Why do people get burned? Qualitative analysis of the causes of burns in a large survey of burn survivors.

BACKGROUND: Understanding the national epidemiology of burns is necessary for effective planning of prevention and treatment services. However, epidemiological studies of burns have often focused on short-term and retrospective investigations of a specific group of burned patients in Iran. Therefore, we conduct a comprehensive study from August 2016 to October 2017, in the Burn Research Center of Iran University of Medical Sciences on approximately 1700 hospitalized burn patients at Motahari Hospital to identify the underlying causes of burns. In this study, an open-ended question was asked about how the burn occurred in the patients. The current study was designed and conducted for the qualitatively analyzing of the responses to this question, using the content analysis method, in order to maximize its use in policymaking and prevention. METHODS: Content analysis of written responses to open-ended questions was done as a part of a large questionnaire survey. This survey was conducted by face-to-face interview at a national referral center for burn injuries. RESULTS: Answers from 1595 patients were coded and the underlying causes of injury were categorized into three themes and 43 subthemes. These underlying causes were lack of knowledge and awareness, inappropriate equipment, and inevitable accidents. The underlying cause of lack of knowledge and awareness had the highest proportion in causing burns in both men and women. The most common subthemes in descending order included lack of skills, dangerous actions, improper location of hot liquids, individual mistakes, and improper use of flammable materials. The top five subthemes with the highest average percentage of burn in patients in descending order were deficiency of residential equipment, self-immolation, accidents, inappropriate location of flammable materials, and unsafe kitchen appliances. CONCLUSION: The focus of prevention programs on educating and increasing awareness of individuals, preferably women, is suggested. Educational programs, tailored to occupational standards and workplace and household equipment, are recommended for men in work environments.

Evaluation of the Effect of Cichorium intybus L. on the Liver Enzymes in Burn Patients: A Randomized Double-Blind Clinical Trial.

Burn injuries are considered an important public health problem in the world. Burns are considered the fourth most common kind of trauma in the world, after traffic accidents, falls, and interpersonal violence. Various biochemical agents are involved in the burn healing process such as cytokines (such as IL-6 and TNF-α), antioxidants, and liver and kidney damage biomarkers. Cichorium intybus L. and milk thistle extracts showed a wide range of pharmacological activities such as significant antimicrobial effect and antioxidant activity, as well as anti-inflammatory, antidiabetic, antiproliferative, antiprotozoal, and hepatoprotective effect. Also, these two herbs possess blood-cleansing, detoxifying, laxative, and invigorating activities. Some research confirmed that the preparations of the extract are very suitable for the treatment of nonalcoholic fatty liver disease. This is a double-blind randomized controlled clinical trial. Patients with 2nd and 3rd degree burns have been selected to participate in the study according to the inclusion criteria. A total of 60 patients were selected and divided into intervention and control groups (30 patients in each group). Patients in the intervention group received chicory seed syrup 10 cc three times a day and 1 placebo capsule, and those in the control group received placebo syrup (10 cc three times a day) and one Livergol (140 mg of silymarin in each capsule) capsule. Lab data such as liver function tests, albumin, creatinine, BUN, and hemoglobin were checked every 3 days and 1 week after discharge. The treatment lasted for 4 weeks. According to the results of the study, although the average of liver enzymes at the end of the study does not show a significant difference between the two groups, the level of liver enzymes in each group decreased on the 15th day of the study compared to the first day. This trial is registered with IRCT20180609040016N1.

Evaluating the Effect of Tranexamic Acid Local Injection on the Intraoperative Bleeding Amount and the Postoperative Edema and Ecchymosis in Primary Rhinoplasty Patients: A Randomized Clinical Trial.

