Management Of Burn Injuries Research Articles

Use of autologous adipose tissue in acute burn wound management: A systematic review

Fat transfer is increasingly used as part of our reconstructive armamentarium to address the challenges encountered in burn wounds and reconstructive surgery. The present systematic review aimed to evaluate the effectiveness of autologous fat transfer for acute burn wound management. A systematic review of the US National Library of Medicine, Cochrane Library, Web of Science, and Embase was conducted on October 15, 2022 (registration number CDR42022369726). A database watch was performed until submission of the manuscript. The review focused on wound healing. All studies reporting fat transfer in adult patients (at least 5 patients reported) with deep 2nd degree burn wounds were included. The database search yielded a total of 720 records and 367 patients were included from 3 studies. A statistically significant improvement in scar texture, scar appearance, and time to healing was reported in one study in the fat transfer group versus control (P<0.001). Similarly, scores for scar color, scar thickness, scar stiffness, and scar regularity increased significantly. The small number of included studies and their heterogeneity did not allow a meta-regression to be performed. This systematic review emphasizes the limited evidence currently available regarding the use of autologous fat transfer to improve burn wound healing in adult patients, even though it seems promising. Future search should focus on randomized controlled trials with a larger number of participants.

Outcome Evaluation of Burn Injury Management: A Study of Selective Traditional Home Remedies.

Background Clinicians classify burns as epidermal, partial thickness (superficial and deep), or full thickness, according to the depth of tissue damage. Although skin is considered the largest organ in the human body, studies investigating burns, their types, and their management has revealed that the background knowledge of burn aid the community possesses remains unsatisfactory. Thus, in this study, we aimed to evaluate the effect of various traditional home remedies, taking into account the type of burns and the nature of the remedies usedfrom a cosmetic point of view. Materials and methods This is an original retrospective study conducted at Dr. Soliman Fakeeh Hospital in Jeddah from June through December 2022. Using the Vancouver Scar Scale (VSS), eligible patients who met our inclusion criteria were invited to participate in the study after a review of their patient history, an assessment of basic vital signs, and a physical examination. Results Fifty-two participants met our inclusion criteria and successfully completed the study. A total of 80 wounds of varying severity in various locations were evaluated. Participants were divided into three categories according to VSS scores indicating good, intermediate, or poor healing. None of the eight cases treated with water resulted in poor healing. However, tomato paste resulted in poor healing for six cases (60%) but moderate and good healing for two cases (20%). Conclusion The safest and most effective initial management for burns among all the reviewed remedies was the application of cool running water, followed by seeking medical attention for evaluation and proper treatment, whereas tomato paste had a markedly poor effect.

Effect of instructional guidelines on Nurses Performance regarding Burn Injury Management in children

Effect of instructional guidelines on Nurses Performance regarding Burn Injury Management in children

Could fibrin sealants be effective in the management of burn injuries?

Burn is a complex pathophysiologic phenomenon, which causes both direct tissue damage, such as extensive hemorrhage, and indirect consequences, such as infections due to external skin barrier destruction. Several therapeutic strategies have been implied so far, but none could provide a combined action against direct and indirect consequences of such a common and serious medical condition. Therefore, novel therapeutic approaches should be investigated. TISSEEL™ is a fibrin sealant which simulates the final steps of the coagulation cascade and could be utilized as an alternate treatment for the immediate burn management, especially in areas where specialized burn departments or surgeons are not available.The present study proposes an effective alternative therapeutic strategy for immediate burn injury. In that way, every surgeon even without huge expertise could successfully manage a burn injury and acute consequences could be prevented. However, future experimental studies should be designed in order to further assess the feasibility and safety of the proposed method and to compare it with the available therapeutic options.

Orthopaedic Wire Debridement: A Novel Surgical Technique for Hypergranulated Burn Wounds

The burn wound healing process can be protracted due to various factors, including burn depth, infection and hypergranulation. Hypergranulation impedes epithelialisation macroscopically by preventing cellular migration across the wound bed and microscopically through cell-to-cell signal interferences. Debridement, which is the act of removing necrotic tissue, hypergranulation, slough and foreign debris from the wound in order to expose the underlying viable bed, can be achieved using various techniques. This aids with wound bed preparation to facilitate and expedite healing. In this article, we present a novel surgical debridement technique using a malleable orthopaedic cerclage wire for the management of a hypergranulated burn wound.

