Demographic Assessment of Burn Injuries in Iranian Patients.

Objective: This study investigated the demographic characteristics and factors influencing burn injuries, primarily in low socioeconomic societies where such incidents are prevalent due to factors such as illiteracy and poverty. Methods: This cross-sectional study included all burn patients admitted to Shahid Motahari Hospital in Tehran, Iran. Demographic data such as age, sex, occupation, education level, and residence as well as detailed information about the burn incidents such as date, time, location, number of people present at the scene, and referral place was collected. Additionally, comprehensive burn details such as cause, extent, severity, previous history, and need for hospitalization directly at the emergency department were documented. Results: The study included 2213 patients (mean age 34.98±19.41 years; range 1-96), with a men predominance (60.6%). The majority of burns (64.4%) occurred at home, primarily due to accidents (99.6%), with boiling water being the most common cause (39.2%). The most frequent burns were second-degree burns (91.8%), with an average injured body area of 6.31±6.67%. There were significant correlations between burn severity and demographic factors such as age, sex, occupation, cause of burn, hospital admission, outcome, and length of stay. Remarkably, the extent of burns was negatively correlated with the distance to the hospital, while positively correlated with the length of hospital stay. Conclusion: Burn injuries were significantly influenced by demographic factors. Enhancing treatment facilities and reducing the time and distance to medical care could be crucial in high-risk cases.

Effects of hydrolyzed collagen alone or in combination with fish oil on the gut microbiome in patients with major burns.

Burns are associated with gut dysbiosis. Collagen peptides and omega-3 fatty acids (FAs) are suggested to improve wound healing and the inflammatory response. These are also correlated with microbiome colonization. Therefore, the present study aimed to investigate the effect of hydrolyzed collagen alone or in combination with fish oil on specific species of the gut microbiome in patients with major burns. In this randomized double-blind clinical trial, 57 adults (aged 18-60 years) with 20-45% total body surface area burns were randomised into three groups to receive either 40 gr hydrolyzed collagen +10 ml sunflower oil, 40 g hydrolyzed collagen +10 ml fish oil or placebo, divided into two daily drinks, for two weeks. Gut bacteria were measured using the real-time quantitative polymerase chain reaction (qPCR) method. The mean concentration of Bifidobacterium was significantly reduced in the control (P = 0.002) and collagen (P = 0.005) groups compared with the baseline values, whereas no significant change was observed in the collagen omega-3 group. The Firmicutes to Bacteroidetes ratio decreased significantly in the collagen group (p = 0.002) after supplementation compared to baseline . No significant changes in concentration of Lactobacillus, Enterobacteriaceae, and F.prausnitzii were observed between or within the study groups. Two weeks of supplementation with collagen and omega-3 FAs in patients with major burns did not result in a significant difference in the concentration of bacteria measured between the study groups. However, the addition of omega-3 FAs prevented a significant reduction in gut Bifidobacterium. Future studies are suggested to investigate the potential efficacy of these nutrients in improving the gut microbiota and clinical outcomes in major burns. REGISTRATION NUMBER: IRCT20131125015536N9.

Larval therapy vs conventional silver dressings for full-thickness burns: a randomized controlled trial.

BACKGROUND: This is the first clinical trial to investigate the effectiveness of maggot debridement therapy (MDT) for full-thickness burn injuries in comparison to conventional silver dressings. METHODS: Thirty-one cases with full-thickness (grade III based on ICD-10 classifications version 2019) burns were assigned into larval therapy (15 cases) and conventional treatment (16 cases) groups. Participants in the MDT group have received loose larvae on days 0, 2, 4, and 6, while controls received a conventional regimen comprised of sharp debridement, silver sulfadiazine, antibiotic therapy, and offloading every day. The primary and secondary outcomes were defined as the time to debridement (from admission to skin autograft) and time to healing (from admission to complete healing post-skin autograft). Patients in two groups were also compared in terms of necrosis resolution, granulation, and granulation/necrosis (g/n) ratio during study time periods. RESULTS: Participants who received larvae had significantly decreased necrosis on days 2 (p = 0.028) and 4 (p = 0.023) compared to those who received control treatment. Significant differences (p < 0.001) were also observed for granulation between the two groups in favor of MDT and the fold changes of g/n in the larvae group were 5, 15, and 13 times higher than that for the conventional regimen on days 2, 4, and 6 of treatment, respectively. Strikingly, a subgroup analysis of high necrotic burns (necrosis > 50%) revealed a significant improvement (p < 0.001) for MDT compared to the control treatment. There were also significant differences (p < 0.001) for the time to debridement and time to healing between the two groups. However, bacterial contamination did not show significant changes between the two treatment regimens. CONCLUSIONS: Our findings revealed that MDT has a favorable superiority over conventional regimen for the treatment of grade-III burns, and thus further clinical trials with larger sample size are warranted to confirm these results.

