Search Results (542)

The association between hypothermia and poor outcomes in severe burn injury is well established. However, the significance of the core-peripheral temperature gradient has not previously been investigated. Institutional guidance at our burns centre advocates avoiding hypothermia and targeting a body temperature between 37.5 and 39.5 °C. The core-peripheral temperature gap should be ≤2 °C, based on expert opinion. Data from 61 patients admitted to the Intensive Care Unit (ICU) with severe burns between 2016 and 2022 were analysed. A higher core temperature at 48 h, avoidance of hypothermia and a core-peripheral temperature gap > 2 °C were associated with reduced odds of mortality. The mean core body temperature and core-peripheral temperature gap increased over the first 48 h (r = 0.5, p < 0.001). All non-survivors had a core-peripheral gap < 2 °C at 48 h. Survivors had a higher mean 48 h gap (1.6 [95%CI:1.3–1.9]) than non-survivors (0.8 [95%CI:0.2–1.4; p = 0.04]). Our findings support previous studies suggesting that avoiding hypothermia and achieving a higher target temperature are associated with reduced mortality. However, it challenges the previous expert consensus that a lower core-peripheral gap indicates better outcomes. Further research with a larger cohort of patients is required to identify whether a higher core-peripheral temperature gap predicts outcomes in critically ill patients with severe burns. Full article

Background/Objectives: Enzymatic debridement with bromelain is a treatment option for deep partial thickness and full thickness burns. This procedure is associated with significant pain, necessitating the use of anesthesia techniques. However, there is limited evidence on the optimal strategy to achieve effective pain control. To detail the anesthetic approach in patients undergoing bromelain-based enzymatic debridement for burn injuries. Methods: A retrospective observational study was conducted by analysing the medical records of burn patients treated with enzymatic debridement using bromelain. The study included patients admitted to the Burn Unit of Vall d’Hebron University Hospital between January 2015 and December 2019. Results: A total of 112 patients met the inclusion criteria. The average burned total body surface area (TBSA) was 10.7% ± 11.4, and the median Abbreviated Burn Severity Index (ABSI) was 5 (range: 2–12). The most commonly burned and treated regions were the upper limbs (73%), followed by the lower limbs (30%) and the abdomen (8%). Regional anesthesia was the predominant technique, utilised in 96% of cases. Among these, axillary nerve block was performed in 47% of patients, with continuous catheter placement in 31%. Pain control was achieved in 61% of patients during the first 48 h following enzymatic debridement. Opioids were required for post-procedure pain relief in 12.5% of cases, and repeat anesthesia was necessary in 2.7%. There was no significant difference in pain management outcomes between single nerve blocks and catheter-based approaches (p = 0.809). Complications were reported in nine patients and included hypotension, nausea, and urinary retention. Conclusions: Bromelain-based enzymatic debridement is a painful intervention requiring specialised anesthetic management. Regional anesthesia techniques offer a safe and effective strategy for pain control, though achieving optimal analgesia during the initial 48 h remains a clinical challenge. Full article

Burn injuries pose a significant threat to human life, with high morbidity and mortality rates. Accurate diagnosis, including the assessment of burn area and depth, is essential for effective treatment and can sometimes be lifesaving. However, access to specialized medical professionals is often limited, particularly in remote or underserved regions. To address this challenge and alleviate the burden on healthcare providers, researchers are investigating automated diagnostic tools. The severity of the burn and the affected body surface area are critical factors in diagnosis. From a computer vision perspective, this requires semantic segmentation of burn images to assess the affected area and determine burn severity. In collaboration with medical personnel, we have gathered a dataset of in situ images from a local children’s hospital annotated by specialist burn surgeons. However, due to the limited amount of data, we propose a two-step augmentation approach: training with synthetic burn images and controlling the encoder by ambiance preservation. The latter is a technique that forces the encoder to represent closely the embeddings of images that are similar and is a key contribution of this paper. The method is evaluated on the BAMSI database, demonstrating that the proposed augmentations lead to better performance compared with strong baselines and other potential algorithmic improvements. Full article

