Scald Burn Research Articles

Discovery of metabolic markers for the discrimination of Helwingia species based on bioactivity evaluation, plant metabolomics, and network pharmacology

Helwingia japonica (HJ), a traditional medicinal plant, is commonly used for the treatment of dysentery, blood in the stool, and scald burns. Three major HJ species, Helwingia japonica (Thunb.) Dietr. (QJY), Helwingia himalaica Hook. f. et Thoms. ex C. B. Clarke, and Helwingia chinensis Batal., share great similarities in both morphology and chemical constituents. The discrimination of medicinal plants directly affects their pharmacological and clinical effects. Here, we solved the taxonomy uncertainty of these three HJ species and explored the discrimination and study of other traditional medicines (TMs). First, the anti-inflammatory effects of the three HJ species were compared using lipopolysaccharide (LPS)-induced inflammatory responses in mouse leukemia cells of monocyte macrophage (RAW) 264.7 cells. Then, plant metabolomics were performed in 48 batches of samples to discover chemical markers for discriminating different HJ species. Finally, network pharmacology was applied to explore the linkages among constituents, targets, and signaling pathways. In vitro experiments showed that the QJY exhibited the most potential anti-inflammatory activities. Meanwhile, 172 compounds were tentatively identified and eight metabolites with higher relative content in QJY were designated as chemical markers to distinguish QJY and the other two species. According to the property of absorbed in vivo, threonic acid, arginine, and tyrosine were selected to construct a component-target-pathway network. The network pharmacology analysis confirmed that the chemotaxonomy differentiation was consistent with the bioactive assessment. The present study demonstrates that bioactivity evaluation integrated with plant metabolomics and network pharmacology could be used as an effective approach to discriminate different TMs and discover the active compounds.

Virtual Reality Animal Rescue World: Pediatric virtual reality analgesia during just noticeable pressure pain in children aged 2-10 years old (crossover design).

Excessive pain during medical procedures is a worldwide medical problem. Most scald burns occur in children under 6, who are often undermedicated. Adjunctive Virtual Reality (VR) distraction has been shown to reduce pain in children aged 6-17, but little is known about VR analgesia in young children. This study tests whether desktop VR (VR Animal Rescue World) can reduce the just noticeable pressure pain of children aged 2-10. A within-subject repeated measures design was used. With treatment order randomized, each healthy volunteer pediatric participant underwent brief cutaneous pressure stimuli under three conditions: (1) no distraction, (2) a verbal color naming task (no VR), and (3) a large TV-based desktop VR distraction. A hand-held Wagner pressure pain stimulation device was used to generate just noticeable pain sensations. Participants indicated when a steadily increasing non-painful pressure stimulus first turned into a painful pressure sensation (just noticeable pain). A total of 40 healthy children participated (43% aged 2-5 years; and 57% aged 6-10 years). Compared to the no distraction condition, the 40 children showed significant VR analgesia (i.e., a significant reduction in pain sensitivity during the VR Animal Rescue World condition), t(39) = 9.83, p < 0.001, SD = 6.24. VR was also significantly more effective at reducing pain sensitivity vs. an auditory color naming task, t(39) = 5.42, p < 0.001, SD = 5.94. The subset of children aged 2-5 showed significant reductions in pain during VR. Children under 6 showed greater sensitivity to pain during no distraction than children aged 6-10. During no distraction, children under 6 years old were significantly more sensitive to pain than children aged 6-10. Virtual reality (VR) significantly reduced the "just noticeable" pressure pain sensitivity of children in both age groups.

Factors associated with an extended length of stay in the pediatric burn patient

BackgroundThe Center for Medicaid and Medicare Services predicts the length of stay for pediatric burn patients based on several variables. However, many patients exceed their anticipated length. This study looks to identify aspects of patient presentation, wound characteristics, treatment, and discharge that are associated with a longer-than-predicted length of stay to identify strategies to safely reduce it. MethodsWe conducted a retrospective chart review of 535 pediatric burn patients admitted to our academic hospital from January 2018 to December 2020. 405 patients met inclusion criteria. Data were collected and analyzed. ResultsAverage patient age was 3.36 years. 72.3% were treated for scald burns. Average length of stay was 13.5 days. 20.5% (n = 83) of patients exceeded their predicted length of stay. In comparing patients who exceeded their predicted length of stay to those who did not, the former had significant differences in burn causes, percent total body surface area burned (12.80% vs 4.24% [P = .000]), and body areas involved. Patients who exceeded length of stay had a higher incidence of endotracheal intubation (15.7% vs 1.3%), surgical intervention (85.5% vs 29.2%), need for tube-feeding (48.2% vs 4.3%), and intensive care unit admissions (22.9% vs 2.2% [P = .00 all]). They also averaged more operations, autografting (31.3% vs 1.6% [P = .00]), total operating room time (250 vs 31 minutes [P = .00]), and time to the first operation (2.32 vs 1.64 days [P = .00]). Tube-feeding averaged 9.52 vs 0.72 days (P = .00) extending patient stay after wound stability (43.9% vs 4.3% [P = .00]). These patients also required more discharge planning, with higher rates of Child Protective Services involvement (39.8% vs 10.9% [P = .00]), services consulted (1.06 vs 0.24 [P = .00]), and discharges to inpatient rehabilitation (8.6% vs 0.6% [P = .00]). 89.6% of all patients followed up in clinic. ConclusionsTwenty percent of pediatric burn patients had a longer length of stay than predicted by the Center for Medicaid and Medicare Services. Many factors were strongly associated with a longer-than-predicted length of stay. Identifying these early on might help reduce length of stay and meet the targets of the Center for Medicaid and Medicare Services.

