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.

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.

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.

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.

Oral chromoblastomycosis: a case report.

A chronic fungal infection in tropical regions, chromoblastomycosis is caused by dematiaceous fungi, the form-family of Fungi Imperfecti, usually affecting one lower limb at the site of a trauma but sometimes involving other areas of the body including head & neck. In this article, we report the case of a rare primary chromoblastomycosis of the palate and chest in a 27-year-old man who was successfully treated with surgical resection and combined drug therapy, and eventually free tissue transfer reconstructive surgical procedure to cure the palatine defect.

Closure of palatal fistula with buccal fat pad flap.

Palatal fistula as a complication of palatal surgery is difficult to manage due to the presence of fibrotic and scarred tissue and the absence of local virgin tissue. Recurrence rates are high. To investigate the efficacy of repairing small and medium sized palatal fistulas using the buccal fat pad (BFP), 20 patients (aged 2.5-19 years) with palatal fistula (10-20mm) underwent closure surgery using a pedicled BFP flap. The nasal layer was closed by a local mucosal flap (turn down flap) and the pedicled BFP flap was used for oral lining. Full epithelialization of the BFP layer was observed within 4 weeks in all patients. A 2mm defect in the anterior part of the previous fistula location remained in one case, which spontaneously healed after 2 months; all others closed successfully. Mild pain and cheek swelling occurred in 10 patients, which disappeared within 5 days with no surgical intervention. This study suggests the pedicled BFP flap is a simple and relatively secure method for palatal fistula management. It is recommended for fistulas less than 20mm in length located in the posterior two-thirds of the palate.

Future perspectives for hand transplant in iran.

Hand transplant program is a communion of physicians and researchers during the current decade. 72 hands and digits were transplanted in 53 patients over the past 13 years. Unlike a solid organ transplant, hand transplantation involves various tissues, so it is called "composite tissue allotransplantation." This article discusses the plans for performing the first hand transplant in Iran.