Burns

Advance Announcement

2010-02-01

Editorial Board

2010-02-01

Acknowledgement to Reviewers - 2009

2010-02-01

Platelet-rich plasma in burns

Norbert Pallua, Timm Wolter, Marta Markowicz — 2010-02-01

Abstract: Platelet-rich plasma stimulates angiogenesis, promoting vascular in-growth and fibroblast proliferation. In addition, PRP functions as haemostatic by forming a fibrin clot. Also application of PRP enhances wound-healing in both soft and hard tissue. A survey of the literature to assess the current clinical experience and the possible effects of platelet-rich plasma (PRP) on wound-healing in burn cases yields only few reports. The application of PRP is not currently standardized and the effects in wound-healing are poorly understood. The use of PRP as an analog to fibrin sealant is also only seldomly reported.The value of PRP application in burns remains unclear. A definitive assessment as to the application of PRP in burn treatment will require further studies. Theoretically the effects of PRP in burn wounds could be beneficial, however the interaction in tissue repair and regeneration must be better understood.

Burn wounds infected by contaminated water: Case reports, review of the literature and recommendations for treatment

2010-02-01

Abstract: First-aid education for the management of burns advocates cool running water over burnt skin to limit soft tissue damage. However, the water used may itself constitute a risk.We report three cases of severe invasive and necrotizing infection in patients who used or immersed themselves in contaminated water in an attempt to extinguish the fire following acute major burns. Wound cultures from all patients yielded Aeromonas hydrophila and two yielded Bacillus cereus. One patient had a complex polymicrobial infection, including zygomycosis with Rhizomucor variabilis. All patients were treated aggressively with wound débridement, including one patient who required bilateral lower limb amputations to control progressive infection. All infections were successfully treated and all patients survived their burn injuries.We review the management of burns complicated by exposure to contaminated water leading to burn wound infections. We describe commonly reported organisms from various water sources, the appropriate initial empirical antimicrobial chemotherapy and present the clinician with a proposed algorithm for managing these serious infections.

An objective long-term evaluation of Integra (a dermal skin substitute) and split thickness skin grafts, in acute burns and reconstructive surgery

Dai Q.A. Nguyen, Tom S. Potokar, Patricia Price — 2010-02-01

Abstract: Introduction: The field of wound healing and tissue repair has advanced rapidly in the last decade, with this there is an increasing emphasis on the importance of the functional and cosmetic outcomes following injury. Integra artificial skin is the most widely used synthetic skin substitute and is reported to have better outcomes in relation to the appearance and elasticity when compared to split thickness skin grafting (SSG). A review of the literature reveals very few trials that are based on an objective evaluation of Integra treated scars as compared to SSGs. This research aimed to provide objective data on the long-term outcome of Integra.Method: All adult patients from the Welsh Burns Centre who had been successfully treated with Integra±SSG were invited to attend a clinic for a follow up provided they had been healed for greater than one year. The hypothesis that Integra scars are more pliable than skin grafts was tested objectively using the Cutometer, a suction device which measures skin elasticity.Results: Of the 13 patients eligible, six were available for assessment. The results of this study suggest that Integra treated sites correlate well with normal skin as measured by the Cutometer. This was statistically significant for the parameters Ur/Ue (elastic function) and Ur/Uf (gross elasticity). On the other hand there was no correlation seen between the patients SSG sites and the patient's normal skin.Conclusion: With advances in medicine we are increasingly able to modulate wound healing and the resultant scars. In order to assess new and often costly treatments the need for objective scar measurement tools have become apparent. Integra has been advocated to improve scarring from injury. However, there have been few studies to evaluate the long-term outcome of Integra as compared to traditional methods such as SSG. In the past scar evaluation has been based on subjective scores by patients and clinicians. Now the mechanical properties of the skin can be evaluated using simple bioengineering methods such as the Cutometer Suction Device. Using this device our study has objectively demonstrated that the elastic properties of areas treated with Integra is comparable to normal skin.