Cutaneous burn injury induces neuroinflammation and reactive astrocyte activation in the hippocampus of aged mice

BackgroundBy 2050, one in six people globally will be 65 or older. Confusion and delirium are significant complications after burn injury, especially in the elderly population. The etiology is still unknown, however complications may be driven by pro-inflammatory activation of astrocytes within the hippocampus (HPC) after burn injury. Reduced levels of phosphorylated cyclic-AMP response binding element (pCREB), caused by elevated systemic pro-inflammatory cytokines, could lead to cognitive decline and memory impairment. MethodsTo examine the effects of remote injury on neuroinflammation in advanced age, young and aged mice were subjected to a 15 % total body surface area scald burn or sham injury, and euthanized after 24 h. Expression of ccl2 and tnfa were measured by qPCR in the whole brain and HPC. Astrocyte activation was measured by immunofluorescence within the HPC. pCREB was measured by immunohistochemistry in the dentate gyrus. ResultsWe saw an 80-fold increase in ccl2 and a 30-fold elevation in tnfa after injury in the whole brain of aged mice compared to young groups and aged sham mice (p < 0.05 and p < 0.05, respectively). Additionally, there was a 30-fold increase in ccl2 within isolated HPC of aged injured mice when compared to sham injured animals (p < 0.05). When investigating specific HPC regions, immunofluorescence staining showed a >20 % rise in glial fibrillary acidic protein (GFAP) positive astrocytes within the cornu ammonis 3 (CA3) of aged injured mice when compared to all other groups (p < 0.05). Lastly, we observed a >20 % decrease in pCREB staining by immunohistochemistry in the dentate gyrus of aged mice compared to young regardless of injury (p < 0.05). ConclusionsThese novel data suggest that remote injury in aged, but not young, mice is associated with neuroinflammation and astrocyte activation within the HPC. These factors, paired with an age related reduction in pCREB, could help explain the increased cognitive decline seen in burn patients of advanced age. To our knowledge, we are the first group to examine the impact of advanced age combined with burn injury on inflammation and astrocyte activation within the brain.

Sociodemographic characteristics and fate of hospitalized burned patients in Al-Hilla city

Background: A burn is defined as a damage to the tissues due to high temperatures or heat, cold, electrical, chemical, friction, or irradiation. In developing countries such as Iraq, burn injuries are widespread, particularly in low-income and rural regions. Burns are considered the fourth most prevalent type of injuries worldwide. Objectives: The aim of this study is to assess the sociodemographic characteristics of hospitalized burned patients, as well as patients’ fate and related risk factors. Materials and Methods: This was a cross-sectional study. The data were collected by interviewing patients who admitted in the burns ward center of Al-Imam Al-Sadiq Teaching Hospital or their companions, for a 3-month period from February 1, 2022 to May 1, 2022. Statistical analysis was done by SPSS version 27. Results: We collected data from 73 burned patients, which showed that most of them were males 53.4%, the mean age ± standard deviation was 18.76 ± 16.81 years, 65.8% living in rural areas, most patients had scald burn 43.9%, with second degree of burns and total body surface area (TBSA) &lt;50%. About the outcome, 38.3% died. We found a significant (P-value &gt;0.05) association between the fate of burned patients and the age, gender, place of burn, degree of burns, TBSA involved, and the presence of inhalational injury. Conclusion: The majority of the burned patients were male children, with scald burns, second-degree burns, and TBSA more than 50%. The mean age was 18.67 ± 16.81 years. The mortality rate was 38.3% and increased with age, female gender, flame burn, TBSA more than 50%, and with inhalation injuries.

