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Split thickness skin grafting is one of the common skin transplantation techniques employed in treating severe burn injuries. Recent experimental studies have shown that the expansions offered by split thickness skin grafts are much lower than what is claimed by the graft manufacturers. To date, limited studies have investigated the effect of slit patterns on the expansions and the possibility of material innovation. This work has experimentally tested novel auxetic slit patterns on a biofidelic skin simulant to evaluate their effect on skin graft expansion. A wide range of variants of alternating slit (AS), I-shaped (IS), and Rotating Triangle (RT) based auxetic patterns were tested. A biaxial testing device was employed to simulate realistic skin stretching during graft implementation. The deformation, expansion, stress-strain response, void area, and maximum gap size were estimated, and the material behavior was also modeled using hyperelastic curve fit coefficients. The key design parameters were determined, which would produce high expansion with minimal voids. The findings of this study are anticipated to throw light on the possibility of using auxetic slit patterns for generating higher expansions in split thickness skin grafts. [ABSTRACT FROM AUTHOR]

Background and Objectives: The objective of this study was to examine the effects of nutritional therapy in adult patients with severe burns. Methods and Study Design: Sixty adult patients with severe burns were enrolled. Data on nutritional intake through enteral nutrition (EN) or parenteral nutrition (PN) on days 7, 14, 21, and 28 post-injury were collected. Patients were divided into target and non-target groups according to whether their energy or protein intake reached the target. Age, length of ventilation, and total bilirubin (TBIL), albumin (ALB), prealbumin (pALB), and C-reactive protein (CRP) concentrations of patients were recorded. Results: The percentage of protein targets with protein delivery was lower than that of energy target with energy delivery. The ratio of PN protein to total protein was lower than that of PN energy to total energy on days 7, 14, 21, and 28 (p<0.001, p<0.001, p=0.001, and p=0.003, respectively). Compared to the non-target group on day 21, the target group was younger, had lower TBIL on day 7, higher ALB and pALB on day 21, and lower CRP on day 14 (p=0.025, p=0.021, p=0.028, p=0.029, and p=0.049, respectively). Multivariate logistic regression analysis showed that older age and longer ventilation were independent risk factors in patients who did not meet the nutritional target on day 21 (p=0.026 and p=0.043, respectively). Conclusions: The protein intake of adult patients with severe burns was low. Compared to the non-target group, the target group had better laboratory test results. Older age and longer ventilation were independent risk factors for patients not meeting the nutritional target. [ABSTRACT FROM AUTHOR]

This article aims to analyze the types of surgical diseases and treatments in ancient China as documented in bamboo and silk texts, with a particular focus on (external) injury, tetanus, burns, rectal and anal diseases, and inguinal hernias. For this analysis, I gathered 85 instances of disease and treatments recorded in these texts. The 85 cases were further categorized into 13 (external) injuries, 13 metal wounds, 6 tetanus, 22 burns, 16 rectal and anal diseases, and 15 inguinal hernias.The analysis revealed that the treatment of (external) injury and burns focused primarily on the wound site, while the treatment of metal wounds and tetanus centered on addressing the internal body. Internal treatments were mainly prescribed through the use of medicine and food. Surgical intervention was recommended primarily for diseases of the rectum and anus, with medications applied to the woundspost-surgery. For inguinal hernias, a high-protein diet was typically prescribed.As we’ve seen, in ancient China, surgical diseases were mainly treated with medication, surgery, and dietary prescriptions. And among these prescriptions, drug prescriptions were utilized not only by medical doctors but also by witch–doctors[巫醫] treating diseases in civilian society and soldiers stationed at frontline military posts. In the absence of medical doctors in both civilian society and frontline units, witch–doctors and frontline units purchased or stockpiled prescription drugs and used them to treat patients according to prescription.

Background: Burns are a common and severe medical emergency requiring immediate specialized care to minimize damage and prevent complications. Burn severity depends on depth, extent, and location, with more complex care needed for burns on critical areas or extensive burns. Nursing is essential in burn management, providing immediate care, adapting treatments, managing pain, preventing infections, and offering emotional support for recovery. The study aims to analyse the epidemiological and clinical characteristics of burns treated at the Hospital Emergency Department of the Hospital Complex of Cáceres (Spain) from January 2018 to December 2022. It looks at factors like gender, age, hospital stay duration, emergency type (paediatric or adult), main diagnosis, skin thickness, burn degree, affected body areas, percentage of body surface area burned, and treatment types. It also investigates how treatment varies by gender, age, skin thickness, and burn severity. The relevance of this research lies in the fact that periodic epidemiological studies are essential to monitor changes in diseases, evaluate the effectiveness of interventions, detect outbreaks quickly, update knowledge on risk factors, and guide health policy decisions. This ensures an adapted and effective response to the needs of the population. Methods: Retrospective, observational study that analysed burn cases treated at the Hospital Complex of Cáceres (Spain) 2018–2022. Inclusion criteria were based on ICD-10 codes for burns, excluding severe cases not treated in this service. Data were analysed using descriptive statistics, Student’s t-tests, Chi-square tests, and ANOVA. Results: 220 patients surveyed, with a mean age of 47 years and 60.9% male. Most burns (95.5%) affected the external body surface, with a mean hospital stay of 7.86 days. Medical treatment was provided to 75.5% of patients, and 24.5% required surgical intervention. Significant differences in treatment procedures were observed according to age, skin thickness, and burn degree. Older patients had more procedures and longer hospital stays. Excision and transfer procedures were more common in full-thickness and severe burns. Conclusions: The findings align with previous research on burn demographics and treatment approaches. Treatment differences by age and burn severity highlight the need for tailored interventions. The study underscores the importance of comprehensive burn management, including psychological support for improved long-term outcomes. Further research could explore the impact of socio-economic factors on burn incidence and treatment. This study was not registered.

The treatment of severe burn injuries, which occur particularly in the context of armed conflicts, is based on a multimodal treatment concept. In addition to complex intensive care therapy, the surgical reconstruction options of plastic surgery and typical antiseptic wound treatment are the main focuses. In recent years, atmospheric cold plasma therapy (ACPT) has also become established for topical, antiseptic wound treatment and for the optimization of re-epithelialization. This case report shows a successful treatment of extensive burn injuries using dermal skin substitute matrix and topical treatment with a large-area cold plasma device to control multi-resistant pathogen colonization. This case report illustrates the importance of ACPT in burn surgery. However, larger case series and randomized controlled trials in specialized centers are needed to assess its place in future clinical practice.

Background: Burns are one of the most common accidental injuries in the community. Improper treatment of burns can lead to disability and even death. Applying topical therapy aims to reduce excessive collagen repositioning and accelerate healing. We tried treating burn wounds with an ointment that uses a combination of cherry leaf extract and manuka honey to test the effectiveness of wound healing. Case presentation: We report two cases of superficial burns that underwent wound treatment using an ointment containing cherry leaf extract and manuka honey. Conclusion: Wound treatment with an ointment containing cherry leaf extract and manuka honey can speed up the healing process in patients with superficial second-degree burns.

Abstract Background Despite an increase in knowledge, blood loss during burn excisional surgery remains a major challenge and is an independent predictor of mortality. During burn surgery, limited measures are available to control the bleeding. Increased fibrinolysis could be one of the contributing factors of blood loss during burn excisional surgery. Tranexamic acid inhibits the fibrinolytic response, and a small body of evidence shows positive effects of tranexamic acid on the volume of blood loss. Methods The main objectives of this study are twofold, (1) to investigate whether tranexamic acid reduces blood loss and (2) to investigate the changes in coagulation after burn trauma and during burn excisional surgery. This study is a multicenter double-blind randomized clinical trial in patients scheduled for burn excisional surgery within the Dutch burn centers. All adult patients scheduled for burn surgery with an expected blood loss of ≥ 250 are eligible for inclusion in this study. The study is powered on a blood loss reduction of 25% in the intervention group. In total, 95 subjects will be included. The intervention group will receive 1500 mg tranexamic acid versus placebo in the other group. Primary endpoint is reduction of blood loss. Secondary endpoints include occurrence of fibrinolysis during surgery, graft take of the split skin graft, and differences in coagulation and blood clot formation. Discussion This protocol of a randomized controlled trial aims to investigate the efficacy of tranexamic acid in reducing blood loss during burn excisional surgery. Furthermore, this study aims to clarify the coagulation status after burn trauma and during the surgical process. Trial registration EudraCT: 2020-005405-10; ClinicalTrial.gov: NCT05507983 (retrospectively registered in August 2022, inclusion started in December 2021).

