Burns : journal of the International Society for Burn Injuries
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Observational Study
Paediatric burn unit in Portugal: Beds needed using a bed-day approach.
Despite the high burden of children with burns, there is not a paediatric burn unit (PBU) in Portugal. We aimed to estimate the Portuguese health care providing needs on paediatric burns. ⋯ Using a groundbreaking approach, the optimal number of PBU beds needed in Portugal is 13. However, as half of the patients who met burn transfer criteria are not transferred, this bed number might be overestimated if this pattern maintains, despite the underestimation with our method approach. If a PBU is to be created the preferable location is Porto. Cost-effectiveness studies should be performed.
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Randomized Controlled Trial
Controlling intraoperative hemorrhage during burn surgery: A prospective, randomized trial comparing NuStat(®) hemostatic dressing to the historic standard of care.
One of the primary intraoperative challenges during burn surgery is to adequately excise the burn while avoiding massive hemorrhage. This has become increasingly important, as we see more burn patients that are older and with more medical comorbidities. While adequate excision down to healthy tissues for deep burns is essential for skin graft to take, it also leads to active bleeding that can be a challenge to control. Good hemostasis is imperative as a hematoma is the most common cause of graft loss. Several new products have become available to help control intraoperative hemorrhage. A new hemostatic dressing, NuStat(®), is available and approved by FDA in United States. ⋯ Based on these findings, NuStat(®) hemostatic action should be comparable to the historic standard of care, and these newer hemostatic agents evaluated further in burn surgery and bleeding during other procedures such as trauma surgery.
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There is a growing volume of data that indicates that serious injury suppresses immune function, predisposing individuals to infectious complications. With recent evidence showing long-term immune dysfunction after less severe burn, this study aimed to investigate post-burn infectious disease morbidity and assess if burn patients have increased long-term hospital use for infectious diseases. ⋯ These findings suggest that burn has long-lasting effects on the immune system and its function. The increase in infectious disease in three different epithelial tissues in the burn cohort suggests there may be common underlying pathophysiology. Further research to understand the underlying mechanisms are required to inform clinical interventions to mitigate infectious disease after burn and improve patient outcomes.
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The NLRP3 inflammasome is a multi-protein complex that assembles in response to tissue damage or infection, triggering activation of caspase-1, an enzyme that converts interleukin (IL)-1β into its active form. A role for the NLRP3 inflammasome is emerging in inflammatory pain, but its influence in other pain types is largely unexamined. Therefore the aim of this study was to assess the role of the NLRP3 inflammasome and its downstream product caspase-1 in a model of acute burn-induced pain in male mice. ⋯ Burn-induced edema was significantly reduced in Ice-/- mice only. Burn-induced weight bearing changes were attenuated in Nlrp3-/- mice and mice administered MCC950 72h after burn only. This study suggests that NLRP3 and its downstream product caspase-1 have a limited role in the development of burn-induced pain.
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Burns have been more prevalent among low socioeconomic populations and in less developed regions. Incredible advances in burn care and social development over the recent decades, however, should have placed the incidence and severity of burns in a downwards trend. The aim of this review was to give an overview on current trends in burn epidemiology across the world. ⋯ Comparisons between the different studies were compromised by the fact that studies emerged from specialized facilities on one hand and general hospitals on the other. Analyzed studies were also frequently focusing on limited patient populations such as "children" or "elderly". Our findings indicate the need for an international burn database with a minimal data-set in order to obtain objective and comparable results in respect of burn epidemiology.