Exploring the efficacy of various wheat bran extracts in promoting burn wound healing: A comparative analysis

Ethnopharmacological relevanceAlthough burn wound management in medical practice has improved, the challenge still exists and demands multidisciplinary participation. Wheat has been extensively used as a remedy of different skin conditions especially burns in almost all parts of Italy. However, the mechanism is still unclear. Aim of the studyTo examine the effects of different wheat bran extracts on the healing of burn wound estimated grossly, histopathologically, and immunologically. Materials and methodsWistar male rats were divided into 5 groups; (control) saline treated group, Mebo (Moist Exposed Burn Ointment), cold-water extract, hot-water extract and methanolic extract groups. After the burn, four groups from the experimental groups were treated with Mebo, cold-water extract, hot-water extract and methanolic extract, respectively, but the negative-control group was treated daily with saline only. The observation was made along days 0, 5, 9, 13, 17 and 21. At the end of the study, rats were sacrificed, and blood samples were collected for biochemical and cytokines estimation in addition to wound samples were collected for histopathological and immunohistochemical studies. ResultsThe histopathological examination showed that the inflammation was significantly decreased in all extract-treated groups when compared with saline and Mebo-treated groups. Epithelial tissue and granulation tissue formation most significantly appeared in the cold water extract-treated group. ConclusionsCold water and methanolic extract groups showed the most rapid and effective healing of the burn wound. Particularly the cold-water extract, due to the sufficient concentration of zinc and phenolic components.

Treatment of superficial and deep partial width second degree burn's wound with allogeneic cord blood platelet gel.

Burns are caused by a variety of mechanisms, including flames, hot liquids, metallurgy, chemicals, electric current, and ionizing and non-ionizing radiation. The most significant burn wound management involves complete repair and regeneration as soon as possible while minimizing infection, contraction, and scarring in the damaged tissue area. Some factors such as delivery of nutrients, growth factors, and oxygen are essential to promote and stimulate the wound healing progress in the burns area. When these factors are not provided, the burn wound undergoes a physiological crisis. The use of growth factors is a promising approach to overcoming this limitation. Umbilical cord blood platelet concentrates are a rich natural source of growth factors. This clinical trial used growth factors released from the lysis of umbilical cord blood platelet concentrates that have a key role in promoting re-epithelization and regeneration of damaged tissues by forming a fibrin network. This study evaluated the effectiveness of allogeneic cord blood platelet gel topical dressing in a group of patients diagnosed with superficial and deep partial thickness (second-degree) burn wounds. Clinical outcomes were compared between the intervention group and a control group of patients with superficial second-degree burn wounds who received the standard routine treatment including paraffin gauze wound dressing and silver sulfadiazine ointment. The study's results showed that the increased rate of recovery and tissue granulation completely promoted to wound healing and burn wound closure, decreased the recovery time, and reduced inflammation and scars caused by burn injuries. However, the use of cord blood platelet gel topical dressing is not currently a routine treatment method in patients suffering from burn wounds. However, the study's results showed that allogenic cord blood platelet gel could be used to treat superficial and deep second-degree burns as a routine treatment. It was also shown that allogenic cord blood platelet gel topical dressing could be a candidate for autograft or after autograft skin transplantation surgery (in donor and recipient sites) instead of skin surgery in some patients. Allogeneic topical wound dressing provides an effective treatment that offers a faster rate of epithelialization and healing of wounds and also decreases patients' scar and inflammation level as well as the length of recovery time. This, finally, leads to better burn wound management and the improved quality of burn wound treatment.

Local delivery systems of drugs/biologicals for the management of burn wounds

Severe burn injuries are one of the major challenging health issues and pertain to significant morbidity and mortality due to their extensive traumatic and physiological damage to the organs. For decades, crucial steps and procedures have been considered to comprehend burn management. Early debridement and graft application are common practices that have improved the conditions and outcomes of burn patients physically and cosmetically. However, many drawbacks are still arising while managing burn treatment. Delayed healing, scarring, infection, and pain are among the reasons. Moreover, it is necessary to overstep to bring up new techniques and medications for improved healing quality. In this present article, we review and discuss the latest treatment of burn wound management and treatment. This review aims to provide a comprehensive discussion of the use of antibiotics and metallic ions for local delivery at wound sites and also provides a thorough briefing of the mechanism of action of these therapeutic agents. Furthermore, this article also provides an overall scenario of burn wound management, different regulations, and the advancement of nanotherapeutics for burn wound management and novel strategies developed in the past decades. Overall, this review article primarily targets to provide the scientific community with some settler ideas and research advancements, that improve and uplift burn wound care with a focus on infections, scarring, drug deliveries, nanomaterial, growth factors, bioactive proteins, and tissue engineering.