Treatment of superficial and deep partial width second degree burn's wound with allogeneic cord blood platelet gel.

BACKGROUND: Burns are caused by a variety of mechanisms, including flames, hot liquids, metallurgy, chemicals, electric current, and ionizing and non-ionizing radiation. The most significant burn wound management involves complete repair and regeneration as soon as possible while minimizing infection, contraction, and scarring in the damaged tissue area. Some factors such as delivery of nutrients, growth factors, and oxygen are essential to promote and stimulate the wound healing progress in the burns area. When these factors are not provided, the burn wound undergoes a physiological crisis. The use of growth factors is a promising approach to overcoming this limitation. Umbilical cord blood platelet concentrates are a rich natural source of growth factors. METHODS: This clinical trial used growth factors released from the lysis of umbilical cord blood platelet concentrates that have a key role in promoting re-epithelization and regeneration of damaged tissues by forming a fibrin network. This study evaluated the effectiveness of allogeneic cord blood platelet gel topical dressing in a group of patients diagnosed with superficial and deep partial thickness (second-degree) burn wounds. Clinical outcomes were compared between the intervention group and a control group of patients with superficial second-degree burn wounds who received the standard routine treatment including paraffin gauze wound dressing and silver sulfadiazine ointment. RESULTS: The study's results showed that the increased rate of recovery and tissue granulation completely promoted to wound healing and burn wound closure, decreased the recovery time, and reduced inflammation and scars caused by burn injuries. However, the use of cord blood platelet gel topical dressing is not currently a routine treatment method in patients suffering from burn wounds. However, the study's results showed that allogenic cord blood platelet gel could be used to treat superficial and deep second-degree burns as a routine treatment. It was also shown that allogenic cord blood platelet gel topical dressing could be a candidate for autograft or after autograft skin transplantation surgery (in donor and recipient sites) instead of skin surgery in some patients. CONCLUSION: Allogeneic topical wound dressing provides an effective treatment that offers a faster rate of epithelialization and healing of wounds and also decreases patients' scar and inflammation level as well as the length of recovery time. This, finally, leads to better burn wound management and the improved quality of burn wound treatment.

Design and evaluation of a skin-on-a-chip pumpless microfluidic device.

The development of microfluidic culture technology facilitates the progress of study of cell and tissue biology. This technology expands the understanding of pathological and physiological changes. A skin chip, as in vitro model, consisting of normal skin tissue with epidermis and dermis layer (full thickness) was developed. Polydimethylsiloxane microchannels with a fed-batched controlled perfusion feeding system were used to create a full-thick ex-vivo human skin on-chip model. The design of a novel skin-on-a-chip model was reported, in which the microchannel structures mimic the architecture of the realistic vascular network as nutrients transporter to the skin layers. Viabilities of full-thick skin samples cultured on the microbioreactor and traditional tissue culture plate revealed that a precise controlled condition provided by the microfluidic enhanced tissue viability at least for seven days. Several advantages in skin sample features under micro-scale-controlled conditions were found such as skin mechanical strength, water adsorption, skin morphology, gene expression, and biopsy longevity. This model can provide an in vitro environment for localizing drug delivery and transdermal drug diffusion studies. The skin on the chip can be a valuable in vitro model for representing the interaction between drugs and skin tissue and a realistic platform for evaluating skin reaction to pharmaceutical materials and cosmetic products.

Effect of a collagen-enriched beverage with or without omega-3 fatty acids on wound healing, metabolic biomarkers, and adipokines in patients with major burns.

