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Burn injuries are considered an important public health problem in the world. Burns are considered the fourth most common kind of trauma in the world, after traffic accidents, falls, and interpersonal violence. Various biochemical agents are involved in the burn healing process such as cytokines (such as IL-6 and TNF-α), antioxidants, and liver and kidney damage biomarkers. Cichorium intybus L. and milk thistle extracts showed a wide range of pharmacological activities such as significant antimicrobial effect and antioxidant activity, as well as anti-inflammatory, antidiabetic, antiproliferative, antiprotozoal, and hepatoprotective effect. Also, these two herbs possess blood-cleansing, detoxifying, laxative, and invigorating activities. Some research confirmed that the preparations of the extract are very suitable for the treatment of nonalcoholic fatty liver disease. This is a double-blind randomized controlled clinical trial. Patients with 2nd and 3rd degree burns have been selected to participate in the study according to the inclusion criteria. A total of 60 patients were selected and divided into intervention and control groups (30 patients in each group). Patients in the intervention group received chicory seed syrup 10 cc three times a day and 1 placebo capsule, and those in the control group received placebo syrup (10 cc three times a day) and one Livergol (140 mg of silymarin in each capsule) capsule. Lab data such as liver function tests, albumin, creatinine, BUN, and hemoglobin were checked every 3 days and 1 week after discharge. The treatment lasted for 4 weeks. According to the results of the study, although the average of liver enzymes at the end of the study does not show a significant difference between the two groups, the level of liver enzymes in each group decreased on the 15th day of the study compared to the first day. This trial is registered with IRCT20180609040016N1. [ABSTRACT FROM AUTHOR]

Background: Great plantain (Plantago major L. or P.major) is a medicinal plant that is available all around the world. The whole plant has several bioactive compounds including terpenoids, flavonoids, phenolic compounds, alkaloids, fatty acids, iridoid glycosides, polysaccharides, and vitamins. Scientific studies have recognized several medical benefits like wound healing, anti-inflammatory, antimicrobial, antiulcerative, and antioxidative agents. The wound-healing capacity of this plant has been investigated under in vivo and ex vivo conditions. In the current study, we aim to compare the therapeutic effect of the P.major extract with 1% sulfadiazine on the healing of second-degree burn wounds.Method: Second-degree burn victims were included in our study. The investigation and control group, respectively, received P. major ointment 10% and silver sulfadiazine ointment 1%. The bacterial culture from the wound site was taken on days 3, 7, 10, 13, and last day of hospitalization. Patients' subjective complaints were obtained through the visual analog scale (VAS). All patients were treated and evaluated in the hospital.Result: Among the 15 patients, 11 were male, and the mean age was 33.3 years. The average complete healing duration was 11.73 vs. 13 days in the P. major and control group, respectively (P=0.166). On the third day, infection control was similar between the two groups, and on the seventh day, all bacterial cultures were negative. Although there was a significant reduction in pain scores during the recovery time, no significant differences in pain reduction were noted between the two groups (P=0.849).Conclusion: We showed that P.major ointment is a safe and suitable herbal compound in the treatment of second-degree burn wounds that not only has wound-healing properties but also is an analgesic and antimicrobial compound. [ABSTRACT FROM AUTHOR]

A life-threatening respiratory disease, coronavirus 2019 (COVID-19), has spread across the globe since December 2019. Many prognostic factors have already been put forward to predict the risk of death and other outcomes. The current study is evaluating the survival rate between hypertensive and non-hypertensive infected patients. Patients who were included in this study were admitted between 20 February to 1 March 2020 in Fars (southwest of Iran) province hospitals. Data were collected from the electronic base registry which contained demographic information, medical symptoms, and signs, underlying diseases, CT scan results, and final outcome. Of all 1239 positive cases, 159 (12.83%) had known with hypertension ant this group was significantly older than non-hypertensive patients (66.1 years Vs 48.95 years, p <.001). According to Kaplan–Meier survival curve and log-rank test, it was seen hypertensive patients deteriorated more rapidly than non-hypertensive group (p =.032). Moreover, HIV, cardiovascular, and kidney disease were diagnosed as factors that increase the risk of death in hypertensive patients. The current study about the survival rate of COVID-19 patients had shown hypertensive patents are in danger of disease severity, although it may be related to their age. Moreover, the probability of other complications like diabetes, smoking, asthma, kidney, and cardiovascular diseases, and either some other infections such as HIV can make the condition complicated and need more consideration to prevent noxious outcomes. [ABSTRACT FROM AUTHOR]

