Burns In Children Research Articles

Effect of dry hydrogen peroxide on Candida auris environmental contamination

Background:Candida auris is an emerging pathogen that exhibits broad antimicrobial resistance and causes highly morbid infections. Prolonged survival on surfaces has been demonstrated, and standard disinfectants may not achieve adequate disinfection. Persistent patient colonization and constant environmental recontamination poses an infection risk that may be mitigated by no touch disinfection systems. We evaluated the efficacy of continuous dry hydrogen peroxide (DHP) exposure on C. auris environmental contamination. Methods: The study was conducted in a large tertiary-care center where multiple patients were identified as either infected or colonized with C. auris. DHP-emitting systems were installed in the ventilation systems dedicated to the adult burn intensive care and children’s cardiac intensive care units. Composite surface samples were collected in a sample of patient rooms and shared clinical workspaces among units with current C. auris patients, before and after installation of the DHP system, and from areas with and without exposure to DHP. The samples included “high touch” surfaces near the patient, the general area of the patient room, shared medical equipment for the unit, shared staff work areas, and equipment dedicated to individual staff members (Table 1). Presence of C. auris was determined by polymerase chain reaction (PCR). Association between DHP exposure and C. auris contamination was determined using the Fisher exact test. Results: In the presence of C. auris patients, 5 baseline samples per unit were taken before DHP was installed, and then 5 samples per unit were taken on days 7, 14, and 28 after installation. Prior to initiation of DHP, 7 (70%) of 10 samples were PCR positive for C. auris. After DHP installation, a statistically significant decrease to 5 (16.7%) of 30 samples (P <.05) was observed. In total, 20 samples (5 before installation and 15 after installation) were collected from units without DHP on the same days. At baseline, 2 (40%) of 5 samples were PCR positive for C. auris. During subsequent periods, 4 (27%) 15 samples were positive (P = .66). No adverse effects were reported by patients, visitors, or personnel in association with the operation of the DHP systems. Conclusions: These findings suggest that DHP is effective in reducing surface C. auris contamination in a variety of patient and healthcare worker surfaces.Disclosures: None

Pattern, Cause of Childhood Burn injuries and their Management Outcome At Jimma Medical Center, Jimma Zone, Oromia Region, Southwest Ethiopia.

Burn injuries are prevalent worldwide, especially in developing countries; and there are significant pediatric burn injuries in Ethiopia. This study was performed to analyze the pattern, cause, and management outcome of burn injuries in Jimma Medical Center. A hospital‑based retrospective cross‑sectional study was conducted at Jimma university medical center burn unit. Data were collected through chart review of pediatric patients aged 0 to 14 years who were admitted to the burn unit with a burn injury. A total of 92 hospitalized children were studied from Jan 1, 2020 to Dec 31, 2021 GC. Data were analyzed using SPSS version 25. The statistical significance was determined using odds ratio (OR) with a 95% confidence interval (CI) and the corresponding P-value of less than 0.05. The majority of the patients were males (52.2%). Scald burn was the most common cause of burn in 57(62.0%). The TBSA of majority of the patients (52.2%) was found to be between 11% and 20%. After adjusting for possible confounders in the multivariate analysis, preexisting illness and time of presentation to care were found to have a statistically significant association with the outcome of burn at discharge (P= 0.007) (P= 0.021) respectively. The most common cause of burn in our setup was scald burn; upper extremities were also the most affected site. According to our study, the factors associated with the outcome of burn injury were preexisting illness and late presentation to health facilities.

