Burn Scores Research Articles

An Optical Tomography-Based Score to Assess Pediatric Hand Burns

To define the morphologic pattern of pediatric hand burns as visualized via optical coherence tomography (OCT) and dynamic OCT (D-OCT). We designed a scoring system to assess the depths of burn wounds on pediatric hands and tested this score in our cohort of children with burn injuries to the hand. Overall, 67 hand burns in 48 children (0–15 years) were prospectively examined. Scans were interpreted by two independent observers. Relevant OCT findings were surface irregularity, loss of epidermis, loss of dermal pattern (skin lines or papillary spots, loss of surface regularity and irregular vascular pattern of the plexus papillaris. Score values were calculated retrospectively. A score of 4 was associated with spontaneous healing without the need for skin grafting, with a positive predictive value of 97%. Deeper wounds with delayed healing and/or the need of skin grafting received a score of 5 or above, with an agreement of medical healing in 80% and a positive predictive value of 56%. OCT and D-OCT provide clinically useful additional information in cases of pediatric hand burns. The OCT burn score has the potential to support clinical decision making and, subsequently, improve clinical outcomes and shorten hospital stays.

Validation of New Burns Score {Sion Prognostic Burns Scoring System (SPBSS)} and its Comparison with Jabalpur Prognostic Score, Baux Score & Apache III Score

Validation of New Burns Score {Sion Prognostic Burns Scoring System (SPBSS)} and its Comparison with Jabalpur Prognostic Score, Baux Score & Apache III Score

Development of a value-based healthcare burns core set for adult burn care

BackgroundValue-based healthcare (VBHC) is increasingly implemented in healthcare worldwide. Transparent measurement of the outcomes most important and relevant to patients is essential in VBHC, which is supported by a core set of most important quality indicators and outcomes. Therefore, the aim of this study was to develop a VBHC-burns core set for adult burn patients. MethodsA three-round modified national Delphi study, including 44 outcomes and 24 quality indicators, was conducted to reach consensus among Dutch patients, burn care professionals and researchers. Items were rated on a nine-point Likert scale and selected if ≥ 70% in each group considered an item ‘important’. Subsequently, instruments quantifying selected outcomes were identified based on a literature review and were chosen in a consensus meeting using recommendations from the Dutch consensus-based standard set and the Dutch Centre of Expertise on Health Disparities. Time assessment points were chosen to reflect the burn care and patient recovery process. Finally, the initial core set was evaluated in practice, leading to the adapted VBHC-burns core set. ResultsTwenty-seven patients, 63 burn care professionals and 23 researchers participated. Ten outcomes and four quality indicators were selected in the Delphi study, including the outcomes pain, wound healing, physical activity, self-care, independence, return to work, depression, itching, scar flexibility and return to school. Quality indicators included shared decision-making (SDM), the number of patients receiving aftercare, determination of burn depth, and assessment of active range of motion. After evaluation of its use in clinical practice, the core set included all items except SDM, which are assessed by 9 patient-reported outcome instruments or measured in clinical care. Assessment time points included are at discharge, 2 weeks, 3 months, 12 months after discharge and annually afterwards. ConclusionA VBHC-burns core set was developed, consisting of outcomes and quality indicators that are important to burn patients and burn care professionals. The VBHC-burns core set is now systemically monitored and analysed in Dutch burn care to improve care and patient relevant outcomes. As improving burn care and patient relevant outcomes is important worldwide, the developed VBHC-burns core set could be inspiring for other countries.

Dietary strategies can increase cloacal endotoxin levels and modulate the resident microbiota in broiler chickens

