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Comparison of prognostic value of Roper Hall and Dua classification systems in acute ocular burns
AimTo compare the predictive outcome of ocular burns using two different prognostic classification systems, that is, Dua and Roper Hall classification.Patients and methodsIn a prospective, randomised, controlled clinical trial, the extent of acute ocular burns in 100 patients was graded by Roper Hall and Dua classifications. Patients were randomised in two groups of 50 each to receive conventional medical therapy alone or additional amniotic membrane transplantation (AMT). Moderate burns were graded similarly (grade II and III) under both systems, while severe burns were classified differently and compared further. Baseline parameters (size of epithelial defect, corneal haze, limbal ischaemia, conjunctival involvement and visual acuity) and outcome variables (healing of epithelial defect, corneal clarity, corneal vascularisation, visual outcome and symblepharon) after 1 year were noted and compared.ResultsThere was no difference in terms of time taken and rate of healing of epithelial defect, but there was a significant difference in extent of corneal vascularisation between grades IV, V and VI (p<0.05). In patients who received AMT in addition to medical therapy, the degree of corneal clarity achieved was significantly better in patients with grade IV burns than either grade V (p=0.045) or grade VI (p=0.024) burns, and final visual acuity was significantly better in these patients (p=0.043). On comparison of patients with grade IV burns (with and without AMT), the outcome in terms of extent of corneal vascularisation was significantly better (p=0.0124) in patients who received AMT.ConclusionsDua classification by providing further subclassification of grade IV ocular burns by Roper Hall into three separate grades has a superior prognostic predictive value in severe ocular burns.
Journal Article
Robert Burns and the United States of America : poetry, print, and memory 1786-1866
This book provides a critical study of the relationship between Robert Burns and the United States of America, c.1786-1866. Though Burns is commonly referred to as Scotland?s ?National Poet?, his works were frequently reprinted in New York and Philadelphia; his verse mimicked by an emerging canon of American poets; and his songs appropriated by both abolitionists and Confederate soldiers during the Civil War era. Adopting a transnational, Atlantic Studies perspective that shifts emphasis from Burns as national poet to transnational icon, this book charts the reception, dissemination and cultural memory of Burns and his works in the United States up to 1866.
BOOK
Efficacy and safety of platelet-rich plasma as an adjunct therapy to split thickness skin graft in burn patients with granulating raw wounds: a prospective, randomized, double-blind study—study protocol
Background
Burn wounds are commonly encountered in clinical settings and the management aims at the prevention of mortality and morbidity due to disability. The platelet-rich plasma (PRP) is blood-derived biomaterial that is enriched with growth factors and cytokines that facilitate wound healing. The PRP has proven its efficacy in various other wounds, but its role in post-burn raw areas and graft take has not been validated. This proposed multicentre randomized controlled trial aims to evaluate the efficacy and safety of platelet-rich plasma as an adjunct therapy to split-thickness skin graft in burn patients with granulating raw wounds.
Method/design
This trial is an investigator-initiated, double-blind multicentre, randomized controlled parallel arm trial alongside trial cost-effectiveness analysis. Granulating deep second-degree and third-degree burns affecting 3–20% of total body surface area (TBSA) at 10–14th post-burn day will be included in the study. A total of 550 patients (275 in each group) will be randomized to receive either standard skin graft or allogenic PRP with skin graft treatment. The primary endpoint will be the mean percentage of graft-take on the 14th postoperative day. The result will be analyzed by two independent assessors who are blinded to the study. Secondary endpoints include (a) time taken for complete wound healing; (b) frequency of adverse events; (c) follow-up with scar index at 3 months, 6 months, and 1 year using the Patient and Observer Scar Assessment Scale (POSAS) score; (d) cost-effectiveness analysis of the intervention compared to the comparator; and (e) to estimate in a subset of participants the association between growth factor levels (PDGF BB and TGF ß-1) of activated PRP and clinical response.
Discussion
The proposed trial will be expected to verify the efficacy and safety of PRP for split-thickness skin graft (STSG) in deep second-degree or third-degree granulating wounds of burn patients based on the outcome of the study.
