Hamid Karimi

Comparison of WBC, ESR, CRP and PCT serum levels in septic and non-septic burn cases

Diagnosis of sepsis is difficult, particularly in cases of burn where signs of sepsis may be present in the absence of a real infection. This study compared serum levels of procalcitonin (PCT), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell (WBC) among 60 burned people with and without infection, in order to assess the value of the information for diagnosis of sepsis. A significantly higher PCT level was observed in the septic group compared to those without sepsis (8.45+/-7.8 vs. 0.5+/-1.0, respectively, p<0.001); no significant differences were found in CRP or WBC levels, neutrophil count or ESR. The area under the receiver operating characteristics curve in the diagnosis of sepsis was 0.97 for PCT (p<0.001) with sensitivity of 100% and specificity of 89.3%. Non-survivors had a mean PCT level significantly higher than that of survivors. Thus the serum PCT level was a highly efficient laboratory parameter for the diagnosis of severe infectious complications after burn, but WBC, neutrophil, ESR and CRP levels were of little value.

Effects of silicone gel on burn scars

AIM To study the efficacy of silicone gel applied to hypertrophic burn scars, in reducing scar interference with normal function and improving cosmesis. METHODS A randomised, double-blind, placebo-controlled trial involving 38 people with hypertrophic burn scars. Each scar was divided into two segments; silicone gel sheet was applied randomly to one of the two and placebo to the other. Participants were seen again after 1 and 4 months. Their data and wound characteristics were collected using the Vancouver scar scale. RESULTS The median age of participants was 22 years (1.5-60 years) and 16 were male; 4 did not attend follow-up and were excluded from the study. There were no significant differences in baseline characteristics. Although after 1 month all scar scale measures were lower in treated areas, only the vascularity scale was significantly different between the two areas. After 4 months, all scale measures were significantly lower in the silicone gel group than in the control group, except for the pain score. CONCLUSION Silicone gel is an effective treatment for hypertrophic burn scars.

Burn injuries during pregnancy in Iran

To report on maternal and fetal outcome in 53 pregnant women seen at a referral burn center.

Why burn patients are referred

BACKGROUND Many burn patients are needed to be referred to a tertiary burn hospital according to the American Burn Association (ABA) criteria. The purpose of this study was to verify the reasons for referring of the burn patients to the hospital. MATERIALS AND METHODS For 2 years, we prospectively surveyed the burn patients referred to a tertiary teaching burn hospital. Data for the following variables were collected and analyzed with SPSS software V21.0: causes of burn; age; gender; total body surface area (TBSA) measured at the referring center; TBSA measured at the receiving center; concomitant diseases and traumas; the reason for referral; condition of patients before and during the transportation; transportation time; presence of infection; presence of inhalation injury, electrical injury, and chemical injury; child abuse; insurance coverage; and results and outcomes of patients. RESULTS A total of 578 burn patients (33.6% of the total admissions) were referred in the study period. Among these patients, 70.9% were females. The mean (SD) age of the patients was 35.3 (19.69) years. The mean (SD) of TBSA was 45.2 (26.3). Of the 578 patients, 45% were referred by request of the family or patients; 9% were referred because lack of diagnostic facility, approximately 43% were referred because of the need to be admitted in a tertiary burn center, 0.7% were referred because of a lack of capacity at other hospitals, and 0.5% were referred because of an error in the estimation of TBSA. CONCLUSIONS A total of 45% of the referrals were by request of the family and patients. Tele-medicine may help to establish a direct contact between expert burn physicians and the patients and thus reduce unnecessary transfers. Approximately 9% of the referrals were because of lack of some diagnostic facilities.

Burns, hypertrophic scar and galactorrhea

Abstract: An 18-year old woman was admitted to Motahari Burn Center suffering from 30% burns. Treatment modalities were carried out for the patient and she was discharged after 20 days. Three to four months later she developed hypertrophic scar on her chest and upper limbs. At the same time she developed galactorrhea in both breasts and had a disturbed menstrual cycle four months post-burn. On investigation, we found hyperprolactinemia and no other reasons for the high level of prolactin were detected. She received treatment for both the hypertrophic scar and the severe itching she was experiencing. After seven months, her prolactin level had decreased but had not returned to the normal level. It seems that refractory hypertrophic scar is related to the high level of prolactin in burns patients.

Bone Marrow Stem Cells and Ear Framework Reconstruction.

