Evaluation of who oral rehydration solution (ORS) and salt tablets in resuscitating adult patients with burns covering more than 15% of total body surface area (TBSA).

Intra-venous (IV) burn resuscitation is effective; nevertheless it has its disadvantages. WHO Oral Rehydration Solution (ORS) has shown high effectiveness in treating dehydration. WHO-ORS, with salt supplement, seems to be suitable for burn resuscitation, where IV resuscitation is not available, feasible or possible. The objective of the study was to evaluate acute phase efficacy and safety, as well as limitations and complications of burn resuscitation using WHO-ORS and salt tablets. This randomized controlled clinical trial was conducted in the Burn Unit, Suez Canal University Hospital, Ismailia, Egypt. The study group was given WHO-ORS (15% of body weight/day) with one salt tablet (5gm) per liter according to Sørensen's formula. The control group was given IV fluids according to the Parkland formula. Patients' vital signs and urine output were monitored for 72 hours after starting resuscitation. Both groups were comparable regarding age, sex, and percentage, etiology and degree of burns. For all assessed parameters, there were no major significant differences between the study group (10 cases) and control group (20 cases). Even where there was a significant difference, apart from blood pressure in the first hour of the first day, the study group never crossed safe limits for pulse, systolic blood pressure, urine output, respiratory rate and conscious level. WHO-ORS with 5gm salt tablets, given according to Sørenson's formula, is a safe and efficient alternative for IV resuscitation. It could even be a substitute, particularly in low resource settings and fire disasters.

La réanimation hydro-électrolytique IV initiale des brûlés est efficace mais connaît des effets indésirables. La SRO de l'OMS a montré son efficacité dans le traitement des déshydratations. Cette solution, supplémentée en sel, semble être utilisable pour la réanimation initiale des brûlés lorsque la voie IV n'est pas utilisable. Une étude randomisée prospective a été réalisée dans le CTB du CHU Canal de Suez d'Ismaïlia. Elle avait pour but d'analyser l'efficacité, l'innocuité, les limites et les complications de l'utilisation de la SRO supplémentée en sel dans la réanimation initiale des brûlés. Le groupe à l'étude (10 patients) recevait 15% de son poids de SRO par jour, additionné de 5 g de sel par litre (formule de Sørensen) quand le groupe contrôle (20 patients) était réanimé par voie IV selon la formule de Parkland. Les patients étaient monitorés (paramètres vitaux, diurèse) pendant 72 h. Les groupes étaient comparables en termes de l'âge, du sexe, de la surface, de la profondeur et de la cause de la brûlure. Il n'y avait pas de différence majeure entre les 2 groupes, exceptée une PA plus basse durant la première heure dans le groupe SRO. Il n'a pas été observé, dans ce groupe, d'anomalie dangereuse le la fréquence cardiaque, le la pression artérielle systolique, de la diurèse, de la fréquence respiratoire ni de l'état de conscience. La solution SRO de l'OMS additionnée de 5 g de sel, délivrée selon la formule de Sørensen, est une alternative efficace et sûre à la réanimation IV initiale des brûlés, qu'elle pourrait remplacer dans les pays à IDH bas et en cas de catastrophe.

Assessment of family physicians' knowledge as an indicator of burn management knowledge among non-burn practitioners in Ismialia, Egypt.

The management of burns within the first hours of injury has a significant impact on mortality and morbidity. In case of burns disasters, most patients are managed by non-burn practitioners. The knowledge held by our local family physicians is thought to be representative of that of non-burn practitioners, as they had not partaken in any courses or training on burn management beyond graduation. With regard to emergency burn management, the knowledge required is: assessment of burn extent and depth, associated injuries, indications of escharotomy, fluid therapy and airway management, as well as safe transportation. The aim of this study therefore was to assess the knowledge of family physicians - as an indicator of that of non-burn practitioners - on emergency burn management, and design accordingly an appropriate burn educational program. An interview questionnaire was distributed to all physicians working in Family Medicine Centers in Ismailia, Egypt, who did not possess a post-graduate degree. A total of twenty-four family physicians (100%) participated in this study. The questionnaire findings showed that, out of a possible score of 25 correct answers, the highest result was 12; achieved by 6 physicians (25%). The highest frequency score was 8 correct responses; obtained by 10 physicians (29.2%). This demonstrated a knowledge deficit among Ismailia's family physicians, and subsequently non-burn practitioners, with regard to burns management, due to gaps in undergraduate teaching.

