Surviving Sepsis After Burn Campaign.

INTRODUCTION: The Surviving Sepsis Campaign was developed to improve outcomes for all patients with sepsis. Despite sepsis being the primary cause of death after thermal injury, burns have always been excluded from the Surviving Sepsis efforts. To improve sepsis outcomes in burn patients, an international group of burn experts developed the Surviving Sepsis After Burn Campaign (SSABC) as a testable guideline to improve burn sepsis outcomes. METHODS: The International Society for Burn Injuries (ISBI) reached out to regional or national burn organizations to recommend members to participate in the program. Two members of the ISBI developed specific "patient/population, intervention, comparison and outcome" (PICO) questions that paralleled the 2021 Surviving Sepsis Campaign [1]. SSABC participants were asked to search the current literature and rate its quality for each topic. At the Congress of the ISBI, in Guadalajara, Mexico, August 28, 2022, a majority of the participants met to create "statements" based on the literature. The "summary statements" were then sent to all members for comment with the hope of developing an 80% consensus. After four reviews, a consensus statement for each topic was created or "no consensus" was reported. RESULTS: The committee developed sixty statements within fourteen topics that provide guidance for the early treatment of sepsis in burn patients. These statements should be used to improve the care of sepsis in burn patients. The statements should not be considered as "static" comments but should rather be used as guidelines for future testing of the best treatments for sepsis in burn patients. They should be updated on a regular basis. CONCLUSION: Members of the burn community from the around the world have developed the Surviving Sepsis After Burn Campaign guidelines with the goal of improving the outcome of sepsis in burn patients.

Burn Admissions Across Low- and Middle-income Countries: A Repeated Cross-sectional Survey.

Burn injuries have decreased markedly in high-income countries while the incidence of burns remains high in Low- and Middle-Income Countries (LMICs) where more than 90% of burns are thought to occur. However, the cause of burns in LMIC is poorly documented. The aim was to document the causes of severe burns and the changes over time. A cross-sectional survey was completed for 2014 and 2019 in eight burn centers across Africa, Asia, and Latin America: Cairo, Nairobi, Ibadan, Johannesburg, Dhaka, Kathmandu, Sao Paulo, and Guadalajara. The information summarised included demographics of burn patients, location, cause, and outcomes of burns. In total, 15,344 patients were admitted across all centers, 37% of burns were women and 36% of burns were children. Burns occurred mostly in household settings (43-79%). In Dhaka and Kathmandu, occupational burns were also common (32 and 43%, respectively). Hot liquid and flame burns were most common while electric burns were also common in Dhaka and Sao Paulo. The type of flame burns varies by center and year, in Dhaka, 77% resulted from solid fuel in 2014 while 74% of burns resulted from Liquefied Petroleum Gas in 2019. In Nairobi, a large proportion (32%) of burns were intentional self-harm or assault. The average length of stay in hospitals decreased from 2014 to 2019. The percentage of deaths ranged from 5% to 24%. Our data provide important information on the causes of severe burns which can provide guidance in how to approach the development of burn injury prevention programs in LMIC.

Uso de apósitos en quemaduras / Dressing options in burns

Además de la naturaleza y el alcance de las lesiones que influyen en las infecciones, el tipo y la cantidad de microorganismos que colonizan la herida por quemadura parecen influir en el riesgo futuro de infección invasiva de la misma. Por esta razón, en el presente artículo analizamos algunas de las diferentes opciones de apósitos utilizados más frecuentemente en el manejo de la lesión por quemadura, con mayor énfasis en los empleados personalmente y considerando que el conocimiento adecuado de estos productos favorece el manejo ambulatorio de los pacientes que sufren quemaduras, puesto que son herramientas efectivas siempre y cuando se utilicen en la manera y tiempo adecuados

In addition to the nature and extent of the lesions influencing infections, the type and number of microorganisms that colonize the burn wound appear to influence the future risk of invasive wound infection. For this reason, this article discusses some of the different dressing options most frequently used in the management of burn injury, more emphatically in those used personally, considering that the appropriate knowledge of these products promote the outpatient management of patients suffering burns; dressings provide effective tools as long as they are used in an appropriate manner and time

Human Mesenchymal Stem Cells: The Present Alternative for High-Incidence Diseases, Even SARS-Cov-2.