Balance is an important component of daily function and impairments can lead to injury and quality-of-life limitations. Balance is not well studied in the burn population. This study examines the frequency of long-term balance impairments and associated factors after a burn injury. The Burn Model System National Database was analyzed. Trouble with balance was self-reported at discharge, 6, 12, 24, and 60 months after injury. Regression analyses examined the associations between demographic and clinical characteristics and balance impairments at 12 months. Of 572 participants, balance impairments were most reported at discharge (40.3%), continuing over 60 months (26.8–36.0%). Those reporting balance impairments (n = 153) were more likely to be older, unemployed, have Medicaid or Medicare, receive inpatient rehabilitation, receive outpatient physical or occupational therapy, have vision problems, have leg or feet burns and swelling, and have foot numbness compared to those without (p ≤ 0.001). Regression analysis demonstrated a 4% increased odds of balance impairment for every increase in year of age (p < 0.001), 71% lower odds if employed at time of injury (p < 0.001), and 140% higher odds if receiving outpatient physical or occupational therapy at 12 months (p = 0.008). Common reports of balance impairments highlight the need for routine screenings to identify burn survivors that may benefit from targeted interventions.

Burn care quality indicators are used to monitor and improve quality of care and for benchmark purposes. The perspectives of burn survivors, however, are not included in current sets of quality indicators while patient-centred care gains importance. The aim of this study was to explore burn survivors’ perspectives on quality aspects of burn care, which was used to translate their perspectives into patient-centred quality of care indicators. Qualitative descriptive research was conducted in a patient panel group. First, thematic analysis was applied to the focus groups to identify overarching themes. Second, patient-centred quality indicators, informed by burn survivors’ valued aspects of care, were defined. Ten burn survivors with an average age of 54 years (SD = 11; range 38–72 years) and mean TBSA burned of 14% (SD = 11%; range 5–35%) participated in two focus groups. Four overarching themes were identified, pointing to the importance of (1) information tailored to the different phases of recovery, (2) significant others’ wellbeing and involvement, (3) a therapeutic relationship and low-threshold access to healthcare professionals and (4) to participate in decision-making. Eighteen patient-centred process quality of care indicators within nine aspects of care were formulated. The overarching themes are reflected in patient-centred quality indicators, which present a broadened and complementary view of existing clinical quality indicators for burn care. Evaluating these patient-centred quality indicators may increase quality of care and refine patient-centred care.

Burn mass casualty event occurrences are rare but will place significant burdens on any burn unit or healthcare system. Effective disaster preparedness plays a significant role in mitigating the aftermath of a burn mass casualty. The aim of this study was to assess the resource requirements during the initial two weeks of a burn mass casualty event. Eight patients in a burn mass casualty event were simulated using the Emergo Train System®. These simulated patients were matched with real historical patients treated in our burn centre, and their resource requirements were analysed. An average of eight staff is required to care for a patient per day along with almost 75 h of operating time (excluding anaesthesia and turnover time). A substantial quantity of consumables was used in the first two weeks. This study has demonstrated the substantial material consumption and staff requirements in the first two weeks of management in a burn mass casualty event. Such findings will offer valuable insight for disaster preparedness planning and resource management strategies.

Burn injuries are among the most traumatic events a person can endure, often causing significant psychological dysfunction and severe pain. Hypnosis shows promise as a complementary intervention to manage pain and reduce the psychological distress associated with burn injury and treatment. This paper reviews the literature regarding hypnosis and potential applications of hypnosis in the management of burns. Hypnosis offers an effective, low-cost intervention that is widely applicable in the management of burns and can play a role in more acute and austere settings where resources are often limited.

Background: Burns constitute a major cause of childhood trauma. There is a need for inexpensive and more effective alternative healing agents, especially in developing countries. Objectives: To compare the rates of healing of burns dressed with either silver sulphadiazine (SSD) or crude undiluted honey and compare the relative costs of both modes. Methods: The studywas carried out at the Wesley Guild Hospital, Ilesa. Twenty seven children with comparable partial thickness burns were prospectively studied for healing of their burn injuries. They were randomly allotted to two treatment groups of dressing with either SSD or crude undiluted honey. The burns sites were assessed clinically on the 3rd, 7th and 21st days for sloughs, exudates, eschars, granulation tissue and epithelialisation. The duration of hospitalisation for each child as well as the quantity and costs of the dressing agents were also documented. Results: Honey-treated burns demonstrated quicker healing with faster wound granulation and epithelialisation. The duration of hospital staywas significantly shorter in patients treated with honey than in those treated with SSD (t = 3.06, p = 0.005). Direct cost of the SSD used was 9.75 times that of the honey. Conclusions: Honey appears to be a superior dressing agent for partial thickness burns than silver sulphadiazine in terms of efficacy and cost. We therefore recommend honey for the dressing of partial thickness burns, particularly in tropical countries where it is readily available and the majority of the people are poor. Enhancement of apiculture should make honey therapy of burns victims much cheaper still.

Abstract Background Burns cause serious physical and psychological harm to patients, placing a heavy burden on the global healthcare system. Our previous study detailed the epidemiological characteristics of burn injuries in Chinese inpatients from 2009 to 2018. Interestingly, the anatomic locations of burn injuries vary by gender, age, provinces, and outcomes among different causes. Therefore, this current study aims to analyze the characteristics of burn injuries in inpatients with various burn sites by collecting data in China from 2009 to 2018. This analysis will inform future healthcare system decisions and provide effective strategies. Methods Burns inpatients from 196 hospitals across 31 provinces in China were included in the study, covering the period from 2009 to 2018. The data collected encompassed information on gender, age, etiology, regions, clinical outcomes, and anatomical locations of the injuries. Data analysis was conducted using Microsoft Excel 2007. Results From 2009 to 2018, a total of 333,995 burns inpatients were recorded. The most vulnerable parts to burns were multiple burn sites (230,090, 68.89%). Women were more susceptible to lower limb burns (15,608, 14%), while men were more prone to eye injuries (8,387, 3.37%) and hand burns (6,119, 2.75%). The age group of 0–10 years was the most vulnerable to burns across all body areas, including internal organs. In China, individuals aged 20–50 years were at a higher risk of head and neck burns compared to other age groups. The Han population showed increased vulnerability to eye injuries (2.12 times higher than minorities), respiratory tract issues (2.09 times higher than minorities), and trunk burns (1.83 times higher than minorities), while being less susceptible to internal organ injuries (0.23 times fewer than minorities) and lower limb burns (0.78 times fewer than minorities). The southwest region had the highest proportion of burns inpatients with burns affecting single body parts, whereas the eastern area had the highest rates of respiratory tract burns (0.85%) and multiple burn sites (80.64%). Scalding was identified as the most common cause of burns, while flame burns (769, 55.81%) and chemical burns (438, 47.35%) were the main causes of respiratory tract and internal organ injuries, respectively. Conclusions This study provides an initial description of characteristics of burns inpatients with various anatomic locations of burns in China over the past decade. Our findings will contribute to the most up-to-date clinical evidence database for healthcare planning and prevention initiatives in both China and other countries.

