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1.
Pak J Pharm Sci ; 37(1(Special)): 185-189, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38747268

RESUMO

Burn is a debilitating and devastating emergency with many physical and psychological sequelae. Essential steps in burn wound management include cleansing/wound debridement, application of topical antimicrobial and dressing of affected body areas. Objective of this study is comparison in effectiveness of Hydro-fiber Silver dressing and 1% silver sulfadiazine dressing in management of pediatric burn patients in terms of wound healing. After ethical approval, 264 patients were enrolled and divided into two groups. Patients were managed with hydro-fiber silver dressing in group A and 1% silver sulfadiazine dressing in group B. An experienced pediatric surgeon examined the wounds for re epithelialization and efficacy was labeled after 15 days. Out of 264 enrolled patients 148(56.06%) were males and 116(43.94%) were females. Mean age of patients was 3.73±2.34 years. Type of burn was Scald in 215(81.4%) patients and flame in 49(18.6%). Depth of burn was 2nd degree in 185(70.08%) patients and 3rd degree in 79(29.92%) patients. Mean TBSA was 19.93±9.62%. In group A the efficacy was achieved in 91(68.9%) patients whereas in group B the efficacy was achieved in 73(55.3%) patients (p-value<0.05). Hydro-fiber Silver dressing is significantly more efficacious as compared to 1% silver sulfadiazine dressing for treatment of pediatric burn.


Assuntos
Bandagens , Queimaduras , Sulfadiazina de Prata , Humanos , Sulfadiazina de Prata/uso terapêutico , Sulfadiazina de Prata/administração & dosagem , Queimaduras/terapia , Queimaduras/tratamento farmacológico , Feminino , Masculino , Pré-Escolar , Criança , Cicatrização/efeitos dos fármacos , Resultado do Tratamento , Lactente , Anti-Infecciosos Locais/uso terapêutico , Anti-Infecciosos Locais/administração & dosagem , Prata/uso terapêutico
2.
J Plast Surg Hand Surg ; 59: 72-76, 2024 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-38769787

RESUMO

BACKGROUND: The purpose of this article is to introduce a method that combines limited debridement and ReCell® autologous cell regeneration techniques for the treatment of deep second-degree burn wounds. METHOD: A total of 20 patients suffered with deep second-degree burns less than 10% of total body surface area (TBSA) who were admitted to our department, from June 2019 to June 2021, participated in this study. These patients first underwent limited debridement with an electric/pneumatic dermatome, followed by the ReCell® technique for secondary wounds. Routine treatment was applied to prevent scarring after the wound healed. Clinical outcomes were scored using the Vancouver Scar Scale (VSS). RESULTS: All wounds of the patients healed completely. One patient developed an infection in the skin graft area and finally recovered by routine dressing changes. The average healing time was 12 days (range: 10-15 days). The new skin in the treated area was soft and matched the colour of the surrounding normal skin and the VSS score ranged from 3~5 for each patient. Of the 20 patients, 19 were very satisfied and 1 was satisfied. CONCLUSIONS: This article reports a useful treatment method that combines electric dermatome-dependent limited debridement and the ReCell® technique for the treatment of deep second-degree burn wounds. It is a feasible and effective strategy that is easy to implement and minimally invasive, and it is associated with a short healing time, mild scar formation and little damage to the donor skin area.


Assuntos
Queimaduras , Desbridamento , Transplante de Pele , Humanos , Queimaduras/cirurgia , Queimaduras/terapia , Desbridamento/métodos , Masculino , Adulto , Feminino , Transplante de Pele/métodos , Pessoa de Meia-Idade , Adulto Jovem , Cicatrização/fisiologia , Cicatriz , Adolescente , Poliésteres
3.
Eur J Med Res ; 29(1): 283, 2024 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-38735989

RESUMO

BACKGROUND: It remains unclear whether additional fluid supplementation is necessary during the acute resuscitation period for patients with combined inhalational injury (INHI) under the guidance of the Third Military Medical University (TMMU) protocol. METHODS: A 10-year multicenter, retrospective cohort study, involved patients with burns ≥ 50% total burn surface area (TBSA) was conducted. The effect of INHI, INHI severity, and tracheotomy on the fluid management in burn patients was assessed. Cumulative fluid administration, cumulative urine output, and cumulative fluid retention within 72 h were collected and systematically analyzed. RESULTS: A total of 108 patients were included in the analysis, 85 with concomitant INHI and 23 with thermal burn alone. There was no significant difference in total fluid administration during the 72-h post-burn between the INHI and non-INHI groups. Although no difference in the urine output and fluid retention was shown in the first 24 h, the INHI group had a significantly lower cumulative urine output and a higher cumulative fluid retention in the 48-h and 72-h post-burn (all p < 0.05). In addition, patients with severe INHI exhibited a significantly elevated incidence of complications (Pneumonia, 47.0% vs. 11.8%, p = 0.012), (AKI, 23.5% vs. 2.9%, p = 0.037). For patients with combined INHI, neither the severity of INHI nor the presence of a tracheotomy had any significant influence on fluid management during the acute resuscitation period. CONCLUSIONS: Additional fluid administration may be unnecessary in major burn patients with INHI under the guidance of the TMMU protocol.


