Cognitive Distortions as Trauma-Specific Irrational Beliefs Among Burn Patients.

Burn injuries are most certainly stressful events, particularly when permanent disfigurement is a result. This situation can lead to the onset of irrational beliefs which can in turn lead to long-term psychological problems such as depression, anxiety, shame, guilt, posttraumatic stress, etc. The objective of this study is to explore the irrational beliefs among burn patients and its correlates in an Iranian sample. This cross-sectional study included 329 patients who had experienced disfigurement, as result of burn injuries. In order to assess irrational beliefs, a Scale for Irrational Thoughts after Burning was used. To identify correlated variables with irrational beliefs, both bivariate and multivariate analysis methods were conducted. In multivariate linear regression, forward strategy was used for building the model. The results of bivariate analysis showed that the location of the burn on bodies (body parts generally exposed in social environment or parts culturally perceived as sensitive areas of body), marital status, urbanities, age group, geographical areas, etiology of burning, and intent of injury had significant relationships with irrational beliefs (P < .05). Using forward linear regression, gender, marital status, geographical areas, etiology of burning, body burn by location (body parts generally exposed in social environment or parts culturally perceived as sensitive areas of body), and intent of injury had significant correlation with irrational beliefs. The models predicted 15.5% (P < .001) of irrational beliefs. Considering to irrational beliefs and development of facilities for screening is necessary. Moreover, consultation with mental health experts after burn injuries is highly recommended.

Men, main victims of hidradenitis suppurativa (A prospective cohort study).

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory disease presenting as painful subcutaneous nodules, characterized by multiple abscess, inter-networking sinus tracts. We present the option of surgical treatment involving wide surgical excision and methods of reconstruction as well as the rate of recurrence. METHOD: This study reviewed 44 sites in 21 patients with moderate to extensive HS treated surgically in our hospital from 2000 to 2016, with a follow up of at least 24 months. RESULTS: A total number of 44 operative procedures were performed during the study period with 13.6% (6 sites) involving axilla, 38.6% (17 sites) involving the gluteal area, 29.5% (13 sites) involving the perineal and perianal area and 11.4% (5 sites) involving the inguinal region, 4.5% (2 sites) involving the scrotal area, and 1.3% (one case) retrorectal abscess. CONCLUSION: Conservative treatment methods have little or no effects especially on gluteal, perineal/perianal and axillary hidradenitis suppurativa. The morbidity associated with the established disease is significant, and the only successful treatment is wide surgical excision.

Psychometric Properties of a New Instrument for Assessing Irrational Thoughts in Burn Victims (Scale of Irrational Thoughts After Burn Injuries).

The objective of this study was to develop and evaluate a scale for assessing irrational thoughts among burned patients. The present study was mixed (qualitative-methodologic) which was performed in several stages such as investigating similar or related scales, interviewing with patients and psychologists. Content validity was calculated by modified KAPPA basis on relevance and clarity. The reliability of the scale was measured using internal consistency and the test-retest method. To determine the construct validity, exploratory factor analysis approach using maximum likelihood extraction with varimax rotation was conducted. A total of 329 burned patients were recruited from Tehran, Tabriz, and Kermanshah provinces of Iran. Modified kappa scores were 0.80 and 0.91 for relevance and clarity of the items included in scale. The Cronbach alpha for overall scale, subscale 1, and subscale 2 were 0.89, 0.88, and 0.8, respectively. Test-retest reliability was also acceptable (intraclass correlation coefficient = 0.80). The best solution from the maximum likelihood analysis of the 39 items of the scale revealed two factors corresponding to the two subscales with 14 items that subscale 1 (self-acceptance) consisted of 10 statements accounting for 60% of the variance (eigenvalue = 5.04) and subscale 2 (distastefulness and pity) consisted of four statements accounting for 40% of the variance (eigenvalue = 1.53). The scale reflects acceptable levels of validity and reliability in assessing the irrational thoughts among Iranian patients. Moreover, the testing populations of both patients with burned faces and patients with other burned body parts indicates that the scale may also be applicable for patients' burn disfigurements on any part of their bodies.

Honey: A Skin Graft Fixator Convenient for Both Patient and Surgeon.