772 Bismuth Tribromophenate Gauze is Superior to Silver Sulfadiazine Cream for Mixed-depth Scald Burns in Children

Abstract Introduction Silver sulfadiazine 1% cream was historically the mainstay initial treatment for burn wounds at our pediatric burn center. Over the last several years, we transitioned to using closed dressings of 3% bismuth tribromophenate petrolatum gauze in the initial care of partial thickness burns with the goal of reducing the pain experienced with daily wound cleaning necessitated when using silver sulfadiazine. The gauze adheres to the wound, allows exudate to drain through, and acts as a scaffold for re-epithelialization after which it falls off without traumatizing the healed burn. The purpose of this study is to compare our burn patient outcomes with the initial use of bismuth tribromophenate gauze to those in patients treated with silver sulfadiazine cream. Methods A retrospective chart review was conducted of our patients aged 5 years and younger presenting with mixed-depth scald injuries within two time frames: 1) years 2004-2008, during which silver sulfadiazine 1% cream was the standard initial choice for wound care at our institution, and 2) years 2015-2018, when 3% bismuth tribromophenate petrolatum gauze had become standard. Data collected included demographics, burn total body surface area (TBSA), length of hospital stay, need for excision or grafting, time to grafting, and graft size. Results Three hundred forty-seven patients were included, 200 of whom were treated with silver sulfadiazine cream and 147 treated with only bismuth tribromophenate gauze. Burn TBSA and rates of skin grafting were similar between the two groups; however, the mean area of the skin graft was significantly smaller (p = 0.027) among the patients in the bismuth tribromophenate group (147 cm2) compared to those in the silver sulfadiazine group (336 cm2). On the other hand, the time from injury to skin grafting was significantly longer in the bismuth tribromophenate group (24 days vs. 9.9 days, p = 0.002), with a larger proportion of these patients returning for elective grafting in the outpatient setting. Conclusions The percentage of patients who required skin grafting in both groups was similar; however, initial treatment with a closed dressing of 3% bismuth tribromophenate petrolatum gauze promotes healing in the zone of stasis, resulting in smaller skin grafts and hence smaller donor sites. The mechanical forces of daily wound cleaning when using silver sulfadiazine cream likely harm those areas at risk, leading to the need for larger skin grafts for coverage. Although time to grafting was longer when using gauze, these patients were in closed dressings with fewer painful changes. Applicability of Research to Practice Bismuth tribromophenate petrolatum gauze remains on a wound bed for up to three weeks, whereas silver sulfadiazine cream must be changed regularly resulting in constant disruption of the healing tissue. Fewer dressing changes combined with later skin grafting could allow burn wounds to demarcate and heal more effectively, benefiting both graft and donor sites.

580 Burn Camp in the Midst of the COVID-19 Pandemic

Abstract Introduction Previous literature has shown that pediatric burn camps provide numerous benefits to childhood burn survivors. Unfortunately, the COVID-19 pandemic resulted in the inability to host camp for fear of viral transmission to burn survivors and camp personnel alike. A comprehensive burn center, with assistance from the firefighter community, hosted its first burn camp since the onset of the COVID pandemic in August of 2022. A camp staff of 54 volunteers modified the previous camp processes to ensure camp was safe, fun and accessible to 20 pediatric burn survivors. Methods This is an academic short report that reviews the process changes necessary to host a safe pediatric burn camp in the midst of the COVID pandemic. All attendees and staff were required to show a negative PCR test result 48 hours prior to arrival at camp. COVID vaccination was encouraged in all participants, however, staff and patients were not required to be vaccinated. Daily symptom tracking was implemented immediately upon arrival to camp. All participants were assigned a thermometer, and daily temperatures and symptom monitoring was performed by the camp director. Masks were mandated when indoors or within close proximity or group activities. There was a quarantine plan in place in the case a camper or staff member became symptomatic, or tested positive for COVID. Lastly, the number of people per cabin decreased from 12 to 8. Results In the early planning phase of camp, it was discovered that some of the participants and staff were unable to obtain a PCR test prior to camp. Therefore, onsite testing was implemented to allow testing as the participants and camp staff arrived to camp. The onsite testing facility was available for the entirety of camp in the case anyone became symptomatic. Implementation of additional camp processes resulted in a successful and safe camp. There were no reported cases of COVID during or after camp. Conclusions As the Public Health Emergency from COVID-19 continues, group activities, such as summer burn camps, with medically vulnerable populations must be altered to protect all stakeholders. We described the steps taken by one burn-center-run camp that enabled children and firefighter volunteers to participate in the full burn camp experience. Plans for the 2023 burn camp are already in process, and the processes implemented in 2022 will be implemented in all upcoming camps to ensure the children and staff are safe from the transmission of COVID. Applicability of Research to Practice N/A