La prise en charge des brûlures pendant les premières heures après le traumatisme a un impact significatif sur la mortalité et la morbidité du patient. Les médecins de famille peuvent représenter les médecins non-spécialistes en brulurologie car ils n'ont pas pris ni des cours ni des formations sur la gestion des brûlures au-delà du diplôme de Médecine. Ces médecins de famille peuvent donc nous donner un indicateur de connaissance de tous les praticiens non-spécialistes en brulurologie en ce qui concerne la prise en charge d'urgence des brûlures. L'essentiel de connaissance que les médecins non-spécialistes en brulurologie doivent maitriser est l'évaluation de l'étendue et de la profondeur de la brûlure et des traumatismes associées, les indications des incisions de décharge, la thérapie liquidienne et les soins de voies respiratoires ainsi que l'assurance de la sureté du transport. L'objectif de cette étude était donc d'évaluer la connaissance des médecins de famille ­ comme un indicateur de celles des praticiens généralistes en ce qui concerne la prise en charge d'urgence des brûlures ­ et de concevoir un programme éducatif approprié. Pour évaluer la connaissance, une questionnaire d'entrevue a été approvisionné aux médecins qui travaillent aux centres de médecine familiale à Ismaïlia, Égypte, qui ne possédaient aucun diplôme d'études supérieures. Un total de vingt-quatre médecins de famille (100%) ont participé à cette étude. Les résultats du questionnaire ont montré que, d'un maximum de 25 bonnes réponses, le résultat le plus élevé était de 12; réalisé par 6 médecins (25%). Le résultat le plus fréquent était de 8 bonnes réponses; obtenus par 10 médecins (29,2%). Cela démontre que chez les médecins de famille d'Ismaïlia, et par la suite chez tous praticiens non-spécialistes en brulurologie, il y a une manque importante de connaissance en ce qui concerne la prise en charge d'urgence des brûlures en raison de lacunes dans l'enseignement de premier cycle.

The clinical and cost effectiveness of bee honey dressing in the treatment of diabetic foot ulcers.

Honey is known, since antiquity, as an effective wound dressing. Emergence of resistant strains and the financial burden of modern dressings, have revived honey as cost-effective dressing particularly in developing countries. Its suitability for all stages of wound healing suggests its clinical effectiveness in diabetic foot wound infections. Thirty infected diabetic foot wounds were randomly selected from patients presenting to Surgery Department, Suez Canal University Hospital, Ismailia, Egypt. Honey dressing was applied to wounds for 3 months till healing, grafting or failure of treatment. Changes in grade and stage of wounds, using University of Texas Diabetic Wound Classification, as well as surface area were recorded weekly. Bacterial load was determined before and after honey dressing. Complete healing was significantly achieved in 43.3% of ulcers. Decrease in size and healthy granulation was significantly observed in another 43.3% of patients. Bacterial load of all ulcers was significantly reduced after the first week of honey dressing. Failure of treatment was observed in 6.7% of ulcers. This study proves that commercial clover honey is a clinical and cost-effective dressing for diabetic wound in developing countries. It is omnipresence and concordance with cultural beliefs makes it a typical environmentally based method for treating these conditions.

Assessment of the relation between prealbumin serum level and healing of skin-grafted burn wounds.

Nutritional status is an important factor in graft healing. Prealbumin (transthyretin) is a better nutritional marker than the widely used albumin serum level. Prealbumin serum levels were estimated in an endeavour to correlate them to graft healing and to serve as a predictor of graft healing in burn wounds. Fifty burned patients undergoing graft in the Suez Canal University Hospital Burn Unit were subjected to this cross-sectional study. Prealbumin levels were assessed on preoperative day and on the fourth postoperative day. Graft healing was considered complete when the take was 90% or more of the grafted area. The most significantly correlated factor to graft healing was serum prealbumin. Serum albumin levels were not in significant correlation with graft healing or prealbumin levels. In addition, serum prealbumin levels were significantly higher in the younger age group and significantly lower in patients with chronic diseases. Serum prealbumin level is a sensitive tool in predicting graft take in burned patients when all local conditions are favourable and optimised. Nevertheless, it seems less sensitive in the prediction of graft healing in small raw areas less than 5% of total body surface area (TBSA).

Assessment of amniotic and polyurethane membrane dressings in the treatment of burns.

As allograft and xenografts are not available in Islamic countries, amniotic membrane seems to be an effective alternative in the management of deep burns. Its proven bioactivities and modest price suggest that it might be superior to synthetic dressings. Forty-six patients were enrolled in this randomized, controlled clinical trial conducted in the Burn Unit at Suez Canal University Hospital, Ismailia, Egypt. All age groups and both gender were included in the study. Only patients with less than 50% total body surface area burned were included, thus minimizing the dropouts in both groups. All were either second or third degree. These patients were randomly assigned either to group I: amniotic membrane (Biomembrane) dressing, or group II: polyurethane membrane (Tegaderm) dressing. Those in group I demonstrated a significantly lower rate of infection and required less frequent dressing changes than those in group II. They also sustained less electrolyte and albumin loss. The rate of healing in the amniotic membrane group was significantly faster than in the polyurethane group. Furthermore, pain was significantly less when Biomembrane was used. Based on these findings, we recommend the use of lyophilized gamma-irradiated amniotic membrane as an effective alternative for allograft and xenografts in Islamic countries and the Jewish population.