Introduction: Major burns and the intensive care required induce numerous physiologic changes and stress responses that impact recovery for months after hospital discharge. Little is known about sleep quantity and quality after index hospitalization discharge. We report on actigraphy and sleep outcome data from subjects enrolled in a prospective trial of home-based virtual rehabilitation (HBVR) after burn injury. Methods: We conducted a randomized controlled trial of a HBVR program over 12 weeks after index hospitalization. In both HBVR and control (usual care) groups, subjects were provided a wrist actigraphy accelerometer device (Garmin vívofit®) to wear. Sleep data were retrieved remotely and analyzed. Actigraphy data were defined a priori as complete if subjects had 5 out of 7 days of actigraphy wear in a week. Average weekly sleep was calculated and reported by group assignment. Sleep-relevant and fatigue outcomes were measured by PROMIS questionnaires at randomization (discharge + 0–30 days), 12-weeks, and 12-months. Descriptive statistics were used for comparisons and linear mixed effect model were used to evaluate trends in PROMIS T-scores between groups. Results: Fifty subjects were enrolled and 48 had complete sleep data. Mean age was 38 ± 14 years and mean burn size was 16 ± 13 % TBSA with a majority of subjects male (71 %). Average sleep duration was within general population norms, with little difference between subjects in the intervention and controls groups in the 12 weeks after study randomization (7.3 vs.7.2 h respectively, p = 0.25). Subjects in control group spent more time in light sleep (4.1 vs. 3.9 h, p

Background: Cooking-related burn injuries are a public health problem, and may be even more likely to occur in countries that are experiencing a transition to cleaner cooking fuels like liquefied petroleum gas (LPG). The risk of burns from cooking with these newer fuels, and safety measures or training to prevent injuries, is not well documented. This study examines the burden of burn injuries and burn prevention education provided to consumer by LPG stove and cylinder vendors. Methods: A cross-sectional study was conducted among 100 burn patients admitted to Muhumbili National Hospital from February 2022 to January 2023 to assess cooking-related burns. Results: We found that among 377 patients with all burn injuries, 100 (26.5%) were cooking-related, with charcoal (51%) and LPG (35%) stoves being the most reported. Females (61%) were more affected than males (39%), and lower education levels were more likely to be associated with burn injuries. Of all burn patients admitted, 57 (15.1%) died. Among those who experienced a cooking-related burn, 7 (7%) died. Children were more affected (59%) by any cooking-related burn injuries, but adults were more likely to experience LPG-related burns (56%). Small cylinders with a burner placed directly over the cylinder as one unit, without a connecting hose, caused less injury than stoves using a larger cylinder with a rubber connecting hose. Conclusion: Safety measures for LPG stoves and fuels, including policies to increase awareness and prevent burn injuries, must be prioritized in countries like Tanzania that are transitioning from solid fuels to LPG fuels for cooking.

Background: There is a global concern regarding increasing colonization and/or infection of paediatric burns patients with multi-drug-resistant organisms, especially in Africa. Surveillance of antimicrobial resistant patterns enables clinicians to opt for the most appropriate empiric antimicrobial agent according to the unit’s susceptibility profile. Objective: This study sought to compile unit-specific antibiograms comparing the organism prevalence and their antimicrobial resistance trends in the paediatric burns unit, Chris Hani Baragwanath Academic Hospital (CHBAH) from January 2015 to December 2019. Methods: A retrospective, laboratory-based review was conducted of bacterial and fungal isolates including antimicrobial susceptibility testing (AST) data from blood cultures and tissue samples. Enterobacterales, non-fermenters, gram-positive organisms, and yeasts were analysed as a percentage of total positive blood cultures comparing 2015–2017 to 2018–2019 data. Analysis of antimicrobial resistance trends was performed for extended-spectrum beta-lactamases (ESBLs), carbapenem-resistant Enterobacterales (CRE), extensively-drug-resistant (XDR) Acinetobacter baumannii, and meticillin-resistant Staphylococcus aureus (MRSA) for the years 2015, 2017, and 2019. Results: A total of 1243 blood culture isolates were studied with A.baumannii (208/1243;17 %), coagulase negative staphylococci (141/1243; 11 %) and Candida auris (53/1243; 4 %) representing the predominant gram-negative bacteria, gram-positive bacteria, and yeast, respectively. A significant decrease in ESBLs (p = 0.00) was noted with a rise in CREs (p = 0.00) during the study period. Majority of the A. baumannii were XDR (≥77 %) despite an appreciable decrease. A notable decrease in MRSA (p = 0.00) isolates was observed. Pseudomonas aeruginosa (72/275; 26 %) was the leading organism recovered from a total of 275 tissue isolates. Conclusion: The results of this study encourage review of the current antimicrobial choices in the unit for empiric antibacterial cover. Due to the low numbers of yeasts, we cannot comment on the institution of early antifungal strategies. We support reinforced infection prevention and control practices as well as antimicrobial stewardship initiatives.

Knowledge translation and consumer testing aims to move research findings from scientists, professional journals, and conferences to the hands of end-users and organizations who use the information regularly. The purpose of this report is to outline the process by which the Burn Model System (BMS) has worked with the Model System Knowledge Translation Center (MSKTC) to develop and disseminate patient education materials to consumers. The National Institute on Disability, Independent Living, and Rehabilitation Research-funded BMS in collaboration with the MSKTC uses a multi-step process for developing and consumer-testing evidence-based/consensus-derived educational information prioritized by consumers. The final written products are made available in both English and Spanish at/below an 8th grade reading level. Products are disseminated through websites, clinical encounters, social media, and national/international engagement with clinicians and burn-related organizations. Written products are reviewed every five years to ensure they remain current and relevant. Number of online views for each product is a key measure of dissemination. Since 2011, the collaboration between the BMS and the MSKTC has produced or updated 22 educational factsheets, three videos, three infocomics, and one infographic. Collectively, these products have been viewed over two million times by people in 216 countries. Online views of all products have generally increased year-to-year. This process makes relevant health information accessible and understandable for consumers. As a result, Burn Model System informational products have been increasingly viewed by US and international consumers.

Skin graft fixation dressing is important in preventing graft shear and loss which are a major source of morbidity particularly in burn patients. We report the successful use of negative pressure wound therapy with instillation and dwell time (NPWTi-d) in burn injuries of the hand for both skin graft fixation and maintenance of safe hand positioning.A 27-year-old man suffered burn injuries on his hands and face which included deep partial thickness burns of his right hand following an industrial explosion. A day after the injury, early debridement and skin grafting of the hand was performed. NPWTi-d was applied by cutting the form into smaller blocks and stacking them in an overlapping fashion we termed the “Jenga method” to securely fix the skin graft in place and fix the hand in intrinsic plus hand positioning for 1 week. The device was set to 10 ml saline immersion for 3 min every 3.5 h and section pressure reduced from −125 mmHg to −75 mmHg due to hand discomfort. Graft take was 95 % and the patient recovered with no joint contracture or other complications.We report this case to demonstrate the use of NPWTi-d for effective skin graft fixation and non-invasive immobilization of the hands and fingers in a safe limb position in a patient with burn injuries and present the stacked block foams “Jenga method” as a useful easy technique for application of NPWT.

Background: Spina bifida cystica (SB) is one of the most common neural tube defects affecting 1 in 2,500 newborns worldwide. Due to the neurological deficits associated with SB, injuries from thermal exposure, trauma, or other etiology may be more severe rendering their treatment a challenge for a traditional approach to burn and wound management. Despite this relatively high disease incidence rate, few studies exist to evaluate wound development or the natural history of wound healing in patients with SB. Case presentation: We present a case of a pediatric patient with a history of SB who sustained a full thickness burn to the right plantar foot in February of 2023. The 8-year-old was riding an all-terrain vehicle when his right foot made contact with the hot tailpipe. The insensate neuropathy associated with the patient’s SB contributed to the extreme severity of thermal contact injury. We report the burn, treatments, the usage of a novel dermal replacement, and outcomes of this case. Conclusion: This case demonstrates successful limb salvage in a pediatric patient with severe plantar foot burns utilizing a novel collagen-elastin dermal matrix for tissue reconstruction. Limb salvage was the preferred treatment option over amputation and a prosthetic considering the patient’s age and need for future prostheses. Given the severity of the burn, the impaired wound healing due to his baseline neuropathy, and his baseline ambulatory status, the optimal outcome in this case was limb salvage, which was successfully achieved.

Acute kidney injury (AKI) is a common and severe complication in severe burns. Preexisting chronic kidney disease (CKD) can make the management more challenging. We present the management strategy adopted in such a case, highlighting the adaptations in fluid resuscitation, dialysis, and septicemia prevention. The case involved the 2nd and 3rd degree burns covering 53% body surface, in a patient with preexisting CKD and hypertension. Despite initial fluid resuscitation, the patient developed AKI. Sustained low-efficiency dialysis (SLED) was started, along with nutritional support using buttermilk diet. Aggressive antibiotic prophylaxis was initiated based on wound swabs culture and sensitivity. Wound debridement was deferred and daily dressing with silver nitrate gel and moisture-retaining film was used. Debridement and grafting were performed on postburn days 43 and 65. The patient was discharged after 80 days, with healed wounds. Our approach included meticulous fluid and nutrition supplementation coupled with SLED and appropriate wound management coupled with aggressive antimicrobial prophylaxis to prevent septicemia.