112 Computer Adaptive Test Development of Preschool Life Impact Burn Recovery Evaluation

Abstract Introduction Measuring physical, psychological, and social outcomes following childhood burn injury is important to understand the impact of the burn. Condition-specific outcomes are highly relevant in assessments for purposes of gauging early growth and development through parent-reported outcome measures (PROMs). Item content in existing PROMs for preschool children is limited and often covers only one construct. Computer adaptive tests (CATs) with advanced psychometric artificial intelligence technologies minimizes respondent burden and enables the creation of a comprehensive condition-specific instrument. This project developed a parent-reported CAT (Preschool1-5 Life Impact Burn Recovery Evaluation (PS-LIBRE1-5) Profile) to measure relevant outcomes after burn injuries in children aged one to under six years. Methods Responses to the field-tested PS-LIBRE1-5 Profile (188 items) were measured on a scale of frequency or ability levels. Scores were coded from 0 to 4 where higher scores reflected better functioning. Factor analysis and Partial Credit Models identified the items retained in the final item bank of each scale. Differential item functioning (DIF) determined if subgroups of burn survivors at the same ability level demonstrated different probabilities of responses. CAT simulations were conducted to estimate the mean score of each scale. The simulated CAT score and full item bank scores were compared based upon the score range, ceiling and floor effects, and marginal reliabilities. Results The child mean age was 3.0 + 1.5 years (n = 498), with primarily mothers (83%) responding. Average burn size and time since burn injury were 4.2% TBSA and 1.1 years, respectively. Analysis resulted in eight scales: Physical (27 items), Communication and language (20 items), Emotional wellbeing (16 items), Mood (11 items), Anxiety (13 items), Peer acceptance (7 items), Play (8 items), and Peer relations (9 items). Severe DIF by ‘age at survey completion’ was shown in 13 items. Ceiling effects were acceptable at < 14%. A CAT was created with the exception of four of the scales (Peer acceptance, Play, Mood, and Anxiety) due to limited item content in these scales’ full item bank. Marginal reliabilities were credible (0.83 to 0.90). CAT simulations revealed that administering the CAT would save the respondent about 14 minutes compared to administering the full item bank. Conclusions Final scales of the PS-LIBRE1-5 Profile contain 111 items and is a comprehensive measure that captures physical, communication and language, psychological, and social functioning of preschool burn survivors in the community. Applicability of Research to Practice This work lays the groundwork for developing a set of age-based CATs, adding to prior adult LIBRE project. The CAT aims to detect the progress of a child during burn recovery for use in clinical practice.

게더타운 UX 디자인 분석을 통한 메타버스 공간 사용성 개선방안 연구

Since the COVID-19 pandemic, the medical field has actively attempted non-face-to-face transformations, and the use of the metaverse has attracted attention in this regard. In this study, we investigated and analyzed the user experience (UX) characteristics and inconveniences that appear in the service objects inside a counseling room at the Hallym University Medical Center's Metaverse Children's Burn Hospital, which was launched on the Gathertown metaverse platform. UX improvement of this hospital is expected to benefit other hospitals as well as non-face-to-face treatments that will eventually be launched in the Metaverse. We first analyzed the non-face-to-face treatment services on the Gathertown metaverse platform based on the techniques reported in the literature and using some examples. Second, the usability of the service object in the counseling room was analyzed via tests. Third, a major analysis was conducted on the UX of the service object. Fourth, a UX design of the service object was proposed, and its usability was evaluated. By analyzing the data collected, the design direction was derived based on three keywords: Object connectivity, object unity, object visibility. Based on these keywords, the object placement and graphic design direction were set to improve the UX of the service object within the counseling room. To better utilize the metaverse platform in non-face-to-face treatments, investigation of other service objects will be conducted as a follow-up study.

A Pilot Randomised Controlled Trial Evaluating a Regenerative Epithelial Suspension for Medium-Size Partial-Thickness Burns in Children: The BRACS Trial.

There is little evidence regarding the efficacy of Regenerative Epidermal Suspension (RES™) management for paediatric partial-thickness burns. The Biobrane® RECELL® Autologous skin Cell suspension and Silver dressings (BRACS) Trial evaluated three dressings for the re-epithelialisation of partial-thickness burns in children. Eligible children (age ≤ 16 years; ≥5% TBSA; ≤48 h of injury) were randomised to silver dressings, RES™/Biobrane® or Biobrane®. The measured outcomes were the time to re-epithelialisation (primary outcome), pain, itch, intervention fidelity, treatment satisfaction, health-related quality of life, health resource utilisation and adverse effects. The median time to re-epithelialisation in days was no different for RES™/Biobrane® at 12 (IQR: 5.6-18.4; n = 7) and slower by two days for Biobrane® at 14 (IQR: 6.3-21.7; n = 7) when compared to silver dressings 12 (IQR: 3.7-20.3; n = 8). Reduced pain, fewer infections, no sepsis, no skin graft, and the lowest impact on health-related quality of life were reported in the RES™/Biobrane® group compared to other groups. Due to the COVID-19 pandemic, recruitment suspension resulted in a smaller cohort than expected and an underpowered study. The pilot trial findings should be interpreted cautiously; however, they indicate that a fully powered randomised controlled trial is warranted to substantiate the role of RES™ for medium to large paediatric partial-thickness burn management.

