Experimental and theoretical investigation of the influence of post-curing on mixed mode fracture properties of 3d-printed polymer samples.

This study explores the mechanical properties and fracture characteristics of additively manufactured acrylonitrile butadiene styrene specimens, focusing on the impact of raster angle and post-process heat treatment. To this end, a large number of tensile and semi-circular bending samples with three distinct raster angles of 0/90°, 22/ - 68°, and 45/ - 45° were prepared and exposed to four types of heat treatments with different temperature and pressure conditions. Simultaneously, theoretical models of maximum tangential stress (MTS) and generalized MTS (GMTS) were developed to estimate the onset of specimen fracture under mixed-mode in-plane loading conditions. Recognizing the non-linear behavior within the stress-strain curve of tensile test samples, particularly in the annealed samples, an effort was undertaken to transform the original ductile material into a virtual brittle material through the application of the equivalent material concept (EMC). This approach serves the dual purpose of bypassing intricate and tedious elastoplastic analysis, while concurrently enhancing the precision of the GMTS criterion. The experimental findings have revealed that while the annealing process has a minimal effect on the yield strength, it considerably enhances energy absorption capacity, increases fracture toughness, and reduces the anisotropy. Additionally, the combined EMC-GMTS criterion has demonstrated its capability to predict the failure of the additively manufactured parts with an acceptable level of accuracy.

An Assessment of the Fire Safety Standards in Iranian Homes and Equipment As They Relate to Fire Accidents.

Fire accidents and burns are one of the leading causes of death and disability worldwide. This study was conducted with the aim of studying the etiology of fire accidents as well as investigating the fire safety standards of both homes and equipment in Iran. Samples included patients with flame burns who consented to answer the questions. Questions covered five areas: patient demographics, epidemiological characteristics of burns, the fire safety status of the home, the fire safety status of the equipment, and the mechanism of the accident. In this study, the mean extent of the burns was 18.07 ± 14.29% of body surface area and was significantly related to the age grouping of the patients. The highest total body surface area (TBSA) was observed in patients between 19 to 39 years. The most common cause of flame injuries was gas explosions (36.81%). The interviews revealed that most of the houses were not equipped with smoke detectors or fire extinguishers. The extent of burns was significantly higher in patients living in unequipped homes (P = 0.047). Cooking equipment was often involved in the accidents (38.1%). Considering the low home fire safety and the role of equipment misuse and damaged equipment use in the occurrence of accidents, it seems that installing fire alarms and firefighting equipment, proper training on how to work with and maintain the equipment, using cooking and heating equipment correctly along with discontinuing use if damaged would all be effective and are highly suggestive to reduce fire injuries.

Les incendies et les brûlures sont une cause majeure de décès et de handicap dans le monde. Les buts de cette étude était d'identifier les causes d'incendie en Iran et d'évaluer la sécurité des maison et des équipements en Iran. Nous avons interrogé des victimes d'incendie acceptant de répondre à nos questions, qui relevaient de 5 sujets: démographie des patients, caractéristiques des brûlures, sécurité- incendie de leur domicile ainsi que des équipements et mécanisme de l'incendie. La surface brûlée était de 18,07 +/- 14,29%, significativement corrélée à l'âge de la victime, la surface maximale étant observée dans le groupe 19-39 ans. Une explosion de gaz était la cause la plus fréquente de déclenchement de l'incendie (36,81%) et les équipements de cuisson étaient impliqués dans 38% des cas. La plupart des habitations ne se pas équipées de détecteurs de fumées (DAAF) ni d'extincteurs, les brûlures étant plus étendues en l'absence de tels matériels (p= 0,047). Il est donc nécessaire de promouvoir l'installation de DAAF et d'extincteurs, de développer l'éducation à l'utilisation et à l'entretien des appareils de chauffage comme de cuisson, de décourager l'utilisation de ces appareils quand ils sont endommagés afin de réduire le risque d'incendie de domicile.

Embryo selection through artificial intelligence versus embryologists: a systematic review.