Assuntos
Queimaduras , Hidratação , Ressuscitação , Humanos , Hidratação/métodos , Masculino , Estudos Retrospectivos , Feminino , Pessoa de Meia-Idade , Adulto , Queimaduras/terapia , Queimaduras/complicações , Ressuscitação/métodos
4.
Rev Bras Enferm ; 77(1): e20220738, 2024.
Artigo em Inglês, Português | MEDLINE | ID: mdl-38747745

RESUMO

OBJECTIVES: to analyze the technologies used by the nursing team in the treatment of skin lesions caused by burns in patients under intensive care. METHODS: this is a scope review conducted on the LILACS, Medline, PubMed, and CINAHL databases without temporal or language restrictions. RESULTS: the highlighted technologies included the use of specialized dressings, biological agents such as probiotics and cyanobacteria, as well as negative pressure therapies and enzymes such as papain and collagenase. Some technologies, such as nanocrystalline silver, demonstrated efficacy in infection control. FINAL CONSIDERATIONS: the study identified essential technologies in burn care, emphasizing the need for further research on "soft" technologies. The findings support the promotion of evidence-based nursing care for burn patients in intensive care and enhance knowledge about effective treatments.


Assuntos
Queimaduras , Cuidados Críticos , Humanos , Queimaduras/terapia , Queimaduras/enfermagem , Queimaduras/complicações , Cuidados Críticos/métodos
5.
Trials ; 25(1): 226, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38556879

RESUMO

BACKGROUND: Burn-related injuries are a major global health issue, causing 180,000 deaths per year. Early debridement of necrotic tissue in association with a split-thickness skin graft is usually administered for some of the 2nd- and 3rd-degree injuries. However, this approach can be complicated by factors such as a lack of proper donor sites. Artificial skin substitutes have attracted much attention for burn-related injuries. Keratinocyte sheets are one of the skin substitutes that their safety and efficacy have been reported by previous studies. METHODS: Two consecutive clinical trials were designed, one of them is phase I, a non-randomized, open-label trial with 5 patients, and phase II is a randomized and open-label trial with 35 patients. A total number of 40 patients diagnosed with 2nd-degree burn injury will receive allogenic keratinocyte sheet transplantation. The safety and efficacy of allogeneic skin graft with autograft skin transplantation and conventional treatments, including Vaseline dressing and topical antibiotic, will be compared in different wounds of a single patient in phase II. After the transplantation, patients will be followed up on days 3, 7, 10, 14, 21, and 28. In the 3rd and 6th months after the transplantation scar, a wound closure assessment will be conducted based on the Vancouver Scar Scale and the Patient and Observer Scar Assessment Scale. DISCUSSION: This study will explain the design and rationale of a cellular-based skin substitute for the first time in Iran. In addition, this work proposes this product being registered as an off-the-shelf product for burn wound management in the country. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT) IRCT20080728001031N31, 2022-04-23 for phase I and IRCT20080728001031N36, 2024-03-15 for phase II.


Assuntos
Queimaduras , Transplante de Células-Tronco Hematopoéticas , Humanos , Queimaduras/diagnóstico , Queimaduras/terapia , Queimaduras/complicações , Cicatriz/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Irã (Geográfico) , Queratinócitos , Transplante de Pele/efeitos adversos
6.
Int Wound J ; 21(4): e14798, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38572761

RESUMO

To systematically evaluate the effects of quality nursing care on wound pain and anxiety in burn patients. Computerised searches of PubMed, Google Scholar, Cochrane Library, Embase, Wanfang, China Biomedical Literature Database and China National Knowledge Infrastructure databases randomised controlled trials (RCTs) on the application of quality nursing care to burn patients were carried out from database inception to October 2023. Literature was screened and evaluated by two researchers based on inclusion and exclusion criteria, and data were extracted from the final included literature. Stata 17.0 software was employed for data analysis. Overall, 15 RCTs and 1115 burn patients were included, including 563 and 552 in the quality care and routine care groups. It was found that, compared with routine care, burn patients who implemented quality care had significantly less wound pain (SMD: -1.79, 95% CI: -2.22 to -1.36, p < 0.001), anxiety (SMD: -2.71. 95% CI: -3.49 to -1.92, p < 0.001) and depression (SMD: -1.74, 95% CI: -2.35 to -1.14, p < 0.001) levels were significantly reduced post-trauma.