The impact of personality and coping on the development of depressive symptoms in adult burns survivors

Rachel M. Andrews, Allyson L. Browne, Peter D. Drummond, Fiona M. Wood — 2010-02-01

Abstract: This prospective study examined the extent to which the personality traits neuroticism, extraversion and agreeableness and coping styles approach, avoidant and ambivalent contribute to the development of depressive symptoms in adult burns survivors at three months post-injury. Participants were 70 adult burns survivors admitted to Royal Perth Hospital in Western Australia between June 2007 and February 2008. Personality was assessed using the NEO Personality Inventory-Revised (NEO-PI-R), coping was evaluated with the Coping with Burns Questionnaire (CBQ) and depressive symptoms were measured using The Centre for Epidemiologic Studies Depression Scale (CES-D). Twenty one percent of retained participants at three months (n=29) reported clinically significant depressive symptoms. There were no significant relationships between depressive symptoms at three months and demographic or burn characteristics. Neuroticism significantly predicted depressive symptoms at three-month follow-up and this relationship was significantly mediated by avoidant coping. In addition, extraversion, avoidant coping and approach coping were all significant and independent predictors of depressive symptoms at three months. These findings suggest that burns patients at greatest risk of developing clinically significant depressive symptoms may be identifiable in the acute recovery phase.

Systemic absorption of amphotericin B with topical 5% mafenide acetate/amphotericin B solution for grafted burn wounds: Is it clinically relevant?

Rachel A. Pendleton, James H. Holmes — 2010-02-01

Abstract: Objective: To determine if patients receiving topical amphotericin B in combination with 5% mafenide acetate solution will acquire systemically detectable levels of amphotericin B.Methods: A prospective, observational study of consecutive patients from May 2007 to March 2008 who received 5% mafenide acetate/amphotericin B (2mcg/ml) solution topically every 4h to their excised and grafted burn wounds for at least 5 days. Serum amphotericin B levels were measured every 5 days during treatment. In addition, the percentage of graft take, occurrence of infection, and potential adverse reactions or toxicities were monitored and recorded.Results: A total of 27 patients were enrolled, accumulating 420 treatment days and 72 amphotericin B levels. Sixty-nine of the amphotericin B levels were undetectable, while 3 were detectable at non-therapeutic levels (<0.5mcg/ml). Of the patients with a detectable serum amphotericin B level, only one experienced adverse reactions that could potentially be attributed to amphotericin B. The mean TBSA burned was 32% (SD±14%), with a mean TBSA treated with solution of 21% (SD±13%). The median duration of treatment was 8 days (range 5–52 days), and the median number of amphotericin B levels drawn per patient was 1 (range 1–19). The median percentage graft take was 95%, and there were no fungal wound infections.Conclusions: We conclude that 5% mafenide acetate/amphotericin B (2mcg/ml) solution, applied to excised and grafted burn wounds, does not produce clinically relevant serum levels of amphotericin B. Based on our observations, this topical regimen is safe.

Burns pruritus—A study of current practices in the UK

Ioannis Goutos — 2010-02-01

Abstract: Pruritus is a universal symptom associated with burns healing. Little research has been conducted to assess physicians’ attitudes and management principles in specialist units. A survey of UK burn units has identified a variety of opinions on the importance of various factors affecting the incidence of pruritus and a lack of a systematic approach in the assessment and treatment of this distressing symptom. A clear pattern emerged favouring the use of antihistaminergic agents for burns pruritus management with a low uptake of agents acting on the central nervous system as well as non-pharmacological adjuncts. The cumulative responses from the cohort of respondents are presented and issues pertinent to further research and clinical management are discussed.