BACKGROUND AND AIMS: The purpose of this study was assessing the effect of local injection of tranexamic acid (TXA) on the amount of bleeding during the primary rhinoplasty and edema and ecchymosis following the surgery. METHODS: In this randomized clinical trial, 50 patients applying for primary rhinoplasty were divided into two groups of intervention and observation. In the intervention group, 10 mg/kg of TXA was injected locally to the operation field. In the observation group, no medicine was injected. The same anesthesia technique was used during the operation for all the patients. Age, sex, blood pressure, bleeding amount during the operation, the amount of edema and ecchymosis on the first and seventh day after the surgery were noted. The data were analyzed by the SPSS software version 24 and using descriptive statistics of frequency and percentage of frequency and Fisher and Mann-Whitney's exact statistical tests. RESULTS: Our results showed that there was a significant difference between the amounts of bleeding during the surgery between two groups (P-value < 0.001). Also, the postoperative edema on the first and seventh day in intervention group was less than the observation group (P-value < 0.001). There were no complications during the surgery and in the follow-up of the patients. CONCLUSION: We revealed that local injection of TXA during the rhinoplasty procedure and decreased the intraoperative bleeding and postoperative ecchymosis and edema without any side effects and complications. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The Clinical Efficacy of Fat Injection on the Repair of Hand Flexor Tendon: A Randomized Clinical Trial.

Background: In recent years, special attention has been paid to minimally invasive and conservative methods in addition to conventional surgical methods to repair tendon damage. In this regard, the effect of fat injection and graft has been of great interest due to its potential in accelerating tissue repair. We aimed to assess the clinical efficacy of fat injection along with conventional approach in patients with flexor tendon injury. Methods: In this randomized clinical trial, 64 patients were randomly scheduled for tendon repair using the usual modified Kessler four-strand method alone or tendon repair using four-strand method and fat injection on the proximal and distal sides of the repair site in the Hazrat Fatemeh Hospital, Tehran Province, Iran in 2022 (IRCT20221206056723N1). Patients were followed-up for eight weeks regarding the function status of the repaired tendon (using Strickland grading test), range of motion (by physical examination) and flexion and extension gaps (by imaging). Results: In the eighth weeks after the treatment, the average Strickland score was significantly higher in the group receiving fat injection (P: 0.009 ). In the two pointed times, the mean range of motion was significantly higher and the mean flexion and extension gaps were significantly lower in those who received fat injection. None of the procedural side effects were observed in the fifth and eighth weeks after the treatment. Conclusion: Fat injection along with usual surgical treatment for tendon repair accelerates and improves tendon function and range of motion.

The clinical outcomes of xenografts in the treatment of burn patients: a systematic review and meta-analysis.

BACKGROUND: Although autografts are not feasible in patients with extensive burn wounds, allografts and xenografts can be used for temporary coverage. In this systematic review and meta-analysis, we compared the outcomes of xenografts and the standard treatment of burn wounds. METHODS: International online databases were searched for English articles comparing xenografts with routine treatment in the burn patients. The random-effects model was used to estimate standardized mean differences (SMD) or odds ratios (OR) with a 95% confidence interval (CI). RESULTS: From a total of 7144 records, 14 studies were included in our review after screening by title and abstracts followed by full-texts. No significant difference in hospital stays was found between the mammalian xenografts and control groups (SMD [95% CI] = - 0.18 [- 0.54-0.18]). The mean number of dressing changes was significantly lower in both mammalian xenografts compared to the controls (SMD [95% CI] = - 1.01 [- 1.61-- 0.41]) and fish xenografts compared to controls (SMD [95% CI] = - 6.16 [- 7.65-- 4.66]). In the fish xenografts, re-epithelialization time was significantly lower compared to controls (SMD [95% CI] = - 1.18 [- 2.23-- 0.14]). CONCLUSIONS: Xenografts showed a significantly lower number of dressing changes and fish xenografts showed significant benefit in re-epithelialization compared to routine treatment. The beneficial results of xenografts suggest further research in the use of different types of xenografts in patients with extensive burn.