Elderly burns; Our clinical experiences

Background: Though mortality rates have decreased with better understanding of burns’ pathophysiology and advanced monitoring, elderly burn patients are still a challenging health problem. The elderly population is increasing worldwide. The aim of this study is to investigate the outcomes of burns for elderly patients and increase medical, public and governmental awareness of the issue. Elderly people should be trained in preventive measures to diminish the number of burn accidents.Methods: Hospitalized patients between 2011 and 2019 were retrospectively studied. Age, gender, burned total body surface area (TBSA), burn agent, comorbidities, location of the burn injury, whether a house fire accompanied, and mortality rates were compared between adult patients (18 to 64 years old) and those who were elderly (65 years or older).Results: Of the 2258 patients, 285 (12.6%) were aged 65 or older. The burned TBSAs of the adult patients were larger than those of the elderly patients (p=0.019). Scalding and contact burns were more frequent among the elderly than the adults (p=0.001). The elderly had greater co-morbidities, were mostly burned at home and more house fires accompanied their injuries than those of the adults (p&amp;lt;0.001). Despite having lesser burned TBSAs, mortality rates were significantly higher in the elderly (p&amp;lt;0.001).Conclusions: As the elderly population increases worldwide, burn treatment facilities should be prepared for their increase in numbers and co-morbidities. To enforce preventive measures, awareness of the growing issue should be raised and public authorities should be alerted to their need to act.

Frequency and Etiology of Pediatric Trauma, Experience at Tertiary Care Hospital

Abstract: Objectives: To determine etiology and spectrum of trauma in children and to make recommendations for its prevention. Materials and Methods: This Hospital based Retrospective observational study was conducted in Department of Pediatric Surgery King Edward Medical University / Mayo Hospital Lahore from March 2021 to February 2022. All patients presented in Pediatric Surgical emergency King Edward Medical University/ Mayo Hospital Lahore were included in this study. Data regarding age, gender, mechanism and severity of trauma and its management was analyzed and recorded on a prescribed Performa. Results: During the study period a total of 3850 patients having trauma were presented in pediatric surgical emergency. There were 2206 (57.3%) male patients and 1644 (42.7%) females with male to female ratio of 1.3:1. Majority of children affected were 8 to 10 years age. Burn trauma was noted in 2400 (62.3%) while 1450 (37.7%) patients have poly trauma due to different etiological factors. Regarding burn trauma, majority of patients 1620 (67.5%) were having scald burn injury. Pedestrians 260 (17.9%) hitting with motor vehicle was noted to be major mechanism of trauma. Conclusion: Motor vehicle collision is most common mechanism of pediatric trauma after pediatric burn injury. There is a need for parental education and strict implementation of traffic laws to prevent trauma at pediatric age group.

Geriatrik Hastalarda Yanık Yaralanmalarının Epidemiyolojik İncelenmesi: 10 Yıllık Analiz

Özet Amaç: Yanık epidemiyolojisi, her bölgenin sosyo-ekonomik etkenlere ve kültürel özelliklerine bağlı olarak değişiklik göstermektedir. Bu travmaların önüne geçilmesi veya azaltılması için alınması gereken tedbirler açısından her bölgede yanık travmalarının etiyolojisine yönelik verilere ihtiyaç vardır. Bu çalışmadaki amacımız 2012- 2021 yılları arasında Yanık Merkezimizde tedavi gören yaşlı Türk ve Suriyeli hastaların demografik ve epidemiyolojik olarak incelenmesidir. Materyal ve Metot: Kurum onayı alındıktan sonra Ocak 2012 ile Aralık 2021 tarihleri arasında, 10 yıllık dönemde, hastanemiz yanık merkezinde yatarak tedavi gören toplam 21531 hastanın kayıtları incelendi. Toplamda 155 hastanın (136 Türk, 19 Suriyeli) demografik ve epidemiyolojik verileri kaydedildi. Ayakta tedavi gören, başka bir merkeze sevk edilen veya kronik yanığı olan hastalar çalışma dışı bırakıldı. Çalışmaya alınan hastanın yaşı, cinsiyeti, yanık nedenleri, yanık lokalizasyonları, yanık şiddeti (toplam vücut yüzey alanı (TBSA) yüzdesine göre hafif, orta, şiddetli ve kritik olarak gruplandırıldı), başvuru zamanı, hastaların ikamet ettikleri yer, hastanede takip süresi ve sonuçları kayıt edildi. Yanık nedenleri; haşlanma, alev, elektrik, kimyasal yanık olarak sınıflandırıldı. TBSA dokuzlar kuralına göre hesaplandı. Yanık lokalizasyonları baş-boyun, gövde(ön ve arka), üst ekstremite ve alt ekstremite, kalça ve genital bölge olarak sınıflandırıldı. Hastaların başvuru tarihleri sonbahar, kış, ilkbahar ve yaz olarak sınıflandırıldı. Hastaların yaşadıkları bölge kentsel ve kırsal olmak üzere iki grupta değerlendirildi. Bulgular: Çalışmaya 97’si (%62.7) kadın, 58’i (%37.3) erkek olmak üzere toplam 155 hasta dahil edildi. En sık görülen neden haşlanma yaralanmalarıydı. Bunu alev yanıkları ve elektrik yanıkları takip ediyordu. Hastaların yanık derecelerinin toplam vücut alan yüzeyine göre sınıflandırdığımızda en yüksek oranda orta (%10-30 TBSA) derecede yanık olduğunu gördük. Yine en sık yanan vücut anatomik bölgesi ise kol(%51.6) ve bacak(%50.3) olmak üzere ekstremitelerde olduğu görüldü. Hastaların 136’sı Türk, 19’u Suriyeli olduğu görüldü. Yanık nedenlerinin analizinde ise kimyasal ve elektrik yanıklarının Suriyelilerde hiç görülmediği, alev ve haşlanma yanıklarının ise Türklerde istatistiksel olarak anlamlı şekilde daha fazla olduğu saptandı. Yanık vücut alanları incelendiğinde ise her iki ırkta da en sık ekstremite yanıklarının olduğu tespit edildi. Takiplerde 15 (%9.7) hastanın öldüğü görüldü. Ölümler arasında ise en sık ölümün %80 oranla 65 yaş altında gerçekleştiği saptandı (p=0.027). Sonuç: Yaşlı nüfustaki yanık yaralanmalarını incelediğimiz bu çalışmada bölgesel nüfus, Suriyeli mülteci sayısı, yaşam koşulları gibi etkenler göz önüne alındığında genç hastalara kıyasla bu özel hasta grubunda tıbbi bakım ihtiyacının fazla ve önemli olduğunu söyleyebiliriz. Geriatrik yanık hastalarında gerek komorbid hastalıklar gerekse yaşlanmanın sistemsel etkisi nedeniyle her adımda multidisipliner yaklaşım ile azalan mortalite ve morbiditeyi yakalayabiliriz.