BACKGROUND & AIMS: This study investigated the effects of collagen hydrolysate and omega-3 fatty acids (FAs) on the rate and quality of wound healing, metabolic disorders, and adipose-derived peptides in patients with major burns. METHODS: In this randomized clinical trial, 66 patients with 20-45% deep partial or full-thickness burns were randomly assigned to three groups to receive either a beverage containing collagen (40 gr/d), collagen (40 gr/d) plus 3 gr/d omega-3 (ω-3) FAs, or placebo for four weeks. Wound healing rate, Vancouver scar scale (VSS), as well as baseline, weeks two and three serum concentrations of adiponectin, fibroblast growth factor 21 (FGF21), neuregulin 4 (NRG4), transforming growth factor (TGF)-ß1, and pre-albumin/hs-CRP ratio were assessed. RESULTS: The wound healing rate during the weeks post-burn (p = 0.006 and p = 0.01), and days of 95% (21.3 ± 6.8 and 22.9 ± 8.7 vs. 34.3 ± 14.8 days, p = 0.003 and p = 0.03) and complete (26 ± 7.7 and 27.4 ± 9.4 vs. 41.1 ± 16.6 days, p = 0.003 and p = 0.01) wound healing were significantly better with Collagen and Collagen. ω-3 compared to the placebo group. The VSS was significantly lower, indicated better scar status, in the both intervention groups compared to the placebo (p = 0.02 and p = 0.01). Wound healing outcomes were not statistically different between the Collagen and Collagen. ω-3 groups. Hs-CRP/pre-albumin ratio was significantly lower in the Collagen. ω-3 than the placebo group at week three (1.2 ± 1.9 vs. 4.8 ± 7.7 dl/l, p = 0.03). The significant decrease in serum adiponectin seen during the trial course within the placebo (10 ± 8.8 to 5.8 ± 4.9 mg/l, p = 0.03) and Collagen (11.8 ± 14 to 8.6 ± 11.7 mg/l, p = 0.03) groups was prevented in the Collagen. ω-3 group (p = 0.4). Circulating FGF21 decreased significantly within the Collagen (p = 0.005) and Collagen. ω-3 (p = 0.02) groups at the end of week three compared to the baseline. CONCLUSIONS: Adding collagen hydrolysate as part of adjunctive therapy improved wound healing rate and quality. These findings as well as the efficacy of omega-3 FAs need to be further confirmed in larger populations. This study was registered with the Iranian Registry of Clinical Trials (IRCT20090901002394N42).

Comparison of the Effect of Using Collective Plus Ag Dressing and Vaseline Gauze Dressing in the Donor of Split-Thickness Burn Grafts.

Background: Skin graft involves removing a part of the skin and using it in another part of the body. One of the most common reasons for using a graft is burns. We aimed to compare the effect of Colactive plus Ag dressing with Vaseline gauze dressing in donor sites of split-thickness skin grafts of burned patients. Methods: The present study was conducted as a randomized clinical trial (RCT) in the Motahari burn Hospital, Tehran, Iran in 1401. The sampling method was done using Cochran's formula and available patients so 15 people were enrolled. The findings of the study were collected using a researcher-made form. Results: The average duration of recovery, the amount and intensity of pain, and the amount of itching between the two types of Colative plus Ag plus Ag dressing with Vaseline gauze are statistically significant at the 95% confidence level. (P-value<0.05). In addition, the findings showed that the average amount of scar left by the wound in the two types of dressings examined is not statistically significant at the 95% confidence level (P-value > 0.05). Conclusion: The use of Colactive silver dressing has less pain, less itching in the donor area, and a shorter average recovery time than Vaseline gauze. The use of the Colactive plus Ag will be more effective than Vaseline gauze.

Comparing Auditory and Visual Distractions for Reducing Pain Severity and Pain Anxiety in Older Outpatients with Burn: A Randomized Controlled Trial.

Pain and anxiety are major issues among older patients with burn injuries. Complementary medicine and non-pharmacological methods can relieve pain and anxiety in older people, but comparison of the effects of these methods needs further research. This study aimed to compare the effects of auditory and visual distractions on pain severity and pain anxiety in older outpatients referred to a burn clinic for dressing change. In this randomized controlled clinical trial, older men were randomly assigned to three groups as auditory distraction, visual distraction, and control (n = 45 in each group). The Visual Analogue Scale (VAS) and the Burn Specific Pain Anxiety Scale (BSPAS) were used to asses pain severity and pain anxiety before and immediately after the interventions, and after wound dressing. Reduction in pain severity and pain anxiety after visual distraction was reported. Auditory distraction only reduced pain anxiety. Therefore, visual distraction had a better effect on alleviating pain anxiety compared with auditory distraction. Visual distraction is suggested to be used during dressing changes for older outpatients with burn injuries in outpatient clinics in order to reduce their burn-related suffering and improve their collaboration with the therapeutic regimen.