Investigating the effect of poly (ɛ-caprolactone) nanofibers scaffolds with random, unidirectionally, and radially aligned morphologies on the Fibroblast cell's attachment and growth behavior.

In the last decade, significant progress in tissue engineering, repairing, and replacing organs has been achieved. The design and production of scaffolds for tissue engineering are one of the main areas which have attracted the researcher's interest. In this regard, electrospinning is one of the most popular methods of nanoscale scaffold similar to extracellular matrix production. This paper reports the fabrication of scaffolds consisting of radially aligned PCL nanofibers by utilizing a collector composed of a central point electrode and a peripheral ring electrode. The chemical and physical properties were compared using SEM, FTIR, XRD, and DSC experiments, as well as biological performance using the MTT method and cell morphology with nanofibers with random and unidirectionally morphology. Results of this study showed greater physical and biological properties for radially aligned nanofibers which make them an excellent candidate for wound healing applications due to the guided cell growth on this type of nanofiber.

The Effect of Rainbow Trout (Oncorhynchus mykiss) Collagen Incorporated with Exo-Polysaccharides Derived from Rhodotorula mucilaginosa sp. on Burn Healing.

Burn is one of the physically debilitating injuries that can be potentially fatal; therefore, providing appropriate coverage in order to reduce possible mortality risk and accelerate wound healing is mandatory. In this study, collagen/exo-polysaccharide (Col/EPS 1-3%) scaffolds are synthesized from rainbow trout (Oncorhynchus mykiss) skins incorporated with Rhodotorula mucilaginosa sp. GUMS16, respectively, for promoting Grade 3 burn wound healing. Physicochemical characterizations and, consequently, biological properties of the Col/EPS scaffolds are tested. The results show that the presence of EPS does not affect the minimum porosity dimensions, while raising the EPS amount significantly reduces the maximum porosity dimensions. Thermogravimetric analysis (TGA), FTIR, and tensile property results confirm the successful incorporation of the EPS into Col scaffolds. Furthermore,the biological results show that the increasing EPS does not affect Col biodegradability and cell viability, and the use of Col/EPS 1% on rat models displays a faster healing rate. Finally, histopathological examination reveals that the Col/EPS 1% treatment accelerates wound healing, through greater re-epithelialization and dermal remodeling, more abundant fibroblast cells and Col accumulation. These findings suggest that Col/EPS 1% promotes dermal wound healing via antioxidant and anti-inflammatory activities, which can be a potential medical process in the treatment of burn wounds.

Epidemiology and etiology of pediatric burns in Iran.

Pediatric burns have long-term physical, psychological, economic, and social consequences for the patient and family. This study was designed to investigate the epidemiology, causes, and mechanism of pediatric burns in Iran, considering the impact the cultural and environmental differences of countries have on burn incidence. This study is a survey study that was performed from 2016 to 2017 on patients referred to Shahid Motahari hospital. Patients in the study included hospitalized children aged 0-18 years who themselves or their parents were able to answer questions. Questions were answered in the categories of the demographic characteristics of the child and parents, epidemiological characteristics of the burn, information on socio-economic and education status, and the underlying causes of the accident. Most burns occurred in the age group less than two years of age and in boys. The most common cause of burns was hot liquids. Collision with containers containing hot liquids inside the kitchen, collision with containers containing hot liquids outside the kitchen space, and overturning containers containing hot liquids were the most common mechanisms of burns. Flame burns were the most common cause of burns in school-age children. Half of the parents had an elementary level or lower education. Economic, social, and cultural conditions of families, parents' education, and access to preventive education are related to the extent and mechanism of burns. Paying attention to epidemiology and recognizing the main causes of child burns plays an important role in designing and planning preventive measures.

Silk fibroin and Nettle extract promote wound healing in a rat model: A histological and morphometrical study.