Pain in critically ill adults with burns should be assessed using structured pain behavioural observation measures. This study tested the clinimetric qualities and usability of the behaviour pain scale (BPS) and the critical-care pain observation tool (CPOT) in this population. This prospective observational cohort study included 132 nurses who rated pain behaviour in 75 patients. The majority of nurses indicated that BPS and CPOT reflect background and procedural pain-specific features (63–72 and 87–80%, respectively). All BPS and CPOT items loaded on one latent variable (≥0.70), except for compliance ventilator and vocalisation for CPOT (0.69 and 0.64, respectively). Internal consistency also met the criterion of ≥0.70 in ventilated and non-ventilated patients for both scales, except for non-ventilated patients observed by BPS (0.67). Intraclass correlation coefficients (ICCs) of total scores were sufficient (≥0.70), but decreased when patients had facial burns. In general, the scales were fast to administer and easy to understand. Cut-off scores for BPS and CPOT were 4 and 1, respectively. In conclusion, both scales seem valid, reliable, and useful for the measurement of acute pain in ICU patients with burns, including patients with facial burns. Cut-off scores associated with BPS and CPOT for the burn population allow professionals to connect total scores to person-centred treatment protocols.

Burns are a significant problem with high associated morbidity and mortality worldwide. Bacteremia is a serious complication that is important in increasing the overall fatality rate in burn injury patients. In this study, we report a case of Streptococcus mitis and Klebsiella pneumoniae mixed infection in severe burns in a 40-year-old female. The patient was transferred from an outside hospital to the emergency unit after burn injuries in a gas explosion accident at home. The patient underwent surgical debridement and antibiotics treatment but died due to sepsis and multiorgan failure. Our case study will help to underscore the important role of Streptococcus mitis and Klebsiella pneumoniae as human opportunistic pathogens in severe burn injury patients.

Background: The most common psychological impact experienced by patients with burn injuries is depression. Several significant risk factors influence depression, including sociodemographic factors (gender, employment status, socioeconomic status, and marital status) and burn characteristics (burn depth, burn area, and total burn surface area). Neutrophil-to-lymphocyte ratio (NLR) was discovered as a new biomarker for depression detection. The purpose of this study was to investigate the correlation of sociodemographic factors, burn characteristics, and NLR with the severity of depression in patients with burn injuries. Methods: This analytic descriptive study was conducted at Dr. Hasan Sadikin General Hospital from June 2022 to April 2023. Samples were assessed by a psychiatrist using the Hamilton Depression Rating Scale instrument, and a differential white blood count was calculated to obtain the NLR value. Results: The study sample consisted of 32 patients, including 27 males and 6 females. There was no correlation of sociodemographic factors and burn wound characteristics with the level of depression. NLR in patients with burn injuries who had no depression, mild depression, and moderate depression was 5.78 ± 2.23, 7.4 ± 1.77, and 13.04 ± 6.25, respectively. NLR was statistically significantly associated with the level of depression in patients with burn injuries (p = 0.001). Conclusion: There was no correlation of sociodemographic factors and burn characteristics with the level of depression. There was a significant correlation between NLR and the level of depression in patients with burn injuries at Dr. Hasan Sadikin General Hospital.

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 postburn 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. [ABSTRACT FROM AUTHOR]

Burns are a significant cause of morbidity and mortality in children. While the majority of pediatric burns are not life-threatening, they can have a significant impact on a child's physical and psychological health. They pose a major social and financial burden, particularly in developing countries. The management of pediatric patients with thermal injuries requires a complex and multifaceted approach. Pediatric burns constitute approximately 40-50% of all reported cases of severe burns. The most common etiologies of pediatric burns include scalds, contact burns, flames, and chemicals. From 80% to 90% of burns occurred at home and were accidental. Despite advancements in treatment, severe burns can lead to life-threatening complications, such as sepsis, multisystem organ failure, and hypermetabolic response or even death. This article aims to provide a literature-based overview of pediatric burn trauma, outlining its unique characteristics, etiology, epidemiology, classification, and initial management. [ABSTRACT FROM AUTHOR]

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Objective: This scoping review aimed to map the adverse reactions in the oral mucosa and face caused by the use of natural products. Methodology: This review was performed according to the Joanna Briggs Institute Manual for Evidence Synthesis and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, with a protocol registered in the Open Science Framework (DOI 10.17605/OSF.IO/R57D8). The search was carried out systematically using PubMed, Scopus, Web of Science, Embase, LILACS, and LIVIVO databases, as well as gray literature through Google Scholar and OpenGrey. Reports of clinical cases on the adverse effects of natural products on the oral mucosa or perioral region of the face resulted from inappropriate use or self-medication were included. Data from the included studies were described in a narrative form. Results: Seven hundred and six studies were identified, and after removing duplicates and applying the eligibility criteria, 28 studies were included. The year of publication ranged from 1976 to 2022. The studies were conducted in 19 countries. Fifty patients were mentioned in the included studies and 34 were female (68%). The natural products most related to adverse reactions were propolis (n = 17), with manifestations such as perioral eczema, edema, erosions, erythema, allergic contact dermatitis, and garlic (n = 9), with manifestations such as chemical burn, burning sensation, vesicles and blisters, crusts, and ulcerations. Conclusion: Propolis and garlic were the natural products with the most reported adverse effects on the oral mucosa and perioral region. [ABSTRACT FROM AUTHOR]

Background: Despite an increase in knowledge, blood loss during burn excisional surgery remains a major challenge and is an independent predictor of mortality. During burn surgery, limited measures are available to control the bleeding. Increased fibrinolysis could be one of the contributing factors of blood loss during burn excisional surgery. Tranexamic acid inhibits the fibrinolytic response, and a small body of evidence shows positive effects of tranexamic acid on the volume of blood loss. Methods: The main objectives of this study are twofold, (1) to investigate whether tranexamic acid reduces blood loss and (2) to investigate the changes in coagulation after burn trauma and during burn excisional surgery. This study is a multicenter double-blind randomized clinical trial in patients scheduled for burn excisional surgery within the Dutch burn centers. All adult patients scheduled for burn surgery with an expected blood loss of ≥ 250 are eligible for inclusion in this study. The study is powered on a blood loss reduction of 25% in the intervention group. In total, 95 subjects will be included. The intervention group will receive 1500 mg tranexamic acid versus placebo in the other group. Primary endpoint is reduction of blood loss. Secondary endpoints include occurrence of fibrinolysis during surgery, graft take of the split skin graft, and differences in coagulation and blood clot formation. Discussion: This protocol of a randomized controlled trial aims to investigate the efficacy of tranexamic acid in reducing blood loss during burn excisional surgery. Furthermore, this study aims to clarify the coagulation status after burn trauma and during the surgical process. Trial registration: EudraCT: 2020-005405-10; ClinicalTrial.gov: NCT05507983 (retrospectively registered in August 2022, inclusion started in December 2021). [ABSTRACT FROM AUTHOR]

Burn injuries pose a significant burden on both patients and healthcare systems. Yet, costs arising from the consumption of resources by these patients are rarely examined in Canada. The objective of this study was to assess real-world costs resulting from the initial hospitalization of patients admitted to a major burn unit in Quebec, Canada. A cost study based on a retrospective cohort was undertaken using in-hospital economic data matched to hospital chart data. Our cohort included all burn-injured patients admitted between April 1, 2017, and March 31, 2021, to the hospital's major burn unit during their initial hospitalization. Descriptive statistics were tabulated for sociodemographic and economic data. Costing data were analyzed unstratified and stratified according to burn severity (i.e., ≥ 20% of total body surface area [TBSA] vs. < 20%). Costs were presented in CAD 2021. Our cohort included 362 patients, including 65 (18%) with TBSA ≥ 20%. The average initial hospitalization cost was $32,360 ($22,783 for < 20% TBSA and $76,121 for ≥ 20% TBSA). Conclusion: Findings reveal that the total cost of the initial hospitalization, from a public hospital perspective, was $11,714,348. Our study underlines the substantial burden associated with burns and highlights the need for long-term cost evaluations. • Burn injuries are resource intensive but their exact cost is unknown in Canada. • Real-world cost of the index hospitalization was estimated at $32,360 (CAD 2021). • Heterogeneity of burn patients contributed to a high variability in costs. • Cost of long-term burn injury care remains unknown. [ABSTRACT FROM AUTHOR]