Skin Grafting Compared with Conservative Treatment in Patients with Deep Second-Degree Burn Wounds of the Trunk and Buttocks.

BACKGROUND: Burns are among the most common causes of injury and result in long-term morbidity, psychological complications, and reduced quality of life. We aimed to evaluate and compare the results of skin grafting versus nonsurgical treatment in patients with deep second-degree burn wounds of the back and posterior trunk. METHODS: This is a descriptive-analytical cross-sectional study of patients with trunk and buttock burns admitted to Burn Hospital in Shiraz, Iran from 2017 to 2019. The skin surface with burns and the final repaired tissue was measured. The Vancouver Scar Score (VSS) and pigmentation, vascularity, thickness, and pliability were assessed. VSS, pigmentation, vascularity, thickness and pliability were considered as outcomes. RESULTS: Seventy-five patients met the criteria for participation; thirty-two patients had skin grafts. The mean age was 27.79±20.03 yr and 53 patients (70.7%) were male. Scars were compared based on pigmentation, vascularity, thickness, and pliability, which was also statistically significant (P<0.001). The mean of VSS was higher in patients with skin graft than those without graft (P<0.001). CONCLUSION: The mean VSS was significantly higher in patients with grade 2 deep burns who received skin grafting than in patients without skin grafting. Due to the lack of donor sites and the need to prioritize skin grafts in burn patients with high total body surface area, it is better to perform skin grafts on the posterior trunk and buttocks in areas with deep grade 2 burns as a last priority and treat this wound with conservative therapy.

Enhancing of Wound Healing in Burn Patients through Candida albicans ß-Glucan.

The mortality and disability-adjusted life years (DALYs) of burn patients are decreasing over time. However, finding novel effective treatment approaches using natural agents is highly considered to reduce the burden of burn injuries. One of the recent agents used in wound healing is ß-glucan, mainly extracted from fungi cell walls. This study aimed to evaluate the effect of 5% (m/m) of yeast ß-glucan ointment on burn wound healing and to assess the impact of ß-glucan on cytokines during the treatment. Thirty-three patients with second or third-degree burns were enrolled in this study. Two groups of twenty-three and ten patients used yeast 5% (m/m) ß-glucan ointment (study group) and Stratamed ointment (control), respectively, on a daily basis, for a maximum of four weeks. The size of the burn wounds was measured before and at the end of the treatment. Blood samples of 14 and 10 patients in the ß-glucan and control groups, respectively, were obtained before and after the treatment, and the enzyme-linked immunosorbent assay (ELISA) was performed to measure the serum concentration of the IL-4, IL-17, and IFN-γ cytokines. The log-binomial model was used to assess the efficacy of the ß-glucan ointment on burn wound healing. ANOVA/ANCOVA was employed to assess the effects of ß-glucan on the serum concentration of cytokines. After adjusting for potential confounders/covariates, patients receiving ß-glucan had better wound healing (RR = 4.34; 95% CI: 0.73 to 25.67; p = 0.11). There was a significant difference in IL-4 secretion between the ß-glucan and control groups after adjusting for potential confounders/covariates (MD = 77.27; 95% CI: 44.73 to 109.82; Cohen's d = 2.21; 95% CI: 1.16 to 3.24; p = 0.0001). The results indicate that 5% (m/m) of ß-glucan has efficacy in burn wound healing, and a significant difference was found in the level of IL-4 after receiving ß-glucan. Further studies with a two-arm design and long-term use of ointment are needed to confirm the effect of ß-glucan on wound healing and cytokine secretion.

Effects of Photobiomodulation and Split-Thickness Skin Grafting in the Prognosis of Wound Healing in Children with Deep Burn Ulcers.

