Search

Self-inflicted burns (SIBs) represent a distinct entity in burn care often associated with an underlying psychiatric etiology. In this review, we summarize the existing evidence on SIBs in North America to inform targeted prevention and interventions for patients afflicted with SIBs. The following databases were queried to identify relevant articles used for literature review: PubMed, Embase, and Scopus. The main outcome measures were burn characteristics and risk factors of SIBs in the American population. A total of 14,189 patients were included across 13 included studies. The percent of total body surface area burned ranged from less than 1% to 100%, with a mean of 29.6% ± 20.7%. Depressive disorders were the most reported overall; however, among mood disorders, bipolar disorder was also reported frequently, while anxiety was reported least. Motives for self-inflicting burn injury included premeditated self-injury as a coping mechanism, escape or response to delusions, impulsive self-injury, and most commonly, suicidal intention. The majority of the studies reported that preadmission drug and alcohol abuse were associated with the occurrence of SIBs. Other identified risk factors for SIB injury included female sex, younger age, unemployment, and unmarried status. From this, it is imperative that targeted interventions are developed to address the complex interplay of psychiatric disorders, drug use, and other demographic risk factors among the American population. It is crucial for initiatives to emphasize early identification of individuals at risk of self-harm, better access to mental health services, and stronger drug abuse programs to target SIB occurrence in the United States., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

