Melanocytic hyperplasia after burn due to electric heating pad burst.

Aesthetics has become a significant aspect of dentistry. Clinicians are facing challenges in achieving acceptable gingival aesthetics as well as addressing biologic and functional problems. The colour of the gingiva plays an important role in overall aesthetics. However the principles and the techniques of management of such problems associated with gingival melanin pigmentation are still not fully established. The degree of melanin pigmentation may vary from person to person. Although clinical melanin pigmentation does not present a medical problem, demand for cosmetic therapy is commonly made by people with moderate gingival melanin pigmentation. The present paper describes a case of simple surgical technique for management of gingival hyperpigmentation caused by excessive melanin pigmentation. It also highlights the relevance of an aesthetically pleasing smile especially in smile conscious individuals.

Don’t get burned by OTC topical analgesics

The electric heating pad represents one of the medical devices that escaped the FDA safety net by a “grandfather” exemption. An amazing number of philosophical safety issues are introduced by this relatively innocuous commodity. Pain relief is a major attribute of heating pads followed by a minor in actual medical efficacy associated with the improvement of local blood circulation. By contrast, the historic downside is very dramatic featuring electrocution, fire, and skin burns. This paper begins with a brief introduction to current protocol for placing new medical devices into the stream of commerce. In the case of heating pads, it is fortunate that the Underwriters Laboratories Inc. developed and promulgated design rules that effectively mitigated the dangers of shock/electrocution and fire. On the other hand, UL has not undertaken a technical program that addresses the skin burn problem that is the focus of this paper. Nevertheless, many heating pad manufacturers are under the impression that their compliance with UL 130 has ameliorated the skin burn propensity of their pads. Heating pad manufacturers have attempted to control skin burn injuries exclusively through the means of on-product and in-manual warnings that have been promulgated by UL, FDA, and CPSC. This approach has tenaciously maintained a burn rate of 1600 cases per year. A different approach to the skin burn problem is automatically orchestrated by invoking the “Safety Hierarchy.” For example, falling asleep and causing prolonged skin exposures to a heated pad can be eliminated by a dead-man control. Exposure to extreme temperatures that arise when both faces of the pad are concurrently covered is perhaps the most prevalent cause of skin burns. This paper exploits the notion of monitoring both face temperatures and shutting off the pad when they are almost the same. We also explored shutting down the pad when the cycle rate of the bang-bang controls was sufficiently slow; higher heating rates are associated with an uncovered face.

SummaryWe conducted a randomised controlled trial to compare the efficacy of forced‐air warming (Bair Hugger™, Augustine Medical model 500/OR, Prairie, MN) with that of an electric heating pad (Operatherm 202, KanMed, Sweden) for maintenance of intra‐operative body temperature in 60 patients undergoing total knee replacement under combined spinal‐epidural anaesthesia. Intra‐operative tympanic and rectal temperatures and verbal analogue score for thermal comfort were recorded. There were no differences in any measurements between the two groups, with mean (SD) final rectal temperatures of 36.8 (0.4) °C with forced‐air warming and 36.9 (0.4) °C with the electric pad. The heating pad is as effective as forced‐air warming for maintenance of intra‐operative body temperature.

Electric heating pad burns

Objective To investigate the dose-effect relationship between Q-switch ruby laser and skin pigmentation in Guinea pigs. Methods Ten Guinea pigs were included in this study, and the back of each pig was divided into 5 areas, negative control area receiving no UVB irradiation or laser treatment, positive control area receiving UVB irradiation but no laser treatment, low-, middle- and high-dose areas receiving UVB irradiation followed by the treatment with laser at an energy density of 1.5, 3.0 and 6.0 J/cm2 for 4, 2, and 1 session, respectively, with an interval of 1 week. Melanin content index (MCI) was determined, and confocal laser scanning microscopy (CLSM) and histopathology were performed to observe melanin granules and melanocytes in the skin tissue from Guinea pigs before the initial laser treatment, 2 and 4 weeks after the final laser treatment. Results The best response was observed in the low-dose areas, and there was a complete clearance of hyperpigmentation in these areas, which maintained 8 weeks without recurrence, while different degrees of skin pigmentation recurred in the middle- and high-dose areas. Moreover, the low-dose areas showed a significantly lower melanin content index (MCI) compared with the middle- and high-dose areas (F = 4.2,P < 0.05), together with a marked reduction in the extent of pigment deposition, melanin granules, melanocyte number and density. Conclusions The efficacy of Q-switched ruby laser on skin pigmentation in Guinea pigs is correlated with the energy density and treatment frequency, and, low intensity and high frequency are often associated with a better treatment outcome. Key words: Lasers; Skin pigmentation; Dose-response relationship, radiation; Guinea pigs