Background: Split-thickness skin grafting (STSG) is a standard therapeutic technique in patients with extensive and deep ulcers. Hospitalization and surgery can result in complications, especially in children. Photobiomodulation (PBM) has been applied in a variety of conditions such as healing of surgical, venous, pressure, and diabetic wounds, but no clinical trial using this method for healing of burn ulcers in children was found on searching the literature. The aim of the study was to evaluate the effect of PBM on the outcome of burn ulcers in children. Materials and methods: Informed consent and protocols were reviewed according to Shahid Beheshti University of Medical Sciences' Medical Ethics Board (IR.SBMU.REC.1394.363) and the Iranian Registry of Clinical Trials (IRCT2016011726069N1). Forty children with deep burn ulcers, who were candidates for STSG, were divided into PBM and STSG groups. A 650-nm laser (power 150 mW, spot size 0.6 cm2, time 10 sec, and energy point 1.5 J) was used for irradiation over the burn area every other day until complete healing in the PBM group. STSG was performed in the STSG group. All other therapeutic care protocols were identical. Results: Thirty-nine children completed the study. The mean ulcer size in the two groups was similar before treatment (PBM = 60.72 cm2 ± 13.8 and STSG = 63.74 ± 7.6). In the PBM group, all wounds healed within 10-12 sessions. Analysis of the burn area was performed 1, 3, and 6 months after injury. There was a significant difference (t test) in the burn area after 6 months in the PBM group compared with the STSG group (t test; p > 0.001). Conclusions: This is the first study to compare PBM and STSG in burn ulcers in children. Results indicated that PBM was an effective alternative to STSG, significantly decreasing the rate of scar and hypertrophic scar formation. Potential mechanisms of PBM that may be involved in burn tissue repair are discussed.

Management of Pyogenic Granulomas Following Burn Wounds.

Pyogenic granuloma following burns (PGB) manifest in patients with different clinical and pathological features which is completely different with classic pyogenic granuloma. Up to now, there is no conclusive theory about presents of PG and its accurate etiology. This is a short brief about a 49-yr-old female with, TBSA 1% which PG develop on her burned area after 2 weeks.

An unprecedented increase in burn injuries due to alcohol-based hand sanitizers during the COVID-19 outbreak.

Background: Due to the COVID-19 outbreak, protective measures including alcohol-based hand rub, received unexampled popularity in Iran. Alcohol hand rub is effective, inexpensive and simple to use, but it is a flammable liquid, which might cause burn injuries. In this study, we investigated burn injuries due to alcohol hand sanitizers during the COVID-19 disease outbreak in Iran. Methods: This cross-sectional study was performed on burn patients referred to Motahari Burns and Reconstruction Center from February 20th, 2020 (official announcement of the epidemic of COVID-19 in Iran) up to April 19th, 2020. All outpatients and hospitalized burn injuries caused by alcohol during the abovementioned period were included. Results: There were 76 burn injuries due to the use of alcohol hand sanitizer. Sixty patients were treated outpatient, and 16 were hospitalized. The mean ± SD age of patients was 33.2±17.9 years and most were males (57 individuals, 75%). Also, the mean ± SD of TBSA was 6.1±6.5%. In hospitalized ones, the mean ± SD hospital stay was 11.7±8.6 days. The most burnt area was the head (39.5%) followed by the right upper limb (35.5%) and the left upper limb (23.7%). Patients were actively engaged in burn injury in 61.8% of cases, while they were passively burnt in 34.2% of cases and in 3.9% the mechanism was unknown. Burn injuries mostly happened in the yard (22.4%) followed by the rooftop (21.1%) and outdoors (18.4%). Conclusion: Appropriate general education, especially through mass media, can reduce burns caused by alcohol-based sanitation during the COVID-19 outbreak. Most of these burn injuries involved face and hands, which are cosmetically and functionally important.

Effect of Collagen Hydrolysate and Fish Oil on High-Sensitivity C-Reactive Protein and Glucose Homeostasis in Patients with severe Burn; a Randomized Clinical Trial.