Assuntos
Ansiedade , Queimaduras , Humanos , Ansiedade/etiologia , Transtornos de Ansiedade , Dor , Queimaduras/complicações , Queimaduras/terapia , China , Ensaios Clínicos Controlados Aleatórios como Assunto
7.
J Wound Care ; 33(Sup4a): cxviii-cxxix, 2024 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-38588060

RESUMO

OBJECTIVE: Accurate assessment of burn depth and burn wound healing potential is essential to determine early treatments. Infrared thermography (IRT) is a non-invasive and objective tool to do this. This systematic review evaluated the accuracy of IRT to determine burn wound healing potential. METHOD: This systematic review and meta-analysis used MEDLINE, EMBASE, CINAHL, PEDro, DiTA and CENTRAL databases. IRT data were extracted from primary studies and categorised into four cells (i.e., true positives, false positives, true negatives and false negatives). Subgroup analysis was performed according to methods used to capture thermal images. RESULTS: The search strategy identified 2727 publications; however, 15 articles were selected for review and 11 for meta-analysis. In our meta-analysis, the accuracy of IRT was 84.8% (63% sensitivity and 81.9% specificity). CONCLUSION: IRT is a moderately accurate tool to identify burn depth and healing potential. Thus, IRT should be used carefully for evaluating burn wounds.


Assuntos
Queimaduras , Termografia , Humanos , Termografia/métodos , Cicatrização , Queimaduras/diagnóstico , Queimaduras/terapia , Acetofenonas
8.
Cell Biochem Funct ; 42(3): e4008, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38613198

RESUMO

Temporal phases of wound healing and their corresponding healing factors are essential in wound regeneration. Mesenchymal stem cells (MSCs) accelerate wound healing via their paracrine secretions by enhancing cell migration, angiogenesis, and reducing inflammation. This study evaluated the local therapeutic effect of human umbilical cord MSCs (hUCMSCs) in the healing of cold-induced burn wounds. An in vitro wound (scratch) was developed in rat skin fibroblasts. The culture was maintained in the conditioned medium (CM) which was prepared by inducing an artificial wound in hUCMSCs in a separate experiment. Treated fibroblasts were analyzed for the gene expression profile of healing mediators involved in wound closure. Findings revealed enhanced cell migration and increased levels of healing mediators in the treated fibroblasts relative to the untreated group. Cold-induced burn wounds were developed in Wistar rats, followed by a single injection of hUCMSCs. Wound healing pattern was examined based on the healing phases: hemostasis/inflammation (Days 1, 3), cell proliferation (Day 7), and remodeling (Day 14). Findings exhibited enhanced wound closure in the treated wound. Gene expression, histological, and immunohistochemical analyses further confirmed enhanced wound regeneration after hUCMSC transplantation. Temporal gene expression profile revealed that the level of corresponding cytokines was substantially increased in the treated wound as compared with the control, indicating improvement in the processes of angiogenesis and remodeling, and a substantial reduction in inflammation. Histology revealed significant collagen formation along with regenerated skin layers and appendages, whereas immunohistochemistry exhibited increased neovascularization during remodeling. Leukocyte infiltration was also suppressed in the treated group. Overall findings demonstrate that a single dose of hUCMSCs enhances wound healing in vivo, and their secreted growth factors accelerate cell migration in vitro.


Assuntos
Queimaduras , Células-Tronco , Animais , Feminino , Humanos , Ratos , Queimaduras/terapia , Inflamação , Ratos Wistar , Cicatrização
9.
Int J Mol Sci ; 25(7)2024 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-38612513

RESUMO

Non-healing wounds and skin losses constitute significant challenges for modern medicine and pharmacology. Conventional methods of wound treatment are effective in basic healthcare; however, they are insufficient in managing chronic wound and large skin defects, so novel, alternative methods of therapy are sought. Among the potentially innovative procedures, the use of skin substitutes may be a promising therapeutic method. Skin substitutes are a heterogeneous group of materials that are used to heal and close wounds and temporarily or permanently fulfill the functions of the skin. Classification can be based on the structure or type (biological and synthetic). Simple constructs (class I) have been widely researched over the years, and can be used in burns and ulcers. More complex substitutes (class II and III) are still studied, but these may be utilized in patients with deep skin defects. In addition, 3D bioprinting is a rapidly developing method used to create advanced skin constructs and their appendages. The aforementioned therapies represent an opportunity for treating patients with diabetic foot ulcers or deep skin burns. Despite these significant developments, further clinical trials are needed to allow the use skin substitutes in the personalized treatment of chronic wounds.


