Burns : journal of the International Society for Burn Injuries
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Review Meta Analysis
A meta-analysis of analgesic and sedative effects of dexmedetomidine in burn patients.
Sedation for burn patients is provided by a variety of techniques determined usually by institutional preferences. The available pool of drugs has recently expanded to include dexmedetomidine (DEX), a α2-adrenergic receptor agonist with analgesic and sedative potential. Beneficial effects of DEX in burn patients have been described in many studies published over the last 5 years. ⋯ Even though there were only a small number of clinical trials available, the meta-analysis shows evidence for deeper and better sedation as well as for prevention of hypertension when using DEX as an adjunct during burn procedures. No evidence was found for reduced pain scores in this setting. The authors recommend the development of a prospective, randomized, controlled multicenter trial with an adequate number of patients to further elucidate the potentially beneficial effects of DEX for the management of burn patients.
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Major burn is often associated with inflammation and coagulation system activation, consumption of endogenous coagulation factors, which have been associated with adverse clinical outcome. Coagulation system dysfunction during early postburn period is characterized by activation of procoagulation pathways, enhanced fibrinolytic activity and impairment of natural anticoagulants activity. ⋯ Modern treatment strategies using antithrombin, protein C and recombinant factor VIIa are based on early and continuous assessment of the bleeding and coagulation status of burn patients. This allows specific goal directed treatment, thereby optimizing the patient's coagulation status early, minimizing the patient's exposure to blood products, reducing costs and improving the patient's outcome.
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The positive effect of supportive family environment on burn-injured child's long term outcome is well established. How parents provide this support as they recover with their children is not addressed especially in low and middle income countries where the burn burden is high. It is assumed that parents are non-compliant in bringing their children for follow up. ⋯ Mothers and fathers formed a team and did their best for their burn-injured children. Assessing and meeting the needs of the parents and empowering parents to provide effective long term care are vital components of burn care. The health professionals' perceptive on parenting burn-injured children need to be explored.
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In order to implement effective burn prevention strategies, the WHO has called for improved data collection to better characterize burn injuries in low and middle income countries (LMIC). This study was designed to gather information on burn injury in Kenya and to test a model for such data collection. ⋯ Burn injuries in Kenya show similarities with other LMIC in etiology and pediatric predominance. Late presentation for care and prolonged LOS are areas for further investigation. The web-based database is an effective tool for data collection and international collaboration.
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Randomized Controlled Trial
Gene expression profiling of negative-pressure-treated skin graft donor site wounds.
Negative-pressure wound therapy (NPWT) is widely used to improve skin wound healing. Although NPWT has been studied as a treatment for wound closure and healing, the molecular mechanisms explaining its therapeutic effects remain unclear. To investigate the effect of NPWT on gene expression, and to discover the genes most dominantly responding to this treatment during skin wound healing, we applied negative pressure on split-thickness skin graft donor sites from the first postoperative day (POD) to the seventh POD. ⋯ The genes most induced were associated with cell proliferation and inflammation, and the most down-regulated genes were linked to epidermal differentiation. Our results provide the first insight into the molecular mechanisms behind NPWT, and suggest that NPWT enhances specific inflammatory gene expression at the acute phase associated with epithelial migration and wound healing. However, its continued use may inhibit epithelial differentiation.