South Asian region contributes 59 % to the global mortality due to burns. However, we find a paucity of literature on the outcomes of burns from low- and middle-income countries (LMICs). South Asian Burn Registry (SABR) is a facility-based burns registry that collected data on in-patient burn care. This study assesses factors associated with mortality, length of hospital stay at the burns center, and functional status of burn patients. Prospective data was collected from two specialized public sector burn centers between September 2014 – January 2015 from Bangladesh and Pakistan. Multivariable logistic, linear, and ordinal logistic regression was conducted to assess factors associated with inpatient-mortality, length of hospital stay, and functional status at discharge, respectively. Data on 883 patients was analyzed. Increased association with mortality was observed with administration of blood product (OR:3, 95 % CI:1.18–7.58) and nutritional support (OR:4.32, 95 % CI:1.55–12.02). Conversely, antibiotic regimens greater than 8 days was associated with decreased mortality (OR:0.1, 95 % CI:0.03–0.41). Associated increase in length of hospital stay was observed in patients with trauma associated with their burn injury, history of seizures (CE:47.93, 95 % CI 12.05–83.80), blood product (CE:22.09, 95 % CI:0.83–43.35) and oxygen administration (CE:23.7, 95 % CI:7.34–40.06). Patients who developed sepsis (OR:6.89, 95 % CI:1.92–24.73) and received blood products during hospitalization (OR:2.55, 95 % CI:1.38- 4.73) were more likely to have poor functional status at discharge. This study identified multiple factors associated with worse clinical outcomes for burn patients in South Asia. Understanding these parameters can guide targeted efforts to improve the process and quality of burn care in LMICs. • Multiple factors determine clinical outcomes for burn injury patients. • In addition to mortality, morbidity and level of functioning are critical outcomes associated with burden of burn injuries. • Patients with comorbid conditions and multiple injuries have long in-patient stay and poorer functional status. [ABSTRACT FROM AUTHOR]

As several recent studies have shown low mortality rates in burn injury induced ARDS early (≤7 days) after the burn, the Berlin criteria for the ARDS diagnosis in this setting may be disputed. Related to this issue, the present study investigated the incidence, trajectory and risk factors of early Acute Respiratory Distress Syndrome (ARDS) and outcome in burn patients, as per the Berlin criteria, along with the concurrent prevalence and influence of inhalation injury, and ventilator-acquired pneumonia (VAP). Over a 2.5-year period, burn patients with Total Burn Surface Area (TBSA) exceeding 10% admitted to a national burn center were included. The subgroup of interest comprised patients with more than 48 h of ventilatory support. This group was assessed for ARDS, inhalation injury, and VAP. Out of 292 admissions, 62 sustained burns > 10% TBSA. Of these, 28 (45%) underwent ventilatory support for over 48 h, almost all, 24 out of 28, meeting the criteria for ARDS early, within 7 days post-injury and with a P a O 2 /F i O 2 (PF) rat i o nadir at day 5. The mortality rate for this early ARDS group was under 10%, regardless of PF ratios (mean TBSA% 34,8%). Patients with concurrent inhalation injury and early ARDS showed significantly lower PF ratios (p < 0.001), and higher SOFA scores (p = 0.004) but without impact on mortality. Organ failure, indicated by SOFA scores, peaked early (day 3) and declined in the first week, mirroring PF ratio trends (p < 0.001). The low mortality associated with early ARDS in burn patients in this study challenges the Berlin criteria's for the early ARDS diagnosis, which for its validity relies on that higher mortality is linked to worsening PF ratios. The finding suggests alternative mechanisms, leading to the early ARDS diagnosis, such as the significant impact of inhalation injury on early PF ratios and organ failure, as seen in this study. The concurrence of early organ failure with declining PF ratios, supports, as expected, the hypothesis of trauma-induced inflammation/multi-organ failure mechanisms contributing to early ARDS. The study highlights the complexity in differentiating between the contributions of inhalation injury to early ARDS and the related organ dysfunction early in the burn care trajectory. The Berlin criteria for the ARDS diagnosis may not be fully applicable in the burn care setting, where the low mortality significantly deviates from that described in the original Berlin ARDS criteria publication but is as expected when considering the actual not very extensive burn injury sizes/Baux scores as in the present study. [Display omitted] • The study revealed that 45% of burn patients with ≥ 10% Total Burn Surface Area (TBSA) required ventilatory support ≥ 48 h. • Inhalation injury, when concurrent with early ARDS, significantly reduced the PaO2/FiO2 (PF) ratios, and increased the overall organ failure rate but did not primarily impact mortality. • A notable early peak in organ failure was observed on day 3, with subsequently a slow decline. This pattern mirrored the trends in PF ratios. • The findings challenge the Berlin criteria for early ARDS diagnosis in burn patients, particularly the link between higher mortality and worsening PF ratios. [ABSTRACT FROM AUTHOR]

After acute burn injury, patients experience a hypermetabolic state often complicated by a stress-induced hyperglycemia. Recent research points towards glycemic variability as a contributing factor in adverse outcomes in critically ill patients. In burn patients, greater glycemic variability has been associated with increased rates of mortality and sepsis. However, no studies to date have examined the impact of glycemic variability on rates of infection in this population or determined which measure may be most useful. Infection, and subsequent sepsis, remains the leading contributor to morbidity and mortality after burn injury. The primary objective of this study is to evaluate the relationship between different measures of glycemic variability and infectious complications in burn patients. This retrospective study included patients admitted to a single American Burn Association-verified burn center between January 1, 2020 and December 31, 2020 with burn or inhalation injury. The primary outcome was a composite of autograft loss, mortality, and proven infection. Secondary outcomes included hospital length of stay and a further analysis of the proven infection component of the composite primary outcome. In addition to mean glucose, several different measures of glycemic variability were used for comparison, including standard deviation, coefficient of variation, mean amplitude of glycemic excursions, and J-index. Outcomes were analyzed using multiple logistic regression analysis while controlling for revised Baux score. A quantile analysis was performed to do determine the optimal mean threshold. Three hundred and ninety-two patients were admitted and screened for inclusion during the study period. Most patients were excluded due to a LOS less than 72 h. 112 patients were included in the study. Of the 112 patients, 22.3% experienced an infectious complication (25 patients with 28 complications). Mean glucose (OR 1.024; 95% CI 1.004–1.045) and J-index (OR 1.044; 95% CI 1.003–1.087) were associated with occurrence of infectious complications. Regarding target mean glucose threshold, a daily mean glucose above 150 mg/dL showed the strongest association with infectious complications (OR 3.634; 95% CI 1.008–13.101). Mean glucose, standard of deviation, and J-index were all independently associated with proven infection. • Mean glucose and J-index were associated with greater rates of infectious complications in burn patients. • Supporting previous literature, a mean glucose of > 150 mg/dL was predictive of infection, graft loss, and death. • Studies examining the effect of glycemic variability on infectious outcomes in higher acuity burn patients is needed. [ABSTRACT FROM AUTHOR]

Burn injuries pose a significant public health challenge, especially in low- and middle-income countries (LMICs). In Bangladesh, burn injuries are prevalent and often result in severe disability or death. However, knowledge regarding the causes of burn injuries, acute burn management, and barriers to seeking burn care in the riverine areas of northern Bangladesh is limited. We conducted a questionnaire-based study in eight subunits and five selected districts in northern Bangladesh to determine the prevalence, causes, and management of burn injuries in these areas. A total of 210 individuals from different households were interviewed, which represented a population of 1020 persons. Among the respondents, 55% reported that at least one member of their household suffered from a burn injury in the past. The most common causes of burn injuries were open fire (41%) and hot fluids (30%). More than 40% of burns were not rinsed with water directly after sustaining the injury. Additionally, almost 30% of respondents did not seek medical care immediately after the injury, with financial constraints being the most commonly cited reason. We found a low rate of adequate cooling and seeking medical care. The need for basic knowledge on prevention and treatment of burn injuries and improved access to affordable health care services in the region is high. • There is a high burn injury prevalence in Bangladesh, leading to severe disability and fatalities. • Open fire and scalds were the most common causes of burn injuries. • A specific household survey in the rural north of Bangladesh was conducted. • There is a concerning lack of immediate water rinsing for almost half of burn injuries. • There is an urgent need for burn injury prevention in northern Bangladesh. [ABSTRACT FROM AUTHOR]