Burn injury is a complex trauma that results in local and generalized edema. Edema fluid limits the exchange of vital nutrients in healing the burn wound and will compromise vulnerable tissues. Although the importance of edema control in tissue salvage is recognized, treatments targeted at edema control have not been critically reviewed. Thus, the objective was to assess the evidence for the effectiveness of local and systemic treatments for edema management immediately after burn injury. Searches for randomized controlled trials were conducted of online databases, research and thesis registers, and grey literature repositories. Handsearches included journals, bibliographies, and proceedings. Authors were contacted to clarify and submit extra study details. Eight studies were included. Management of acute major burn resuscitation including colloid increases lung edema (mean difference [MD], 0.04 ml/ml alv vol; 95% confidence interval [CI], 0.03-0.04; P < .00001) and mortality (risk ratio, 3.67; 95% CI, 1.16-11.58; P = .03). Continuous administration of vitamin C in acute burn resuscitation reduces local wound edema (MD, -3.50 ml/g; 95% CI, -4.63 to -2.37; P < .00001) and systemic fluid retention (MD, -8.60 kg; 95% CI, -13.47 to -3.73; P = .0005). Local acute hand burn edema is reduced (MD, -29.00 ml; 95% CI, -53.14 to -4.86; P = .02), and active hand motion increased (MD, 10.00°; 95% CI, 4.58-15.42; P = .0003), using electrical stimulation with usual physiotherapy. Each review outcome was based on a small single-facility study. Thus, future research in intervention for acute burn edema must focus on multicentre trials and validation of outcome measures in the burn population.

Objective To study the efficacy of simple Chinese medicine steam spray and comprehensive rehabilitation nursing after facial burn deep Ⅱ degree.Methods 80 patients were randomized into the treatment group (40 cases) and the control group (40 cases).The treatment group was given the treatment of Chinese medicine steam spray.The control group was given the treatment of Chinese medicine steam spray,pressure therapy,physical therapy,rehabilitation training and psychotherapy.The clinical efficacy of two groups was evaluated respectively after 3 months.Results After 3 months,the skins of most of patients in the treatment group were nearly normal with no pigmentation and scar hyperplasia.The cure rate was 72.5 ％,the obvious effective rate was 12.5 ％,and the effective rate was 7.5 ％.Some patients in the control group were lightly and inconspicuously pigmented,but the pigmentation area was reduced.The colour of their skins was not different from that of the normal skin.The cure rate was 42.5 ％,the obvious effective rate was 12.5 ％,and the effective rate was 25.0 ％.The effects of the two groups were significant differences (P＜0.05).Conclusions Comprehensive rehabilitation nursing after the facial burn can reduce the pigmentation and scar hyperplasia and improve the quality of life. Key words: Facial burn; Skin care; Comprehensive rehabilitation treatment; Chinese medicine steam spray

Introduction Patients with diabetes typically account for 3 to 14% of burn patients. Diabetes augments the challenges presented to the body with a burn injury. Vascular injury, increased blood viscosity, and immune system dysfunction all put diabetic patients at a higher risk for developing an infection and poor wound healing. Also, the peripheral neuropathy associated with diabetes, dampening sensation, largely contributes to lower extremity burns during colder months when patients are using heating pads or warm compresses. There is conflicting evidence in the literature regarding predicted outcomes and hospital courses of diabetic burn patients. We analyzed how this prevalent comorbidity impacts health consequences among patients with burn injuries to strengthen treatment strategies and predict outcomes. Methods A retrospective cohort analysis was performed on all patients between 2015-2020 over the age of 18 years that presented to our emergency department for burns. The data was obtained from the electronic medical record and statistical analysis was conducted using SPSS version 28. Results Of the 1329 patients included, 14% were diabetic. 26% of diabetic patient burns experienced scald burns, while only 15% of nondiabetic burns were of that category (p&amp;lt; 0.01). Upper extremity burns were more common in non-diabetic patients (68%) compared to diabetic patients (50%) (p&amp;lt; 0.01). Nondiabetic patients presented statistically ≈1.5% lower area percentage of second-degree burns and ≈2.5% TBSA, compared to the diabetic population. We did not see any seasonal variations in burn incidents between the diabetic and non-diabetic populations. Having diabetes was not significantly correlated with having surgery, number of surgeries, surgical complications, infections, or being admitted to the ICU. Diabetes was a significant variable for increased length of stay (roughly 3 days longer when age, BMI, number of surgeries, total TBSA, and ICU days were held constant). Conclusions The glycemic state of burn patients is important because of the influence of hyperglycemia on circulation, immune cell migration and function, and tissue repair. Our data recognize an extended hospital stay for diabetic patients, but without increased surgical complications. Moreover, we did not see a difference in burn occurrence for diabetic patients in colder months, likely due to the lack of cold temperatures in this region. Rather, we typically expect lower extremity burns in diabetics resulting from walking outside barefoot. Understanding diabetes as a comorbidity is crucial for preparing a treatment plan, particularly in burn injuries that strain the body’s healing capacity. Applicability of Research to Practice Diabetes is a prevalent comorbidity that challenges the body's capability to heal. Understanding the impact diabetes has on burn outcomes can better prepare physicians to care for these patients.