STUDY QUESTION: What is the present performance of artificial intelligence (AI) decision support during embryo selection compared to the standard embryo selection by embryologists? SUMMARY ANSWER: AI consistently outperformed the clinical teams in all the studies focused on embryo morphology and clinical outcome prediction during embryo selection assessment. WHAT IS KNOWN ALREADY: The ART success rate is ∼30%, with a worrying trend of increasing female age correlating with considerably worse results. As such, there have been ongoing efforts to address this low success rate through the development of new technologies. With the advent of AI, there is potential for machine learning to be applied in such a manner that areas limited by human subjectivity, such as embryo selection, can be enhanced through increased objectivity. Given the potential of AI to improve IVF success rates, it remains crucial to review the performance between AI and embryologists during embryo selection. STUDY DESIGN SIZE DURATION: The search was done across PubMed, EMBASE, Ovid Medline, and IEEE Xplore from 1 June 2005 up to and including 7 January 2022. Included articles were also restricted to those written in English. Search terms utilized across all databases for the study were: ('Artificial intelligence' OR 'Machine Learning' OR 'Deep learning' OR 'Neural network') AND ('IVF' OR 'in vitro fertili*' OR 'assisted reproductive techn*' OR 'embryo'), where the character '*' refers the search engine to include any auto completion of the search term. PARTICIPANTS/MATERIALS SETTING METHODS: A literature search was conducted for literature relating to AI applications to IVF. Primary outcomes of interest were accuracy, sensitivity, and specificity of the embryo morphology grade assessments and the likelihood of clinical outcomes, such as clinical pregnancy after IVF treatments. Risk of bias was assessed using the Modified Down and Black Checklist. MAIN RESULTS AND THE ROLE OF CHANCE: Twenty articles were included in this review. There was no specific embryo assessment day across the studies-Day 1 until Day 5/6 of embryo development was investigated. The types of input for training AI algorithms were images and time-lapse (10/20), clinical information (6/20), and both images and clinical information (4/20). Each AI model demonstrated promise when compared to an embryologist's visual assessment. On average, the models predicted the likelihood of successful clinical pregnancy with greater accuracy than clinical embryologists, signifying greater reliability when compared to human prediction. The AI models performed at a median accuracy of 75.5% (range 59-94%) on predicting embryo morphology grade. The correct prediction (Ground Truth) was defined through the use of embryo images according to post embryologists' assessment following local respective guidelines. Using blind test datasets, the embryologists' accuracy prediction was 65.4% (range 47-75%) with the same ground truth provided by the original local respective assessment. Similarly, AI models had a median accuracy of 77.8% (range 68-90%) in predicting clinical pregnancy through the use of patient clinical treatment information compared to 64% (range 58-76%) when performed by embryologists. When both images/time-lapse and clinical information inputs were combined, the median accuracy by the AI models was higher at 81.5% (range 67-98%), while clinical embryologists had a median accuracy of 51% (range 43-59%). LIMITATIONS REASONS FOR CAUTION: The findings of this review are based on studies that have not been prospectively evaluated in a clinical setting. Additionally, a fair comparison of all the studies were deemed unfeasible owing to the heterogeneity of the studies, development of the AI models, database employed and the study design and quality. WIDER IMPLICATIONS OF THE FINDINGS: AI provides considerable promise to the IVF field and embryo selection. However, there needs to be a shift in developers' perception of the clinical outcome from successful implantation towards ongoing pregnancy or live birth. Additionally, existing models focus on locally generated databases and many lack external validation. STUDY FUNDING/COMPETING INTERESTS: This study was funded by Monash Data Future Institute. All authors have no conflicts of interest to declare. REGISTRATION NUMBER: CRD42021256333.

Prevalence of Thrombocytopenia in the First Week After Burn Injury and Its Relationship With Burn Severity in Shahid Motahari Hospital Over a Period of 6 Months in 2017.

A platelet count of less than 150,000 per microliter of blood is called thrombocytopenia. Platelet count monitoring is essential in the care of burn patients. The aim of this study was to evaluate platelet count in groups of patients with different percentage of burns on the body surface and its relationship with the severity of burns and mortality. This retrospective descriptive cross-sectional study was performed on patients admitted to Shahid Motahari Hospital over a period of six months. The study was conducted on burn patients who were admitted to the hospital on the first day after injury. Patients were divided into two groups of with or without thrombocytopenia in the first week. Demographic information and treatment information about the patients were recorded. SPSS V.26 software was used for the statistical analysis of data. In this study, the prevalence of thrombocytopenia in the first week after burns was 36%. The variables of age, sex, duration of hospitalization, burn agent, percentage of burns and use of silver sulfadiazine ointment were significantly different in the two groups of patients. The group without thrombocytopenia had a mortality rate of 5.1%, while the group with thrombocytopenia had a rate of 32.2%. Based on the results of this study, thrombocytopenia is significantly associated with mortality in burn patients. Furthermore, the results of this study indicate that age, sex, burn agent, percentage of burns, and the use of silver sulfadiazine ointment have a clear impact on the thrombocytopenic status of patients.

La thrombopénie est définie par un compte plaquettaire <150 000/mm3, et la surveillance de la numération plaquettaire (NP) fait partie de la biologie de routine chez les brûlés. Cette étude a pour but l'évaluation de la cinétique de la NP chez des brûlés sur des surfaces variables et sa relation avec la sévérité de la brûlure et la mortalité. Il s'agit d'une étude rétrospective auprès de patients admis dans les 24h suivant leur brûlure dans le CTB de l'hôpital Shahid Motahari durant une période de 6 mois. Nous avons comparé ceux ayant subi une thrombopénie dans la première semaine aux autres (démographie, traitement), les statistiques ayant été réalisées avec SSPS version 26. La prévalence de la thrombopénie précoce est de 36%. Âge, sexe, cause, surface brûlée, recours à la sulfadiazine argentique et durée d'hospitalisation étaient différents entre les deux groupes. La mortalité des patients thrombopénique était de 32,2% VS 5,1%. Elle est significativement associée à la mortalité. L'âge, le sexe, la cause, la surface et la sulfadiazine argentique sont associées à la survenue de thrombopénie.

Epidemiology and Etiology of Burns in Iran Through the Examination of the Economic, Social and Educational Situation.