Egg Yolk Basti – A Boon to Heal Accidental Burn Wound

Burn injuries are frequent, horrifying, and life-threatening conditions that are still challenging to cure. Complications like scarring, keloid formation, and contractures are the main challenges for the treating surgeon. Burn injuries can occur from fire, moist heat, electrical source, chemical agents, radiations, etc. The Ayurvedic classics explain different treatment modalities for the management of burn wounds In this case study, A Case of 54 years old male patient came to OPD of Shalyatantra Department Parul institute of Ayurveda with complains of accidental burn injury, wound over right foot and burning pain over right leg. In past history we have found that patient burned from hot liquid before 15 days. He had taken contemporary medicines and iv fluids for Initial Management. Treatment protocol given for this patient is wound care, debridement and wound healing. Wound healing was promoted with the help of nutrient enemata in the form of egg yolk basti. Document supports that the absorptive capacity of the colonic mucosa could be used to provide partial nutrition who at present require central lines for intravenous feeding. This would avoid the many metabolic, infective, and technical complications associated with the parenteral route.

Enhanced Healing of Cutaneous Burn Wounds in Diabetic Rats: with the administration of β-glucans Having Dual Significant Properties- Antioxidant Effects and Phenotypic Transition

The aim of this study was to evaluate the effects of β-Glucans obtained from Saccharomyces cerevisiae on the wound healing process in diabetic rats induced with streptozotocin. The investigation evaluated multiple wound healing parameters, such as the closure of the wound, alongside the assessment of CD68 and CD163 proteins, which function as indicators for M1 and M2 macrophages, respectively. The study also investigated the effects of β-Glucans on inflammatory markers, specifically IL-6 and IL-10. Additionally, the researchers analysed hydroxyproline and hexosamine levels, and performed histopathological examinations. The current study examined the anti-inflammatory effects by employing the paw edoema and cotton pellet induced granuloma methods. The findings of this study suggest that β-Glucans exhibit therapeutic properties that may have potential benefits in the treatment of burn injuries among individuals diagnosed with diabetes. These substances facilitate expedited healing of burn wounds, augment tensile strength, and exhibit properties that combat oxidation and inflammation. In addition, β-Glucans have been shown to enhance the levels of tissue hydroxyproline and hexosamine, leading to the enhancement of collagen synthesis and the development of the extracellular matrix in burn wounds of individuals with diabetes. Importantly, -Glucans have a beneficial impact on the inflammatory stage of burn wound healing without inhibiting the generation of pro-inflammatory mediators, particularly interleukin-6 (IL-6). By increasing production of the anti-inflammatory mediator interleukin-10 (IL-10), they also aid in the proliferation process. By increasing CD163 expression and decreasing CD68 expression, the research showed that -Glucans had a substantial effect in promoting the switch from the M1 to M2 phenotype at the appropriate moment. The end result is faster recovery from burn injuries in diabetic rats. Overall, the results support beta-glucans' therapeutic potential in the effective management of burn wounds in diabetic patients. Keywords: β-Glucans, Diabetic burn wound, Biochemical analysis, Phenotypic Transition, Western blot analysis, wound healing,

Platelet-Rich Plasma in Regenerative Medicine: Possible Applications in Management of Burns and Post-Burn Scars: A Review.

Contribution of platelets in tissue regeneration and their possible application in regenerative medicine, which is primarily mediated via secretion of granular components following platelet activation, has been well established in the recent decades. Therefore, platelet rich plasma (PRP), as a portion of plasma with higher concentrations of platelets than the baseline level, is now an attractive therapeutic option in various medical fields mainly for tissue repair and regeneration following injuries. Burn injuries are devastating trauma with high rate of morbidities affecting several aspects of the patient's life. They require a long-time medical care and high costs. However, even following the best treatment procedures, post-burn scars are inevitable consequence of burn healing process. Therefore, development of new treatment modalities for both burn healing and prevention of post-burn scar establishment seems to be necessary. Regarding the well-known role of PRP in wound healing, here we aimed to provide a comprehensive insight in the possible application of PRP as an adjuvant therapy for the management of burn injuries and subsequent scars. In terms of the following keywords (individually or in combination), original/review articles were searched in PubMed, Scopus, and Google Scholar databases from 2009 to 2021: platelet rich plasma, PRP therapy, platelet biology, platelet function, burn healing, burn scar, scar formation, burn management, wound healing, regenerative medicine. All type of articles or book chapters in English language and relevant data were included in this review. This review initially focused on PRP, its mechanisms of action, preparation methods, and available sources. Then, pathophysiology of burns and subsequent scars were discussed. Finally, their current conventional therapeutic modalities and implication of PRP in their healing process were highlighted.