Background: In thermal injuries, enzymatic debridement is a viable option for treating partial- and full-thickness burns, allowing for rapid removal of damaged tissue with minimal bleeding and without sacrificing healthy dermis. Enzymatic debridement using Nexobrid^® combined with negative wound pressure therapy (NWPT) appears to promote healing, as enzymatic debridement helps preserve healthy tissue integrity and epithelial reserves. We explored therapeutic alternatives following enzymatic debridement to assess healing outcomes and reduce reliance on skin grafts. Methods: 24 patients with deep or partially deep thermal burns on 5–40% of total body surface area (TBSA) underwent enzymatic debridement; then, half received NWPT and the other half were treated with topicals. Results: Enzymatic debridement effectively removed necrotic tissue and facilitated healing. Only three patients required skin grafts (<10% TBSA). Enzymatic debridement combined with NWPT expedited daily healing, reduced hospitalization days, and eliminated wound secretion, as confirmed by bacteriological examination. This approach was more effective compared to enzymatic debridement followed by topical treatments. Conclusions: Nexobrid^® in combination with NWPT is a promising alternative to surgical treatment, improving healing, reducing the need for skin grafts, and alleviating pain associated with dressing changes. It may be particularly useful in extensive burns, where epithelial reserves are limited. Full article

Backgrounds: Burn injuries present significant medical challenges due to their complexity in healing and potential for severe scarring. This study evaluates the efficacy of Manuka honey in accelerating burn wound healing compared to conventional antibiotic ointments. Methods: Using a porcine model resembling human skin, nine Landrace breed female pigs with standardized deep dermal burns were treated with either Manuka honey in alginate or a combination of antibiotic ointments. Wound healing was assessed through macroscopic evaluation, a histopathological analysis, and immunohistochemical staining over a 60-day period. Results: Our findings indicate that the Manuka honey treatment was associated with significantly increased collagen density in the treated wounds compared to the control group (p < 0.05). The immunohistochemical analysis revealed lower macrophage activity (Iba1 staining) and a reduction in Ki67 expression on days 10 and 17 in the Manuka honey group, suggesting a more rapid transition toward tissue remodeling. The quantitative analysis showed a trend toward delayed epithelialization and increased inflammation in the control group, while wounds treated with Manuka honey exhibited faster reepithelialization and improved epidermal regeneration. However, additional studies are required to further assess collagen fiber organization and overall dermal architecture. Conclusions: These findings support the potential of Manuka honey as a beneficial treatment for burn wound healing, with evidence of enhanced reepithelialization and collagen deposition. Further research, including clinical trials, is necessary to fully elucidate its role in clinical practice and optimize treatment protocols. Full article

Sepsis is the leading cause of mortality in patients with burn injuries and it may represent, in these patients, a real diagnostic challenge. Here we studied the profile of miRNAs contained in extracellular vesicles (EVs) (EV-miRNAs) isolated from plasma from burn patients complicated by sepsis at admission and 7 days later. We enrolled 28 burn patients, 18 with (Burn Septic Patients—BSPs) and 10 without (Burn non-Septic Patients—BnSPs) sepsis. Ten healthy subjects (HSs) were used as additional controls. After EV isolation by charge precipitation and miRNA extraction, we proceeded with a two-phase approach. Through a first screening phase, we identified 178 miRNAs differentially expressed in BSPs compared to HSs. Among these, by a validation phase based on qRT-PCR, we found that miR-483-5p, miR-193a-5p, and miR-188-3p were increased in the BSPs compared to the BnSPs and HSs. Upon ROC analysis, all three miRNAs showed a good accuracy in differentiating BSPs from BnSPs, especially miR-483-5p (AUC = 0.955, p-value = 0.001). Moreover, we found 173 miRNAs differentially expressed in BSPs after 7 days from enrollment compared to T0, among whose miR-1-3p, miR-34a-3p, and miR-193a-5p decreased in BSPs after 7 days, in parallel with a decrease in SOFA scores. Finally, the other two miRNAs, miR-34a-3p and miR-193a-5p, positively correlated with the SOFA score. In conclusion, we identified several miRNAs—namely miR-483-5p, miR-193a-5p, and miR-188-3p—with potential clinical utility as diagnostic biomarkers in a heterogeneous population of burn patients at high risk of developing sepsis. Moreover, we found some miRNAs (miR-1-3p, miR-34a-3p, and miR-193a-5p) that vary according to the course of sepsis and others (miR-34a-3p and miR-193a-5p) that are associated with its clinical severity. Full article