Burn accidents continue to cause severe physical, psychological and economic damage to individuals and communities, especially in low- and middle-income countries. The present study was designed and conducted to investigate the epidemiology and identify the causes/mechanisms of burns in Iran, focusing on the economic, social and educational status of patients. This is a survey study that was performed from August 2016 to October 2017 on patients referred to Shahid Motahari University Hospital in Tehran. Samples included all patients whose parents or children were able to answer the questions. The data was extracted and analysed with SPSS Statistics v. 21. A total 1708 patients participated. Most of the patients were 19 to 39 years old. 70.6% had achieved a high school diploma or lower, and 11.5% patients were illiterate. Most of the patients lived in urban areas (91.7%) and in most cases, 4 people or less lived in a common space. Heat burns, chemical (acid) burns, and electrical burns account for the majority of cases. Most patients were unfamiliar with safety standards for burn prevention, safely stopping a fire, and fire safety equipment (alarms and extinguishers). The most common burn mechanisms were hot liquids inside the kitchen (12.6%) and gas explosion (11.9%). Based on these findings, the implementation of codified training programs, continuous control and monitoring of the safety standards in home and work environments, and the establishment of laws to standardize cooking and heating equipment will play an important role in reducing burn injuries in our country.

Les brûlures ont des conséquences physiques, psychologiques et économiques sévères (ces dernières aussi bien vis à vis de l'individu que de la communauté), en particulier dans les pays à IDH moyen et bas. Cet étude avait pour but d'explorer l'épidémiologie (causes et mécanismes) des brûlures en Iran et de rechercher des corrélations avec les statuts socio-économique et éducatif. Elle a été réalisée entre août 2016 et octobre 2017 auprès des 1 078 patients hospitalisés au CHU Shahid Motahari de Téhéran capables (eux même ou leur entourage) de répondre à notre questionnaire. Les données ont été extraites et analysées avec SSPS 21. La majorité des patients était âgés de 19 à 39 ans, 70,6% avaient reçu un enseignement de niveau lycée au plus haut et 11,5% étaient illettrés. Ils étaient urbains pour 91,7% d'entre eux, dans une habitation renfermant 4 personnes ou moins. La majorité des brûlures étaient thermiques, électriques ou chimiques. Peu de patients connaissaient les mesures de prévention globales, d'extinction d'un feu et de matériel d'extinction ou de détection de fumées. Les 2 mécanismes les plus fréquents étaient l 'ébouillantement dans la cuisine (12,6%) et l'explosion de gaz (11,9%). Ces données rendent nécessaire le déploiement de mesures d'éducation et surveillance des moyens de sécurité, au domicile comme au travail. Légiférer sur les équipements de cuisson et de chauffage permettrait aussi de réduire l'incidence des brûlures dans notre pays.

Investigation Of Common Burn Mechanisms, And Training And Safety Conditions In The Workplace.

Workplace burn injuries are associated with significant physical, psychological, and social challenges. This study was designed and conducted to investigate the common burn mechanisms, and training and safety conditions in the workplace. The study is a cross-sectional study that was performed on patients admitted to Shahid Motahari University Hospital in Tehran from August 2016 to October 2017. Samples consisted of patients who suffered burns at work and were able to answer research questions. Data were recorded in tablets by electronic patient registration forms.Of the total burn patients under study, 14.28% were injured in the workplace. The burns were mainly thermal, followed by electrical, chemical, and inhalation burns. 38.2% of patients were not trained for safety measures at work and 27.8% of patients were not given personal protective equipment. 39.0% of workspaces were not safe against the risk of burns. Failure of devices and equipment was the cause of 28.8% of the accidents. Electrical damage, the ignition of flammable materials, gas explosions and contact with molten materials were the most common mechanisms in the occurrence of workplace burns. The lack of awareness by workers, lack of attention to the use of safety equipment at work, and the presence of damaged equipment are the main causes of burn accidents in the workplace. Therefore, the implementation of codified safety training and monitoring the observance of safety measures by workers and employers are recommended.

Les brûlures sur le lieu de travail ont des conséquences physiques, psychiques et sociales. Nous avons étudiés les circonstances de survenue de ces accidents, les conditions de sécurité et l'entraînement (au mesures de sécurité, NDRLF). Elle a été réalisée auprès de tous les patients admis au CHU Shahid Motahari de Téhéran entre août 2016 et octobre 2017. Sur l'ensemble des patients, 14,28% avaient subi un accident de travail (AT). Les brûlures étaient, par ordre décroissant, thermiques (matériel inflammable, explosion de gaz, contact avec liquide en fusion), électriques, chimique et pour finir lésions isolées d'inhalation. Un entraînement n'avait pas été dispensé à 38,2% des blessés ; 27,8% d'entre eux ne disposaient pas d'Équipement Personnel de Protection (EPP), 39% des sites n'étaient pas sécurisés contre l'incendie. L'absence de formation spécifique, l'absence d'utilisation des EPP et du matériel défectueux sont les facteurs de risque le plus souvent retrouvés en cas d'AT. Nous recommandons donc le développement de protocoles de préventions adossés à des audits de leur respect, tant par l'encadrement que par les ouvriers.

Effectiveness of incorporating occupational therapy in rehabilitation of hand burn patients.

One of the main goals in the rehabilitation process of patients with burn to their hands is their return to society and their professional occupation, which has a direct positive influence on these patients' quality of life. The goal of this research project was to investigate the effect of early intervention with occupational therapy in patients with burns to their hands. The study included 30 patients with second or third degree hand burns. Patients were added to the study 12 days after their burn wounds and grafted areas had healed. They had 3 sessions of occupational therapy per week for 8 weeks. These sessions included active and passive range of motion exercises, active resistive exercises, stretching exercises and practicing activities of daily living. Functionality of the hand was assessed before and after the 8 weeks of occupational therapy using the DASH questionnaire. The average initial DASH score before intervention with occupational therapy was 60.9, and after 8 weeks of occupational therapy it was 33.9 (average difference between the pre-intervention and post-intervention DASH scores is 27 points, p < 0.001). After 8 weeks of occupational therapy, patients performed activities of daily living with a lot less difficulty, and an increase in functionality of the hands was observed. This study suggests that early intervention with rehabilitative therapies is advantageous and may result in improved hand function.