Endotoxins released from poultry feces have been associated with impaired human health. Because endotoxins are released from gram-negative intestinal bacteria, it was hypothesized that dietary strategies may influence endotoxin excretion via modulation of gut microbiota. We therefore tested dietary strategies that could potentially reduce cloacal endotoxin levels in broiler chickens. One-day-old male Ross 308 (N = 1,344) broilers were housed in 48 pens (N = 8 pens/treatment, 28 chickens per pen) and fed 1 of 6 diets for 35 days (d) in a 3-phase feeding program: a basic diet (CON) that served as the reference diet, or basic diet supplemented with butyrate (BUT), inulin (INU), medium-chain fatty acids (MCFA) or Original XPC™LS (XPC), or a high-fiber-low-protein (HF-LP) diet. A significant (P < 0.05) increase in cloacal endotoxin concentration at d 35 was observed in BUT as compared to CON. Analysis of cloacal microbiota showed a trend (P < 0.07) for a higher gram-negative/gram-positive ratio and for a higher relative abundance of gram-negative bacteria at d 35 (P ≤ 0.08) in BUT and HF-LP as compared to CON. A significant (P < 0.05) increase in average daily gain (ADG) and improved feed conversion ratio (P < 0.05) were observed in MCFA during the grower phase (d 14-28), and a significant (P < 0.05) increase in average daily feed intake (ADFI) was observed in MCFA during d 0 to 28. Broilers fed HF-LP had a significantly (P < 0.05) higher FCR and lower ADG throughout the rearing period. No treatment effects were found on footpad dermatitis, but BUT had worst hock burn scores at d 35 (P < 0.01) and MCFA had worst cleanliness scores at d 21 but not at d 35 (treatment*age P < 0.05), while INU had better cleanliness as compared to CON at d 35 (P < 0.05). In conclusion, especially BUT and HF-LP were able to modulate resident microbiota and BUT also increased cloacal endotoxin levels, which was opposite to our hypothesis. The present study indicates that cloacal endotoxin release can be affected by the diet but further study is needed to find dietary treatments that can reduce cloacal endotoxin release.

The Angiopoietin-2/Angiopoietin-1 ratio increases early in burn patients and predicts mortality

BackgroundAngiopoietin-2 (Angpt-2) is involved in the pathogenesis of the capillary leak syndrome in sepsis and has been shown to be associated with worse outcomes in diverse critical illnesses. It is however unclear whether Angpt-2 plays a similar role in severely burned patients during the early phase characterized by massive capillary leakage. Our aim was to analyze the Angiopoietin-2/Angiopoietin-1 ratio (Angpt-2/Angpt-1 ratio) over the first two days in critically ill burn patients and examine its association with survival and further clinical parameters. MethodsAdult burn patients with a total burn surface area (TBSA) ≥ 20% treated in the burn intensive care unit (ICU) of the University Hospital of Zurich, Switzerland, were included. Serum samples were collected prospectively and serum Angpt-1 and Angpt-2 were measured by enzyme-linked immunosorbent assay (ELISA) over the first two days after burn insult and stratified according to survival status, TBSA and the abbreviated burn severity index (ABSI). Due to hemodilution in the initial resuscitation phase, the Angpt-2/Angpt-1 ratio was normalized to albumin. ResultsFifty-six patients were included with a median age of 51.5 years. Overall mortality was 14.3% (8/56 patients). The total amount of infused crystalloids was 12́902 ml (IQR 9́362–16́770 ml) at 24 h and 18́461 ml (IQR 13́024–23́766 ml) at 48 h. The amount of substituted albumin was 20 g (IQR 10–50 g) at 24 h and 50 g (IQR 20–60 g) at 48 h.The albumin-corrected Angpt-2/Angpt-1 ratios increased over the first 48 h after the burn insult (d0: 0.5 pg*l/ml*g [IQR 0.24 – 0.80 pg*l/ml*g]; d1: 0.83 pg*l/ml*g [IQR 0.29 – 1.98 pg*l/ml*g]; d2: 1.76 pg*l/ml*g [IQR 0.70 – 3.23 pg*l/ml*g]; p < 0.001) and were significantly higher in eventual ICU non-survivors (p = 0.005), in patients with a higher TBSA (p = 0.001) and in patients with a higher ABSI (p = 0.001). ConclusionsIn analogy to the pathological host response in sepsis, the Angpt-2/Angpt-1 ratio steadily increases in the first two days in critically ill burn patients, suggesting a putative involvement in the pathogenesis of capillary leakage in burns. A higher Angpt-2/Angpt-1 ratio is associated with mortality, total burn surface area and burn scores.