INTRODUCTION: Considering the anti-inflammatory, antimicrobial ability, and antioxidant effects besides stimulating ability of silk fibroin (SF) in cell migration and proliferation of Nettle, the current study aimed to investigate the effect of Nettle leaf extract (NLE) and SF on histology, morphometrical parameters and apoptosis on the wound in the rat model. MATERIALS AND METHODS: Wistar rats are divided into 5 groups, including 1-control (rats with healthy skin and no treatment); 2-wound (without any treatment); 3-SF (administration of silk fibroin solution for 14 consecutive days); 4- Nettle (administration of Nettle ointment for 14 consecutive days), and 5- Eucerin group (administration of Eucerin substance for 14 consecutive days) and then assessed wound area by photography, angiogenesis, inflammation, and thickness of epidermis using hematoxylin and eosin (H&E) staining, collagen deposition, and structure of dermis layers evaluated by Masson's trichrome staining and the apoptosis index determined by tunnel assay on days 7, 14 and 21. RESULTS: photographic illustrations showed that the wound surface environment on the seventh day in group 4 was significantly different from group 2 (p < 0.002). The rate of wound healing on the fourteenth day was higher in groups 3 and 4 than in group 2 (p < 0.001). Also, at this time, group 4 was significantly different from group 3 and group 5 (p = 0.003 and p = 0.000, respectively). There was a significant difference in epidermal thickness between the wound group and other experimental groups (p < 0.05). The number of apoptotic cells at the wound edges on the seventh day in both group 3 and group 4 had a significant decrease compared to other groups of wounds (p = 0.000), but there was a significant increase on the fourteenth day. Also, on the 21st day, a significant decrease in apoptotic cells was observed in both group 3 and group 4 compared to other wound groups (p = 0.000). DISCUSSION AND CONCLUSION: Nettle and SF maintain cell homeostasis and accelerate wound closure by reducing cell apoptosis and enhancing cell proliferation on the seventh day, but by increasing the apoptosis of fibroblast cells on the fourteenth day, they lead to remodeling and keratinocytes migration to epidermis formation. Increased apoptosis also seems to be one of the pathophysiological mechanisms to prevent the formation of keloid and hypertrophic scar tissue. SF and Nettle extract, by increasing cell proliferation and migration of different cell types to the site of injury, control the remodeling process by inducing and regulating apoptosis in the first two weeks of wound healing and accelerating the process of collagen deposition and epithelialization.

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.

Multilayered 3-D nanofibrous scaffold with chondroitin sulfate sustained release as dermal substitute.

Electrospun nanofibers for skin tissue engineering applications face two main challenges. The low thickness of electrospun mats is the main reason for their weak load-bearing performance at clinical applications and limited cell penetration due to their small pore sizes. We have developed multi-layered nanofibrous 3D (M3DN) scaffolds comprising gelatin, polyvinyl alcohol, and chondroitin sulfate (CS) by an electrospinning method and attaching three electrospun layers via ethanol to cause interface fibers to come in contact with each other. Prepared M3DN scaffolds revealed a sustained CS release profile. The improved mechanical performance, stable release of CS, and penetration capability of the cells and blood vessels through the spaces between layers in the prepared multi-layered nanofibrous scaffolds demonstrate their potential applications in response to the increasing demand for replacement of damaged dermis. The results of animal studies on the dorsal skin of Rat with full-thickness wounds have shown that the reconstruction of full-thickness skin lesions is significantly higher for M3DN scaffolds than a control group (treated with sterile gauze). The amount of epithelization, collagen arrangement, and inflammatory cells (acute and chronic) has been investigated, and their associated results demonstrated that M3DN scaffolds have great potential for full-thickness wound restoration.

Fabrication and In Vitro Evaluation of A Chondroitin Sulphate-Polycaprolactone Composite Nanofibrous Scaffold for Potential Use in Dermal Tissue Engineering.