Tsugishige Kondo, The Father of Japanese Surgery: Exploring the History of Hideyo Noguchi's Hand Reconstruction With a Forearm Flap Before the Establishment of Plastic Surgery in Japan.

Hideyo Noguchi is one of the most famous scientists in Japan's history, and his portrait has adorned the ¥1,000 banknotes since 2004. He had a childhood burn injury resulting in severe hand scarring and contracture that plagued his early life and education.The resulting hand deformity required 3 separate reconstructions with the third and most complex surgery performed by Professor Tsugishige Kondo just before Noguchi's final medical doctor license examination in 1897. In this surgery, Kondo released the contractures using the first radial forearm flap performed in Japan long before the establishment of plastic surgery in the country.Reviewing the history of Kondo, we find that he likely learned the art of reconstructive surgery along with many other surgical techniques during his stay in Europe from 1891 to 1896 where he was mentored by 4 prominent surgeons of the era: Christian Albert Theodor Billroth, Vincenz Czerny, James Israel, and Carl Nicoladoni. During this period, Czerny reported performing the world's first breast reconstruction using lipoma transfer, and Nicoladoni performed the world's first thumb reconstruction with a chest flap and with toe-to-thumb transfer. Kondo may have watched these world's first operations and may have also been taught these innovative techniques including the forearm flap directly by these pioneers. He returned to Japan and successfully applied these reconstructive surgery methods in his practice and teaching, as evidenced by the landmark surgery of Hideyo Noguchi's hand, and laid the foundations for the development of plastic surgery in Japan.

Preoperative Anxiety and Postoperative Pain in Children with Burn Patients and Their Correlation Analysis

Background: Burn is a kind of skin tissue damage under the influence of heat source, which is a common type of accidental injury in current society. Objective: To investigate the status of preoperative anxiety and postoperative pain in children with burn patients, and to analyze the correlation between preoperative anxiety and postoperative pain. Methods: A total of 108 pediatric patients who underwent burn surgery under general anesthesia in our hospital from October 2020 to August 2021 were selected. FLACC and Facial Expression Pain Scale were used to evaluate the pain of the children, and STAI and YPAS were used to evaluate the anxiety of the children. Correlation was used to analyze the effect of preoperative anxiety on postoperative pain in burn children. Results: Preoperative anxiety and severe anxiety accounted for more than 50% of burn children, and there was a statistically significant difference in preoperative anxiety and postoperative pain between 1-3-year-old children and 4-12-year-old children. The influencing factors of postoperative pain in children with burns were analyzed, including burn area, depth of burn, and previous operations. The multivariate analysis showed that the risk factors for postoperative pain in children were age, burn area, depth of burn, preoperative anxiety of children, and parental trait anxiety, after statistical test, it shows that each influencing factor has a significant influence on postoperative pain in children (P < 0.05). In the correlation analysis of preoperative anxiety and postoperative pain in children with burns, it was shown that preoperative anxiety in children aged 1 to 3 years had a significant impact on postoperative pain of children, and the correlation analysis showed that preoperative anxiety of children with burns There was a positive correlation between anxiety score and postoperative pain (r=0.479, P=0.001). Conclusion: The incidence of preoperative anxiety in children with burn patients is high, and the postoperative pain scores are also different in different age groups. In addition, there is a current correlation between preoperative anxiety and postoperative pain in children with burn patients, and the correlation is positively correlated, that is, the higher the patient's anxiety score, the more intense the patient's postoperative pain.

"Prevention of childhood burns in times of pandemic: a virtual and interactive campaign"

"Prevention of childhood burns in times of pandemic: a virtual and interactive campaign"

Nasal drip of dexmedetomidine for optimal sedation during PICC insertion in pediatric burn care.

