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In recent years, there has been an increased use of neuroleptic agents in the unit care in trauma patients. There is a lack of prospective data, and most of the information is obtained from related cases. It is needed to have a high index of suspicion with regard to excluding neuroleptic malignant syndrome (NMS) in patients taking neuroleptics and presenting with hyperthermia, because of the potentially fatal consequences. It is a rare syndrome in the burn patient with a lack of proven treatments, and high morbidity and mortality are related. In the actual literature there are few related cases of NMS in the polytrauma patient, particularly in association with psychiatric conditions. In burn NMS is a rare complication with difficult diagnosis, because of the similar symptoms that can occur either in patients in the Burn Unit Care with other fatal conditions that are present in the acute phase response. Actually, there is no marker for the NMS, which difficult the early diagnosis and prognosis. The treatment still is based on case reports, with lack of clinical trials, but remain as standard and universally accepted. Besides that, the neural signaling of the NMS indicates possibilities for better understanding of the pathophysiology treatment protocol., (Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.)

Introduction: At all stages of wound healing, growth factors and cytokines play a particularly important role in the interaction with keratinocytes cellular receptors. Keratinocytes have received little attention about their potential to act as a source and target of cytokines. Changes in the cytokine levels after the burning occur prior to the metabolic abnormalities. Thus, it may be possible to develop therapeutic interventions that can mitigate the acute inflammatory response and modulating expression of these cytokines. The objective was to evaluate the expression of 84 genes mediators of the inflammatory response by using PCR array in a primary human epidermal cultured keratinocytes from patients with burns., Methods: Keratinocytes cultured from normal skin around injury from small and large burn patient were treated for DNA synthesis. The samples were analyzed by the PCR Superarray(®) assay and curve analyses were performed for 84 relevant human genes and their involvement in the inflammatory cytokines pathway and receptors. These genes were checked for the up or down regulation. And it was used MetaCore™ for the analysis of networks and Gene Ontology (GO) processes., Results: Chemokines of the CXC family were more expressed in the large burn group, except CXCL12. The C, CC and CX3C chemokine family were downregulated, especially in the small burn group. The interleukins IL8 and IL1B were more expressed in large burn than in small burn; except IL13RA1, IL13 and IL5RA that were downregulated, mainly in the small burn group., Conclusions: The cytokine profile showed some important differences between the large and small burn patients, and from this original database, we can create new interventional trials in acute inflammation in burns., (Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.)

Purpose: To evaluate the expression profile of genes related to Toll Like Receptors (TLR) pathways of human Primary Epidermal keratinocytes of patients with severe burns., Methods: After obtaining viable fragments of skin with and without burning, culture hKEP was initiated by the enzymatic method using Dispase (Sigma-Aldrich). These cells were treated with Trizol(r) (Life Technologies) for extraction of total RNA. This was quantified and analyzed for purity for obtaining cDNA for the analysis of gene expression using specific TLR pathways PCR Arrays plates (SA Biosciences)., Results: After the analysis of gene expression we found that 21% of these genes were differentially expressed, of which 100% were repressed or hyporegulated. Among these, the following genes (fold decrease): HSPA1A (-58), HRAS (-36), MAP2K3 (-23), TOLLIP (-23), RELA (-18), FOS (-16), and TLR1 (-6.0)., Conclusions: This study contributes to the understanding of the molecular mechanisms related to TLR pathways and underlying wound infection caused by the burn. Furthermore, it may provide new strategies to restore normal expression of these genes and thereby change the healing process and improve clinical outcome.