Journal of burn care & research : official publication of the American Burn Association
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Deep partial-thickness burns exhibit ambiguous behavior, either spontaneously healing or evolving into full-thickness burns. The aim of this study was to investigate these lesions for the presence of apoptotic cells and to compare their rate with that of superficial and full-thickness burns. We used colocalization of DNA fragments (ie, terminal deoxynucleotidyl transferase Biotin-dUTP nick end labeling) and Fas ligand CD95 antibodies to calculate the apoptotic rate of superficial, deep partial-thickness and full-thickness burns in 45 patients after the thermal injury. ⋯ A significant greater apoptotic rate was present in cells of deep partial-thickness burns when compared with superficial and full thickness. These data would suggest that deep burns sustain an ischemic damage that forces cells to undergo apoptosis and could represent the biologic basis for their clinical evolution into full-thickness burns. Further correlation studies are now required to confirm this hypothesis.
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Randomized Controlled Trial
Effect of a fish oil and arginine-fortified diet in thermally injured patients.
Burn injury induces a hypercatabolic inflammatory state, predisposing burn patients to malnutrition, poor wound healing, and infectious complications. We conducted this study to determine what effect a diet fortified with fish oil and arginine (FAD) would have on wound healing in a thermally injured population. Twenty-three thermally injured patients were enrolled in this randomized double blind enteral feeding study from July 2002 to August 2004. ⋯ The role of fortified enteral diets in the outcomes of thermally injured patients deserves further study. Such a future study should be conducted in a multicenter trial and involve inhalation injury stratification systems to accurately score and randomize patients for inhalation injury. Finally, the frequency and pattern of infections in patients receiving fortified enteral diets deserves further evaluation.
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Contemporary planning for disaster response to terrorist events usually assumes the use of chemical, radiological, or biological weapons. Historically, most victims of terrorist attacks are injured by the use of conventional explosives rather than weapons of mass destruction. Such attacks will likely produce victims who have suffered burn injuries along with conventional trauma. ⋯ A review of pertinent medical, technical, and popular literature relating to terrorism and explosives, along with instruction received at Hadassah Hospital, Jerusalem, Israel on the management of mass casualty terrorism events was undertaken, and the pertinent medical and scientific literature relating to bomb delivery methods, blast mechanics, blast pathophysiology, and medical response to a terrorist bombing is presented here. Although terrorist use of chemical, radiological, or biological weapons is possible, historical analysis consistently demonstrates that the most likely terrorist weapon causing a mass casualty event is a standard explosive device detonated in a crowded area. The medical basis for management of such casualties is herein described.
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We sought to identify whether patterns exist in the Burn Injury Rehabilitation Model Systems' database among participants lost to follow-up at 6, 12, or 24 months after injury and to define characteristics that reliably discriminate between persons who are lost to follow-up and those who are not. All participants met the American Burn Association criteria for major burn injury, were 18 years of age or older, received care from one of four burn model systems, and consented to participate in a 2-year prospective data-collection process. Step-wise logistic regression was used to develop three prediction models for the probability of loss to follow-up. ⋯ Successful follow-up at 6- and 12-month intervals increased the likelihood of achieving a follow-up at 24 months after injury. The sociodemographic risk factors for attrition identified in this study represent significant enduring vulnerabilities. The findings necessitate a close examination of several factors and the use of strategies to reduce the risk of attrition.
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Emotional distress as well as psychosocial resources in 55 patients with burn injuries was assessed during acute and follow-up treatment. Results showed significantly greater values of emotional distress among patients when compared with norms of the general population. As well as higher levels of general psychopathology, particularly prevalent were anxiety, depression, and posttraumatic symptoms. ⋯ Reactions to burn accidents vary individually. The results demonstrate the importance of routine screenings of psychological symptoms. An early identification of patients at-risk allows for tailored psychotherapeutic interventions and can thus help to improve quality of life and general well-being of burn patients on a long-term basis.