Background: Telemedicine is increasingly used, especially in low- and middle-income countries, to provide health care, including the diagnosis and management of burns. Objective: The purpose of this study is to investigate the use of telemedicine in the treatment of burn patients. Material and Methods: Medline/PubMed, Embase, Web of Science, and Google Scholar were searched. Studies were eligible for inclusion if they were published between 2012 and 2022. MeSH terms such as "Telemedicine" with entry terms of "mHealth", "mobile health", "telehealth", "eHealth" as well "burns" and "self-care" were used. Results: The findings revealed that telemedicine can contribute to increase patients' knowledge about burn conditions, improve self-care skills, remote patient follow- up, teleconsultation, medical education, as well doctor-patient relationship. This technology can also help reduce the costs of patients' transportation and treatment, decrease unnecessary referrals and outpatient visits, expand access to burn care to rural communities, especially in low- and middle-income countries, and enable greater allocation of scarce specialist resources at the burn center. Conclusion: Incorporating mHealth technologies into the daily processes of burn care can improve the quality of burn care services. [ABSTRACT FROM AUTHOR]

Background: Magnetic resonance imaging of the breast is becoming a useful adjunct to mammography and sonography for the detection of breast lesions. However, it is not yet accepted as a routine examination for all breast cancer patients due to the lack of data regarding whether breast magnetic resonance imaging impacts recurrence or survival. This trial examines the use of magnetic resonance imaging for detection of additional lesions in patients with dense breasts and its effect on surgical treatment. Methods: Between November 2011 and November 2012, 51 patients with a confirmed diagnosis of breast cancer and dense breasts underwent bilateral breast magnetic resonance imaging. Cases were reviewed to determine if the breast magnetic resonance imaging detected additional masses, changed the preoperative clinical staging, the operation plan, or prompted additional testing. Results: Magnetic resonance imaging detected 37 additional masses in 19 patients that were not detected by mammography. Cancer occult to mammography was detected by magnetic resonance imaging in one woman. Breast magnetic resonance imaging upstaged the cancer in 7 (13.72%) out of 51 patients. Magnetic resonance imaging impacted surgical treatment in 4(7.84%) out of 51 patients. Conclusions: Magnetic resonance imaging is effective in the identification of additional masses in dense breasts that are not visualized on mammography. Of the 51 patients, 4 (7.84%) who underwent magnetic resonance imaging altered their surgical management due to the magnetic resonance imaging findings. Further studies should be undertaken to show that breast magnetic resonance imaging can change local recurrence and survival. [ABSTRACT FROM AUTHOR]

Background: Burn is one of the most significant injuries in industrial and developing societies and is one of the most important traumas leading to hospitalization. The aim of this study was to identify the epidemiology, geographical distribution, and outcome of electric burns in Fars province and to present the distribution map., Methods: In this descriptive-analytical study, the study population involved all electrical burn victims admitted to Amir al-Momenin and Ghotbeddin Hospitals from 2008 to 2019 in Fars province in the south of Iran. Data were analyzed using SPSS software version 22., Results: Among a total of 246 patients, the average age was 30.78 ± 11.07. The highest frequency among educational levels was among under-diploma patients (38.6%), and the majority were employed (87.4%). Also, most of the patients were from urban areas (70.3%). The majority of burn incidences occurred at the workplace (57.7%). Also, among the high voltage patients, 25 patients (30.9%) had an amputation, while among low voltage only 12 patients (16.2%) had an amputation. Non-surgical treatment was applied in 68 (28%) cases, while Escharotomy was performed in 28 (11.4%) patients. There was also a statistically significant association between burn voltage and amputation (P= 0.039)., Conclusion: Based on our report, the rate of electrical burn injuries in Iran is still high, which underlines the need for stronger efforts in effective prevention, such as better public education and the establishment of strict regulations regarding the distribution and use of electricity., Competing Interests: 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.

