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San Jose, CA, United States

The moist, dead tissue within a burn is a nutrient-rich medium that will support the growth of a variety of bacterial species, placing burns patients at greater risk of infection than those with other wound types. Traditionally, burn wounds have been managed with topical silver based dressings, but a Cochrane Review suggests that there is evidence that Honey may have a role to play. A prospective evaluation was undertaken to assess the performance of Actilite or Algivon Plus on burn wounds. Source

Hoogewerf C.J.,Burn Center
Cochrane database of systematic reviews (Online) | Year: 2013

Burn injuries are an important health problem. They occur frequently in the head and neck region - the area central to a person's identity, that provides our most expressive means of communication. Topical interventions are currently the cornerstone of treatment of partial-thickness burns to the face. To assess the effects of topical interventions on wound healing in people with facial burns of any depth. We searched the Cochrane Wounds Group Specialised Register (searched 12 November 2012); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 10); Ovid MEDLINE (1950 to November Week 1 2012); Ovid MEDLINE - In-process & Other Non-Indexed Citations (searched November 12, 2012); Ovid EMBASE (1980 to 2012 Week 45); and EBSCO CINAHL (1982 to 9 November 2012) for relevant trials. We did not apply date or language restrictions. Randomised controlled trials (RCTs) that evaluated the effects of topical treatment for facial burns were eligible for inclusion in this review. Two review authors independently assessed and included the references identified by the search strategy. Included trials were assessed using a risk of bias form, and data were extracted using a standardised data extraction sheet. For dichotomous and continuous outcomes, we calculated risk ratios and mean differences, respectively, both with 95% confidence intervals (CI). We included five RCTs, comprising a total of 119 participants. Two studies compared two different antimicrobial agents and three compared a biological or bioengineered skin substitute with an antimicrobial agent. All studies had small sample sizes and were at high risk of bias. Heterogeneity of interventions and outcomes prevented pooling of data. In three studies time to complete wound healing was significantly shorter for those using a skin substitute than for those using an antibacterial agent, but the quality of the evidence was low. Pain was significantly reduced with the use of skin substitutes in both studies that reported this outcome in all groups, range mean differences -2.00 (95% CI -3.82 to -0.18) to -4.00 (95% CI -5.05 to -2.95) on a 10-point scale. There is insufficient high quality research and evidence to enable conclusions to be drawn about the effects of topical interventions on wound healing in people with facial burns. Source

Lancerotto L.,Burn Center
Burns : journal of the International Society for Burn Injuries | Year: 2011

Burn centres are 'hubs' of referral for large areas and should be organised in a network optimised for the needs of their area. Burn centres' organisation and activity in Italy are analysed with reference to burn epidemiology in the country. A questionnaire was submitted to Italian burn centres concerning organisation, activity and epidemiology of burns treated in 2008. A total of 2067 patients were admitted to a burn centre in 2008; 50% of burns were due to flames (21% alcohol); and 25% of patients were <14 years old. Overall mortality was 5.3%. 144 beds in 15 burn centres were available (seven reserved for children; bed/inhabitants ratio, 1/414, .023). However, distribution is not uniform in the country. Bed rotation was 14.4 patients/bed, and hospital stay varied from 11.7 days for <20% total body surface area (TBSA) burns to >120 days for burns >70%. About half (57%) of patients admitted had less than 20% TBSA burns, 32% had 20-50% TBSA burns, 7% from 50% to 70% and 4% over 70% TBSA. A national network coordinating burn centre activity is lacking. Italy seems to have less availability of beds for burn care than other countries, and distribution and organisation of the network may be improved. The high prevalence of child burns should be noticed and this makes prevention campaigns advisable. Copyright © 2010 Elsevier Ltd and ISBI. All rights reserved. Source

Van Hattem S.,University of Groningen | Beerthuizen G.I.,Burn Center | Kardaun S.H.,University of Groningen
British Journal of Dermatology | Year: 2014

Acute generalized exanthematous pustulosis (AGEP) and Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) are rare but severe cutaneous adverse drug reactions. Especially in TEN, large areas of the skin and mucosae may become detached. Although AGEP and SJS/TEN are distinct entities with a different clinical picture, pathogenesis, prognosis and treatment, they may share some features, raising the hypothesis of overlap between both entities. We present a severe case of AGEP, caused by flucloxacillin, clinically presenting with TEN-like features and pronounced systemic symptoms with haemodynamic and respiratory instability. Furthermore, we present a review of the literature on cases of AGEP with features resembling SJS/TEN or a supposed overlap with SJS/TEN. What's already known about this topic? Acute generalized exanthematous pustulosis (AGEP) can be accompanied by mild systemic involvement. Coalescence of pustules in AGEP can result in clinically toxic epidermal necrolysis (TEN)-like cutaneous features. Histopathology can assist in the differential diagnosis between AGEP and Stevens-Johnson syndrome or TEN. What does this study add? Flucloxacillin may cause AGEP. Severe neutrophilia in AGEP can contribute to the severity of systemic involvement. A literature review could not substantiate the existence of an AGEP-TEN overlap. © 2014 British Association of Dermatologists. Source

Struck M.F.,University of Leipzig | Gille J.,Burn Center
Annals of Burns and Fire Disasters | Year: 2013

Burn wound infections remain the most important factor limiting survival in burn intensive care units. Large wound surface, impaired immune systems, and broad-spectrum antibiotic therapy contribute to the growth of opportunistic fungal species. Faced with challenging fluid resuscitation, wound excision and cardiopulmonary stabilization, mycosis in burns are likely to be underestimated. Diagnostic performance can sometimes be delayed because clinical signs are unspecific and differentiation between colonization and infection is difficult. Therapeutic measures range from infection prophylaxis over treatment with antifungal agents towards radical amputation of infected limbs. New methods of early and reliable detection of fungal organisms, as well as the use of novel antifungal substances, are promising but require wider establishment to confirm the beneficial effects in burn patients. This review aims to highlight the main important aspects of fungal infections in burns including incidence, infection control, diagnostic and therapeutic approaches, prognosis and outcomes. Source

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