Background:Repair of total human ear loss or congenital lack of ears is one of the challenging issues in plastic and reconstructive surgery. Objective:The aim of the present study was 3D reconstruction of the human ear with cadaveric ear cartilages seeded with human mesenchymal stem cells. Method:We used cadaveric ear cartilages with preserved perichondrium. The samples were divided into 2 groups: group A (cartilage alone) and group B (cartilage seeded with a mixture of fibrin powder and mesenchymal stem cell [1,000,000 cells/cm3] used and implanted in back of 10 athymic rats). After 12 weeks, the cartilages were removed and shape, size, weight, flexibility, and chondrocyte viability were evaluated. P value <0.05 was considered significant. Results:In group A, size and weight of cartilages clearly reduced (P < 0.05) and then shape and flexibility (torsion of cartilages in clockwise and counterclockwise directions) were evaluated, which were found to be significantly reduced (P > 0.05). After staining with hematoxylin and eosin and performing microscopic examination, very few live chondrocytes were found in group A. In group B, size and weight of samples were not changed (P < 0.05); the shape and flexibility of samples were well maintained (P < 0.05) and on performing microscopic examination of cartilage samples, many live chondrocytes were found in cartilage (15–20 chondrocytes in each microscopic field). Conclusion:In samples with human stem cell, all variables (size, shape, weight, and flexibility) were significantly maintained and abundant live chondrocytes were found on performing microscopic examination. This method may be used for reconstruction of full defect of auricles in humans.

The epidemiology of geriatric burns in Iran: a national burn registry-based study

Defining the epidemiology and outcome of geriatric burn patients is critical for specialized burn centers, health-care workers, and governments. Better resource use and effective guidelines are some of the advantages of studies focusing on this aspect. The outcome of these patients serves as an objective criterion for quality control, research, and preventive programs. We used data from the burn registry program in our country. For 2 years, >28,700 burn patients were recorded, 1721 of whom were admitted. Among them, 187 patients were ≥55 years old. Sixty-nine percent of patients were male and 31% female, with a male to female ratio of 2.22:1. The mean±standard deviation (SD) of age was 63.4±8.1. The cause of burns was flame (58.2%) and scalds (20.3%). Most of the burns were sustained at home. The mean duration of hospital stay was 19.5 days (range 3-59 days). The mean (SD) of the total body surface area (TBSA) was 20.3% (8.4%). The median hospital stay (length of stay (LOS)) was 11 days (SD=14). The increase in TBSA was related to a longer LOS (p<0.02). Burn wound infection developed in 44.3% of patients. The presence of inhalation injury was significantly related to mortality (p<0.001). Among the patients, 9% recovered completely, 74.9% recovered partially (requiring further treatment), 1% underwent amputation, and 12.8% died. The lack of insurance coverage did not affect the survival of our geriatric burn patients. However, being alone or single, ignition of clothing, cause of burn, comorbid illnesses, complications following the burn, TBSA, age, and sepsis were positively correlated with mortality. The mean cost of treatment for each patient was about

Long term outcome and follow up of electrical injury

7450.

Bilateral mandibular distraction in micrognathism or hypoplasia of mandible, hazrat fatemeh hospital

Abstract Objective To evaluate the outcome of electrical burn on a patients life performance and the disability induced by this type of injury. Methods This study is a prospective 6 years descriptive study. The injured patients admitted to our center between 2006 and 2008 were followed for 6 years to estimate the ability of their life and job performance after the injury. Results In the patients, 96.8% were male. The mean age of patients was 27.9 years. 73.9% of those injuries were occupational injuries. 86.5% were pure electrical injuries. 81% of patients went back to their previous job within a 5-6 year period. Only 5% had the ability to perform their usual daily activities-these patients needed financial support from family, insurance companies and government. Unfortunately 6.3% were totally disabled and needed complete help even for their minor natural needs. These patients are young and probably have a long-term life expectancy and would have a huge financial impact on the government and society. The mean length of hospital stay was 17.7 d. The mean total body surface area burned was 13.3%±11.5%. We could see an association between high voltage burns and falling down (P=0.005). High voltage burns needed longer periods away from work (197 d) in comparison with low voltage injuries (145.8 d) (P=0.003). Conclusions High voltage electrical burns are severe, needing more flap repairs and/or amputations and cause longer periods away from work.

PRP and Metaplasia in repaired tendon

Objective To determine the results of Bilateral Distraction Osteogenesis (DO) versus traditional methods in treatment of micrognathia.