Background: Burns are among the most common causes of injury and result in long-term morbidity, psychological complications, and reduced quality of life. We aimed to evaluate and compare the results of skin grafting versus nonsurgical treatment in patients with deep second-degree burn wounds of the back and posterior trunk., Methods: This is a descriptive-analytical cross-sectional study of patients with trunk and buttock burns admitted to Burn Hospital in Shiraz, Iran from 2017 to 2019. The skin surface with burns and the final repaired tissue was measured. The Vancouver Scar Score (VSS) and pigmentation, vascularity, thickness, and pliability were assessed. VSS, pigmentation, vascularity, thickness and pliability were considered as outcomes., Results: Seventy-five patients met the criteria for participation; thirty-two patients had skin grafts. The mean age was 27.79±20.03 yr and 53 patients (70.7%) were male. Scars were compared based on pigmentation, vascularity, thickness, and pliability, which was also statistically significant ( P <0.001). The mean of VSS was higher in patients with skin graft than those without graft ( P <0.001)., Conclusion: The mean VSS was significantly higher in patients with grade 2 deep burns who received skin grafting than in patients without skin grafting. Due to the lack of donor sites and the need to prioritize skin grafts in burn patients with high total body surface area, it is better to perform skin grafts on the posterior trunk and buttocks in areas with deep grade 2 burns as a last priority and treat this wound with conservative therapy., Competing Interests: The authors declare that there is no conflict of interests.

Introduction. One of the most important resistant mechanisms in Gram-negative bacteria is extended spectrum β-lactamases (ESBLs). Harbour-related genes on plasmids, increase the risk of resistance transmission among commonly reported hospital infections. Aim. This study was designed to explore the dissemination of Pseudomonas aeruginosa producing ESBLs on their plasmids recovered from the different wards of Amir-Al-Momenin burn center, Affiliated with Shiraz University of Medical Sciences. Methodology. Among 256 isolates, 88 (34.38 %) P. aeruginosa strains were isolated from burn hospitalized patients. Samples were processed for antibiotic resistance using the Kirby-Bauer method while MIC was performed for colistin. MIC was used by the microdilution broth method as recommended by Clinical and Laboratory Standards Institute guidelines. Related studied genes were evaluated on extracted plasmids by the PCR method. Results. According to the phenotypic and molecular steps, a total of 58 (65.91 %) and 74 (84.10 %) strains detected positive ESBLs, respectively. Based on antibiogram tests, a total of 63 (71.59 %) isolates were detected as multidrug resistant. All ESBL P. aeruginosa isolates showed identical antimicrobial susceptibility profiles. The genotypic prevalence of ESBLs for bla SHV , bla TEM , bla GES , bla OXA-10 and bla PSE genes was 47.73, 78.41, 5.58, 3.41, 4.55 %, respectively. Conclusion. All P. aeruginosa strains producing ESBLs had plasmids containing related genes. The data indicated a high prevalence of ESBL among P. aeruginosa isolates in the southwest of the Iran burn center and their enzyme types were diverse.

Background: Use of matrix-derived biologic scaffolds has become a treatment of choice in several clinical issues. This study assessed biochemical methods in production of three-dimensional scaffolds from human skin., Methods: Human skin was prepared from circumcisions, washed in phosphate buffer saline (PBS) and kept at -20ºC until use. The skin samples underwent various methods. In group A, NaCl, Triton X100 and EDTA solution were used for removal of epidermis and was subdivided to three subgroups. The solution for removal of epidermis was similar for all subgroups, but decellularization was different. Group B was subdivided into 6 subgroups, NaCl in different concentrations was used for removal of epidermis and decellularization happened using SDS in various concentrations and different time intervals. Group C was subdivided to 3 subgroups, trypsin was used for removal of epidermis and decellularization was conducted applying NaOH or SDS. Washing was performed using only PBS. In group D, decellularization was done applying SDS. Histomorphometric study was conducted to compare the groups., Results: No fibroblast was present in A2, B2, B4, and C3 subgroups after decellularization. Histological photographs from subgroups A1 to A3 revealed several cells and collagen fibers. Dense collagen fibers in pink color were noted in all subgroups; but, epidermis was absent., Conclusion: It was shown that 1M NaCl was the best solution for removal of epidermis, 0.5% SDS for 2 h was the most effective solution for decellularization and PBS was the best solution for washing, while the solutions are easily available and cost-effective., Competing Interests: The authors declare no conflict of interest.