Burns, biofilm and a new appraisal of burn wound sepsis

Peter Kennedy, Susan Brammah, Edward Wills — 2010-02-01

Abstract: Purpose: Following a burn, the wound may become colonized and septic complications may ensue. Many organisms, commonly isolated from burn wounds produce biofilms, which are defined as a collection of organisms on a surface surrounded by a matrix. Biofilms are associated with development of antibiotic resistant organisms and are refractory to the immune system. The presence of biofilm in the burn wound has not been documented.Methods: A study was undertaken using light and electron microscopy to determine the presence of biofilm in the burn wound. Specific stains were used to detect the presence of micro-organisms and associated carbohydrate, a major constituent of the biofilm matrix. A concurrent microbiological study of the burn wound was also carried out.Results: Biofilm was detected in ulcerated areas of the burn wound. Bacterial wound invasion with mixed organisms was also commonly detected.Conclusions: The finding of biofilm in the burn wound has significance in our understanding of burn wound sepsis and supports the evidence for early excision and closure of the burn wound. Due to the recalcitrant nature of biofilm associated sepsis and the difficulty in disrupting biofilm it has implications for the future development of wound care dressings.

Factors affecting survival in adult patients with massive burns

2010-02-01

Abstract: Objective: To identify treatment-related factors associated with mortality in massively burned adult patients. Methods: This retrospective cohort study examined survival outcomes at a burn unit of 54 beds and 10 burn ICU beds, totaling 900 admissions per year. The cases of 102 adult patients, admitted consecutively from January 1993 to October 2007, with massive burns (burn area>70% of the total body surface area, TBSA) were studied. Relevant variables were recorded from the initial injury and throughout the hospital course. Survival analysis, based on univariate and stepwise multivariate Cox proportional hazards regression, was performed to determine which variables predicted mortality. Results: The overall mortality rate was 30.4%. Burn size, severe inhalation injury, full-thickness burns, serum creatinine levels, inotropic support, platelet counts<20,000 per mm3, sepsis and ventilator dependency were significantly associated with mortality as determined by univariate analysis. Only sepsis, ventilator dependency and platelet counts were significant independent predictors of mortality as determined by multivariate analysis. Conclusions: Sepsis, ventilator dependence (indicating severe respiratory complications), and low platelet counts (indicating thrombocytopenia) are associated with increased mortality risk in adult patients with massive burns. Methods should be sought to ameliorate these complications during treatment in burn-care units.

Experiences in organizing Advanced Burn Life Support (ABLS) provider courses in Japan

2010-02-01

Abstract: The ABLS course sponsored by the ABA has not yet been made available in Japan, although it is strongly desired. During the 3 years between 2006 and 2008, authorized ABLS provider courses were given once a year in Japan as part of preparations to reach an agreement between the ABA and the JSBI for the continuation of ABLS provider courses in Japan. These courses were provided as one of the programs available at the annual meeting of the JSBI. Nine Japanese registered ABLS instructors (including some candidates) acted as lecturers. Two national faculty members and one course coordinator, acting as ABA observers, participated in the first and second courses. In total, 64 physicians (37 emergency physicians, 20 plastic surgeons, 4 intensivists and 3 general surgeons) attended the courses. Course management and instructor behavior were reviewed by the ABA observers and the 64 physicians in attendance using questionnaires. The ABA observers rated the courses as “outstanding” in every aspect (course faculty, facilities, course organization, course conduct, and adherence to ABLS philosophies). The pre-course planning, course conduct, and course evaluations were professional and adhered to the highest educational standards. However, several areas of the ABLS course content may require revision to accommodate differences in standard medical treatment between the United States and Japan. Two percent of the physicians rated the courses as easy, 59% rated the course as moderate, 22% rated the course as slightly difficult, and 6% rated the course as difficult. The courses were generally evaluated as very good by 28% of the physicians and good by 56%. The major opinion regarding the organization of the course in Japan was that the course should have undergone appropriate curriculum changes to accommodate societal differences (including the translation of the course into Japanese) as well as modifications to the disaster management and patient transport sections. Regarding the organization of future ABLS courses in Japan, the active involvement of the JSBI is inevitable. Several areas of the ABLS course content may need to be revised to accommodate differences in standard medical treatment between the United States and Japan. A joint effort between the ABA and the JSBI regarding appropriate curriculum changes to accommodate societal differences as well as modifications to some sections would increase the applicability of the course in Japan.