Journal Article
Handy health guide to burns and blisters
\"Have you ever touched a hot pan by accident? You may have even gotten slightly burned when you did. Authors Alvin and Viriginia Silverstien and Laura Silverstein Nunn explore the different types of burns you can get, and how to best prevent burns, blisters, and sunburns.\"-- Provided by publisher.
Book
Superficial partial burns and donor sites are unique wounds: case series of extended wear Cutimed ® Sorbact
Background: Superficial partial burns and donor site wounds are unique and do not behave like other wounds, warranting a unique approach. A dressing with an antimicrobial effect to prevent infection and minimise trauma at the wound by extending wear time promotes spontaneous healing by epithelialisation. The properties of Cutimed® Sorbact® achieve this goal in its temporary skin-like substitute action. This audit aims to illustrate that our management of superficial partial burns and donor sites is successful.Methods: A prospective audit was done from January to June 2019 at the Harry Gwala Regional Hospital, where Cutimed® Sorbact®was used at the burn surgeon’s discretion. Sorbact® was typically chosen for acute superficial partial-thickness burns at presentation and donor sites.Results: A total of 27 patients were included. There were 14 superficial partial-thickness burns (nine children and five adults) treated with a mean wear time of 14 days to healing, with two patients having a wear time of 17 and 22 days, respectively. There were 13 donor sites treated (eight children and five adults), with 12 cases healed by day 17 and one complication of depth conversion.Conclusion: Frequent removal of the primary Cutimed® Sorbact® dressing in the epithelialising wound causes trauma to the wound, leading to delayed healing despite the absence of infection. Leaving the primary Cutimed® Sorbact® in situ while monitoring for complications leads to successful outcomes. This has been adopted as standard management in our service for superficial partial burns and donor sites.
Journal Article
Demographic profile and clinical characteristics of patients presenting with acute ocular burns
Purpose:
To study and compare the demographic and clinical profile of acute ocular burns (AOB) in children and adults.
Methods:
This retrospective case series included 271 children (338 eyes) and 1300 adults (1809 eyes) who presented to two tertiary eye care centers within one month of sustaining AOB. Data regarding demographics, causative agents, severity of injury, visual acuity (VA), and treatment were collected and analyzed.
Results:
Males were more commonly affected particularly among adults (81% versus 64%, P < 0.00001). Among children, 79% sustained domestic injuries, whereas 59% of adults had work-place injuries (P < 0.0001). Most cases were due to alkali (38%) and acids (22%). Edible lime (chuna, 32%), superglue (14%), and firecrackers (12%) in children, and chuna (7%), insecticides, lye, superglue (6% each), toilet cleaner (4%) and battery acid (3%) in adults, were the main causative agents. The percentage of cases with Dua grade IV-VI was greater in children (16% versus 9%; P = 0.0001). Amniotic membrane grafting and/or tarsorrhaphy were needed in 36% and 14% of affected eyes in children and adults, respectively (P < 0.00001). The median presenting VA was logMAR 0.5 in children and logMAR 0.3 in adults (P = 0.0001), which improved significantly with treatment in both groups (P < 0.0001), but the final VA in eyes with Dua grade IV-VI burns was poorer in children (logMAR 1.3 versus logMAR 0.8, P = 0.04).
Conclusion:
The findings clearly delineate the at-risk groups, causative agents, clinical severity, and treatment outcomes of AOB. Increased awareness and data-driven targeted preventive strategies are needed to reduce the avoidable ocular morbidity in AOB.
Journal Article
Bacterial Infections After Burn Injuries
Patients who are admitted to the hospital after sustaining a large burn injury are at high risk for developing hospital-associated infections. If patients survive the initial 72 hours after a burn injury, infections are the most common cause of death. Ventilator-associated pneumonia is the most important infection in this patient population. The risk of infections caused by multidrug-resistant bacterial pathogens increases with hospital length of stay in burn patients. In the first days of the postburn hospitalization, more susceptible, Gram-positive organisms predominate, whereas later more resistant Gram-negative organisms are found. These findings impact the choice of empiric antibiotics in critically ill burn patients. A proactive infection control approach is essential in burn units. Furthermore, a multidisciplinary approach to burn patients with a team that includes an infectious disease specialist and a pharmacist in addition to the burn surgeon is highly recommended.
Journal Article