Un des buts de la rééducation des patients aux mains brûlées est la réinsertion à la société et au travail, ce qui a une influence directe sur leur qualité de vie. Le but de cette étude était d'évaluer l'effet de l'introduction précoce de l'ergothérapie dans le programme de rééducation de 30 patients brûlés des mains (2ème et 3ème degrés). Ce programme, comprenant 3 séances d'ergothérapie hebdomadaires pendant 8 semaines, débutait 12 j après la cicatrisation. Les séances comportaient des exercices moteurs actifs et passifs, des exercices actifs contre résistance, des étirements et des exercices mimant les mouvements de la vie quotidienne. Les capacités fonctionnelles des mains étaient évaluées avant et en fin de programme, en utilisant le questionnaire DASH. Il était initialement de 60,9 et de 33,9 en fin de programme (différence 27 points, p< 0,001). Après 8 semaines d'ergothérapie, les patients avaient beaucoup moins de difficulté à réaliser les gestes de la vie courante et on observait une augmentation des capacités fonctionnelles des mains. Cette étude suggère que l'introduction précoce de l'ergothérapie peut permettre une amélioration de la fonction des mains brûlées.

The effects of stress-coping strategies and group cognitive-behavioral therapy on nurse burnout.

The purpose of this study was to determine the effects of teaching stress-coping strategies and group cognitive-behavioral therapy on stress and burnout among nurses. Stress and burnout have always been a significant problem in nursing, which can have a direct or indirect negative impact on the individual and his/her social life. A semi-experimental study was conducted on 60 nurses by means of a pre-test and post-test design. Nurses meeting the inclusion criteria were assigned to two groups, a control group and an intervention group, by the block randomization method. The nurses in the intervention group received group cognitive-behavioral therapy. They completed the Maslach Burnout Inventory (MBI) before, immediately after and one month post intervention. There was a significant negative correlation only between burnout and work experience (r = -0.35 and p = 0.01). After intervention, burnout (p = 0.002) significantly decreased. The effectiveness of the intervention was also maintained after a month. The results showed that stress-coping strategies and group cognitive-behavioral therapy can be effective in reducing burnout. This method can be used to provide counseling services for nurses in health centres.

Le but de cette étude était d'évaluer les effets d'un apprentissage de gestion du stress (AGS) et de thérapie cognitivocomportementales de groupe (TCCG) sur le stress et le burn- out des infirmièr(e)s, reconnus comme des problèmes récurrents chez eux (elles), avec des impacts sur leur vie. Une étude semi- expérimentale pré et post- test a été conduite chez 60 infirmièr(e) s, réparti(e)s en 2 groupes (intervention I qui bénéficiait TCCG et témoin T, randomisation en blocs), après vérification des critères d'inclusion. Ils (elles) complétaient l'inventaire de burn- out de Maslach avant, juste après et 1 mois après la TCCG. On notait une corrélation inverse entre expérience et burn- out (r=-0,35 ; p= 0,01). Le burn- out décroissait significativement (p = 0,002) après intervention, effet persistant à 1 mois. Cette étude montre que AGS et TCCG semblent efficaces sur le burn- out. Elle pourrait faire partie d'une proposition de services dans les CTB.

Treatment of third-degree burn wounds in animal specimens: acellular dermis or partial-thickness skin graft.

Several dermal products have been introduced to substitute dermal tissues. In this study we review the effects of these products on repairing third-degree burn wounds and managing complications in animal specimens. Using an interventional approach, rats were randomly assigned to four groups (G1 to G4). Two wounds were created on the back of each rat. An open wound was left on the back of rats in G1; in G2, wounds were covered with a thick rat derived-ADM product and overlying thin skin graft; on G3 rats, similar third degree ulcers were made with one ulcer covered with harvested thin skin graft. In G4, ulcers were covered with a thin rat derived-ADM product and thin graft. Factors such as take rate, histopathological score, wound contracture and graft contracture were compared on the 7th, 15th, 21st and 30th day. Mean graft take rate on the 30th day in the thick ADM, thin ADM and graft group showed a significant difference (p=0.015). Histopathological score on the 30th day in the thin ADM, thick ADM and graft group showed no considerable difference. Mean graft take rate was significantly better in the thin ADM and graft group than in the thick ADM group. Wound contracture was significantly more severe in the thick ADM and control group than in the thin ADM and graft group.

Plusieurs produits ont été introduits dans le but de substituer le derme. Dans cette étude, nous avons étudié l'effet de ces produits sur la cicatrisation et la gestion des complications après brûlure expérimentale. Nous avons étudié 4 groupes (G1 à G4) de rats ayant subi deux brûlures du dos. Celles de G1 étaient laissées à l'air, G2 recevaient un Derme Artificiel Acellulaire (DAA) dérivé de rats épais recouvert d'une greffe fine, G3 recevaient une greffe conservée, G4 recevaient DAA fin et greffe fine. Le taux de prise de greffe, le score histologique, la rétraction de la brûlure et de la greffe ont été comparés à J7, J15, J21 et J30. A J30, les taux de prise de greffe étaient significativement différents entre G2, G3 et G4 (p=0,015), étant moins bons en cas d'utilisation de DAA en couche épaisse. De même, la rétraction était plus intense après utilisation de DAA en couche épaisse qu'en couche fine ou après greffe seule. Les résultats histologiques étaient comparables.

