Clinical features of gastroesophageal reflux disease and erosive esophagitis: Insights from patients undergoing esophagogastroduodenoscopy in resource-limited Ethiopia.

BACKGROUND: Gastroesophageal reflux disease (GERD) is a common disease worldwide with varying clinical presentations and risk factors. Prevalence data for Africa is lacking, but an increasing trend is expected due to demographic and epidemiological transitions. Although endoscopic studies for general gastrointestinal disorders have shown some patients with erosive esophagitis (EE), no studies in Ethiopia have investigated the clinical characteristics, risk factors, and severity of GERD using esophagogastroduodenoscopy (EGD). AIM: To assess the clinical features of GERD in Ethiopian patients who underwent EGD and determine the severity and risk factors of EE. METHODS: We conducted a multicenter, retrospective cross-sectional study of 221 patients diagnosed with GERD and endoscopic findings of EE at Trauma Associated Severe Hemorrhage and Amniotic Membrane Stem Cell between January 2019 and August 2022. Data were collected from electronic medical records and phone call interviews. We used descriptive statistics and binary logistic regression analysis with SPSS version 26 to identify the association between variables with a statistical significance set at P value < 0.05. RESULTS: The mean ± SD age of the patients was 44.8 (± 15.9) years, with a male-to-female ratio of 1.6:1. The most commonly reported symptom was epigastric pain (80.5%), followed by heartburn (43%). Los Angeles (LA)-A EE was diagnosed in 71.1% of patients, followed by LA-B (14.9%), LA-C (7.7%), and LA-D (5.9%). Multivariate analysis showed that age 50 or above, presence of bleeding, and endoscopic findings of duodenitis/duodenopathy were significantly associated with severe EE (P < 0.05). Stricture and Barrett's esophagus were observed in 4.5% and 1.36% of patients with EE, respectively. CONCLUSION: Most of the patients had milder EE with fewer complications. However, severe EE was more prevalent in older patients and those with duodenitis/duodenopathy.

Prophylactic Systemic Antibiotic and Systemic Glucocorticoid Therapy After Burn Inhalation Injury: A Report of Two Cases and Review of Literature.

Burn inhalation injury is a significant risk factor for mortality in burn patients. Despite the considerable progress made in the treatment of burn inhalation injury, there remains no consensus on the appropriate course of treatment, leading to ongoing controversy regarding the use of prophylactic systemic antibiotics and systemic glucocorticoids. This study presents two cases of burn inhalation injury diagnosed by fiberoptic bronchoscopy and treated with systemic glucocorticoids and prophylactic systemic antibiotics. By conducting a literature review, this study aimed to discuss the application of systemic glucocorticoids and prophylactic systemic antibiotics in patients with burn inhalation injuries. The suitability of prophylactic systemic antibiotics and systemic glucocorticoids for treating burn inhalation injury patients necessitates a comprehensive assessment of the patient's condition and an accurate judgment of the course of their disease.

AN OUTBREAK OF EXTENSIVELY DRUG-RESISTANT ACINETOBACTER BAUMANNII IN A BELGIAN TERTIARY BURN WOUND CENTER.

The burn intensive care unit (ICU) of the Queen Astrid Military Hospital experienced an outbreak with an extensively drug-resistant Acinetobacter baumannii (XDR-Ab) strain, which began when all burn wound patients from all over Belgium were sent there as part of the national COVID-19 action plan. The purpose of this study is to report on the investigation and strategies that were implemented to contain the outbreak. Between October 2020 and May 2021, five of the 72 patients admitted to the ICU met the acute outbreak case definition (attack rate 7%). Their median age was 46 years and their median total body surface area burned was 39%. All patients developed at least one XDR-Ab infection, with in total three pulmonary, three bloodstream and five burn wound infections. One patient died. All XDR-Ab isolates were only susceptible to colistin. Whole genome sequencing of the isolates from the first two patients revealed an identical A. baumannii ST2 genotype, suggesting an outbreak. XDR-Ab-positive patients were cohorted with dedicated staff. The infection control team intensified its training on hand hygiene, excreta management and bio-cleaning procedures. Concurrently, 30 environmental samples were collected, which proved negative for XDR-Ab. Spatio-temporal associations were found for all XDR-Ab-positive patients, suggesting cross-transmission via staff's hands. We describe an XDR-Ab outbreak in a burn ICU over a seven-month period, in a context of increased workload. This series underlines the importance of a correct staff-to-patient ratio, especially in outbreak situations.

