Search

This is the first reported case of survival of a significant burn in a patient with established Addison's disease. The systemic stress response to thermal injury is well recognised, there is a marked hypermetabolic response with prolonged periods of catabolism. In particular, the elevation of plasma cortisol levels is crucial for this response to severe systemic stress. Cortisol elevation is maintained for the duration of burn wound healing, is proportional to the burned body surface area and the normal circadian rhythm of endogenous cortisol is lost. Acute adrenal insufficiency has been described in patients suffering major burn injuries with generally poor outcomes. We discuss the management and complications of adrenal replacement therapy in a severe burn setting, as illustrated by this case report. [ABSTRACT FROM AUTHOR]

The number of diabetic patients presenting to burn services is predicted to increase significantly over the next decades. Diabetes mellitus represents an independent risk factor for sustaining burn injuries and mediates alterations to key physiological systems including the vascular, renal, nervous, gastrointestinal and immune system. The effects of the pathophysiological permutations need to be carefully considered during both the acute as well as the long-term rehabilitation phase of injury. The purpose of the first part of this review is to outline the metabolic permutations observed in diabetes mellitus pertinent to the clinical presentation and management of burn patients.

Diabetes mellitus is an increasingly prevalent comorbidity in patients presenting to burn facilities. Diabetic patients tend to be older and present in a delayed manner with deeper injuries predominantly affecting the lower limb. Morbidity from burns is higher in this cohort including a longer length of hospital stay, greater need for surgical interventions and increased rate of infective complications. Nevertheless, there seems to be little effect of diabetes on associated mortality. The second part of this review article concentrates on the epidemiological profile of diabetic burn patients and the effect of the disease on morbidity and mortality. In addition, we present a review of therapeutic adjuncts, which may hold promise for the future management of this cohort of burn patients.

Intracellular synthesis of silver nanoparticles (AgNPs) using Rhodococcus spp. is demonstrated. The synthesized nanoparticles were characterized by UV-Vis spectroscopy, X-ray diffraction, energy dispersive spectroscopy, Fourier trans-form infrared spectroscopy, and transmission electron microscopy. Transmission electron microscopy study of microorganisms' revealed synthesis of nanoparticle was occurring inside the cell, in the cytoplasm. AgNPs ranged from 5 to 50 nm. Formed nanoparticles were stable in the colloidal solution due to presence of proteins on the surface. AgNPs showed excellent bactericidal and bacteriostatic activity against pathogenic microorganisms., (Copyright © 2014 Elsevier B.V. All rights reserved.)

A novel approach for the green synthesis of silver nanoparticles (AgNPs) from aqueous solution of AgNO3 using culture supernatant of phenol degraded broth is reported in this work. The synthesis was observed within 10 h, and AgNPs showed characteristic surface plasmon resonance around 410 nm. Spherical nanoparticles of size less than 30 nm were observed in transmission electron microscopy. X-ray diffraction pattern corresponding to 111, 200, 220, and 311 revealed the crystalline nature of the as-formed nanoparticles. It was found that the colloidal solution of AgNP suspensions exhibited excellent stability over a wide range of ionic strength, pH, and temperature. The effect of pH and ionic strength indicated that stabilization is due to electrostatic repulsion arising from the negative charge of the conjugate proteins. The AgNPs showed highly potent antimicrobial activity against Gram-positive, Gram-negative, and fungal microorganisms. The as-prepared AgNPs showed excellent catalytic activity in reduction of 4-nitrophenol to 4-aminophenol by NaBH4. By manufacturing magnetic alginate beads, the reusability of the AgNPs for the catalytic reaction has been demonstrated.

The green synthesis of supported noble metal nanoparticles is now the most exciting field for various catalytic applications as well as biomedical applications. In this paper we report a novel synthesis method of a polymer consisting of silver nanoparticles (AgNPs) using immobilized microorganisms in alginate beads. Microorganisms present in the polymer reduce aqueous AgNO3 to AgNPs which get trapped in the polymer to form Ag-Alginate (Ag-Alg) biohydrogel. The formed biohydrogel was characterized by UV-visible (UV-Vis) spectroscopy, dynamic light scattering (DLS) spectroscopy, X-ray diffraction (XRD), Fourier transform infrared (FT-IR) spectroscopy, scanning electron microscopy (SEM), energy dispersive X-ray (EDS), transmission electron microscopy (TEM), and selected area electron diffraction (SAED) analysis. TEM analysis showed that less than 15 nm AgNPs formed in the polymer. The Ag-Alg biohydrogel exhibited efficient heterogeneous catalytic activity in the reduction of 4-nitrophenol to 4-aminophenol in the presence of NaBH4 in aqueous solution with durable reusability. Also this biohydrogel showed excellent antimicrobial activity against pathogenic bacteria (antibiotic resistant) and fungi. The described synthesis method of Ag-Alg biohydrogel can be considered robust, cost effective and eco-friendly. The formed highly catalytic active biohydrogel can be used as catalyst in industries and drinking water purification.