Social determinants of health in pediatric scald burns: Is food access an issue?

BackgroundBurn injury risk, severity, and outcomes have been associated with socioeconomic status. Limited data exist to evaluate health access-related influences at a structural population level. This study evaluated factors at the Census-tract level, specifically evaluating food access and social vulnerability in pediatric scald burns. MethodsA single-institution retrospective review using the trauma registry and electronic medical record was conducted of pediatric burns between 2016 and 2020. Home address was coded to the Census-tract level and bulk analyzed. Socioeconomic metrics of the home environment were evaluated from publicly available databases, the United States Food and Drug Administration Food Access Research Atlas, and the Centers for Disease Control’s Social Vulnerability Index. ResultsThere were 840 patients that met inclusion criteria (49.8% scald, N = 418). The mean total body surface area for scalds was 6.6% with an age of 10.2 years; 76% (n = 317) of scalds had Medicaid, and 15% (n = 63) were due to hot noodles. Scalds occurred more in females (45.7%, N = 191 vs 28.0%, N = 118; P < .0001), non-White race (62.7%, N = 262 vs 29.1%, N = 123; P < .0001), and low-income and low-food access populations (39.8%, N = 147 vs 30.4%, N = 116; P = .007). Low-food access Black populations showed increased scald injury (18% [interquartile range 6–35] vs 10% [interquartile range 4–25]), whereas all other populations showed no association. The patients with scalds had a higher overall social vulnerability index (0.67 vs 0.62, P = .008). ConclusionOften related to poverty, health access, and health equity, population-level social determinants of health like social vulnerability and food access have significant impact on health care and should influence health outreach and systems improvement.

Length of Stay Per Total Body Surface Area Burn: A Validation Study Using the National Burn Registry.

A length of stay (LOS) of one day per percent total body surface area (TBSA) burn has been generally accepted but not validated in current pediatric burn studies. The primary objective of this study is to validate previous Pediatric Injury Quality Improvement Collaboration (PIQIC) findings by using a national burn registry to evaluate LOS per TBSA burn relative to burn mechanism, sociodemographic characteristics, and clinical factors which influence this ratio. We evaluated patients 0-18 years old who sustained a burn injury and whose demographics were submitted to the National Burn Registry (NBR) dataset from July 2008 through June 2018. Mixed effects generalized additive regression models were performed to identify characteristics associated with the LOS per TBSA burn ratio. Among 51,561 pediatric burn patients, 45% were Non-Hispanic White, 58% were male, and median age was 3.0 years old (IQR: 1.0, 9.0). The most common burn mechanism was scald (55.9%). The median LOS per TBSA burn ratio across all cases was 0.9 (IQR: 0.4, 1.75). In adjusted models, scald burns had a mean predicted LOS per TBSA burn value of 1.2 while chemical burns had the highest ratio (4.8). Non-Hispanic White patients had lower LOS per TBSA burn ratios than all other races and ethnicities (p &lt; .05). These data substantiate evidence on variance in LOS per TBSA burn relative to burn mechanism and race/ethnicity. Knowing these variations can guide expectations in hospital LOS for patients and families and help burn centers benchmark their clinical performance.