L'unité de soins intensifs (USI) pour brûlés de l'Hôpital Militaire Reine Astrid a connu une épidémie avec une souche d'Acinetobacter baumannii extrêmement résistante aux antibiotiques (XDR-Ab), qui a commencé pendant la période où tous les patients brûlés de Belgique y étaient référés à la suite du plan national COVID-19. Le but de cette étude est de décrire l'enquête épidémiologique et les stratégies utilisées pour contenir l'épidémie. Entre octobre 2020 et mai 2021, cinq des 72 patients admis à l'USI ont répondu à la définition de cas (taux d'attaque 7%). L'âge médian était de 46 ans, la surface corporelle brûlée médiane de 39%. Tous les patients ont développé au moins une infection par XDR-Ab : trois pneumonies, trois bactériémies et cinq infections de brûlures. Un patient est décédé. Tous les isolats XDR-Ab n'étaient sensibles qu'à la colistine. Le séquençage du génome entier des isolats des deux premiers patients a révélé un génotype identique d'A. baumannii ST2, suggérant une épidémie. Les patients XDR-Ab positifs ont été cohortés avec du personnel dédié. L'équipe d'hygiène hospitalière a intensifié sa formation sur l'hygiène des mains, la gestion des excréta et les procédures de bio-nettoyage. Simultanément, 30 échantillons environnementaux ont été collectés, qui étaient négatifs pour XDR-Ab. Des liens spatio-temporels ont été trouvés pour tous les patients XDR-Ab positifs, suggérant une transmission croisée manuportée. Nous décrivons une épidémie de XDR-Ab dans une USI pour brûlés sur une période de sept mois, dans un contexte de charge de travail accrue. Cette série souligne l'importance d'un ratio personnel-patients approprié, en particulier dans les situations d'épidémie.

CONSENSUS ON THE APPLICATION AND CARE OF BROMELAIN-BASED ENZYMATIC DEBRIDEMENT ON BURNS.

Treatment of burned patients involves early excision of the burn. The approach to this excision has changed since bromelain-based enzymatic debridement was introduced. This treatment option reduces complications from the surgical procedure and improves scar quality. It is indicated for partial and full thickness burns. It is important to agree on the nursing care before, during and after enzymatic debridement treatment to ensure an optimal preparation and maintenance of the wound bed for later treatment to be most successful. A multi-centre Delphi study was conducted with enzymatic debridement nursing care on burned patient experts. A coordinating group developed a 29-item questionnaire based on clinical guidelines and experience. Two question rounds were asked, reaching consensus on answers > 70%. Nine panellists from nine leading burns centres in Spain participated. The aim was to develop a national consensus on enzymatic debridement treatment based on clinical practice and evidence from almost 1500 cases. The experts reached 29 agreements on different aspects of treatment and patient condition: general considerations about the treatment, burned patient admission, treatment prior to enzymatic debridement, applying debridement, removing enzymatic debridement and the post-enzymatic debridement phase. The expert consensus on nursing care of the burn patient and application of bromelain-based enzymatic debridement includes general recommendations for the patient before, during and after application and the planning of localised care after debridement. This consensus document supports knowledge on enzymatic debridement technique, increasing safety in clinical nursing practice and ensuring successful treatment for the patient.

L'excision précoce est la référence dans le traitement des brûlures. Sa technique a été transformée par le débridement enzymatique à la bromélaïne. Cette technique, indiquée dans les brûlures intermédiaires et profondes, réduit les complications chirurgicales et améliore la qualité cicatricielle. La qualité des soins locaux, avant, pendant et après l'application de bromélaïne, est un paramètre important d'efficacité. Nous avons organisé une étude basée sur la méthode Delphi auprès de 9 experts de 9 CTB espagnols. Le groupe de coordination a réalisé un questionnaire à 29 items à partir des recommandations et de leur expérience (quasiment 1 500 cas au total). Deux séances ont été organisées, dans le but d'obtenir les agréments de plus de 70% des participants. Un consensus a été obtenu sur les 29 questions posées, se rapportant aux généralités, aux critères d'admission, au traitement avant bromélaïne, à son application, à son retrait et aux soins ultérieurs. Les recommandations de soins locaux consécutives recouvrent les phases avant, pendant et après utilisation. Elles permettent une amélioration de l'efficacité et de la sécurité du débridement enzymatique.

COMPARATIVE STUDY OF STRIPED CATFISH (PANGASIUS HYPOPHTHALMUS) SKIN, NILE TILAPIA (OREOCHROMIS NILOTICUS) SKIN, AND PORCINE SKIN AS A XENOGRAFT MATERIAL FOR BURN WOUND.