OBJECTIVE: Poly(ε-caprolactone) (PCL) has considerable mechanical and biological properties that make it a good candidate for tissue engineering applications. PCL alongside proteins and polysaccharides, like gelatin (GEL) and chondroitin sulphate (CS), can be used to fabricate composite scaffolds that provide mechanical and biological requirements for skin tissue engineering scaffolds. The aim of this study was fabricating novel composite nanofibrous scaffold containing various ratios of GEL/CS and PCL using co-electrospinning process. MATERIALS AND METHODS: In this experimental study, PCL mixed with a GEL/CS blend has limitations in miscibility and the lack of a common solvent. Here, we electrospun PCL and GEL/CS coincide separately on the same drum by using different nozzles to create composite nanofibrous scaffolds with different ratios (2:1, 1:1 and 1:2) of GEL to CSPCL, and we mixed them at the micro/nanoscale. Morphology, porosity, phosphate-buffered saline (PBS) absorption, chemical structure, mechanical property and in vitro bioactivity of the prepared composite scaffolds were analysed. RESULTS: Scanning electron microscopy (SEM) images showed beadless nanofibres at all ratios of GEL to CS-PCL. The composite scaffolds (2:1, 1:1 and 1:2) had increased porosity compared to the PCL nanofibrous scaffolds, in addition to a significant increase in PBS absorption. The mechanical properties of the composite scaffolds were investigated under different conditions. The results demonstrated that all of the composite specimens had better strength when compared with the GEL/CS nanofibres. The increase in PCL ratio led to an increase in tensile strength of the nanofibres. Human dermal fibroblasts (HDF) were cultured on the fabricated composite scaffolds and evaluated by 3-(4,5-dimethylthiazol- 2-yl)-5-(3 carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS) analysis and SEM. The results showed the bioactivity of these nanofibres and the potential for these scaffolds to be used for skin tissue engineering applications. CONCLUSION: The fabricated co-electrospun composite scaffolds had higher porosity and PBS absorption in comparison with the PCL nanofibrous scaffolds, in addition to significant improvements in mechanical properties under wet and dry conditions compared to the GEL/CS scaffold.

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.

Epidemiology of Occupational Electrical Injuries.

Electrical injuries are an uncommon but very destructive type of burn, with serious complications and disabilities for the victims. This study was conducted due to the importance of understanding the epidemiology of electrical accidents in planning to prevent their occurrence. This is a retrospective cross-sectional study that was performed on patients with electrical burns referred to Shahid Motahari Educational and Medical Center from 2017 to 2018. Patients' information was entered in the researcher-made information registration form, including demographic and accident-related information. In this study, most of the accidents occurred in the workplace with high-voltage electricity. Contact with overhead cables and wires was the most common cause of injury. Excision and graft surgeries were the most common type of surgery. The variables of sex, age, length of hospital stay, and type of job had a significant relationship with the type of voltage (P < .05). The difference between the ratio of men to women and the length of hospitalization in the group of injured with high-voltage electricity was greater and most of these patients were construction workers. The variables of sex, nationality, length of hospital stay, and cause of the accident had a significant relationship with the type of job (P < .05). Construction workers are the main group at risk of electrical damage in Iran. Therefore, it is recommended to conduct more extensive studies in the field of recognizing and implementing practical methods of preventing electrical injuries, especially in high-risk work environments.

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.

The Epidemiology of Chemical Burns Among the Patients Referred to Burn Centers in Shiraz, Southern Iran, 2008-2018.

