Journal of burn care & research : official publication of the American Burn Association
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Acute kidney injury (AKI) is a common and morbid complication in patients with severe burn. The reported incidence of AKI and mortality in this population varies widely due to inconsistent and changing definitions. They aimed to examine the incidence, severity, and hospital mortality of patients with AKI after burn using consensus criteria. ⋯ Presence of and increasing severity of AKI are associated with increased hospital mortality. AKI appears to be independently and strongly associated with mortality in patients with TBSA ≤ 40%. Further investigation to develop risk-stratification tools tailoring this susceptible population is direly needed.
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Observational Study
Evaluation of Procalcitonin Accuracy for the Distinction Between Gram-Negative and Gram-Positive Bacterial Sepsis in Burn Patients.
Sepsis is the main cause of death in burns. Early institution of antimicrobial therapy is crucial to optimize outcomes but superfluous therapy increases adverse events, microbial resistance, and costs. Blood cultures are the gold standard for diagnosis but can take 48 to 72 hours. ⋯ Most elevated levels were related to nonfermentative Gram-negative bacteria and by Klebsiella pneumoniae and other Enterobacteriaceae. PCT levels were significantly higher in burn patients with Gram-negative sepsis comparing to patients with Gram-positive sepsis and controls. The determination of PCT levels may help the choice of empirical antimicrobial therapy while microbiological culture results are not available, despite not fully ensuring the desirable degree of precision.
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Amputations following a burn injury, although infrequent, may affect community reintegration and create a barrier to returning to work. The objective of this study was to compare patient and injury characteristics, quality of life, and employment status for those with and without amputation using a national longitudinal database of people with burn injuries. In this retrospective review of prospectively collected data, group differences were examined using descriptive statistics. ⋯ Amputation was a statistically significant predictor of SF-12 scores at 6 months for both PCS (β = .10, P = .003) and MCS (β = -.07, P = .04) scores. Amputations are relatively rare following burn injury and are more often associated with electrical and contact injuries. Whereas, people with amputations were less likely to be employed at 12 months postburn, those who were employed before the injury were more likely to return to work regardless of amputation status.
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Over the years, many cultures have used herbs for serious health problems. Garlic (Allium sativum) pose hypocholesterolemic, fibrinolytic, antidiabetic, and antibiotic actions. However, it has unusual adverse effects such as chemical burns and contact dermatitis when used topically. In this case report, the authors present two cases of topical garlic burn caused after the use of crushed garlic with a bandage for pain relief due to arthritis.
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Hypertrophic scar (HTS) occurs frequently after burn injury. Treatments for some aspects of scar morbidity exist, however, dyspigmentation treatments are lacking due to limited knowledge about why scars display dyschromic phenotypes. Full thickness wounds were created on duroc pigs that healed to form dyschromic HTS. ⋯ MiTF expression was not different upon further exploration, but TYR, TYRP1, and DCT were upregulated in intact biopsies measured by qRT-PCR and confirmed by immunostaining. This is the first work to confirm the presence of melanocytes in hypopigmented scar using qRT-PCR and primary cell culture. An understanding of the initial steps in dyspigmentation signaling, as well as the downstream effects of these signals, will inform treatment options for patients with scars and provide insight to where pharmacotherapy may be directed.