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.

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.

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.

Improved diagnostic accuracy of breast MRI through combined apparent diffusion coefficients and dynamic contrast-enhanced kinetics.

This study investigated the relationship between apparent diffusion coefficient (ADC) measures and dynamic contrast-enhanced magnetic resonance imaging (MRI) kinetics in breast lesions and evaluated the relative diagnostic value of each quantitative parameter. Seventy-seven women with 100 breast lesions (27 malignant and 73 benign) underwent both dynamic contrast-enhanced MRI and diffusion weighted MRI. Dynamic contrast-enhanced MRI kinetic parameters included peak initial enhancement, predominant delayed kinetic curve type (persistent, plateau, or washout), and worst delayed kinetic curve type (washout > plateau > persistent). Associations between ADC and dynamic contrast-enhanced MRI kinetic parameters and predictions of malignancy were evaluated. Results showed that ADC was significantly associated with predominant curve type (ADC was higher for lesions exhibiting predominantly persistent enhancement compared with those exhibiting predominantly washout or plateau, P = 0.006), but was not significantly associated with peak initial enhancement or worst curve type (P > 0.05). Univariate analysis showed significant differences between benign and malignant lesions in both ADC (P < 0.001) and worst curve (P = 0.003). In multivariate analysis, worst curve type and ADC were significant independent predictors of benign versus malignant outcome and in combination produced the highest area under the receiver operating characteristic curve (0.85 and 0.78 with 5-fold cross validation).