Substance abuse is a risk factor in burn victims, which can affect burn etiology and burn-related morbidities.

Biomechanics of skin grafts: effect of pattern size, spacing and orientation

Skin graft expansion is the key to the treatment of severe burn injuries requiring skin transplantation. While high expansions have been claimed by a majority of graft manufacturers, the realistic expansions reported to date with skin grafts are much lower. To clarify this discrepancy, we attempted to understand the biomechanics of skin grafts through the study of common graft pattern sizes, spacing, and orientation, and their influence on mesh expansion and induced stress. A novel skin simulant material and additive manufacturing were employed to develop the skin graft models. Tensile testing experiments were conducted to study expansion and overall stresses, and a finite element model (FEM) was used to characterize the local trends. At low strains (i.e., <1), the mesh expansion ratio was reported to be below 1, which increased up to 1.93 at a high strain of 2. The pattern size and spacing were not observed to affect the expansion much (i.e., <10%). With a change in orientation, the expansion decreased across all graft models and strains. High localized induced stresses were reported for high strains, which varied with graft orientation. The novel observations highlight the achievable expansions without overstressing, with standard slit patterning in skin grafts. These findings will not only help achieve better mesh expansion outcomes in burn surgeries but also guide the development of novel graft patterns for enhanced expansion in the future.

Management of severe burn injuries with novel treatment techniques including maggot debridement and applications of acellular fish skin grafts and autologous skin cell suspension in a dog

CASE DESCRIPTION A 3-year-old 27-kg female spayed American Bulldog with severe burn injuries caused by a gasoline can explosion was evaluated. CLINICAL FINDINGS The dog had extensive partial- and full-thickness burns with 50% of total body surface area affected. The burns involved the dorsum extending from the tail to approximately the 10th thoracic vertebra, left pelvic limb (involving 360° burns from the hip region to the tarsus), inguinal area bilaterally, right medial aspect of the thigh, and entire perineal region. Additional burns affected the margins of the pinnae and periocular regions, with severe corneal involvement bilaterally. TREATMENT AND OUTCOME The dog was hospitalized in the hospital’s intensive care unit for 78 days. Case management involved provision of aggressive multimodal analgesia, systemic support, and a combination of novel debridement and reconstructive techniques. Debridement was facilitated by traditional surgical techniques in combination with maggot treatment. Reconstructive surgeries involved 6 staged procedures along with the use of novel treatments including applications of widespread acellular fish (cod) skin graft and autologous skin cell suspension. CLINICAL RELEVANCE The outcome for the dog of the present report highlighted the successful use of maggot treatment and applications of acellular cod skin and autologous skin cell suspension along with aggressive systemic management and long-term multimodal analgesia with debridement and wound reconstruction for management of severe burn injuries encompassing 50% of an animal’s total body surface area.

Experimental justification for prompt neutralization of traumatic action of thermal exo- and endogenous damage factors (morphological features)

Objective: morphological substantiation of efficiency of prompt neutralization of traumatic action of exogenous and endogenous damage factors in burn injuries in experimental conditions. After simulating the burns on 60 rats, the traumatic hyperthermic damage factors in the main group were immediately neutralized by a gauze napkin soaked in water. Depending on its duration, the animals were divided into subgroups. Such applications were not performed on the control group. The study involved histological examination of tissues. Animals of the main groups had the presence of histologically confirmed skin appendages with a formed scar of connective tissue without signs of inflammation. In animals of the control group there were no skin appendages, which indicates a deeper thermal damage to tissues and the impossibility of self-epithelialization of wounds. These results confirm the importance and necessity of prompt neutralization of the traumatic effect of damage factors as the main elements of burn depth formation.

Do Psychological Factors, Pain, and Sleep Quality Correlate With Disability and Occupational Performance in Hand Burns?