Analysis of the effect of subcutaneous injection of omental-derived cells on the healing of third degree burns in rats: a preliminary study.

Burn injury is considered a global health issue. Third degree burn wounds do not heal spontaneously and require skin grafts. Some factors could contribute to wound healing. In this study we assessed the effect of non-fatty omental cells in burn wound healing. Similar third degree burn wounds were induced on the back of 192 rats. Forty-eight of these rats were put in a control group that did not receive any treatment. The rest of the rats were put in 3 groups, each receiving a different treatment regime. Rats in group 2 had a daily application of silver sulfadiazine; group 3 rats were injected with omental cells, and group 4 rats were injected with phosphate buffer saline (PBS) once, followed by daily application of Vaseline to the burned region. Parameters such as open epidermis length, number of epidermal cell layers, granulation tissue thickness (GTT) and neutrophil density were evaluated in each group. The average open epidermis length in the omental cell group was less than in the other groups on days 10 and 20 (P<0.05). The thickness of epidermal cell layers in the group receiving cells was greater than in the other groups on all days. On the 20th day, there was a significant difference in GTT between the four groups (P<0.05). The injection of non-fatty omental cells has a positive effect on third degree burn wounds in rats.

Les brûlures sont un problème de santé publique. Celles du 3ème ne peuvent guérir spontanément et requièrent des greffes cutanées. Certains facteurs pourraient contribuer à la cicatrisation. Nous avons évalué l'effet des cellules épiploïques non adipocytaires sur la cicatrisation des brûlures. Des brûlures similaires, du 3ème degré au niveau du dos ont été infligées à 192 rats. Quatre vingt huit d'entre eux, contrôles (groupe 1), n'ont reçu aucun traitement. Les autres ont été répartis en 3 groupes recevant chacun un type de traitement. Le groupe 2 a reçu chaque jour une application de sulfadiazine argentique ; le groupe 3 a reçu une injection de cellules épiploïques ; le groupe 4 une injection de sérum salé suivis d'application journalière de vaseline. La longueur non épidermisée, le nombre de couches de cellules épidermiques, l'épaisseur du tissu de granulation et la densité de neutrophiles ont été évalués. La longueur non épidermisée à J10 et J20 était plus courte dans le groupe 3 (p<0,05). L'épaisseur des couches épidermiques était constamment supérieure dans ce groupe. À J20, les différences d'épaisseur du tissu de granulation étaient significatives entre tous les groupes. L'injection de cellules épiploïques non adipocytaires a un effet favorable sur l'évolution de brûlures du 3ème degré chez le rat.

Diabetes and foot burns.

The incidence of diabetes and diabetic foot burns is increasing worldwide. In the present study, we surveyed frequency, morbidity and mortality of diabetic foot burn patients in our centre. The study was a cross-sectional survey with one-year follow up of our adult diabetic patients with lower extremity burns. Data on demographics, cause of burn, time from injury to hospital, TBSA, presence of neuropathy and diabetic foot, treatment plan for controlling blood sugar, smoking, infection, morbidity, co-morbid diseases, amputation and mortality were gathered from patient files. Statistical analysis was done with SPSS 21 software. A p value less than 0.05 was considered significant. Of the 34,300 burn patients seen in a year, 2096 were admitted according to ABA criteria. 47 patients had diabetic foot burn. Half of them had diabetic neuropathy. 48.9% had type I diabetes and 51.1% had type II. 70.2% were male, 29.8% were female. Mean +/- SD age was 58 +/- 14 years; 14 patients were smokers and 40 had co-morbid diseases. Hypertension frequency was 44%, ischemic heart disease 25%, CVA 8.5% and renal failure 6.4%. Half of the patients had uncontrolled blood sugar. Mean +/- SD delay in admission was 2.5±1.5 (days). Mean +/- SD TBSA was 2.4 +/- 1.4%. Mean +/- SD length of stay was 11.4±6.1 (days). 8.5% underwent amputation and there were no deaths. Diabetic foot burn patients delay seeking medical attention, have a longer length of stay, more complications and more amputations than other burn patients (compared with our previous study on burn patients). Prevention and training programs are highly needed to prevent foot burns.