The population of overweight patients presenting to burn facilities is expected to increase significantly over the next decades due to the global epidemic of obesity. Excess adiposity mediates alterations to key physiological responses and poses challenges to the optimal management of burns. The purpose of this study is to document the general epidemiological aspects of thermal injuries in the obese population, outline relevant physiological aspects associated with obesity, and draw attention to topics relating to the management, rehabilitation, and prognosis of burns in this emerging subpopulation of patients.

Objective: To report the first case series of gauze-based negative pressure wound therapy (NPWT) as an adjunct to collagen-elastin dermal template resurfacing and provide a brief overview of the current knowledge and controversies regarding NPWT in association with dermal templates., Method: In this prospective study, patients undergoing single stage resurfacing with Matriderm (Dr Suwelack Skin & Health Care, Germany) between September 2007 and September 2008 at Stoke Mandeville Hospital were identified and followed up. A gauze-based NPWT system (V1STA) was used to secure the dermal template and split skin graft to the wound bed. Rates of epithelialisation, the patients' analgesic requirements and patient concordance with the device were all recorded., Results: In the 10 patients studied (7 males and 3 females) this modality of vacuum therapy was found to be effective in all cases for bolstering single stage collagen-elastin dermal templates onto wounds, and contributed to excellent rates of epithelialisation (mean: 94%, range: 70-100%). Additionally, patient concordance with the device was excellent and the costs associated with its use were much lower compared with foam-based NPWT., Conclusion: We recommend the consideration of gauze-based NPWT as cost-effective alternative to foam based modalities in association with the use of dermal templates.

To review the current evidence on therapeutic agents for burns pruritus and use the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) classification to propose therapeutic protocols for adult and paediatric patients. All published interventions for burns pruritus were analysed by a multidisciplinary panel of burns specialists following the GRADE classification to rate individual agents. Following the collation of results and panel discussion, consensus protocols are presented. Twenty-three studies appraising therapeutic agents in the burns literature were identified. The majority of these studies (16 out of 23) are of an observational nature, making an evidence-based approach to defining optimal therapy not feasible. Our multidisciplinary approach employing the GRADE classification recommends the use of antihistamines (cetirizine and cimetidine) and gabapentin as the first-line pharmacological agents for both adult and paediatric patients. Ondansetron and loratadine are the second-line medications in our protocols. We additionally recommend a variety of non-pharmacological adjuncts for the perusal of clinicians in order to maximise symptomatic relief in patients troubled with postburn itch. Most studies in the subject area lack sufficient statistical power to dictate a 'gold standard' treatment agent for burns itch. We encourage clinicians to employ the GRADE system in order to delineate the most appropriate therapeutic approach for burns pruritus until further research elucidates the most efficacious interventions. This widely adopted classification empowers burns clinicians to tailor therapeutic regimens according to current evidence, patient values, risks and resource considerations in different medical environments.

The gastrocnemius muscle remains the workhorse for providing soft tissue over the knee and upper tibia. Nevertheless, we have found the island posterior calf fasciocutaneous flap to be a valuable alternative. We describe 10 cases in which an island posterior calf fasciocutaneous flap was used to cover defects over the knee and tibia. Three cases were after knee arthroplasty wound dehiscence, three cases were of traumatic soft-tissue loss, three cases involved replacement of unstable skin, and one case required closing a synovial fistula. This series is compared with 10 contemporaneous consecutive cases of soft-tissue loss around the knee that were reconstructed with a gastrocnemius muscle flap. Nine posterior calf fasciocutaneous flaps survived completely, and one flap had to be replaced because of poor flow. Although this flap is technically more demanding, we have found that it offers some advantages over the gastrocnemius. These include a greater flexibility of size and shape, a longer arc of rotation to reach suprapatellar defects, the provision of sensate skin with protective though crude sensation, less bulk, and the avoidance of a twitch. The flap is also easy to re-elevate from the recipient site for subsequent orthopedic work.

The fixation of skin grafts often poses a problem, particularly in patients who have undergone tangential excision and grafting for burns. Sutures, staples, fibrin glue and other adhesives have been used for graft fixation. We present the use of Opsite spray as a simple method for graft fixation and stabilization. Opsite markedly reduced pain and discomfort at the time of first graft dressing and obviated the necessity for an anaesthetic which is often required for the removal of staples.

Thirty-two patients were admitted to the South-East Scotland Burn Unit over a 4-year period (1990-94), with burns sustained as a consequence of chip-pan fires. This represented 7 per cent of all admissions to the unit. Fourteen patients came from the Edinburgh city area, and 18 from surrounding countries. There were 14 males and 18 females, and an average age of 51.6 years. The average burn surface area was 4.7 per cent. Eighteen patients had burns to their hands, this being the most common area involved. Fourteen patients were managed conservatively, and 18 needed operative intervention. The patients spent an average of 19.4 days in hospital, and they required 46.3 days for complete healing to take place. Prevention by increased community awareness and widespread education is necessary to minimize the incidence, morbidity and cost of this relatively common and preventable type of burn.