Detection of VEB-1, OXA-10 and PER-1 genotypes in extended-spectrum β-lactamase-producing Pseudomonas aeruginosa strains isolated from burn patients

2010-02-01

Abstract: Resistance of Pseudomonas aeruginosa strains to the broad-spectrum cephalosporins may be mediated by the extended-spectrum β-lactamases (ESBLs). These enzymes are encoded by different genes located on either chromosomes or plasmids. This study aimed to investigate the prevalence of ESBLs and antimicrobial susceptibilities of P. aeruginosa isolated from burn patients in Tehran, Iran. Antimicrobial susceptibility of 170 isolates to cefpodoxime, aztreonam, ciprofloxacin, ofloxacin, ceftazidime, cefepime, imipenem, meropenem, cefotaxime, levofloxacin, piperacillin–tazobactam and ceftriaxone was determined by disc agar diffusion test. Polymerase chain reaction (PCR) amplification of the genes encoding OXA-10, PER-1 and VEB-1 was also performed. All isolates (100%) were resistant to ceftazidime, cefotaxime, cefepime and aztreonam. Imipenem and meropenem were the most effective anti-pseudomonal agents. The results revealed that 148 (87.05%) of the isolates were multidrug resistant and 67 (39.41%) of the isolates were ESBL positive. Fifty (74.62%), 33 (49.25%) and 21 (31.34%) strains among 67 ESBL-producing strains amplified blaOXA-10, blaPER-1 and blaVEB-1 respectively.In conclusion, the high prevalence of multidrug resistance (87.05%) and production of OXA-10, PER-1 and VEB-1 genes in P. aeruginosa isolates in burn patients confirm that protocols considering these issues should be considered in burn hospitals.

Effect of vagus nerve stimulation on thermal injury in rats

2010-02-01

Abstract: Objective: To investigate the effects of vagus nerve stimulation on haemodynamics, pulmonary histopathology, arterial blood gas and pro-inflammatory responses to thermal injury.Interventions: Forty-eight male Sprague–Dawley (SD) rats were randomly divided into six equal groups: normal control (NC) group; thermal injury (TEM) group subjected to 40% total body surface area (%TBSA) third-degree thermal injury; vagotomy (VGX) group subjected to bilateral cervical vagotomy after thermal injury; electrical stimulation (STM) group subjected to bilateral cervical vagotomy plus the left vagus nerve trunk electrical stimulation (5V, 2ms and 1Hz) after thermal injury; the antagonist of muscarinic acetylcholine receptor (MRA) group administrated with atropine (0.1mgkg−1) before electrical stimulation and the antagonist of nicotinic acetylcholine receptor (NRA) group administrated with hexamethonium (10mgkg−1) before electrical stimulation.Measurements and main results: The haemodynamics, histopathology of lung tissue, arterial blood gas, lactic acid, tumour necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels were measured. Vagus nerve electrical stimulation not only significantly increased the mean arterial pressure (MAP) and heart rate (HR), but also decreased the infiltration of inflammatory cells into interstitial and alveolar spaces after thermal challenge and attenuated TNF-α and IL-6 production. Hexamethonium pre-treatment significantly reversed the effects of vagal electrical stimulation, but atropine administration before electrical stimulation had no such effects.Conclusions: Direct electrical stimulation of the vagus nerve might produce therapeutic effect on thermal injury. The effect may be realised by limiting the inflammatory response via nicotinic acetylcholine receptors in rats.

