Management of hypertrophic burn scar: a comparison between the efficacy of exercise- physiotherapy and pressure garment-Silicone on hypertrophic scar

Our study aims to investigate the effectiveness of other treatment methods for burn related scarring and to determine the possibility of their routine administration in similar clinical settings. Through a prospective study, 66 patients were enrolled to receive either the conventional pressure garment therapy [PGT] and Silicone [control group] or exercise and physiotherapy [case group]. Patients were visited regularly to be examined for the status of their scars' regression, limbs' dysfunction, and joint motion. Then, these two groups were compared to determine the efficacy of exercise and physiotherapy as an alternative to the conventional treatment with PGT. After about 20 months follow-up, decreased articular range of motion [ROM] was: 16 [51.5%] cases compared to 5 [15%] of controls had mild, 11 [35.5%] of the cases compared to 13 [39.5%] of the controls had moderate; and 4 [13%] of the cases compared to 15 [45.5%] of the controls had severe decreased ROM which revealed statistically significant difference [P<0.01]. At the same time, Vancouver Scar Scale score was: 15 [48%] of the cases and 6 [18%] of the controls had mild Scar Scale, 12 [39%] of the cases and 14 [42.5%] of the controls had moderate score and 4 [3%] of the cases and 13 [39.5%] of the controls had severe score which revealed a statistically significant difference [P<0.05]. Our study showed that physical therapy and exercise are more effective than PGT, in management of burn hypertrophic scar, hence could be an alternative in cases that conventional therapy cannot be used for any reason

Prediction of mortality in pediatric burn injuries: R-Baux score to be applied in children [pediatrics-Baux score]

R-Baux score has obtained an acceptable validity and accuracy in predicting burn-related mortality. However, its usage and efficacy among pediatric burn patients has not been well documented. The aim of this study was to employ Pediatrics-Baux [P-Buax] score as modified version of R-Baux score in these patients to determine how it could be applicable in this population. Through a prospective study, 870 pediatric burn patients were enrolled. P-Baux and R-Baux scores were calculated for each patient and they were categorized to different groups according to these scores. Mortality and further death probability were measured for each subject and then analyzed by logistic regression model to reveal how they change in relation with age in pediatric burn patients. R-Baux score for 95% probability of death revealed a mean of 73 among patients of this study. Also P-Baux score was measured in these patients with inhalation injury which showed to be 55 for 95% probability of death. Results showed that age had a positive prognostic value in contrast to the negative prognostic value of Total Body Surface Area [TBSA] and inhalation injury. Our analysis showed that in children under the age of 15 years, age has a positive prognostic value while TBSA and inhalation injuries had negative prognostic values in relation to mortality. Hence, in contrast to the adult population, burn injury related mortality may be predicted by modified R-Baux score as [TBSA - age + [18xR]] which could be named as P-Baux score

comparative study of cardioprotective effect of three anesthetic agents by measuring serum level of troponin-T after coronary artery bypass grafting

Cardiac surgery is associated with some degree of myocardial injury. Preconditioning first described in 1986 was pharmacologic and non- pharmacologic. Among the long list of anesthetic drugs, isoflurane as an inhaling agent along with midazolam and propofol as injectable substances have been documented to confer some preconditioning effects on myocardium. In this study cardiac Troponin T [cTnT] ,as a reliable marker, was used for evaluating myocardial injury. This prospective double blind study was comprised of 60 patients scheduled for CABG and were randomly assigned into three groups who received infusion of propofol or midazolam or isoflorane. Surgical procedures and anesthetics were similar for 3 groups. cTnT measured preoperatively and at 12, 24 and 36hr after arrival in ICU. There were no statistically significant differences in mean cTnT levels between three groups in the preoperative period and 12-24 hours after arrival in ICU. However, mean cTnT in 3 groups at 36 hours after arrival in ICU were different [P< 0.013] and cTnT level was significantly higher in midazolam group [P<0.001] and lowest in isoflurane group [P=0.002]. There were significant differences on cTnT levels between anesthetic groups of isofluran, midazolam and propofol at 36 hr after surgery. Preconditioning effect of isoflurane was higher than the other two groups