Outcomes of a fixed-dose combination of sucralfate, metronidazole, and lidocaine in patients undergoing anorectal surgery: Results from a prospective, single-centre study

Background: Various topical applications provide varying pain control outcomes among patients undergoing surgery for anorectal conditions like haemorrhoids, anal fissures, and anal fistulae with varying outcomes. We evaluated the outcomes of a fixed-dose combination of sucralfate, metronidazole, and lidocaine as a local application following anorectal surgery. Methods: This was a prospective, single-arm, single-centre study with 50 patients who underwent anorectal surgery. Coprimary endpoints were 1) proportion of patients with minimal clinically important difference (MCID) defined as 10-point reduction in 100-mm visual analogue scale (VAS) score and 2) mean reduction in anal pain on VAS, from baseline to 3 and 6 weeks after surgery. Proportion of patients with complete wound healing and reduction in symptoms of itching, bleeding, and burning and incidence of adverse events (AEs) and tolerability were also assessed. Results: Of 50 patients, 18.0%, 26.0%, and 56.0% underwent haemorrhoidectomy, fissurectomy, and fistulectomy, respectively. All patients achieved MCID at week 3, which was maintained at 6 weeks. The mean VAS score for anal pain reduced significantly from 68.6 at baseline to weeks 3 and 6, respectively (p&lt;0.001). The pain score reduced significantly by 36.5 and by 59.4 at weeks 3 and 6, respectively, in patients who underwent haemorrhoidectomy, by 43.5 and 71.7 at weeks 3 and 6, respectively, in patients who underwent fissurectomy, and by 37.6 and 61.2 at week 3 and 6, respectively, in those who underwent fistulectomy. The mean changes in itching, bleeding, and burning scores at weeks 3 and 6 reduced significantly in the total cohort and in the subgroups. Complete wound healing was achieved in 40.0% of patients by week 6. No AEs were reported and the study medication was well tolerated. Conclusion: The topical FDC was effective, with a good safety and tolerability profile, in patients undergoing surgery for anorectal conditions. Clinical trial registration: CTRI/2020/11/029298.

42 Utilizing FAB Scores to Determine Next Level of Care for Patients with Burn Injury

Abstract Introduction Determining next level of care for burn patients is a difficult task for the entire medical team. Secondary to the nature of the injury, patients often do not have the social or economic support required to return to their prior level of function. The Functional Assessment for Burns (FAB) score has been shown an objective measure to determine functional independence and a predictor of discharge outcomes in adults. However, it is undetermined whether this assessment can be utilized to guide next level of care and time which it takes to return to prior level of function. We hypothesized the number of therapy sessions to be positively associated with patients’ return to baseline FAB. Methods This single center, retrospective study of patients admitted to a single ABA-verified burn center was completed by collecting FAB assessment scores within 48 hours of admission and within 48 hours of discharge over the last year. Demographics, injury characteristics, surgical procedures, and number of treatment sessions were collected. Shapiro-wilk test was utilized to test for normality. Regression analysis was utilized to analyze variable associations with changes in FAB scores. A paired t test was used to compare paired FAB scores between admission and discharge. Results One-hundred patients were included with a median age of 53 (38.5, 64) years and 7 (3.5, 14) percent total body surface area burned (TBSA). The median FAB for preadmission (preadm.), admission (adm.), and discharge (DC) were 35 (35, 35), 17 (14, 24), and 24 (19, 32), respectively. The paired difference between adm. and DC scores (&amp;lt; 0.001) indicated significant improvement. TBSA and age, together, were significant predictors of change in preadm. to adm. FAB (r2=0.202, p&amp;lt; 0.001). Adm. FAB and TBSA were both associated with number of therapy sessions. Only 16% of patients returned to preadm. level of functional independence by discharge with only 20% qualifying for / entering a post-acute inpatient rehabilitation facility. Number of combined therapy sessions was not associated with return to preadm. FAB. Of note, only 28% returned within 90% of preadmission FAB by discharge. In fact, 13% actually saw their FAB regress from adm. to DC. None of the collected variables were associated with the negative change in FAB scores through admission. Conclusions In this sample, number of sessions was not predictive of return to preadmission FAB; however, this may be due to the low numbers that achieved the milestone at all. Despite this fact, there was an alarmingly small number admitted to a subsequent inpatient rehabilitation facility. There was a significant improvement in paired scores from admission to discharge. Taken together, there may be value in reassessing inpatient rehabilitation facility adm. criteria. Applicability of Research to Practice FAB scores may be a useful indicator of further rehabilitation needs.