Proteomic change of peripheral lymphocytes from scald injury and Pseudomonas aeruginosa sepsis in rabbits

2010-02-01

Abstract: Background: Increased susceptibility to infection has been related to impairment of lymphocyte-regulated immune responses after severe burn. The aim of this study is to identify the differential expression of proteins in circulating lymphocytes from scald injury and Pseudomonas aeruginosa sepsis in rabbits to provide a basis for pathogenesis of burns and sepsis. Methods: Rabbits were subjected to sham burn (A), 30% scald (B), A+bacterial challenge (C) or B+bacterial challenge (D). Bacterial challenge was inflicted by an injection of 2.0×108CFU P. aeruginosa (ATCC27853) in the auricular vein 22h after the burn procedure. The animals were sacrificed 24h later. Lymphocytes were isolated, and the differential proteins in the lymphocytes from the experimental and control animals were identified by two-dimensional electrophoresis (2-DE) coupled with matrix-assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF-MS), two of which were confirmed by Western blotting. Results: Nineteen differential protein spots were found by 2-DE and 12 spots (11 proteins) were identified. Differential expression of peroxiredoxin and annexin I was validated by Western blotting. Among the identified proteins, the expression levels of cofilin, cyclophilin A, ubiquitin, nucleoside diphosphate kinase, glutamate dehydrogenase and annexin I were down-regulated in group B, excessively down-regulated in group D, but mildly in group C, and peroxiredoxin was up-regulated in groups B and D. Conclusions: Proteome changes in lymphocytes from P. aeruginosa sepsis in the scalded rabbits were revealed, which are related to immune suppression and the pathogenesis of sepsis after scald injury.

Longitudinal changes in plasma Transforming growth factor beta-1 and post-burn scarring in children

2010-02-01

Abstract: Transforming growth factor beta1, a multifunctional growth factor, plays a pivotal role in wound healing and has been shown to accelerate impaired wound healing. However, high systemic levels of Transforming growth factor beta1 have generally been associated with fibrotic disease processes such as myelofibrosis and pulmonary fibrosis.Hypertrophic scarring occurring during childhood interferes with growth, impairs the function and causes immense psychological and aesthetic problems. Burns is the leading cause of hypertrophic scarring. We studied the longitudinal relationship between plasma Transforming growth factor beta-1 and post-burn wound healing and scarring in children.We discovered that the plasma levels of Transforming growth factor beta-1 rapidly increased to significantly higher levels in the first two weeks post-injury and fell thereafter, in patients who healed with good quality scars post-burn. By contrast, the increase in plasma TGFβ1 levels in the early stages after-burn, was noticeably absent in patients who developed hypertrophic scarring. We propose that this change in the systemic levels of TGFβ1 early after the burn may be used as an indicator of patients at risk of developing hypertrophic burn scars. This group of patients could then be targeted for early pharmacological/physical interventions to reduce/prevent scar-related morbidity in burn survivors.

Effect of imiquimod on partial-thickness burns

2010-02-01

Abstract: Background: Burns can result in substantial morbidity through fibroblast proliferation and contracture. Imiquimod (IMQ), an immune response modifier and upregulator of endogenous cytokine expression, has been shown to suppress fibroblast proliferation. It is widely used in the treatment of viral, neoplastic and non-neoplastic skin conditions and has recently been tested in the reduction of hypertrophic scarring and keloids. To our knowledge, no other study has so far evaluated the effect of IMQ on cutaneous burns.Methods: Partial-thickness burns were produced on the dorsum of 32 Wistar rats. Right-sided wounds received saline and left-sided wounds received 5% IMQ cream three times/week following injury. Photographs taken on post-burn days (PBD) 4, 7, 14 and 21 were evaluated for wound appearance using a clinical assessment scale and a visual analog scale. Scars were measured by digital planimetry. Samples stained with hematoxylin–eosin were submitted to conventional histological analysis. Samples stained with Sirius Red were analyzed under polarized light for collagen morphometry.Results: Visual scores were higher in the saline group on PBD 21 (p<0.05). Wound edge migration rates were lower (p<0.05) and conventional histology showed accentuated inflammation and delayed reepithelialization in the IMQ group. Type-I and type-III collagen deposition increased in the saline group and decreased in the IMQ group. Conversely, the proportion between type-I and type-III collagen differed significantly between treatments on PBD 4 and 21 (p<0.05 in both cases).Conclusions: Short-term topical imiquimod treatment of partial-thickness burns in rats did not improve clinical appearance and scarring but rather decreased fibrosis. Significant differences in collagen deposition were observed between the treatments.