Skin grafts can be used effectively to cover burn injuries. A critical element of this treatment is the adherence of the graft to the wound bed. Honey has been shown to increase the adherence of skin grafts to wound beds and have antibacterial and anti-inflammatory effects and increase healing rate of wounds. We therefore devised a clinical trial to determine the effect of honey on skin graft fixation in burn injuries. Sixty patients were included in this study (in 30 patients, graft was fixed with medical honey, and in 30 patients, it was fixed with dressing or suturing). All patients in two groups were evaluated for infection, graft loss, graft contraction, severity of pain, and need for re-operation. The most common cause of burn was kerosene. Honey significantly decreased infection rate on fifth day and reduced the patient pain. The mean hospital stay was shorter in honey group. Contraction of graft was significantly less in honey group. Honey has strong adhesive properties for skin graft fixation. Medical honey is a natural material, not synthetic. For this reason, we can advise the application of medical honey for the fixation of split thickness skin graft.

Enhancement of burn wounds healing by platelet dressing.

BACKGROUND AND AIMS: The goal of this study was to evaluate the efficacy of platelet dressing in the treatment of burn wounds and compare its results with silver sulfadiazine dressing. MATERIAL AND METHODS: Between 21 march 2011 to 21 September, 50 patients with burn injuries were selected by a randomized double-blind controlled trial. In order to eliminate the biological and personal variables among the various treated burn wounds, in the same patient, distal or proximal, lateral or medial part of burn wound were selected for dressing with platelet or silver sulfadiazine. All patients were designated for homologous component use. The dressing was repeated every day up to complete healing. RESULTS: The results indicated that treatment with platelet enhanced epithelialization and accelerate epithelialization and granulation tissue formation. Platelet dressing to be most significant in this respect compared with silver sulfadiazine dressing. CONCLUSION: It is concluded that topical application of platelet enhanced the wound healing process in burn patients.

Efficacy of fibrin glue on seroma formation after breast surgery.

Background and Objectives. This study was designed to determine the effectiveness of fibrin glue plus conventional drain placement versus conventional drain placement in the prevention of seromas after breast procedures. Among methods employed to reduce seroma magnitude and duration, fibrin glue has been proposed in numerous studies, with controversial results. Design and Setting. A prospective, randomized, controlled study of subjects who were randomized into control and experimental groups was conducted. Methods. Collected data included age, surgeon, medical and surgical history, comorbidities, procedure performed, number of axillary nodes, number of positive axillary nodes collected, final pathologic diagnosis, cancer stage, hospital stay, postoperative day of drain removal, complications, incidence of seroma formation, interval to seroma resolution, and number of postoperative visits. Results. Analysis of 60 patients showed similarly matched groups. Seroma formation rate was 24.1% in the control group and 16.1% in the fibrin glue group. The rate of wound complications was similar. Conclusions. Although use of fibrin sealant resulted in a nonsignificant decrease in seroma formation rate compared with that of drain placement, the higher cost and cumbersome technique tend to indicate that there is no advantage to using fibrin glue over drain placement with the technique described.

Stress disorder and PTSD after burn injuries: a prospective study of predictors of PTSD at Sina Burn Center, Iran.

BACKGROUND: A burn injury can be a traumatic experience with tremendous social, physical, and psychological consequences. The aim of this study was to investigate the existence of post-traumatic stress disorder (PTSD) and predictors of PTSD Checklist score initially and 3 months after injury in burns victims admitted to the Sina Burn Center in north-west Iran. METHODS: This prospective study examined adult patients aged 16-65 years with unintentional burns. The PTSD Checklist was used to screen for PTSD. RESULTS: Flame burns constituted 49.4% of all burns. Mean PTSD score was 23.8 ± 14.7 early in the hospitalization period and increased to 24.2 ± 14.3, 3 months after the burn injury. Twenty percent of victims 2 weeks into treatment had a positive PTSD screening test, and this figure increased to 31.5% after 3 months. The likelihood of developing a positive PTSD screening test increased significantly after 3 months (P < 0.01). Using multivariate regression analysis, factors independently predicting PTSD score were found to be age, gender, and percentage of total body surface area burned. CONCLUSION: PTSD was a problem in the population studied and should be managed appropriately after hospital admission due to burn injury. Male gender, younger age, and higher total body surface area burned may predict a higher PTSD score after burn injury.

Generalized peritonitis requiring re-operation after leakage of omental patch repair of perforated peptic ulcer.

BACKGROUND/AIM: Peptic ulcer perforations are a common emergency, but available literature is silent on the exact definition, incidence, management, and complications of peritonitis due to omental patch leakage. PATIENTS AND METHODS: Retrospective data were collected on 422 patients who underwent omental patch repair of perforated peptic ulcer between March 20, 1999 and March 20, 2006. The definitive diagnosis of perforated peptic ulcer and omental patch leakage was obtained at surgery. RESULTS: Seventeen (4%) patients experienced generalized peritonitis due to omental patch leakage. Mean age was 60.6 years. Mortality rate was 29.4%, and the mean hospital stay was 23.6 days. Delay in surgical approach, shock on admission, and age were all significantly associated with increased mortality. CONCLUSIONS: Peritonitis due to omental patch leakage can result in significant morbidity and mortality. The most common causes of omental patch leakage and operative procedures were unknown and reinsertion of omentum, respectively. Factors such as shock on admission or delayed surgery, have significantly contributed to fatal outcomes and need careful attention.