L'incidence du diabète et, concomitamment, des brûlures du pied chez ces patient, est en augmentation dans le monde. Nous rapportons la fréquence, la morbidité et la mortalité des brûlures du pied chez les diabétiques vues dans notre centre. Il s'agit d'une étude en cross-over avec suivi sur 1 an des adultes diabétiques avec une brûlure de l'extrémité distale des membres inférieurs. Nous avons relevé les données démographiques, les comorbidités, la cause et l'étendue de la brûlure, le délai entre brûlure et hospitalisation, le tabagisme, la présence de neuropathie et de pied diabétique, la stratégie d'équilibration glycémique, les infections, la nécessité d'amputation, la mortalité. Les analyses ont été réalisées avec SSPS 21, un p<0,05 étant considéré significatif. Deux mille quatre vingt seize des 34 300 patients vus ont été hospitalisés (en utilisant les critères de l'ABA). Quarante sept diabétiques (48,9% type 1 ; 51,1% type 2) avaient une brûlure de pied. Ils étaient âgés de 58 +/- 14 ans ; 70,2% étaient des hommes (29,8% des femmes). Quatorze étaient fumeurs, 40 avaient une pathologie associée (HTA 44%, coronaropathie 25%, insuffisance rénale 6,4%). La moitié d'entre eux avaient un diabète mal équilibré. Ils étaient admis après 2,5 +/- 1,5 jours et restaient 11,4 +/- 6,1 jours. La surface brûlée était évaluée à 2,4 +/- 1,4%. Une amputation a été nécessaire dans 8,5% des cas, aucun patient n'est mort. Les diabétiques avec un pied brûlé consultent plus tardivement, restent plus longtemps, ont plus de complications et sont amputés plus fréquemment que les autres brûlés (données d'une étude précédente). Des programmes d'éducation et de prévention sont réellement nécessaires vis-à-vis de ces patients.

Comparing the effect of colactive plus ag dressing versus nitrofurazone and vaseline gauze dressing in the treatment of second-degree burns.

Wound care quality and speed of burn healing are important factors that affect the treatment, prognosis and complications of burns. Burn care is challenging, and the ideal method controversial. The aim of this study was to compare the effects of a new dressing (ColActive dressing) in the treatment of superficial second-degree burns versus traditional dressing including Vaseline and Nitrofurazone. This was a randomized clinical trial study involving 25 cases. A superficial second-degree burn area was divided into two parts in each patient; randomly, traditional dressing was used on one area, and ColActive plus Ag dressing on the other. Every 3 days, after removing the dressings and washing the wounds, wound surface area was evaluated by medical photographic records and J image software. Wound surface area in the two groups was compared before dressing and on the 3rd, 6th, 9th and 12th day afterwards. The difference was not significant before dressing, but significant on the 3rd, 6th, 9th and 12th post-operative day. The difference was significant in both groups, but it was more prominent in the ColActive group (p<0.001) than in the traditional group (p<0.05). Considering the results of this study and good results in previous case reports, ColActive may be more effective than traditional dressing. We suggest a more comprehensive study for a longer period with a larger number of cases to compare other important variables such as scar quality, cost, and pain in the two dressings.

La qualité des soins locaux et la vitesse de cicatrisation sont d'importants paramètres affectant le traitement, le pronostic et les complications des brûlures. La méthode idéale reste encore à trouver. Le but de cet étude est de comparer un nouveau pansement (ColActive ®) au traditionnel nitrofurazone/vaseline sur les brûlures du 2ème superficiel. Il s'agit d'une étude randomisée portant sur 25 patients. Les zones de 2ème superficiel étaient divisées en 2 recevant, après tirage au sort, l'une ColActive® Plus Ag, l'autre nitrofurazone/vaseline. Après nettoyage, les photographies des brûlures étaient évaluées en utilisant Image J, à l'entrée et à J3, 6, 9 et 12. Les différences étaient significatives à J3, 6, 9, 12 avec une valeur de p plus prononcée (<0,001) dans le groupe ColActive® Plus Ag que dans le groupe contrôle (<0,05). Considérant ces résultats en faveur de l'utilisation de ColActive® Plus Ag, nous suggérons une étude plus globale, sur un nombre plus élevé de patients, comparant aussi la qualité cicatricielle, le coût et la douleur.

Introduction to a case of orf disease in a burn wound at Motahari Hospital.

Orf disease is caused by a double-stranded DNA virus of the Parapox family. Human infection is mostly due to occupational hazard and handling infected animals. Our patient was an 18-year-old woman who suffered burns in 2015. Total Burn Surface Area (TBSA) was 22% and cause of burn was flame. One week after hospital admission, she underwent skin grafts of her upper extremities. However, vegetative granulomatous ulcerations developed on the wound, resulting in the grafts failing to take. After careful investigation into the patient's history, we discovered that the water used to douse the flames was from a drinking trough for sheep. Suspecting Orf disease, we disinfected the wounds and dressing tools with Dakin's solution. We waited about 12 days to perform a new skin graft, and most of the grafted skin took. PCR test for Parapox virus was positive. Orf disease should be considered a distinct possibility in burn patients with a history of probable contamination. Manipulation of the disease in the early stages of burn wound could potentially spread it and change the degree of the wound, therefore being aware of this possibility can save the patient unnecessary pain and time. To prevent a nosocomial outbreak of Orf, wound care and wound disinfection should be scrupulously carried out. Isolation and disinfection of the entire dressing tool should be considered. Educating wound care providers in burn hospitals and scrupulous wound disinfection would protect the patient from cross contamination and allow skin grafts to take with ease, without the formation of ulcerations associated with Orf.