Epidemiology of outpatient burns in Tehran: An analysis of 4813 cases

2010-02-01

Abstract: This study aims to demonstrate the epidemiologic characteristics of outpatient burn injuries in Tehran. This cross-sectional study was performed over a 1-year period in a referral burn centre in Tehran and included all outpatient burns. The required data were recorded by two trained physicians. Of the 4813 studied patients, including 293 infants, 2901 patients (60%) were male (P<0.001). The mean age of the adult patients was 31.3±18.3 years, while for infants it was 10.68±2.27 months. In all age groups and both genders, scalding was the most common aetiology. Majority of the burns were non-intentianal (n=4808) and 70.5% of the injuries occurred at home. Housewives consisted of 24% of the burn patients. With respect to the site of burn, multiple injuries were the most frequent (53%) followed by upper extremities (37%). Most of the burns (96%) were partial thickness. Significant association was present between the aetiology and depth of burn (P<0.001). The mean affected total body surface area (TBSA) was 3.16±2.92% and there was significant association between burnt TBSA and the mechanism of injury (P<0.001). In conclusion, it seems that women aged 21–30 years and children younger than 10 years are at greater risk of these injuries and therefore should be the target for preventive strategies.

Integra Artificial Skin® for burn scar revision in adolescents and children

Dorothea Stiefel, Clemens Schiestl, Martin Meuli — 2010-02-01

Abstract: Integra Artificial Skin®, a biosynthetic dermal template, is well established in acute burn surgery. The aim of the study was to determine the role of Integra in the surgical treatment of postburn scars in a younger population.Between March 1998 and November 2004, 17 patients (n=17; mean age=13.15 years) underwent complete excision of hypertrophic scars or keloids (1–4% TBSA; extremities=47%, head/neck=35%, trunk=18%) with subsequent implantation of Integra for defect closure. Split thickness skin grafting (STSG) of the Integra-derived neodermis was performed 3 weeks after the first operation.Scar excision and primary Integra implantation was successful in all but one patient (94%) who (6%) needed reimplantation once. Integra's mean take rate was 99.7% for all primarily successful patients. Complications occurred in three patients (18%), including minor problems without long-term consequences in 12% (seroma formation), and major problems in 6% (hematoma formation). Take rate of STSG ranged from 50% to 100% (mean 94%). Functional and cosmetic long-term outcome showed results scored “excellent” in 53%, “good” in 36%, and “fair” in 11%. Comparison of pre- and postoperative findings revealed a significant functional improvement in all and a considerable cosmetic improvement in all but two patients.These results suggest that Integra is a valid new treatment modality for extensive burn scar revision in younger patients.

Aquacel® Ag with Vaseline gauze in the management of toxic epidermal necrolysis (TEN)