Prevention of radiation dermatitis with skin hygiene and washing: a systematic review and meta-analysis.

This systematic review and meta-analysis aims to evaluate the effects of washing in patients receiving radiotherapy (RT) on radiation dermatitis (RD) severity. A literature search was performed using Ovid MEDLINE, Embase, and Cochrane databases between January 1, 1946, and January 31, 2023. Four randomized controlled trials (RCTs) studying the effects of washing with or without soap on RD were identified. A meta-analysis was conducted for clinician-reported outcomes using RevMan 5.4 and a narrative synthesis for patient-reported outcomes due to a lack of reported data amenable to quantitative comparison in accordance with the Synthesis Without Meta-analysis (SWiM) guidelines. The Cochrane Risk of bias (RoB2) and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria were used to assess risk of bias and certainty of evidence, respectively. Two RCTs met the inclusion criteria for meta-analysis. Washing with or without soap significantly reduced the incidence of severe RD (OR: 0.32, 95% CI: 0.19-0.55, p < 0.01) and moist desquamation (OR: 0.25, 95% CI: 0.12-0.52, p < 0.01). Two of four trials found an association between washing and reduced itching score (p = 0.38). Pain score was not found to be significantly different with or without washing in any of the four studies (p = 0.07). The two studies that assessed burn scores did not detect any difference between the washing group versus no washing group (p = 0.25). Washing was associated with improved quality of life (QoL) measures in one study. Washing with or without soap during RT resulted in less severe RD and less moist desquamation. Given the QoL benefits of washing, it should be advocated as part of routine skin care during RT.

Effect of silvopasture system on fearfulness and leg health in fast-growing broiler chickens.

A silvopasture system intentionally integrates trees, forages, and livestock, allowing dual land use. These systems can provide high-quality habitat for broiler chickens; however, such systems have not been widely adopted by the broiler industry in the United States. The objective of this study was to examine the effect of silvopasture versus open pasture access on fearfulness and leg health in fast-growing broiler chickens. A total of 886 mixed-sex Ross 708 chicks in Experiment 1 (Exp 1) and 648 chicks in Experiment 2 (Exp 2) were housed in coops and had access to 16 (Exp 1) or 12 (Exp 2) 125m2 silvopasture plots (x̄ = 32% canopy cover) or open pasture plots (no canopy cover) from day 24 of age. Fearfulness was measured using a tonic immobility test (tonic immobility duration), and leg health was assessed by quantifying footpad dermatitis, hock burns, gait, and performing a latency-to-lie test on days 37-39 of age. Birds in the silvopasture treatment were less fearful than birds in the open pasture treatment. Overall, birds in both silvopasture and open pasture systems had excellent leg health. Silvopasture birds had lower footpad dermatitis scores than open pasture birds. Silvopasture birds tended to have worse gait than open pasture birds in Exp 1, but not in Exp 2. Hock burn scores and latency-to-lie did not differ between treatments in Exp 1 or Exp 2. Raising birds in silvopasture reduced fear and improved footpad health compared to birds raised in open pastures, which indicates that silvopasture systems provide some benefits for affective state and leg health in fast-growing broilers.

Initial Laboratory Values Can Predict Mortality in Burn Patients.

There are several burn scores used to predict mortality in burn patients. However, minimal data exists on the role of laboratory values in risk stratification. We hypothesized that laboratory derangements seen on admission can predict mortality in burn patients. A retrospective chart review was conducted on burn patients admitted to a busy Level 1 Trauma and Burn Center from 2013 to 2019. Data analysis included patients with partial or full thickness burns and a total body surface area (TBSA) burn greater than 15%. Exclusion criteria included patients presenting with electrical burns, non-thermal conditions (Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis, or soft tissue infections) or patients with significant polytrauma. 112 patients were included in the analysis. Admission phosphate, creatinine, albumin, and glucose levels were associated with mortality. There was a difference in serum phosphate (3.48 and 6.04 mg/dL), creatinine (0.85 and 1.13 mg/dL), albumin (3.26 and 2.3 mg/dL), and glucose (138 and 233 mmol/L) levels for survivors and non-survivors; respectively. There were increased mortality rates seen in patients presenting with abnormal serum levels compared to normal serum levels (Phosphate: 7.5% vs. 53.3%, creatinine: 13.5% vs. 38.9%, albumin: 38.5% vs. 8.10% and glucose: 10.1% vs. 31.6% (normal vs. abnormal; respectively)). Serum sodium, potassium, and hemoglobin levels had no association with mortality. Specific laboratory derangements seen on admission are associated with an increased risk for mortality. This can be used as a framework for future studies in risk stratification of burn victims.