La maladie de Orf est causée par un virus à ADN bicaténaire du genre Parapox. L'infection humaine est principalement contractée au travail, lors de la manipulation d'animaux infectés. La patiente est une femme de 18 ans, brûlée en 2015 par flamme, sur 22 % SCT, ayant nécessité une greffe des membres supérieurs à semaine. Le développement de lésions granulomateuses ulcérées a entraîné la lyse des greffes. L'enquête étiologique a découvert que l'eau utilisée pour l'extinction des flammes provenait d'un abreuvoir pour moutons, ce qui nous a amenés à suspecter une maladie de Orf et badigeonner les lésions au Dakin. Nous avons effectuer une nouvelle greffe, en grande partie intégrée, 12 j plus tard. La PCR Parapox est revenue positive. Le syndrome d'Orf doit être évoqué chez un patient brûlé chez lequel une contamination est probable. Les interventions sur une zone brûlée infectée sont susceptibles d'acutiser l'infection en faisant évoluer défavorablement la brûlure. Ainsi, son diagnostic et son traitement préalables permettent d'éviter au patient des douleurs et un retard de cicatrisation. La désinfection optimale de la zone infectée et l'isolement du patient permettent d'éviter une dissémination nosocomiale. La formation des soignants aux mesures de prévention et d'hygiène, générales et spécifiques permet d'optimiser la prise en charge de ces patients.

Investigating the relationship between microalbuminuria and prognosis of patients with severe burns in the Motahari Burn Hospital.

Microalbuminuria seems to be a reflection of increased vascular permeability caused by systemic inflammatory response, and is likely to be a predictor of mortality, sepsis and other outcomes of severe burn patients. We investigated the impact of microalbuminuria on the prognosis of patients with severe burns. This is a prospective study on severe burn patients (above 20%) admitted in the first 24 hours after burns to the Motahari Burn Hospital. Patients' microalbuminuria was measured at admission and 48 hours later, and its relationship with patient prognosis (sepsis, renal failure, death, inhalation injury and systemic inflammatory response syndrome) was analyzed. We concluded that microalbuminuria at admission in patients with severe burns was directly related to inhalation injury (P = 0.018), ARDS during hospitalization (P = 0.001) and length of hospital stay (P = 0.025). Moreover, microalbuminuria at 48 hours after admission had a direct connection with patient death (P = 0.001), sepsis (P = 0.001), renal failure (P = 0.001) and SIRS (P = 0.001). Microalbuminuria is a simple, noninvasive, fast and affordable test to predict sepsis, mortality, renal failure, systemic inflammatory response and a finding associated with inhalation injury in severe burn patients, making it a fast prognostic predictor that helps to improve the management of these patients.

Une microalbuminurie semble traduire l'augmentation de perméabilité capillaire due à une réaction inflammatoire systémique et pourrait être un paramètre pronostic de mortalité, sepsis et autres évolutions des patients gravement brûlés. Nous avons étudié la relation entre microalbuminurie et devenir des patients sévèrement brûlés. Il s'agit d'une étude conduite chez des patients brûlés sur plus de 20% de SCT admis dans le CTB Motahari dans les 24 h suivant l'accident. La microalbuminurie a été mesurée à l'entrée et à h48 et son association avec une inhalation de fumée ainsi qu'avec le devenir du patient (sepsis, insuffisance rénale, décès, réponse inflammatoire systémique) a été analysée. La microalbuminurie à l'entrée est associée avec l'inhalation de fumées (p=0,018), la survenue d'un SDRA (p=0,001) et la durée d'hospitalisation (p=0,025). La microalbuminurie à h48 est associée au décès (p= 0,001), au sepsis (p= 0,001), à l'insuffisance rénale (p= 0,001) et au SIRS (p= 0,001). La microalbuminurie est un marqueur simple, rapide et abordable, fortement corrélé au sepsis, à la mortalité, à l'insuffisance rénale, au SIRS, fréquemment associé à une inhalation de fumées. Ceci en fait un marqueur pronostic rapide pouvant aider à améliorer la prise en charge de ces patients.

LA50 in burn injuries.

Burn injuries put a huge financial burden on patients and healthcare systems. They are the 8th leading cause of mortality and the 13th most common cause of morbidity in our country. We used data from our Burn Registry Program to evaluate risk factors for mortality and lethal area fifty percent (LA50) in all burn patients admitted over two years. We used multiple logistic regressions to identify risk factors for mortality. LA50 is a reliable aggregate index for hospital care quality and a good measure for comparing results, also with those of other countries. 28,690 burn patients sought medical attention in the Emergency Department, and 1721 of them were admitted. Male to female ratio was 1,75:1. 514 patients were under 15 years old. Median age was 25 (range: 3 months - 93 years). Overall, probability of death was 8.4%. LA50 was 62.31% (CI 95%: 56.57-70.02) for patients aged 15 and over and 72.52% (CI 95%: 61.01-100) for those under 15. In the final model, we found that Adjusted OR was significant for age, female sex, TBSA and inhalation injury (P < 0.05). LA50 values showed that children tolerate more extensive burns. Female sex, burn size, age and inhalation injury were the main risk factors for death. Authorities should pay special attention to these variables, especially in prevention programs, to reduce mortality and improve patient outcome. Children have better outcome than adults given equal burn size. Suicide rates are higher for women than men in our country.

Les brûlures sont responsables d'une lourde charge financière pour les patients et les systèmes de santé. Elles représentent dans notre pays la 8ème cause de mortalité et la 13ème cause de morbidité. En utilisant les données de 2 ans du programme de surveillance des brûlures, nous avons évalué les facteurs de risque de mortalité (par régression logistique) et la surface létale 50% (SL50). Cette mortalité 50% est un bon indicateur d'efficacité de soins et de comparaison entre centres et pays. Le service d'accueil des urgences a pris en charge 28 690 patients parmi lesquels 1 721 ont été hospitalisés. Le ratio hommes/femmes était de 1,75/1. Cinq cent quatorze patients avaient moins de 15 ans. L'âge médian était de 25 ans (3-93). La mortalité globale était de 8,4%. La SL50 était de 63,31% SCT (CI95 56,57-70,02) au-delà de 15 ans et de 72,52% SCT (CI95 61,01-100) en deçà. Les facteurs de risque de mortalité étaient l'âge, le sexe féminin, la surface brûlée et l'inhalation de fumées, paramètres sur lesquels devraient s'appuyer les campagnes de prévention. Les brûlures volontaires sont, dans notre pays, plus fréquentes chez les femmes que chez les hommes.