Mesenchymal stem cells (MSCs), defined as plastic adherent cells with multipotent differentiation capacity in vitro, are an emerging and valuable tool to treat a plethora of diseases due to their therapeutic mechanisms such as their paracrine activity, mitochondrial and organelle transfer, and transfer of therapeutic molecules via exosomes. Nowadays, there are more than a thousand registered clinical trials related to MSC application around the world, highlighting MSC role on difficult-to-treat high-incidence diseases such as the current COVID-19, HIV infections, and autoimmune and metabolic diseases. Here, we summarize a general overview of MSCs and their therapeutic mechanisms; also, we discuss some of the novel clinical trial protocols and their results as well as a comparison between the number of registries, countries, and search portals.

[Verapamil in conjunction with pressure therapy in the treatment of pathologic scar due burn injury]. / Verapamilo en conjunto con prendas de compresión en el tratamiento de cicatriz patológica causada por quemadura.

BACKGROUND: Keloids and hypertrophic scars are dermal fibro-proliferative disorders unique to humans. Their treatment is a true challenge with multiple options, but not all the time with good results. Unfortunately this problem is not uncommon in patients with history of burn injury. The aim of this article is to evaluate the use of verapamil and pressure garments in patients with hypertrophic or keloid scar caused by burn injury. METHODS: We included patients with a hypertrophic or keloid scar caused by burn injury candidate to treatment with pressure garment. The pathologic scars were evaluated by serial photographic records, Vancouver and Posas scales. The scales of Vancouver and Posas were compared with t Student. RESULTS: We included 13 scars in 11 patients. Four scars were located in the legs, 4 in the arms, 4 in the face-neck and 1 in the abdomen. The dose of verapamil was calculated .03mg per kg. Injections were scheduled every 7 to 10 days until complete 6 sessions. Taking in count Posas scale, patients referred improvement in pigmentation (.01), thickness (.005), pliability (.01) and surface area (.004). In the Vancouver scale the observers mentioned improvement in elevation (.008), pigmentation (.014), vascularity (.022), flexibility (.014) and pruritus (.003). No adverse effects were found in verapamil injection. CONCLUSIONS: Verapamil was useful in conjunction with pressure garment to improve the condition of the keloid and hypertrophic scar caused by burn.

Introducción: la cicatriz queloide y la hipertrófica son desordenes fibro-proliferativos únicos de los humanos, su tratamiento representa un reto en con pocas opciones. El uso de prendas de compresión resulta útil, sin embargo el proceso de maduración no es tan rápido; decidimos usar verapamilo para facilitar este proceso y poder mejorar la calidad de vida de nuestros pacientes. El objetivo de este estudio es evaluar el uso del verapamilo y las prendas de compresión en pacientes con cicatrización patológica como consecuencia de quemadura. Métodos: incluimos pacientes con cicatrización patológica, ya sea queloide o hipertrófica, causada por quemadura. La cicatriz fue evaluada con fotografías seriadas, escala de Vancouver y Posas. Los resultados fueron comparados con la prueba de t de Student. Resultados: incluimos 13 cicatrices en 11 pacientes. La localización de las cicatrices fue en: brazos 4, piernas 4, cara y cuello 1, y abdomen 1. La dosis de verapamilo se calculó a .03 mg por kg de peso. Las inyecciones se aplicaron de manera intralesional y se administraron cada 7 a 10 días, hasta completar 6 sesiones. Encontramos mejoría en los siguientes parámetros de la escala de Posas: pigmentación, pliabilidad, endurecimiento y superficie. En la escala de Vancouver: elevación, pigmentación, vascularidad, flexibilidad y prurito. No encontramos efectos adversos con la administración de verapamilo. Conclusiones: el verapamilo fue útil en conjunto con las prendas de compresión para mejorar las condiciones de la cicatriz queloide e hipertrófica causadas por lesiones por quemadura.

Noninvasive determination of burn depth in children by digital infrared thermal imaging.

Digital infrared thermal imaging is used to assess noninvasively the severity of burn wounds in 13 pediatric patients. A delta-T (ΔT) parameter obtained by subtracting the temperature of a healthy contralateral region from the temperature of the burn wound is compared with the burn depth measured histopathologically. Thermal imaging results show that superficial dermal burns (IIa) show increased temperature compared with their contralateral healthy region, while deep dermal burns (IIb) show a lower temperature than their contralateral healthy region. This difference in temperature is statistically significant (p<0.0001) and provides a way of distinguishing deep dermal from superficial dermal burns. These results show that digital infrared thermal imaging could be used as a noninvasive procedure to assess burn wounds. An additional advantage of using thermal imaging, which can image a large skin surface area, is that it can be used to identify regions with different burn depths and estimate the size of the grafts needed for deep dermal burns.