OBJECTIVE: To investigate the prevalence of chemical burns among the patients admitted to Shiraz burn treatment centers. METHODS: It is a descriptive study that was conducted on 62 patients with chemical burns who were admitted between 2008 and 2018. The patients' records were used in the research using the census sampling process. A questionnaire with questions about age, sex, the extent of the burn, the cause of the burn, duration of hospital stay, level of education, incident location, and clinical outcome was used to collect data (survival-death). The data was analyzed by using descriptive statistical methods. RESULTS: The prevalence of chemical burns was 1% during 2008-2018. Acid and alkali burns were accounted for 93.5% and 6.5% of burns, respectively. 77.4% of patients were male, and 22.6% were female. The mean age of patients was 27 years. The average burn percentage was 16%. 70.6% of patients were illiterate or had primary education. Burns occurred at the workplace and home in 12.9% and 66.1% of cases, respectively. Moreover, Burns occurred due to accident (61%), acid attack (29%), and self-immolation (10%). The average length of hospital stay was 20 days. One patient (1.6%) died from burns. CONCLUSION: The study's findings revealed that chemical burns were more common in men than women, and the majority of chemical burns occurred at home. To minimize the occurrence of chemical burns and acid attacks, teaching methods of preventing burns is important at home and work, as well as restricting non-specialists' access to chemicals.

Investigating the Impact of Collagen-Chitosan Derived from Scomberomorus Guttatus and Shrimp Skin on Second-Degree Burn in Rats Model.

BACKGROUND: The present study focused on burning as one of the main causes of mortality with detrimental economic and social effects in the world. The purpose of this study was to investigate the impact of collagen-chitosan gel extracted from Scomberomorus guttatus and shrimp skin in the treatment of second degree burn healing among rats. MATERIALS & METHOD: To fulfill the purpose of the study, chitosan and collagen were extracted respectively from shrimp and Scomberomorus guttatus skin waste by the acid-based method and were evaluated by using Pico Tag, SDS-PAGE. The burn wound healing efficiency of marine collagen-chitosan gel was examined in vivo using rats. Three different ratios of collagen and chitosan blend (Col-CH, 1:3, 1:1 and 3:1) were prepared to obtain the most effective Col-CH gel for burn wound healing and were compared to the animals treated with silver sulfadiazine ointment. Healing burn wound was studied by measuring wound surface area with Image J and histopathologic examination was carried out based on the mean of epithelialization, fibroblastic cells, acute and chronic inflammatory cells, angiogenesis, structure collagen and the amount of collagen on days 15 and 25 post-burn. RESULTS: The results of SDS-PAGE indicated that the extracted collagen was type I and it was composed of two α (α1 and α2) chains. Amino acid analysis showed a much higher glaycin content in extracted collagen which amounted to one-third of the total amino. The wound surface measurement showed a significant reduction in wound size in the group treated with Col-CH (3:1) compared to silver-sulfadiazine treated group on 15th and 25th days. Histopathological findings represented a high score in epithelialization, collagen, collagen structure, fibroblast cell and a decrease in inflammatory cells infiltration in Col-CH (3:1) treated group on 25th day. The most obvious finding of the present study is that chitosan-collagen gel (3:1) represented a better efficacy compared to sulfadiazine in burn wound healing on day 25 post-burn.

Three Year Study of Infection Profile and Antimicrobial Resistance Pattern from Burn Patients in Southwest Iran.

INTRODUCTION: Burn wound infections, as one of the most important risk factors, cause serious complications in burns. Hence, the focus of medical care should be preventing infections and resistant isolates. The current study investigates the prevalence of infectious agents and antimicrobial resistance patterns during three years. MATERIALS AND METHODS: A total of 960 isolates were collected from different sample kinds cultured for 615 burn patients who were hospitalized during January 2016 to December 2018 in Amir-Al-Momenin Burn Center. The type of microorganism and their antibiotic resistance patterns were identified by microbiological tests and the standard disk-diffusion method according to the introduced standard techniques. RESULTS: Incidence of positive growth was seen more in males than in females. Most of the burns encountered were due to flame injuries (35.4%). Based on the diversity of bacterial isolates, Pseudomonas aeruginosa was the most frequent pathogen (49.9%), followed by Klebsiella sp. (9.7%), Acinetobacter sp. (7.2%) and Staphylococcus aureus (6.5%). The trend of resistance of meropenem was declining in P. aeruginosa isolates. Klebsiella sp. as the second most prevalent agent showed a high level of resistance to the studied antibiotics. The antibiogram results for S. aureus isolates showed an increasing trend in MRSA isolates. CONCLUSION: By evaluating the infectious agent, it was found that although frequencies of microorganisms and resistant isolates were a little high, performing a multidisciplinary approach controls the trend during the study period. These achievements have been gained due to a strict politicized infection control and stewardship program in the appointed burn center.