Although electrical injuries (EIs) are rare traumas in the pediatric age group, they are considered one of the most devastating injuries. We aimed to evaluate the patterns and outcomes of pediatric high-voltage injuries (HVIs) vs low-voltage injuries (LVIs), admitted to the burn center within the efforts of determining evidence-based data for contributing to burn prevention strategies. A retrospective study was conducted on children with EIs hospitalized in the Burn Center of Adana City Training and Research Hospital for 8 years (2013-2020). Data including the patients' clinical and demographic characteristics, the percentage of total body surface area with burns (%TBSA), length of hospital stay, exposure place, electrical current type, and treatment results were collected and analyzed. EIs were detected in 57 (2.5%) of 2243 acute pediatric burn injury admissions. EIs were most frequently observed in the form of HVIs, among children within the age range of 13 to 18 years, mostly in residential outdoor environments, where the high-power lines still passing close to the home roofs and balconies, resulting from contact with them. Besides, to a lesser extent in LVIs, in the home environment among children younger than 5 years, which was caused by connection with substandard electrical cords/poor-quality electrical devices and inserting an object into the electric sockets. Concerning the mean of %TBSA, HVIs suffered more extensive burns than LVIs. The most frequently affected anatomical regions among HVIs and LVIs were the upper limb, followed by the lower limb. While superficial partial- and deep partial-thickness burns were significantly more common among the LVIs, full-thickness burns were more prevalent among the HVIs. The amputation rate was 12% of which only one of them was major amputation (forearm above the elbow joint). HVIs had more elevated creatine kinase (CK) and CK-myocardial band (CK-MB) levels than LVIs but were not correlated with electrocardiography findings. Only one death (caused by HVI) was observed, with a mortality rate of 1.8%. Pediatric EIs are less common than scald or fire flame-related burns in this age group but can cause significant morbidity and even mortality, especially in severe burns. It is possible to prevent possible morbidity and mortality by strengthening compliance with safety precautions, especially with parental education and raising social awareness. In this context, taking necessary precautions for passing high-voltage power lines under the ground, the standardization of electrical cables by the relevant legal regulations, the use of socket covers in homes, promoting the widespread use of residual current relays, and arrangements to be taken against the use of illegal electricity are among measures for the prevention strategy.

(134) - Evaluating the impact of high fat diet on pain behaviors in mice with acute burn injury

During the COVID-19 pandemic, the Brazilian Health Surveillance Agency recommended the use of alcohol-based sanitizer to limit the spread of the coronavirus disease and also warning the population of the possible hazards derived from its misuse, such as burn injuries.1 However, within the last year, anecdotal reports of Brazilian physicians suggested an increase of flame burns (particularly, hand burns) caused by the incautious use of alcohol sanitizer.2 This study aimed therefore to investigate whether flame burns caused by alcohol increased in a Brazilian Burn Center during the pandemic. To our knowledge, this study was the first to investigate acute flame burns caused by the external use of alcohol in Brazil during the COVID-19 pandemic. In this retrospective study, we included all patients with acute flame burns caused by the external use of alcohol admitted as in-patients between March 2019 and December 2020 at the Burn Center at the João XXIII Hospital in Belo Horizonte, Brazil, while out-patients were excluded. Available data were extracted from medical records. The study group consisted of in-patients admitted during the pandemic (March 1–December 31, 2020), while the control group of in-patients admitted before the pandemic (March 1, 2019–February 29, 2020). Comparison between groups was done with Chi-squared, Fisher’s, or Wilcoxon Mann–Whitney Rank Sum tests, as appropriate. P value ≤.05 was considered significant. All analyses were conducted in R v4·03.3 This study was approved by the Brazilian Research Ethics Committee (IRB number: 2270.01.0029603/2020-27) and the Boston Children’s Hospital Research Ethics Committee (IRB number: 20-2133).