Objectives: To compare the outcomes of early excision and grafting between pediatric and adult patients with deep burns of less than 40% total body surface area burns (TBSA)., Methods: This is a prospective comparative study. Overall, 106 patients admitted to Ghotbodin Burn Center in Shiraz, Iran from September 2012 to September 2013, were included in the study. All patients had less than 40% TBSA burn and had excision and grafting under 14 days from their injury. Patients were divided into two age groups of younger than 14 (n=49) and older than 14 (14-65) years old (n=57). During a 6-month follow-up period, the two groups were compared regarding mean percentage of graft take, total scar score, duration of hospital stay and itching score., Results: During follow-up, the two groups did not show a significant difference in graft take, total scar score and itching score ( p =0.461, p =0.363 and p =0.637, respectively). Clinically, the pediatric group showed less hospital stay (12.25±9.1 vs. 16±12.9), however this was not statistically significant ( p =0.091)., Conclusion: Adults and elderly patients (14-65 years old) compared to pediatric patients (less than 14 years old) with less than 40% TBSA burns, can expect similar results regarding scar score, graft take, itch score and hospital stay, after excision and grafting performed less than two weeks from their initial injury., Competing Interests: None of the authors have any commercial and financial conflicts of interest to be declared regarding the manuscript.

Objective: To compare the outcome of patients with up to 60% total body surface area (TBSA) thermal burns undergoing ultra-early and early excision and grafting., Methods: This historical cohort study was performed in two referral burn centers of Shiraz during a 1-year period from 2015 to 2016. We included those patients with thermal burns up to 60% TBSA who underwent ultra-early (48-72 hours) and early (7-10 days) excision and grafting. We excluded those who were hemodynamically unstable and those with electrical burns. The outcome of patients was determined by graft success, operation duration, blood loss, hospital length of stay and mortality rate., Results: We included a total number of 107 patients with mean age of 32.1 ± 11.6 years. There were 65 (60.7%) men and 42 (39.3%) women among the patients. Both study groups were comparable regarding the baseline characteristics. Ultra-early excision and grafting was associated with more, higher graft success rate ( p =0.048), lower infection rate ( p =0.037), shorter hospital length of stay ( p =0.044) and lower mortality rate ( p =0.027)., Conclusion: Ultra-early excision and grafting in patients with thermal burns covering less than 60% TBSA was associated with higher graft success rate, shorter hospital length of stay, lower infection rate and lower mortality rate when compared to early surgery.

Objective: To compare outcome of patients with burns covering less than 15% of total body surface area(TBSA) undergoing early excision and grafting or delayed skin grafting., Method: This was a non-randomized clinical trial including 54 patients with less than 15% TBSA burn referring to Ghotboddin Hospital of Shiraz. They were assigned to two study groups, each group including 27 patients: the early excision and grafting group (EEG group) and the delayed grafting group (DG group). Patients were followed postoperatively for 6 months. Hospital stay, graft success rate, itching score and scar formation during 6 months of follow-up were recorded and compared between two study groups., Results: During the study 1 patient was lost to follow-up in early excision and grafting group. Baseline characteristics were comparable between two study groups. The graft success rate was significantly higher in those patients who underwent early excision and grafting when compared to delayed grafting group (96.88% vs. 92.88%; p=0.033). However the length of hospital stay, itching and scar scores were comparable between two study groups after 6 months of follow-up., Conclusion: In patients with burns covering less than 15% TBSA, early excision and grafting is associated with higher graft success rates compared to the delayed excision and grafting. How ever length of hospital stay, itching and scar formation is comparable between the two techniques.