Intraoperative cerebral hypoperfusion and electroencephalogram suppression resulting in neurological complications after cardiac surgery : the need for an in depth investigation.

Reports on the demographic profile of older populations estimate that, in 2050, 19 countries will have at least 10% of their population aged 80 years or more. Many high risk elderly patients undergo cardiac surgery. In addition, advanced age has been shown to be a strong predictor of adverse neurological outcome. Despite sig- nificant improvements achieved in the perioperative care of cardiac surgical patients, neurological complications remain a global health issue. Recent findings have pointed out that cerebral hypoperfusion and too deep levels of anesthesia are major sources of adverse neurological outcomes. Cerebral near-in-frared spectroscopy provides information about cerebral perfusion non-invasively, and is increasingly used. Depth of anesthesia is evaluated using monitors that are based on processed electroencephalogram. This non-systematic review focuses on the results of studies performed with each monitor separately, and the need for a combined evaluation of their utility and eventual impact on neurological outcomes. The use of a combined cerebral monitoring strategy based on the two aforementioned monitors is proposed in order to optimize cerebral outcomes.

A mechanistic model for oxide growth and dissolution during corrosion of Cr-containing alloys.

We have developed a corrosion model that can predict metal oxide growth and dissolution rates as a function of time for a range of solution conditions. Our model considers electrochemical reactions at the metal/oxide and oxide/solution interfaces, and the metal cation flux from the metal to the solution phase through a growing oxide layer, and formulates the key processes using classical chemical reaction rate or flux equations. The model imposes mass and charge balance and hence, is labeled as the Mass Charge Balance (MCB) model. Mass and charge balance dictate that at any given time the oxidation (or metal cation) flux must be equal to the sum of the oxide growth flux and the dissolution flux. For each redox reaction leading to the formation of a specific oxide, the metal oxidation flux is formulated using a modified Butler-Volmer equation with an oxide-thickness-dependent effective overpotential. The oxide growth and dissolution fluxes have a first-order dependence on the metal cation flux. The rate constant for oxide formation also follows an Arrhenius dependence on the potential drop across the oxide layer and hence decreases exponentially with oxide thickness. This model is able to predict the time-dependent potentiostatic corrosion behaviour of both pure iron, and Co-Cr and Fe-Ni-Cr alloys.

Financial burden of burn injuries in iran: a report from the burn registry program.

Understanding the cost of burn treatment is very important for patients, their families, governmental authorities and insurance companies. It alleviates patient and familial stress, provides a framework for better use of resources, and facilitates better performance between burn centers. Hospital burn costs can provide a basis for authorities to budget for acute burn treatment, for further management of chronic complications, and for planning prevention and public educational programs in Iran. To identify costs we used data from our burn registry program. Over the two-year assessment period, we treated roughly 28,700 burn patients, 1,721 of whom were admitted, with a mortality rate of 5.9%. The male to female ratio was 1.7:1 (63% male; 37% female). Flame burns were most frequent (49.8%) followed by scalds (35.7%). Mean hospital stay was 14.41 days (range 0-64 days). Mean TBSA was 17.39%. Skin grafts were carried out in 65.4% of the patients, with a mean of 5.2 surgeries per patient. The total cost of all patient admissions over the two years was US$ 4,835,000. The maximum treatment cost for one patient was US$ 91,000. The mean cost per patient was US$ 2,810 (29,500,000 Rials). The mean cost for each percent of burn was US$ 162. The mean cost for a one-day stay in hospital was US$ 195. The mean cost of each operation was US$ 540. Patients who contracted infections endured longer hospital stays, meaning increased costs of US$ 195 per day. With comparable outcome and results, the cost of burn treatment in Iran is cheaper than in the US and Europe.

Connaître le coût du traitement d'un brûlé est très important pour les patients, leur famille, les autorités gouvernementales et les compagnies d'assurance. Ces informations peuvent rassurer les familles, donner des bases pour adapter les subsides gouvernementaux (pour la prise en charge initiale et celle des séquelles) et promouvoir une meilleure utilisation des ressources dans les services concernés. Afin de modéliser le coût de la prise en charge d'un patient brûlé, nous avons examiné les données de notre service. Au cours de deux ans d'évaluation, nous avons traité environ 28 700 patients brûlés, parmi lesquels 1 721 ont été hospitalisés, avec une mortalité de 5.9%. Le rapport hommes-femmes était de 1,7:1 (63% d'hommes; 37% de femmes). Le coût total global était 4 835 000$ (maximum pour un patient 91.000$), soit un coût moyen de 2 810$ (29,5 millions de rials). Le coût moyen par « pour cent brûlé ¼ était de 162$, de 195$ par journée d'hospitalisation et de 540$ par intervention chirurgicale, ce qui se révèle inférieur aux coûts observés aux États-Unis et en Europe.