The percent total body surface area (TBSA) burned is a critical determinant of the required level of care, initial management, and prognosis in patients with burns. The current gold standard for estimating this measurement, the Lund-Browder (LB) chart, requires familiarity with its construction and may not be practical for use by first responders in the field. In this study, we present a novel burn surface area calculator mobile application developed for first responders and validate its accuracy. Infant, pediatric, and adult manikins were fabricated with 8 simulated burns of varying sizes and distributions. In total, 42 preclinical medical students and firefighters were tasked with estimating the TBSA of each burn using both the FireSync EMS app and LB chart. Univariate analysis and mixed-effects linear regression modeling were performed to compare the accuracy of both methods in relation to user experience, manikin size, and burn size. FireSync EMS significantly reduced overestimation bias (0.11%, SD 2.33 vs 0.91%, SD 4.12, P = .002), particularly for burns on child-size manikins (P < .001) and burns involving <10% (P = .005) and >20% (P = .030) TBSA. Multivariable modeling revealed that the LB chart was an independent determinant of the magnitude of estimation error, with a 1.19 times multiplicative effect relative to FireSync EMS (P < .001). The participants overwhelmingly found FireSync EMS easier, more intuitive, faster, and preferable (P < .001 for all). FireSync EMS may be an easier, faster, and more accurate alternative to the LB chart for estimation of the TBSA burned., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Timely admission to the burn unit is crucial. Ideal burn care requires prompt interventions such as wound and body temperature management, infection control, and fluid resuscitation to prevent complications like burn progression and infection. In this study, we identify specific factors and outcomes associated with delayed admission to a regional burn center., Methods: Patients admitted to a large urban burn center from January 2015 to December 2023 were retrospectively queried, with subsequent collection of demographic and outcome variables from chart review. Descriptive statistics, Welch's t-tests of unequal variances, and Chi-square analysis were performed. Multiple logistic regression was performed to explore the association between delayed admission and ICU stay, ventilator requirements, and mortality., Results: A total of 3137 patients were included in the study. Approximately 63.4 % of patients were admitted within 24 h, while 36.6 % had a significant delay in care of over 24 h after injury. Male patients were likely to experience delayed admission (39.0 vs. 31.8 %, p < 0.001). There was no significant difference in age between the two cohorts (38.6 vs. 39.7 years, p = 0.199). There was no significant difference in time to admission by racial background (p = 0.061). Total body surface area burned (TBSA) varied between the delayed and control cohorts (15.5±18.7 % vs. 8.2±12.9 %, p < 0.001). Patients who were single (p < 0.001) and lived alone (p = 0.011) were more likely to experience a delay in burn unit admission. Homelessness (p < 0.001), substance abuse disorder (p < 0.001), and uninsured status (p < 0.001) were also associated with delayed admission. In regression analysis when controlling for TBSA, delay in care was significantly associated with a greater requirement for ICU stay (p < 0.001) and mechanical ventilation (p = 0.021) but was not associated with increased mortality (p = 0.232)., Conclusion: Sociodemographic variables such as homelessness, lack of social support, and substance abuse are associated with delayed burn unit admission. Knowledge of these factors can inform future interventions to improve outcomes for vulnerable patients, promoting better recovery and long-term outcomes after burn injury., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Social media offers a readily available, cost-effective way for medical experts to disseminate knowledge and shape public health outcomes but also allows for the spread of misinformation. This study aims to analyze burn-related material on social media by creator, content type, and engagement. Facebook, TikTok, and X (formerly Twitter) were queried with the following search terms: "burn," "burn injury," "burn recovery," and "burn treatment." Identified accounts were then manually screened for relevance. Year of creation and engagement metrics were collected. Accounts were categorized by content and creator type. Data were reported using descriptive statistics and visualized graphically to explore trends. Our search yielded 434 profiles, 234 of which met the inclusion criteria. TikTok had the most engagement at a median of 43,500 followers per account, with 38.3% of accounts focusing on individual experiences of burn survivors primarily on personal accounts (48.3%). In contrast, content on Facebook was related to the promotion of medical services (36.9%), whereas the most represented creator type was medical centers (33.6%). Nonprofits made up 40.4% of accounts on Twitter/X and more than a third of the content focused on patient advocacy, support, or burn prevention (36.5%). Important topics like burn education, prevention, and social support are lacking on major social media platforms. Engagement from burn care organizations and burn experts on social media is necessary. The findings of this study may guide advocates in the burn community on where and how to disseminate information on social media., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Despite the growing incidence of burn injuries globally and the advancements in physical recovery, the psychological aspect of burn trauma recovery remains inadequately addressed. This review aims to consolidate existing literature on posttraumatic stress disorder (PTSD) and depression in adult burn survivors, recognizing the need for a holistic approach to burn recovery that encompasses both physical and mental health. The comprehensive analysis of 156 studies revealed significant variations in methodological approaches, leading to challenges in creating standardized protocols for mental health assessment in burn care. Key findings include the identification of a wide range of psychological assessment tools and a substantial research gap in low- and middle-income countries, where the majority of burn injuries occur. Only 7.0% of the studies assessed interventions for PTSD or depression, indicating a lack of focus on treatment modalities. The studies identified demographic factors, patient history, psychosocial factors, burn injury characteristics, and treatment course as risk factors for PTSD and depression postburn injury. The review highlights the need for early screening, intervention, and attention to subjective experiences related to burn injury, as these are strong predictors of long-term psychological distress. It also emphasizes the complexity of addressing psychological distress in burn survivors and the need for more standardized practices in assessing PTSD and depression specific to this population., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Glucagon-like peptide-1 (GLP-1) agonists mimic the action of GLP-1, a hormone that regulates blood glucose levels via stimulation of insulin release and inhibition of glucagon secretion. After burn, the current literature suggests that the use of GLP-1 agonists results in less insulin dependence with similar glucose control and hypoglycemic events to patients receiving a basal-bolus insulin regimen. GLP-1 agonists may also promote wound healing through various mechanisms including angiogenesis and improved keratinocyte migration. Despite the potential benefits, GLP-1 agonists reduce gastrointestinal motility which impacts their widespread adoption in burn care. This dysmotility can result in inadequate nutrition delivery, unintentional weight loss, and is a potential aspiration risk. The net impact of these medications on burn patients is unclear. Given their potential to demonstrate the safety, efficacy, and optimal dosing of various GLP-1 agonists in acute burn management., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

While patient education materials (PEMs) across various specialties have been reported as being too difficult to read, the quality and understandability of PEMs related to scar management have not been assessed. In this study, we report the breadth of scar management interventions and readability of online PEMs authored by academic societies and university hospitals. Websites of academic medical societies and university hospitals with scar revision PEMs were assessed for relevance. PEM readability was assessed via Flesch Reading Ease, Flesch-Kincaid Grade Level, and Gunning-Fox Index scores. Understandability and actionability were evaluated using the Patient Education Material Assessment Tool (PEMAT). A total of 26 scar revision PEMs met the inclusion criteria. The most commonly mentioned scar management interventions were scar revision surgery (73%) and laser scar revision (70%), with minimal emphasis on noninvasive methods like scar massage or sun protection. Readability analysis yielded a mean Flesch reading level of 8.8. Overall, PEMAT understandability of online scar treatment PEMs was moderate, with a median of 76.0% (IQR 71.5%-80.5%). PEMs from all specialties and institution types were lacking in actionability, with median actionability of 40.8% (IQR 38.1%-60.0%). Online scar revision PEMs included a wide breadth of scar management interventions; however, the least costly interventions, such as sun protection and scar massage, were not commonly included. PEMs for scar management could be improved by simplifying language, including visual aids, and including checklists or specific steps, patients can take to take action on scar management interventions., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