Burns significantly impact children’s physical and psychosocial recovery, even in cases of non-severe injuries, leading to long-term health and mental health risks. This study explores the psychosocial benefits of a community-based exercise program for children recovering from burn injuries, addressing concerns such as anxiety, reduced physical activity, and social challenges. A pre-test–post-test design assessed the effects of an 8-week community-based trampoline exercise intervention on psychosocial outcomes in children and their caregivers. No significant or clinically meaningful physical improvements were observed across measures such as MET score, grip strength, BMI percentile, or heart-rate recovery despite a significant improvement in trampolining performance (p < 0.0001). Psychosocial outcomes showed improved child emotional function (PedsQL, p = 0.024) as reported by parents, though children’s self-reported emotional function and Child PTSD Symptom Scale (CPSS) scores remained unchanged. Parent-reported strengths and difficulty scores for the child remained stable over time but were higher than population norms for hyperactivity and emotional difficulty. Parental post-traumatic stress symptoms decreased significantly over time (p = 0.050), with reductions in avoidance (p = 0.009), hypervigilance (p = 0.007), and intrusion scores (p = 0.026). Children significantly improved their trampolining performance, while parents reported enhanced emotional function for their child. However, children’s self-reports did not reflect these emotional improvements. Full article

Background: Evidence indicates that pediatric burns are a significant form of trauma. They affect not only children but also their parents, who often experience short- and long-term psychopathological symptoms. The body of knowledge on the impact of hospitalization on parents has expanded; however, there is a dearth of evidence on the dynamics of parental relationships, parental experiences, and how these experiences affect their parenting. Objectives: This study aims to map and summarize the available literature on the repercussions of trauma associated with pediatric burns and hospitalization on parental and family dynamics. Methods: A scoping review will be carried out in accordance with the JBI methodology, based on the PCC. Studies involving hospitalized children (up to the age of 18) who have suffered accidental burns and their parents or caregivers will be included. The literature study will examine the effects of pediatric burn-related trauma on family and parental dynamics, emphasizing interventions and adjustment strategies that support children and families affected by this injury. Studies related to hospital settings and returning home will be included and analyzed by two independent reviewers using a standardized form developed for this study. The databases consulted will be Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed/Medline, Collection of Psychology and Behavioral Sciences (via EB-SCO), PsycInfo, Cochrane Library, Embase, and Web of Science (Clarivate). Results: The results will be summarized narratively, presented in tables or diagrams, to highlight key findings related to parental experiences with burned children, the trauma associated with this episode, and its impact on parenting. In addition, strategies developed within the framework of the care partnership will be highlighted. Conclusions: Understanding how family dynamics change after a child suffers a burn injury and goes through the hospitalization process is crucial for nurses to improve their practice. We hope that this review will promote partnership-oriented, family-centered nursing practice in the care of child burn victims and their families, as well as assist in the identification of knowledge gaps in the literature and potential areas for future research and development. Full article

Introduction: Hyperspectral Imaging (HSI) combined with an augmented model-based data processing enables the measurement of the depth-resolved perfusion of burn wounds. With these methods, the fundamental problem of the wound dynamics (wound conversion or progression) in the first 4 days should be parametrically analyzed and evaluated. Material and Methods: From a cohort of 59 patients with burn injuries requiring medical intervention, 281 homogenous wound segments were selected and subjected to clinical classification based on the duration of healing. The classification was retrospectively assigned to each segment during the period from day 0 to day 2 post-burn. The perfusion parameters were presented in two parameter spaces describing the upper and deeper perfusion. Results: The investigation of value distributions within the parameter spaces pertaining to four distinct categories of damage from superficial dermal to full-thickness burns during the initial four days reveals the inherent variability and distinct patterns associated with wound progression, depending on the severity of damage. The analysis highlights the challenges associated with estimating the burn degrees during this early stage and elucidates the significance of deeper tissue perfusion in the classification process, which cannot be discerned through visual inspections. Conclusions: The feasibility of early classification on day 0 or 1 was assessed, and the findings indicate a restricted level of reliability, particularly on day 0, primarily due to the substantial variability observed in wound characteristics and inherent dynamics. Full article