Comparison of patterns of burn severity and clinical characteristics of pediatric patients in a referral burn center: a retrospective analysis

Objective: Burn injuries continue to be an important public health problem worldwide, and childhood burns constitute the most critical burden among these injuries. Although less common, pediatric non-scald burn injuries (NSBIs) generally have a more severe course and cause more significant morbidity and mortality than scald burns (SBs). Many studies only address SBs or NSBIs separately. There are limited studies comparing severity patterns and clinical characteristics of both injuries. It aimed to investigate the severity patterns and clinical characteristics of SBs and NSBIs in hospitalized pediatric patients and compare them with the existing literature. Methods: A retrospective comparative study design was created among hospitalized pediatric patients. The most frequently observed SBs caused by hot water-tea/hot milk/oil-sauce-soup formed the first group. At the same time, as burn severity was thought to be relatively varied according to initial burn conditions, the NSBIs (fire-flame-related/electrical/contact/chemical-burns) constituted the other group. Data were extracted from the University of Health Sciences- Adana Faculty of Medicine (UHS-AFM) patient files and the electronic registry system. Results: While SBs constituted 83% of 1715 hospitalized pediatric patients, NSBIs formed only 17% of the study group. Additionally, pediatric non-scald burn injuries had a more severe course in this study. It was determined that NSBIs were responsible for more than two-thirds of mortality compared to SBs. This patient group also required approximately three times more surgical procedures (escharotomy/fasciotomy). Also, the length of hospital stay (LOS) was approximately two times longer than SBs, 23.5±30.5 (1-258), vs. 11.8±9.9 (1-136) (p<0.001). While 31.4% of NSBIs required skin grafts (n=91), only 14% of SBs had (p<0.001). This identified high trend was consistent with the depth of deep partial-/full-thickness burns, which was detected in only 28.6% of SBs and more than 51% of NSBIs (p<0.001). Conclusion: Further comparative studies on the actual mechanisms of SBs and NSBIs may help develop new strategies from a different perspective on burn prevention programs. In addition to the education of school-age children and their families, there is also a need to raise public awareness on the prevention of burn injuries by using all possible mass media.

IL-27 Promotes Intestinal Barrier Integrity following Ethanol Intoxication and Burn Injury.

Alcohol intoxication combined with burn injury can lead to life-threatening complications, including sepsis, multiple organ failure, and death. After an acute burn, the gastrointestinal system becomes hypoxic because of fluid loss and reduction of intestinal blood flow. This can cause perturbations in the intestinal epithelial barrier, immune function, and the composition of the gut microbiome. Increased gut permeability leads to proinflammatory signaling, contributing to further damage to the intestinal barrier. Recent studies have suggested that IL-27 plays an anti-inflammatory role, which may be beneficial in intestinal barrier repair. Therefore, in this study, we examined the effect of ethanol and burn injury on IL-27 in the small intestine, as well as the potential beneficial role of IL-27 in restoring the intestinal barrier after intoxication and burn. Male C57BL/6 mice were gavaged with 2.9 g/kg ethanol before receiving a ∼12.5% total body surface area scald burn with or without rIL-27 in resuscitation fluid. Our results demonstrate that IL-27-producing cells are reduced in the small intestine after injury. When IL-27 is supplemented in resuscitation fluid, we were able to restore intestinal barrier integrity and transit, mediated through increased intestinal epithelial cell proliferation, reduced inflammatory cytokines, and increased anti-inflammatory cytokine IL-10. We also observed increased gene expression of tight junction proteins. These findings suggest that IL-27 may be a contributor to maintaining proper intestinal barrier function after injury through multiple mechanisms, including preventing excess inflammation and promoting intestinal epithelial cell proliferation and tight junction integrity.

Global trends in pediatric burn injuries and care capacity from the World Health Organization Global Burn Registry.