Ambulatory treatment of chronic pilonidal sinuses with lateral incision and primary suture.

BACKGROUND: Outpatient management is appropriate for chronic pilonidal sinuses. Even though there are different surgical treatments for pilonidal sinuses, the outcome may not be uniformly satisfactory. The aim of this paper was to examine the ambulatory treatment of chronic pilonidal sinuses with lateral incision and primary suture. METHODS: We present our experience with outpatient management of asymptomatic chronic pilonidal disease. We prospectively studied patients presenting with pilonidal disease from Mar. 20, 2005, to Mar. 20, 2008. All were managed as outpatients. We reviewed presentation, treatment, healing, time off work and recurrences. RESULTS: In all, 150 patients (131 men and 19 women) with chronic pilonidal sinuses underwent ambulatory plain lateral excision and primary repair during the study period. The mean age of patients was 22.1 years. The mean duration of surgery was 18.4 minutes. No general complications occurred. Local complications consisted of 3 wound infections and 4 wound hematomas. No sinus recurrence occurred. The healing rate was fast in all patients. CONCLUSION: Advantages of ambulatory plain lateral excision and primary repair include immediate treatment, minimal pain and a quick return to normal activities. This method is a simple and effective procedure in the treatment of uncomplicated pilonidal sinuses.

A comparative study of the burn wound healing properties of saline-soaked dressing and silver sulfadiazine in rats.

The purpose of this study was to further investigate that phenomenon and to explore the effect silver sulfadiazine on wound healing. Full-thickness burn wounds were created on the dorsum of Wistar albino rats under anesthesia. The wounds were treated with silver sulfadiazine and saline-soaked dressing for fourteen days, and then observed until healed. Wound surface area was measured each three days. Time to 50% and 90% healing was compared. No clinical infections occurred. Wound half-life and healing times were shortest in the saline-soaked group (P < 0.0001) in full-thickness burns. Wound contraction was delayed by silver sulfadiazine. These data suggest that silver sulfadiazine retard burn wound healing. Infection control without delay of burn wound healing is most appealing and clinical trials are planned.

The effect of Kombucha on post-operative intra-abdominal adhesion formation in rats.

BACKGROUND: Peritoneal adhesions are fibrous bands of tissues formed between organs that are normally separated and/or between organs and the internal body wall after peritoneal injury. The aim of the study was to investigate the effect of intra-peritoneal administration of Kombucha on intra-peritoneal adhesions. MATERIALS AND METHODS: Eighty Wistar rats were subjected to standardized lesion by scraping model and were randomly divided into two groups. Group I received no treatment, and Group II received 15 ml of Kombucha solution intra-peritoneally. On the post-operative 14th day adhesion intensity score, inflammatory cell reaction and number of adhesion bands were determined. RESULTS: In the control group, there were no rats with grade 0 and I adhesions. In the group II, there were 26 rats (78.8%) with grade 0-2 adhesions. Adhesion intensity was significantly less in group II (P<0.0001). Number of adhesion bands was significantly less in group II (P<0.001). CONCLUSION: It was concluded that intra-peritoneal administration of Kombucha might be useful for preventing peritoneal adhesions.

Epidemiology and outcome of 121 cases of chemical burn in East Azarbaijan province, Iran.

AIM: To explore the epidemiology, mechanisms, complications, morbidity and mortality associated with chemical burns. METHODS: Data from 121 cases of chemical burn treated in our department over a 5-year period were compared. Data were obtained by prospective proforma. RESULTS: A mean 7.98% of total body surface area was burned. This series had a male:female ratio of 10:1, with a mean age 35.3 years. Young men experiencing work-related accidents were the most frequent victims. The majority of chemical burns occurred away from home (98.3%), particularly in the working environment (78.5%); 111 (91.7%) burns were accidental and 10 (8.3%) constituted criminal assault. Tar was the most frequent agent involved, followed by acid, and the hands were the most frequent site of injury. Most burns were small and of second degree; 10.7% of cases involved serious ocular damage. The mean hospital stay was 10 days, and the mortality rate was 1.7%. CONCLUSIONS: Constant safety education for the public and professional training for workers would reduce the incidence of chemical burns. Prevention strategies must be coordinated on a national level.

Burns in diabetic patients.