Background: Ophthalmic emergencies are acute conditions that progress rapidly, posing a significant threat to a patient’s vision and requiring urgent intervention to prevent permanent visual impairment. This study aimed to assess the general awareness of ocular chemical burns and the adequacy of the immediate response measures while also seeking to improve the understanding of these injuries and contribute to promoting a healthier society. Methods: A comprehensive literature review was performed, and the most frequently reported questions were incorporated into the original survey. An anonymous questionnaire, available both online and in print, was developed to conduct a cross-sectional study to assess the general knowledge of the causes, symptoms, and appropriate first aid measures to be applied in cases of chemical ocular trauma. Results: Between April and May 2024, 175 individuals completed the questionnaire and were included in the study. More than half (54%) of the tested population demonstrated a poor level of knowledge about chemical ocular injuries, and only 30.9% of the respondents correctly indicated the need for imminent treatment. Twenty percent of the respondents could not identify whether alkalis or acids are more hazardous. Additionally, 5.7% of the respondents falsely considered consultation with an emergency department a priority before thorough irrigation. Most of the respondents (60.6%) incorrectly indicated that the appropriate first aid measures and treatment depend on the substance involved, and 68.1% of the respondents stated that treatment in the emergency department should be delayed, allowing for anamnesis collection and thorough examination. Conclusions: Ocular chemical injuries can substantially impact an individual’s quality of life. The present study found that the public knowledge concerning ocular chemical trauma, and the necessary immediate treatment is insufficient. Public education is vital, as delaying prompt and thorough irrigation at the chemical injury site may result in irreversible complications. Full article

Burn injuries are a common traumatic condition, and the early diagnosis of burn depth is crucial for reducing treatment costs and improving survival rates. In recent years, image-based deep learning techniques have been utilized to realize the automation and standardization of burn depth segmentation. However, the scarcity and difficulty in labeling burn data limit the performance of traditional deep learning-based segmentation methods. Mainstream semi-supervised methods face challenges in burn depth segmentation due to single-level perturbations, lack of explicit edge modeling, and ineffective handling of inaccurate predictions in unlabeled data. To address these issues, we propose SBCU-Net, a semi-supervised burn depth segmentation network with contrastive learning and uncertainty correction. Building on the LTB-Net from our previous work, SBCU-Net introduces two additional decoder branches to enhance the consistency between the probability map and soft pseudo-labels under multi-level perturbations. To improve segmentation in complex regions like burn edges, contrastive learning refines the outputs of the three-branch decoder, enabling more discriminative feature representation learning. In addition, an uncertainty correction mechanism weights the consistency loss based on prediction uncertainty, reducing the impact of inaccurate pseudo-labels. Extensive experiments on burn datasets demonstrate that SBCU-Net effectively leverages unlabeled data and achieves superior performance compared to state-of-the-art semi-supervised methods. Full article

Skin disorders are the fourth most common cause of all diseases, which affect nearly one-third of the world’s population. Topical drug delivery can be effective in treating a range of skin disorders, including microbial infections, skin cancer, dermatitis, burn injury, wounds, and psoriasis. Bioadhesive nanoparticles (BNPs) can serve as an efficient topical drug delivery system as they can serve dual purposes as bioadhesives and nanocarriers, which can mediate targeted drug delivery, prolong retention time, and deepen drug penetration through skin layers. There is an increasing demand for BNP-based applications in medicine because of their various advantages, including biodegradability, flexibility, biocompatibility, and enhanced adhesive strength. A number of BNPs have already been developed and evaluated as potential topical drug delivery systems. In addition, a range of studies have already been carried out to evaluate the potential of BNPs in the treatment of various skin disorders, including atopic dermatitis, irritant contact dermatitis, skin cancer, psoriasis, microbial infections, wounds, and severe burn injuries. This review article is timely and unique, because it provides an extensive and unique summary of the recent advances of BNPs in the treatment of wide-ranging skin disorders. Moreover, this review also provides a useful discussion on the bioadhesion mechanism and various biopolymers that can be used to prepare BNPs. Full article