Role of medicinal herbs and phytochemicals in post burn management.

Burn management is a natural and distinctly programmed process involving overlapping phases of hemostasis, inflammation, proliferation and remodeling. Burn wound healing involves initiation of inflammation, re-epithelialization, granulation, neovascularization and wound contraction. Despite the availability of multiple preparations for management of burn wound, there is dire need for efficacious alternative agents. Current approaches for burn wound management include pharmaceutical agents and antibiotics. However, high cost of synthetic drugs and accelerated resistance to antibiotics is challenging for both developed and developing nations. Among alternative options, medicinal plants have been a biocompatible, safe and affordable source of preventive/curative approaches. Due to cultural acceptance and patient compliance, there has been a focus on the use of botanical drugs and phytochemicals for burn wound healing. Keeping in consideration of medicinal herbs and phytochemicals as suitable therapeutic/adjuvant agents for burn wound management, this review highlights therapeutic potential of 35 medicinal herbs and 10 phytochemicals. Among these, Elaeis guineensis, Ephedra ciliate and Terminalia avicennioides showed better burn wound healing potential with varied mechanisms such as modulation of TNF-alpha, inflammatory cytokines, nitric oxide, eicosanoids, ROS and leukocyte response. Phytochemicals (oleanolic acid, ursolic acid, kirenol) also showed promising role in burn wound management though various pathways involving such as down regulation of TNF-alpha, IL-6 and inflammatory mediators including plasma proteases and arachidonic acid metabolites. This review provides a pavement for therapeutic/adjuvant use of potential botanical drugs and novel druggable phyto-compounds to target skin burn injury with diverse mechanisms, affordability and safety profile.

549 The Quality of TikTok Videos in the Education, Prevention, and Management of Burn Injuries

Abstract Introduction Most burn injuries are preventable, and appropriate first aid post-injury results in improved outcomes for the patient as well as a reduced burden on the healthcare system. Many patients turn to internet resources for education and management approaches for their burn injuries. With the rising popularity of social media platforms for the promotion of health information, this creates a more accessible educational realm for those who may not know where to otherwise access informational resources. However, most content on social media is not validated or reliable. Previous studies have investigated the quality of online burn prevention, education, and management videos on platforms such as YouTube. In this study, we attempt to assess the quality of such videos on TikTok, a newer and rapidly growing platform. Methods Videos on TikTok were searched for using 27 keywords (hashtags) such as #burn, #education, #prevention, #management, and #firstaid. The first 30 videos for each hashtag were reviewed. The Global Quality Scale (GQS) was used to assess the quality of the videos that fell within the inclusion criteria. Metrics such as views, viewer engagement, commentary, and likes were also examined. Results Of 525 reviewed videos, 72 met inclusion criteria. 47.2% (n=34) were on first aid or medical management, 33.4% (n=31) were on basic information, and 9.7% (n=7) were on prevention. Only 5.6% (n=4) videos cited sources. The mean GQS score was 2.45. 50% of videos (n=36) were made by creators with medical training, and of those videos, the GQS score was 3.13, whereas content made by creators with no medical training had a mean GQS of 1.81 (p &amp;lt; 0.001). The excluded videos (n=453) fell into 6 main categories: unrelated (n=273), burn wounds (n=106), personal experiences (n=49), advertisements (n=8), questions (n=2), and non-English videos (n=15). Viewership varied from 41 to 4.2 million views. Conclusions Overall, information regarding burns on TikTok is unsatisfactory. Additionally, viewers are more drawn to lower quality videos. While quality varies amongst the different sources and is dependent on the creator, there is a significant gap in reliable content regarding burns, demonstrating an opportunity for validated content creation in this realm. Patients must exert caution and be selective when using TikTok as an educational resource regarding burns. Applicability of Research to Practice This review addresses key gaps in the knowledge base on TikTok for reliable burn information. This will later be used as a framework to create a series of educational videos for patients.