Assuntos
Queimaduras , Pé Diabético , Pele Artificial , Humanos , Bioengenharia , Engenharia Biomédica , Queimaduras/terapia
10.
BMC Health Serv Res ; 24(1): 486, 2024 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-38641612

RESUMO

BACKGROUND: Burn treatments are complex, and for this reason, a specialised multidisciplinary approach is recommended. Evaluating the quality of care provided to acute burn patients through quality indicators makes it possible to develop and implement measures aiming at better results. There is a lack of information on which indicators to evaluate care in burn patients. The purpose of this scoping review was to identify a list of quality indicators used to evaluate the quality of hospital care provided to acute burn patients and indicate possible aspects of care that do not have specific indicators in the literature. METHOD: A comprehensive scoping review (PRISMA-ScR) was conducted in four databases (PubMed, Cochrane Library, Embase, and Lilacs/VHL) between July 25 and 30, 2022 and redone on October 6, 2022. Potentially relevant articles were evaluated for eligibility. General data and the identified quality indicators were collected for each included article. Each indicator was classified as a structure, process, or outcome indicator. RESULTS: A total of 1548 studies were identified, 82 were included, and their reference lists were searched, adding 19 more publications. Thus, data were collected from 101 studies. This review identified eight structure quality indicators, 72 process indicators, and 19 outcome indicators listed and subdivided according to their objectives. CONCLUSION: This study obtained a list of quality indicators already used to monitor and evaluate the hospital care of acute burn patients. These indicators may be useful for further research or implementation in quality improvement programs. TRIAL REGISTRATION: Protocol was registered on the Open Science Framework platform on June 27, 2022 ( https://doi.org/10.17605/OSF.IO/NAW85 ).


Assuntos
Queimaduras , Indicadores de Qualidade em Assistência à Saúde , Humanos , Queimaduras/terapia , Hospitais , Melhoria de Qualidade
11.
Artigo em Chinês | MEDLINE | ID: mdl-38664029

RESUMO

Objective: To explore the effects of early debridement and conservative eschar removal followed by wound coverage with acellular dermal matrix (ADM), i.e., early surgery, in the treatment of children with deep burns. Methods: This study was a retrospective cohort study. From January 2017 to December 2022, 278 deep burned hospitalized children aged 1-7 years who met the inclusion criteria were admitted to Central Hospital Affiliated to Shandong First Medical University. According to the differences in treatment processes, 134 children who underwent early surgery+routine dressing change were enrolled in eschar removal+dressing change group (77 males and 57 females, aged 1 (1, 2) years), and 144 children who underwent only routine dressing change were enrolled in dressing change alone group (90 males and 54 females, aged 1 (1, 2) years). Fifty-one children without full-thickness burns in eschar removal+dressing change group were enrolled in eschar removal+dressing change group 1 (26 males and 25 females, aged 1 (1, 2) years), and 57 cases of the 83 children with full-thickness burns who did not undergo autologous skin grafting at the same time of early surgery (namely early skin grafting) in eschar removal+dressing change group were included in eschar removal+dressing change group 2 (37 males and 20 females, aged 1 (1, 2) years). Seventy-six children without full-thickness burns in dressing change alone group were included in dressing change alone group 1 (51 males and 25 females, aged 1 (1, 3) years), and 68 children with full-thickness burns in dressing change alone group were included in dressing change alone group 2 (39 males and 29 females, aged 1 (1, 2) years). For deep partial-thickness burn wounds and small full-thickness burn wounds in eschar removal+dressing change group, the eschar removal was performed on the basis of retaining a thin layer of denatured dermis so as to preserve the healthy tissue of the wound base, and ADM was applied to all wounds externally after eschar removal. For larger full-thickness burn wounds in this group, especially those located in the functional part of joints, eschar removal to the plane layer of viable tissue and early autologous skin grafting was needed. When the superficial wounds of children healed or tended to heal, the residual wounds were evaluated, and elective autologous skin grafting was performed if it was difficult to heal within 14 days. The healing time, intervention healing time, times of operation/dressing change, and times of intervention operation/dressing change in children with deep partial-thickness burn wounds of children in eschar removal+dressing change group, dressing change alone group, eschar removal+dressing change group 1, and dressing change alone group 1 were recorded. At the last follow-up (follow-up period was set to 7-12 months), the modified Vancouver scar scale (mVSS) scores of the most severe area of scar hyperplasia of healed deep partial-thickness burn wounds of 54 children in eschar removal+dressing change group and 48 children in dressing change alone group were recorded. The healing time and times of operation/dressing change of all burn wounds of children in eschar removal+dressing change group and dressing change alone group, and the healing time and times of operation/dressing change of full-thickness burn wounds of children in eschar removal+dressing change group 2 and dressing change alone group 2 were recorded. The incidences of wound infection, sepsis, fever, and fever after 5 days of burns in children of eschar removal+dressing change group and dressing change alone group during wound healing. Results: Compared with those in dressing change alone group, the healing time and intervention healing time were significantly shortened, and the times of operation/dressing change and times of intervention operation/dressing change were significantly reduced in children with deep partial-thickness burn wounds in eschar removal+dressing change group (with Z values of -11.00, -11.33, -12.64, and -11.65, respectively, P<0.05). Compared with those in dressing change alone group 1, the healing time and intervention healing time were significantly shortened, and the times of operation/dressing change and times of intervention operation/dressing change were significantly reduced in children with deep partial-thickness burn wounds in eschar removal+dressing change group 1 (with Z values of 6.57, 6.46, 8.04, and 6.57, respectively, P<0.05). At the last follow-up, the mVSS score of the most severe scar hyperplasia area of healed deep partial-thickness burn wounds of 54 children in eschar removal+dressing change group was 4.00 (3.00,5.00), which was significantly lower than 6.50 (5.00,7.00) of 48 children in dressing change alone group (Z =-4.67, P<0.05).Compared with those in dressing change alone group, the healing time was significantly shortened, and times of operation/dressing change was significantly reduced in all burn wounds in eschar removal+dressing change group (with Z values of -5.20 and -6.34, respectively, P<0.05). Compared with those in dressing change alone group 2, the healing time was significantly shortened, and times of operation/dressing change was significantly reduced in full-thickness burn wounds in eschar removal+dressing change group 2 (with Z values of -5.22 and -5.73, respectively, P<0.05). During wound healing, the probabilities of fever and fever after 5 days of burns in children of eschar removal+dressing change group were significantly lower than those in dressing change alone group (with χ2 values of 4.13 and 3.91, respectively, P<0.05); only 1 child in dressing change alone group developed sepsis, and there was no statistically significant difference in the wound infection rate of children in the two groups (P>0.05). Conclusions: For children with deep burns, early surgery, and early skin grafting or elective autologous skin grafting as needed, have better short-term and long-term effects than those without early surgery.