Screening of Various Genotypes of Castor for Resistance against Castor Leafhopper, Empoasca flavescens Fabricius

A screening trial with 10 castor genotypes to assess their relative reaction to leafhoppers (Empoasca flavescens) was conducted at CCSHAU, Regional Research Station, Bawal during the Kharif season, 2019-20. Among the 10 genotypes, leafhopper population varied from 2.3 to 8.3. Based on leafhopper population and hopper burn score, the triple bloom genotypes Maharaja-9 and GCH-7 were found tolerant to leafhopper whereas the single bloom genotype DCH-177 was highly susceptible. The phenols content in the castor leaves had a significant negative correlation with leafhopper population and hopper burn score while total carbohydrates present in the leaves had a significant positive correlation with leafhopper population and hopper burn score. The intensity of bloom and phenols and carbohydrates content were found to play a major role in the infestation of castor leafhopper.

An Analysis of Demographic and Triage Assessment Findings in Bushfire-Affected Koalas (Phascolarctos cinereus) on Kangaroo Island, South Australia, 2019-2020.

Simple SummaryIn the 2019–2020 Australian bushfires, Kangaroo Island, South Australia, experienced catastrophic bushfires that burnt approximately half the island, with an estimated 80% of the koala population lost. During and after the fires, koalas presented to a designated triage facility over a span of 10 weeks, with 50.2% during the first 14 days of the bushfire response (304 records available). Burns were observed in 67.4% of koalas, with the majority (60.9%) classified as superficial burns, primarily affecting the limbs and face. Poor body condition was recorded in 74.6% of burnt koalas and dehydration in 77.1%. Negative final outcomes (death or euthanasia, either at triage or at a later date) occurred in 45.6% of koalas and were significantly associated with higher mean burn score, maximum burn severity, number of body regions burnt, poor body condition score, and dehydration severity. The findings of this retrospective study may assist clinicians in the field with decision making when triaging koalas in future fire rescue efforts.In the 2019–2020 Australian bushfires, Kangaroo Island, South Australia, experienced catastrophic bushfires that burnt approximately half the island, with an estimated 80% of the koala population lost. During and after the event, rescued koalas were triaged at a designated facility and a range of initial data were recorded including rescue location and date, sex, estimation of age, body condition and hydration, and assessment of burn severity (n = 304 records available). Koalas were presented to the triage facility over a span of 10 weeks, with 50.2% during the first 14 days of the bushfire response, the majority of which were rescued from regions of lower fire severity. Burns were observed in 67.4% of koalas, with the majority (60.9%) classified as superficial burns, primarily affecting the limbs and face. Poor body condition was recorded in 74.6% of burnt koalas and dehydration in 77.1%. Negative final outcomes (death or euthanasia, at triage or at a later date) occurred in 45.6% of koalas and were significantly associated with higher mean burn score, maximum burn severity, number of body regions burnt, poor body condition score, and dehydration severity. The findings of this retrospective study may assist clinicians in the field with decision making when triaging koalas in future fire rescue efforts.

Patient-reported outcomes with risankizumab versus fumaric acid esters in systemic therapy-naïve patients with moderate to severe plaque psoriasis: a phase 3 clinical trial.