CONTEXT AND AIMS: Diabetic burn patients comprise a significant population in burn centers. The purpose of this study was to determine the demographic characteristics of diabetic burn patients. MATERIALS AND METHODS: Prospective data were collected on 94 diabetic burn patients between March 20, 2000 and March 20, 2006. Of 3062 burns patients, 94 (3.1%) had diabetes; these patients were compared with 2968 nondiabetic patients with burns. Statistical analysis was performed using the statistical analysis software SPSS 10.05. Differences between the two groups were evaluated using Student's t-test and the chi square test. P < 0.05 was considered as significant. RESULTS: The major mechanism of injury for the diabetic patients was scalding and flame burns, as was also the case in the nondiabetic burn patients. The diabetic burn patients were significantly older, with a lower percentage of total burn surface area (TBSA) than the nondiabetic burn population. There was significant difference between the diabetic and nondiabetic patients in terms of frequency of infection. No difference in mortality rate between diabetic and nondiabetic burn patients was observed. The most common organism in diabetic and nondiabetic burn patients was methicillin-resistant staphylococcus. Increasing %TBSA burn and the presence of inhalation injury are significantly associated with increased mortality following burn injury. CONCLUSIONS: Diabetics have a higher propensity for infection. Education for diabetic patients must include caution about potential burn mishaps and the complications that may ensue from burns.

The effect of piroxicam on the formation of postoperative, intraabdominal adhesion in rats.

BACKGROUND/AIMS: Peritoneal adhesions are fibrous bands of tissues formed between organs that are normally separated and/or between organs and the internal body wall after peritoneal injury. Antiinflammatory agents were used to reduce the initial inflammatory response to tissue injury and, hence, the subsequent formation of adhesion. The aim of this study was to investigate the effect of intraperitoneal instillation of piroxicam on intraperitoneal adhesions. METHODS: Eighty Wistar rats were subjected to standardized lesion by using the scraping model and were randomly divided into four groups. Group I (control) received no treatment; groups II, III, and IV received 10-12.5 mL of 0.05, 0.1, and 0.2 mg/mL piroxicam solution, respectively, after surgery. On the 14th postoperative day, the adhesion intensity score, inflammatory cell reaction, and the number of adhesion bands were determined. RESULTS: There were no rats with grade 0 adhesions in the control group. There were 10 rats (50%) with grade 2 and eight rats (40%) with grade 3 adhesions. The adhesion intensity (P < 0.0001) and the number of adhesion bands (P < 0.001) were significantly lower in groups III and IV. No significant difference was observed in the adhesion intensity or the number of adhesion bands between groups I and II. CONCLUSIONS: Intraperitoneal instillation of piroxicam solution might be useful for preventing peritoneal adhesions.

Electrical and lightning injuries.

The aim of this study was to explore the mechanisms, complications, morbidity, and mortality associated with electrical injuries. Of 5053 acute burn admissions during a 5-year period, 202 patients (4%) had electrical burn injuries. Their mean age was 27.5 years (range, 3-71 years). Ninety-eight percent were male, and the extent of burn ranged from 1% to 70% TBSA (mean, 10.5 +/- 10.7% TBSA). High-voltage electricity caused 54% of the electrical injuries. Forty-two percent were caused by low-voltage currents and 4% by lightning. A total of 217 surgical procedures were performed on 202 patients Fifteen patients (7.4%) required amputation. All patients who had abnormal electrocardiograms underwent cardiac monitoring. Four had cardiac complications. Mean hospital stay was 13.9 +/- 14.6 days (range, 1-90). Four patients (2%) died. Electrical burn injuries continue to be a serious problem of modern society. Climbing power poles is the most common mechanism for high-voltage injury. Special consideration is required to prevent this type of injury in our region.

Burns in pregnancy.

A 9-year prospective study of burns in pregnant women hospitalized at the Sina hospital burn center was conducted to determine the etiology and outcome of pregnant patients. Fifty-one patients (27.45% self-inflicted, 72.55% unintentional) were identified and stratified by age, burn size, presence or absence of inhalation injury, trimester of pregnancy, maternal and fetal mortality, and cause of burn. The mean patient age was 24.2 years. There were 20 maternal deaths and 23 fetal deaths. The majority of which (maternal: 13 and fetal: 13) were among self-inflicted burned pregnant women. The mean burn size was 37.7%, and was significantly larger for nonsurvivors of mother than survivors (68.8% versus 17.6%; p<0.001). In the 51 pregnant women, as the total burned body surface area exceeds 40%, both maternal and fetal mortality reaches 100%. Inhalation injuries were strongly associated with large burns, and were presents in all suicide patients. Kerosene ignition (68.6% of all patients, 100% of self-inflicted patients) was the most common type of burn. Large burn size was the strongest predictor of mortality of mother and fetus followed by the presence of inhalation injury.