Assuntos
Derme Acelular , Queimaduras , Desbridamento , Transplante de Pele , Humanos , Masculino , Queimaduras/terapia , Queimaduras/cirurgia , Feminino , Estudos Retrospectivos , Lactente , Pré-Escolar , Transplante de Pele/métodos , Desbridamento/métodos , Criança , Cicatrização
12.
Biomaterials ; 308: 122558, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38581764

RESUMO

Mesenchymal stem cell (MSC)-based therapy is an effective strategy for regenerative therapy. However, safety and ease of use are still issues to be overcome in clinical applications. Exosomes are naturally derived nanoparticles containing bioactive molecules, which serve as ideal cell-free therapeutic modalities. However, issues such as delivery, long-term preservation and activity maintenance of exosomes are other problems that limit their application. In this study, we proposed the use of rapid freeze-dry-thaw macroporous hydrogels for the encapsulation of HucMSC-derived exosomes (HucMSC-Exos) combined with an antimicrobial peptide coating. This exosome-encapsulated hyaluronic acid macroporous hydrogel HD-DP7/Exo can achieve long-term storage and transport by lyophilization and can be rapidly redissolved for treatment. After comprehensively comparing the therapeutic effects of HucMSC-Exos and HucMSC-loaded hydrogels, we found that HucMSC-Exos could also effectively regulate fibroblasts, vascular endothelial cells, and macrophages and inhibit myofibroblast-mediated fibrosis, thus promoting tissue regeneration and inhibiting scar formation in a mouse model of deep second-degree burn infection healing. These properties of lyophilized storage and whole-process-repair make HD-DP7/Exo have potential application value and application prospects.


Assuntos
Peptídeos Antimicrobianos , Exossomos , Hidrogéis , MicroRNAs , Cicatrização , Animais , Exossomos/metabolismo , Hidrogéis/química , Cicatrização/efeitos dos fármacos , Camundongos , Humanos , MicroRNAs/genética , MicroRNAs/metabolismo , Peptídeos Antimicrobianos/química , Peptídeos Antimicrobianos/farmacologia , Bandagens , Células-Tronco Mesenquimais/citologia , Células-Tronco Mesenquimais/metabolismo , Queimaduras/terapia , Ácido Hialurônico/química , Masculino , Cicatriz , Camundongos Endogâmicos C57BL
13.
Artigo em Chinês | MEDLINE | ID: mdl-38664028