2010-02-01

Abstract: Toxic epidermal necrolysis (TEN) is a rare condition with potentially high mortality and involves severe exfoliative disease of the skin and mucous membranes induced by drugs. The reported fatality of TEN varies widely from 20% to 60%. The technique for TEN wound coverage described in this article involves the use of various dressings.Patients and methods: Nine women with histologically confirmed TEN (>30% total body surface area, TBSA) were treated at our burn intensive care unit. All patients received hydrotherapy and wounds were covered with Aquacel® Ag and Vaseline gauzes onlay. Following this, elastic cotton bandage was wrapped around the dressing. The dressing was changed and the wound evaluated twice a week. Efficacy was established by the wound achieving ≥95% re-epithelialisation of the study area.Results: The mean age was 60.1 years (range from 7 to 88 years). The percentage of body surface area affected by epidermal slough ranged from 30% to 85% TBSA, with a mean of 51%. One patient expired due to severe sepsis on day 3. Eight patients achieved over 95% wound healing. All wounds healed well without the need for skin grafting. However, two of them expired on day 14 and day 20 because of pneumonia and retention of carbon dioxide, respectively. The average duration to achieve 95% wound healing was 10.4 days in eight cases (range from 7 to 14 days). No adverse reactions were noted.Conclusion: Aquacel® Ag dressing can be easily removed during hydrotherapy. The wound pain is reduced. By changing the dressing just twice a week, we were able to evaluate the wound directly, decrease the odour and increase the quality of life of the patients. In addition, lower frequency of dressing changes decreases the manpower requirements and is cost effective. Use of Aquacel® Ag with Vaseline gauze is a good alternative for the management of TEN wounds.

Effect of tetramethylpyrazine on DRG neuron P2X3 receptor involved in transmitting pain after burn

2010-02-01

Abstract: A burn is a severe injury, and the resulting pain can be very significant. Currently, opioids are the primary method of pain management, but these drugs have side effects; thus, it is of prime focus to research the mechanisms of pain formation and analgesic drugs.Objective: To investigate the effects of tetramethylpyrazine (TMP) on burn pain mediated by the P2X3 receptor.Methods: First-degree and superficial second-degree burn models were used. The mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) were measured, and P2X3 receptor expression on nerve terminals in burn-injured skin were detected by immunohistochemistry. The effects of TMP on the P2X receptor agonist-activated currents in freshly isolated burn-injured rat dorsal root ganglion (DRG) neurons were studied by whole-cell patch-clamp technique.Main Results: One hour following the procedure, MWT and TWL in first and second-degree paw-burns with normal saline (NS) treatment were lower than those in the unburned control group and lasted for 24 or 96h, respectively (p<0.01). After 24h, MWT and TWL in the first-degree paw-burn with TMP treatment were significantly increased as compared with NS treatment; no difference was found when compared to the unburned control group. MWT and TWL in the second-degree paw-burn in the TMP treatment group were significantly increased at 48h compared to NS treatment. No difference was found with the values for the unburned control group after 72h. On day 3 after the burn, P2X3-receptor expression in the nerve terminal in the burn-injured skin of the first- and second-degree dorsal burns in the NS treatment group was higher than those in other groups (p<0.05). After treatment with TMP, P2X3-receptor expression of the nerve terminal in the first- and second-degree dorsal burns of the TMP treatment group was significantly decreased. ATP-activated currents (IATP) on the DRG neurons of the second-degree dorsal burn in the NS treatment group were markedly higher than those in the second-degree dorsal burns in the TMP treatment group and the unburned control group (p<0.05); there were no significant differences between the second-degree dorsal burn in the TMP treatment group and the unburned control group (p>0.05).Conclusion: TMP alleviates nociceptive transmission of burn-injury pain mediated by the P2X3 receptor.

Vishweshwaraiah Iron Steel Limited (VISL) fire disasters following steel converter blast, 30 July 2003

Pramod Kumar — 2010-02-01

Abstract: A fire disaster occurred in Vishweshwaraiah Iron Steel Limited (VISL), Bhadravathi, India on 30 July 2003. The steel converter containing 24,000kg of liquid metal (pig iron) at very high temperature exploded. A total of 30 workers became victims. Seven persons died on the spot. Twenty-three victims were transferred to the VISL hospital; of these, six were transferred to the burns unit of the Kasturba Hospital, Manipal (180km from VISL). All six treated at the burns unit suffered 3–65% total body surface area (TBSA) burn, two had external injuries and two had eye involvement. Out of the six patients admitted at the burns unit, two expired (one due to refractory shock and another due to pulmonary embolism). Out of four survivors, one underwent tangential excision; another underwent operation for removal of foreign body from both soles and the remaining two were managed conservatively. Of the four survivors, two who had eye injuries, one developed minute corneal opacities within 2 months. The total duration of hospital stay of survivors at the burns unit varied from 8 to 43 days. All the victims were counselled by VISL psychiatrists before resuming their duties. Except the one who developed mixed anxiety–depression disorder, all survivors returned to work. The article describes the mechanism of the incident, injuries sustained and suggestions in relation to future safety measures.