In a phase 3 clinical study, patients from Germany with moderate to severe psoriasis who were naïve to systemic treatment and received risankizumab had greater and more rapid disease improvements compared with those who received fumaric acid esters (FAEs). To evaluate patient-reported outcomes (PROs) in patients treated with risankizumab compared with FAEs. Adult patients were randomized 1:1 to receive either risankizumab 150mg subcutaneous injections at weeks 0, 4 and 16 or FAEs (Fumaderm® ) provided according to the prescribing label. PRO secondary endpoints assessed were Psoriasis Symptom Scale (PSS), Dermatology Life Quality Index (DLQI), 36-Item Short Form Health Survey, version 2 (SF-36v2), Patient Benefit Index (PBI), Hospital Anxiety and Depression Scale (HADS), Patient Global Assessment (PtGA) and European Quality of Life 5 Dimensions 5 Level (EQ-5D-5L). PROs were assessed at weeks 0, 16 and 24. Sixty patients each were randomized to receive risankizumab or FAEs. A significant PSS improvement was observed with risankizumab vs. FAEs at weeks 16 and 24 for total and psoriasis-associated redness, itching and burning scores (P<0.001). DLQI scores were significantly lower (reflecting better health-related quality of life) with risankizumab vs. FAEs, with least squares (LS) mean differences of -7.4 and -7.6 at weeks 16 and 24, respectively (both P<0.001). Patients randomized to risankizumab also had larger improvements in SF-36 Physical and Mental Component Summary scores, HADS anxiety and depression scores, PtGA, and EQ-5D-5L index and visual analogue scale scores (all P≤0.002) at weeks 16 and 24 compared with FAEs. PBI was significantly higher, indicating greater benefit, with risankizumab vs. FAEs, with an LS mean difference of 1.1 and 1.3 at weeks 16 and 24, respectively (both P<0.001). Risankizumab provides significant benefits over FAEs in improving PROs across several dimensions in patients with moderate to severe psoriasis.

The prevalence of allergic conjunctivitis based on outpatients in Baotou area

Objective: To explore the prevalence and influencing factors of allergic conjunctivitis in Baotou area at different times. Methods: A cross-sectional study was conducted in January 2021, 111 patients with allergic conjunctivitis who were admitted to the Department of Ophthalmology, the Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology in 2020 were selected as the research subjects. The basic information, allergic conditions, living habits and other information of the patients were obtained by self-made questionnaire. The pollen concentration and allergy related indicators(allergic duration and frequency, eye itching score, eye burn score, eye foreign body sensation score, tears score and the total scores) of 2019 and 2020 were analyzed by paired sample t-test. The pollen concentration of 2019 and 2020 were analyzed by Wilcoxon signed rank test. The allergy related indicators of different genders were analyzed by independent sample t-test. The allergy related indicators of different ages were analyzed by one-way analysis of variance. The relationship between the length of wearing masks and the allergy related indicators were analyzed by Spearman correlation analysis. Results: Among the 111 patients with allergic conjunctivitis, 54 were males and 57 were females, ranging in age from 8 to 69 years old, with a median age of 35 years old and an average age of (36.77±13.18) years old. The average pollen concentration in Baotou in 2019 was (125.35±222.64) grains/1 000 square millimeter, and the average pollen concentration in Baotou in 2020 was (107.38±137.29) grains/1 000 square millimeter. There was no significant difference in pollen concentration between the two years(Z=-0.178, P=0.859). The severity of allergic indicators in all patients in 2020 is significantly lower than in 2019(t values were 4.701,3.587,2.582,3.661,4.444,2.784,2.555,3.886,respectively, with P<0.05). The severity of allergic indicators in male patients is lower than that of female patients (t values were -1.558, -1.257, -3.41, -3.085, -2.335, -2.897, -2.652, -4.124, respectively). The prevalence of allergic conjunctivitis dose not vary significant with age (P values were 0.504, 0.095, 0.499, 0.265, 0.284, 0.655, 0.421, 0.976, respectively). In 2020, the average time that patients wear masks is (6.55±3.28) h/d, and there is a correlation with the difference in allergy duration (r=0.191, P=0.045). Conclusion: The severity of allergic conjunctivitis in Baotou in 2020 was significantly improved compared with that in 2019, which may be related to masks wearing.

Hydroxychloroquine- A new treatment option for erosive oral lichen planus.