Burn injury remains a health problem, specifically in Indonesia. In major burns, xenograft has been proved to be useful as temporary wound coverage. However, some xenografts are not widely available due to cultural, financial and religious backgrounds, or have an unesthetic appearance, such as the scaly appearance of tilapia fish xenograft. Striped catfish (Pangasius hypophthalmus) is a scaleless fish that has abundant type 1 collagen. This study aimed to compare striped catfish skin to commonly used xenograft (Nile tilapia and porcine skin) as xenograft material for burn wound. In this experimental study, nine different skin samples of striped catfish, Nile tilapia and porcine were prepared and histologically examined using hematoxylin-eosin stained samples. Macroscopic and microscopic features of each sample were documented and analysed. The macroscopic skin appearances of striped catfish were hairless and scaleless with black-silver color and moderate thickness. As for microscopic features, the epidermal thickness of striped catfish skin (8.49±1.60 µm) was significantly different to both Nile tilapia (2.18±0.37 µm; p<0.001) and porcine skin (42.22±14.85 µm; p=0.002). The dermal thickness of striped catfish skin (288.46±119.04 µm) was similar to Nile tilapia (210.68±46.62 µm; p=0.783) but differs significantly to porcine skin (1708.44±505.12 µm; p<0.001). The integrity and collagen organization of striped catfish was also similar to tilapia based on semi-quantitative histology scoring system (p>0.05). Striped catfish had potential macroscopic appearance and comparable microscopic features to Nile tilapia; smoother macroscopic appearance, thicker epidermis, and similar dermis thickness. Therefore, we believe it can be potentially used as a xenograft material. Further studies are required to evaluate the effectiveness and feasibility of striped catfish xenograft in burn wound management.

Les brûlures restent un problème de santé publique, en Indonésie comme ailleurs. Les xénogreffes ont montré leur utilité comme couverture temporaire en cas de brûlure étendue. Certaines xénogreffes peuvent n'être pas utilisables pour des raisons financières, culturelles ou religieuses. L'aspect écaillé des xénogreffes de tilapia peut aussi rebuter. Le silure- requin a une peau dépourvue d'écaille, abondante en collagène de type 1. Cette étude expérimentale compare cette xénogreffe à celles de tilapia du Nil et de porc. Neuf biopsies cutanées de silure- requin, tilapia du Nil et de porc ont été examinées macroscopiquement et histologiquement (après coloration hématoxyline- éosine). Macroscopiquement, la peau de silure- requin est glabre, dépourvue d'écaille, argent à noire et d'épaisseur modérée. Microscopiquement, l'épiderme du silure- requin (8,49 +/- 1,6 µm) est plus épais que celui du tilapia du Nil (2,18 +/- 0,37; p<0,001) et moins épaisse que celui du porc (42,22 +/- 14,85; p = 0,002). L'épaisseur du derme du silure- requin est comparable à celle du tilapia du Nil (288,46 +/- 119,04 VS 210,68 +/- 46,62 µm; p = 0,783), nettement plus fin que celui du porc (1 708,44 +/- 505,12 µm; p < 0,001). L'organisation du collagène, évaluée par un score histologique semi- quantitatif, est similaire chez les 2 poissons. Ces aspects macroscopique et microscopique de la peau du silurerequin en font un candidat à la xénogreffe, devant être étudié plus avant.

Simultaneous viscoelasticity and sprayability in antimicrobial acetic acid-alginate fluid gels.

Acetic acid is a promising alternative to antibiotics for topical applications, particularly burn wounds, however its site specificity and retention are impaired by poor material properties. In this study, acetic acid was investigated as both the gelling agent and antimicrobial active in alginate fluid gels. The formed microstructure was found to be directly dependent on acetic acid concentration, leading to highly tuneable material properties. At clinically relevant concentrations of 2.5-5 % acetic acid, the fluid gels were elastically dominated at rest, with viscosities up to 7 orders of magnitude greater than acetic acid alone. These material properties imparted long term surface retention and microparticle barrier function, not seen with either acetic acid or alginate solutions. Most notably, sprayability was enhanced simultaneously with the increased viscosity and elasticity due to the introduction of a discretised microstructure, leading to a remarkable tenfold increase in spray coverage. Formulation was found not to inhibit antimicrobial activity, despite the less acidic pH, with common burn wound pathogens Staphylococcus aureus and Pseudomonas aeruginosa being equally susceptible to the fluid gels as to acetic acid solutions.

EPIDEMIOLOGIC AND THERAPEUTIC APPROACHES TO SEVERE BURN INJURY IN KOSOVO: A COMPREHENSIVE REVIEW.

The aim of this study is to provide a comprehensive review of the current therapeutic approaches to severe burn injuries. The study will cover the epidemiology of burn injuries, treatment options and adjunctive therapies. It will also emphasize the importance of a multidisciplinary approach in treatment options and discuss current challenges and future directions for research in the treatment of burns. This study aims to provide updated, evidence-based information and guidelines for medical professionals involved in the management of severe burn injuries, and to improve care and outcome for patients affected by these injuries. The WHO states that burn injuries are a major public health concern worldwide, with an estimated 180,000 deaths annually, with the majority of these deaths occurring in low- and middle-income countries.