RESUMO

Objective: To explore the effect of early eschar dermabrasion combined with antimicrobial soft silicone foam dressing (hereinafter referred to as foam dressing) in treating the deep partial-thickness burn wounds in children. Methods: This study was a randomized controlled trial. From June 2021 to December 2022, 78 pediatric patients with deep partial-thickness burns who met the inclusion criteria were admitted to the Department of Burns in Guiyang Steel Plant Employees Hospital. According to the random number table, the pediatric patients were divided into two groups, with 38 cases left in combined treatment group (with 20 males and 18 females, aged 26.00 (16.75, 39.75) months) and 39 cases in foam dressing group (with 21 males and 18 females, aged 19.00 (14.00, 31.00) months) after the exclusion of one dropped-out child in follow-up. The pediatric patients in combined treatment group underwent eschar dermabrasion of the wound within 48 hours after injury, the wound was covered with foam dressing after operation, and the dressing was replaced once every 7 days; for the pediatric patients in foam dressing group, the wound was sterilized within 48 hours after injury and covered with foam dressing, and the dressing was replaced once every 2 to 3 days. After the wound healing, the children in both groups were routinely applied with silicone gel twice a day for 3 weeks before started wearing elastic sleeves for more than 18 hours a day, and continuously for over than 6 months. The degree of pain during dressing change was evaluated using the children's pain behavior inventory FLACC. The adverse reactions during the treatment period, number of dressing changes, and wound healing time were observed and recorded. Six months after wound healing, the Vancouver scar scale (VSS) was used to evaluate the condition of the wound scar. Results: When changing dressing, the FLACC score for pain of pediatric patients in combined treatment group was 3.5 (2.0, 5.0), which was significantly lower than 6.0 (5.0, 8.0) in foam dressing group (Z=-5.40, P<0.05). During the treatment period, no adverse reactions such as wound edema, fluid accumulation, or peripheral skin rash allergies occurred in any pediatric patient in both groups. The number of dressing changes of pediatric patients in combined treatment group was 3 (3, 4) times, which was significantly less than 8 (7, 10) times in foam dressing group (Z=-7.58, P<0.05). The wound healing time of pediatric patients in combined treatment group was (19±5) days, which was significantly shorter than (25±6) days in foam dressing group (t=-4.48, P<0.05). Six months after wound healing, the VSS score for scar of pediatric patients in combined treatment group was 5 (2, 8), which was significantly lower than 7 (5, 10) in foam dressing group (Z=-3.05, P<0.05). Conclusions: Compared with using foam dressings alone, early eschar dermabrasion combined with foam dressings can reduce the number of dressing changes, alleviate the pain during dressing changes, and shorten the wound healing time in treating children with deep partial-thickness burns, and effectively alleviate scar hyperplasia by combining with anti-scar treatment post burns.


Assuntos
Bandagens , Queimaduras , Dermabrasão , Cicatrização , Humanos , Masculino , Feminino , Queimaduras/terapia , Queimaduras/tratamento farmacológico , Pré-Escolar , Lactente , Cicatrização/efeitos dos fármacos , Dermabrasão/métodos , Silicones/administração & dosagem , Anti-Infecciosos/uso terapêutico , Anti-Infecciosos/administração & dosagem
15.
J Control Release ; 369: 545-555, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38588825

RESUMO

Severe burn injuries with massive dermal loss are often underestimated despite their significant impact on morbidity and mortality. Resembling the natural extracellular matrix (ECM), hyaluronic acid (HA)-based dressings have been extensively explored as suitable candidates for burn wound treatment. However, native HA hydrogel's limitations, such as low mechanical strength, rapid degradation, and uncontrollable drug delivery, hinder its efficacy, especially for full-thickness burns requiring injectable hydrogels with robust antibacterial and angiogenic capabilities. Herein, we present a novel multifunctional sequential dual-curing hydrogel system, combining hyperbranched poly(DMA-DMAPMA-PEGDA) (DDP) polymer with thiolated hyaluronic acid (HA-SH). The DDP copolymer, featuring multi-vinyls and catechol functionalities, facilitates two curing reactions taking place sequentially with HA-SH under physiological conditions, balancing convenient injection with the mechanical strength essential for effective wound management. Furthermore, the resulting DDP/HA hydrogels demonstrate enhanced therapeutic attributes, including intrinsic angiogenic and antimicrobial effects, setting them as promising dressing options for deep burn wound therapy.


Assuntos
Queimaduras , Catecóis , Ácido Hialurônico , Hidrogéis , Cicatrização , Ácido Hialurônico/química , Ácido Hialurônico/administração & dosagem , Hidrogéis/administração & dosagem , Hidrogéis/química , Queimaduras/tratamento farmacológico , Queimaduras/terapia , Animais , Catecóis/administração & dosagem , Catecóis/química , Cicatrização/efeitos dos fármacos , Humanos , Masculino , Bandagens , Antibacterianos/administração & dosagem , Antibacterianos/química , Regeneração/efeitos dos fármacos , Reagentes de Ligações Cruzadas/química , Injeções , Camundongos
16.
J Tissue Viability ; 33(2): 160-164, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38622036

RESUMO

BACKGROUND: In discharge phase process, supporting patients to develop their own self-care strategies will increase their self-management skills and reduce complications and other health problems that may arise. AIM: The aim of the study is to examine the learning needs of individuals with burns regarding pre-discharge care and treatment and the factors affecting them. METHOD: Data from this cross-sectional study was collected with the "Descriptive Characteristics Form" and "Patient Learning Needs Scale (PLNS)". The study population consisted of patients hospitalized in the adult burn unit of a university hospital in eastern Turkey between May and October 2021. RESULTS: In the present study, it was observed that the pre-discharge learning needs of the patients were at a high level according to the mean score of the general score of the PLNS. Education level, marital status, companion experience and body mass index effected PLNS. CONCLUSIONS: In light of the results, it is recommended that discharge training be planned individually and determined according to the individual's learning needs and affecting factors.