Oral Lichen planus (OLP) is a chronic, debilitating, immune-mediated disease whose management is considered a challenge in medical science. To quantitatively evaluate the effect of administration of enteral hydroxychloroquine (HCQS) as a monotherapy for six months on the extent and severity of erosive OLP using reticular score, erythema score and ulcerative score (REU score), and to subjectively evaluate the success of HCQS as a therapeutic drug for OLP-e using Tel Aviv-San Francisco Scale, visual analogue scale (VAS) and severity of burning sensation (BURN score). Prospective clinical trial. A total of 45 subjects received 200 mg of HCQS bid for six months. REU, VAS, BURN scores and Tel Aviv-San Francisco Scale readings were taken at the beginning of the study (baseline) and three- and six-month intervals post administration of enteral HCQS. Subjects were examined for any adverse drug outcomes for one year after the cessation of enteric HCQS therapy. Data were analysed with SPSS version 25. There was a stark reduction in REU, VAS and BURN scores during the study period, with a statistically significant reduction (P < 0.05) seen at three- and six-month time intervals as compared to baseline. Further, the mean of change in R, E and U scores showed a statistically significant difference, with the highest reduction seen at baseline to six-month time interval. The Tel Aviv-San Francisco Scale showed 70%-100% remission in disease in more than 70% of subjects. Enteral HCQS can be considered a viable treatment option for the enigma that is erosive OLP.

Silicon supplementation affects mineral metabolism but not bone density or strength in male broilers.

Because leg injuries produce welfare concerns and impact production for broilers, numerous interventions have been suggested as potential solutions. One mineral which may affect bone quality is silicon. The objective of this study was to determine if supplementing bioavailable silicon could affect bone morphology, mineralization, and strength without negatively influencing welfare and meat quality. Male broilers were raised from d 1 after hatching until 42 d of age and randomly assigned to treatment groups for silicon supplementation in water: Control (no supplement, C; n = 125), Normal (0.011 ml supplement/kg bodyweight, N; n = 125) and High (0.063 ml supplement/kg bodyweight, H; n = 125). Toe damage, footpad dermatitis, hock burn, and keel blisters were assessed on d 42. Blood samples were collected from wing veins for serum osteocalcin, pyridinoline cross-links, and mineral analysis. Clinical QCT scans and analysis were conducted immediately before four-point bending tests of tibias. Texture analysis was performed on cooked fillets. Silicon supplementation tended to increase daily water consumption in N and H as compared to C (P = 0.07). Footpad dermatitis and hock burn scores were higher in H than in N or C (P < 0.05 for both comparisons). Supplementation altered serum minerals (P < 0.001), but bone density, morphology, and strength measures were similar among groups. The highest level of supplementation in the current study on a kg bodyweight basis was above recommended intakes but below previous amounts demonstrating silicon’s positive influence on bone, indicating that previously suggested minimum thresholds need to be reevaluated. Factors such as growth rate and mechanical loading likely play a greater role in developing bone quality than trying to supplement on top of good basic nutrition alone.

The ABSI is dead, long live the ABSI - reliable prediction of survival in burns with a modified Abbreviated Burn Severity Index

ObjectivesThe Abbreviated Burn Severity Index (ABSI) is a widely used and simple score to predict mortality after burn injuries. On the one hand, significant improvements in intensive care management and surgical treatment result in an increased survival rate. On the other hand, the aging population might lead to an increased injury-related mortality rate. Therefore, the question arises whether the ABSI still accurately predicts survival. MethodsData of 14,984 patients from the German Burn Registry from 2015 to 2018 were analyzed to re-evaluate the variables included in the ABSI, identify discrepancies between the predicted age-related probability of survival and the actual survival rate. Descriptive statistics, univariate analysis and binary logistic regression were used to test the variable impact and to establish a modified score. ResultsThe original ABSI does not accurately predict the survival in the present cohort. In particular, univariate analysis identified age, total body surface area burned, full thickness burn and inhalation injury as significant impactors on survival. Moreover, sex could not be confirmed as significant and was, therefore, excluded from the modified score. The assumption of a linear relation between age and mortality was not correct. We developed a new age scale representing the actual existing relationship. The resulting modified score was significantly more accurate in predicting the probability of survival for all burn score categories. ConclusionThe ABSI does not accurately predict probability of survival. Mortality is overestimated in severely burned patients. A modified version was developed that was significantly more accurate in predicting the probability of survival in this cohort.