290 Admission Inflammatory Cytokine Levels Are Predictive of Fluid Resuscitation Requirements in Thermally Injured Patients

Abstract Introduction Resuscitation of patients with major thermal injury is accomplished with crystalloid infusion-based injury size and patient weight ultimately titrated based on patient response. Estimations of fluid requirements can be imprecise and predicting responsiveness lacks precision. Previous work has demonstrated perturbations in both proinflammatory and anti-inflammatory cytokines in burn patients. However, there is a paucity of literature examining the impact of these perturbations and their usefullness to help predict resuscitation needs. This study sought to examine patient specific cytokine levels which may provide better insight into resuscitation requirements. Methods Burn injured patients presenting to a regional center over six years were prospectively enrolled in this observational clinical trial. Blood samples were collected on admission. Plasma cytokine levels (IL-1b, IL-6, IL-10, IL-12p70 and TNF-a) were quantified by ELISA. Crystalloid resuscitation volumes during the first 48 hours were assessed for correlation with cytokine levels after adjusting for weight and %TBSA. Results Thirty-eight patients were included in the analysis. Mean total body surface area (TBSA) burned was 26.7±14.4%. Elevated levels of IL-6 significantly correlated with normalized resuscitation volumes (ml/kg/%TBSA) from 8-24hrs and 24-48hrs (r=0.52, p&amp;lt; 0.001; r=0.41, p&amp;lt; 0.01). Elevated levels of IL-10 were also significantly correlated with normalized crystalloid volumes from 8-24hrs and 24-48hrs (r=0.55, p&amp;lt; .01; r=0.46, p&amp;lt; 0.001). Elevated levels of TNF-a also correlated with normalized crystalloid volumes from 8-24hrs and 24-48hrs (r=0.60, p&amp;lt; 0.0001; r=0.57, p&amp;lt; 0.001). Conclusions Predicting resuscitation volumes (and preventing over excessive crystalloid administration—fluid creep) is an integral aspect of burn injury management and there is a need for more objective methods for measurement. Phenotyping patients based on admission cytokine levels employing point of care assays may be a novel aid in predicting resuscitation needs and avoiding fluid creep. Applicability of Research to Practice Proper burn resuscitation is an integral aspect in the care of the burn-injured patient. Establishing adjuncts to help estimate fluid requirements or risk of over-resuscitation could be integral in establishing more individualized care.

Old Wine in new Bottles: Silver Sulfadiazine Nanotherapeutics for Burn Wound Management.

According to the World Health Organization (WHO), ∼180,000 casualties are recorded every year due to burns, majorly from low- and middle-income countries that require medical attention. For the last 5 decades, silver sulfadiazine (SSD) 1% cream has been the most widely used topical antimicrobial agent for managing burn wound infections. Although SSD is considered the gold standard therapy in burn wound management, however in the last 10 years, several studies have reported the negative impact of SSD on the wound healing process. The therapeutic potential of SSD is restricted by its poor solubility, and antimicrobial action appears only after the dissociation of SSD into silver ions (Ag+) and sulfadiazine (SD). Pharmaceutical researchers and industries are looking for alternative strategies to overcome the challenges and limitations of the available SSD formulation due to rising costs, extensive time commitment, and the high risk of failure associated with the de novo development of new antimicrobial drugs. Recent advances in drug delivery systems nanotechnology-based strategies have had a colossal impact on them, particularly in burn wound management. Nanoparticulate systems and nanotools could be considered as potential drug delivery approaches for burn management. This contemporary review provides an abridgment of the literature on advanced SSD nanotherapeutics and their importance in managing burns.