Trauma-informed care practices are associated with a culture of safety following traumatic experiences, including medical trauma. An interactive, web-based training package ('Responsive CARE') was developed for voluntary uptake by paediatric burns health professionals to increase staff knowledge about trauma-informed practice. This paper reports on a mixed methods process evaluation conducted alongside a preliminary effectiveness study of 'Responsive CARE'. The process evaluation was conducted using The Consolidated Framework for Implementation Research (CFIR) and a logic model, to examine feasibility of both the intervention and implementation strategy. Health practitioners (including senior managers) delivering care to children and caregivers attending an outpatient burns service were eligible to enrol in 'Responsive CARE'. Qualitative interview data and quantitative metadata were used to evaluate the implementation outcomes (adoption, acceptability, fidelity, feasibility and preliminary effectiveness). Children and caregivers attending an outpatient service for change of burn wound dressing or burn scar management during the 3-month control or 3-month intervention period were eligible to enrol in the effectiveness study. The impact on child pain and distress, as well as cost, was investigated using a pretest-posttest design. Thirteen (from anticipated 50 enrolled) health professionals (all female) with mean 10 years (SD=11) of experience with paediatric burns hospital-based outpatient care completed an average of 65% (range 36% to 88%) of available content. Twenty-five semi-structured interviews were completed with health practitioners (21 female) and with 14 caregivers (11 female). Four themes were identified as influencing feasibility and acceptability of the intervention: 1) Keeping a trauma-informed lens; 2) Ways of incorporating trauma-informed care; 3) Working within system constraints; and 4) Being trauma-informed. Preliminary effectiveness data included 177 participants (median age 2 years, and median total body surface area burn 1%). Causal assumptions within the logic model were unable to be fully tested, secondary to lower-than-expected adoption and fidelity. We found no significant difference for pain, distress and per-patient hospital care costs between groups (pre- and post-intervention). Future implementation strategies should include organizational support to keep a trauma-informed lens and to incorporate trauma-informed principles within a medical model of care. Despite efforts to co-design a staff education intervention and implementation approach focused on stakeholder engagement, adaptations are indicated to both the intervention and implementation strategies to promote uptake highlighting the complexity of changing clinician behaviours. ● The Consolidated Framework for Implementation Research was a good fit for study purpose. ● Strategies targeting stakeholder engagement were insufficient for optimal uptake. ● Assessing readiness and capacity for change may be central to successful implementation. [ABSTRACT FROM AUTHOR]

Multiplatform messaging applications also referred to as cross-platform instant messaging play an important role in delivery of healthcare and education with its low cost, ease of use and accessibility. To evaluate the existing evidence regarding the use of multiplatform messaging applications in facilitating consultations and decision-making processes in the context of burns care, as well as to assess the impact of such applications on burns care and rehabilitation. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and PROSPERO protocol CRD42021265203. The CASP and JBI tools were used to evaluate the quality of the studies. Eight hundred fifty-three papers were retrieved from PubMed, CINAHL, Scopus, EMBASE and LILACS published up to July 2022 (updated August 2023) with no time restrictions applied. An analysis of the seven studies included in this review, inclusive of 16 Multiplatform messaging applications, revealed six themes. These encompassed the utilization of social media for directing and managing clinical practice, as a mode of communication, for evaluating the quality-of-care provision, for investigating available platforms and their technological features, measuring quality of life and for examining issues related to confidentiality. Multiplatform messaging applications offer a solution for individuals with burn injuries to stay in direct contact with burn specialist clinicians for their follow-up and subsequent rehabilitation phase of recovery. • Multiplatform messaging applications play an important role in burn care. • Such platforms avoid unnecessary admissions and are easily accessible and cost- effective. • Multiplatform messaging apps allow burn survivors and caregivers to maintain direct communication with clinicians. • Multiplatform messaging applications lack transparency regarding confidentiality and privacy. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the moderating role of gender in the relationship between burn severity, perceived stigmatization and depressive symptoms at multiple time points postburn. This multi-center study included data from two cohorts. Cohort 1 consisted of 215 burn survivors, participating in a longitudinal study with measures at 3 and 12 months postburn. Cohort 2 consisted of 180 burn survivors cross-sectionally assessed at 5 – 7 years postburn. Both cohorts completed self-reported measures of perceived stigmatization and depressive symptoms. The number of acute surgeries (i.e., no surgery, 1 surgery or 2 or more surgeries) was used as indicator of burn severity. Relations between number of surgeries, depressive symptoms, and perceived stigmatization, including possible indirect effects, were evaluated with gender-specific path models. In both men and women, number of surgical operations was related to higher levels of depressive symptoms and perceived stigmatization at 3 months after burn. In women, number of operations was still directly related to both constructs at 12 months after burn, which was cross-sectionally confirmed in the 5–7 years after burn cohort. In men, from 3 to 12 months after burn, depressive symptoms and perceived stigmatization were bidirectionally related, and, through these effects, number of surgeries was indirectly related to both outcomes. In the cross-sectional 5–7 years after burn cohort, number of operations was related to stigma but not to depressive symptoms of men. Number of operations had a different effect on psychosocial adaptation of male and female burn survivors. In women, a persistent direct link from number of operations to both depressive symptoms and perceived stigmatization was found over time. In men, the effect of number of operations was most evident in the short-term, after which perceived stigmatization and depressive symptoms became interrelated. This indicates that burn severity remains a factor of significance in psychological adjustment in women, whereas in men, this significance seems to decrease over time. • Effect of burn severity on psychosocial adaptation is gender-related • Women: number of surgeries persistently related to depressive symptoms and stigmatization • Men: number of surgeries indirectly related to depressive symptoms and stigmatization • Men: stigmatization and depressive symptoms strongly interrelated over time [ABSTRACT FROM AUTHOR]

Burns to the face and neck are a source of considerable distress and a challenge to manage with dressings. Further, these often superficial injuries pose a risk of scarring and altered pigmentation. Silicone gels have emerged as a potential solution to the challenges of conservative management for face and neck burn injuries. The aims of this study were to explore the effect of topical silicone compared to routine treatment of conservatively managed burns to the face and neck. This single-blind, randomised, controlled trial compared topical silicone film-forming dressing to standard of care for superficial partial thickness burns to the face and neck. Time to healing was the primary outcome and secondary outcomes included: 1) scar assessments (modified Vancouver Scar Scale, Dermalab Combo and Patient and Observer Scar Assessment Scale) at six weeks and three months; and 2) pain intensity scale at wound review appointments. Of the 55 participants in the face/neck study, 34 were male and 21 were female. Median age was 36 years (range from 25 to 47 years). The median time to healing for the silicone group was 9 days (CI 7.6 −10.4) and the control group was 7 days (CI 5.3- 8.7), p = 0.056. Analysis demonstrated significantly reduced pigmentation at six weeks in mVSS scores for the silicone group (Md = 0, IQR = 0) compared to the control group (Md = 0, IQR = 0 – 3), p = 0.043. We found no evidence of differences in reported pain between the groups (Silicone - Md = 1.15, IQR 0.3 – 4.5 vs control group - Md = 1.5, IQR 0.6 – 3.8, z = −0.63, p = 0.53). No other differences were observed, and no adverse events were associated with the topical silicone in the study whereas an infection and a reaction were experienced in the control group. Film-forming silicone gel had comparable effects to standard of care emollient on wound healing of superficial partial thickness burns of the face and neck. Silicone treated wounds were associated with a significant improvement in scar pigmentation outcome at six weeks post-burn. • Topical silicone gel was comparable to emollient for facial wound healing. • Silicone gel was associated with improved early scar pigmentation outcomes. • No adverse effects were reported with the use of topical silicone gel. [ABSTRACT FROM AUTHOR]