Smoking and Diabetes Control in Adults With Type 1 and Type 2 Diabetes: A Nationwide Study From the 2018 National Program for Prevention and Control of Diabetes of Iran.

OBJECTIVES: Smoking is among the top leading causes of morbidity and mortality worldwide. To date, studies on the association between smoking and diabetes complications and metabolic control have shown conflicting results. In this study, we aimed to assess the association of smoking with micro- and macrovascular complications of diabetes and lipid and glycemic indices. METHODS: We used the National Program for Prevention and Control of Diabetes of Iran database of 99,651 adult patients with diabetes across Iran. Multiple logistic regression models were used to examine the association between smoking and diabetes complications including cardiovascular disease, neuropathy, nephropathy and retinopathy. This association was adjusted for age, sex, duration of diabetes, glycated hemoglobin (A1C), hypertension, hyperlipidemia, medication, obesity and type of diabetes. RESULTS: Smoking was associated with cardiovascular disease, nephropathy, retinopathy and neuropathy (odds ratios [ORs] for patients with type 1 diabetes were 1.51, 2.29, 2.70 and 2.40, respectively; for patients with type 2 diabetes, ORs were 1.27, 1.21, 1.51 and 1.70, respectively; all with p values <0.001). Among patients with type 1 diabetes, smoking was significantly (p<0.05) associated with A1C (OR, 2.12), 2-h postglucose level (OR, 1.30), triglycerides (OR, 1.48) and high-density lipoprotein (HDL) control (OR, 1.34). Among patients with type 2 diabetes, smoking was significantly associated with A1C (OR, 1.09) and HDL control (OR, 1.21). CONCLUSIONS: Smoking was associated with multiple diabetes complications including cardiovascular disease, neuropathy, nephropathy and retinopathy and worse A1C and HDL control in both patients with type 1 and type 2 diabetes. It was also associated with worse 2-h postglucose level and triglyceride control among patients with type 1 diabetes. Our findings signify that national programs for smoking prevention and cessation may be beneficial to diabetes control in Iran.

Immunomodulatory properties of umbilical cord vein mesenchymal stromal cells influenced by gestational age and in vitro expansion.

In vivo and in vitro aging of the mesenchymal stromal cells (MSCs) can affects their properties. We investigated the immunomodulatory properties of the term and preterm human umbilical cord vein MSCs (UCV-MSCs) at the passages (P) 2 and 5. Term and preterm UCV-MSCs at P2 and 5 were co-cultured with two-way mixed lymphocyte reaction. Proliferation, IFN-γ and IL-10 protein levels, mRNA levels of the COX-2, TGF-ß1, TNF-α, IL-4 and FoxP3 were assessed. The term UCV-MSCs and P5 of the term and preterm UCV-MSCs had stronger inhibitory effects on cell proliferation than the preterm UCV-MSC and P2, respectively (P = 0.001). In supernatants of the co-cultures, IFN-γ was higher in the term UCV-MSC than the preterm UCV-MSC, while IL-10 was higher in the preterm UCV-MSCs than the term UCV-MSCs. Also in the co-cultures, COX-2 expression in the term UCV-MSCs and P2 was higher than the preterm UCV-MSCs and P5, respectively and TGF-ß1 expression in the term UCV-MSCs was higher than preterm. Conclusively it appears that the term UCV-MSCs, and P5 of the term and preterm UCV-MSCs showed a higher immunomodulatory ability than the preterm UCV-MSCs and P2, respectively.