INTRODUCTION: Collagen and omega-3 fatty acids (FAs) are suggested to have anti-inflammatory, anti-oxidant, and insulin-sensitizing properties. The aim of this study was to investigate the effect of collagen hydrolysate and omega-3 FAs on inflammation and insulin resistance in patients with major burns. METHODS: In this double-blind randomized clinical trial, 66 patients with 20-45% burns were assigned to either of the three groups of collagen (40 gr/d), collagen (40 gr/d) plus fish oil (10 ml/d), or control. High-sensitivity C-reactive protein (hs-CRP), fasting blood glucose (FBG) and insulin concentrations, and homeostatic model assessment for insulin resistance (HOMA-IR) were assessed at baseline, as well as end of weeks two and three. RESULTS: Based on post-hoc analyses, hs-CRP levels were significantly lower in the collagen (p=0.026) and collagen+omega-3 (p=0.044) groups compared to the control group, at week three. However, pre- to post- (week three) changes of hs-CRP were significantly higher only in the collagen+omega-3 group compared to the control group (173.2 vs. 103.7 mg/l, p=0.024). After three weeks of the intervention, insulin (11.3 and 11.9 vs. 22.8 µIU/ml) and HOMA-IR (2.9 and 2.8 vs. 7.9) values seemed to be clinically, but not statistically, lower in both intervention groups compared to the control group. Pre- to post- (week three) values of FBG decreased significantly in the collagen (p=0.002) and collagen+omega-3 (p=0.036) groups. Insulin (p=0.008) and HOMA-IR (p=0.001) decreased significantly only in the collagen+omega-3 group at week three compared to the baseline. CONCLUSIONS: Supplementation with collagen hydrolysate and omega-3 FAs can improve hs-CRP concentration and probably insulin resistance in patients with severe burns. Omega-3 FAs had additional effects on modulating inflammation. Larger clinical trials are needed to confirm the current findings especially in terms of glucose homeostasis.

A comparison on the scar development when done through overlapping versus approximating seams techniques - A clinical trial.

INTRODUCTION: Skin autografting is performed widely for deep burn wounds as an ideal coverage. Scaring at the site of grafting has been always a challenge for surgeons. Many methods have been proposed to lessen the probability of scaring, but conflicting results have been obtained. It is said that the suture type is important in the development of scaring. Seams technique has also been introduced to decrease scar after autografting. OBJECTIVE: We sought to compare two approximating (AP) and overlapping (OV) Seams technique to compare the development of scars. METHODS AND MATERIALS: Patients with deep burns of 10% to 50% TBSA who were candidates for grafting entered this double-blind randomized trial. One side of the graft was fixed with a stapler using the "approximating" technique and the other side was fixed by the "overlapping" technique with a 1-2 mm margin overlap. The Vancouver Scar Scale (VSS) standard was used to evaluate scar formation at the graft edges at six months. Data entered SPSS 16 and analyzed. A P-value below 0.05 was considered as statistically significant. RESULTS: Thirty-six patients entered. Two (5.6%) were females and 34 (94.4%) males. The mean age of patients was 39.14 ± 8.53 years. The mean burn surface area percentage was 15.2 ± 2.84. Vascularity Scar index had no statistically significant difference between the overlapping and approximating techniques (P = 0.564). However, pigmentation (P = 0.014), pliability (P = 0.008) and the height indices (P < 0.001) were statistically significantly better in the approximating technique. The mean of total score of Vancouver was better in the approximating technique as well (P < 0.001). CONCLUSION: We compared two techniques of Seams between the normal skin and the graft edge for the first time. We showed that the AP method had a better Vancouver score compared to the OV regarding pigmentation, height, and pliability indices.

Efficacy of allogeneic cord blood platelet gel on wounds of dystrophic epidermolysis bullosa patients after pseudosyndactyly surgery.

Epidermolysis bullosa (EB) is a rare genetic disorder characterized by the formation of blisters and wounds in skin and mucous membranes; it is classified into four types and has various methods of treatment. Management of previous wounds and prevention of formation of new lesions are the most important strategies in the course of therapy to improve patient's quality of life; lack of wound management can lead to further complications such as infection. The current study investigated the therapeutic effects of allogeneic platelet gel (prepared from umbilical cord blood) in a group of children diagnosed with dystrophic epidermolysis bullosa (DEB) eligible for surgical correction of pseudosyndactyly in the hand. The post-surgical clinical outcome in this group was compared with the clinical outcomes of DEB patients receiving the standard treatment (paraffin gauze wound dressing and topical antibiotics) after corrective surgery. The current study results showed an increase in the rate of recovery and promotion of tissue granulation, complete wound healing, and a decrease in pain level and treatment period. The application of cord blood platelet gel topical dressing was not a conventional method of treatment in patients with DEB wounds and blisters. However, the current study results demonstrated that this gel dressing could effectively accelerate epithelialization and healing of the wounds and decrease patients' pain and post-surgical recovery period, which altogether leads to improvements in patients' overall quality of life.

Comparison of Modified Meek Technique with Standard Mesh Method in Patients with Third Degree Burns.