For peripherally inserted central catheter (PICC) inserting, tranquil cooperation of children for an extended period is often required. Therefore, sedation is routinely induced clinically prior to PICC inserting. Chloral hydrate is a commonly used sedative for children. However, its clinical acceptance has remained low. And the sedation effect is non-satisfactory. Previous studies have confirmed the safety and effectiveness of intravenous/oral dosing or nasal dripping for sedation during the examinations of electrocardiography and computed tomography. Yet few studies have assessed the sedating efficacy of dexmedetomidine nasal drops for PICC inserting. From a cohort of 40 hospitalized patients scheduled for PICC inserting, 15 children employing a novel sedative mode of dexmedetomidine nasal drops at a dose of 2 ug/kg were assigned into group A while group B included another 25 children sedated routinely via an enema of 10% chloral hydrate at a dose of 0.5 mL/kg. The Ramsay's scoring criteria were utilized for assessing the status of sedation. Two groups were observed with regards to success rate of sedation, onset time of sedation and occurrences of adverse reactions. Statistical inter-group differences existed in success rate and onset time of sedation. The success rate of group A was higher than that of group B (93.3% vs 64.0%, X2 = 4.302, P = .038 < 0.05). Group A had a faster onset of sedation than group B (14.86 ± 2.57 vs 19.06 ± 3.40 minutes, t = 3.781, P = .001 < 0.05). No inter-group difference of statistical significance existed in occurrence of adverse reactions (P = 1.000 > 0.05). Logistic regression analysis showed that the success rate of sedation in group A was higher than that in group B, and the difference was statistically significant (P = .036 < 0.05). For sedating burn children, nasal dripping of dexmedetomidine is both safe and effective during PICC inserting. Without any obvious adverse reaction, it may relieve sufferings and enhance acceptance.

Pediatric Burns Debridement Under Sedoanalgesia During the COVID-19 Pandemic: A Cost-Effective Alternative.

Early debridement of childhood burns under sedoanalgesia in the emergency department (ED) may help to reduce the need of surgery and delay in treatment. We performed a retrospective study in burned children who underwent debridement in the ED under sedoanalgesia between March 2020 and December 2020 (COVID group), and were compared with the same months in 2019 (control group). Demographics, burns features, admission rate, and estimated costs associated were collected. A total of 733 children presented at the ED with burns (302 COVID group and 431 control group) without significant differences in burn features between them. Admission rate was significantly lower in COVID group (9.4% vs 19.4%; P < .001), as was the total associated cost for each group ($101 585 vs $209 656; P < .001). The use of sedoanalgesia for the early treatment of pediatric burns in the ED during COVID-19 pandemic is a cost-effective alternative that has reduced the need for hospital admission and associated costs.

Effect of Collagen Dressing in the Treatment of Superficial Partial Thickness Burn in Children

Introduction: Burn is the most devastating of all injuries and a major global public health crisis. Biological dressings with collagen create the most physiological interface between the wound surface and environment and are impermeable to bacteria. Collagen dressing is easily applicable, non-immunogenic, non-pyrogenic, hypo allergic and pain free. Collagen is an endogenous substance which forms an important structural component in connective tissue. By applying it over the wound, exposed dermis and free nerve endings get covered leading to reduction in pain and infection. Objective: To assess the efficacy of collagen dressing in burn wound management. Methods: Prospective interventional study was carried out at the Department of Burn and Reconstructive Surgery, faculty of Paediatric Surgery, Bangladesh Shishu Hospital &amp; Institute. A total 20 patients were included in this study after fulfillment of all selection criteria during the study period. Result: The mean pain relief time, wound healing and hospital stay were 2.7±0.6 days, 7.3±1.0 days and 4.5±0.6 days respectively. Conclusion: Collagen dressing is safe and effective in the treatment of superficial partial thickness burn in children.