The need to integrate palliative/end-of-life care across healthcare systems is critical considering the increasing prevalence of health-related suffering. In burn care, however, a general lack of practice recommendations persists. Our burn unit developed practice recommendations to be implemented and this study aimed to examine the components of the practice recommendations that were utilised and aspects that were not to guide further training and collaborative efforts. We employed a prospective clinical observation approach and chart review to ascertain the utilisation of the recommendations over a 3-year period for all burn patients. We formulated a set of trigger parametres based on existing literature and burn care staff consultation in our unit. Additionally, a checklist based on the practice recommendations was created to record the observations and chart review findings. All records were entered into a secure form on Google Forms following which we employed descriptive statistics in the form of counts and percentages to analyse the data. Of the 170 burn patients admitted, 66 (39%) persons died. Although several aspects of each practice recommendation were observed, post-bereavement support and collaboration across teams are still limited. Additionally, though the practice recommendations were comprehensive to support holistic care, a preponderance of delivering physical care was noted. The components of the practice recommendations that were not utilised include undertaking comprehensive assessment to identify and resolve patient needs (such as spiritual and psychosocial needs), supporting family members across the injury trajectory, involvement of a palliative care team member, and post-bereavement support for family members, and burn care staff. The components that were not utilised could have undoubtedly helped to achieve a comprehensive approach to care with greater family and palliative care input. We find a great need to equip burn care staff with general palliative care skills. Also, ongoing collaboration/ partnership between the burn care and palliative care teams need to be strengthened. Active family engagement, identifying, and resolving other patient needs beyond the physical aspect also needs further attention to ensure a comprehensive approach to end of life care in the burn unit. • Palliative care is synonymous with end of life care in burns management. • Burn care staff need to be equipped with generalist palliative care skills. • Ongoing collaboration with palliative care teams is warranted to promote access to specialist palliative care. [ABSTRACT FROM AUTHOR]

On February 6, 2023, two separate destructive earthquakes with magnitudes of 7.7 and 7.5 occurred in Kahramanmaraş, Türkiye. More than 50,000 people lost their lives, and over 100,000 were reported injured. In this study, patients referred to hospitals with burn diagnosis and management of burn wounds following the disaster were evaluated. Information on burn injury admissions related to the earthquake was collected from all burn facilities in the country within 15 days after the earthquake. The patients' demographics, being under rubble, rescue times, burn causes, grafting procedures, and deaths were recorded. Following the earthquake, burn victims were transferred to the 13 Burn Treatment Centers located in 10 provinces. A total of 191 patients were burned. Among the burn patients, 101 (52.9%) were rescued from the rubble 2–60 h after the earthquake. Eight patients who were hospitalized at the burn centers died. Scalding and flame burns were the most common etiologies. Burned total body surface area, concomitant crush injury, hospitalization, and mortality was higher among the patients trapped under rubble (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively). Victims who stayed longer time under the rubble required significantly more grafting procedures (p < 0.001). In a literature review, it was observed that there are a limited number of publications reporting earthquake-related burns. In the February, 6 Türkiye earthquake, flame burns were seen due to small fires that occurred in collapsed buildings during the earthquake. And also contact burns and hot liquid burns were seen in earthquake victims trapped under rubble. Bursting hot water pipes, overturned stoves, contact with hot central heating radiators, and heated construction irons caused scalding and contact burns. It is believed that prolonged entrapment may cause delays in burn treatment or lead to deeper burns due to prolonged contact with the burning agent, increasing hospitalization rates. This earthquake once again drew attention to burn injuries that could occur during and after earthquakes, including those that may occur under rubble. • During high magnitude of earthquakes burn injuries could also occur. • Trapped under rubble may result with deeper burn wounds • Being under rubble increase need of grafting for treatment of burns [ABSTRACT FROM AUTHOR]

Few studies have explored the mental health status of parents of children with burns and the moderating effect of social support on them. A survey was performed with parents of 112 burn-injured children at a burn center in China. Their perceived stress, anxiety, depression, sleep quality, and social support were measured by the Chinese Perceived Stress Scale, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, and Perceived Social Support Scale. ➀ The prevalence of anxiety (46.43%), depression (52.67%) and poor sleep quality (43.75%) of parents indicated that they experienced emotional and sleep disorders;➁ The perceived stress was positively correlated with sleep quality, anxiety and depression（P＜0.01), and negatively correlated with perceived social support (p＜0.05); ➂ Social support had a significant moderating effect on their perceived stress and anxiety, depression, but not on their sleep quality. With high social support, parental perceived stress had a significant positive association on anxiety and depression, while with low perceived social support, parental perceived stress had no significant association on anxiety and depression. Parents of burned children had increased stress, obvious symptoms of anxiety and depression, and poor sleep quality. Social support had a significant buffering effect on them under low pressure, and high pressure will hinder the buffering effect of social support on stress. Therefore, the ideal services to improve mental health should be provided for them to face different levels of stress. • Parents of children with burns have high levels of anxiety, depression and poor sleep quality; • Parental perceived stress was positively correlated with their anxiety, depression and sleep quality; • The benefits of increasing social support for parents with low stress in practical life may be higher after the burn event. [ABSTRACT FROM AUTHOR]

Ethnic minorities experience disparities in prevention and treatment of burn injury. Research focused on burn injuries in Indigenous populations is limited. This review summarizes literature on burn injuries in Indigenous populations to be considered to inform new research. A search was conducted in CINAHL, Ovid MEDLINE, PSYCinfo and SocINDEX. for "burn OR scars OR scald OR deformity OR disfigurement" and "Aboriginal OR Indigenous OR First Nation OR American Indian OR Maori OR Native OR Torres Strait Islander OR Amerindian OR Inuit OR Metis OR Pacific Islander". Inclusion 1) peer reviewed studies of burns in Indigenous persons 2) in English. Exclusion 1) no data specific to Indigenous burns 2) not peer reviewed 3) not in full text 4) protocol publications. The search identified 1091 studies with 51 for review. Sixteen were excluded. The 35 included publications were published between 1987 and 2022. Findings indicated higher incidence of injury and poorer outcomes amongst Indigenous people. Indigenous people suffered more flame and inhalation burns, had longer lengths of stay, and more complications including hypertrophic scarring. Australian Indigenous patients struggle with a lack of culturally safe communication and support for aftercare. Racial disparities exist in burn injury incidence and outcome for Indigenous persons. Qualitative research in this area will help providers better understand the experiences of Indigenous burn patients to develop more culturally competent care. We are currently developing a study using qualitative hermeneutic methodology to learn about the experiences of Indigenous burn survivors' injuries, recovery, and social reintegration. • There are disparities in both injury incidence and outcomes for Indigenous populations. • Indigenous populations suffer more flame and inhalation injuries. • Indigenous burn population in Australia are underserved by current aftercare practices. • There is little research in North America addressing burn injuries in Indigenous populations. [ABSTRACT FROM AUTHOR]

To investigate the status of demoralization syndrome and the factors affecting demoralization in burn patients. This study employed a cross-sectional research design and utilized a face-to-face questionnaire to gather data from adult burn patients with burn depths classified as second-degree or higher. The Demoralization Scale Mandarin Version, the Perceived Social Support Scale, the Herth Hope Index, and the Medical Coping Method Questionnaire were used to assess the level of demoralization, perceived social support, sense of hope, and coping strategies, respectively. General information, including socio-demographic data and disease characteristics, were collected. The patients' level of demoralization was categorized as the mean ± 1 standard deviation of the DS-MV scores. The data was analyzed using IBM SPSS 26.0 software to explore the relationship between the variables. This study included 381 burn patients with a mean DS-MV score of 34.62 ± 18.319. Of these, 66 (17.3%) had mild demoralization, 241 (63.3%) had moderate demoralization, and 74 (19.4%) had severe demoralization. Cause of burn, total burn area, average monthly income of the individual, occupation, sense of hope, perceived social support, and medical coping strategies were the important factors associated with the severity of demoralization in burn patients. Patients with burn injuries exhibit a notable prevalence and severity of demoralization indicating focused attention. By considering associated risk factors, healthcare professionals can devise and execute tailored intervention strategies aimed at mitigating the occurrence and intensity of demoralization in burn patients. • More than half of burn patients suffer from demoralization syndrome. • Hope, perceived social support, and acceptance-resignation coping styles are important factors affecting the burn patients' demoralization syndrome. • Total area of burns, cause of burns, occupation, and economic status can influence the level of demoralization among burn patients. [ABSTRACT FROM AUTHOR]