Background and Objectives: Burn injuries are one of the most common traumas after traffic accidents, falls, and interpersonal violence. This study was done to investigate the correlation between psychological factors, pain, and sleep quality, and disability and occupational performance in subjects with hand and upper extremity burns. Methods: A total of 80 patients with hand and upper extremity burn injuries (16 females and 64 males) with a Mean±SD age of 39.9±10.79 years, mean burn depth (Deep Partial Thickness/ Full Thickness) of 3.42±2.66, and Mean±SD burns extent 1.06±0.24 participated in this non-experimental cross-sectional study using a non-probability sampling method. Their psychological disorders were measured using the Beck Anxiety Disorder Scale and the Self-Rating Depression Scale. The pain was assessed using the Visual Analogue Scale, sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI), disability was assessed using the Shortened Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire, level of independence in daily living activity was measured by the Modified Barthel Index, and occupational performance was measured by the Canadian Occupational Performance Measure (COPM). Results: Psychological factors, pain, and sleep quality were significantly correlated with disability and occupational performance. The regression models explained up to 34.4% of the variance for disability outcome and 12.4% for occupational performance. By assessing the correlation between the psychological disorders, pain, and sleep quality, and disability and occupational performance in these patients, we found that sleep quality was the strongest contributing factor Followed by PSQI. Conclusion: Sleep quality is one of the important factors affecting the occupational performance of patients with hand and upper extremity burns injury that should be considered by therapists.

Occupational Burn Injuries in Finland 2011-2015

IntroductionThis study comprises all hospitalized work related burn injuries in one country during 2011-2015. The purpose was to describe demographics, causes and risk factors of occupational burn injuries with special focus on the outcome of return to work. Material and methodsThis is a retrospective study on two data sources of which Finnish Workers’ Compensation Center´s (FWCC) register includes all work-related burn cases at a given time. Additional data has been obtained from those patients, who were referred to the National Burn Centre (NBC) during the same time according to the Emergency Management of Severe Burns (EMSB) criteria. We compare demographics, injury mechanisms and general burn data of these two patient groups. ResultsBased on FWCC register, in 2011-2015 occurred 11623 work related burn cases of whom 54% were men. During the study period NBC admitted 26 patients fulfilling EMSB criteria. The most severe patients treated in NBC had injuries affecting multiple body parts. In FWCC data hand was most injured body part. Kitchen/bakery work was the most common profession in FWCC register but in NBC material industrial and transport professions dominated. In FWCC register patients had lower mean age (37 years vs. 43 years). Most severe injuries occurred among older patients: in NBC data those with total body surface area 40% or over had mean age 53 years. Majority of patients returned to work. ConclusionSafety at work in Finland is good and the vast majority of work-related burn injuries are minor. Young adults working in kitchen and bakery work are susceptible to minor burn injuries whereas, unexpectedly, elderly men working in transports and industry sustain most severe burn accidents. Retirement after work related injury becomes very expensive for all parties and this data can be used in preventing those cases as well as the minor accidents.

A Review of Burn Patients Requiring Extracorporeal Membrane Oxygenation at a Burns Facility

Respiratory compromise is a recognised sequelae of major burn injuries, and in rare instances requires extracorporeal membrane oxygenation (ECMO). Over a ten-year period, our hospital trust, an ECMO centre and burns facility, had five major burn patients requiring ECMO, whose burn injuries would normally be managed at trusts with higher levels of burn care. Three patients (60%) survived to hospital discharge, one (20%) died at our trust, and one patient died after repatriation. All patients required regular, time-intensive dressing changes from our specialist nursing team, beyond their regular duties. This review presents these patients, as well as a review of the literature on the use of ECMO in burn injury patients. A formal review of the overlap between the networks that cater to ECMO and burn patients is recommended.

Burns in a Suburban Teaching Hospital: A Retrospective Record Review in Kanchipuram, India

Background: Burn injuries rank among the most severe type of injury with high morbidity and mortality worldwide. Burn injuries not only affect patients physical health but also affects their social and psychological well being along with severe economic loss to the individual, their family and to the society. About 90% burn injuries are preventable, but poor adherence of safety measures and awareness leads to disability and disfigurement throughout their life. Hence, the need for various demographic variables to understand the cause and pattern in our region are required. Objectives: To describe the demographic and socio-cultural aspects of burn patients and to learn the cause of burn victims in our region. Materials and Methods: A record based retrospective study was conducted at Saveetha Medical College and Hospital, Thandalam, Kanchipuram district. The medical records of all patients over a period of 4 years (January 2017 to December 2020) were reviewed. Data were recorded on a pre-structured and pretested questionnaire. Chi-square test was done to study association between socio-demographic variables and burn injury and (p<0.05) was considered statistically significant. Results: A total of 208 burn cases were involved in this study out of which 56.7% were females and 43.3% were males. Most of the burn patients were 31-45 years and lived in rural areas. The majority of burn injuries were accidental; thermal burns was the most common cause of deep burns. Conclusion: Socio-demographic factors are important in raising educational programs and awareness in rural areas for improving quality of life.