Virtual reality in pain reduction in burnt children: Quasi-experimental pilot study

Virtual reality in pain reduction in burnt children: Quasi-experimental pilot study

A Health Education Program for Mothers to Prevent Burn in Early Childhood

A Health Education Program for Mothers to Prevent Burn in Early Childhood

Plasma lipidomics reveal systemic changes persistent throughout early life following a childhood burn injury

Abstract Background Non-severe paediatric burns can result in poor long-term health outcomes. This occurs even in cases with good acute burn-related outcomes, including minimal scarring. The mechanisms that underpin the transition from non-severe burn to sustained negative long-term health impacts are currently unknown. However, sustained metabolic and immune changes have been observed in paediatric burn studies, suggesting these changes may be important. The plasma lipidome consists of a rich pool of bioactive metabolites that play critical roles in systemic processes including molecular signalling and inflammation. We hypothesised that changes in the plasma lipidome may reflect underlying changes in health status and be linked to long-term health after burn trauma. Methods This study analysed the lipidome in children who had previously experienced a non-severe burn, compared to non-injured controls. Thirty-three participants were recruited between the ages of 5 and 8 years who had experienced a non-severe burn between the ages of 1 and 3 years. Plasma samples were also collected from a non-injured, healthy, age and gender matched control group (n = 21). Plasma lipids were measured using reversed-phase liquid chromatographymass spectrometery (LC-MS). Results In total 838 reproducible lipid species from 19 sub-classes passed quality control procedures and progressed to statistical analysis. Analysis of individual lipid metabolites showed significantly higher concentrations of lysophosphatidylethanolamines and phosphatidylethanolamines, and significantly lower concentrations in myristic, palmitic and palmitoleic acids in the plasma of those who had experienced burn injury compared to controls. Conclusion Long-term changes in the lipid profile may give insight into the mechanisms underlying poor long-term health subsequent to non-severe burn injury. Further work to investigate the relationship between long-term pathology and lipidomic changes may lead to a better understanding of the causes of secondary morbidity post-burn and to clinical intervention to reduce the long-term health burden of burn trauma.

Psychosocial Impact of Electrical Burn in Children: A Follow-Up Study Conducted at a Tertiary Care Hospital.

Introduction Electrical burn injuries are very common in the pediatric population and are usually accidental and sometimes occupational. The objective of our study was to evaluate the epidemiology of electrical burn injuries and prospectively evaluate the long-term psychosocial impact of electrical burn injuries in children. Materials and methods A qualitative interview study was conducted prospectively among sixty patients presented to Holy Family Hospital, Rawalpindi, Pakistan. Demographic details, mode of presentation, detail of injury, total body surface area, initial condition, and surgical interventions were noted during their stay at the hospital. Their physical and psychological outcomes were evaluated by administering the Strength and Difficulties Questionnaire (SDQ) and Body Dysmorphic Disorder Questionnaire (BDDQ) via telephonic interviews after six weeks of discharge from the hospital. The study was conducted over a span of 1 year from January 2021 to January 2022. Results There were 60 patients who presented to the department of pediatric surgery during the span of the study. The mean age was 9.9 years ± 3.133 years (SD) and 80% of the patients were above 8 years of age with a male-to-female percentage of 86.67% to 13.33%, respectively. Forty-two (70%) patients incurred high-voltage electrical burns while 18 (30%) suffered low-voltage electrical burns. Mortality was 13.33% (n=8). Out of 52 patients who survived, 35 (67.30%) were labeled as having Body Dysmorphic Disorder upon administration of BDDQ through a six-week follow-up. The majority of the patients had abnormal or borderline results in different scales of SDQ. Conclusion The long-term psychological stress and the varied spectrum of psychiatric disorders in electrical burn patients are profound. The prevention of burn injuries can be effectively achieved by educating parents about safety measures and improving health infrastructure. Implementation of a dedicated national program for psychological support of burn patients should be made accessible to all patients.

Topical Use of Heparin and Silver Sulfadiazine Cream in the Treatment of Second Degree Burn in Children: A Comparative Study

Introduction: Burn is a complex disease process, a trauma to physique as well as psyche. Visible disfigurement caused by burns translates into an altered pattern of socialization which in turn can have serious psychological ramifications. Patients with burns require immediate specialized care in order to minimize morbidity and mortality. So, the important part of the management of burns is wound management. Objectives: To assess the efficacy of topical heparin and silver sulfadiazine cream in burn wound management. Methods: Prospective comparative interventional study was carried out at the Department of Burn &amp; Reconstructive Surgery, Faculty of Paedicatric Surgery, Bangladesh Shishu Hospital and Institute. A total 42 patients were included in this study after fulfilment of all selection criteria during the study period. Patients were randomly selected into two groups. In group A (n=21) patients were treated with topical heparin and in group B (n=21) patients were treated with silver sulfadiazine cream. Results: The mean pain relief time was 1.76±0.54 days in group A and 5.52±0.98 days in group B. The difference was statistically significant (p&lt;0.05). The mean wound healing time was 4.62±0.86 days in group A and 8.0±1.97 days in group B. The difference was statistically significant (p&lt;0.05). The mean hospital stay was 5.57±0.75 days in group A and 8.10±1.97 days in group B. The difference was statistically significant (p&lt;0.05). Conclusion: Topical use of heparin is safe and more effective than silver sulfadiazine cream in the management of second-degree burns in children.