BackgroundBurn injuries are a major cause of death and disability globally. The World Health Organization (WHO) launched the Global Burn Registry (GBR) to improve understanding of burn injuries worldwide, identify prevention targets, and benchmark acute care. We aimed to describe the epidemiology, risk factors, and outcomes of children with burns to demonstrate the GBR's utility and inform needs for pediatric burn prevention and treatment.MethodsWe performed descriptive analyses of children age ≤ 18 years in the WHO GBR. We also described facility-level capacity. Data were extracted in September of 2021.ResultsThere were 8,640 pediatric and adult entries from 20 countries. Of these, 3,649 (42%) were children (0–18 years old) from predominantly middle-income countries. The mean age was 5.3 years and 60% were boys. Children aged 1–5 years comprised 62% (n = 2,279) of the cohort and mainly presented with scald burns (80%), followed by flame burns (14%). Children >5 years (n = 1,219) more frequently sustained flame burns (52%) followed by scald burns (29%). More than half of pediatric patients (52%) sustained a major burn (≥15% total body surface area) and 48% received surgery for wound closure during the index hospitalization. Older children had more severe injuries and required more surgery. Despite the frequency of severe injuries, critical care capacity was reported as “limited” for 23% of pediatric patients.ConclusionsChildren represent a large proportion of people with burn injuries globally and often sustain major injuries that require critical and surgical intervention. However, critical care capacity is limited at contributing centers and should be a priority for healthcare system development to avert preventable death and disability. This analysis demonstrates that the GBR has the potential to highlight key epidemiological characteristics and hospital capacity for pediatric burn patients. To improve global burn care, addressing barriers to GBR participation in low- and low-middle-income countries would allow for greater representation from a diversity of countries, regions, and burn care facilities.

Burn injuries in the older population and understanding the common causes to influence accident prevention

IntroductionThe over 65 years old are a fast growing population leading to a future increase in patients. Burn injuries can have a serious effect on a patient’s health, requiring longer hospital stays and affecting their mortality. The regional burns unit at Pinderfields General Hospital cares for all patients with burn injuries in the Yorkshire and Humber region in the United Kingdom. The aim of this study was to understand the common causes of burn injury in the elderly population and to provide scope on what actions need to be carried out to influence accident prevention in the future. MethodsIn this study, patients were aged 65 years or older and had to have been admitted for a minimum of one night to the regional burns unit at Yorkshire, England from January 2012. The data was collected from the International Burn Injury Database (iBID), which included a total number of 5091 patients. After the inclusion and exclusion criteria were applied there were a total number of 442 patients over 65 years old. The data was analysed using descriptive analysis. Results13.0% of all patients admitted with a burn injury were over 65 years old. In the over 65 years old, 31.2% of burn injuries were most common during the activity of food preparation. Out of all the burn injuries within food preparation 75.4% were due to a scald injury. Additionally, 42.3% of scald burns from food preparation were due to hot fluid spills from a kettle or saucepan, rising to 73.1% after including burns from cups of tea and coffee. 21.2% of scalds from food preparation were caused by cooking with hot oil. ConclusionsThe main cause of burn injuries in the elderly of Yorkshire and Humber was food preparation. The majority of the food preparation burn injuries were a scald burn due to the handling of hot fluids, either from a saucepan or a kettle. A prevention strategy aiming to make people aware of this finding can help reduce burn injuries in the over 65 years old age group.

Comparative Analysis of the Risk Factors among Survivors and Non-Survivors Burned Children

Background: Burn trauma in children results into high mortality and morbidity with lifelong consequences. Lack of health care facilities, equipped burn centers, illiteracy, poor infra structure and involvement of girls in cooking activities at early age are potentiating factors towards high mortality. Objectives: To determine key factors resulting into high mortality in children Study Design: Cross-sectional study Place and Duration of Study: Department of Paediatric Surgery Sahiwal Teaching Hospital &amp; Sahiwal Medical College Sahiwal from 1st May 2019 to 28th February 2022. Methodology: One hundred and eighty four patients upto the age of 12 years with more than 10% partial thickness burn and less than 10% full thickness burn and any percent electric burn were included. Age, sex, presence of inhalation injury, total burn area, development of wound infection, sepsis, mode of burn, surgical intervention and length of hospitalization were all used to predict mortality. Resuscitation was done according to ATLS guide lines on admission. Topical treatment and intravenous antibiotics were given. Fasciotomy was done wherever needed. Wound swab was taken culture sensitivity on 5th day. Results: Overall mortality was 18.47%. Eighteen (53%) of non-survivors were 3-7 years. Mortality was high in females (61.67%). With regards to cause of burn, flame burns remained at the top in survivors (48%) while scalds in non-survivors (61.76%). 50% of patients presented with partial thickness burn (75/150) in survivors while 50% (17/34) with mixed burns in non-survivors. Mean total body surface area burn was 14.9% in survivors and 40.6% in non-survivors. Non-survivors presented late as compared to survivors. Hospital stay for survivors ranged from 1-28 days while non-survivors stayed 3-18 days before death (Mean 5.9 and 7.4 days) respectively. Conclusion: Age less than 7 years, females, scald burn, delayed presentation, full thickness or mixed burns with burn surface area more than 40% are significant risk factors for high mortality in burned children. Keywords: Burn, Children, Mortality, Sepsis, Scald

Globularia arabica Methanolic Leaf Extract Has Higher Efficacy on Burn Wound Healing in Diabetic Rats Compared to Malva slyvestries Methanolic Leaf Extract.