Light emitting diode (LED) color and broiler growth: effect of supplementing blue/green LED to white LED light on broiler growth, stress, and welfare

Light emitting diode (LED) lighting provides an affordable lighting option for use in commercial poultry production. However, more information is needed to understand the effects of LED color on broiler welfare and growth. Five consecutive flocks (1 in summer, 1 in fall, 2 in winter, and 1 in spring) of straight run Ross 708 × Ross 708 broilers were reared in commercial type barns for 45 D. For white only (WO) treatment, birds were reared under white LED only (Agrishift MLB). For white supplemented (WS) treatment, birds were reared under white LED (Agrishift MLB) in the center aisle, with supplemental blue/green LED lighting (Agrishift MLBg) above the feed and water lines on either side of the barn. Each barn housed 26,200 chicks, and there were 2 barns in each treatment (n = 52,400/treatment). Treatments were rotated among barns between each flock. On day 45, blood samples were collected from 20 birds/barn (n = 40/treatment) to assess the plasma corticosterone (CORT) level and heterophil/lymphocyte ratio. On day 45, 100 birds/barn (n = 200/treatment) were weighed individually and assigned scores for hock burn and foot pad dermatitis. All measures were affected by trial (P < 0.001). Plasma CORT and body weight were affected by the treatment × trial interaction (P ≤ 0.001). Overall, birds in the WS treatment had higher day 45 live body weight (P < 0.001) and lower hock burn scores (P = 0.032) than birds in the WO treatment. Birds in the WS treatment had higher day 45 body weight overall (P < 0.001) and in trials 1, 3, and 5, although the overall body weight was lower in trials 1, 3, and 5 than in trials 2 and 4. Supplemental blue/green LED improved hock burn scores and increased overall day 45 body weight. However, trial differences suggest that more data are needed to determine whether supplementing blue/green LED to white LED improves body weight gain in mixed sex broiler chickens.

Could neutrophil-to-lymphocyte ratio be a new mortality predictor value in severe burns?

Background: The aim of our study was to demonstrate if there is any relation between the neutrophil-to-lymphocyte ratio (NLR) and mortality in severe burns Methods: The records of 366 patients who were admitted to Intensive Care Unit of Burn Center of Derince Training and Research Hospital between January 2012 and December 2015 were evaluated retrospectively. The cases who were hospitalized in service or did not require intensive care were not included in the study. The cases were divided into two groups: ex-group (Group 1) and discharge group (Group 2). In both groups demographic information such as age, gender, burn scores, neutrophil counts and lymphocyte counts during admission to the hospital were recorded. NLR is the ratio of absolute neutrophil count to the absolute lymphocyte count. Results: NLR was 10.94±7.63 in the exitus group and 5.5±5.56 in the discharged group. NLR was increased in mortality group and this value was statistically significant (p=0.00). Independent relationship between prognoses and NLR was shown with logistic regression analyses (Odds Ratio 0.895, 95% confidence interval 0.856-0.936, p=0.00). Conclusion: NLR has increased in mortality group. Our study showed that NLR is correlated with probability of mortality after severe burn injuries. Therefore, it can be used as a cheap, easily obtained and new mortality predictor in severe burns.

Use of the burn intervention score to calculate the charges of the care of burns

BackgroundTo our knowledge this is the first published estimate of the charges of the care of burns in Sweden. The Linköping Burn Interventional Score has been used to calculate the charges for each burned patient since 1993. The treatment of burns is versatile, and depends on the depth and extension of the burn. This requires a flexible system to detect the actual differences in the care provided. We aimed to describe the model of burn care that we used to calculate the charges incurred during the acute phase until discharge, so it could be reproduced and applied in other burn centres, which would facilitate a future objective comparison of the expenses in burn care. MethodsAll patients admitted with burns during the period 2010–15 were included. We analysed clinical and economic data from the daily burn scores during the acute phase of the burn until discharge from the burn centre. ResultsTotal median charge/patient was US$ 28 199 (10th–90th centiles 4668-197 781) for 696 patients admitted. Burns caused by hot objects and electricity resulted in the highest charges/TBSA%, while charges/day were similar for the different causes of injury. Flame burns resulted in the highest mean charges/admission, probably because they had the longest duration of stay. Mean charges/patient increased in a linear fashion among the different age groups. ConclusionOur intervention-based estimate of charges has proved to be a valid tool that is sensitive to the procedures that drive the costs of the care of burns such as large TBSA%, intensive care, and operations. The burn score system could be reproduced easily in other burn centres worldwide and facilitate the comparison regardless of the differences in the currency and the economic circumstances.