In-hospital outcomes of paediatric burn injuries managed in children’s hospitals compared to general hospitals

IntroductionIn Australia and New Zealand, children with burn injuries are cared for in either general hospitals which cater to both adult and paediatric burn injuries or in children’s hospitals. Few publications have attempted to analyse modern burn care and outcomes as a function of treating facilities. AimThe aim of this study was to compare in-hospital outcomes of paediatric burn injuries managed in children’s hospitals to those treated in general hospitals that regularly treated both adult and paediatric burn patients. MethodsA retrospective cohort study of cases was undertaken using data from the Burns Registry of Australia and New Zealand (BRANZ). All paediatric patients with data for an acute or transfer admission to a BRANZ hospital and registered with BRANZ with a date of admission between 1 July 2016 and 30 June 2020 were included in the study. The primary outcome of interest was the acute admission length of stay. Secondary outcome measures of interest included admission to the intensive care unit and readmission to a specialist burn service within 28 days. The Alfred Hospital Ethics Committee granted ethical approval for this study (project 629/21). ResultsA total of 4630 paediatric burn patients were included in the analysis. Approximately three quarters of this cohort (n = 3510, 75.8%) were admitted to a paediatric only hospital, while the remaining quarter (n = 1120, 24.2%) were admitted to a general hospital. A greater proportion of patients admitted to general hospitals underwent burn wound management procedures in the operating theatre (general hospitals 83.9%, children’s hospitals 71.4%, p < 0.001). Patients admitted to children’s hospitals had a longer median time to their first episode of grafting (children’s hospitals 12.4 days, general hospitals 8.3 days, p < 0.001). The adjusted regression model for hospital LOS indicate that patients admitted to general hospitals had a 23% shorter hospital LOS, compared to patients admitted to children’s hospitals. Neither the unadjusted or adjusted model for intensive care unit admission was significant. After accounting for relevant confounding factors, there was no association between service type and hospital readmission rates. ConclusionsComparing children’s hospitals and general hospitals, different models of care seem to exist. Burn services in children’s hospitals adopted a more conservative approach and were more inclined to facilitate healing by secondary intention rather than surgical debridement and grafting. General hospitals are more “aggressive” in managing burn wounds in theatre early, and debriding and grafting the burn wounds whenever considered necessary.

Pay more attention to the management of burn wounds of special causes and sites

The treatment of burn wounds of special causes and sites is a very challenging clinical work. In this paper, we briefly discussed the incidence rates of chemical burns, electric burns, facial burns, hand burns, and perineal burns, as well as the complexity and severity of pathological injury of the corresponding wound tissue. In addition, we briefly discussed the main principles and methods of clinical treatment, as well as the difficult problems to be solved. It is hoped to attract attention and provide reference for further improving the overall treatment ability of burns.

Novel recombinant endolysin ointment with broad antimicrobial activity against methicillin-resistant Staphylococcus aureus isolated from wounds and burns.

The major problem in the management of burn wounds is infections. Methicillin-resistant Staphylococcus aureus (MRSA) is one of the major causes of infection in burn wounds. Antibiotic-resistant bacteria around the world have become a major therapeutic challenge. Bacteriophages and their lysin are suggested as an antimicrobial alternative agent. The approach of this study was to evaluate the potential of recombinant phage lysin ointment efficacy in MRSA burn wound infection invitro. Whole genome sequencing was performed to the three isolated bacteriophages by ABM, USA using Illumina next-generation sequencing (NGS) technology. De novo assembly and genetic analysis carried out. Expression of lysin genes was performed by cloning using Escherichia coli JM109. Lysin protein extraction and purification was performed before and after cloning using precipitation by ammonium sulfate, dialysis, and gel filtration chromatography. Dose-dependent assay and time-kill curve experiment was performed for 2 lysins showed that recombinant lysin 2 functions more than its non-recombinant lysins 2 with the same concentration of 0.5µg/mL. Both lysins' ointment was prepared and compared with commercial ointments. 62 (78.4%) out of 79 wounds a burns swabs were detected as S. aureus and S methicillin-resistant S. aureus (MRSA) rate was determined to be 29 (46.8%) in total, while 33 isolates (53.2%) determined as methicillin-sensitive S. aureus (MSSA). According to the antibiotic susceptibility test results, all S. aureus isolates were identified as sensitive against vancomycin, ceftaroline, and linezolid. Results shows one lysogenic bacteriophage and three distinct lyticspecific S. aureus bacteriophage were isolated from sewage. For each of the three samples, a single contig was possible to be obtained. Sample BP-SA2 had the best coverage, and the contig was slightly longer than the other bacteriophages. In addition, BLAST search identified Staphylococcus bacteriophage vB-SscM-1 (accession KX171212.1) as the closest match to the public database. Finally, the gene annotation was checked, and two potential lysin genes were identified. Besides the two ends, there are only 4 SNPs between the three genomes. It should be noted that the two lysin genes from the genomes have no SNPs, and are identical across the three genomes. It can be seen that the three bacteriophages (BP-SA1), (BP-SA 2), and (BP-SA3) form their own tight cluster. It can be seen that (BP-SA 2) is more closely related to Staphylococcus bacteriophage vB-SscM-1 genome and most noticeable 5' region of S5 and vB-SscM-1 are now located at 3' end of vB-Sau-Clo6. The investigation of the two lysin genes in (BP-SA 2) by whole genome sequencing showed that there is some homology with vB-SscM-1; although the first gene is annotated as hypothetical protein, the second gene is annotated as amidase. The same two lysin genes are identified in all three bacteriophage genomes by the RAST. The putative protein sequences of the discovered phage lysin was analyzed using protein search with UniProt/Swiss-Prot database, and all matches suggest that the putative protein of the discovered phage lysin is a real endolysin. The three samples of bacteriophage were harboring both (Lysin 1 and lysin 2) genes were amplified. Afterward, 2-lysin genes were cloned successfully; for the dose-dependent assay, the same incubation time of recombinant lysins and its two non-recombinant lysins with the bacteria for 30min. It is found that the bactericidal activity of these groups increased in correlation with their concentrations. For the time-kill curve experiment, it showed that Recombinant lysin 2 functions more than its non-recombinant lysins 2 with the same concentration of 0.5µg/mL. Both lysins' ointments have potential activity against S. aureus isolates more than mupirocin and have a similar activity with Fusidic acid through applying 10µL from lysin 1 ointment, lysin 2 ointment, mupirocin ointment 2%, and Fusidic acid cream 2%. In vitro lytic spectrum analysis revealed that 100% (29/29) tested S. aureus were sensitive. One dose of lysin ointment resulted in a reduction of 3.3 log units in the number of bacteria (from an initial count of 2×105CFU/mg) at 18hours compared with one dose of mupirocin, PBS, or Aquaphor. Specifically, this study provides evidence that the application of lysin ointment has significant potential as an alternative strategy for MRSA infections.