This study aimed to see how effective Globularia arabica and Malva slyvestries-based cream formulations were at healing scald burn wounds in rats. Depending on ointment, preparations of 1%, 5%, and 10% w/w were created. For comparison, an ointment base and a regular burn cream composed soframycine were utilized. Rats introduced a burn by solidifying equipment at 100°C on a 14-mm2 shaved dorsal region. A deep second-degree burn was created, and the percentage of wound contraction was measured over the next 15 days. The rats were euthanized on days 8 and 15, and histological slides were prepared using hematoxylin and eosin staining. Compared to the control group, there was a substantial increase in wound contraction and a significant decrease in the duration of epithelialization in the based ointment-treated groups. However, as paralleled to Globularia arabica, significant (P < .05) results were observed with 10% Globularia arabica cream, whereas Malva slyverstries indicate minimal healing. Soframycine causes a substantial increase in wound contraction (P < .05). Soframycine cream with 10% Globularia arabica therapy resulted in practically complete re-epithelialization and re-structuring of wound tissue on histological examination, whereas Malva slyversries treatment resulted in low epithelization during treatment days. The findings suggest that Globularia arabica-based cream has the wound-healing capability.

Montelukast, an Antagonist of Cysteinyl Leukotriene Signaling, Impairs Burn Wound Healing.

Burns are severe injuries often associated with impaired wound healing. Impaired healing is caused by multiple factors, including dysregulated inflammatory responses at the wound site. Interestingly, montelukast, an antagonist for cysteinyl leukotrienes and U.S. Food and Drug Administration approved for treatment of asthma and allergy, was previously shown to enhance healing in excision wounds and to modulate local inflammation. In this study, the authors examined the effect of montelukast on wound healing in a mouse model of scald burn injury. Burn wound tissues isolated from montelukast- and vehicle-treated mice at various times after burn injury were analyzed for wound areas ( n = 34 to 36), reepithelialization ( n = 14), inflammation ( n = 8 to 9), and immune cell infiltration ( n = 3 to 6) and proliferation ( n = 7 to 8). In contrast to previously described beneficial effects in excision wounds, this study shows that montelukast delays burn wound healing by impairing the proliferation of keratinocytes and endothelial cells. This occurs largely independently of inflammatory responses at the wound site, suggesting that montelukast impairs specifically the proliferative phase of wound healing in burns. Wound healing rates in mice in which leukotrienes are not produced were not affected by montelukast. Montelukast delays wound healing mainly by reducing the proliferation of local cells after burn injury. Although additional and clinical studies are necessary, our study suggests that burn patients who are on montelukast may exhibit delayed healing, necessitating extra observation.

Acipimox Induces the Hepatic Accumulation of Long‐Chain Diacylglycerides and Triglycerides in Severely Burned Sprague Dawley Rats

ObjectivePersistent lipolysis is a hallmark of severe burns, contributing to futile triglyceride cycling and the accumulation of lipid in ectopic tissues. It has been suggested that the administration of acipimox, a potent inhibitor of lipolysis, may blunt the hypermetabolic response to burns. However, what impact massive burns has on the accumulation of individual lipid species in the liver and how this is affected by acipimox treatment is unknown.HypothesisWe hypothesize that large burns results in the accumulation of lipotoxic species within the liver and that this can be prevented by administering acipimox.MethodsThirty‐two male Sprague Dawley rats were randomized to receive either a scald burn (~60% total body surface area) or sham procedure, performed under isoflurane general anesthesia. Afterwards, animals were further randomized to receive either acipimox (50 mg/kg/day) or vehicle (saline) by i.p. injection administered once a day for 7 days. On day 7, animals were euthanized and the liver snap frozen in liquid nitrogen. Liver lipids were extracted by using a chloroform:methanol (2:1) solution and diacylglycerol (DAG), triacylglycerol (TAG), free fatty acids (FFA) and cholesterol esters (CE) separated by thin‐layer chromatography. Afterwards, individual lipid classes were esterified to methyl esters, derivatized using heptane, and analyzed by gas chromatography (GC). The fatty acids C16:0, C18:0, cis/trans C18:1, cis 18:2, C20:0, C22:0, C24:0, and C22:6 were resolved by GC for each of the lipid classes examined.ResultsLiver weights were comparable between groups. Burn injury had no significant effect on the concentration of liver lipids compared to sham treated animals, irrespective of lipid class (P &gt; 0.05). In contrast, the administration of acipimox significantly increased liver C16:0 (2.1‐fold; P &lt; 0.05), trans C18:1 (2.5‐fold; P &lt; 0.05), and cis C18:2 (5.5‐fold; P &lt; 0.05) TAG content in burned animals, when compared to injured animals treated with vehicle. No effect of acipimox on liver lipids was observed in sham treated animals.ConclusionContrary to expectations, acipimox causes the accumulation of long‐chain TAGs in rat liver following massive burns, but this is not observed in response to burn injury alone. The ability of acipimox to cause unwanted hepatic metabolic side effects warrants further investigation before it is used clinically to treat massive burns.