Assuntos
Queimaduras , Alta do Paciente , Humanos , Estudos Transversais , Feminino , Masculino , Queimaduras/terapia , Queimaduras/psicologia , Adulto , Turquia , Alta do Paciente/estatística & dados numéricos , Alta do Paciente/normas , Pessoa de Meia-Idade , Inquéritos e Questionários , Idoso , Avaliação das Necessidades/estatística & dados numéricos
17.
Injury ; 55(6): 111545, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38584078

RESUMO

There remains a paucity of evidence on the early predictors of long-term Health-Related Quality of Life (HRQoL) outcomes post-burn in hospitalised adults. The overall aim of this study was to identify the factors (personal, environmental, burn injury and burn treatment factors) that may predict long-term HRQoL outcomes among adult survivors of hospitalised burn injuries at 12 months post-burn. A total of 274 participants, aged 18 years or over, admitted to a single state-wide burn centre with a burn injury were recruited. Injury and burn treatment information were collected from medical records or the hospital database and surveys collected demographic and social data. HRQoL outcome data were collected at 3-, 6- and 12-months using the 12-Item Short Form Survey (SF-12 v1) and Burns Specific Health Scale-Brief (BSHS-B). Personal, environmental, burn injury and burn treatment factors were also recorded at baseline. Analyses were performed using linear and logistic regression. Among 274 participants, 71.5 % (N=196) remained enrolled in the study at 12 months post-burn. The majority of participants reported HRQoL outcomes comparable with population norms and statistically significant improvements in generic (SF-12 v1) and condition-specific (BSHS-B) outcomes over time. However, for participants with poor HRQoL outcomes at 12-months post-burn, Univariable predictors included longer hospital length of stay, unemployment at the time of injury, a diagnosed pre-injury mental health condition, inadequate pre-burn social support, intentional injury, recreational drug use pre-injury and female gender. The early multivariable predictors of insufficient HRQoL outcomes were female gender, a previously diagnosed mental health condition, unemployment, inadequate social support, intentional injury, and prolonged hospital length of stay. These results suggest potential factors that could be used to screen and burns patients for psychosocial intervention and long-term follow up.


Assuntos
Queimaduras , Qualidade de Vida , Sobreviventes , Humanos , Queimaduras/psicologia , Queimaduras/terapia , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Sobreviventes/psicologia , Inquéritos e Questionários , Nível de Saúde , Apoio Social , Hospitalização/estatística & dados numéricos , Adulto Jovem , Idoso
18.
J Wound Care ; 33(5): 335-347, 2024 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-38683776

RESUMO

OBJECTIVE: Burn injuries pose a heightened risk of infection, which is primarily responsible for increased morbidity and mortality. Factors such as extensive skin damage and compromised immunity exacerbate this vulnerability. Pseudomonas aeruginosa and Staphylococcus aureus are frequently identified in burns, with Gram-negative Pseudomonas aeruginosa often resistant to antibacterial agents. While Flaminal, an alginate-based wound dressing (Flen Health, Belgium), aids wound healing, its antibacterial effects are limited compared with 1% silver sulfadiazine (1% SSD). In contrast, Prontosan Wound Gel X, a betaine and polyhexanide-based hydrogel (B. Braun Medical AG, Switzerland), has been shown to effectively combat various microbes and promotes wound healing. METHOD: In this study, two research cohorts were retrospectively established (control group: patients receiving standard of care with the alginate-based wound dressing; intervention group: patients receiving the polyhexanide hydrogel wound dressing), comprising patients admitted to a burn centre between 2019 and 2022. Patients were eligible when continuous wound treatment with either of the two wound dressings was performed. Laser Doppler imaging (LDI) scans were conducted. Regions of interest (ROIs) were selected based on LDI scans and divided into healing time categories. Wound swabs were collected and the presence of Pseudomonas aeruginosa and Staphylococcus aureus was documented. Bacterial load was evaluated using a semiquantitative scale. Wound healing was recorded. RESULTS: The control group consisted of 31 patients with 93 ROIs, while the intervention group had 67 ROIs involving 29 patients. Both groups exhibited similar proportions of healing time categories (p>0.05). The polyhexanide hydrogel dressing outperformed the alginate-based dressing in antiseptic efficacy by significantly reducing the incidence of Pseudomonas aeruginosa- and Staphylococcus aureus-positive cultures in patients' wounds. Wound healing time for conservative treatment was comparable between groups. CONCLUSION: In this study, the polyhexanide hydrogel dressing minimised Pseudomonas aeruginosa and Staphylococcus aureus colonisation in burn wounds, demonstrating strong antibacterial properties, emphasising its potential to minimise infections in burn injuries.