The aim of this study was to assess the feasibility of using serial bronchoalveolar lavage fluids (BALFs) to characterize the course of cell damage and inflammation in the airways of pediatric patients with acute burn or inhalation injury. This was a prospective, longitudinal, descriptive pilot study conducted at the Burn and Pediatric Intensive Care Units in a tertiary care medical center. Six consecutively intubated and mechanically ventilated pediatric patients with acute inhalational injuries were studied. Serial BALF specimens from clinically indicated bronchoscopies were used to measure DNA and cytokine levels. BALF DNA levels for the six pediatric burn subjects were the highest within the first 72 hours after burn injury and declined thereafter. At the early stages after injury, BALF DNA levels (median [min, max] 3789 [1170, 11,917] ng/ml) were similar to those in adult burn patients and pediatric cystic fibrosis or bronchiectasis patients and was higher than those in pediatric recurrent pneumonia patients. BALF DNA levels in children and adults with inhalation injury correlated significantly with BALF interleukin-6, interleukin-8, and transforming growth factor-β1 levels. The patient with the most severe early visible airway mucosal damage and soot pattern at bronchoscopy, as well as the most extensive burns, also had the highest average early BALF DNA level (11,917 ng/ml) and the longest ventilator course and hospital stay. Procedures were well tolerated. In children with acute burn and inhalational injury, airway cellular damage and inflammation (reflected in high BALF DNA levels) appear to peak during the first 72 hours after burn or inhalation injury followed by a slow decline. Serial analysis of factors in airway secretions is feasible and has the potential to reveal important pathophyisiologic pathways and therapeutic targets for the treatment of acute inhalational injuries.

ObjectiveTo understand the injury pattern of contact burns from therapeutic physical modalities.MethodA retrospective study was done in 864 patients with contact burns who discharged from our hospital from January 2005 to December 2008. The following parameters were compared between patients with contact burns from therapeutic modalities and from other causes: general characteristics, burn extent, cause of burn injury, place of occurrence, burn injury site, treatment methods, prevalence of underlying disease, and length of hospital stay were compared between patients with contact burns.ResultsOf the 864 subjects, 94 patients were injured from therapeutic modalities. A hot pack (n=51) was the most common type of therapeutic modality causing contact burn followed by moxibustion (n=21), electric heating pad (n=16), and radiant heat (n=4). The lower leg (n=31) was the most common injury site followed by the foot & ankle (n=24), buttock & coccyx (n=9), knee (n=8), trunk (n=8), back (n=6), shoulder (n=4), and arm (n=4). Diabetes mellitus was associated with contact burns from therapeutic modalities; the odds ratio was 3.99. Injuries took place most commonly at home (n=56), followed by the hospital (n=33), and in other places (n=5).ConclusionA hot pack was the most common cause of contact burns from therapeutic modalities, and the lower leg was the most common injury site. Injuries took place most commonly at home. The patients with contact burns from therapeutic modalities showed high correlation to presence of diabetes mellitus. These results would be helpful for the prevention of contact burns due to therapeutic modalities.

Objective: To explore the clinical effects of artificial dermis combined with vacuum sealing drainage (VSD) and autologous split-thickness skin graft in repair of scar contracture deformity after extensive burn. Methods: A total of 8 patients with scar hyperplasia and contracture deformity on joint after healing of extensive burn were admitted to our hospital from August 2015 to August 2017. There were 5 females and 3 males aged 8 to 45 years with an average of 23 years. In the first stage operation, scar tissue on contracture site was removed, and the wound was covered by artificial dermis followed by continued VSD treatment. On 10-14 d after the first stage operation, the artificial dermis tissue formed, and the second stage autologous split-thickness skin grafting and continued VSD treatment were performed. Routine anti-scar therapy was carried out after healing of wounds. Time of wound healing after the second stage operation was recorded. Colour and texture of the split-thickness skin graft, scar formation condition of the donor site, and action condition of the operation site during follow-up were observed. Results: The wounds of 8 patients were healed in 10-14 d after the second stage operation. During follow-up of 6-24 months, the split-thickness skin graft was with smooth surface and good elasticity, and the function of joint recovered well. The donor site in head healed well with no scar. Only pigmentation was left in the donor site of thigh, and scar was not obvious. The patients and their family members were satisfied. Conclusions: After application of artificial dermis combined with VSD and autologous split-thickness skin graft in repair of scar contracture deformity after extensive burn, the skin grafting area and donor site were with unobvious scar hyperplasia, and the joint function in the operation area was good.