Introducing the "SIMline"-A Simulation Course in the Management of Severe Burns as a Tool in Undergraduate Medical Education.

Background: Management of burn injuries presents a complex and challenging situation for medical staff, especially for inexperienced young doctors. However, training on how to treat burn victims in the clinical setting is rarely taught in undergraduate medical classes. We have created the "SIMline", a simulation training program explicitly designed for coaching medical students in burn management. Methods: A total of 43 students participated in the "SIMline" course, which took place at the training facility at the Medical University of Graz, between 2018 and 2019. The course provided theoretical classes, practical exercises, and a full-scale care process simulation training. The learning progress of the students was monitored via a formative integrated test. Results: Students showed great progress throughout the course of the "SIMline" program, as their test scores improved by an average of 88%. The passing rate was 0% at the first exam (prior to course) as compared to 87% at the final exam, taken after the training. Conclusions: Comprehensive practical training programs in burn care are underrepresented in medical education. The "SIMline" course presents a novel and effective approach in training medical students in burn management. However, follow-up evaluation is necessary to confirm long-term educational benefits.

Friction burns in cyclists: An under-recognised problem

IntroductionCycling-related friction burns, also known as abrasions or “road rash”, can occur when cyclists are involved in a fall or a collision. However, less is known about this type of injury as they are often overshadowed by concurrent traumatic and/or orthopaedic injuries. The aims of this project were to describe the nature and severity of friction burns in cyclists admitted to hospitals with specialist burn services in Australia and New Zealand. MethodsA review of cycling-related friction burns recorded by the Burns Registry of Australia and New Zealand was undertaken. Summary statistics described demographic, injury event and severity, and in-hospital management data for this cohort of patients. ResultsBetween July 2009 and June 2021, 143 cycling-related friction burn admissions were identified (accounting for 0.4% of all burns admissions during the study period). Seventy-six percent of patients with a cycling-related friction burn were male, and the median (interquartile range) of patients was 14 (5–41) years. The greatest proportion of cycling-related friction burns were attributed to non-collision events, namely falls (44% of all cases) and body parts being caught or coming into contact with the bicycle (27% of all cases). Although 89% of patients had a burn affecting less than five percent of their body, 71% of patients underwent a burn wound management procedure in theatre such as debridement and/or skin grafting. ConclusionsIn summary, friction burns in cyclists admitted to participating services were rare. Despite this, there remains opportunities to better understand these events to inform the development of interventions to reduce burn injury in cyclists.