BACKGROUND: Covering burn wounds, especially high surface area burns has been always a challenge for surgeons. The Meek technique has been introduced to increase the covering area. There is paucity of clinical trials comparing the Meek technique and mesh in the same individuals to assess it efficacy. METHODS: In a case-control study, 20 patients with grade III burns who underwent the Meek technique and mesh in different areas/limbs were enrolled. Expansion rate, re-epithelization, operation time, wound infection, graft failure, etc. were compared between the two groups. RESULTS: Among patients, 18 were males and 2 were females. The mean of total body surface area (TBSA) was 36.9±16.6%. Mean time of re-epithelialization in the Meek group was 2.8±2.5 months and in the mesh group was 5.0±2.1 months (p=0.01). Operation time was shorter in modified Meek technique (p=0.04). Expansion ratio was higher in modified Meek technique (p=0.04). Local wound infection rates were slightly different without a statistically significant difference. CONCLUSION: Meek technique provided higher surface area coverage in comparison to mesh; in addition to faster re-epithelization. Therefore, it is recommended to consider the Meek technique as a routine procedure, especially those with high surface area burns.

Simvastatin combined with bone marrow mesenchymal stromal cells (BMSCs) improve burn wound healing by ameliorating angiogenesis through SDF-1α/CXCR4 pathway.

OBJECTIVES: Chemokines are wound mediators that promote angiogenesis during wound healing. We hypothesized that Simvastatin in combination with the bone marrow mesenchymal stromal cells (BMSCs) improve burn wound healing by ameliorating angiogenesis via SDF-1α/CXCR4 pathway. MATERIALS AND METHODS: Under general anesthesia, deep partial-thickness burns were created on the inter-scapular area of 48 male rats. Study groups were administrated with petroleum jelly (Simvastatin Vehicle), a single dose of intradermal BMSCs (1×106), topical Simvastatin (0.5 mg/kg) daily and combination of BMSCs and Simvastatin for 14 days. In this study, we used MTT assay, in vivo and in vitro wound closure, H&E and Trichorome staining, immunohistochemistry (IHC), real- time PCR, Western blot and tube formation assay. RESULTS: A significant improvement in wound closure percentage, epithelial thickness, collagen remodeling, and up-regulation of stromal cell-derived factor 1 alpha (SDF1α), C-X-C chemokine receptor type 4 (CXCR4), protein kinase B (AKT), and phosphatidylinositol 3- kinase (PI3K), as well as CD31 and vascular endothelial growth factor (VEGF) expression were observed after treatment with simvastatin, BMSCs and combination of them compared to the vehicle group. However, the co-treatment group revealed considerable superiority in examined factors. BMSCs treated with Simvastatin showed the highest viability in the concentration of 0.5 and 1 Nanomolar (nM). Increment in proliferation and capillary vessels formation of BMSCs was observed in the 0.5 nM and 1 nM concentrations of Simvastatin in vitro. CONCLUSION: Treatment of deep partial-thickness of burns with co-treatment of BMSCs and Simvastatin resulted in improved burn wound healing through up-regulating of SDF-1α/CXCR4 pathway.

Candidemia in pediatric burn patients: Risk factors and outcomes in a retrospective cohort study.

BACKGROUND AND PURPOSE: Despite advances in burn care and management, infections are still a major contributor to morbidity and mortality rates in patients with burn injuries. Regarding this, the present study was conducted to investigate the prevalence and importance of candidemia in pediatric burn patients. MATERIALS AND METHODS: Blood samples were collected from the patients and cultured in an automated blood culture system. Candida species were identified using specific culture media. The relationship between candidemia and possible risk factors was evaluated and compared to a control group. RESULTS: A total of 71 patients with the mean age of 4.52±3.63 years were included in the study. Blood cultures showed candidemia in 19 (27%) patients. Based on the results, C. albicans was the most common fungus among patients with and without candidemia. The results of statistical analysis also showed that candidemia was significantly correlated with total body surface area (TBSA), mechanical ventilation, duration of total parenteral nutrition, length of intensive care unit (ICU) stay, presence of neutropenia, and R-Baux score (all P≤0.001). In this regard, TBSA, length of ICU stay, R-Baux score, and Candida score were identified as the determinant factors for mortality due to candidemia. CONCLUSION: Candidemia increases the mortality and morbidity rates associated with burn injuries. Prompt diagnostic and prevention measures can reduce the unfortunate outcomes via controlling the possible risk factors.