Etiology and outcome of pediatric burns in Tabriz, Iran.

A 3-year prospective study of burn victims hospitalized at a major burn center was conducted to determine the etiology and outcome of pediatric burns. One thousand one hundred sixty patients under the age of 14 years identified and stratified by age, sex, burn size, presence or absence of inhalation injury, and cause of burn. The mean patient age was 2.2 years, and the male:female ratio was 1.6:1. There were 74 deaths overall (6.4%), the majority of which (44) were among children under 5 years of age. Except for burn incidence, there were no significant differences between males and females. The mean burn size was 19%, and was significantly larger for nonsurvivors than survivors (50.3% versus 16.8%; P<0.001). Inhalation injuries were strongly associated with large burns, and were present in all flame-burn fatalities. Scalds were the most common type of burn among children under 5 years of age; flame burns predominated in older children. There were 39 deaths related to scalds. Large burn size was the strongest predictor of mortality followed by the presence of inhalation injury and the length of time to intravenous access.

Giant prosthetic reinforcement of the visceral sac: the Stoppa groin hernia repair in 234 patients.

BACKGROUND: Recurrent and complex bilateral inguinal hernias are associated with a high recurrence rate. Giant prosthetic reinforcement of the visceral sac (GPRVS) is popular in America and Europe, but there are no prospective data from Iran. PATIENTS AND METHODS: From 20 March 1995 to 20 March 2003, 234 patients (227 men and 7 women) with 420 inguinal hernias (186 bilateral and 48 unilateral) underwent repair using a large polyester mesh based on Stoppa's preperitoneal technique. Mean age was 60 years (range 25 to 88) and 44.8% had one or more comorbid conditions. In 154 instances, the relapsed hernia had already been operated once or twice for recurrence. RESULTS: Mean hospital stay after surgery was 2.2 days (range 1-13 days). The mean operative time was 45 minutes (range 30-75 minutes). General complications were one case of upper gastrointestinal bleeding, one case of ileus and one case of atelectasis. Local complications consisted of three local seroma formations. In no instance was postoperative neuralgia, chronic pain or testicular atrophy, mesh infection or death reported. Follow-up was obtained in all patients. The recurrence rate was 0.71% (3 of 420) per inguinal repaired or 0.85% (2 of 234) per patient. Factors predicating a high risk for recurrence included large hernia size (>5 cm), failure of one or more previous repairs (65.8%, 154 of 234), chronic cough and associated lower abdominal hernias. CONCLUSION: GPRVS is anatomic, sutureless, tension-free and the absolute weapon to eliminate all type of groin hernias. No other technique produces better results for the repair of recurrent and re-recurrent groin hernias.

Biliary peritonitis requiring reoperation after removal of T-tubes from the common bile duct.

BACKGROUND: Bile peritonitis can occur when a T-tube is electively removed from the common bile duct, but this is regarded as a rare complication. Plastic T-tubes are known to increase this risk and should not be used. Latex rubber T-tubes are preferred, but the peritonitis can still occur. METHODS: Prospective data were collected on 1375 patients who underwent common bile duct exploration between March 20, 1994 and March 20, 2003. RESULTS: Thirty-four (2.47%) patients experienced generalized bile peritonitis after T-tube removal from the common bile duct. Mean age was 63.65 years. In all cases, a soft silicon-coated latex rubber T-tube was placed into the bile duct. All T-tubes were removed 21 days after surgery. Thirty-four patients developed acute generalized biliary peritonitis immediately after T-tube removal and required urgent active intervention. The mortality rate was 5.9%, and the mean hospital stay was 14.6 days. CONCLUSIONS: The most common causes of lack of formation of T-tube tract and operative procedure were unknown and T-tube reinsertion, respectively. T-tube removal can result in significant morbidity and mortality.

Women victims of self-inflicted burns in Tabriz, Iran.

From 20 March 1998 through 20 March 2002, a total of 412 cases of self-burning were admitted to the burn center of East Azarbaijan, located in the city of Tabriz, Iran. The average age was 25.5 years; 99% of self-burning cases were female. A total of 76.5% of those patients were in the 15-19 and 20-29 year age groups. Most cases were married, housekeepers and illiterate and poor. Seventy-five percent of the patients had impulsive suicidal intention. The major motive was marital conflict. The mortality rate was 79.6%. The mean burned surface area was 65.5%. Kerosene was used by 77% of the patients as a burning agent.