Skin ph variations from the acute phase to re-epithelialization in burn patients treated with new materials (burnshield®, semipermeable adhesive film, dermasilk®, and hyalomatrix®). Non-invasive preliminary experimental clinical trial.

The aim of this trial was to measure the pH value of the skin of burn patients using a non-invasive method, from the acute phase through to complete re-epithelialization. The research was then completed by treating the patients with new materials and innovative methods to verify whether this had an effect on the skin pH and on re-epithelialization time. In this clinical trial, the patients were medicated repeatedly with hydrogel (Burnshield®) kept in place by a transparent, semipermeable adhesive film with a moisture vapour transmission rate equivalent to 1600 until day 5 or 6 post-burn. In one patient, treated silk (DermaSilk®) was applied several times until re-epithelialization; in another patient, synthetic hyaluronic acid (Hyalomatrix®) was applied. Various studies using Dermasilk® have confirmed that the fibroin in silk stimulates re-epithelialization, in addition to keeping the burned skin disinfected, thanks to the antimicrobial agent contained in the treated silk. Hyalomatrix® was used on the other patient, as in other studies, as a temporary substitute for the skin in deep burns. Late complications (keloids and hypertrophic scars) can give rise, even after prolonged periods of time, to Marjolin's ulcer (carcinoma but also melanoma and sarcoma), which can develop in the course of a year. A recent Danish trial affirms that appropriate burn treatment facilitates re-epithelialization and decreases the incidence of Marjolin's ulcer. For the trial, we used a centimetre-wide strip of reactive paper sensitive to pH variations and an acid test (Duotest® kit) as a reference, applied for more than one minute on the patient's burned and slightly damp skin. We performed control procedures on the patient's normal skin, away from the wound site. The pH was measured from day 1 post-burn and every other day thereafter until complete re-epithelialization. We found alkaline pH values for the burned skin from the day of the burn until day 12, with an alkaline pH peak on day 4 (10.5 in the first patient, 9.5 in the second). The values then gradually returned to normal (pH, 5.5) from day 13 onwards. The mean re-epithelialization time was similar in the two patients, equivalent to 24.5 days (25 days in the first patient, 24 in the second), with a mean follow-up of 21 months (33 months in the first case, 9 in the second). No early or late complications were observed.

[The education tree. Experiences from one century of anti-diabetic treatment]. / L'albero educativo. L'esperienza di un centro antidiabetico.

The educational experience of a Diabetic Care Centre, throughout 15 years is described using the metaphor of the tree. Each course organized for different patients with different needs is a branch that contributes to the development of the tree. The importance of a common philosophy and the team work are considered pivotal for the growth and development of the educational tree. One hundred twenty-nine courses have been organized to data and 239 follow-up evaluations were performed.