Cortical blindness—A rare complication of severe burns: A report of seven cases and review of the literature

Yuanlin Zeng, Youlai Zhang, Guohua Xin, Lijin Zou — 2010-02-01

Cortical blindness (CB), sometimes called cerebral blindness, is a bilateral visual impairment caused either by damage to the occipital lobes and or by optic radiation upon the lateral geniculate body . CB is common in cerebral surgery, gynaecology and obstetrics, but very rare among people within burns. We report seven cases of CB associated with severe burns.

Burned by a battery–coin short circuit: Old concept for a new burn

Roba Khundkar, Claudia Malic, Catalina Estela — 2010-02-01

The first known artefacts that may have served as batteries are the Baghdad Batteries (250 bc and 640 ad) and may have been used for electroplating gold . The modern story of the battery started with the discovery of “animal electricity” by Luigi Galvani and the Voltaic pile, invented by the Italian physicist Alessandro Volta in 1800. Since then, batteries have become a common power source for many household and industrial applications. Disposable batteries are most commonly used in portable devices with either low current drain, only used intermittently, or used well away from an alternative power source.

Vishweshwaraiah Iron Steel Limited (VISL) fire disasters following ladle refining furnace accident, July 12, 1996

Pramod Kumar — 2010-02-01

Vishweshwaraiah Iron and Steel Limited (VISL) is the first steel industry (in India) of the pre-independence era (established in 1922), situated at Bhadravathi, Karnataka, India. VSIL produces cast iron from iron ore in three steps. During the third step, the product of second step called a ladle is transported by ladle vehicles and cranes at a 40ft height to the ladle refining area. During the third step, excess oxygen in the ladle is removed in ladle refining furnaces by adding coke, alloying elements (C, Mn, Si, Ni, Cr, etc.) a mixed, the carbon content is adjusted and undesirable contaminants are removed .

Style over substance: A needless contact burn from a protruding car exhaust pipe

Shinichiro Sakata, Craig A. McBride, Roy M. Kimble — 2010-02-01

In children, exhaust burns are overwhelmingly due to motorcycles and quad bikes ; however, burns due to car exhaust are uncommon. Children usually suffer burns after being backed over and trapped under the vehicle's exhaust system . There is a paucity of literature regarding paediatric exhaust burns from vehicles other than motorcycles.

Burn wounds and microorganisms

Oguz Karabay, Bahri Teker — 2010-02-01

We read the article by Guggenheim et al. with great interest . We had three main objections to this study. First, the burn wound is very prone to microbial colonization and it is clear that colonization is different from infection. In this study, the skin swab method was used to isolate the causative organism of burn infection. However, the burn surface culture while helpful, sometimes it fails to predict the progression of burn wound infection. Moreover, high CNS percentage in the study result might be related with this situation. We think that if they had used wound depth biopsy specimens for culture, their results would likely to yield very important information about invasion of the infected organism.

Burn wounds and microorganisms

Merlin Guggenheim — 2010-02-01

We appreciate the insightful comments on our study by Dr. Karabay, as well as the opportunity to provide a response. We fully agree with Dr. Karabay in that burn wound colonization may be different from burn wound infection. As stated in the paper, our aim was to study and elucidate shifts in the bacterial spectrum colonizing burn wounds and corresponding antibiotic susceptibilities during a 20-year study period. Therefore, we aimed to include as many microbiological samples as possible, thus we analyzed results from skin swabs, tracheal secretions and intraluminal catheters. A correlation with burn wound infection was beyond the scope of the present work, particularly when considering the vast amount of data analyzed over a 20-year study period.