Assuntos
Alginatos , Antibacterianos , Biguanidas , Queimaduras , Cicatrização , Humanos , Alginatos/uso terapêutico , Biguanidas/uso terapêutico , Queimaduras/terapia , Masculino , Feminino , Estudos Retrospectivos , Adulto , Antibacterianos/uso terapêutico , Antibacterianos/administração & dosagem , Pessoa de Meia-Idade , Cicatrização/efeitos dos fármacos , Pseudomonas aeruginosa/efeitos dos fármacos , Bandagens , Infecção dos Ferimentos/tratamento farmacológico , Staphylococcus aureus/efeitos dos fármacos , Hidrogéis
19.
Health Policy Plan ; 39(5): 457-468, 2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38511492

RESUMO

There is growing scholarly interest in what leads to global or national prioritization of specific health issues. By retrospectively analysing agenda setting for India's national burn programme, this study aimed to better understand how the agenda-setting process influenced its design, implementation and performance. We conducted document reviews and key informant interviews with stakeholders and used a combination of analytical frameworks on policy prioritization and issue framing for analysis. The READ (readying material, extracting data, analysing data and distilling findings) approach was used for document reviews, and qualitative thematic analysis was used for coding and analysis of documents and interviews. The findings suggest three critical features of burns care policy prioritization in India: challenges of issue characteristics, divergent portrayal of ideas and its framing as a social and/or health issue and over-centralization of agenda setting. First, lack of credible indicators on the magnitude of the problem and evidence on interventions limited issue framing, advocacy and agenda setting. Second, the policy response to burns has two dimensions in India: response to gender-based intentional injuries and the healthcare response. While intentional burns have received policy attention, the healthcare response was limited until the national programme was initiated in 2010 and scaled up in 2014. Third, over-centralization of agenda setting (dominated by a few homogenous actors, located in the national capital, with attention focused on the national ministry of health) contributed to limitations in programme design and implementation. We note following elements to consider when analysing issues of significant burden but limited priority: the need to analyse how actors influence issue framing, the particularities of issues, the inadequacy of any one dominant frame and the limited intersection of frames. Based on this analysis in India, we recommend a decentralized approach to agenda setting and for the design and implementation of national programmes from the outset.


Assuntos
Queimaduras , Política de Saúde , Prioridades em Saúde , Saúde Pública , Queimaduras/terapia , Humanos , Índia , Estudos Retrospectivos , Formulação de Políticas
20.
Pediatr Emerg Care ; 40(5): 390-394, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38459619

RESUMO

OBJECTIVES: Early wound management for pediatric patients with partial-thickness burns in the emergency department remains debatable. This study aims to evaluate the value of emergency conservative debridement under topical anesthesia in improving short-term prognosis of pediatric partial-thickness burns. METHODS: This retrospective cohort study enrolled children with partial-thickness thermal burns presenting to the emergency department within 6 hours postburn. All the enrolled patients were divided into 2 groups: the debridement group and the dressing group. The associations between emergency conservative debridement and time to reepithelialization was analyzed by using Kaplan-Meier curves with log rank test and multivariate Cox regression analysis. Moreover, the associations between emergency conservative debridement and in-hospital cost and length of stay were also evaluated. RESULTS: All baseline characteristics between groups were comparable (all P > 0.05). Emergency conservative debridement under topical anesthesia significantly decreased the median value of time to reepithelialization (13 vs 14 days, P = 0.02). Cox regression analysis showed that emergency conservative debridement significantly improved wound reepithelialization after adjusting for burn size (odds ratio, 4.07; 95% confidence interval, 1.64-10.11; P < 0.01). The mean length of stay of patients receiving conservative wound debridement was lower than that of patients in the wound dressing group (14.3 ± 7.3 vs 18.8 ± 10.4 days, P < 0.01), but not in terms of mean in-hospital cost per 1% total body surface area (2.8 ± 1.9 vs 3.0 ± 2.1 × 103 RMB per 1% total body surface area, P = 0.58). CONCLUSIONS: Emergency conservative debridement of pediatric partial-thickness burns under topical anesthesia significantly improves the wound healing outcomes without increasing health care burden.


Assuntos
Anestesia Local , Queimaduras , Desbridamento , Humanos , Desbridamento/métodos , Masculino , Estudos Retrospectivos , Feminino , Queimaduras/terapia , Pré-Escolar , Prognóstico , Lactente , Criança , Cicatrização , Tempo de Internação/estatística & dados numéricos , Bandagens/economia , Serviço Hospitalar de Emergência , Tratamento Conservador/métodos , Resultado do Tratamento
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