The Effect of Lipolysis Inhibitor Acipimox on Brown Adipose Tissue Bioenergetics and Uncoupling Protein Abundance in Severely Burned Rats

IntroductionUncoupling protein 1 (UCP1) activation in brown adipose tissue (BAT) contributes to the hypermetabolic stress response to burn trauma. Strategies that target BAT UCP1 could be beneficial in controlling burn‐induced hypermetabolism. Acipimox, an inhibitor of adipose tissue lipolysis, has been shown to be effective at blunting burn‐induced lipolysis and expression of UCP1 protein in rodent white adipose tissue. The impact of acipimox on BAT bioenergetics and uncoupling protein abundance is currently unknown. We hypothesized that acipimox would blunt burn‐induced UCP‐1 dependent respiration and UCP‐1 protein levels in BAT.MethodsSixty‐four male Sprague‐Dawley rats received a 60% TBSA scald burn (n=32) or sham procedure (n=32) and were subsequently randomized to receive either acipimox (n=16/group; 50 mg/kg/day i.p.) or vehicle (n=16/group) daily for 7d. BAT was harvested from the interscapular fat pad on day 7 after burn and mitochondrial respiratory function assessed by high‐resolution respirometry. GDP‐sensitive respiration was assayed as a direct measure of UCP1 function. UCP1 and adenine nucleotide translocator (ANT2) protein levels were determined by western blot.ResultsUCP1‐dependent and UCP1‐independent uncoupled respiration in BAT was reduced at 7d after severe burn, independent of treatment (injury effect, P&lt;0.01). Post‐burn, UCP1‐dependent respiration accounted for 65% of total uncoupled respiration compared to 59% in sham rats (injury effect, P&lt;0.05), independent of treatment. Acipimox appeared to exert a lowering effect on UCP1‐dependent respiration (treatment effect, P=0.07) but not on UCP1‐independent respiration. Neither burn nor treatment with acipimox had a significant effect on UCP1 protein levels. Protein levels of ANT2, a carrier protein involved in fatty acid‐induced uncoupling, were greater in response to acipimox (treatment effect, P&lt;0.05).ConclusionBAT UCP1 function than UCP1 protein content is greater in severely burned rats. Acipimox appears to reduce UCP1‐dependent respiration, independent of UCP1 protein levels. The effect of acipimox on BAT ANT2 protein content may partly explain the absence of an effect on UCP1‐independent respiration, but this warrants further investigation.The protocol was approved by the University of Texas Medical Branch IACUC.

Use of the Lipolysis Inhibitor Acipimox Fails to Modulate Chronic Muscle Protein Synthesis Rates or Attenuate the Loss of Muscle Mass in a Rodent Model of Severe Burns

ObjectiveMassive burns result in chronic lipolysis of adipose stores resulting in ectopic lipid accumulation. Given reports that hyperlipidemia and/or increased intramyocellular lipid accumulation is associated with impaired synthesis of muscle proteins, we hypothesized that administering the lipolysis inhibitor acipimox could protect muscle protein synthesis capacity in a rodent model of burns, thereby blunting the loss of muscle mass.MethodsSprague Dawley rats (4 groups, 16 animals per group, n = 64) were randomized to receive a scald burn (~ 60 % total body surface area; n=32) or sham procedure. Animals in each group were assigned to receive either vehicle (saline) or acipimox (50 mg/kg/day) daily by i.p. injection for 7 days. All animals received a bolus of deuterated water (10 ml/kg, i.p.) followed by supplementation in drinking water (2 %) to monitor habitual muscle protein synthesis rates (MPS). On day 7, animals were sacrificed, and tissues collected. MPS was calculated by measuring intracellular and bound deuterium enrichment of alanine via Gas Chromatography Isotope Ratio Mass Spectrometry.ResultsSevere burns resulted in significant body weight loss compared to the sham injury group (7 % vs 10 %; p &lt; 0.001). However, acipimox administration did not prevent the loss of body weight. There was a trend for gastrocnemius and tibialis anterior muscle weights to be lower in burn animals (P = 0.058 and P=0.057, respectively). However, acipimox did not prevent the loss of muscle weight with burn injury. Neither burn injury nor acipimox administration impacted habitual MPS rates.ConclusionIn sharp contrast to what is observed in patients, severe burns do not alter habitual MPS rates in rats. Given evidence that rats still experience a loss of muscle mass in response to thermal injury, it suggests that the dominant mechanism by which muscle protein content declines in these animals is via enhanced muscle proteolysis. Acipimox appears to exert no beneficial impact on muscle protein homeostasis in burn injured rodents.