Background and Objectives: Fungal burn wound infections (FBWIs) are one of the most disastrous complications in burn patients. The present study investigated the incidence and the species distribution of fungal agents isolated from burn lesions and reviewed the feautures, underlying conditions, and outcomes of patients. Materials and Methods: The wounds were swabbed and cultured on Sabouraud Dextrose Agar with chloramphenicol medium. Fungal identification was performed using internal transcribed spacer (ITS) and beta-tubulin sequencing. Results: A total of 380 swab specimens were obtained. Of these, 101 patients (26.75 %) were positive in culture. Among the 101 positive cases, most isolates were from males (n= 68, 67.33%) and most of them were over 30 years old. Flame (n=38, 37.63%) was the predominant cause of burns, and previous history of ICU admission (n=35, 34.66%), presence of central venous catheter (n=25, 24.75%), and diabetes mellitus (n=17, 16.83%) were the main underlying conditions. Candida parapsilosis complex (n=36, 35.64%), and Pichia kudriavzevii (C. krusei) (n=8, 7.92%) represent the most commonly isolated species Also, 2 out of 101 patients (2%) died. Conclusion: In the present study, non-albicans Candida species were much higher frequent than C. albicans with most cases associated with Candida parapsilosis complex. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the effects of aerobic exercises in addition to standard treatment on parameters such as neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), and lymphocyte–monocyte ratio (LMR) in patients with burns. A total of 31 hospitalized patients included in the study were divided into two groups using covariate adaptive randomization method according to burn percentage and burn type (1st:standard treatment, 2nd: standard treatment + aerobic training). NLR, PLR, and LMR were evaluated for 5 weeks in all groups. Independent samples t -test and Mann–Whitney U test were used to examine differences between the two groups. For comparing more than two groups, Friedman's test was used for non-normally distributed variables and Bonferroni test was used as the post hoc pairwise comparison method. Intragroup comparison of individuals in group 1 showed that the NLR values on days 7 and 14 were significantly higher than those on days 28 and 35 (p < 0.05). Intragroup comparison of individuals in group 2 showed that the NLR values on days 1, 7, and 14 were significantly higher than those on days 21 and 35. Additionally, the NLR values on day 14 were higher than those on day 28. Individuals in group 1 showed a significant increase in PLR values each week (p < 0.05). The addition of aerobic training to standard treatment in patients with burns may be more effective in improving inflammation markers such as NLR, PLR, and LMR. [ABSTRACT FROM AUTHOR]

The epidemiology, care, and outcomes of perineal and genital burns (PG) in high-income countries have been previously described, but an analysis of this topic in LMICs has yet to be performed. We use the World Health Organization's Global Burn Registry to fill this gap. The GBR was searched from inception to November 2023 to identify all burn patients, excluding cases from high-income countries. Demographics and mechanism of injury were retrieved. Primary outcomes were length of hospital stay (LOHS), surgical intervention, discharge with physical impairment, and mortality. A multivariate regression analysis was performed controlling for burnt total body surface area (TBSA), age, sex, inhalation injury, mechanism of burn and care center characteristics. Of 9041 patients identified, 1213 (13.4 %) had PG burns with 136 (1.6 %) isolated to the PG region. PG patients had higher TBSA (p < 0.001) and more inhalation injury (p < 0.001). They had better access to rehabilitation and lower access to theater space for burns (p < 0.001). Multivariable analysis showed that PG patients had longer LOHS (p = 0.001), greater mortality (p < 0.001), were less likely to undergo surgery (p = 0.01) or be discharged home with physical impairment (p = 0.03). Similarities and differences exist between high- and low/middle-income countries in terms of the patterns of injury, care, and recovery in patients with PG burns. The longer LOHS and higher mortality among PG patients, previously reported in high-income countries, are verified. This highlights the importance of greater vigilance when caring for such patients. [ABSTRACT FROM AUTHOR]

To compare the acute healing outcomes of Biobrane® and Epiprotect® in paediatric partial thickness (PT) burns. All paediatric patients (age <18 years) with PT burns managed using either Biobrane® or Epiprotect® over a 5-year period at our burns unit were included. The primary outcome was time to complete healing. Secondary outcomes included adherence, infection rates, length of hospital stay, duration of acute follow-up and return to the theatre. Among the 99 patients included, 38 received Epiprotect® and 61 received Biobrane®. The mean total body surface area (TBSA) was 6% (range 1%−15%) and median age was 21 months (range 5–169 months). Median time to healing in the Epiprotect® group was 19.5 days and 16 days in the Biobrane® group (P =.14). The median hospitalisation length was the same for both products (2 days, P =.85). Infection rate was lower in the Epiprotect® group (2.6% vs 16.4%, P =.048). There was no difference in adherence rate. These trends were preserved when depth sub-groups were analysed. Adherence and infection rates were not affected by post-operative antibiotics (P >.99 and P =.65, respectively) in either group. The rate of return to the theatre for further surgery was 13.2% for both products (P >.99). Our findings demonstrate that acute healing outcomes with Epiprotect® in paediatric PT burns are comparable to those with Biobrane®, with significantly lower infection rates for Epiprotect®. These results suggest that Epiprotect® is a viable alternative to Biobrane®. Nevertheless, further prospective randomised studies are required to investigate the short- and long-term outcomes. [ABSTRACT FROM AUTHOR]

Management of procedural pain in burn care is challenging. Lidocaine-prilocaine cream 5%, eutectic mixture of local anesthetics (EMLA®), is a widely used, effective local anesthetic cream approved for normal intact skin, genital mucosa for superficial surgical procedures, and debridement of chronic leg ulcers. This comprehensive review aimed to determine the safety, analgesic efficacy, and effects of EMLA on burn pathophysiology to provide evidence-based clinical recommendations for introducing the topical anesthetic into burn care. The PRISMA guidelines were followed for conducting a systematic PubMed search to include all relevant preclinical and clinical studies, according to pre-specified eligibility criteria. Fifteen studies were included in a qualitative synthesis, among which nine were human and six were animal studies. To date, safety and pharmacokinetic data on EMLA application in burns have been limited. Nevertheless, human studies indicated that EMLA is safe and provides adequate procedural-pain relief in adults when applied to smaller burns. Caution should be exercised when using EMLA in younger children, as systemic toxicity, pertaining to prilocaine-induced methemoglobinemia, has been reported owing to overdosing (high doses applied over large burn areas). Furthermore, animal studies demonstrate the potential beneficial effects of EMLA on burn pathophysiology such as anti-inflammatory, decreased capillary permeability to plasma proteins and edema formation, and improved tissue perfusion, which are factors that may impact burn wound progression. Current data on EMLA use in the management of procedural pain in small burns are sparse but suggest that EMLA is safe and effective in adults. Further clinical pharmacokinetic studies are warranted, especially for application on larger burn areas. [ABSTRACT FROM AUTHOR]

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Introduction The rising prevalence of electronic cigarette (e-cigarette) use has prompted concerns regarding its potential health implications. While much attention has focused on respiratory and cardiovascular effects, injuries, oral trauma, and bone fractures linked to e-cigarette use have received less scrutiny. This paper aims to comprehensively review the landscape of injuries, oral trauma, and bone fractures induced by e-cigarettes, shedding light on this underexplored facet of e-cigarette-related harm. Material and Methods This literature review has analyzed 16 papers. Inclusion criteria: researches and case reports published after 2015. PubMed and Google Scholar has been searched to identify the papers. Analysis of the Literature Existing literature suggests a growing incidence of injuries, oral trauma, and bone fractures associated with e-cigarette use, albeit with limited systematic investigation. Mechanisms underlying these injuries range from device malfunctions to inadvertent impacts during use. Case reports highlight a spectrum of injuries, including oral burns, dental trauma, and skeletal fractures, often involving the face and mouth regions. Conclusions Despite the lack of comprehensive epidemiological data emerging evidence underscores the need for heightened awareness and preventive measures to mitigate e-cigarette-related injuries. Enhanced education, regulation of e-cigarette devices, and promotion of safer usage practices are crucial steps towards reducing the burden of e-cigarette-related harm on oral and skeletal health. [ABSTRACT FROM AUTHOR]