Analysis of Energy and Density in Treating Hypertrophic Scar After Burn in Children with CO2 Dot Matrix Laser.

Objective: To analyze and compare the effect of the combination of energy and density parameters of CO2 dot matrix laser in the hyperplastic stage of pediatric burn. Materials and Methods: A total of 160 pediatric patients with hypertrophic scar after limb burn from 2017 to 2020 were randomly divided into four parameter groups (n = 40). The patients were treated with ablative fraction carbon dioxide laser, once every 10 weeks. During the interval of laser treatment, Compound Heparin Sodium and Allantoin Gel (Contractubex) was applied externally, tid, and elastic cover or elastic bandage is attached to the affected limb. Scoring based on the Vancouver Scar Scale is performed before each laser treatment, The score before the first treatment was the initial score, which was scored by two people separately, and the average score was calculated. Subsequently, the patients were treated four times and scored. The differences between each treatment and the first score of each parameter group were compared. Under the same energy and different treatment density, the scores after each treatment were compared. Under the same density and different energy, the scores after each treatment were compared. The bleeding and pigmentation of each parameter group were compared. Results: The increase of density can show the therapeutic effect earlier than the increase of energy, and 25mj energy and 10% density have better intervention effect. With the course of disease and the progress of treatment, the correlation between intervention effect and parameters tends to weaken. Comparing the number of cases with different scores between each treatment and the first time, the score in the 5% density group was lower than that in the 10% density group, but there was no significant difference between the 25mj and 17.5mj energy levels in the same density group. The intervention effect of the increase of density on scar was better than that of energy, and the increase of energy and density could aggravate the pain. Conclusion: In pediatric burn hypertrophic scars treated by CO2 dot matrix laser in exfoliation mode, the intervention effect of increasing density is better than that of energy. When setting laser treatment parameters, we should give priority to increasing density and adjust energy according to the effect of treatment and the condition of pain, bleeding and color precipitation. In this study, the best combination of parameters is 17.5mj/10%.

Seasonal and spatial variations of bioaerosols and antibiotic resistance bacteria in different wards of the hospital

Introduction: Transmission of bioaerosols through the air is known as an important route for a wide range of nosocomial infections. Therefore, in the present study, we aimed to evaluate the type and diversity of bioaerosols and antibiotic resistance of bacterial bioaerosols in the indoor environments of Sina educational and treatment hospital, Tabriz, Iran. Methods and materials: 150 samples of bacteria and fungi (75 fungi and 75 bacteria) bioaerosol samples were collected on petri dish containing Sabouraud dextrose agar from February to March and June to July 2020 in three periods of daytime (morning, noon and evening) according to National Institute for Occupational Safety and Health (NIOSH 0-800) standard. After sampling, fungal and bacterial samples were incubated and the disk diffusion agar method (Kirby-Bauer) was used for assessing the antibiotic resistance. Results: The concentration of bioaerosols varied significantly in different wards. In addition, the concentration of bioaerosols in winter was observed to be higher than in summer. The highest and lowest airborne fungal concentrations were found in burns operating room and men's infectious ward (49 CFU/m3) and children's burns ward (28 CFU/m3), respectively. The predominantly isolated bacteria were Streptococcus spp. (38%) and Staphylococcus spp. (37%). Also, the main isolated fungi belonged to the genera Aspergillus (75.9%) and Penicillium (22.5%). The highest rates of antibiotic resistance were observed for colistin (100%) in Gram-negative and penicillin (84.2%) in Gram-positive. Conclusion: Timely and regular disinfection of hospital wards can affect the density of bioaerosols. Owing to the prevalence of COVID-19 epidemic in the world, the staff and patients often were wearing masks, gloves and special clothing as well as using disinfectants to prevent coronavirus infection in wards during the summer sampling.