Background and Objectives: Postmenopausal women are often treated with exogenous female hormones to alleviate physical symptoms and support mental health. We posit that women treated with estrogen fare better following burn injury. Materials and Methods: De-identified patient data were obtained from TriNetX, a global healthcare research network. Adult postmenopausal women were enrolled if they were diagnosed with burn injury within 10 years after menopause onset. Patients with pre-existing abnormal uterine bleeding, gynecologic cancer, and chronic liver or heart disease were excluded. The population was grouped into those who received and those who did not receive estrogen treatment (ET) for evaluation of subsequent complications. Cohort balancing was performed using the exact match approach of Inverse Probability Treatment Weighting (IPTW). The average treatment effects (ATEs) and confidence intervals were computed for these balanced cohorts. Results: Postmenopausal women with ET had a lower risk of endometrial hyperplasia and malignancy 3 months (ATE = −0.005, −0.006) and 3 years (−0.007, −0.008) after mild burn injury (less than 20% of total body surface area) (p < 0.05), regardless of age. At the 3-month timepoint, postmenopausal women aged 45–65 with ET exhibited preventive effects against acute kidney injury (−0.0332), cerebral infarction (−0.0279), breast cancer (−0.0278) and severe sepsis (−0.011) after mild burn injury (p < 0.05) compared to women who did not receive ET. After 3 years, 45–65-year-old women with ET exhibited decreased rates of breast cancer (−0.0479) and endometrial hyperplasia (−0.0116) (p < 0.05) compared to those without ET. Conclusions: Estrogen treatment decreases the risk probabilities of breast cancer and other complications in postmenopausal women from 3 months to 3 years after mild burn injury. Full article

Burn injuries cause severe muscle wasting and weakness. However, the relative contribution of neuromuscular junction (NMJ) degradation remains elusive. We investigated the associations of plasma c-terminal agrin fragment-22 (CAF22), a marker of NMJ degradation, with muscle decline in burn patients. We recruited male patients with burns (n = 32, age = 32.3 ± 4.5 years, percent burn area = 15.2 ± 2.3) and age-matched controls to evaluate handgrip strength (HGS), skeletal muscle mass index (SMI), phase angle, and creatine kinase and plasma levels of CAF22, c-reactive protein, and 8-isoprostanes. We used an unpaired t-test and regression analysis for statistics. The burn patients had lower HGS, SMI, and phase angle than the controls (all p < 0.05). These patients also exhibited higher plasma CAF22, CRP, 8-isoprostanes, and creatine kinase than the controls (all p < 0.05), suggesting NMJ degradation and heightened inflammation and oxidative stress. Correlation analysis revealed significant correlations of plasma CAF22 with HGS and phase angle in the burn patients, suggesting the potential contributions of NMJ degradation to muscle weakness and atrophy (both p < 0.05). We also found correlations of plasma CRP with HGS and phase angle in these patients (both p < 0.05). Altogether, NMJ degradation appears to play a significant role in burn-induced muscle injury and may warrant further investigation for potential therapeutic interventions. Full article

The accurate assessment of parameters such as burn degree, volume, and depth is a prerequisite for the effective treatment of patients. However, as an unsteady heat transfer process, the temperature of the burn damage volume changes over time, and it is difficult to accurately calculate the integral value of the damage, which is used to assess the burn degree. Therefore, it is impossible to accurately determine the location and volume of damage at all burn degrees. In this study, the C language is used to program a user-defined function of the burn damage integral formula, and the coupled numerical simulation method is used to calculate the heat transfer and damage in a high-temperature water burn process. Then, the temperature and burn damage integral value of each point can be determined to accurately assess and distinguish the burn degree in real time, and estimate the position distribution, volume size, and transient change trend of each burn degree. Under the working conditions selected in this paper, the heat source mainly affects the epidermis and dermis directly below, and has less influence on the area above, which is in convective heat transfer. The damage integral value is very sensitive to temperature, and the highest damage integral value caused by 373 K is two and four orders of magnitude higher than that of 363 K and 353 K, respectively. The increase in the heat source temperature caused the volume of a third-degree burn to increase rapidly in the early stage of injury, but the volume of second-degree and first-degree burns did not change much. After heating at 373 K for 15 s and delaying the action for 45 s, the volume of first-, second-, and third-degree burns accounted for 0.4, 2.9, and 1.9%, respectively, and the total volume of damage accounted for only 5.2% of the total volume. Full article