Burns : journal of the International Society for Burn Injuries
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Paediatric burns are a significant international public health problem. Developing and developed countries report similar challenges regarding paediatric burn prevention programs. Paediatric burns requiring healthcare often incur significant health and opportunity costs, death or long-term disability. This paper reviews international burn prevention strategies, and considers implementation of effective prevention strategies in South Africa. REVIEW QUESTION: Are there differences between developed and developing countries regarding causes and prevalence of paediatric burns, prevention strategies, and evidence of effectiveness? REVIEW FRAMEWORK: Implementing effective burn prevention strategies in South Africa. ⋯ More work is required to establish effective, sustainable community-wide prevention programs in developed and developing countries. Effective paediatric burn prevention programs for South Africa should acknowledge parent and child literacy, how and where information is best accessed, the need to adapt effective hazard reduction programs to informal settlements, and the importance of legislated minimum safe housing standards. This requires significant commitment from Government, communities and individuals.
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Controlled Clinical Trial
Thiamine supplementation increases serum thiamine and reduces pyruvate and lactate levels in burn patients.
The importance of vitamins for optimal metabolism is well established. However, currently little is known about the optimal vitamin levels required for burn patients. As a consequence, current practice both for macronutrient supplementation and vitamin supplementation varies widely between burn units. ⋯ Lastly, pyruvate and lactate levels appear closely associated in a linear relationship. This study suggests thiamine supplementation increases serum thiamine and that this increase is associated with a decrease in pyruvate and lactate levels. Further study of changes in metabolic flux associated with thiamine supplementation and a randomised control trial of thiamine supplementation are required to establish whether thiamine supplementation is beneficial to burn patients' metabolism and recovery.
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Inhalation injury is a major cause of morbidity and mortality in thermally injured patients but is difficult to quantify. A number of parameters can be useful evaluating inhalation injury including bronchoscopy, PaO(2)/FiO(2) (P/F) ratio, and carboxyhaemaglobin (COHb) levels. Identification of markers that permit early detection of the degree of damage caused by inhalation injury is important to predict patient survival. ⋯ Logistic regression indicated that the combination of TBSA, age and P/F ratio was highly predictive of mortality following major burns. This study supports the predictive nature of the P/F ratio in relation to survival in adults. Larger prospective studies using bronchoscopic findings and P/F ratio would give us a better indication as to the value of a scoring system in adults that are admitted with inhalation injuries.
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There are valid concerns that burn shock resuscitation is inadequate; a tendency to over-resuscitate the patient seems to exist which may increase complications such as compartment syndrome. The purpose of this study was to survey members of the ISBI and ABA to determine current practices of burn resuscitation. ⋯ Large variations exist in resuscitation protocols but the Parkland formula using LR is still the dominant method. Most feel that their resuscitation protocol works well.
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Partial-thickness burns incite a multitude of responses which eventually culminate in cutaneous wound repair. We hypothesized that these events would evoke extensive alterations in gene expression thereby orchestrating the complexity of spatial and temporal events that characterize "normal" human wound healing. In the present study, gene expression from partial-thickness areas at defined temporal periods (1-3 days, 4-6 days, and 7-18 days) after injury were compared to normal non-wounded skin. ⋯ Our foundational data (based on samples from 45 individuals) provide a comprehensive molecular gene expression portrait of the cutaneous reparative responses that are initiated during the first 17 days after injury. Our efforts also represent an initial endeavor to move beyond the historically defined "morphological phases" of wound repair toward reporting molecular clues that define the temporal sequence of healing in human subjects. Further analysis of genes that are either affected or remain not affected following injury to normal skin is expected to identify potential targets for therapeutic augmentation or silencing.