Le but de cette étude est de présenter une revue exhaustive de la prise en charge des brûlés sévèrement atteints. Ceci comprend l'épidémiologie, la stratégie thérapeutique et les traitements adjuvants. Elle met en avant l'importance d'une approche multidisciplinaire, les difficultés actuelles et les directions prises par la recherche. Elle veut améliorer les soins et le devenir des patients au moyen de la mise à disposition des professionnels des dernières données factuelles et des recommandations actuelles. L'OMS indique que les brûlures représentent un problème de santé publique à l'échelle mondiale, responsables annuellement de 180 000 décès, survenant en majorité dans les pays à niveau de développement bas ou moyen.

Bufalin Regulates STAT3 Signaling Pathway to Inhibit Corneal Neovascularization and Fibrosis After Alkali Burn in Rats.

PURPOSE: Bufalin (BU) is a bioactive ingredient extracted from the skin and parotid venom glands of Bufo raddei, which can effectively inhibit angiogenesis. The aim of this study was to investigate whether BU could affect corneal neovascularization (CoNV). METHODS: A rat CoNV model (right eye) was constructed by administration of NaOH, and the left eye served as a control. Corneal damage scores of rats were detected. Hematoxylin & eosin, TUNEL, and Masson staining examined pathological changes, apoptosis, and fibrosis of corneal tissues. Immunohistochemistry and western blotting assessed the expression of proteins. RESULTS: BU intervention resulted in a significant reduction in corneal inflammatory cells, repair of corneal epithelial hyperplasia, significant reduction in stromal edema, and reduction in vascular proliferation. BU can inhibit corneal neovascularization. CONCLUSION: This study demonstrated that BU inhibits CoNV, fibrosis, and inflammation by modulating the STAT3 signaling pathway, elucidating the intrinsic mechanism of its protective effect. BU has great potential in the treatment of CoNV caused by corneal alkali burns.

Advanced biomarker clustering analysis reveals mortality predictors in burn patients with sepsis.

This study addresses the challenge of predicting mortality in sepsis among burn patients. Given the heterogeneity of sepsis, especially in the context of burn injuries, this study aims to identify reliable biomarkers for mortality prediction. The study is a retrospective review, focusing on the evaluation of various biomarkers and their changes over time in a burn patient cohort. Conducted in the Burn Intensive Care Unit of Hangang Sacred Heart Hospital, the study involved a retrospective review of 1,659 adult burn patients from January 2010 to December 2022. Key biomarkers analyzed include lactate levels, pH, platelets, procalcitonin, and others. Advanced clustering methodologies, such as dynamic time warping and hierarchical clustering, were utilized to classify patients into distinct groups based on their biomarker profiles and clinical outcomes. The study identified four patient clusters with unique lactate level trajectories. Significant findings include the identification of procalcitonin, pH, and platelets as key predictors of mortality, with varying degrees of efficacy across different clusters. For instance, in the "Persistent Rise" cluster, pH and platelet count showed Area Under the Curve (AUC) values of 0.756 and 0.753, respectively, indicating their strong predictive power. The study concludes that a combination of biomarkers, especially lactate dynamics, can effectively predict mortality in burn-induced sepsis. The results advocate for a more personalized approach in managing sepsis in burn patients, considering the specific biomarker trajectories. These findings are crucial for enhancing treatment strategies and improving patient outcomes in burn care.

A multi-centre prospective cohort study investigating the roles of psychological flexibility and self-compassion in appearance concerns after burn injuries.

OBJECTIVES: Appearance concerns following burn injuries are common. Psychological factors are important in maintaining such concerns. However, there is a lack of longitudinal or prospective research investigating their development. This study investigated whether psychological flexibility and self-compassion at hospital admission predicted subsequent appearance concerns. DESIGN: A multi-centre prospective cohort study across six burn services. METHODS: Adults (n = 175; 67% male) in hospital following burn injuries were recruited. Questionnaires measuring appearance concerns, psychological flexibility, self-compassion, post-traumatic stress disorder symptoms and perceived noticeability were completed during hospital admission and two- and six-months later. Demographic and burn injury information was collected. RESULTS: Correlational analyses showed that increased psychological flexibility and self-compassion at admission were associated with decreased appearance concerns cross-sectionally and prospectively at two- and six-month follow-up. These associations remained significant when controlling for key covariates (i.e. gender, age, ethnicity, percentage total body surface area burnt, perceived noticeability, PTSD symptoms). Multiple linear regression analyses revealed that psychological flexibility and self-compassion predicted appearance concerns during hospital admission. Although psychological flexibility significantly predicted appearance concerns over time, it became non-significant when controlling for baseline appearance concerns. CONCLUSIONS: Psychological flexibility has a protective role against appearance concerns soon after burn injuries, although this protective role is reduced when accounting for baseline appearance concerns. Early interventions targeting psychological flexibility (i.e. acceptance and commitment therapy) may be beneficial after burns if adapted to address appearance-related concerns.