Burns : journal of the International Society for Burn Injuries
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This systematic review investigated the effectiveness and safety of intensive insulin therapy (IIT), insulin secretagogues and sensitisers in burn patients. PubMed, Embase, clinicaltrials.gov and Cochrane central were searched from 1990 to 2016. Title/abstract screening, full-text review, critical appraisal and data extraction were carried out by two independent reviewers. ⋯ Meta-analyses could not be performed for sensitisers or secretagogues. These findings support recommendations that moderate insulin administration (130-150mg/dL) is the prudent approach in burn patients. The evidence is relatively sparse and further research is warranted.
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Randomized Controlled Trial
The efficacy of excision followed by intralesional 5-fluorouracil and triamcinolone acetonide versus excision followed by radiotherapy in the treatment of ear keloids: A randomized control trial.
The ear is the common site for keloid formation especially in women after ear piercing. Surgery is the main stay of treatment in these lesions but there are large numbers of treatment failures in surgery alone. ⋯ Excision and intralesional 5-FU/TAC is an effective treatment for keloids on the ears.
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Burn injuries commonly occur in vulnerable age and social groups. Previous research has shown that frailty may represent a more important marker of adverse outcome in healthcare rather than chronological age (Roberts et al., 2012). In this paper we determined the relationship between burn injury, frailty, co-morbidities and long-term survival. ⋯ Based on the data from our unit, sustaining a burn as an elderly person does not reduce life expectancy. Medical and surgical complications, immediate, early and late, although higher with greater frailty and TBSA of burn, but do not adversely affect survival in this population.
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Comparative Study
Burn wounds in the young versus the aged patient display differential immunological responses.
Individuals in the geriatric age range are more prone than younger individuals to convert their partial thickness thermal burns into full thickness injuries. We hypothesized that this often observed clinical phenomenon is strongly related to differential local injury responses mediated by the immune system. ⋯ Our study has identified at least 2 well known cytokines, CCL5 (RANTES) and EGF, which are differentially regulated in response to burn injury by young versus aged burn victims. Evidence suggests that a proinflammatory environment can explain the high conversion rate from partial to full thickness burns. Our data suggest the need for future studies at the point of injury (cutaneous targets) that may be modulated by post burn release of cytokines/chemokines.
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Large burns excision and graft can produce major blood loss. The main objective of this study is to evaluate the blood loss in relation with the excision size in square centimeters (cm2) in adults. ⋯ The results that were obtained, i.e. approximately 0.8ml/cm2 of excised and grafted skin, are similar to those of other published studies, which concerned specific populations such as pediatrics. Determining blood loss in one centre can help physicians to calculate the excisable area without any transfusion. However, blood loss can vary widely between patients and one must consider individual clinical situation to provide safe surgery.