There is no consensus on the optimal management of diabetic foot burn injuries. Here, we systematically identify studies reporting on diabetic foot burns and evaluate outcomes among patients managed operatively vs nonoperatively. PubMed, Embase, and Web of Science were searched. Screening was performed by independent reviewers. Primary research studies with English full texts published between 1980 and 2023 that discussed outcomes of foot burns in adults with diabetes were included and critically appraised using validated tools. Results are presented using descriptive statistics of aggregated data. The search yielded 2402 nonduplicate papers, of which 35 met the inclusion criteria. Nine papers were included for meta-analysis, including 7 retrospective comparative analyses, 1 cross-sectional study, and 1 retrospective chart review. There were 1798 diabetic foot burn patients. The mean age was 58.2 years (SD 4.12), and 73.1% (n = 1314) were male. A total of 15.7% (n = 283) of patients were surgically managed, including debridement (3.7%, n = 66), grafting (8.2%, n = 147), flap (0.2%, n = 3), and primary amputation (7.1%, n = 127). The secondary amputation rate, defined as amputation following initial surgery, was 4.9% (n = 14). The overall amputation rate was 7.8% (n = 141). Other complications included infection (4.0%, n = 72), osteomyelitis (1.9%, n = 34), and graft failure (8.2%, n = 12). One study reported functional status at the last visit. Diabetic foot burns are highly morbid. The surgical management of these complex injuries is high risk, as amputation results in poorer quality of life and functional outcomes., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Online patient education materials (PEMs) on lymphedema surgery were assessed for quality, readability, and content. A total of 37 PEMs were identified, primarily authored by academic/medical organizations. Readability scores indicated materials were difficult to read, with an average Flesch-Kincaid Grade Level of 10.4. PEM Assessment Tools showed acceptable understandability (72.3%) but poor actionability (28.5%). PEMs often lacked information on surgical risks, postoperative care, and long-term follow-up. Simplifying language and adding visual aids could improve PEM effectiveness., (© 2024 Wiley Periodicals LLC.)

Despite the growing recognition of self-harm as a pressing public health issue, demographic risk factors of self-inflicted burn (SIB) injuries in the U.S. have not been extensively described. In this retrospective study, we seek to identify demographic risk factors and patterns associated with SIB injuries at an urban burn center. Charts were reviewed of patients admitted to a single American Burn Association (ABA)-verified burn unit between 2015 and 2023 with a history of SIB injury, identified with ICD10 code X76.XXXA. Descriptive statistics, Welch's t-test of unequal variances, and Chi-Squared-analysis were performed. A total of 3,212 patients were admitted to our institution for management of acute burn injury, with 94 (2.9%) patients who presented with SIB injury. SIB patients were more likely than the control cohort to be male (p = 0.035), single (p=0.008), unhoused (p < 0.001), live alone (p < 0.001), and have documented psychiatric diagnoses (72.3% vs. 2.1%, p < 0.001). They had larger %TBSA affected (p < 0.001) and higher rates of inhalation injury (p < 0.001). The SIB cohort also showed significantly higher rates of positive urine toxicology results, primarily for stimulants and opiates (p < 0.001). Patients with SIBs had longer hospital stays (21.7 ± 2.6 days vs. 12.0 ± 22.1 days, p = 0.006), higher rates of ICU admission (p < 0.001), and mechanical ventilation requirement (p < 0.001). Mental health support services, substance abuse rehabilitation programs, and community outreach need to be prioritized, especially targeting vulnerable populations such as the unhoused., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Purpose: Data after enhanced recovery after surgery (ERAS) with same-day discharge in breast reconstruction is limited. This study evaluates early postoperative outcomes after same-day discharge in tissue-expander immediate breast reconstruction (TE-IBR) and oncoplastic breast reconstruction., Methods: A single-institution retrospective review of TE-IBR patients from 2017 to 2022 and oncoplastic breast reconstruction patients from 2014 to 2022 was performed. Patients were divided by procedure and recovery pathway: group 1 (TE-IBR, overnight admission), group 2 (TE-IBR, ERAS), group 3 (oncoplastic, overnight admission), and group 4 (oncoplastic, ERAS). Groups 1 and 2 were subdivided by implant location: groups 1a (prepectoral) and 1b (subpectoral), and groups 2a (prepectoral) and 2b (subpectoral). Demographics, comorbidities, complications, and reoperations were analyzed., Results: A total of 160 TE-IBR patients (group 1, 91; group 2, 69) and 60 oncoplastic breast reconstruction patients (group 3, 8; group 4, 52) were included. Of the 160 TE-IBR patients, 73 underwent prepectoral reconstruction (group 1a, 25; group 2a, 48), and 87 underwent subpectoral reconstruction (group 1b, 66; group 2b, 21). There were no differences in demographics and comorbidities between groups 1 and 2. Group 3 had a higher average body mass index than group 4 (37.6 vs 32.2, P = 0.022). There was no significant difference between groups 1a and 2a or between groups 1b and 2b in rates of for rates of infection, hematoma, skin necrosis, wound dehiscence, fat necrosis, implant loss, or reoperations. Group 3 and group 4 showed no significant difference in any complications or in reoperations. Notably, no patients in same-day discharge groups required unplanned hospital admission., Conclusions: Many surgical subspecialities have successfully adopted ERAS protocols into their patient care and have shown both its safety and feasibility. Our research shows that same-day discharge in both TE-IBR and oncoplastic breast reconstruction does not increase risk for major complications or reoperations., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Recently, the potential use of phytocannabinoids (pCBs) to treat different pathological conditions has attracted great attention in the scientific community. Among the different pCBs, cannabidiol (CBD) has showed interesting biological properties, making it a promising molecule with a high security profile that has been approved for treatment as an add-on therapy in patients afflicted by severe pharmaco-resistant epilepsy, including Dravet syndrome (DS), Lennox-Gastaut syndrome (LGS) and tuberous sclerosis complex (TSC). CBD is pharmacologically considered a "dirty drug", since it has the capacity to bind different targets and to activate several cellular pathways. GABAergic impairment is one of the key processes during the epileptogenesis period able to induce a generalized hyperexcitability of the central nervous system (CNS), leading to epileptic seizures. Here, by using the microtransplantation of human brain membranes approach in Xenopus oocytes and electrophysiological recordings, we confirm the ability of CBD to modulate GABAergic neurotransmission in human cerebral tissues obtained from patients afflicted by different forms of pharmaco-resistant epilepsies, such as DS, TSC, focal cortical dysplasia (FCD) type IIb and temporal lobe epilepsy (TLE). Furthermore, using cDNAs encoding for human GABA A receptor subunits, we found that α1β2 receptors are still affected by CBD, while classical benzodiazepine lost its efficacy as expected.

Gastric secretion was studied in two groups of rats in which pyloric ligature with wire was previously peformed. One of the groups was acutely bled until hypovolemia. The following parameters were checked: gastric volume, acid and pepsin secretion, Pu/g of stomach, chloride, potassium, and sodium. A significant decrease in volume, acid and pepsin secretion, Pu/g of stomach and chloride and increase in potassium in the hypovolemic rats found. There was no significant change in sodium concentration. There was no significant difference in the pepsinogen concentration in gastric mucous between both groups of rats.

A comparative study of gastric secretion in rats with pyloric ligature according to either Shays' or Dais' methods was carried on, studying in both groups gastic acid and peptic secretions, mucous pepsinogen, and Na+, K+, and Cl-. The acid-peptic output as well as gastric Pu/g were greater in Dais' method. There were no changes regarding mucous pepsinogen when comparing both methods. Cl- and Na+ determinations showed minimal changes, whereas K+ showed no difference in both methods. We explain these modifications based on the difference in the secreted volume, since the acid concentration and Pu/ml are practically the same when comparing both methods.

Gastric secretion was studied in two groups of rats in which pyloric ligature was made according to Dai's method. Both groups were put in a hypopressure chamber. One of the groups was normovolemic. The other group was made hypovolemic by acute bleeding. The following parameters were checked in gastire contents: volumen, acid and pepsin secretion, U.P./g. of stomach, chloride, potassium and sodium; in gastric mucosa total U.P. and pepsinogen concentration were measured. In the rats subjected to acute hypovolemia and hypoxia it was found a significant decrease in acid secretion, chloride and potassium mEq/1; there were no statistically significant changes in volume, pepsin secretion; U.P./g. of stomach and sodium mEq/1. Total U. P. and U.P./. of stomach increased in the gastirc mucosa.

Gastric secretion was checked in two groups of rats with pyloric ligature and experimental hypovolemia subjecting one of the groups to acute hypoxia; in this group there was significant decrease in volume, acid and pepsin secretion and potassium concentration in gastric contents. In gastric mucosa pepsinogen was increased. We wish to emphasise in these changes, the importance of water and hypoxia in electrolytic balance.